chiropractors

Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain

CF 322: Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain

Today we’re going to talk about Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #322 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9).  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I’m recording on a Monday and we have the big West Texas Conference coming up this Friday for the Texas Chiropractic Association. It’ll be in Lubbock, TX so about an hour and 45 minutes south of where I’m at here in Amarillo.  I’ve paid for our Parker intern, Dontae, to come with. I think it’s up to the older folks to get the younger folks engaged in our state associations. If you listen long enough, in every podcast, at the end, I say that the ACA and our state associations need bus in the leadership positions if this profession is ever going to continue gaining integration into the system as a whole. If we’re ever going to achieve 1st or 2nd referral status for a non-complicated msk issue, we damn well better start behaving like part of the team instead of part of a fringe cult from outer space. 

Here’s a thought, hey clinic owners and lead doctors with associates, if you don’t require your associates to be a part of their state associations, you are absolutely, undeniably part of the problem. It’s as much Your responsibility to bring them up correctly as it is theirs to start getting involved in their profession.  Oh, I’m getting fired up this morning, damnit!! I’ve held enough positions in the TCA at this point that I’ve lost count and ever since my first year of involvement, our membership has been the issue. We have about 25% of our licensed DCs in the state of TX as actual members in the TCA. So, if we have 6,500 DC in the state, then about 1600 or so are members. Not active members. Just dues-paying members.

Minimal effort members, you might say. 

Consider that the state of TX has around 70,000 physicians and the vast majority are required to be paying members of their predatory state association. The official name is Texas Medical Association but we call them the Evil Empire.  Tell me…..how in the hell are 1600 chiropractors, of which only about 50 are actually active, supposed to turn the tide or battle effectively against an Evil Empire of approximately 60,000 or more? Then throw in lead chiropractors and clinic owners that are sitting on their asses not giving a squirt one way or another and not showing their associates how to give back to their profession and how to protect their rights?

Come on…..it’s almost too ridiculous to even talk about. Why do we have to say this stuff?  it’s disappointing and astonishing.  I sat in a Board Of Directors meeting many years ago. It cost us money to be there and cost us money to be out of our clinics to be there. Fighting an uphill battle that the majority of the DCs in the state don’t care about. It’s self-defeating. But one of my colleagues and friends said, “If not us, then who?” And then it’s OK. Fight the battles nobody else is willing to fight.

Get in, impose your will. Make sure evidence-based, patient-centered practice models are at the forefront of your state association’s initiatives and influence and get the crazy aliens off of the stages at your states continuing education conferences. 

Literally, about 20 people run your associations at any point in time. Hop in. One person can make a world of difference.  Raise your hand. Send an email. Just show up and be there. 

Item #1 Our first one this week is called “Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts” by McKee et. Al and published in JAMA Neurology on August 28, 2023 and that’s blisterin’ hot!! Remember, the citations can be found at chiropracticforward.com under this episode. 

McKee AC, Mez J, Abdolmohammadi B, et al. Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts. JAMA Neurol. 2023;80(10):1037–1050. doi:10.1001/jamaneurol.2023.2907

Why They Did It Young contact sport athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE). They wanted to characterize the neuropathologic and clinical symptoms of young brain donors who were contact sport athletes.

How They Did It This case series analyzes findings from 152 of 156 brain donors younger than 30 years identified through the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank who donated their brains from February 1, 2008, to September 31, 2022.  Neuropathologic evaluations, retrospective telephone clinical assessments, and online questionnaires with informants were performed blinded. Data analysis was conducted between August 2021 and June 2023.

Exposures  Repetitive head impacts from contact sports.

Main Outcomes and Measures  Gross and microscopic neuropathologic assessment, including diagnosis of CTE, based on defined diagnostic criteria; and informant-reported athletic history and informant-completed scales that assess cognitive symptoms, mood disturbances, and neurobehavioral dysregulation.

What They Found Among the 152 deceased contact sports participants included in the study, CTE was diagnosed in 63 (median age, 26 years).  Of the 63 brain donors diagnosed with CTE, 60 were diagnosed with mild CTE (stages I or II).  Brain donors who had CTE were more likely to be older  Of the 63 athletes with CTE, 45 were men who played amateur sports, including American football, ice hockey, soccer, rugby, and wrestling; 1 woman with CTE played collegiate soccer.  For those who played football, duration of playing career was significantly longer in those with vs without CTE  Athletes with CTE had more ventricular dilatation, cavum septum pellucidum, thalamic notching, and perivascular pigment-laden macrophages in the frontal white matter than those without CTE. 

Cognitive and neurobehavioral symptoms were frequent among all brain donors.  Suicide was the most common cause of death, followed by unintentional overdose; there were no differences in cause of death or clinical symptoms based on CTE status.

Wrap It Up This case series found that young brain donors exposed to repetitive head impacts were highly symptomatic regardless of CTE status, and the causes of symptoms in this sample are likely multifactorial. 

Item #2 Our second one this week is called, “Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain” by Ryum et al and published in Pain Reports in September of 2023 and it’s hot to the touch!

Ryum T, Stiles TC. Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain. Pain Rep. 2023 Sep 13;8(5):e1092. doi: 10.1097/PR9.0000000000001092. PMID: 37719924; PMCID: PMC10501475.

Why They Did It Treatment of chronic low back pain (CLBP) based on the fear-avoidance model (FAM) has received support in randomized controlled trials, but few studies have examined treatment processes associated with treatment outcome.  This study examined changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy as mediators of the relation between changes in pain intensity and disability in exposure-based treatment of CLBP.

How They Did It Data from a randomized controlled trial with 2 treatment arms (which were the fear avoidance model with/without in-session exposure)  Change scores (pre to booster session) were computed for all variables, and the indirect effect of change in pain intensity on change in 3 measures of disability, through change in the proposed mediators, was tested in parallel mediation analyses.

What They Found Decreases in pain catastrophizing and fear-avoidance beliefs, as well as increases in pain self-efficacy, mediated a unique proportion of the relation between changes in pain intensity and disability, depending on the outcome measure.  The direct relation between changes in pain intensity and disability was absent when indirect effects were controlled.

Wrap It Up The results suggest that the way pain is interpreted (pain catastrophizing, fear-avoidance beliefs), as well as pain self-efficacy, are all more critical for reducing disability in exposure-based treatment of CLBP than symptom relief per se. You’ve been hearing this from you Ol’ Uncle Jeffro since about 2019 now. Since I went through the Diplomate of the Neuromusculoskeletal Medicine program. Which used to be called the DACO or the ortho diplomate.

It was the DACO when I started and changed in the middle of my education.  I wondered why but it became quickly apparent. There was as much Neuro in the process as there was ortho and yellow flags, upregulated CNS, fear avoidance and all kinds of Neuro tidbits were front stage. So, an ortho diplomate no longer adequately described what we were learning. 

Anyway, pay attention to this stuff. It will absolutely get your patients better when you understand it! Alright, that’s it.

Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so 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 https://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 (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8)

CF 319: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8).  If you haven’t been following along, the World Health Organization has recommended spinal manipulative therapy for back pain, however, they rated it at very low confidence.

Which is the same rating they gave ultrasound. We know SMT is more effective than that so I went into the recommendations, I found the papers the WHO cited as their references for their rating of SMT, and now I’m covering each and every one of them. We’re doing this every other week and now we’re on Part 8.  Also if you’re following along, you’ll know that a lot of these papers are extremely old compared so newer more impressive and more favorable papers that have emerged in more recent years.

You’ll also, if you’re like me, continue to get more and more certain that there is an agenda in the WHO leadership that keeps SMT from taking its rightful step forward in the treatment of noncomplicated Neuromusculoskeletal issues.  Stick with me, we’ll talk more about it.  But first, here’s that sweet sweet bumper music    

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. 

