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CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

Today we’re going to talk about chiropractic prevalence, a new article in JAMA with some pretty terrible projections for opioid use and deaths, and new information on kiddos and the time they spend on screens. 

But first, here’s that bumper music

Chiropractic evidence-based productsIntegrating Chiropractors

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

You have collapsed into Episode #62

Introduction

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

Evidence-Based Chiropractic Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. 

DACO

Let’s talk a bit about the DACO program. Man, this is how it goes with the DACO: just yesterday morning, I had a patient come in, mid-’60s and literally everything hurt. Restless leg syndrome was her main complaint but her GP just yesterday already started her on Vitamin D and iron supplements so she’s going in the right direction there. I have heard of acupuncture being good for it as well but have not seen any research on that so can’t make that claim. 

Anyhooo…literally everything hurt, couldn’t sit down and basically, a general overall look of being unwell for a lack of a better word. She just didn’t look healthy. I started asking her about bone scans and she’d never had one. Well, this guy just gets feelings and when I get a feeling, they get sent out. I sent her out for a bone scan. 

No kidding, that afternoon I sit down for a class. The next one up? Yep, diagnosing osteoporosis. Lol. Wouldn’t you know it? Anyway, had I had this class before the encounter with the new patient, I might not have sent her. I’m not sure.

But, it’s just funny how in tune with clinical practice the classes really are. Also, as a consequence of the class, I have a quick sheet made up that changes the way I deal with potential osteoporosis patients from here on out. Forever and ever amen. 

Personal Happenings

So far, not a lot of blowback on my recent episode covering my thoughts on faith-based practices. Sometimes I’m mouthy, right? I get it. Who the hell cares what I have to say? I don’t know who cares honestly. Lol. But, we’re growing and growing so at least some of you identify with my way of thinking.

I’m religious and I think that’s what makes me feel that I can be credible in critiquing certain things in regard to religion. I just have a hard time with management companies coaching their impressionable doctors how to use the bible to manipulate scared patients looking for answers. When I think about it, it makes my pee hot. 

Anyway, it turns out that you guys agree with me and that makes me like you even more. Before you know it, we’re all going to be besties and share milkshakes with two straws and all of that mumbo jumbo. 

I’m glad you’re here with me today as we dive into the information I have for you this week. Here we go. 

Item #1

I want to start with one that had some conclusions I found surprising and somewhat encouraging……sort of. This new paper from The Journal of Alternative and Complementary Medicine published January 18, 2019, and authored by Stephanie Taylor, Patricia Herman, Nell Marshall, and colleagues called “Use of Complementary and Integrated Health: A Retrospective Analysis of US Veterans with Chronic Musculoskeletal Pain Nationally[1].”

Due to time constraints on me, I didn’t go beyond the abstract here so….freaking sue me. I’ll have it cited in the show notes at chiropracticforward.com so you can go get it and dive in you over-over-achiever you with all that time sitting around. Must be nice pal. 

Why They Did It

The authors say that little is known regarding the use of complementary and integrative health therapies for chronic pain in the VA system which is the nation’s largest integrated healthcare system. We will get into chiropractic prevalence briefly.

In my experience, I can echo this paper’s sentiment that the VA is at the forefront of the movement away from opioids and toward alternative healthcare. 

They researched this paper over 2 years for the use of 9 types of alternative therapies that included meditation, yoga, acupuncture, chiropractic, guided imagery, biofeedback, tai chi, massage, and hypnosis. 

What they found

27% of younger veterans with chronic musculoskeletal pain use alternative healthcare

The most used for was meditation at 15%. I found that surprising. Meditation means slowing down, sitting still, relaxing, and all that good stuff. In this day and age, I just have a hard time seeing that as the most prevalent form of alternative healthcare. 

We all think we’re so busy and, for us chiropractors, a lot of us really ARE too busy to stop and meditate. I may just be taking my own personal experience here and assuming everyone else on the planet is like me and, of course, that’s not true. Still, meditation was the most prevalent in this study. 

Yoga was next at 7%. Again, I guess I haven’t realized how popular yoga is getting these days but, I know the VA is pushing it so that may be playing a part in it. 

Coming in in 3rd place we have acupuncture. Once again, it’s surprising to me but, the VA is directing the recommendations and, in the real world, outside of the VA, acupuncture does not out-pace chiropractic. I do believe the VA is seeing it’s use for PTSD and chronic pain though and is responding appropriately. 

Finally, here comes Chiropractic care coasting in in 4th place for chiropractic prevalence.

Ugh. We know outside the enclosed ecosystem of the VA, chiropractic care is not less prevalent than yoga, meditation, and acupuncture. But, being within the VA, we know that medical doctors, PA’s, and nurse practitioners are making these recommendations and referrals so we still clearly have a lot of work to do. We are still a world away from where we need to be in regard to chiropractic prevalence,

You know what else that means though right? There are incredible potential and opportunity. If the VA is an example of the rest of the allopathic world, we could say that even fewer than 5% of chronics get referred to us from the GPs and orthopedic surgeons. I think that’s fair because most of them are unaware of Dr. Christine Goertz’s work that was published in JAMA not long ago.

If you’re unfamiliar with that, go listen to Episode 25 of this podcast. In short, she showed how veterans with chiropractic care mixed in with their traditional care had better outcomes. That’s when we started seeing the referrals from the VA

Also, you’ll notice that all of the nine therapies tracked here were on the list of first-line therapies that came from the updated recommendations by the American College of Physicians in February of 2016[2]. 

I guess my point on the paper here is that the medical world, or at least the VA part of it, is paying attention to research regardless of whether it goes against their previously held biases. They are absolutely trying to reverse the opioid epidemic. And we have a lot of work to do to gain that trust and get those referrals. When they’re recommending meditation before chiropractic care for chronic pain, then there is a ton of room for us to shine. So go shine it up all you shiny happy people out there. 

Item #2

On to item numero dos, number 2 for our non-Spanish speaking population out there. This one is discouraging and…..well….awful if I’m being honest.

This one is from JAMA called “Prevention of Prescription Opioids Misuse and Projected Overdose Deaths in the United States” published on February 1, 2019, and authored by Quiushi Chen, Marc Larochelle, David Weaver, and colleagues[3].

Why They Did It

In JAMA, they always start with the question being answered here. The authors wanted to answer this one: “what is the projected effect of lowering incident non-medical prescription opioid use on the future trajectory of the opioid overdose crisis in the USA?

I’m just going to cut to the chase on it and leave a bunch of details out. Here’s why. I don’t want us getting bogged down in the details and methods and all that stuff.

I want you to be able to retain just a few numbers and not be distracted by the rest of the minutiae. You like that word? I know you do. Minutiae, You say that to the right fellow nerd and you may just get you a date, people.

It’s a powerful word so take it, use it, enjoy it. I swear I’m undiagnosed ADHD. I swear it. 

Anyway, here’s the deal, although we as a nation, as a world, now see the issues with opioids and are now trying to address the issue, It’s not getting better and it won’t get any better according to this paper. 

Check it out, according to this paper, the annual number of opioid overdose deaths is projected to increase from 33,100 in 2015…..then we know that 72,000 died in 2017….all the way up to 81,700 deaths projected 2025. 

