chiropractor

Manipulation For Concussion, Sleep And Cognitive Decline, & Dementia Predictors And Prevention

CF 148: Manipulation For Concussion, Sleep And Cognitive Decline, & Dementia Predictors And Prevention

Today we’re going to talk about manipulation and concussion, sleep and cognitive decline, dementia predictors and prevention. 

But first, here’s that sweet sweet bumper music

Subscribe button 

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

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

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

 

You have found yourself smack dab in the middle of Episode #148

Now if you missed last week’s episode , we were joined by Dr. Katie Pohlman, head of research at Parker University and the ACA Researcher of the Year for 2020. That right there is enough for you to just go and listen I think. What a great person and professional to have on our team. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function

On the personal end of things…..

On the personal side of things, it’s still looking up. I’m back to about 140-145/week. We started this Monday off with 7 new patients and 4 re-exams. As of right now, I’m writing this on a Monday. We already have 143 scheduled this week and that without today’s patients being all set up for Wednesday and Wednesday’s patients be re-booked on Friday so I’m looking to definitely have an up-week this week. 

If you listen regularly, I was at about 185-220 per week prior to COVID so, maybe we can make some strides this week toward getting back to some of the big numbers again. Maybe maybe. Fingers crossed. 

How are your numbers? I asked in our private group and will try to remember to share with you in next week’s episode. With me still being at about 80% or so, I’m curious if my experience is normal or not. If you want to jump into the private Chiropractic Forward group and comment on the thread, that’d be great or send me an email at dr.williams@chiropracticforward.com Either works just fine. 

Here’s a preview of something I’m working on. Many don’t know this but there was a big blow up at the World Federation of Chiropractic starting with the conference last year in Berlin. Now, just a month or so ago, several of the biggest baddest researchers we have in our profession left the WFC research committee and from an outsider looking in, it appears to be due to pressure from the ICA and the WFC sponsors. Sponsors that we evidence-based chiropractors use and sponsors that our money and business has given some teeth to. On the surface, it seems we have given them teeth to embolden the ICA and bully our top researchers. 

So, my goal is to compile as much information as I can in order to present what happened and why. I want to present it in a fair and well-balanced way looking only for the truth on the matter. I want to know which makes me suspect that you want to know as well. 

Everyone in the know has remained very hush hush on the matter and, if this is the vitalist side organizing sponsors that we use as well to bully the research community, then I want to know who I need to be doing business with and which businesses I may choose to find an alternative to. 

Be looking for that coming down the pike. I’m not trying to shake up the chiro world. I just want to know what happened and I may reconsider doing business with the businesses that made it happen. Because, again, on the surface, it seems our points of view on how the profession should proceed into the future are not in alignment. No pun intended. 

Outside of that, still so far so good around here. Just being smart and trying to stay healthy. Hell, I’m healthier now than I think I’ve ever been. I went back on Weight Watchers. It’s a program I was on about 8 years ago. I lost about 45-50 pounds without really much effort. I swore to the almighty I’d never put that weight back on again. Well…..I did. Lol. 

So, I’m back on the struggle bus but honestly, it’s not that bad. The program always made so much sense to me. It just teaches you how to eat what you’re surrounded by every day. Including fast food even. If you’re not familiar, based on height and weight, you’re assigned a point value. You’re allowed a certain number of points per day and overage points per week should you exceed those points. 

At the same time, foods are assigned point values and, once you are familiar with how much foods count against your daily points, you are able to make educated choices as to what is OK to eat and what just isn’t really worth eating. 

It’s a simple concept and I have to say, it works like crazy. I’ve lost over 15 pounds in about 3 weeks or so. 

Here’s to the next 45!!! Dammit. 

Alright, let’s get on with it this week. 

Item #1

This first one is called “Effectiveness of Osteopathic Manipulative Medicine vs Concussion Education in Treating Student Athletes With Acute Concussion Symptoms” by Yao et. al(Yao S 2020)., published in Journal of the American Osteopathic Association on August 7, 2020. Hot hot hot, it’s a lot hot! 

Why They Did It

The authors say that “current treatment options are limited and difficult to individualize. Osteopathic manipulative medicine (OMM) can aid musculoskeletal restrictions that can potentially improve concussion symptoms. Get that, they didn’t even say that they want to determine if it helps. They just straight up say osteopaths can help. Dammit. Chiropractors have to be more diplomatic in their research abstracts. 

As far as their objectives, more specifically, they said, “To assess concussion symptom number and severity in participants with concussion who received either OMM or an educational intervention.”

How They Did It

  • It was a randomized controlled trial 
  • Conducted at the New York Institute of Technology
  • Patients had concussion-like symptoms due to recent head injury within the previous 7 days
  • They were split randomly into two groups
  • One got manipulative therapy
  • The other group got concussion education intervention
  • They were assessed before and after with the Symptom Concussion Assessment Tool fifth edition

What They Found

  • 30 paticipants
  • The manipulation  group had significant decrease in symptom number and symptom severity compared with the concussion group

Wrap It Up

When used in the acute setting, OMM significantly decreased concussion symptom number and severity  compared with concussion education. This study demonstrates that integration of OMM using a physical examination-guided, individualized approach is safe and effective in the management of new-onset symptoms of uncomplicated concussions.

