CF 300: Disc Resorption & Pickleball Injuries Today we’re going to talk about Disc Resorption & Pickleball Injuries. 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!
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 chiropracticforward.com
You have found yourself smack dab in the middle of Episode #300
Now if you missed last week’s episode , we talked about Colorectal Cancer In The Young & AI-Powered Chronic Pain Management. Make sure you don’t miss that info. Keep up with the class.On the personal end of things….. So let’s talk about unplanned time off. Because that’s when the he’ll happened to me last week. Holy cow my friends. I got sick. And when I say sick, I mean really sick. I’m not talking about a man cold thing. I’m talking sick like maybe hospital kind of sick.
Last week, I went to work on Wednesday feeling pretty damn poor. It only got worse through the day. By the end of the day, I was done. I was full blown sick and getting messy.
I missed Thursday and Friday at work because I was out sick with a stomach bug. I do not cancel a day full of patients. Ever. So you know it’s serious when I cancel. Especially two days. You that are regulars here know that I commonly see 40 or so per day so I had to cancel 80 or so patients and I never take that lightly for personal as well as financial reasons.
But let’s back up. When I say ‘stomach bug’, that seems to minimize what I’m now referring to as ‘The Incident’.
What I really mean by ‘bug’ is a big alien Chuck Norris bug with a fu man chu and ninja stars that smells of Marlboros and diesel.
I haven’t been that sick in 7 or 8 years. I almost went to the ER twice and seriously questioned if I’d ever eat any food at all again. Ever.
I was thinking, “So….this is how it ends…I’ve had a good life….it’s been a pretty good run”
I’ve had COVID three or four times and would take that over the alien Chuck Norris stomach bug any day.
My stomach is still giving me little zingers and reminders of what we went through together every now and then but I’m mostly good to go at this point. Thank God. I’ll share that an IV up at Creek Stone on Friday with heartburn and nausea meds added to it was very helpful.
On a slightly related note; I’ve never had Pedialyte before ‘The Incident’ and, after threeor four gallons, I have to say……it’s actually pretty tasty and low calorie! 😎
So, this my recommendation based on personal first hand experience, if you are approached by an alien Chuck Norris bug with a fu man chu and ninja stars that smells of Marlboros and diesel, my advice is to go to the other side of the street and keep walking with your head down.
Oh, and figure out a way to make the clinic run without your presence requires at all times. I’ve tried and I am trying. Trust me. I’m not a solo Chiro on purpose. You hear me advertise for an associate at the top of every show, right?
Right. So, still considering hiring. Just have to get the right one. When it’s time, it’ll happen naturally.Item #1 The first one this week is called “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-analysis” by Zou et. Al. and published in Clinical Spine Surgery on July 31, 2023, and that’s a zinger! Why They Did It This study aimed to analyze the incidence of spontaneous resorption of lumbar disk herniation (LDH) after conservative treatment. How They Did It
We strictly refer to the standard established in the PRISMA (Preferred Reporting Items for a Systematic Review and Meta-analysis) statement, comprehensively searched electronic databases using the terms related to the spontaneous resorption of LDH.
Two reviewers independently evaluated the potential studies, extracted, and analyzed the enrolled data.
Thirty-one studies with 2233 patients who received conservative treatment were included for this analysis.
What They Found
We found that the pooled overall incidence of disk resorption was 70.39%, 87.77% for disk sequestration, 66.91% for disk extrusion, 37.53% for disk protrusion, and 13.33% for disk bulge, respectively.
Wrap It Up The existing evidence shows that the overall resorption incidence of LDH was 70.39%, the resorption incidence of ruptured LDH is higher than that of contained LDH. There are significant differences in the resorption incidence among countries. The resorption process mainly occurred within 6 months of conservative treatment.
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 can’t live without those products, send me an email and I’ll 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“Pickleball injuries could cost Americans up to $500 million this year, analysis finds” by Megan Cerullo and published in Money Watch and CBS News on June 27, 2023, hot tamale! It’s an article so the high spots we shall hit. The explosive growth of Pickleball in recent years is contributing to higher injury rates and health care costs, particularly among seniors, according to analysts at UBS. They estimate in a report that injuries related to pickleball could cost Americans between $250 million and $500 million in medical costs this year, mostly related to wrist and leg sprains and fractures.