They are projecting from 2016-2025 to lose a total of approximately 700,400 people to opioid deaths. They say about 80% of that will be due to illicit opioids. I don’t know how the hell they can tell that but that may be a little bit of, “yeah it’s happening but it’s not our fault,” BS going on there but who knows? In this paper, they’re assuming that the illegal use of opioids will increase from 61% in 2015 to 80% by 2025. I don’t know. Sounds like fuzzy math to me but I’m not a researcher. 

I think their numbers are fuzzy because we know 2015 saw about 36,000 die, but then 2016 saw around 63,000 die if I remember correctly. Then, 2017 saw 72,000 die. Are you seeing the graph there in your mind? It’s not only up and to the right on this deal, but its up and to the right like it’s climbing Mt. Everest. The numbers have harnesses fastened tightly and ropes and expert climbing guides and they’re going straight up the face like pros! 

These guys are guessing that by 2025, in 9 years, the deaths will only have increased a total of 9,000 per year, so….they’ll only increase an average of 1,000 deaths per year. Do you see why I think they’re crazy? The deaths increased by 9,000 just last year. Do you see what I’m saying? I’m not saying they’re wrong but….they’re wrong. Lol. 

They then say that across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3%-5.3%. 

Their quoted conclusion is, “This study’s findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.”

So what do we take from this exactly? Here’s my deal. On the surface at least it smells like a steaming pot of shoo shoo caca doody, 

Instead of recognizing the fact that unnecessary surgeries were many times the reason people got addicted in the first place, and that there are amazing opportunities outside the allopathic world to prevent those unnecessary and financially motivated surgeries, they say, “Hey look, a lot of this is done illegally and that’s just going to get worse and our part of this is really very small.

In fact, we can lower the prescriptions of opioids but it’s really not going to do a lot of good and, in fact, we think we should still be able to prescribe them as much as we are right now….blah blah blah poop coming out of the mouth and falling onto the floor with a splat. 

They are making guesses 9 years in the future what addict behaviors will be. I think that’s presumptuous and ultimately impossible. I just thought it was entertaining and that you all might enjoy this group trying to minimize responsibility or what role they can really play on decreasing opioid use.

I could totally be mischaracterizing this and they may have the best intentions in mind. While I trust my GP and I trust the friends of mine that are surgeons personally….I just don’t trust stuff like this. 

Obviously, I don’t agree with them but I’m a bumpkin chiro on the Texas Plains. I wouldn’t listen to me if I were them either. Lol. 

Item #3

OK, last item for this week and it’s something I’m admittedly fascinated with and I think that’s because I have a high schooler and a 5th grader and this stuff hits home any time I see it or read about it. 

This one was in JAMA too and called, “Association Between Screen Time and Children’s Performance on a Developmental Screening Test” written by Sheri Madigan, Dillon Browne, Nicole Racine and colleagues[4] published January 28, 2019. 

Why They Did It

The main question they were trying to answer was this, “Is increased screen time associated with poor performance on children’s developmental screening tests?” Basically, does screen time have a direct effect on child development?

They had 2,441 kiddos in it. A random-intercepts, cross-lagged panel model revealed that higher levels of screen time at 24 and 36 months were significantly associated with poorer performance on developmental screening tests at 36 months and 60 months. 

What They Found

Their conclusion was, “The results of this study support the directional association between screen time and child development. Recommendations include encouraging family media plans, as well as managing screen time, to offset the potential consequences of excess use.”

Yes, it’s easy to just hand them a device and hope they’re quiet long enough to get a nap in. Guilty as charged. Guilty as charged. 

But, turns out as we may have guessed if we really thought about it 8-9 years ago when all of this really started….this isn’t in their best interest in the long run. 

Chiropractic evidence-based productsIntegrating Chiropractors

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

http://www.chiropracticforward.com

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TuneIn

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About the Author & Host

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

 

Bibliography

1. Taylor S, H.P., Marshal N,, Use of Complementary and Integrated Health: A Retrospective Analysis of U.S. Veterans with Chronic Musculoskeletal Pain Nationally. J Altern Complement Med, 2019. 25(1).

2. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2017. 4(166): p. 514-530.

3. Chen Q, L.M., Weaver D,, Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States. JAMA Network Open, 2019. 2(2): p. e187621-e187621.

4. Madigan S, Association Between Screen Time and Children’s Performance on a Developmental Screening TestAssociation Between Screen Time and Child DevelopmentAssociation Between Screen Time and Child Development. JAMA Pediatrics, 2019.

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

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

CF 052: Chiropractic Forward Podcast Year One Review

 

 

 

CF 059: Don’t Be Dumb on Cervicogenic Headache

CF 059: Don’t Be Dumb on Cervicogenic Headache

Today we’re going to talk about headaches. More specifically, we’re going to talk about cervicogenic headaches. How can we recognize cervicogenic headache, and get better at diagnosing and treating cervicogenic headache?

But first, here’s that delicious bumper music

Integrating Chiropractors

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

You have crashed into Episode #59 like a bull in a china cabinet. You know, I’ve been told before that I’m a little like a bull in a china cabinet. That what I don’t break I poo on. Was that more palatable than some of the other words I could have used? I certainly hope so because me saying it that way just doesn’t sound very Jeff-like but I try to keep it mostly high brow and not too profanity-laced. 

DACO

As always, let’s talk a bit about the DACO program. I decided I kind of dread the eLearning episodes. Although the information is excellent, I’m one of those that doesn’t want to miss a word in the notes. These can be somewhat complex topics and, I’m afraid that if I miss something, it’ll be important and I’ll have trouble making sense of it all when I re-visit it. 

That could be my undiagnosed anxiety issue at play. Who the hell knows but it’s a fact so that means that I have to transcribe the entire 20-40 minutes of video or I’m not happy with the final result of the class. There are notes on these classes. A worksheet that helps organize it all but, there is a lot on the videos that is not on the worksheet so transcribe I must and I’m starting to despise that process. 

It’s admittedly a quirk of mine and probably won’t be your experience on the deal if you give it a try. As a result, I have started combining the Communication Drills. So I’ll take an eLearning episode and then I’ll take a Communication Drill and basically alternate them to keep me from getting burned out and to keep me moving forward efficiently. I’m averaging 8 or so hours a week so we’re still clicking along like a tired locomotive. 

Recent classes have been Managing Migraine Headaches, Diagnosing Cervicogenic Headaches, A Neurological Approach to Scoliosis, and Thinking Laterally With The Disc Patient. 

Coming Up

I gotta tell you, you all really liked the episode we did with Dr. James Lehman, episode 55, and the one we did on what I despise about this profession, episode 56. We are up over 7,200 downloads and that’s pretty exciting Y’all. This little thing of ours is rocking and rolling and shows no signs of slowing down either. 

That’s because THE Dr. Christine Goertz is coming on the show in late February. Wow! That’s a biggie! I’m going to let you in on a little secret. You’d already know this if you were in our private Chiropractic Forward Group on Facebook. You would have even had the chance to suggest questions for me to ask her when she comes on the show. You should probably go ahead and become a member. 

Speaking of the episode where we talked about the magical disappearing osteophytes, I was a little worried if I’m being honest about that one. I hated being negative like that and I was a bit concerned some of you would have a problem with that. Oh contrare, I think I had more feedback on that one than any of our episodes. 

It appears you guys agree and there is indeed no room for that mystical hunk o junk in our great profession. Of course, there isn’t. We knew that. Sometimes you just have to blow off a little steam and be the old guy saying, “get off my lawn ya punks!”