So let me just say this. Why in the H E double Hockey sticks does Osteopathic manipulation somehow trump chiropractic manipulation? Here’s your answer. It doesn’t if you see research validating osteo manipulation, then you just saw research validating chiropractic manipulation. Just because they got their outliers in line in a way that chiropractic has never even tried to do itself, doesn’t make their manipulation superior. At all. 

Adjusting Disc Herniations and Bulges

 

Item #2

This one is called “Association Between Sleep Duration and Cognitive Decline” by Ma, et. al(Ma Y 2020). and published in JAMA on September 21, 2020. My glasses just steamed up when I read that….because it’s that hot. 

Why They Did It

They wanted to answer the question, “What is the association between sleep duration and cognitive decline in the general aging population?”

How They Did It

  • This was a pooled cohort study 
  • Participants were 2 randomly enrolled cohorts comprising 28,756 individuals living in England and China
  • 50 years or older for the English
  • 45 years or older for the Chinese
  • Self-reported sleep duration per night according tro face-to-face interviews
  • Global cognitive z scores were calculatied 

Wrap It Up

They concluded that “an inverted U-shaped association between sleep duration and global cognitive decline was found, indicating that cognitive function should be monitored in individuals with insufficient (≤4 hours per night) or excessive (≥10 hours per night) sleep duration.” 

Item #3

This one is short, it’s an article in JAMA called “Nearly Half of Dementia Cases Could Be Prevented or Delayed” by Bridget Kuehn, published in JAMA on September 15, 2020. Fresh, sizzlin suckatash. 

Why They Did It

Basically, on this article, they’re covering the fact that there was a report in The Lancet back in 2017 identifying 9 preventable risk factors for dementia. They were….and still are:

  • Having little or no education
  • Hypertension
  • Untreated hearing impairment
  • Smoking
  • Obesity
  • Depression
  • Physical inactivity
  • Diabetes
  • Low social contact

This article is basically an update saying the emerging evidence suggests there are 3 more preventable dementia risk factors. They are:

  1. Head injuries
  2. Excessive alcohol consumption in midlife
  3. Air pollution exposure later in life. 

Some of the recommended steps to prevent dementia are as follows:

  • countries should provide primary and elementary education for all children,
  • take steps to prevent obesity and diabetes,
  • reduce air pollution 
  • reduce secondhand smoke exposure. 
  • programs to prevent people starting smoking, 
  • Prevent or treat hearing loss, and 
  • prevent head injuries,
  • encourage hearing aid use and smoking cessation. 
  • maintaining systolic blood pressure of 130 mm Hg or lower in midlife, 
  • limiting alcohol to fewer than 21 servings per week, and 
  • maintaining an active lifestyle.

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

 

 

Store

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

 

The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.

And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

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

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. 

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. 

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Ma Y, L. L., Zheng F, (2020). “Association Between Sleep Duration and Cognitive Decline.” JAMA Open 3(9).

Yao S, Z. H., Angelo N, Leder A, Mancini J, (2020). “Effectiveness of Osteopathic Manipulative Medicine vs Concussion Education in Treating Student Athletes With Acute Concussion Symptoms.” J Am Osteopth Assoc

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #147.

Now if you missed last week’s episode , we talked about how chiropractic helped the VA cut opioid use among veterans and then we talked about diagnosing lumbar stenosis. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function

On the personal end of things…..

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

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

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

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

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

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

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

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

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

Introduction

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

How are things at Parker University today?

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

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

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

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

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

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

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

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

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

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

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

Store

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

 

The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

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

Website http://www.chiropracticforward.com

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

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

YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

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

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

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

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

Bibliography

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

 

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

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

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

But first, here’s that sweet sweet bumper music

Subscribe button

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

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

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

 

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

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

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

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

On the personal end of things…..

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

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

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

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

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

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

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

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

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

Item #1

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

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

Why They Did It

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

Yeah, me either. Anyway……

How They Did It

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

What They Found

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

Wrap It Up

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

Adjusting Disc Herniations and Bulges

 

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

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

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

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

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.

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

 

Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  

Picture a T bar with a built-in drop piece.  This greatly reduces the time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.

It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

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

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

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

Item #3

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

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

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

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

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

Key Takeaways

Store

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

Subscribe Button

The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.

And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

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

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. 

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. 