The investment bank was prompted to examine the issue after UnitedHealth Group, whose stocks the Wall Street firm covers, said that health care utilization rates have jumped in recent months among Medicare users.
Sounds like a damn insurance company now doesn’t it? Trust me, the know the numbers. Which is stil stunning that they’re not requiring referrals to chiros for non-complicated msk pain. I bet it’s because so many damn chiropractors are crazy and doing non-evidence-based, doctor-centered care still. Just a guess. Anyway, Over roughly the last three years the number of recreational players around the U.S. has soared 159%, from 3.5 million in 2019 to 8.9 million in 2022, according to data from the Sports and Fitness Industry Association.
And the sport is poised for even faster growth. UBS analysts forecast that more than 22 million “Picklers,” as players are known, will be thwacking balls back and forth this year. Seniors make up a third of the most avid players, according to the firm’s estimate, which defines that as people who whip out their paddles at least eight times per year.
UBS analyzed this rapid growth, while also examining common pickleball-related injuries, to come up with its projection of medical costs directly attributable to sport. Overall, UBS estimates that $377 million worth of medical costs in 2023 will stem from pickleball. Roughly 80% — or $302 million — of the total relates to outpatient treatment in settings such as emergency rooms and doctor’s offices, the bank said.
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!
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
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube 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
Zou T, Liu XY, Wang PC, Chen H, Wu PG, Feng XM, Sun HH. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-analysis. Clin Spine Surg. 2023 Jul 31. doi: 10.1097/BSD.0000000000001490. Epub ahead of print. PMID: 37559207. https://www.cbsnews.com/news/pickleball-injuries-will-cost-americans-up-to-500-million-this-year/
CF 292: Discs In Low Back Pain & Unnecessary Surgeries Via COVID
Today we’re going to talk about Discs In Low Back Pain & Unnecessary Surgeries Via COVID
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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 #292
Now if you missed last week’s episode, we talked about Racial and Ethnic Disparities In Chronic Low Back Pain & Pregnancy And Cannabis Use . Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Isn’t it funny how things work sometimes? I had something odd happened recently here in the clinic. We found out that our acupuncturist was moving to a different chiropractor’s office. She’s been with us for about eight years. What she’s credentialed through me to see veterans through our VA system.
So the VA randomly called us one day inquiring on her moving to another office and when that is happening, etc. Well, it was news to us. So we reached out to the acupuncturist and she admitted that she had plans to move but had not shared them with us yet. Although Amarillo Texas is about 225,000 people, there are only 3 acupuncturists in the entire area. It’s just not that popular here.
Although, it is definitely gaining in popularity. So the prospects of us being able to bring on another acupuncturist quickly are very slim. However, we went ahead and reached out to the one we really wanted to work with us. I have a good relationship with her, but things have just not worked out to where we could’ve actually worked together before. It turns out that she was tired of her current situation and was interested in making a move.
So she came in for an interview, we talked, and she was on board. We started the credentialing process with the VA that very day, so, while it takes 90 days to get credentialed, at this point, we are already almost a month into the process. That should significantly shorten the waiting period for our veterans to switch to a new acupuncturist and soften the landing.
Oh, in the meantime, if our previous acupuncturist, had any plans of stealing our patients, and taking them to a new place, that is going to be hard for her to accomplish. She hast to get completely re-credentialed, and I promise you were ahead of her on getting that done. In addition, the veterans have to get authorization to see her and she hast to get credentialed before they can even start the process of getting authorized through her. Whereas here in my clinic the machine is already built. The gears are already oiled and greased, and we are at fine-tune the machine. I think there’s no doubt we are going to come out ahead on this transition.
One thing we all know is that the one constant in life is that things are always changing.
Many of us are going through changes with staff. I have 3 CA’s and that third spot. It’s just a constant turnover. I have another one that will start in two weeks. The last one lasted for about two weeks. The one before her lasted about three months. It’s been miserable but when we find the right one I think it will have been worth it anyway, that’s what’s on my mind this morning. Getting acupuncture back up and running and marketed, and getting another new staff member up and going.