That was episode 56 for me. “Get off my lawn and stop driving so fast in a 30 mph zone yeah steampunk loving jackasses! And quit looking at my daughter like that before I shoot you in the nose hole!” We’re in Texas and all. lol. 

Cervicogenic Headache

Alright, let’s tackle cervicogenic headache a bit here. The first thing I want to say here is that, prior to the DACO classes, I had assumed that cervicogenic headache had a much higher prevalence than it does in reality. In your clinic, it really doesn’t show up all that much compared to the other forms of headaches. 

Breaking that down a little, tension-type headaches are the most prevalent at 38% of cases, migraines are next at 10%, and cervicogenic headache brings up the rear-end of the group at about 4% of cases. 

If it only makes up 4% of cases, why the heck are we covering it this week you may ask. Well, let me answer that since you’re so damn inquisitive today. 

Because it still makes up your patient base, you need to be able to notice it, and it’s one of the forms we can be fairly effective in treating. 

The first thing we gotta do is rule out a pathological headache by testing 

  • Steady gait over a normal base
  • Normal vital signs
  • Normal Romberg’s test
  • Quick screen of cranial nerves looking for extra-ocular movements, nystagmus, symmetrical pupils with normal reaction to light, normal facial muscle tone, and things like that. 
  • And then a basic screen of tendon reflexes, motor power and pathological reflexes like Babinski’s and Hoffman reflexes

 

What Does It Look Like?

So, what does a cervicogenic headache typically look like? Well, the first thing is that it is technically a secondary headache which means it is the symptom of something else that’s going on. 

Cervicogenic headache is usually 

  • Unilateral, side-consistent pain referred from a source in the neck. In fact, many times, you can elicit the head pain by pressing on the facets of the C2/3 region. 
  • Usually, the pain starts in the upper cervical region and then spreads toward the front of the head, orbital region, temples, vertex, or ears.
  • The pain may also spread to the ipsilateral shoulder or arm
  • Also, the pain is precipitated or aggravated by special neck movements or sustained neck posture. 
  • It’s mostly in the adult population with females being four times more affected than men. 
  • Sufferers can have suboccipital neck pain, dizziness, and even lightheadedness 

Paper #1

Let’s look at this paper called “Cervical musculoskeletal impairment in frequent intermittent headache. Part 1: subjects with single headaches” authored by G. Jull and published in 2007 in the International Headache Society[1]. 

They were testing musculoskeletal function in headache types like tension-type, migraine, and cervicogenic.

In all but one measure (kinesthetic sense), the cervicogenic headache group were significantly different from the migraine, tension-type headache and control groups. 

They found that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the cranio-cervical flexion test, had 100% sensitivity and 94% specificity to identify cervicogenic headache. 

They found that collectively, restricted movement, in association with palpable upper cervical joint dysfunction and impairment in the cranio-cervical flexion test, had 100% sensitivity and 94% specificity to identify cervicogenic headache.

It doesn’t get much more sensitive and specific than that does it? 100% and 94%. Bam, you got a cervicogenic headache Patient Jones and I have pretty much zero doubt about that. Yes…that feels good to be that confident. 

Paper #2

This next paper is called “Upper cervical and upper thoracic manipulation vs. mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial[2].” It was authored by James Dunning, and what looks like about 30 others and published in BMC Musculoskeletal Disorders in 2016. 

In the beginning here the authors say that no studies have directly compared the effectiveness of cervical and thoracic manipulation to mobilization and exercise in individuals with cervicogenic headache. Thus the reason for the study. 

They had 110 participants here that were randomized to receive both cervical and thoracic manipulation or mobilization and exercise. 

What They Found

“Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with CH, and the effects were maintained at 3 months.”

Time for superhero sound effects….Bam, snap, pow, shazam!

One of these days, I’m really going to incorporate sound effects into my efforts here but until then, you’re stuck with my ridiculous superhero effects. Lol. 

Paper #3

Moving on, this next paper is called “Dose-response for chiropractic care of chronic cervicogenic headache and associated neck pain: a randomized pilot study.” It was authored by M Haas, et. al. and published in the Journal of Manipulative and Physiological Therapeutics[3]. 

Why They Did It

To acquire information for designing a large clinical trial and determining its feasibility and to make preliminary estimates of the relationship between headache outcomes and the number of visits to a chiropractor.

What They Found

There was substantial benefit in pain relief for 9 and 12 treatments compared with 3 visits.

The authors concluded, “A large clinical trial on the relationship between pain relief and the number of chiropractic treatments is feasible. Findings give preliminary support for the benefit of larger doses, 9 to 12 treatments, of chiropractic care for the treatment of cervicogenic headache.”

Paper #4

Roughly that same group led by M.  Haas, et. al. later published this one in 2018, just last year, called “Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial.” It was published in Spine Journal[4]. 

They were looking to settle in on the optimal number of visits for the care of cervicogenic headache with spinal manipulative therapy. 

It was a two-site, open-open-table randomized controlled trial with 256 participants. 

What They Found

There was a linear dose-response relationship between spinal manipulative therapy visits and days with cervicogenic headache. For the highest and most effective dose of 18 treatments, days suffering from cervicogenic headache were reduced by half and about 3 more days per month than for the light-massage control group. 

And there you have it people, more information than you probably expected to get on Cervicogenic headache today. 

This week, I want you to go forward knowing more about cervicogenic headache than you did before you listened to this podcast. I want you to see it, test for it, recognize it, and fix it!

Integrating Chiropractors

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

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About the Author & Host

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

 

Bibliography

1. Jull G, Cervical Musculoskeletal Impairment in Frequent Intermittent Headache. Part 1: Subjects With Single Headaches. International Headache Society, 2007. 27(7).

2. J, D., Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskelet Disord, 2016. 17(1): p. 1.

3. Haas M, Conservative physical therapy management for the treatment of cervicogenic headache: a systematic review. J Man Manip Ther, 2013. 21(2): p. 113-24.

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

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

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

CF 041: w/ Dr. William Lawson – Research For Neck Pain

 

 

CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

Today we’re going to talk about the patient experience being more important than your marketing, we’ll talk about some research from JAMA on lumbar stenosis, and some research on upper cervical manipulative therapy on fibromyalgia. 

But first, here’s that bumper music

Integrating Chiropractors

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

You have clumsily stumbled into Episode #58 knocking lamps off of the end tables and generally making a mess of the place.

DACO

As with every week, let’s talk a bit about the DACO program and my progress. I was doing the Communication Drills but they kept referring to eLearning Episodes. So let’s break that down a bit real quick for those interested in the program. The bulk is made up of 40 Diagnostic Drills, 46 Communication Drills, and 17 eLearning Episodes. 

You get 2 hrs credit for each Diagnostic or Communication Drill and you get 3 hours credits for each eLearning Episode. 

Now, since Communication Drills kept referring to eLearning Episodes, I figured I would switch focus and go through them and then return to the Communication Drills. Still with me?

The eLearning Episodes are very much video based on a downloadable worksheet to take notes on. I take notes digitally though so I’m still getting my angle of attack down on these and how I want to best tackle them and have great notes I’m getting it figured out. 

DACO Classes

So far, I’ve taken classes on Adjusting locally and thinking globally about how a cervical adjustment can affect even the low back. The neurology is amazing. A class on blurry vision from a pain in the neck. Again, the neurology people. I don’t know how I made it day to day before this stuff. Then last weekend I took one on making sense of a headache. 