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

 

Bibliography

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

 

w/ Dr. Aric Frisina-Deyo – Chiropractors In An FQHC Setting & Setting The Bar High Early On

CF 137: w/ Dr. Aric Frisina-Deyo – Chiropractors In An FQHC Setting & Setting The Bar High Early On

 Today we’re going to be joined by Aric Frisina-Deyo. We’re going to discuss the ins and outs of working in an FQHC. You’ve heard us talk about it before with Dr. James Lehman. How do you do it, what can you expect out of it, and what does it look like? But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #137

Now if you missed last week’s episode, we talked about adjustments making a person stronger, providing more endurance, and providing improved balance. We talked about new evidence on muscle relaxers, and we talked about the best recovery posture after some intense training. Find out if it’s better to recover having your hands on your knees or standing up with your hands behind your head like we’ve been taught over the years. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

On the personal end of things….. So far, so good. Staying steady, healthy, and strong. No big drop-offs in business but no big growth beyond our 80% mark either. Like I said last week, 80% is my new normal for now and, if that’s my new cap, then it’s time to simply start comparing my weekly numbers to the 80% mark and just continue growing and comparing to that.  Basically, my 80% is what I’m now accepting as my new 100% if that makes sense. That’s my roof or my ceiling. I have stopped comparing my numbers currently to the numbers of last year or the numbers of pre-COVID.

It’s not fair to me or my employees. Like it or hate it, there is a new normal for now and for the foreseeable future and I’m living and operating in that world for now.  That just makes more sense to me. Otherwise, I’m trying to reach a bar that is very difficult to reach and I think I’ll be perpetually frustrated and nobody’s got time for that.

So, I’m comparing my numbers to last week’s numbers and last month’s numbers. It just makes more sense.  I have a new assistant taking care of the Chiropractic Forward website. You’ll have to go check it out here and there. She’s in the process of updating the Store link where we have evidence-based patient education brochures and brand new posters for your offices.  Just go to chiropracticforward.com and click on the Store link while you’re there. Maybe sign up for our weekly email newsletter while you’re at it. No spam, just a weekly reminder on Thursdays when the new episodes go live. That’s it. 

Introduction Alright, let’s get on with the show and introduce our guest today. Today we’re joined by Dr. Aric Frisina-Deyo. Being in only his second year of practice, Aric was wondering why I’d be interested in his story. Well, it’s simple, he is integrated into and working for an FQHC. Meaning, he’s already functioning at the top of the game and I want to know about it. 

I’m guessing if I want to know about it, many of you would like to know about it.  First, you may think your area doesn’t have an FQHC and for the most part, you’re probably wrong. Just pull out your Google machine and type in ‘FQHC and the area you live in’. See what it pulls up. Dr. James Lehman pulled that one on me when I told him I didn’t think my area had any.

Well, turns out we had two of them and I had no idea. One more in the win column for Dr. Lehman.  What is an FQHC, you might ask? It stands for Federally Qualified Health Center. If you have listened to either of the episodes we have had with Dr. James Lehman from the Neuromusculoskeletal Medicine Diplomate of the University of Bridgeport.    to start the second year of the three year Neuromusculoskeletal Medicine Residency through the University of Bridgeport. Very active while a student holding numerous positions in clubs and student government, Aric was able to take MDT and MPI which, along with this schooling, has helped to shape his practice style.

He is currently providing care to underserved populations in New Britain, Danbury and Clinton, CT in Federally Qualified Health Centers in a multidisciplinary setting alongside MDs, DOs, APRNs, PAs, Podiatrists, Dentists, Dieticians, other Allied Health Professionals. Aric is also working toward his diplomate in Neuromusculoskeletal Medicine and has had the privilege to assist in instruction for the orthopedic and neurological examination labs at UBSC. When not treating patients, studying or moderating FTCA, Aric can be found spending time with his wife and two children. He has already co-authored 6 research publications. 

So let’s welcome Aric to the show thank you for joining us today. 

Tell us where you are located and a little about the area if you don’t mind. 

Before we get to the FQHC’s, tell me a bit about your journey to becoming a chiropractor. I always say that it’s not the first thing that comes to mind when most kids are deciding what they want to be when they grow up. 

Tell me about where you attended college and your unique experience there that has led to your position and the current practice environment.   

Is there an advantage to being a resident in an FQHC? Explain the pros and cons of your experience. 

Do you evaluate or see many chronic pain patients?

Do your patients tend to present with many co-morbidities or are they usually just spinal pain.

If so, how do you manage the co-morbidities?

Do you care for many high-impact chronic patients with disabilities? And…..for our audience, can you explain the difference between high-impact chronic pain and run-of-the-mill chronic pain?

Tell us about your experience working with and interacting with your medical field counterparts there at the FQHC. 

Do you see the FQHC being your preferred practice setting going forward or is a private practice in your future?

Before we wrap up here, I met you through Dr. Kris Anderson up in North Dakota. He’s been a previous guest on our podcast. He has suggested you have something working with dry needling research. Can you share some of that information with us?