It’s a constant churn and, as they say in the military, just embrace the suck and keep trucking. It all pays for your life and for the life of your family members. Might as well enjoy all of it that you can and embrace the parts you feel suck your soul and keep that part in the proper context.
Item #1
The first on today is called “Intervertebral disc degeneration and how it leads to low back pain” by Ashish D Diwan, James Melrose and published in Pub Med on Nov14 2022. Dayum. That’s hot.
Why They Did It
The purpose of this review was to evaluate data generated by animal models of intervertebral disc (IVD) degeneration published in the last decade.
The review aimed to highlight the valuable contributions of these animal models in identifying molecular events associated with pain generation.
IVD degeneration is a complex process contributing to spinal pain, and understanding the underlying mechanisms is crucial for developing effective therapeutic strategies to alleviate pain, promote disc repair and regeneration, and prevent associated neuropathic and nociceptive pain.
How They Did It
The researchers conducted a review of existing studies that employed animal models of IVD degeneration.
They likely searched relevant databases, academic journals, and publications from the past decade to gather a comprehensive dataset.
The selected studies would have used various animal models and experimental methods to induce IVD degeneration.
These animal models mimic certain aspects of human IVD degeneration, allowing researchers to study the molecular events and mechanisms involved in pain generation.
What They Found
Through their review, the researchers observed that in degenerated IVDs, there is nerve ingrowth and an increased number of nociceptors (pain-sensing neurons) and mechanoreceptors (sensors of mechanical stimuli).
The biomechanically incompetent and abnormally loaded degenerated IVDs experience increased mechanical stimulation, leading to heightened low back pain.
This finding helps establish a link between IVD degeneration and pain generation, shedding light on the complexity of the process.
The review also highlighted the potential of a specific factor called “growth and differentiation factor 6” in addressing IVD degeneration. Studies using this factor in IVD puncture and multi-level IVD degeneration models, along with a rat xenograft radiculopathy pain model, demonstrated its ability to prevent further deterioration in degenerate IVDs. The factor exhibited regenerative properties that promoted the recovery of normal IVD architectural functional organization and inhibited the generation of inflammatory mediators, which contribute to disc degeneration and low back pain.
Wrap It Up
The review of animal models of IVD degeneration provided valuable insights into the molecular events underlying pain generation in degenerate IVDs. It emphasized the importance of understanding the complex multifactorial process of IVD degeneration to identify potential therapeutic targets for pain relief and disc repair.
One promising candidate identified through the review was “growth and differentiation factor 6,” which showed considerable potential in preventing further deterioration of degenerate IVDs, promoting regeneration, and inhibiting the generation of inflammatory mediators.
The findings from these animal models suggest the need for human clinical trials with this compound to assess its efficacy in treating IVD degeneration and preventing low back pain generation in humans. Overall, this review underscores the significance of animal models in advancing our understanding of IVD degeneration and pain mechanisms, ultimately leading to improved treatment strategies for patients suffering from low back pain.
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 can‘t live without those products, send me an email and I‘ll 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, “100,000 older Americans got unnecessary surgeries during dangerous first year of COVID-19” by Aaron Toleos and published in Lown Institute on May 17, 2022. Hot potato!
Why They Did It
The Lown Institute conducted this analysis to shed light on the issue of overuse of medical procedures in American healthcare, particularly during the COVID-19 pandemic. The aim was to bring attention to the fact that even during a public health crisis, unnecessary procedures were still being performed on vulnerable patients, potentially exposing them to harm and wasting healthcare resources.
How They Did It
The analysis was based on Medicare claims data from January to December 2020. The Lown Institute used the 100% Medicare claims database to evaluate the volume of overuse for eight common low-value procedures. The specific procedures and criteria for overuse were determined based on the institute’s previously published research into the measurement of low-value care at hospitals.
What They Found
The Lown Institute found that a total of 106,474 unnecessary procedures were identified during the analyzed period. The most overused procedure by volume was coronary stents, with 45,176 procedures performed. Other procedures with high rates of overuse included vertebroplasty for osteoporosis, hysterectomy for benign disease, and spinal fusion for back pain.
The analysis also revealed that approximately one in five of these low-value procedures met the criteria for overuse across the country. Even some of the nation’s most well-regarded hospitals had rates of overuse above the national average. For example, all of the top 20 hospitals ranked by U.S. News had rates of coronary stent overuse above the national average, with four of them having rates at least double that.