I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #319 Now if you missed last week’s episode, we talked about How Specific Are Adjustments & Nerve Flossing Effectiveness.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

As I’ve discussed in recent episodes, my house, meaning my clinic, got in a bad way in 2023 and I believe we are finally on the upswing.  We have slowed down in our new patients because of Google SEO and website companies and changes. I think I’ve corrected that.  We have had inconsistent team culture in the clinic because of constant turnover. I still have work to do here but I feel like we have a more dependable team at the moment than I’ve had in the past 18 months so I’m encouraged.  Speaking of an incredible amount of turnover, our billing has been inconsistent. Inexperienced staff just let rehab and other services walk out the door without getting done. That adds up really fast and shows up in our monthly collections.

Now that my wife is up at the front desk and now that it’s become a focus for us, this is getting under control. Basically, staff knows that their comfort comes secondary to the financial health of the clinic. Meaning, whether we feel like it or not, the patients need to be doing the services we have prescribed them. We’re getting there. That’s not a black and white thing there but we are doing more of the services prescribed than we have been.  We are now on our 4th billing and collections company in the past 5 or 6 years. We just haven’t been able to find a dependable one that just does their damn job. I think we have one now.

They started in November and we hope to see the benefits in the next few weeks. I think we already are.  So, you can see what I’ve been up to. It was a swim or swim option. Not a sink or swim. Sink is never in the list of options. So we’ve been swimming and it’s showing up in progress and that makes this old man happy. 

Now, something I’ve always struggled with is treatment recommendations. I like standardization. I like Being able to tell someone confidently, I need to see you 3x/week for 2 weeks or whatever the recommendation might be. I don’t want to make it up from patient to patient. Standardization is something our profession desperately needs in my opinion.  As my colleague and friend, Dr. Brandon Steele once said in our DACO class…..if you go to the doctor with an ear infection in Dallas, NYC, Chicago, LA, or Seattle, you’re going to always get pretty much the same thing. The Standard for that profession.  If you go to a chiro, you don’t know what the hell you’re going to get.

X-rays for no reason and BAM, bait and switch….now you need 70 visits in one year to fix a curve that 20-year longitudinal studies show doesn’t really mean much of anything. You got a neck problem, bam, you need 50 visits to boost your immunity and make sure all nerve impulses are fully expressed because how can God’s full potential for you be realized if your spine is out of alignment. Yes….true story folks. True story. 

You have back pain, BAM, x-rays show degenerative spurs and if you see me 3x/day for 2 weeks, we’ll reduce the size of those spurs. Yes….true story. And that crew is holding seminars trying to teach crap like that to other suckers in our profession.  Or on the other end of the spectrum, you’ve had pain for 10 years and have a disability associated with it so it’s technically high-impact chronic pain….BAM….you can be fixed in 2 visits with a course of exercises for you to be using at home. 

It’s just not standardized.

So, through my association with Dr. Jay Greenstein from Washington DC and who is a mover and shaker in the industry and who has been active in Clinical Compass, I eventually formulated a standardized treatment protocol for my office that you might find useful as well. It’s really pretty simple. 

If it’s acute or less than 4 weeks in duration, I’ll see the patient 3x/week for 2 weeks. 

If it’s subacute, or between 4 and 12 weeks in duration, I’ll see the patient 2x/week for 3 weeks. 

If it’s chronic, or anything lasting beyond 3 months, I’ll see them 2x/week for 4 weeks. 

At the end of the protocol at each level, acute, subacute, or chronic….if the patient is doing great, we then start to stairstep the frequency out and slowly withdraw from treatment to prevent the return of the injury.

If there is not improvement or the patient gets worse at any time, we will either change treatment and try something different, or we will find a provider that has a better chance at helping the person recover. 

Now, of course, PI patients don’t fit into this schematic well so I use the Quebec Task Force on WAD for them but most of my patients will fit very well into this protocol.  It’s simple. It’s a way to standardize recommendations in my clinic from the owner to any associates. It’s an easy way for associates to get comfortable recommending treatment. And I like it so much that I made a poster out of it that you can find in the Chiropractic Forward private Facebook group.  I’ll send you one here in the US for $55 if you want one.

I’m putting one in my exam room so that when I’m doing the ROF, they’ve already read it and all I have to do is point to it and say, “‘You’re right here, and here is your recommendations. See you on M, W, and F.” Alright, good to go on all that, let’s hop in. 

Item #1 Our first one that the WHO used to keep the chiros down today is called, “Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial” by Nejati et. Al. published in Pain Physician in January of 2019. Not new, not old. Remember, the citations can be found at chiropracticforward.com under this episode.  Nejati P, Safarcherati A, Karimi F. Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019 Jan;22(1):53-61. PMID: 30700068.

Why They Did It The sacroiliac joint dysfunction (SIJD) has been found to be the primary culprit for lower back pain (LBP), but it is still overlooked and treated as LBP. There are no guidelines or appropriate therapeutic protocols for SI dysfunction. Thus, there is a need for an effective treatment strategy for SI dysfunction.

Objective: To compare exercise therapy (ET), manipulation therapy (MT), and a combination of the 2 (EMT) in terms of their effectiveness in treating SI dysfunction.

How They Did It Study design: A comparative, prospective, single-blind randomized controlled trial .

Setting: Sports Medicine Department of Rasoul Akram Hospital.

Methods: A total of 51 patients with lower back or buttock pain resulting from SI dysfunction were randomly assigned to 1 of 3 study groups: exercise therapy, manipulation therapy, or a combination of the 2.  The exercise therapy group received posterior innominate self-mobilization, sacroiliac joint stretching, and spinal stabilization exercises.  The manipulation therapy group underwent posterior innominate mobilization and SI Joint manipulation.  Lastly, the combination group received manipulation maneuvers followed by exercise therapy. Pain and disability were assessed at 6, 12, and 24 weeks after the intervention

What They Found All 3 groups demonstrated significant improvement in pain and disability scores compared to the baseline (P < 0.05).  The difference among these therapeutic protocols was found to be a function of time.  At week 6, manipulation therapy showed notable results, but at week 12, the effect of exercise therapy was remarkable.  Finally, at week 24, no significant difference was observed among the study groups. A major limitation of the present study is lack of a control group receiving a type of intervention other than the experimental protocols. Another limitation is the short duration of follow-ups.

Wrap It Up Exercise and manipulation therapy appear to be effective in reducing pain and disability in patients with Si dysfunction. However, the combination of these 2 therapies does not seem to bring about significantly better therapeutic results than either approach implemented separately.

Item #2 The last one today is called, “Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study” by Nambi et. Al published in European Journal of Physical Rehabilitation Medicine in December of 2018. Not new, not old.

Nambi G, Kamal W, Es S, Joshi S, Trivedi P. Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study. Eur J Phys Rehabil Med. 2018 Dec;54(6):880-889. doi: 10.23736/S1973-9087.18.05005-0. Epub 2018 Apr 24. PMID: 29687966.

Why They Did It Low back pain (LBP) is a common musculoskeletal disorder causing pain and disability in most of the countries. In recent years, new approaches such as Spinal manipulation and laser therapy have been considered as an alternative to conventional exercise and also found contradicting results in terms of its effectiveness.

Aim: A study to compare the combined effects of spinal manipulation, Laser and exercise versus Laser and exercise alone in chronic non-specific low back pain (cnLBP).

How They Did It Design: Randomized control study.

Setting: Subjects with cnLBP were treated with spinal manipulation, Laser and exercise in outpatient department for four weeks.

Population: Three hundred and thirty subjects who fulfilled the selection criteria were randomized (1:1:1 ratio) into spinal manip-laser-exercise (N.=110), Laser-Exercise (N.=110) and control group (N.=110).

Methods: The outcome measurements were Visual Analog Scale (VAS), Modified Modified Schober Test (MMST) Roland and Morris Disability Questionnaire (RMDQ), Physical Health Questionnaire-9 (PHQ-9) and Health Related Quality of Life-4 (HRQOL-4).  Baseline and follow-up measurements were measured at 4 weeks, 6 and 12 months by a blinded investigator.

What They Found Three hundred and twenty-six subjects completed the intervention and 304 completed the 12-month follow-up.  Demographic variables show homogeneity between the groups and ANOVA analyses showed significant improvement (P<0.001) in pain reduction (VAS), flexion range of motion (MMST), functional disability (RMDQ), depression status (PHQ-9), and quality of life (HRQOL-4) in spinal manipulation-laser-exercise group compared to the other two groups at one-year follow-up.