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

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

Website http://www.chiropracticforward.com

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

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

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

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

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

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

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

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

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

CF 124: w/ Dr. Michael Massey – Doing Thing Right, Medicolegal Thoughts, and How We Better Protect Ourselves Today we’re joined by Dr. Michael Massey. We’re going to talk about What We chiropractors Are Doing Wrong, we’ll talk about Medicolegal things, and we’ll talk about How chiropractors can go about Better Protecting Ourselves But first, here’s that sweet sweet bumper music  
Chiropractic evidence-based products

Integrating Chiropractors

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

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

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
  OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #124 Now if you missed last week’s episode, we talked about the primary spinal practitioner program, gabapentin, and cervical curvatures. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. Before we get to our guest this week, I did a thing Being an evidence-informed practitioner can present a set of problems at times. Mostly problems with regard to patient volume because we don’t typically treat a patient with long-term recommendations. So we see them come and go depending on if they hurt or not. It can lead to lulls, disappointment, and boredom if there’s not a steady stream of new patients coming through your pearly gates each and every month. I have taken various courses over the years at Udemy so when I decided to create a course, I immediately thought Udemy would be a good place to start.  While I’m still building the course and adding content every week, it’s live and ready to go for those interested in getting started. I’m putting the link to the course at this point in the show notes. https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B Over the last two years or so, I’ve averaged almost 80 new patients every month as a solo practitioner. If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like.  Just go to udemy.com and do a search on Marketing An Evidence-Based Chiropractic Practice and check it out. It will grow and expand in the coming months and if you get just one patient from the ideas shared in it, it paid for itself. Now imagine if you get a bunch….well then it’s priceless. udemy.com and the course is called Marketing and Evidence-based Chiropractic Practice.  I usually drop some personal thoughts and updates on the clinic and things like that. When we have a guest join me on the show, I typically drop that section and just get on with it. It’s no different today. So, let’s get on with it.  Today we are joined by Dr. Michael Massey who hails from the great state of Tennessee. Athens, TN to be exact with is just Northeast of Chattanooga.  Dr. Michael Massey has been in private practice for nearly 30 years and is no stranger to the inner workings of insurance companies or the creation and administration of regulations.  He has worked in and around commercial and federal insurance carriers for most of his time in practice, serving as a liaison, a consultant, and a contracted employee.   He is also a certified coder, a certified healthcare quality manager, and a quality assurance/utilization review diplomate.  He has additionally served as the president of his state chiropractic association, a delegate to the American Chiropractic Association, the chairman of the ACA Coding and Reimbursement Committee, and as a 10-year member of his state Board of Chiropractic Examiners, while simultaneously serving as a delegate to both the Federation of Chiropractic Licensing Boards and the National Board of Chiropractic Examiners.   He also regularly serves as a nationally-sought expert witness for malpractice and insurance fraud cases.  This diverse experience offers him a unique perspective and a comprehensive skill set to speak on insurance matters, coding, documentation, HIPAA, Medicare, compliance, personal injury, and risk management. Welcome to the show Dr. Massey. May I call you Mike or Michael? Now, first question is, how are you enjoying this grand global pandemic we’re currently blessed with? I have been to Nashville a few times but only recall going through Chattanooga one time when I was on a family vacation back when I was a freshman in high school. I recall it being one of the most beautiful areas I’d ever seen and, from what I remember, I’d probably still classify it that way. I did a little research on Athens, TN. It appears the population is 13,458 hoomans. My region is about 280,000 for comparison sake. What’s it like practicing in a small-town setting where you only have that many to draw from for new patients? Or are you close enough to Chattanooga that you can draw off of their population as well? We met through the miracles of the private Facebook group called the Forward Thinking Chiropractic Alliance. You are typically pretty active in the group and then we met face to face at the Forward ’19 event out in St. Louis back in September. You were teaching a class on Documentation with Dr. Greg Friedman.  I love the group. I’m active here and there, I’ve joined the membership, I support the group. I see the value for sure. While I’m minimally active, I have learned a lot from others just by lurking a little. OK….lurking a lot. What would you say you’ve found to be your biggest takeaway from the FTCA group? What’s been the big bang for the buck for you with it? Documentation is not typically something finds much fascination in but you guys did a good job taking a dry subject and communicating the information in a way that was interesting.  Coding and documentation, for me, can be like pouring salt or maybe hot sauce in my eyeballs. I find it displeasing in general. So, what on Earth got you into coding and documentation? Why is that, of all things, your wheelhouse? From a procedural coding perspective, what are the most common mistakes made by chiropractors?  How about from a diagnostic coding perspective? I don’t know how other states are but here in TX, we have to have 4 hours of medicare, ethics, and documentation every year. Required hours. I think it’s insane to force grown professionals to do this when we could be learning how to take better care of our patients. I can see maybe every other year or every 5 years as a refresher. But I’m not down with every year. What’s your view on this? Relative to clinical documentation, what are the top two or three nuggets of advice you’d offer to both newer doctors as well as those who have been in practice for a while? You’ve had a good bit of experience working with insurance companies, can you offer some insight into their perception of our profession?  Where do they seem to believe we fit best in the system?  What are their primary concerns or frustrations with us? Now we collaborated briefly on a case you were working on recently having to do with stroke. I believe you were defending a chiro if I’m not mistaken. How’d it turn out? Did the good guys win the day? When we’re talking about risk management, as we just mentioned, you have experience doing expert witness work for malpractice cases. Is there any consistency in the types of lawsuits you’re seeing?  Are the allegations typically similar?  Are there specific things chiropractors do/don’t do that seem to trigger lawsuits? How did you get into the med/legal work?  How do you prepare to be a good witness? What are a few critical risk management tips you wish every chiropractor knew? Let’s talk about something I know is near and dear to you and you’ve been putting together for a while now. Pretty much since we first traded private messages through Facebook. It’s called Practice Mechanics and it’s something you’ve put together with Dr. Rob Pape out in California.  Rob is another very active member and moderator with the FTCA group. I talk a lot about FTCA on this podcast. I should push my private group as much as I push FTCA. Lol. But there are less in my private group and the FTCA members are way more active.  Anyway, Rob is like the jedi ninja dude in there and always has an interesting take on whatever the post of the day happens to be. Tell me about Practice Mechanics, tell me about teaming up with Rob on this project, and give us some clue of who it would be good for, where it’s at, and where it’s going? What’s the big picture? We’re going to link the Practice Mechanics website at this point in the show notes at chiropracticforward.com so you can go find out more about it. https://www.practice-mechanics.com Thanks for coming on the show with us, Dr. Massey.  Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, belive it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 
Chiropractic evidence-based products

