disc degeneration

Predicting Frailty & A 30-Year Study On Disc Degeneration

CF 184: Predicting Frailty & A 30-Year Study On Disc Degeneration Today we’re going to talk about using bone or musculoskeletal parameters to predict frailty and then we’ll cover a 30-year study on disc degeneration. Sit tight and chew on the morsels of knowledge we’re about to dish up for you.  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. We’re the Metallica of chiropractic research……if there is such a thing. 

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. 

You have found yourself smack dab in the middle of Episode #1844

Now if you missed last week’s episode , we talked about the factors leading to surgery for some discs and then we talked about recent information concerning disc innervation and what happens when a disc is injured. 

Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

So for personal happening this week, we are getting the training set up for a nurse practitioner down in Dallas. Our medical Director is good enough that he would like to be trained on what the nurse practitioner is doing as well. That means good things for us. 

When the medical Director is on board with the nurse practitioner, nothing but good happens. 

I’m still promoting and pushing my book. The one I’d love for you to purchase called “‘The Remarkable Truth About Chiropractic: A Unique Journey Into The Research’. It’s on Amazon and you can find the link on my homepage at chiropractscforward.com so go give it a look-see and a purchase. You can get it in paperback and as an ebook. 

This is an amazing resource for you practitioners in the field. Definitely for you content creators. Whether you’re looking for info to post on your social media, whether you’re teaching your patients and need material, or it you’re putting together a speech you need to give to a group……THIS is your resource to make your life easier and to save time. Seriously. Just flip to the topic and pick out the papers you like. BOOM….done. 

I noticed that the forward thinking chiropractic alliance had their fire event this past weekend. With all of the things I’m involved in, I was unable to attend either live or online. 

But, I purchased the online package so will be reviewing it when it is available online. It was all about implementing rehab into your practice and making money doing it. I love rehab and exercise being a part of my every day practice so I’m looking forward to waiting through all of the information. I am still trudging through the forensics fellowship and I have to say, it is not material that I enjoy. In fact, it’s pretty awful. 

But, with the forensics fellowship being a subsidiary of the orthopedics fellowship that I already went through, I only have to do 100 hours rather than 300 so there’s no reason to not do it. So, I am begrudgingly going through it. It feels like I would assume running through quicksand feels. I hate the material but I plan on enjoying The final results. 

Also, as part of the Parker CBI program, I have an intern coming on board. He’s going to move out to Amarillo for a semester and follow us around and work in the office starting in September. 

Throw that in on top of a nurse practitioner starting full-time with us on August 2, and I should have my hands full. This podcast is getting more and more challenging to write produce and record every week. Depending on how all of this goes in the fall, I may be forced to begin releasing an episode every two weeks rather than every week. Stay tuned. That decision is on the horizon. 

Other than all of that, I am involved in all of my extracurricular activities as well.

I am still going to the track and throw in the shot put and discus on the weekends and planning on competing in some masters events next spring and summer. Still trying to lose weight and stay involved in working out and being in the healthy lifestyle. And I’m still busy doing all of my artwork that I’ve been doing all along. 

If you’re interested in any of that you can find it on Facebook at Jeff Williams art. If I was that weren’t enough, I’m busy putting together a new band and music projectWell my voiceover career is also expanding and growing and growing a little bit crazy at the moment. You could say my cup runneth over exponentially. 

For that reason, let’s get on with the research.

Item #1

The first one is called “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi et al. (Sääksjärvi S 2020) and published in Spine Journal in October of 2020 which is cooling off but still pretty damn steamy. Hot enough to eat. 

Why They Did It

The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up

How They Did It

  • A prospective follow-up study.
  • In an earlier study, 75 conscripts aged 20 years with LBP had their lumbar spine examined by MRI. 
  • At a follow-up of 30 years, the subjects were contacted; 
  • 35 of 69 filled a pain and disability questionnaire, 
  • and 26 of 35 were also reexamined clinically and by MRI. 
  • The images were evaluated for decreased signal intensity and other degenerative changes. 
  • Association between decreased signal intensity of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher exact test. 
  • Association between decreased baseline signal intensity and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test.

What They Found

  • The total number of lumbar discs with decreased signal intensity increased from 23 of 130 to 92 of 130 
  • Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased signal intensity at baseline were more likely to have severely decreased signal intensity at follow-up, compared to healthy discs. 
  • Other degenerative changes were also more common in these discs. 
  • Severity of DD at baseline did not have a significant association with current pain or disability.

Wrap It Up

In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.

CHIROUP ADVERTISEMENT

Item #2

Our last one today is called “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study” by Tembo et. al. (Tembo 2021)       and published in Calcified Tissue International in 2021….ouch….don’t touch it…..it sizzles. 

And honestly….who the hell knew there was an entire damn journal called calcified tissue international?? How damn niche can you get?? For reals. And don’t tell me it’s pronounced nish because I’m just going to kick you in the shin if we meet in person. I’m going with niche because there are riches in niches. Not in nishes so don’t do it. 