Outstanding information and all lined up to make you better, make you wiser in your decision-making, and making you a better communicator with your patients and colleagues. 

If you’re waiting to get started on the DACO, get started. I’ll be glad to help you if you’ll email me at dr.williams@chiropracticforward.com

I’m about wrapped up with some cool stuff that you all may be interested in on our website at chiropracticforward.com. If you’ll go there and sign up for our newsletter on our home page, I’ll be able to let you know all about it when it’s ready to roll out.   

Great week for listens Y’all. Thank you for tuning in. Everyone loved Dr. James Lehman’s episode. That was a big one for us! If you missed it, it’s episode #55. Candy for your ears. I see that sucker being the number one listened to podcast pretty quickly. 

Onto the Discussion

Let’s get to trying to make your practice better. This first one we’ll discuss is titled, “Patient experience five times as likely to drive consumer loyalty as marketing” by Christopher Cheney with HealthLeaders(Cheney C 2018). It was published on December 28, 2018. Once again, I know you dig the new stuff. 

If you’re getting after it. If you’re hustling, then you’re marketing. Marketing isn’t something you do once, is it? Oh no, it isn’t. It’s something you do every damn day if you’re doing it effectively. It’s exhausting, isn’t it? But it can be fun too. 

Marketing

Isn’t it fascinating that just changing the color of the border on your marketing material has the potential to elicit a different behavior from the recipient? Or changing the color of the shirt that the person in the ad is wearing affects the response rate? It’s amazing. But, it’s also exhausting to contemplate all of the different combinations of possibilities of words, colors, placements, and all of that crap. 

Good grief. You could make yourself crazy and how many chiropractors usually have the budget to hire a full-time marketing person that actually had a marketing degree? Not many would be the answer you’re looking for if you were confused on that. It was more rhetorical than anything. 

Here in this article, Mr. Cheney says that the patient experience while in your office is the primary driver of patients’ consumer loyalty at health systems, hospitals, and physician practices. He based this information on a recent Press Ganey report I would normally link for you in the show notes but it looks like a bit of click bate. As in leave your email and get the report crapola and I’m not doing that to my peeps. Ain’t nobody got time for that. 

Hell, I can hardly get you guys to give ME your email address and most of you are loyal listeners! Lol. 

Consumer Loyalty

Anyway, he says that consumer loyalty is vital for not only your profit at the end of the month but also helps you take better care of long-term patients with multiple chronic illnesses. 

Hell, that’s why we got into this business; taking care of people. I have to say that if you got into this business to get rich, you’re taking the long way around buddy. Lol. Most of us got into this business to take care of people when nobody else was able to get results with them. And then hopefully keep them that way!

Here’s what raised my antennae straight up, he said, “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

WHAT?

What was that? Let me repeat that just in case my DACO talk put you to sleep. Hey, wake the hell up and listen to this. “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

That is astounding. Of course, some of you already had this figured out and being 20 + years into this dealio, I have it figured out to an extent as well but FIVE TIMES more effective than billboards, TV, print, or radio?

I did NOT have that much figured out. Do you know how I know I didn’t have all of that figured out? Well, it’s because I am spending too much damn money on all that crapola. They interviewed over 1,000 adults on this survey. 

I do have it figured out to the extent that I tell my staff that we are certainly in the healthcare business but they’re fools if they think we are not also in the customer service business. You better believe it. I tell them that I’d much rather a patient leave feeling the same but feeling great about the people they met and the experience they had here and feeling hopeful about what we can accomplish with them as opposed to them leaving my office sore because I either rushed through the appointment or thought we’d equate appointment success with a popping noise and pushed so hard that I finally got a pop sound but ended up making the patient feel worse. 

That goes for the front desk too, doesn’t it? They’re the first point of contact and the last point of contact. If they’re not friendly when people come in and greet them warmly and are very welcoming, well….we’re already behind the 8-ball there and had better make up some ground in the back of the office. And when they leave…..oh nobody likes to pay their own money out of their own pocket and they damn sure don’t like to pay it to someone they don’t like personally. 

Here is a quote from the report, “Healthcare organizations can tap the power of patient experience, the report says. “To harness that influence, providers should capitalize on the power of word-of-mouth marketing by viewing the patient experience as an essential part of their acquisition strategy. By gaining a deep understanding of what gets people talking about positive patient experiences, identifying opportunities to advance the conversation and disseminating key information, healthcare systems can naturally align the mission of delivering safe, high-quality, patient-centered care with the business of acquiring and retaining consumers.”

The Big 4

They went on to line our 4 Big One’s that should be a part of any healthcare facility’s strategy for getting and keeping patients. They were:

  1. Give every patient a voice – They’re not just talking about listening to them when they visit your office and tell you about their conditions. They describe delivering surveys via text and email as well as the standard outreach protocols. 
  2. Identify factors that drive and erode patient loyalty. They say to really know where you can improve, you gotta know positive loyalty metrics on things like the likelihood to refer or recommend your office to their network of people. Imagine man, being a former member of BNI, they teach that each person, whether they know it or not, has a network of 250 people in their lives. I get 55-65 new patients per month. That’s 13,750-16,250 potential work of mouth contacts that can either hear the good about our office or, if we allow them to catch us on bad days….that’s up to 16,250 people that can hear bad things about us. You can see why it’s so important to have positive patient experiences in your office just as often as you possibly can. Especially in the days of social media. There is no room for ego, for talking down to your patients or scolding your patients, or any of that crap. Patient-centered is more than an idea, it’s how you’d better be carrying yourself. 
  3. Use natural language processing to analyze comments. What the hell does that mean? Well, they say that it is language that allows aggregation of comments into clear brand equities and liabilities, allowing for proactive management of both experience and brand. That sounds like an overly wordy and annoying resume if I’m being honest. Basically, it’s using computers to analyze emails, customer feedback forms, surveys and things like that to identify the root cause of customer dissatisfaction or, we hope, customer satisfaction. I’d like to lead you further down this path but, obviously, I have more to learn on it myself. 
  4. Post ratings and reviews in physician profiles. Ensure that future patients have the most convenient access to all information they seek by including comments – both positive and negative. I can’t deal with negative comments. They hurt. Lol. 

Reviews

They also say that you need to be earning quality reviews online for Yelp, Google, Facebook, and all that good stuff. If you don’t know the value of reviews at this point, you just might be a lost cause. Lol. 

They also say you must address negative reviews online in a professional way while understanding that negative reviews are an opportunity to learn and improve. 

But, when it’s not right and borderline illegal, I believe it’s OK to have your attorney contact the person leaving that negative review. Here’s what happened. We offer a service. Not chiropractic but a service that a girl that treated here for some time decided she would begin offering here in town without being certified in any way to perform. 

OK, annoying for sure but then she, one of her little buddies and her boyfriend go online and leave us bad reviews for the exact same service. So there we were with 80 or so 5-star reviews. Not one negative review. And then three 1 star reviews popping up out of nowhere. Nope, she got a call from my attorney and they went away very quickly. 

Ain’t nobody got time for that crap, right? I know I don’t and I have little tolerance for people that want to try to tear down something others have built just to try to further themselves. 

Before my face gets too red and I start to stutter, let’s move onto the next topic. 