Integrating Chiropractors

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

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

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

CF 052: Chiropractic Forward Podcast Year One Review

CF 052: Chiropractic Forward Podcast Year One Review

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

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

Integrating Chiropractors

Welcome

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

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

DACO Program

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

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

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

Products

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

One-Year Anniversary

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

Number 10

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

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

 

Number 9

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

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

Number 8

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

CF 028: Will Chiropractic First Finally Take Its Place?

 

Number 7

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

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

 

Number 6

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

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

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

 

Number 5

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

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

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

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

 

Number 4

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

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

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

 

Number 3

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

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

 

Number 2

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

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

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

 

Number 1

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

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

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

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

 

Wrap Up

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

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

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

Integrating Chiropractors

 

The Message

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

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

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

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

Key Point: 

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

That’s Chiropractic!

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

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

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

Website

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

Today we’re going to talk about what I think is some good news that bodes very well for the chiropractic future, for chiropractic integration, chiropractic effectiveness, and playing well with others. We’ll discuss a paper on non-pharma ways of treating pain and then we’ll discuss an article showing how roadblocks are set up to keep Americans from following those recommendations.

Stick with us as we shake it all out, but first, here’s that bumper music

Integrating Chiropractors

Welcome to the podcast today, I am still pretty new to the podcast game so, in case you don’t know me just yet,…I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.

You have gallivanted into Episode #46 and we are so glad you did.

DACO Program

Let’s talk a bit about the DACO program, I have gone through 30 hours live and have taken 12 hours online so far. That makes 42 of the 300 but hey, who’s counting right? The last one I took had to do with Cervical pain and neural tension. I’m man enough to admit that, while I have an A in the class, I missed a question on this one and here’s what I’m going to say…..STOP. Stop asking trick questions dammit.

Honestly, you can know the material cold but the way they ask some of the questions, there’s no telling what the hell the answer is. “Which statement makes the most clinical sound?” Fine…no problem. But, as you read through them, there is maybe one answer that is very thorough while the others are not technically incorrect but aren’t quite as comprehensive as the one answer. Then, yes…..the feared…..ALL OF THE ABOVE.

Uh huh….just ask the damn question and be fair about it. That’s all I’m saying. On one hand, one answer is most definitely more clinically sound than the others. On the other hand, all of them have some correct aspects. So, you’re bound to miss some here or there and, with only 5 questions, you miss one, you make an 80. An 80 is hard for me to swallow friends.

So….cut it out, people. Be fair in your questioning. Thank you very much

The material though, my goodness. I can’t even begin to tell you all how wonderful the material is. Of course, I like some of the classes more than others. The one on pain was not necessarily my favorite but I muddled through it and still know a ton more about pain than I did prior to. Pain is a difficult topic but they did an excellent job of lining it out for us.

Every class makes a difference. Without a doubt. Let me know if you need some guidance on getting started on your DACO. Which was the main thing for me….just getting started in the first place. It’s a bit confusing but once you get enrolled and get that first class under your belt, you’re good to go. Just email me at dr.williams@chiropracticforward.com

Sign up for our Chiropractic Forward Newsletter

If you haven’t yet, please go sign up for our Chiropractic Forward newsletter by going to chiropractic forward.com and it’ll pop up right there. You can’t miss it. It almost punches you right in the face. Help us keep pass along important stuff here by getting on that newsletter. Never any more than once per week. Promise.

Evidently, you and your colleagues are catching onto this here podcast. We appreciate it and we appreciate your continuing sharing it with you people. That’s the only way to grow.

Front Desk Woes

So far, we still have the front desk staff in place. So that’s been amazing to not be obsessing about. It is really hard to find the right person with the right qualities to fill that spot. I’m not spouting fake numbers when I tell you that we see an average of about 60 new patients per month by myself.