Why They Did It

How They Did It

  • This longitudinal study included 287 men aged ≥ 50 yr at baseline (2001–2006) from the Geelong Osteoporosis Study
  • Baseline musculoskeletal measures included femoral neck bone mineral density (BMD), appendicular lean mass index (ALMI, kg/m2) and whole-body fat mass index (FMI, kg/m2) and lower-limb strength
  • Frailty at the 15 yr-follow-up (2016–2019) was defined as ≥ 3 and non-frail as < 3, of the following: unintentional weight loss, weakness, low physical activity, exhaustion, and slowness
  • Potential confounders included anthropometry, smoking, alcohol, FMI, socioeconomic status and comorbidities

What They Found

  • Forty-eight (16.7%) men were frail at 15 yr-follow-up.
  • Musculoskeletal models were better predictors of frailty
  • Musculoskeletal parameters improved the predictability model for frailty after 15 years

Wrap It Up

In general, muscle models performed better compared to bone models. Musculoskeletal parameters improved the predictability of frailty of the referent model that included lifestyle factors. Muscle deficits accounted for a greater proportion of the risk for frailty than did bone deficits. Targeting musculoskeletal health could be a possible avenue of intervention in regards to frailty.

And now you know…..the rest of the story….

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. 

 

Purchase Dr. Williams 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

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

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

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

About the Author & Host

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

Bibliography

Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347.  

Tembo, M. C., Mohebbi, M., Holloway-Kew, K.L, (2021). “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study.” Calcified Tissue Int.    

Multifidus & Disc Degeneration, Opioids & First Provider, Craniocervical Instability

CF 084: Multifidus & Disc Degeneration, Opioids & First Provider, Craniocervical Instability

Chiropractic evidence-based products
Integrating Chiropractors
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Today, it’s like the olden days here at the Chiropractic Forward Podcast. That’s right. No guests, just moiah. Me. Unfiltered and onery as usual. I’ve had stuff piling up in my archives and we’re going to sprint through some of it and see what sticks. We’re going to talk about the multifidus and some new research on it having to do with disc degeneration, we’ll talk about why what provider you see after low back injury can make all the difference, and we’ll talk about some hint that fibromyalgia and even POTS is theorized to be caused by craniocervical instability. Maybe?

It’s a heaping plate of knowledge noodles so keep your seat, the Italian mama that feeds you too much is in the kitchen. But first, here’s that yummy like a meatball bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have shimmied into Episode #84

Before we get started, 

I’m happy to introduce a new sponsor for the Chiropractic Forward Podcast called GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again on a loop in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, to encourage referrals, and to present the benefits of the specific and different products and services you offer.

It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. With this system, you tcan truly just set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice and…your discounted rate will be locked in for as long as you have a subscription. 

So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take your practice to the next level with GoChiroTV.

And thanks to them for being involved in what we’re trying to accomplish here. 

Personal Happenings

If you hear something here that you really like and would like it in written form rather than spoken, just hop onto  chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too. 

Item #1

Our first paper to cover is called “Physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration” and is authored by G. James, D. M. Klyne, et. al. and was published in European Spine Journal in May of 2019(James G 2019). 

Why They Did It

The authors here say that chronic low back pain….chronic…longstanding low back pain literally changes and remodels the multifidus muscles. They go on to say that physical activity reduces the local inflammation that comes before multifidus fibrosis during intervertebral disc degeneration (IDD), but its effect is unknown. This study aimed to assess the development of fibrosis and its underlying genetic network during intervertebral disc degeneration and the impact of physical activity.

How They Did It

This research was actually done on mice. To keep the entertainment value of this podcast as high as possible, I’m not going to get specific here as far as substance P, MMP2, blah blah blah. We’ll just head right to the conclusion of the paper. 

They say “these data reveal the fibrotic networks that promote fibrosis in the multifidus muscel during chronic intervertebral disc degeneration. Furthermore, physical activity is shown to reduce fibrosis and regulate the fibrotic gene network.” 

So they’re saying move it move it move it. 

Item #2

This next paper is called “Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain” and is authored by TC Azad, D Vail, and J. Bentley et. al. It was published in the esteemed Spine Journal in February of 2019. (Azad TD 2019)

Why They Did It

The authors wanted to determine whether provider specialty influences patterns of opiate utilization long after initial diagnosis. I’d say that’s a great question to be asking these days. When we have 72,000 die in one year from opioid-related causes, that should be up there on the ‘what the hell’ list wouldn’t you agree?

How They Did It

The study was a retrospective longitudinal cohort analysis of patients diagnosed in 2010, with continuous enrollment 6 months prior to and 12 months following the initial visit.

They identified 478,981 newly diagnosed opiate-naive patients. 

They estimated the risk of early opiate prescription and long-term opiate use based on the provider type at initial diagnosis.

What They Found

  • 40.4% of the patients received an opiate prescription within 1 year and 4% met the criteria for long-term use. 
  • The most common provider was family practice. They were associated with 24.4% risk of early opiate prescription and a 2% risk of long-term opiate use. 
  • Risk o freceiving an early opiate prescription was higher among patients initially diagnosed by emergency medicine or at an urgent care. 
  • Risk of Long-term opiate use was highest for aptietns initially diagnosed by pain management doctors or by physical medicine and rehabiliation providers. 