Wrap It Up Spinal manipulation combined with laser therapy and conventional exercise is more effective than laser therapy and conventional exercise alone in chronic non-specific low back pain. I mean….isn’t this one by itself enough to raise SMT above that of the level of ‘very low confidence’? That one alone? That randomized controlled trial? No? No wonder so many mistrust the WHO on so many different issues. It makes no sense to me.    Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.

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

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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 preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

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

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so 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 https://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 (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    

Safety of SMT in the Cervical Spine & Chiropractors’ Beliefs Around the Need for X-rays

CF 277: Safety of SMT in the Cervical Spine & Chiropractors’ Beliefs Around the Need for X-rays

Today we’re going to talk about the safety of SMT in the cervical spine & Chiropractors’ beliefs around the need for x-rays.

But first, heres that sweet sweet bumper music

 

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making  evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.   We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people 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.  I’m so glad you’re spending your time with us learning together.   Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com   If you haven’t yet I have a few things you should do.

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com

  You have found yourself smack dab in the middle of Episode 277   Now if you missed last week’s episode, we talked about Subacromial Dry Needling & Lumbar Discs With Stenosis Present. Make sure you don’t miss that info. Keep up with the class.  

 

On the personal end of things…..

I have just returned from the Tampa mastermind meeting so this likely will be shorter than normal. Mostly because after I’ve been gone a few days, the stuff has piled up and I’m usually tied up trying to get my desk cleared off and back to business as usually. The youz as the kids would say.   Tampa was good stuff, we had a talk from the Scheduling Institute and I was really impressed.

Wow.

I think this is a path I need to be going down and I think that path should start yesterday. Eye opening is just the most minimal way to put it.   We have hot seat sessions where one of us sits in the middle and tells the group their issues then the entire group asks questions and tries to offer help and advice to solve and move past those problems.  

We have Each One Teach One sessions to help learn what’s working for others in their practices. Kevin Christie and myself presented a 30 minute spot on ChatGPT.

Lindsey Mumma did one on niching your practice. And Ben Fergus did one on automating his front desk and check-in procedures. He’s done a lot of interesting things with his practice.   Again, get yourself into a Mastermind or create one. It’s outstanding.   Kevin is looking to maybe start another, separate group for the West Coast and Mountain area so keep your eyes and ears out. We’ll probably have Kevin on the podcast in the near future talking about that as well.   Let’s get at it.  

Item #1

The first one today is called “Safety of chiropractic manipulation of the cervical spine: a prospective national survey” by Haymo W Thiel, Jennifer E Bolton, Sharon Docherty, Jane C Portlock and published in PUBMED on October 1, 2007.  

 

Why They Did It  

To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors.  

 

How They Did It  

  • They studied treatment outcomes obtained from 19,722 patients.

 

  • Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine.

 

  • Serious adverse events, defined as “referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity,” and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment.

 

What They Found  

  • Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events.

 

  • This translates to an estimated risk of a serious adverse event of, at worse approximately 1 per 10,000 treatment consultations immediately after cervical spine manipulation, approximately 2 per 10,000 treatment consultations up to 7 days after treatment and approximately 6 per 100,000 cervical spine manipulations.

 

  • Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse approximately 16 per 1000 treatment consultations.

 

  • Up to 7 days after treatment, these risks were headache in, at worse approximately 4 per 100, numbness/tingling in upper limbs in, at worse approximately 15 per 1000 and fainting/dizziness/light-headedness in, at worse approximately 13 per 1000 treatment consultations.

 

Wrap It Up  

Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.     Before getting to the next one,   I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.  

Item #2

Our last one this week is called, “Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession” by Philip A. Arnone, Steven J. Kraus, Derek Farmen, Douglas F. Lightstone, Jason Jaeger 4 and Christine Theodossis  and published in Journal of Clinical Medicine on 10 March 2023. Hot potato!  

Why They Did It  

  • Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value.
  • Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of Plain Radiography of the spine in practice.

  How They Did It

  • In creating the survey for this study, the authors intended to be consistent with Evidence-Based Practice and developed a series of 11 questions to adequately reflect the clinical opinion and experience of the US DCs on the utilization of Plain Radiography of the spine in a chiropractic clinical setting.

 

  • The survey included a variety of both Likert and binary response options that could accurately reflect each DCs’ clinical opinions and experience rather than solely binary response options.

 

  • Many aspects of the clinicians’ decision process were considered during the process, including why practitioners would or would not order Plain Radiography of the spine, what value DCs attribute to Plain Radiography of the spine, how to adequately reflect DCs’ clinical opinion and experience of Plain Radiography of the spine as it relates to patient care, and issues related to plain radiography utilization safety and research.

 

What They Found  

  • There is an inverse relationship in the responses between DCs that do and do not utilize Plain Radiography of the spine in their practice; however, the clinical opinion of US DCs who utilized Plain Radiography of the spine in their practice assigns a high value to the utilization of Plain Radiography of the spine.

 

  • These doctors believe it to be safe and that the DCs’ clinical experience is adequate for recommending Plain Radiography of the spine.

 

  • In summary, 77.6% of these DCs indicated that Plain Radiography of the spine has value beyond the identification of pathology, 79.1% indicate that x-rays important regarding biomechanical analysis of the spine, 83.0% noted they are vital to chiropractic practice and 84.7% believe they aid in measuring outcomes.

 

Wrap It Up  

  • This survey provides the most extensive insight into the clinical opinion of the US chiropractic profession regarding Plain Radiography of the spine and suggests that the majority of the DCs consider utilization of x-rays to have value beyond the identification of pathology, to be vital to chiropractic practice and essential to biomechanical analysis.

 

  • The DCs who utilized Plain Radiography of the spine only to rule out pathology in the presence of red flags are, in fact, statistical outliers in this study and may represent a minority of US DCs.

 

  • A majority of the DCs also consider the doctors’ clinical experience and expertise, coupled with patient preferences, to be appropriate for recommending Plain Radiography of the spine.

 

  • Most DCs in this survey found that sharing spinal radiographic findings with the patient is beneficial for patient outcomes. All participants in the survey believed that patient outcomes would benefit from continued research regarding appropriate utilization of Plain Radiography of the spine.

 

  • The results of this survey clearly indicate the value of Plain Radiography of the spine reflected by DCs and demonstrate the need for continued research to help understand how this value can affect the quality of care, conservative correction of spinal alignment and patient health.

 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.   Let’s get to the message. Same as it is every week.  

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

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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 cant beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

 

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

 

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

 

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

 

Key Point:

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

 

Thats 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 cant 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

 

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 (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

 

Risk/Reward For Low Back Pain Treatments & Chiropractors In An Interprofessional Practice Setting

CF 266: Risk/Reward For Low Back Pain Treatments & Chiropractors In An Interprofessional Practice Setting

Today we’re going to talk about Risk/Reward For Low Back Pain Treatments & Chiropractors In An Interprofessional Practice Setting

 

But first, heres that sweet sweet bumper music

 

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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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, look down your nose at people 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.  I’m so glad you’re spending your time with us learning together.   Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com   If you haven’t yet I have a few things you should do.

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward Facebook group, and then
  • Review our podcast on whatever platform you’re listening to
  • Last thing real quick, we also have an evidence-based brochure and poster store at com

  You have found yourself smack dab in the middle of Episode #266   Now if you missed last week’s episode , we talked about where to adjust and the types of adjustments that were most beneficial. Make sure you don’t miss that info. Keep up with the class.   On the personal end of things…..

Man oh man…..we’ve been having such an interesting time around these parts. If you’ve been listening along with me, I lost 3 of my 4 full time employees within only a 2 week span. That’s almost like starting completely over. Stressful, kind of shock and awe type of thing.   But, turns out, if you have a spouse or partner that knows the front desk and has the flexibility in their work schedule to put other things on the back burner and come in and help you turn it around, then that’s freaking gold, people. Listen to the words exiting my piehole. “Make sure your significant other knows how to run the front desk, bill, verify insurance, and put in charges.   Without this, we would have been in terrible shape. My wife is my failsafe. She’s fierce when backed into a corner as well. So, when we kind of feel on the defensive, BAM!