No associate. I had a colleague recently tell me they don’t think they could do that by their self. I have to admit, I didn’t realize it was an impressive amount. Lol. I was glad to hear it though. Here’s my deal though, I don’t hold onto them. I see them, get them better, and will have them again in a year or so when they re-injure something.

I have about 40 or so visits booked per day and that’s pretty manageable when you have great staff. I still work from 8-1 on Fridays too. The majority of my time is spent on new patients trying to figure them out. After we have a direction with a patient, however, we have a team of people that really help take the workload off of me other than the actual adjusting.

And, in case anyone is wondering out there, I adjust manually, Diversified with some drops here and there. Very little activator. Some muscle work when appropriate but there’s not a lot of fluff in a visit once we are rocking and rolling with a case.

I tell them that I can really drag this visit out and make it last a lot longer than it takes if they want me to but most are ready to get in and out and back to work. And that works well for us too.

Getting back on track

Anyway, back to the original point: it’s hard to find someone that is not intimidated by the insurance demands, new patients, existing patients, etc…but excited about chiropractic effectiveness….looking them in the eyes all day every day all day.

Plus, a third of the building is massage, day spa services so, the right person is key. They get intimidated and leave. Lol. I suppose it’s a good problem to have. But, so far so good with the new one!

As I’ve said before, I will certainly keep you updated.

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.

Let’s get into the papers

Let’s kick off the discussion today with one from McGregor, et. al. 2014 called “Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey.” It was published in BMC Complementary and Alternative Medicine[1].

In the background section of the abstract, the authors’ discuss how healthcare has increased in complexity and there has developed a need for interprofessional collaboration. Amen, brothers and sisters.

It goes on to talk about how different factions within the chiropractic profession are contrary to each other and how one faction holding unorthodox practice beliefs and behaviors may compromise interprofessional relations going forward.

We can have all of the research on our side but when you have one faction of the profession spouting chiropractic effectiveness for everything under the sun, well, the credibility of the profession as a whole really suffers.

The purpose of this paper was, “to quantify the professional stratification among Canadian chiropractic practitioners and evaluate the practice perceptions of those factions.”

How do you go about figuring this stuff out? Luckily, there are far more intelligent people out there in the world. They took a stratified random sample of 740 Canadian chiropractors and surveyed them in an attempt to determine faction membership and how professional stratification could be related to views that could be considered unorthodox to current evidence-based care and guides.

What they found

Out of 740 questionnaires, 503 came back.

Less than 18.8% of the chiropractors were in the faction considered to be unorthodox in the perceptions of the conditions they treat.

They also state that prediction models suggest that unorthodox perceptions of health practice related to treatment choices, x-ray use, and vaccinations were strongly associated with unorthodox group membership.

The conclusions reached here were as quoted, “Chiropractors holding unorthodox views may be identified based on response to specific beliefs that appear to align with unorthodox health practices.”

Despite continued concerns by mainstream medicine, only a minority of the profession has retained a perspective in contrast to current scientific paradigms. Understanding the profession’s factions is important to the anticipation of care delivery when considering interprofessional referral.”

Basically, what they’re saying is that, in Canada at least, there are 20% of you chiropractors walking around saying your nerve doctors, that you fix everything under the sun, and you’re releasing the innate and turning on the power. This isn’t chiropractic effectiveness. This is belief. Not research-based findings.

That 20 % is REALLY putting 80% of us that have busted our butts and learned the latest science and research….you’re putting us at risk of staying right where we’ve always been rather than expanding, integrating, and being the experts in what we do.

We are masters at what we do but there are 20% out there keeping anyone that matters from taking the rest of us seriously. When we are talking about legitimate chiropractic effectiveness, that 20% has taken away our credibility.

Parento’s principle proves to be a real thing once again. 20% of chiropractors do all of the work in discrediting the other 80% of the profession.

Next paper

Let’s go to the next paper before I lose my mind.

This one is called Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care[2]. It was published in June of 2018 in Explore: The Journal of Science and Healing and was written by Heather Tick MD along with a team of other medical doctor/PhDs.

Dr. Tick is a specialist in pain management in Seattle Washington. She even has her own website and blog. All that good stuff. You can check it out at heathertickmd.com if you are so inclined.

A little more about her: She co-founded and directed one of the first inter-disciplinary pain centers in Toronto from 1991 – 2008 and has been involved in research with the University of Waterloo at the Department of Kinesiology, the Canadian Memorial Chiropractic College (CMCC), the University of Washington, and the University of Arizona.

She served as the Director of the Integrative Pain Clinic at the University of Arizona in the Department of Family and Community Medicine until Dec 2011, when the University of Arizona Health Plan recruited her to start the integrative medicine pain clinic for Medicaid patients.

Dr. Tick currently serves at the forefront of research and teaching as a Clinical Associate Professor at the University of Washington in the departments of Family Medicine and Anesthesia & Pain Medicine and is also the first holder of the prestigious Gunn-Locke Endowed Professorship of Integrative Pain Medicine at the University of Washington.