Next Paper

This next paper is called, “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” The lead author on this one is Ibrahim Moustafa and it was published in Rheumatology International in July of 2015(Moustafa I 2015). 

And can we just stop a second appreciate the last name Moustafa? Can we do that? Holy cow, if I had a good head of hair and a last name like Moustafa, I’d have the world on a leash ya know. But I don’t have good hair and my name is Williams (so boring) so let’s move on. 

Why They Did It

The aim of this study was to investigate the immediate and long-term effects of a one-year multimodal program, with the addition of upper cervical manipulative therapy, on fibromyalgia management outcomes in addition to three-dimensional (3D) postural measures.

It was a randomized controlled trial with a one-year follow-up. 

What They Found

The addition of the upper cervical manipulative therapy to a multimodal program is beneficial in treating patients with fibro.

I threw that one in for you Upper Cervical guys. You’re getting some love when it comes to treating fibro and I know fibro sufferers will appreciate that. 

I think, after learning more about the upper cervical spine in the DACO course, that it’s fascinating to think about. There is so much going on in the upper three segments in terms of sensorimotor and proprioception that it just blows your mind. 

Last Paper

OK, on to the last paper. This one is called “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial(Schneider M 2019)”. It was authored by Michael Schneider, DC, Ph.D., Carlo Ammendolia, DC (who we have covered here before for stenosis), and Donald Murphy, DC et. al. It appeared in JAMA on January 4, 2019, and here’s how it goes. 

Why They Did It

The question to answer for them was, “What is the comparative effectiveness of 3 types of nonsurgical treatment options for patients with lumbar spinal stenosis?”

Now the 3 types of protocols they tested were medical care, group exercise, and manual therapy/individualized exercise. 

The medical care consisted of medications and/or epidural injections. 

The group exercise classes were supervised by fitness instructors in senior community centers. 

The manual therapy/individualized exercise consisted of spinal mobilization (because it works and is awesome I assume), stretches, and strength training provided by chiropractors and PTs. 

A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity.

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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TuneIn

About the Author & Host

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

 

Bibliography

  • Cheney C (2018) “PATIENT EXPERIENCE FIVE TIMES AS LIKELY TO DRIVE CONSUMER LOYALTY AS MARKETING.” HealthLeaders.
  • Moustafa I (2015). “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” Rheum Inter 35(7): 1163-1174.
  • Schneider M, A. C., Murphy D, (2019). “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis A Randomized Clinical Trial.” JAMA Network Open 2(1): e186828.

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

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

 

CF 057: What Is Contributing To Low Back Pain And More Opioid Bashing

CF 057: What Is Contributing To Low Back Pain And More Opioid Bashing

Today we’re going to talk about What Is Contributing To Low Back Pain And More Opioid Bashing from us. We hate them and they don’t do any good anyway so why did 72,000 people have to die at their hands last year in America?

But first, here’s that bumper music.

Integrating Chiropractors

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

You have fumbled your way into Episode #57

Junk I Say

Let’s first talk a bit about junk I say. I drive myself crazy and here’s why; I get flustered sometimes. I don’t know why. Honestly, I’d like to eventually go on the speaking circuit but I think I’ll be terrible at it. Lol. I get flustered. 

I always listen to the episodes after they post. For a couple of reasons but it’s kind of like why a football team will watch game tape the day and week after a game. I do the same thing. I want to identify where I can improve and how I can make myself and the show better from week to week. 

Well, I invariably catch myself saying stuff that makes no sense. Like in the recent episode where I discussed the lack of research for lumbar fusion, I referred to an orthopedic surgeon as an osteopath. What? Trust me…..I know the damn difference so things like that make me want to punch myself in the nose a little. 

Another is that, without thinking, I’ve been calling it the diplomate of American chiropractic orthopedists. Yeah….that’s not what it is and I know that. Lol. It’s the Diplomate of the Academy of Chiropractic Orthopedists and those folks can be a member of the American Chiropractic Orthopedists. You see the confusion, right?

Anyway….I’m not a dummy people. Well, most days anyway. I still have my brain farts but I’m usually fairly put together. Or at least I like to think I am. Reminds me of a comedian I heard when I was a kid. He said, “I may look dumb, but that doesn’t mean I’m not!” Yeah….so you just think about that for a bit. 

The DACO

Speaking of the DACO program, “What’s the latest?”, you may ask. To that I would answer that a lot is going on actually. I slowed down for a bit but picked it back up during the holidays with the spare time I had. 

More communication drills including ideas and instruction on how to tactfully disagree with our medical counterparts. For instance, if they diagnose a patient with a disc and we are CERTAIN it’s an SI, how are you going to let them down softly and keep them from going away mad ala Motley Crue…girl….don’t go away mad. Just go away. 

You know we all have egos and you know damn well that “king ego” exists in the medical world. How do you tell those people they’re at odds with the research? I’m afraid there are some of them that would rather be wrong than be corrected. 

How do you tell them that they diagnosed a tension-type headache when, in reality, the symptoms are more in line with a cervicogenic headache? And then, how do you tell a GP that probably doesn’t like cervical manipulation that you recommend just that?

Things that make you go “Hmmmm….”

At the end of each of the Communication Drills, they give you a script to help you in the future should the need pop up for you to artfully and tactfully slap around Mr. King Ego without them really knowing you payahed them across the face with a glove. 

Short Show 

Alright, it’s a crazy week. I’m trying to close out 2018 as far as stats go and all that good stuff so this episode ain’t gonna be a big one. 

Before we get to it though, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It’s just an email. We’ll send you one once a week when a new episode pops up and, if we have something cool to tell you about, I’ll include it in that email. No extra emails. Don’t be so stingy with that damn email address. 

Don’t be like a college kid with the last piece of pizza. Don’t be that kid. 

Onto the Research

Let’s get to the goodies, folks. Let’s start with this one from BMC Musculoskeletal Disorders by Shanthi Ramanathan, Peter Hibbert, Louise Wiles, Christopher Maher, and William Runicman called “What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study[1].”

 

First thing here is that Chris Maher is a busy guy, y’all. Seriously. He is a Physical Therapist and I believe lives in Australia if I remember correctly. He was on a paper we discussed recently having to do with lumbar fusion as well as being on The Lancet series of papers for low back pain. He’s a mover and shaker

Why They Did It

Knowing that low back pain is non-specific in 90% of cases, low back pain is treated as an independent entity even though we know other conditions exist with it or contribute to it. What comorbidities? Things like obesity, diabetes, heart disease, high blood pressure, arthritis, etc…

What They Found

One hundred and sixty-four LBP patients were included in the analysis. Over 60% of adults with LBP in Australia had one of 17 comorbidities documented, with females being more likely than males to have comorbid conditions.

Wrap Up

This study established that the presence of comorbidities is associated with poorer care for LBP. Understanding why this is so is an important direction for future research.

Paper #2

Onward we march…. This one is called “Chiropractors’ views on the use of patient-reported outcome measures in clinical practice; a qualitative study.” It was written with Michelle Holmes as the lead author followed by Felicity Bishop, David Newell, Jonathan Field, and George Lewith and it was published in Chiropractic and Manual Therapies in December of 2018[2]. 

I know you people like the new stuff. 

Why They Did It

Patient-reported outcome measures (also known as OATS in my office and probably your office as well. OATS meaning Outcome Assessments)

Anyway, OATS are widely available for use in musculoskeletal care there’s not much research exploring the implementation of OATS in clinical practice. They wanted to see what chiropractors’ views were on OATS to identify any barriers and facilitators to implementing OATS in chiropractic care.