Mama bear comes out and makes it happen.

And she has. She’s the gamechanger.   In case you haven’t followed along, we lost all 3 within 2 weeks. The first two both gave us one month notice. The last one, our front desk staffer, gave us no notice at all. Just up and quit. Thanks to my wife, we were up and running on day one and haven’t missed a beat. In fact, we’ve already grown our weekly visits. Just two weeks in with a new front desk that cares and is knocking it out for us.  

Turns out, my low numbers all this Fall and Winter weren’t bad marketing and all that. It was that the simple jobs or booking and re-booking weren’t being tended to the way we asked. That didn’t just fall on the shoulders of one person. It was several. Now that we’ve started from scratch, our systems are being re-implemented and it’s making a difference quickly.   Now you get to not hear about it anymore very soon. I’m only sharing with you so that, should you go through some of the stuff I’ve dealt with recently, you’ll have a broader knowledge base to make corrections from. When you’d increased your marketing yet the numbers remain low, it’s probably internal. Not external.  

I’m 50 and still learning lessons.  

During the Fall 2022 Slowdown ….that’s what it will forever be referred to by the way….the Fall 2022 Slowdown…..we brought Darcy Sullivan of Propel on board to get our website SEO enpoint and dialed in. If I’m going to have a slowdown, it’s not going to be because of being cheap and not taking care of the #1 source of referrals….which is Google.  

So I brought Darcy on and did the package where they basically do the whole thing for me because, let’s be honest, I don’t have the time nor the expertise for it.   We’ve gone through the process and now she’s updated my website and we’re ready to see what happens with the Google machine. Between Darcy at Propel and my wife handling front desk duties until she gets the new staffer trained up….I’m in a no-lose situation my friends.   I’m looking forward to reporting back on how well Darcy’s crew does for us.   Now, let’s get going with the research, shall we?          

Item #1  

The first on today is called, “Benefits and harms of treatments for chronic non-specific low back pain without radiculopathy: Systematic review and meta-analysis” by Ronald J. Feise and published in The Spinal Journal on November 15, 2022. Dayum. That’s hot.    

Why They Did It  

The aim of this review was to compare the benefits and harms of treatments for the management of chronic low back pain without radiculopathy and to report the findings in a format that facilitates direct comparison (Benefit-Harm Scale: level 1 to 7).    

How They Did It  

  • This was a registered systematic review and meta-analysis of randomized controlled trials. I
  • nterventions included non-pharmacological (acupuncture, spinal manipulation), pharmacological and invasive treatments compared to placebo.
  • Best evidence criteria were used. Two independent reviewers conducted eligibility assessment, data extraction and quality appraisal.

    What They Found  

  • The search retrieved 17,362 records.
  • Three studies provided data on the benefits of interventions, and 30 provided data on harms.
  • Studies included interventions of acupuncture (n=8); manipulation (n=2); pharmacological therapies (n=9), including NSAIDs and opioid analgesics; surgery (n=8); and epidural corticosteroid injections (n=3).
  • Acupuncture and manipulation were effective in reducing pain intensity compared to sham.
  • The benefit of the other interventions was scored as uncertain due to not being effective, statistical heterogeneity preventing pooling of effect sizes, or the absence of relevant trials.
  • The lowest risks were for acupuncture, spinal manipulation, NSAIDs, combination ingredient opioids, and steroid injections, while they were higher risks for single ingredient opioid analgesics (level 4) and surgery (level 6).

    Wrap It Up  

  • There is uncertainty about the benefits and harms of all the interventions reviewed due to the lack of trials conducted in patients with chronic non-specific low back pain without radiculopathy.
  • From the limited trials conducted, non-pharmacological interventions of acupuncture and spinal manipulation provide safer benefits than pharmacological or invasive interventions.
  • There were high harms ratings for opioids and surgery.

    Before getting to the next one,   Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.    

I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.  

Item #2  

Our last one this week is called, “Chiropractors in interprofessional practice settings: a narrative review exploring context, outcomes, barriers and facilitators” by Corrie Myburgh and published in Biomed central on 16 December 2022. Hot potato!    

Why They Did It  

To determine the added value of interprofessional interventions over existing mono-professional practice, elucidation of specific health care issues, service delivery contexts and benefits of combining multiple service provider is required.  

How They Did It  

  • A search of relevant databases was performed
  • The search was conducted in October 2021.
  • Two reviewers independently screened the articles. In case of disagreement consensus was reached through discussion.
  • An article was included if it described interprofessional practice including a chiropractor and outcome measurements relating to interprofessional service delivery were reported.
  • In particular, articles were included if they had peer-reviewed scientific content in the form of journal articles, book chapters, and conference proceedings

    Wrap It Up  

  • Very limited evidence from which to judge the value of interprofessional practice interventions involving chiropractors is currently available. Exploratory studies have outlined issues relating to feasibility and potential value of interprofessional practice initiatives across at least four domains of practice.
  • However, only one study was identified with the specifically stated purpose of investigating an interprofessional practice practice intervention for a particular health care issue; this being low back pain in older patients.
  • The discourse relating to interprofessional practice involving chiropractors appears to be at an early stage of development and further studies conducted specifically to evaluate interprofessional practice solutions for specific health care issues are urgently required.

So, we need some research. We want to be part of the team so let’s prove that we can provide value and be a valuable member of the team.   Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.   Let’s get to the message. Same as it is every week.  

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

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

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 cant beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

 

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

 

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

 

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

 

Key Point:

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

 

Thats 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 cant 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

 

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 (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Recognizing Cervical Artery Dissection

 CF 244: Recognizing Cervical Artery Dissection Today we’re going to talk about Recognizing Cervical Artery Dissection But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent education for you AND your patients. It saves you time in putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #244 Now if you missed last week’s episode , we talked about Chiropractic Adjustments To Avoid Other Procedures & we talked about Male Vets With Chronic Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, I just turned the big 50 people. It hurt a little. I’m not going to lie. I’ve always been one to really value and enjoy being young. I didn’t just go through it without appreciating my abilities and what I could do and accomplish.  I loved being an athlete and running and all of that good stuff. They say it’s just a number but that number is engrained in my joints and I feel it. Part of it is a weight thing.

Being 6’ 4” and 275 or so isn’t great for joints of the body so I’m on it. We’ll get that down. I’m determined.  So, 50 is blah for me but it’s over and it’s onward ho. I have too many irons in the file to be worrying about birthdays and all of that stuff. 

Business is pretty solid for back-to-school. It’s pretty steady. Which is surprising. I’m changing up some marketing in the near future and will share some of my experience on that. I’m a little nervous to dive more into marketing because if I’m honest, I’m at capacity as it is.  I saw 27 new patients last week. Just me. We had a total of about 180 visits and that’s just about as much as I can do. But with the type of marketing, we’re going to be trying, we’ll be more likely to only get the patients in here that we want to work with that are already fully committed and motivated.  We shall see. But for now, let’s get on with the research. We have some fun ones this week. 

Before I do that though, I have to tell you, that Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #1

This first and only one this week is getting some attention due to a recent artery dissection suffered by a woman in Georgia. Unfortunate for sure. I don’t know the particulars so we won’t go into that specifically but, when things like this happen, we start seeing more and more about the chiropractors cause stroke thing.  Typically, this isn’t true and there is a lot of research backing that up. I want to cover an article today that just came out called, “How to Recognize A Cervical Artery Dissection’ by James Demetrious, DC, DABCO (DABCO 2022) and published in PostGrad DC on July 18, 2022. Kaplowy! 

That’s hot!

Since this is an article, we’ll dispense with the traditional format and hit the high notes.  The arrticle highlights an excellent paper that came out not long ago that we covered here on the podcast. It’s by Chaibi et al (Chaibi A 2018) and was in the Annals of Medicine in 2019. In their paper, they cited high-quality research that affirms 

  • Manual therapy doesn’t no result in an increased risk of CAD
  • There is no strong evidence that manual therapy provokes CAD. 