In this paper, Dr. Tick starts by saying “Medical pain management is in crisis; from the pervasiveness of pain to inadequate pain treatment, from the escalation of prescription opioids to an epidemic in addiction, diversion and overdose deaths.”

I like that opening quote. I like it a lot, folks. She’s saying that the medical way of managing pain isn’t working and throwing more pills at it is a downward spiral. And I agree as I’m sure you do as well.

She goes on saying, “There is pressure for pain medicine to shift away from reliance on opioids, ineffective procedures and surgeries toward comprehensive pain management that includes evidence-based nonpharmacologic options.

“Transforming the system of pain care to a responsive comprehensive model necessitates that options for treatment and collaborative care must be evidence-based and include effective nonpharmacologic strategies that have the advantage of reduced risks of adverse events and addiction liability.”

Conclusion

The evidence demands a call to action to increase awareness of effective nonpharmacologic treatments for pain, to train healthcare practitioners and administrators in the evidence base of effective nonpharmacologic practice, to advocate for policy initiatives that remedy system and reimbursement barriers to evidence-informed comprehensive pain care, and to promote ongoing research and dissemination of the role of effective nonpharmacologic treatments in pain, focused on the short- and long-term therapeutic and economic impact of comprehensive care practices.

Here’s what I hate to do: I hate quoting an abstract word for word. It’s usually dry and well….boring. But, what she says here is so spot-on, quoting it was the best way to get it across in an equal manner. Meaning that I couldn’t say it better myself. Chiropractic effectiveness is becoming undeniable at this point.

She nails it:

  1. It’s not working
  2. We need non-pharma options that are backed by evidence
  3. There are barriers set up to prevent non-pharma options from being utilized
  4. There is ignorance in regards to non-pharma options and that needs to be addressed through education
  5. Continued research is needed

Further down into the paper, the authors mention in one spot that chiropractic care is 60-70% less likely to be reimbursed. Is that accurate? We are typically covered by most insurance plans no?

When they are saying that there are barriers set up to prevent complementary options, this may fit her rhetoric or point but I just haven’t experienced it being that much less likely to have coverage.

They cite a paper by James Whedon, Et. al. where they found, for New Hampshire[3], there was 60%-70% less reimbursement. I wonder if that is consistent throughout the US or if it’s isolated to New Hampshire?

That’s a great question and if one of you out there in podcast listening land knows the answer, please email me at dr.williams@chiropracticforward.com and fill me in. I’m curious and I’m pretty sure the rest of us out there are too.

Under their Evidence-Based Non-pharm Therapies for Acute Pain, they point out that non-pharma therapists have shown effective in acute pain with opioid paring in the hospital setting as a result of their use and the therapies mentioned in the paper are acupuncture, chiropractic, osteopathic manipulative therapy, massage, physical therapy, relaxation, and cognitive behavioral therapy.

The authors also site spinal manipulative therapy as being effective for chronic pain including migraines, cervicogenic headache, neck pain, low back, hip pain, patellofemoral syndrome, and on and on. Of course, we chiropractors know this stuff but it’s great to see it in black and white and as part of a paper written exclusively by MDs and PhDs.

This is a long paper with a lot of excellent information. I highly encourage your checking it out. Just go to our show notes for links and citations.

Wrap it up

A great takeaway from this paper is this quote, “In general, the costs of evidence-based nonpharmacologic options are nominal compared to medical costs of treating chronic pain with risk mitigation and greater potential for engaging patients in ongoing self-care.”

This is exactly why we are discussing chiropractic effectiveness at length these days. It is paramount for the future of our patients as well as for the the chiropractic future for people to get this message.

Last Paper

The last paper I want to talk about is by our very own Dr. Christine Goertz, DC, Ph.D. with Steven George, PT, Ph.D. as her side-kick and is published in JAMA. It’s called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Change[4]” and published on October 5 of this year so, just this month. Brand new.

Dr. Goertz begins by relating low back pain with the obvious opioid crisis and goes into last year’s recommendation that you’ve heard here a million times.

The recommendations from the American College of Physicians for low back pain which recommended spinal manipulative therapy as a first-line therapy for chronic and acute low back pain.

We will talk about it in upcoming episodes but Dr. Goertz also mentions the new Gallup-Palmer Poll where they found that 78% of US adults prefer to use non-pharma options for back and neck pain.

In the article, she cites a paper by Heyward, et. al[5].  called “Coverage of Nonpharmacologic treatment for low back pain among US public and private insurers” that found coverage of some therapies (like chiropractic) was available in most health plans but that there are significant barriers to patient access identified.

Barriers such as visit limits, prior authorization requirements, and high out-of-pocket expenses. And that payment policies targeted toward coordination of pharmacological and nonpharmacological care were virtually nonexistent.