What They Found

“Chiropractors are increasingly using OATS in their clinical practice. The aim of this qualitative study was to examine the views of chiropractors on using OATS. Exploring chiropractors’ experience of using OATS, this study identified how clinician knowledge and engagement and organizational barriers and facilitators affect implementing OATS in chiropractic care, such as choosing the appropriate OATS and systems to use in their practice. Chiropractors also identified possible training needs of chiropractors regarding OATS, with training including the process and benefits of using OATS in clinical practice.”

Opioids

Now, in our “beating a dead horse” segment, let’s bash the hell out of opioids, shall we? Well, don’t mind if I do!

This one is by Jason Busse, a Chiropractor by the way, and associate professor in the department of anesthesia at McMaster University’s school of medicine in Ontario, Canada……. Canada has it going on, folks. Seriously.

Here’s a chiropractor in the department of anesthesia at a school of medicine. We need to get that guy on our podcast don’t you think?

The paper was also written by Li Wang, Ph.D., and Mostafa Kamaleldin. Easy for you to say. 

It’s called “Opioids for Chronic Noncancer Pain; A systematic review and meta-analysis[3]” and appeared in JAMA in December of 2018. 

Why They Did It

They wanted to find out if the use of opioids to treat chronic noncancer pain was associated with greater benefits or harms compared with placebo and alternative analgesics.

Wrap It Up

In this meta-analysis of RCTs of patients with chronic noncancer pain, evidence from high-quality studies showed that opioid use was associated with statistically significant but small improvements in pain and physical functioning, and increased risk of vomiting compared with placebo. Comparisons of opioids with nonopioid alternatives suggested that the benefit for pain and functioning may be similar, although the evidence was from studies of only low to moderate quality.

CNN’s Spin 

CNN actually did an article by Michael Nedelman[4], on this paper where they get a little deeper saying the following, “For adults with chronic pain, opioids offer narrow improvements over placebo for pain and physical functioning, on average, according to a new analysis published Tuesday. And the majority of patients will experience no meaningful benefit.”

Subgroups of the studies included in the analysis suggest that non-opioid alternatives — such as NSAIDs, certain antidepressants and medical cannabis — may offer similar benefits to opioids on average. But the evidence for that is less strong, Busse said.

Question

Here’s my question for Dr. Busse, “Considering the fact that the American College of Physicians and The Lancet promote spinal manipulative therapy for acute and chronic low back pain as an alternative to opioids, and considering you are a chiropractor, why did your research not include spinal manipulative therapy as one of the alternative treatments?”

My guess is that maybe there were not enough randomized controlled trials comparing spinal manipulative therapy directly to opioids? I’m not sure why, to be honest. 

What We Know

But, we do know from JAMA that a current review found that spinal manipulation therapy is associated with moderate improvements in pain and function in patients with acute low back pain[5].

We know from Keeney et al that there “Reduced odds of surgery were observed for…those whose first provider was a chiropractor. 42.7% of workers [with back injuries] who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor[6].”

From Haas et. al[7]., we know “Acute and chronic chiropractic patients experienced better outcomes in pain, functional disability, and patient satisfaction; clinically important differences in pain and disability improvement were found for chronic patients.”

There are so many others that I just don’t have the time to get into right now but, I’m certainly interested in papers comparing the two directly to each other. I bet I already know the answer and I bet you do too. 

Integrating Chiropractors

The Message

Here’s why you know the answer already……it’s because we know that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

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Stitcher:

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

TuneIn

About the Author & Host

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

 

Bibliography

1. Ramanthan S, H.P., Wiles L, Maher C, Runicman W,, What is the association between the presence of comorbidities and the appropriateness of care for low back pain? A population-based medical record review study. BMC Musculoskelet Disord, 2018. 19(391).

2. Holmes M, B.F., Newell D, Field J, Lewith G,, Chiropractors’ views on the use of patient-reported outcome measures in clinical practice: a qualitative study. Chiropr Man Therap, 2018. 26(50).

3. Busse J, W.L., Kamaleldin M,, Opioids for Chronic Noncancer Pain: A Systematic Review and Meta-analysis. JAMA, 2018. 320(23): p. 2448-2460.

4. Nedelman, M., Opioids offer little chronic pain benefit and wane over time, study says, in CNN. 2018: CNN Online.

5. Page N, Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain. Journal of American Medical Association (JAMA), 2107. 317(14): p. 1451-1460.

6. Keeney BJ, Early predictors of lumbar spine surgery after occupational back injury: results from a prospective study of workers in Washington State. Spine (Phila Pa 1976), 2013. May 15(38): p. 11.

7. Haas M, A practice-based study of patients with acute and chronic low back pain attending primary care and chiropractic physicians: two-week to 48-month follow-up. J Manipulative Physiol Ther, 2004. Mar-Apr;27(3): p. 160-9.

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

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

CF 031: No More High Risk & Useless Drugs From Here On – Getting Off Opioids

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

 

 

 

CF 056: What Does A Spinal Manipulation Do In Medical Terms & What I Despise About My Profession

Today we’re going to talk about what a chiropractic spinal manipulation is, we’ll talk about what it does and what happens there. We’re also going to talk about what I sincerely despise about our great profession. Depending on how fired up I get here, this one should be a good episode.

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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iTunes

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Stitcher:

TuneIn

About the author:

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

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

Today we’re going to talk about the reliability of clinical tests assessing the cervical spine, what is happening when adjusting a neck as far as the integrity of the cervical spine, and what the CDC says about opioids. It’s all fascinating all the time here at the Chiropractic Forward Podcast 

But first, here’s that bumper music

Integrating Chiropractors

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

You have drifted all slow and gently into Episode #51

DACO

As has become the tradition, let’s talk a bit about the DACO program. DACO stands for Diplomate of American Chiropractic Orthopedist. Trudging along. I’m up to I believe 84 of the required 300. Classes this last week were on frozen shoulder, piriformis syndrome, Important aspects of lumbar MRI, and inguinal pain. 

This stuff is just invaluable, folks. I’m an organizational freak but at the end of each course, I’ll make myself a quick sheet that I can reference when something like that comes through the door. I think making these little quick sheets will really help to get some of the more rare or difficult cases figured out quickly. 

I’ve already put the lumbar differential diagnosis sheet to use a few times as well as the dizziness quick sheet I created. I have shared several times here that I don’t sit around a lot either at work or at home. I’m a busy bee. 

Vacation & Hobbies

Going on vacation, don’t even try to take me to a beach. If my wife wants to go to the beach, that’s all her. I’ll tag along and I’ll check in on her out there reading a book from time to time but, for the most part, I’ll be off doing, seeing, and experiencing. The ability to sit still and just relax…..that’s an ability I did not receive in this lifetime. 

As a result, I make live edge furniture. Go to Facebook and look up Amarillo live edge and custom furniture. I am a sculpture and charcoal artist. Go back to Facebook now and look up River Horse Art Gallery. I’m in the process of teaching myself to paint right now too. I also am a singer/songwriter. Go back to Facebook once again. Yes, once again and look up Flying Elbows Perspective.

Crazy name indeed. 