Chaibi and Russell cite high-quality research to support these conclusions:

  • The rarity of CAD also makes the provision of epidemiological evidence challenging.
  • However, several extensive cohort studies and meta-analyses have found no excess risk of CAD resulting in secondary ischaemic stroke for chiropractic SMT compared to primary care. [2, 3, 4]
  • Similarly, retrospective cohort studies have reported no association with traumatic injury to the head or neck after SMT for neuromusculoskeletal pain.
  • Studies have disproven any misconception about whether SMT strains exceed failure strains.
  • No changes in blood flow or velocity in the VA of healthy young male adults were found in various head positions and during a cervical SMT.
  • Thus, these studies support the evidence of spontaneous causality or minimally suggest very low risk for serious AEs following SMT.

For my office, I try my best to minimize the risk to as close to zero as possible. If there is a young person in the office with unilateral neck pain for no reason, especially combined with a severe headache, they’re getting the inquisition, folks. I’m a research nerd and through my years of doing this podcast, I have compiled 19 questions that I feel can give us the best possible screen for CAD. Feel free to use them for yourself. They are as follows:

  • Is there any difference in upper arm strength from side to side?
  • Is there pain or numbness in one side of the face?
  • Can the patient raise both eyebrows equally?
  • Is there any difference in the size of the pupils?
  • Does the patient have an even smile?
  • Is the tongue straight when you have the patient stick it out?
  • Do they have a mostly even grip bilaterally?
  • Can they perform a resisted shoulder shrug evenly bilaterally?
  • Do you have a head pain or headache that developed suddenly and can be sharp or throbbing?
  • Do you have a headache that is worse when laying down?
  • Do you have difficulty speaking or swallowing?
  • Do you have any visual abnormalities?
  • Do you have unsteadiness or lack of coordination beyond what you consider normal?
  • Are you having any recent onset hiccups?
  • Are you having any hearing loss or pulsing tinnitus?
  • Are you having any nausea or vomiting?
  • Signs of nystagmus?
  • Any other neurological symptoms?
  • Do they have any light-headedness or fainting, disorientation, unexplained anxiety, disturbances in the ears, tremors, or sweating?

Now, if after all of those questions, you have accurately documented this complaint and should have a good direction forward. Most of the time, after the screen, I’m comfortable moving on. I’ve done my due diligence. However, I’m sure I’ve lost some patients over the years because if some of these are answered yes with no clear explanation for them, they’re getting an MR-A or a CT-A or I’m not working on them. Plain and simple.  I tell them my first job is to do no harm. My second job is to make them better.  Most appreciate it and are happy to do the imaging. 

So, there you go. If you’d like more information on why chiropractors are almost never solely responsible for CAD, I put together a very comprehensive and, I think, entertaining rundown of the information and I did it in various forms so that you could get the info however you like.  I put it in a blog on my website at chiropracticforward.com. The blog is called Debunked; The Odd Myth That Chiropractors Cause Strokes. The link can be found in the show notes right here at this point in the episode.  https://www.chiropracticforward.com/blog-post/debunked-the-odd-myth-that-chiropractors-cause-strokes-revisited/

I also have it in video form on YouTube with the same title   And just to be sure you could get the information in your preferred format, I made podcast episodes covering the same information in depth. The episodes of this podcast are Episodes 13, 14, and 15

I invite you to dive in a bit so you can be on top of it all. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so 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 https://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 (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

  • Chaibi A, R. M. (2018). “A risk-benefit assessment strategy to exclude cervical artery dissection in spinal manual-therapy: A comprehensive review.” Annals of Medicine.
  • DABCO, J. D. D. (2022). “How to Recognize a Cervical Artery Dissection?” PostGradDC.    

Exercise For Depression & Manipulation For Tendinopathy

CF 228: Exercise For Depression & Manipulation For Tendinopathy Today we’re going to talk about Exercise For Depression & Manipulation For Tendinopathy But first, here’s that sweet sweet bumper music

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back anrd 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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #228 Now if you missed last week’s episode , we talked about nerve flossing carpal tunnel and we talked about catastrophizing. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things….. I just got back from the MCM Mastermind that was started by Dr. Kevin Christie. This group is just outstanding y’all. I mean honestly, Dr. Mark King of the Motion Palpation Institute is a member. How do you beat that?? Dr. Jay Greenstein of Kaizenovate and Kaizo care clinics in Washington DC. Dr. Ben Fergus of the GRIP method. Seriously. THE Dr. Brett Winchester is joining us at the next one. You can’t make this stuff up. 

One theme we discussed a lot this weekend was The Front Stage and Back Stage Systems in your practice. Strategic Coach was kind enough to be our guest presenter and they rocked it.  Another theme I kept on bringing up was whatever you can have a vision on and take consistent action on, will happen for you.  BUT YOU MUST HAVE BOTH VISION AND ACTION. 

In our Mastermind Group we have: 

    • A Doc who takes one week off per month 
    • A Doc who lives in a different state than 
    • where is practice is located 
    • At least 5 practices clear well over 1M in revenue (and they are high quality of evidence informed care) 
    • One that is exiting patient care in the Fall
    • A Doc who is building a short term rental business – that’s me! 
    • All Docs who no matter their accomplishements and the size of their practices…..they are still pushing the envelope and humble enough to come to each meeting with a Beginner’s mind. Eager to learn and eager to share thier knowledge and experience. 

Remember, it’s not HOW….it’s WHO.

Who do you know that can help you get where you want to be? I know 14 others right now in this group.  What would you love to have in 5 years that is big? Our group has top chiros from North Carolina, Texas, Florida, Connecticut, Missouri, Montana, Ohio, Maryland, Minnesota, Alabama, and Illinois.  We meet four times a year to raise our games. World class care through a mastermind and collaboration of some of the best in the country. To be the best, it makes sense to learn from the best. It’s pretty exciting! 

Next meeting is in July in Sarasota.  I’m already making plans. I believe Dr. Christie is interested in growing the group by about 5 or so more seats. If you’re interested, let Dr. Christie know. Send him and email to drkchristie@gmail.com 

Before we get to the research, we all know that the number one type of case that we want is a personal injury case – they are gold because the clients are more compliant, and we get paid at rates far above insurance or Medicare or Medicaid. The patient’s attorney tells them to go for treatment as doing so enhances their legal case and gets them more money. The problem is, how do we get PI cases?  Attorneys don’t generally respond to your invitation for lunch. And let’s face it, they’re a tough bunch. I have the answer. An attorney I know has put together a system, that is both in written and video form, that shares how to approach attorneys and get them to send their PI clients to you. This is the real deal. Attorney Paul Samakow’s system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment.

Go to gettingpicases.com/cs

That’s gettingpicases.com/cs

One more time so you get it right:   gettingpicases.com/cs

Item #1

This first one is called, “Association Between Physical Activity and Risk of Depression A Systematic Review and Meta-analysis” by Pearce et. al. (Pearce M 2022) and published in Jama Psychiatry on April 13, 2022 – Dayumm that’s fresh and hot. 

Why They Did It

To systematically review and meta-analyze the dose-response association between physical activity and incident depression from published prospective studies of adults.

How They Did It

PubMed, SCOPUS, Web of Science, PsycINFO, and the reference lists of systematic reviews retrieved by a systematic search up to December 11, 2020

What They Found

  • Fifteen studies comprising 191,130 participants and 2,110,588 person-years were included. 
  • Heterogeneity was large and significant. 
  • Those accumulating HALF the recommended volume of physical activity had 18% lower risk of depression. 
  • Adults accumulating the recommended volume of 8.8 marginal metabolic equivalent task hours per week had 25% lower risk with diminishing potential benefits and higher uncertainty observed beyond that exposure level. 

Wrap It Up

This systematic review and meta-analysis of associations between physical activity and depression suggest significant mental health benefits from being physically active, even at levels below the public health recommendations. Health practitioners should therefore encourage any increase in physical activity to improve mental health.

Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

The last one today is called, “”The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review” by Savva et. al. (Savva C 2021) and was published in the Journal of Manual and Manipulative Therapy in 2021 – aye chi wa wa. Steamy. 

Why They Did It

To summarize the available literature with regards to the potential analgesic effect and mechanism of joint mobilization and manipulation in tendinopathy. 