She says pretty clearly the following: In regards to most health plans surveyed, they did not have policies in place that:

  1. emphasize the use of nonpharmacological treatments at the forefront of the patient experience
  2. provide meaningful levels of coverage for care professionals who focus on guideline-adherent nondrug therapies like spinal manipulation, exercise, massage, acupuncture, and cognitive behavioral therapy
  3. us financial incentives that favor the use of nonpharmacological options over commonly prescribed pharmaceuticals, including opioids

Wrap it up

She also calls out healthcare executives quite effectively I thought by saying, “Relative to stigma, Heyward et al found that health care executives did not believe expanded coverage of nonpharmacological treatments is supported by the existing literature.

As outlined in the ACP guideline referenced earlier, in many cases nonpharmacological treatments offer equal benefit or even improved benefit, with lower risk, than commonly used pharmaceutical options.”

And by suggesting that future coverage policies should be based on unbiased reviews of the evidence appropriately balancing risk with benefit rather than prior dogma or biases.

Lastly, Dr. Goertz discusses cost-effectiveness and the need for future payment policies to decrease patient out-of-pocket expenses to strongly encourage earlier us of evidence-based non-harms options.

The Heyward paper demonstrated how trips to PTs or DCs are usually 6-12 visits with an out-of-pocket of $150-$720 or more. She then showed how Lin et. al. showed the median cost of a 30-day  supply of preferred generic opioid by commercial insurers is $10.

How does that add up for the Joe Blow citizen on the street?

It doesn’t.

I love how they sum it up by saying, “Restricting access to opioids without addressing the underlying problem of chronic care management for low back pain is unlikely to positively affect the opioid crisis. Well-conceived guidelines that encourage the use of evidence-based, nonpharmacological treatment options exist and must be enabled by changes in public health policies that better guide care delivery and reimbursement.”

Boom, Snap, kapow, Shazam…

Honestly, where would we be without Dr. Goertz? We’d still be moving the direction we’re moving in because of the opioid issue but she has done some amazing work that is putting us on the fast track where we hope to go rather than on the snail’s pace.

This week, I want you to go forward understanding that It’s happening folks. we are now able to cite papers in JAMA that are pro-chiropractic. Pro-complementary health care. Anti-pharma. This is big stuff. We are in the right place at the right time. And, it was in part, the failure of many in the medical kingdom that put us here. 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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

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

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

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

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

Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Change | Complementary and Alternative Medicine | JAMA Network Open | JAMA Network

Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care – Explore: The Journal of Science and Healing

https://www.ncbi.nlm.nih.gov/pubmed/28304182?dopt=Abstract

Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey | BMC Complementary and Alternative Medicine | Full Text

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2705853

Bibliography

1. McGregor M, Differentiating intraprofessional attitudes toward paradigms in health care delivery among chiropractic factions: results from a randomly sampled survey. BMC Comp Altern Med, 2014. 14(51).

2. Tick H, Evidence-Based Nonpharmacologic Strategies for Comprehensive Pain Care. Explore J Science Healing, 2018. 14(3): p. 177-211.

3. Whedon JM, e.a., Insurance Reimbursement for Complementary Healthcare Services. J Altern Complement Med, 2017. 23(4): p. 264-267.

4. C, G., Insurer Coverage of Nonpharmacological Treatments for Low Back Pain—Time for a Chang. JAMA, 2018. 1(6).

5. Heyward J, Coverage of Nonpharmacologic Treatments for Low Back Pain Among US Public and Private Insurers. JAMA, 2018. 1(6).

CF 020: Chiropractic Evolution or Extinction?

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

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

 

 

 

CF 028: Will Chiropractic First Finally Take Its Place?

 Will Chiropractic First Finally Take Its Place?

Chiropractic First is on the table today.

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

But first, here’s that bumper music

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap Up

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A quick visit to their website tells us the following:

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

 

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

 

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

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

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

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

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

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

Chiropractic led to:

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

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

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

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

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

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

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

Key Takeaways:

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

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

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

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

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

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

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

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

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

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

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

 

Social Media Links

iTunes

Bibliography

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

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

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

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

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

 

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

WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

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

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast and I am honored to have you join me today.  Thank you to those of you that send emails and like and share our content on Facebook and Twitter. You make it fun. If you haven’t already noticed, we have “Tweetable” quotes from our show notes. All you have to do is click the Tweet button and you’re all set. 

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

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

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

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

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

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

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

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

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

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

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

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

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

Why They Did it

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

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

How They Did It

They used a belief elicitation design

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

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

What They Found

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

Wrap It Up

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

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

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

Why They Did It

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

How They Did It

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

What They Found

  • Acute back pain (0-3 months)

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

  • Chronic back pain (3 months and beyond)

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

  • Chronic back-related leg pain

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

Wrap It Up

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

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

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

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

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

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

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

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

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

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

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

 

Social Media Links

iTunes

Bibliography

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

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

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

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

How Can Research Help You Talk To The Medical Profession?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why They Did It

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

How They Did It

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

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

What They Found

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

Wrap It Up

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

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

Again, pretty recent stuff. 

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

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

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

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

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

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

Social Media Links

iTunes

REFERENCES

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

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

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

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

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

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

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

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

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

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

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