So, here’s the point. It’s not to brag or pump my tires. The point is that this is how important I’ve found the DACO program to be. While I haven’t completely put everything else on hold, the DACO has taken priority of my time. One reason is that I want to motor through it quickly and efficiently. The next reason would be that I’ll be the only DACO in all of Texas West of the Dallas/Ft. Worth metroplex. 

What does that get me? Maybe a pat on the back. Maybe a part time or full-time gig on staff at an FQHC. As we have mentioned in previous episodes, there are reports of DCs on FQHC staffs making as little as $120/visit up to $300/visit on even Medicaid visits. Unbelievable. But you have a better shot at getting into the system when you are specialized AKA – a Diplomate. 

Just a part of making us all better. You guys and gals need to be looking at this stuff. 

Before we hop into the papers for the week, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. I think I have some pretty cool stuff coming down the pike you’ll be interested in. That’s in you enjoy evidence-based education.

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Paper #1

The first paper here is called “Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration” It was done my Madege Lemurnier et. al. and published in the European Spine Journal in September 2017[1]. 

Why They Did It

With a title as long as that one, what the heck are they doing here? They say they were hoping to determine the reliability of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. 

How They Did It

They updated the systematic review of the 2000-2010 Bone and Joint Decade Task Forst on Neck Pain and Associated Disorders. 

They searched the literature for studies on the reliability and validity of Doppler velocimetry to evaluate the cervical arteries. 

They had two independent evaluators look through it all

What They Found

  • Preliminary evidence showed that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joint. Or rule in I suppose. Just in case you are unaware of the cervical extension-rotation test, it’s exactly as it sounds. Have the patient extend and then rotate toward the side you’re testing. When you combine this maneuver with palpation you can typically get a good idea of whether the patient is suffering from a facet issue. You need to know that this test is also effective in sniffing out a low back facet issue as well. Lumbar extension and then rotation can give you some good clues sometimes.
  • The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling’s and the upper limb neurodynamic tests.
  • No evidence found for doppler velocimetry. 

Wrap It Up

Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension–rotation test, neurological examination, Spurling’s and the upper limb neurodynamic tests.

Paper#2

On to our second paper. This one is called “Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation” and appeared in Spine Journal in August of 2018 and was authored by Dr. William J. Anderst, et. al[2].

Why They Did It

Since cervical manipulation is such a common intervention for neck pain, the authors wanted to characterize the forces involved and the facet gapping that takes place during manipulation. 

How They Did It

It was a laboratory-based prospective observational study

It included 12 patients 

Each patient had acute mechanical neck pain

One of the outcome measurements was the neck pain rating scale (NPRS)

Other measurements were taken for amount and rate of cervical facet joint gapping 

What They Found

The authors concluded, “This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”

Pretty cool stuff. 

Paper #3

Our last paper for this episode is called, “CDC: Drug overdoses hit new record.” It’s an article on thehill.com written by Nathaniel Weixel and was published on August 15th of this year, 2018[3]. 

The article leads off saying that 72,000 Americans died from drug overdoses in 2017 and that’s based on information provided by the Centers for Disease Control and Prevention. That is a new record folks and we have our friends in the medical realm to thank for it. 

Who’s To Blame?

Now, that, of course, doesn’t mean pharmacists and medical doctors are bad and there was a mass conspiracy to cause this deal. But it does mean that SOME of them are bad. SOME doctors are doing time in an orange outfit right now because they knew better but the dollar was mightier than common sense and common decency. 

There were pharmacies dispensing 100x more than their population could ever consume but they want to not refer to us and talk about the integrity of the cervical spine. That kind of crap is what got us here.

But, it’s also what has brought chiropractors from the shadows into the light. When you have the mess the medical field has created, then you have to start looking for the non-pharma solutions and we are it. 

Comparison

72,000 deaths. You ever heard of the Vietnam War? Of course, you have. We all have. Some either remember or have seen what a big deal it was. The deaths, the protests, the loss. I’ve been to the Vietnam Wall in Washington DC several times. It’s profound. It’s stunning to see all of those names. 

Just to compare, the total number of those lost in Vietnam stands at 58,220. Now keep in mind, that takes into account deaths from as early as 1956 all the way up to as late as 2006 and comes from Defense Casualty Analysis System Extract Files from The Vietnam Conflict Extract Data File. 

I did my homework. I’m not giving you fake numbers here. 

Essentially, 13,780 more deaths happened because of opioids, In just one year. In just 2017. That doesn’t even begin to scratch the surface when you start totaling up 2016, 2015, and further back. Unbelievable isn’t it? 

If we look at it, 2014 had 28,647 deaths, 2015 had 33,100 deaths, 2016 saw 63,632 deaths…..and then 72,000 in 2017. 

I’m guessing you can see the trend. Hell yes, it’s an epidemic.

The Math

I’ll do the math for you because I love you and I’m glad you’re here and I don’t want you to have to think too hard while you’re giving me your time. Over the last 4 years, that’s approximately 200,000 opioid-related deaths. 197,379 to be more specific. 

The genie seems to be out of the bottle.

While we can’t put the genie back in, we can offer solutions for the future. Many of those addicted to opioids became addicted due to spinal surgery. Many of those surgeries were unnecessary. One paper I reviewed showed that approximately 5% of lumbar fusions are necessary making about 95% of the unnecessary. Yeah….95%. 

The Answer

We have the answer people. The American College of Physicians, The White House, The Lancet, 2 papers in JAMA, Consumer Report surveys, The Joint Commission, The FDA…..seriously, there is not one reason that we aren’t inundated by spinal pain referrals at this very moment. No reason at all. It actually makes me mad as hell that we are not. 

Exactly what the hell does it take to make general practitioners, neurosurgeons, orthopedic surgeons, nurse practitioners, and physician assistants understand that an evidence-based chiropractor is best situated to help these people as a first-line therapy?

Integrating Chiropractors

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author and Host:

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

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

CF 012: Proven Means To Treat Neck Pain

CF 041: w/ Dr. William Lawson – Research For Neck Pain

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

 

 

 

Bibliography

1. Lemeunier N, Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. Euro Spine J, 2017. 26(9): p. 2225-2241.

2. Anderst W, Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine (Phila Pa 1976), 2018. 0(0).

3. Weixel N. CDC: Drug overdoses hit new record. The Hill 2018  5 August 2018]; Available from: https://thehill.com/policy/healthcare/401961-cdc-drug-overdoses-hit-new-high-in-2017.

 

 

CF 048: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART TWO)?

CF 048: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (Part TWO)?

Today we’re going to continue our talk from last week on whether or not a disc herniations change as you sit up, stand up, or move around. We went over some pretty good research last week. This week, it’s time for the cherry on the top. 

But first, here’s that bumper music

Integrating Chiropractors

 

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

You have scampered into Episode #48. I use scamper this week because, as my son was playing with his aunt and uncle’s dog named Rowdy down in Dallas last weekend, that was the way he described when the dog would take off after the tennis ball every time. Scamper. Great word that I plan on using more from here on out where appropriate. 

Diplomate of Chiropractic Orthopedists

The DACO this weekend down in Dallas. The class was with James Lehman. Dr. Lehman, in case you do not know, is with the University of Bridgeport Connecticut. His official title from their website is Associate Professor of Clinical Sciences, Health Sciences, College of Chiropractic. 