What They Found

  • The effect of these techniques in rotator cuff tendinopathy and lateral elbow tendinopathy, applied alone, compared to a placebo intervention or along with other interventions has been reported in some randomized controlled trials which have been scrutinized in systematic reviews. 
  • Literature in other tendinopathies such as medial elbow tendinopathy, de Quervain’s disease and Achilles tendinopathy is limited since the analgesic effect of these techniques has been identified in few case series and reports. 
  • Therefore, the low methodological quality renders caution in the generalization of findings in clinical practice. 
  • Studies on the analgesic mechanism of these techniques highlight the activation of the descending inhibitory pain mechanism and sympathoexcitation although this area needs further investigation.

Wrap It Up

Study suggests that joint mobilization and manipulation may be a potential contributor in the management of tendinopathy as a pre-conditioning process prior to formal exercise loading rehabilitation or other proven effective treatment approaches. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store

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

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so 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 https://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 (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

Pearce M, G. L., Abbas A, (2022). “Association Between Physical Activity and Risk of Depression: A Systematic Review and Meta-analysis.” JAMA Psychiatry.  

Savva C, K. C., Korakakis V, Efstathiou M, (2021). “The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review.” J Man Manip Ther 29(5): 276-287.    

Some Chiropractors Could Be Better

CF 153: Some Chiropractors Could Be Better Today we’re going to talk about chiropractors, the subluxation – vitalistic group in our profession and we’ll probably make some grumpy vitalistic enemies out of these chiropractors in the process.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #153 Now if you missed last week’s episode , we talked about spinal instability clinical pearls and we tal ked about degeneration and the facets. That was some good stuff you need to to have in your back pocket. 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…..

I’m doing hte same stuff you’re doing for the most part. I’m just struggling through this second wave of COVID. Trying to stay smart and trying to stay healthy. I wish I could say the same for everyone around me.  For example, I just had a staff member start this week off by telling me she started working a part time job on the weekends because she got an apartment she thought she could afford but it’s not as easy as she thought.  Anyway, at this part time job, her buddy drank out of her drink. She’s like, oh well, it’s just my friend. No big deal. Yeah, no big deal friend called her today…..2 days after that…..and is feeling bad and going to get tested. Now, does that mean my girl has it? Of course not. The friend wasn’t even symptomatic so the chances are low she has it in the first place and if she does have it now, the chances she was shedding the virus then are low. 

Still…..come on man. Be smart. My daughter goes to school with 1000 plus kids every day and I don’t let her take a sip of my drink or anything like that. Much less a buddy at my part time job. Hell no. hell no.  So those are the things we get to battle with, right? We can control everything about what we personally do but we can’t control our kids at school with their friends. We can’t control my other kid at college and his behavior. We can’t control our staff when they’re not here at work.  We just do our best, keep our fingers crossed, and keep working diligently. And hopefully safely.  Not because I’m necessarily scared of getting it. Mostly because I don’t want to shut my practice down for 2 weeks minimum. Who can afford that? So let’s get on with pissing people off, shall we? 

If you don’t understand by this point that there is a divide in our profession that simply cannot be healed, tied together, or unified, well….I don’t know what to do for you. You just need to pay more attention.  If at any point you have thought the two groups could come together, you are fooling yourself. This profession either needs to be split into two completely different degrees and entities or the vitalists need to practice their minimal practice and sit in the back seat and shut the hell up.  Yep….shots fired. I know. I’ll explain more as we go. Every now and then I get fired up and this is one of those times. I’m triggered. I’m the grumpy old ‘get the hell off of my lawn’ guy. More specifically, I’m ‘raise your damn game and quit actiing like fools’ guy. 

I should tell you why I’m triggered first. As our listeners are well-aware, I am a member of lots of Facebook groups but the most notable would be the Forward Thinking Chiropractic Alliance. Most friends and family would classify me as conservative in finances and life in general but when it comes to my profession, I’m all about progressive change and forward momentum. So this group fits me very well.  Anyway, one of the members posted a screenshot of a doctor  – trust me – I use that ‘doctor’ term extremely loosely here – it was a post of this guy claiming that with one table, by himself, he treated 99 chiropractic patients and 9 new patient exams all in 3 hours.  I did the math for you all. That’s right at 2 minutes per patient.

Well, for many of us, that’s not too far off of the mark for established patients. Some of you are boutique practices and spend 30 minutes to an hour with each patient and charge out the wazoo for that. But, for most of us, we are adjusting, passing off to our staff for therapy and rehab and moving on to the next patient.  I want to be fair here. My face to face time is typically 3-5 mintues with an established just depending on what questions I have to answer, if there’s a new complaint popping up that needs evaluated, new patient education, and things like that. Some slightly less than 3 mintues, some quite a bit longer than 5 minutes. 

Now, my patients’ whole visit will clock in on average around 20-30 minutes after therapy and/or rehab but that is delegated to the staff.  Here’s the real kicker for me on this joke. The new patients. I can not get past the new patients. Now I’ve seen 7 or 8 new patients in a day while juggling another 50 or more established patients. But damn man…that’s over the course of a 7 hour day. And, while I don’t think it makes me particulary any more special than anyone else, I have a Fellowship in neuromusculoskeletal medicine. I can come to a diagnosis somewhat quickly when compared to others.  Still, my exam, unless it’s a simple rib complaint or something easy like that, it’s going to take 30-45 mintues. Easy. And that’s with staff doing their history and intake part.

Them filling out OATS takes time on top of that. Plus, I recorded a 7 minute, ‘Welcome to our practice’ video they all watch.  Look, there’s no damn way on this damn planet anyone calling themselves doctor works that many new patients through in 3 hours while juggling 99 established patients and claims they’re doing a good job. No way now how. Nope, no, negatory, NO! Worst of all, he’s a vitalist, practice management guru so he’s offering to show other, impressionable knuckleheads how to mistreat patients all on their own.

Solo crappery if you will. Crappy treatment all by themselves. With his crappy guidance. What a crappy deal.  I have 34 mutual friends with this person and that’s just disappointing. It truly is. Many of you know who I’m referring to but I see no point in mentioning names because the last thing I want is to bring him even more attention. Especially when I don’t see the reason even one person would pay him any at all.  I have no way of knowing how long they’re spending with new patients but let’s just agree that it’s not 30-45 minutes.

There’s no way. I know this because if he spent 30 minutes with each of the 9 new patients, that would be about 4 and a half hours. Much more than the 3 hours he talked about in the post.  We are forced to assume it is much less than that. So let’s play with the math. Three hours is 180 minutes. I think we can all agree on that. A former attendee to one of his seminars said he bragged in the seminar that he could adjust a patient top to bottom in just 30 seconds. As a sidenote, he taught how to have the trash can right next to the door so that he could tear the face paper and grap the door knob in one smooth motion so as to have the door open and showing the person out before they’re even off of the table. That way, you don’t have to talk to them.  So you don’t have to talk to the patient……you get that?

Good Lord, can you imagine a doctor having to speak to their patient after treatment is provided? The horrors!!! Anyway, let’s say 30 seconds is his record but it actually takes one minute on average per patient. If 30 seconds is the fastest, can’t we assume there will at least be some greeting involved in the appointment? Some questions from time to time? There may be some 30 second appointments in there but there may be some minute and a half and some two minute appointments as well. I think that’s fair. 