Wrap It Up
The analysis conducted by the Lown Institute highlights the persistence of overuse of medical procedures in U.S. hospitals, even during a major public health crisis like the COVID-19 pandemic. Despite previous knowledge that certain procedures, such as coronary stents for stable coronary disease, are of limited clinical benefit, they continue to be performed at high rates. This raises concerns about patient safety, healthcare costs, and the need to address the issue of overuse in the American healthcare system. The findings call for greater attention to evidence-based practices and the promotion of appropriate and necessary medical interventions to ensure better patient outcomes and more efficient use of healthcare resources.
Let’s get to the message. Same as it is every week.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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.
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
CF 279: Newer Information On Nonsurgical Spinal Decompression
Today we’re going to talk about newer non-surgical decompression information.
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!
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 #279
Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Alright, a new week. I want to return back to a topic I have mentioned briefly before and that’s Darcy and Propel. She and they have re-vamped my website SEO. I have to admit, when a solo doc gets too damned busy to babysit a website and he/she is too damned cheap to pay someone to babysit the site, the SEO can sink.
Now, don’t think I don’t do anything alright. I absolutely do. I write a blog every single week over a different topic. I then take that script and make a Youtube and Facebook video out of it, blah blah blah. I do lots of stuff. However headings, tags, keywords, etc…..yeah, not my skillset. Nor should it be my skillset.
So, it sank and as a result, so did my new patients that I was getting through Googles. Many of you know I’m a voice actor and real estate investor, artist, etc and had been putting my extra time into some of the extras I’ve been involved in. Lately, my attention gets drawn away from things I would normally be handling, like checking on Google Analytics from time to time to see how we’re performing.
Well, since going through Propel’s re-vamp and me making it a priority to do some of the things they suggested, I think we are back on track. I checked my site’s progress over the last 18 days compare to the previous 18 days, the last month to the previous month, etc. And I found that we are indeed on the upswing!
Thank goodness. I would also say that it is reflected directly into the new patient numbers recently. Last year it was nothing for me to have 20-25 new patients in a week. That took a hit as the website took a hit and fell down to 12-14 ish per week. In just the last two weeks we’ve had 17 and then just last week we had 19 so it looks like we are back running in the right direction. I truly think that is a result of paying more attention to the performance of my website.
Most of you know that SEO is a slow grow. Nobody can flip a switch and you’ll be number 1 this week. But, early indicators are that Propel and Darcy Sullivan have got some magic up their sleeves.
And no….I don’t get anything at all out of telling you that. I’m just being open and honest with you.
Alright, let’s dive in.
Item #1 The first on today is called “Effects of non-surgical decompression therapy in addition to routine physical therapy on pain, range of motion, endurance, functional disability and quality of life versus routine physical therapy alone in patients with lumbar radiculopathy; a randomized controlled trial” by Fareeha Amjad, Mohammad A Mohseni-Bandpei, Syed Amir Gilani, Ashfaq Ahmad, Asif Hanif and published in PubMed on March 16 2022. Dayum. That’s hot.
Why They Did It
The objective of this study was to determine the effects of decompression therapy in addition to routine physical therapy on pain, lumbar range of motion (ROM), functional disability, back muscle endurance (BME), and quality of life (QOL) in patients with lumbar radiculopathy.
How They Did It
A total of sixty patients with lumbar radiculopathy were randomly allocated into two groups, an experimental and a control group, through a computer-generated random number table.
Baseline values were recorded before providing any treatment by using a VAS, Urdu version of Oswestry disability index, modified-modified Schober’s test, prone isometric chest raise test, and SF-36 for measuring the pain at rest, functional disability, lumbar ROM, back muscle endurance, and quality of life, respectively. All patients received twelve treatment sessions over 4 weeks, and then all outcome measures were again recorded.