Wrap It Up

Initial provider type influences early opiate prescription and long-term opiate use among opiate-naïve patients with newly diagnosed low back and lower extremity pain.

Looky here ya see, I’m just going to lay it out for you. Zero percent of opiate-naive patients get prescribed OR hooked on opiates from seeing a chiropractor. Zero. 

I’ll even go further than that and say that approximately 70-80% of them get good to excellent results and improvement of their complaint. I know this through the ChiroUp tracking system they use across the country. 

You know what else I know through the ChiroUp tracking? I know that these results happen in only about 7 visits. Kow a Chow!! I know you can’t see it but you can picture that karate chop placed precisely to deliver a virtual coup de grace. 

Alright, Enough silliness. On to out final item here. 

But before we do that –  Let’s take a short break to talk about ChiroUp. If you’re a regular listener of our podcast, you I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the train. 

Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99

Item #3

Item #3 is an article titled “Could Craniocervical Instability Be Causing myalgic encephalomyelitis/chronic fatigue syndrome, Fibromyalgia & POTS?” written by Cort Johnson and published in Health rising.org on February 27, 2019. (Johnson 2019)

This was actually sent to me by a cardiologist friend of mine and I’m really glad he sent it my way because it’s interesting as hell. Follow along. 

I’ll read you the first paragraph here, “Jeff had a typical ME/CFS onset: he was a young, healthy and active individual before being felled by a viral infection and a high temperature. The infection left him with headaches, dizziness, muscle weakness and pain, sound and light sensitivity, and a general sense of being worn down that was exacerbated by exercise – which he soon had to stop altogether. Socializing was the next activity to go as he buckled down to focus on getting through graduate school.”

The article goes on to talk about all of his various visits to specialists and how nothing seemed to work. In fact, he continued to decline in health all of the way to the point that he was essentially bedridden with little to no tolerance for any kind of exertion. We’re talking little energy to chew food and being wheeled into the bathroom to take a shower. Serious stuff. 

Turning his head one way could cause him to nearly lose consciousness and he felt a little like a bobble doll when he walked. His head felt heavy. 

Doing his own homework to try to basically save his own life, he stumbled across craniocervical instability, aka atlantoaxial instability, aka cranial-cervical syndrome and things started to make sense for Jeff. 

Here’s another quoted paragraph from the article, “The strange headaches, the heavy head, the problems turning his head in one direction, the autonomic nervous system issues – they could all be explained by loosened or lax ligaments at the junction between his skull and his vertebrae which kept his head properly situated atop his body. 

With his head destabilized, his spinal column was contacting and compressing his brainstem – throwing his autonomic nervous and sensory systems out of whack. His ANS had become so disturbed that even during sleep when it theoretically should have been mostly at rest – it was oscillating up and down causing bizarre heart rates.”

Craniocervical instability has been associated with conditions like rheumatoid arthritis, Ehlers Danlos Syndrome, Downs Syndrome, and other inflammatory conditions. The doctors were dismissive that, outside of any of these conditions, that he could actually have it. 

Just to expound on Ehlers Danlos a bit, one in 15 of EDS patients have craniocervical instability. 1 in 15 is a pretty good amount. Just another good reason to familiarize yourself with the Beighton scale and see if your EDS patients have other issues like we’re discussing here. 

It seems the correct imaging for CCI is a dynamic CT scan with flexion and extension view but not everyone can get dynamic CTs can they? I believe flexion and extension x-rays can give you a hint as well. 

So, skipping to the end of the story, Jeff had a fusion of the top two vertebrae to his skull and all symptoms poof disappeared. Which is awesome and good for him for diagnosing his issue and for being an advocate for himself. Those medical doctors can be a bit pesky when you go against what they think. 

The article also says there are only a few neurosurgeons in the world that can perform this sort of fusion. I sent the article to another friend of mine who just happens to be a neurosurgeon himself. He said that the whole article was really interesting and he was glad I sent it but he was confused why they think that there are only a few in the world that can do this surgery. He said they have to do it all of the time but, admittedly, it’s because of trauma. Not CCI. 

Still, it seem this is a surgery most neurosurgeons can do if needed. 

Great article, and great story that I’m linking in the show notes for you so click on it and check it out for yourself. There is a ton more with differenct patient stories so give it a read through. It’ll make you better. 


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Contact

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

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

Connect

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

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About the Author & Host

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

Bibliography

Azad TD, V. D., Bentley J, (2019). “Initial Provider Specialty Is Associated With Long-term Opiate Use in Patients With Newly Diagnosed Low Back and Lower Extremity Pain.” Spine 44(3): 211-218.

James G, K. D., Millecamps M, (2019). “ISSLS Prize in Basic science 2019: Physical activity attenuates fibrotic alterations to the multifidus muscle associated with intervertebral disc degeneration.” Euro Spine J 28(5): 893-904.

Johnson, C. (2019). “Could Craniocervical Instability Be Causing ME/CFS, Fibromyalgia & POTS? Pt I – The Spinal Series.” Health Rising.