So, if each of the 99 established takes an average of one minute, which is stillsubstandard care by the way, if they all average one minute, then that leaves 81 minutes to examine and evaluate 9 new patients. That means he has roughly 10-15 minutes for each new patient to do the following if he’s going to adequately assess the patient and have a specific diagnosis outside of subluxation slaying and spine whispering.  He’s got to:

  • Review the history taken by the staff before he came in
  • Review the range of motion if taken in advance by the staff
  • Review the vitals 
  • Meet the patient and listen to their story
  • Assess gait
  • Assess standing posture
  • Check yellow flags and discuss any that are present with the patient
  • Check for red flags – not everyone needs x-rays
  • Check reflexes
  • Check dermatomes
  • Check muscle strength (not freaking AK)
  • Check neurodynamic positions for radiculopathy
  • Assess for Ehler-Danlos and hypermobility
  • Check orthos
  • Check neuro testing
  • Check for extension/flexion bias positions in some cases
  • Come up with an accurate diagnosis
  • Educate the patient on their diagnosis
  • If chronic pain is part of the case, he has to educate on CNS upregulation and the biopsychosocial aspect of pain which is at least a 5 mintues conversation. 
  • Teach proper movement and biomechancis to remove the daily pain triggers
  • He has to answer questions the patient may have

Hell, I wonder if he’s ever had someone lay on their stomachs propped on their elbows for 3 minutes to see if they can identify a home self management strategy for their low back pain? Hell no. Three minutes wouldn’t fit into this doctor-centered model.  I have no way of knowing but I’m guessing the exam consists of ‘checking subluxation’ and telling them to lay down.

Pop, pop, pop, the ridiculous power is on, see you tomorrow for you next life-saving adjustment. It’s silly. And it’s insane. And it’s not evidence-based. And it’s not patient-centered. It’s not special. It doesn’t take talent other than being able to sell targets garbage. It’s the lowest common denominator and nothing more. 

The point being made here is that one cannot do an adequate, responsible, and appropriate exam in this amount of time. And assuming they average only one minute per patient face to face, that’s substandard as hell. Would you want your kid or brother or sister or mom or dad shuttled through an office like a bullet from a gun? Or would you want them to go to someone that cares, connects with them, slows down a tad and takes their time to listen and work with them? The answer is obvious and if you tell me you’d rather your family go to this guy or anyone like them, then you’re just being obstinate and disagreeable.

It’s obvious which style is superior in healthcare.  Maybe working on an assembly line you’d like to see fast, efficient, and little attention given to the specifics. But not in healthcare. This model, I’m sorry to be blunt here….this model is garbage when we are working with the breathing, ever-changing human body.  And….oh this guy loves him some of him. Oh my goodness. If someone likes to look in the mirror every morning, it’s probably this guy. Now, he’s selling his unique brand of BS to others. He’s doing a good job of it too. He’s got sycophants all over now learning how to shuttle them out of the office without having to speak to them. 

They’re in the comments section of this post proclaiming him a rock star! BS. Rock on! I can’t wait to do this when I get out of school! You’re an inspiration. How awesome!!! Blahditty freaking blah. BS, BS, BS. I would comment, “What an embarrassment to our chiropractic community! What a fool! What about exercise and rehab? What about quality over quantity? You give our profession a bad name. You’re one of the reasons we have zero cultural authority and can’t pass a bill in the legislature because you and your followers are irresponsible!!!”  You know….things like that.  Now, I’ve been asked why I talk bad about other chiropractors.

Running them down and such. I don’t call it that at all. I call it policing our own and calling out BS when it’s right under your nose. I don’t know about you but I don’t want BS under my nose. It stinks. And not only can I smell it, but everyone else I come into contact with smells it as well. So, basically, these people’s actions reflect on me, my business, and my livelihood. And yours as well. So if you’ve been going along to get along thinking it doesn’t matter, it does matter. It matters to your bottom line. 

Can you imagine if we were to have more cultural authority and more integration into a regular healthcare protocol…..can you imagine how full our offices would be? Low back pain is the number one reason for disability globally folks. Yet we only see 10% of the damn population. It’s obvious why and the Palmer Gallup poll laid it out. The biggest reason people don’t go to chiropractors is because they don’t freaking trust us. Because of fools like this.  Lots of high volume clinics like this slay subluxations non-stop for weeks and weeks. Some see people every week for life. Think about a self-adjuster. The more they did it, the easier it got to the point they created instability in their neck, they have consistent chronic pain, and now they’re a mess.

Can we see this happen in patients that are adjusted too often for too long? Of course we can!!  These spine whipering TORs are many times creating instability and causing chronic pain. Which is the damn thing the knuckleheads are supposed to be treating in the first place. But they were too lazy to get educated beyond college and some continuing education each year about proper documentation and how to adjust an elbow.  What if they have a hypermobile EDS patient that really needs weight training but they just keep hammering away at what they call subluxations? This is low quality garbage for people that aren’t taking the time to properly evaluate their patients in the new patient exam.  In one of his videos he says, “The patient doesn’t care about anything other than does the doctor care and can he help me?” Again, I use that doctor term exceedingly loosely. I have to just say that he is 100% wrong. Yes, patients do care about those two things but you know what else they care about?

They also care that their doctor is smart. Is on top of his game. Is making decisions in the best interest of the patient and not the clinic or the doctor’s wallet. They care about proper biomechanics so they don’t re-injure their back. They care that if they’re hyper mobile, maybe they shouldn’t be adjusted and should focus on weight training instead. They care that a slight decrease in neck curvature isn’t really the harbinger of death and disease some chiros act like it is. They want to know their doctor is making decisions on their care based on accurate diagnoses. Is making decisions on their care based on research and not philosophy. Trust me, they care about a hell of a lot more than How incredibly arrogant of this supposed doctor to think he has the only answer to what patients care about. They’re not freaking sheep with little to no thought processes.

They’re smart as hell in many cases and they absolutely care about a whole lot of stuff is missing. Saying they don’t is selling them short and it’s unfortunate that he’s going around teaching that. One more example of him being doctor-centered rather than patient-centered. “I….the doctor….knows what the patient really wants and cares about. They can’t think for themselves.” Garbage.  Of course patients don’t care about the biopsychosocial aspects of pain. They don’t even know what the hell that is. But we as professionals should absolutely know and absolutely care and leverage it to our advantage. We should know about upregulated CNS and educate patients about it. Because it matters. The question might be, “Why would people keep going back?”

Well a lot don’t but, in general the ones that do have typically had the crap scared out of them based on x-rays that usually shouldn’t have even been taken in the first place. “Looky here, loss of curvature, that is so concerning. I’m really worried about this and what it means for your future if we don’t get that fixed. That’ll be 58 visits this year at a cost of $4800. That’ll be upfront and here’s the contract to hold you to it.”  Predatory, unbelievably unethical, astoundingly unprofessional, and embarrassing.  Fro every patient referred to a clinic like this, I’d guess they lose one that thinks they and every other chiropractor on the planet is insane.

Thank you vitalists. I really appreciate it. So much. thank you.  Clinics like this only see their successes. So they think they’re amazing. I’ll be honest, I see A LOT of patients coming to see me from practices like this because patients can’t stand being shuttled through like cattle, not being listened to, feeling that the care is substandard, being scared by the doctor into treatment, being scared into contracts, and things of that sor They feel taken advantage of and they don’t like it. And I don’t blame them. I just appreciate them for giving me a chance to show them that the majority of chiropractors don’t engage in foolish crap.

That we can play an integral part in resolving their pain. I have heard the most embarrassing stories about chiropractors from patients that escaped clinics like this. A chiropractor can still focus on subluxations but do it in an evidence based, patient-cantered way. Wanna help more people? Hire more docs to handle that patient load and be able to have the time it takes to spend with the patients to do a proper job. Serve more people.  Just hire more people to do it. I just want better from this guy and people like him. I want a standard in our profession. I want more from our profession. I want to have a conversation with someone in the medical field or someone that knows very little about chiropractic and not feel the need to apologize for guys like this.

He’s clearly a talented guy and a leader on some level. I just wish the talent was more focused on evidence-based, patient-centered endeavors. Basically, I don’t have a problem with people practicing under the subluxation model when they’re not advising against vaccines. We didn’t learn enough about them to be a damn authority on it. Stay out of the conversation either direction. It is not ours to have. Can you imagine telling a mother not to get a baby vaccinated and then the baby gets measles? Steer clear of that conversation.  Anyway, I don’t mind people practicing that model. At the end of the day, we are all moving bones. The adjustment is the cornerstone of my practice but it’s only a piece of my practice. IT’s not the end-all-be-all. IT’s a puzzle piece but the piece is the biggest piece of my puzzle and it’s right in the center of the puzzle. Nothing more nothing less.