Dr. Lehman is also one of the main drivers of this DACO program. Through Univ. of Bridgeport Connecticut, he has teamed up with CDI out of Australia and their courses in neuromusculoskeletal online education. It is VERY well done. Very professional and very worthwhile. You can find that at https://cdi.edu.au

We talked a lot about some stuff that I want you to hear straight from him so we’ll do an interview with him very soon but the gist of it all is this: get certified in something other than simply having your doctor of chiropractic degree. 

FQHC

I’ve heard a couple of opinions. I’ve heard the Diplomate programs are worthless now and that people are moving away from them. But, I think that’s coming from people that don’t want to take the time or put in the effort. The real story is most likely that our system, for good or bad, is moving away from private practice and TOWARD integrating through the group offices and through the Federally Qualified Health Centers. 

There are chiropractors being reimbursed in the system up to $300 for a Medicaid visit and around $150 on the lower end. 

I have to thank Dr. Craig Benton once again for bringing this to my attention. Did you guys know that, given the right positioning, you could make that much per appointment from freaking Medicaid?

Here’s the deal though: you have to be a specialist. A Diplomate. So, is it really useless? I say it most certainly is not. 

Whiplash Section

Now the course, the course this weekend was on whiplash. I’ve been through Art Croft’s 4 part Advanced Certification on Whiplash Biomechanics and Traumatology so I can say with a lot of honesty that a good portion of the course was a refresher for me. 

But, I absolutely learned a solid amount of new stuff as well. Such as Axillary compression. Axillary compression was not a condition of the shoulder that was on my radar screen prior to this course. 

That is one simple little example but there was a gob of nuggets for the nugget pouch and as always, I really walked away feeling that I will be better at my job on Monday. But it’s always that way. Even after just a 2-hour online course. It’s phenomenal.

Personal

Continuing the ongoing saga of hiring a front desk staff member in the year 2018. Here’s what all I’m going to say about it. Looks like my wife has found a new full-time job. Lol. Get the picture?

It looks like I may have a cool speaking gig coming up in February. Nothing solid but, if I were to come to your state convention or to some sort of event you are at, what topic along the vein of Chiropractic Forward’s typical content would you like to learn more about? 

If you are a regular listener and familiar with what we have been doing here this last year, I’d really appreciate it if you would take just a minute and email me at dr.williams@chiropracticforward.com and give me a little guidance. What topics would you want to see in a presentation?

I’m glad you’re here and hopefully, I didn’t ramble too much before getting to the meat and taters. Here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

On To The Research

Picking up from last week, we want to start in on the changes disc herniations undergo when axial pressure is placed on them. In other words, what happens to disc herniations from the time the MRI is taken laying down to the point where the person sits up. 

I have to preface it all by saying go listen to last week’s episode which is #47, please. It tells you how it is very common in the medical field amongst even radiologists to assume or guess that there is no change in the disc or in the herniation when axial pressure is applied. Research tells us differently. 

This week we want to start with a paper called “Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines.” It was done by Ferreiro Perez, et. al[1]. and published in the European Journal of Radiology

How they did it

  • 89 Patients studied
  • 45 of them had their low back imaged
  • 44 patients had their necks imaged
  • The images were done in both the lying down position as well as the sitting.

What They Found

  • The overall combined recumbent (lying down) miss rate in cases of pathology was 15%
  • Overall combined recumbent underestimation rate in cases of pathology was 62%
  • Overall combined upright-seated underestimation in cases of pathology was 16%.

Wrap It Up

Upright-seated MRIs were seen to be superior to recumbent MRIs in 52 of the patients studied for conditions of posterior disc herniations and spondylolisthesis. Recumbent MRIs were only superior in 12% of the patients.

Next, this one is titled, “Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading” by Ahn et al[2].

Why They Did It

The authors in this paper were wanting to determine if disc degeneration will increase the severity of spinal stenosis when the spine is loaded with axial pressure. 

How They Did It

They had 51 patients with symptoms of neurogenic intermittent claudication and/or sciatica that had their MRIs loaded as well as non-loaded. 

The foramen involved were all measured for changes in sizes.

Wrap It Up

Here’s what they found, “More accurate diagnosis of stenosis can be achieved using MR imaging with axial loading, especially if grade 2-4 disc degeneration is present.”

AKA:” Seated or loaded MRIs are superior for assessing lumbar stenosis. 

Next, this one is by Willen[3] and it’s called “Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication.” It appeared in Spine Journal in 1997. 

They had 50 people with CTs, 34 were imaged with MRI, the imaging was performed laying down as well as axially loaded. 

They closed it up by saying, “Axial loading of the lumbar spine in computed tomographic scanning and magnetic resonance imaging is recommended in patients with sciatica or neurogenic claudication when the dural sac cross-sectional area at any disc location is below 130 mm2 in conventional psoas-relaxed position and when there is a suspected narrowing of the dural sac or the nerve roots, especially in the ventrolateral part of the spinal canal in psoas-relaxed position”

Next Paper

This one is by Kanno, et. al[4]. called “Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography?” It appeared in Spine Journal in 2012. 

44 patients, with imaging in the supine position and then with axial load added. The dural sack was measured 

“The size of the sack was significantly reduced in the axially loaded imaging and the axial loaded MRI detected severe constriction with a higher sensitivity (96.4%) and specificity (98%) than the conventional MRI.”

Next paper

This one is by Danielson et. al. from 2001 called, “Axially loaded magnetic resonance image of the lumbar spine in asymptomatic individuals.” This paper appeared in Spine Journal in 2001 as well. 

MRIs were performed lying down as well as with axial load on the participants. The axial loading was performed lying down, face up with a compression device built for this study specifically. The diameter of the dural sack was measured to check for the differences. 

The authors said, “A significant decrease in dural cross-sectional area from psoas-relaxed position to axial compression in extension was found in 24 individuals (56%), most frequently at L4-L5, and increasingly with age.”

Pretty cool stuff right there people. 

I want you to go forward this week knowing what you get from listening to this podcast every week. You get things you can absolutely use and implement immediately. Some of you may gain confidence now that you know some research that you maybe didn’t know previously. Some of you may now be able to tell a patient that has a 5mm central posterior herniation that 5mm isn’t telling us the whole story. 

It’s telling us part of the puzzle but that discs respond to positioning and various stresses we put on the discs through our activities. 

Use it or lose it

This can give you some extra guidance in your recommendations when you consider disc herniations change and get worse, stenosis gets worse when the patient sits up or bends forward. 

If you aren’t up on directional preference exercises, McKenzie, and CRISP protocols, it’s time to get there folks. It’s time to get there. The anatomy absolutely responds to movement and positioning. 

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.

Contact Us!

I want to ask you to go to chiropracticforward.com and sign up for our newsletter. We love to stay in touch and want to offer you discount specials when we get our educational products up and rolling. 

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

Chiropractic Forward Podcast Facebook GROUP

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

CF 047: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (PART ONE)?

CF 035: Chiropractic & Disc Herniations

Bibliography

1. Ferreiro P, e.a., Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines. Eur J Radiol, 2007. 62(3): p. 444-8.

2. Ahn TJ, e.a., Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading. Neurol Med Chir (Tokyo), 2009. 49(6): p. 242-7.

3. Willen J, e.a., Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine (Phila Pa 1976), 1997. 22(24): p. 2968-76.

4. Kanno H, e.a., Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography? Spine (Phila Pa 1976), 2012. 37(16): p. E985-92.

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 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.