What They Found
By using the ANCOVA test, a statistically significant between-group improvement was observed in VAS, Oswestry disability index, back muscle endurance, lumbar ROM, role physical (RP), and bodily pain (BP) domains of SF-36, which was in favour of decompression
Wrap It Up
It was concluded that a combination of non-surgical spinal decompression therapy with routine physical therapy is more effective, statistically and clinically, than routine physical therapy alone in terms of improving pain, lumbar range of motion, back muscle endurance, functional disability, and physical role domain of quality of life, in patients with lumbar radiculopathy, following 4 weeks of treatment. 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 can’t live without those products, send me an email and I’ll 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, “Regression of lumbar disc herniation by physiotherapy. Does non-surgical spinal decompression therapy make a difference? Double-blind randomized controlled trial” by Aynur Demirel, Mehmet Yorubulut, Nevin Ergun and published in PubMed on September 17, 2022. Hot potato!
Why They Did It
The aim of the study determining whether or not Non-invasive Spinal Decompression Therapy(NSDT) was effective in resorption of herniation, increasing disc height in patients with lumbar disc herniation (LHNP).
How They Did It
A total of twenty patients diagnosed as lumbar disc herniation and suffering from pain at least 8 weeks were enrolled to the study. Patients were allocated in study (SG) and control groups (CG) randomly.
Both groups received combination of electrotherapy, deep friction massage and stabilization exercise for fifteen session. The study group received additionally Decompression different from control groups. Numeric Anolog Scale, Straight leg raise test, Oswestry Disability Index (ODI) were applied at baseline and after treatment. Disc height and herniation thickness were measured on Magnetic Resonance Imagination which performed at baseline and three months after therapy.
What They Found
Both treatments had positive effect for improving pain, functional restoration and reduction in thickness of herniation. Although reduction of herniation size was higher in the study group than control groups, no significant differences were found between groups and any superiority to each other
Wrap It Up
This study showed that patients with lumbar disc herniation received physiotherapy had improvement based on clinical and radiologic evidence. Decompression can be used as assistive agent for other physiotherapy methods in treatment of lumbar disc herniation.
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.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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.
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
CF 242: Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs Today we’re going to talk about Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs 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!
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 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 #242 Now if you missed last week’s episode , we talked about Does Supplementation Work & Non-Surgical Treatment For Stenosis. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Well, last week was insanity around my office. I personally saw about 196 appointments and our nurse practitioner had his best week since we integrated and brought medical services into our clinic. He saw 38 appointments not counting me. I say, “Not counting me,” because I got the hormone pellets. If you’re not familiar, go search up BioT or search up Evexipel. We use Evexipel and it’s a hormone balancing or optimization procedure. The provider does some blood work and finds out where you’re at with some key hormones.
I’m way low on testosterone which makes me insane because I could drop some weight but I’m not nearly as bad as a lot of folks I see. I’m 6’4” and about 272. Yes, I should ideally be about 220 or even less if you listen to the government. However, I was a college offensive lineman and I’ve been a pretty thick dude my whole life. I have a dad bod but I’m not waddling around and having a hard time getting through doors is what I’m saying. OK? Anyway, I’m not sedentary either. I get lots of activity from 190+ patients in a week to exercise and throw the discus.
I’m a go-getter so the low T thing makes me a little insane but it is what it be and that’s just me. So, time to do it. We use Evexipel and when I did BioT, it was in the butt cheek and it was pretty freaking sore for about 5-7 days. Evexipel does the pellets in the flank for men and 4 days later, I have had very little to basically zero pain. It’s been amazing.
The pellets take about 5 days to start being absorbed in the body so I’m looking forward to the benefits. I’ll keep you updated. For my practice specifically, you’ve heard me mention that we will patch one hole and another leak will spring and I’m always on the lookout for them. Well, I found one just this morning. We had 1 96 patients on my side last week. I show up for work this morning and look at the schedule and there are only 36 patients on my schedule today.
I guess this issue didn’t register with any of my staff members because when I asked what happened to my schedule this week, they just acted like it’s normal and the week starts filling out on Mondays. Oh no no no. That’s not how we need to be looking at it. Let’s do a little high-level, global thinking here. I saw 25 new patients last week. If they’re all on schedule, that’s at least 25 appointments booked on the following Monday. Remember Monday has 36 currently.
Well, 6 of those are new patients. So, let’s throw out those 6 new patients and that leaves us with 30 today. If we remove the new ones from last week, the 25 that should have been guaranteed…..then that just leaves us with 5 established patients. 5. Cinco. Cinco freaking established patients for a Monday. So, when we’re looking at it in this manner, well, clearly there’s a problem. Patients aren’t on schedule and we’ve had significant fall-off.