It’s not spiritual. It’s just a really big, very effective tool I have.  My issue is the thought that a thorough and comprehensive exam is not necessary. That connecting with patients is not important. That talking with them, answering their silly questions, and educating them is not important.  It all is very important and all of it, like it or not, takes time. It just does and time is a constant we must all contend with and work within the contraints of.  So….that’s me, folks. Raw. And mostly censored because trust me, I cuss like a sailor when I’m not on this podcast. I could make this discussion so much more colorful and it’s deserving of the cuss words.  I know many of you know this guy and you think he’s the bees knees and you’ll probably tune out here and think I’m just an awful person because

I’m talking this way about him but here’s the deal, we cannot let quackery and foolishness not only permeat what should be an evidence-based, patient-centered healthcare discipline…..but it is pervasive. Not only is it permeating, but it’s pervasive. You don’t have to look far to find a sycophant.  I have 34 nutual friends with this knucklehead afterall. What more do I need to say? So, more akin to the medical field, we should recognize BS, we should call it out, and we should educate against it. And that’s what I’m doing. Every week.  It’s not the subluxation-based thing that gets me. I’m used to that. It’s the culture around it that is insane.

Don’t vaccinate, as long as you stay adjusted, don’t worry about COVID, or any other disease, I say a knucklehead guru in school telling me adjstements pushed cancer out of guy’s body. Come on, man. When New Mexico had a shortage of practitioners and allowed chirorpactors to go to two extra years of education to get an advanced practitioner certificate to help prescribe and help handle the patient load, you know who showed up to testify against their own colleagues? Vitalist, subluxation-based, crazy-eyed imbecile chiropractors holding on to green books, the words of BJ, and a philosophy created in the late 1800’s.

Yeah, great look folks.  You know who is against the ACA’s push for Medicare parity? Yeah, not just the usual suspects like the AMA. Nope, hell, the AMA’s best teamates against chiropractic are the vitalists. Yeah, I’ve seen the sychophants of Matthew McCoy railing against us being treated equally under Medicare. Explain that for me….someone….please explain that.  Again, it’s not the subluxation. I don’t personally use or care for that word or philosophy but that’s not it. IT’s the insane leaders of that cult and the culture surrounding it that makes me want to punt baby bunnies into the damn stratosphere.  So, if you’re a subluxation person, my beef is not with you as long as you’re not scaring and taking advantage of your patients. As long as you’re not telling them to see you 80 times this year to keep them healthy and all that. I have no beef with you. 

Especially if you’re a Christian. Telling a patient that they were made imperfectly by a God you put every bit of your faith in makes no sense. at all. Y’all I’m a Christian. God makes no mistakes. He didn’t put us on Earth imperfect and in need of a chiropractor every week of our lives or be a miserable wreck of a person just waiting around on death’s doorstep. What a foolish concept for the faith-based models out there. The Body By God group. It’s silly. Sure be faitful, no problem there. But don’t tell people that they need you.

Otherwise, God can’t express himself fully without you. Yes, that is one of their talking points in case you were wondering. Insanity.  Current guides tell us to use spinal manipulative therapy for movement dysfunction, use exercise and rehabilitation, use low level laser, use heat, yoga, acupuncture, and soft tissue manual therapy, use balance and proprioceptive training as well. These are all ways of leveraging modalities to great effect in resolving pain. They also teach us to NOT create dependency in the patient upon us.

They shouldn’t depend on us. We should be teaching them ways to self manage ongoing pain at home and see them for periodic flare-ups.  That’s evidence-based and that’s patient-centered. 180 degrees opposite of what this practice I’m speaking about is doing.  There are so many amazing chiropractors in the world that have raised their games to such a level that they can command respect and money for their opinions and treatment. Then…..there just aren’t. They’re educationally lazy but they can sure talk a great game.  I’d like to see eveyrone raising the level. Raising the standard and taking this profession into an era of growth, progress, and respect. 

Item #1

It’s called “The disappearance of the primary care physical examination – losing touch” by Dr. Paul Hyman(Hyman P 2020), and MD and it was published in JAMA on August 24, 2020.  Damn the sizzle!!

It’s an article so high points we will hit upon He starts out by asking, “What is a physica examination worth?” He says he’s noticed that physical exams seem to be falling by the wayside in recent years and that fact has been highlighted for him since looking at the daily schedule and determining which will be see face to face in the days of COVID.  He says that an exam is clearly needed at times for a diagnosis but that he’s realizing other ways he commonly uses exams as well. He says it is a means through which he pauses and physically connects with patients. It’s a way to demonstrate his knowledge and authority to the patient.

He says it’s also a chance to persuade patients and reevaluate their narrative.  On the part about demostrating your knowledge, what are you demonstrating when you do a minimal, piss ant exam? Whether you know it or not, you may be demonstrating your lack of knowledge, right? Especially when that patient has had enough of your crap and goes to someone that knows what they’re doing. When the patients say, “This is awesome! The other chiropractor didn’t do any of this,” well, we have a pretty good idea of where you’ve been before getting to us.  He goes on to say, “When patients and I disagree on a plan, the physical examination not only provides data, it also acts as an arbiter.” 

He makes an excellent point here when he says, “In an admission of my own insecurity, the physical examination remains one of the few domains where I maintain a sense of professional skill and authority. I have never been much of a proceduralist. The mainstay of what I offer to patients is the ability to listen to them, to use critical thinking skills, and to offer my knowledge and experience. But those skills are sometimes challenged in a world where patients research their own health and develop their own medical narratives.

The physical examination remains a place where I offer something of distinct value that is appreciated.” You cannot make a difference in patients’ lives when you don’t know what the hell is wrong with them because you didn’t have the knowledge it takes to be accurate or because you only took 10 minutes to examine them.  CHIROUP ADVERTISEMENT

Item #2

This second item is called “Chiropractic, one big unhappy family: better together or apart?” by Leboeuf-Yde et. al. (Leboeuf-Yde C 2020) from February 2019 and published in Chirorpactic and Manual Therapies. 

Again, it’s an article so hittin the high spots.  They say that the profession has a long history of internal conflict. Today, the division is between the ‘evidence-friendly’ faction that focuses on musculoskeletal problems based on a contemporary and evidence-based paradigm, and the ‘traditional’ group that subscribes to concepts such as ‘subluxation’ and the spine as the centre of good health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care. They argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect.  We also contend that the profession could be conceptualised as existing on a spectrum with the ‘evidence-friendly’ and the ‘traditional’ groups inhabiting the end points, with the majority of chiropractors in the middle. I personally call the ones in the middle agnostics.

They take a little subluxation/innate talk to heart but think evidence-based is the way to go but are not motivated about learning any of the evidence and research. Or just don’t know where to go to find it.  They say this middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of ‘you never know who and what will respond to spinal manipulation’. We believe that this ‘silent majority’ makes it possible for groups of chiropractors to practice outside the logical framework of today’s scientific concepts. In their conclusion they say, “There is a need to pause and consider if the many reasons for disharmony within the chiropractic profession are, in fact, irreconcilable. It is time to openly debate the issue of a professional split by engaging in formal and courageous discussions.

This item should be prioritised on the agendas of national associations, conferences, teaching institutions, and licensing/registration as well as accreditation bodies. However, for this to happen, the middle group of chiropractors will have to become engaged and consider the benefits and risks of respectively staying together or breaking up.” No matter where you stand on it, it’s though-provoking and I’m sure to find email inbox filling. Lol.

I’m sure I get plenty of hate mail on this episode but I’ll get a lot of support as well. I cannot simply sit by and see BS and sweep it up under the rug. We have to meet it and stand boldly in front of it, and turn it away. For the betterment of ourselves, our profession, and our patients. 

 

Alright, that’s it.

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

Bibliography

  • Hyman P (2020). “The Disappearance of the Primary Care Physical Examination—Losing Touch.” JAMA Internal Med 180(11): 1417-1418.
  • Leboeuf-Yde C, I. S., Young K, Kauchuk G, Hartvigsen J, (2020). “Chiropractic, one big unhappy family: better together or apart?” Chiropr Man Therap 27(4).      

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

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

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

Do it do it do it. 

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

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

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

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

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

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