This means I’m either not doing my job educating them on why they need to be consistent, or the staff isn’t encouraging the message and supporting the message, or the front desk isn’t getting them rescheduled. Or all three. Either way, we basically bled 25 new patients last week. So, that hole has to get plugged, yet again, this week. Another thing to consider is that it’s basically Back To School time and that’s traditionally a slow-down time for us. So that something else can go stupid next week. Because that’s the way it goes.
Item #1
This first one is called “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation” by Wu et. al. (Wu SK 2022)and published in BMC Musculoskeletal Disorders on July 30 of 2022. Bam!!! Into the frying pain! It’s hot.
Why They Did It
To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation.
They were followed up with videofluoroscopic images.
The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements.
What They Found
The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients’ intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment.
After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02-8.67%, and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12-9.18% compared to the baseline.
Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82-8.66%.
Active lateral flexion away from the affected side significantly increased the foramen by 3.71-6.78%
Wrap It Up
The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in the intervertebral foramen areas of the patients with disc herniation.
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
I saw this one in the Forward Thinking Chiropractic Alliance group on Facebook and it’s pretty darn interesting. It’s called, “Prone Position MRI of the Lumbar Spine in Patients With Low Back Pain and/or Radiculopathy Refractory to Treatment” by Avellanal et. al.and published in Pain Physician in August of 2022 damnit this Is the first day of August it just doesn’t get any more fire than that heat!
Why They Did It
There are patients with limiting low back pain (LBP) with or without radicular pain in whom conventional supine magnetic resonance imaging (MRI) show no causative pathology. Despite the limitations of dynamic axially loaded MRI examinations, these imaging studies have shown a striking ability to diagnose pathology unrecognized by conventional MRI. The difference in findings between supine and prone MRI with patient symptom correlation has not been studied.
How They Did It
Nineteen patients suffering from chronic moderate-to-severe LBP and/or radicular pain
Nonresponsive to conventional therapy or interventional treatment
Both supine and prone MRIs were performed and analyzed by a neuroradiologist.
Specific supine and prone measurements were registered, including spinal canal area, lateral recess diameter, foraminal area, and ligamentum flavum thickness.
Three-dimensional MRI reconstructions of varying pathology patterns were created.
What They Found
In 52.6% of cases, disc pathology or increased disc pathology was seen only on prone imaging.
They observed significant buckling and increased thickness of the ligamentum flavum in 52.6 % of cases in the prone position that was absent from the supine MRIs.
They also documented varying grades of spondylolisthesis and facet joint subluxation resulting in significant foraminal stenosis in 26.3% of prone cases not seen from supine MRIs.
Wrap It Up
Four patterns of pathological findings have been identified by MRI performed in the prone position.
These findings were not observed in the supine position.
Prone MRI can be a significant and useful tool in the diagnosis and treatment of patients with back pain refractory to treatment whose conventional supine MRIs appeared unremarkable.
Which I also take as yet another reason you cannot trust MRI’s for definitive diagnosis of the source of pain.
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.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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.
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 Wu SK, C. H., You JY, Bau JG, Lin YC, Kuo LC (2022). “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation.” BMC Musculoskelet Disord 23(1): 728.
CF 216: Return To Play After Herniation & Water vs. PT Exercises Today we’re going to talk about return To Play After Herniation & Water vs. PT Exercises 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!
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 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 #216 Now if you missed last week’s episode , we talked about the MCM Mastermind that I am a member of & we talked about CAM Acceptance Among Medical Specialists. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
I’m still settling back in after that Florida mastermind that we talked about last week. Still getting my mind wrapped around the information and the best ways to implement the ideas. One of my biggest obstacles to practice has been good, evidence-based, patient-centered guidelines for dosing. Meaning, how many times should a patient be seen? Well, one of the mastermind members is Dr. Jay Greenstein. If you don’t know him, I suggest you get that remedied muy pronto mi amigo. Jay has done a lot of work with Clinical Compass and based on research in the Journal of Manipulative and PHhysiologica Therapies and based on Haas’s research in Spine, Dr. Greenstein has been kind enough to guide me along.
Here’s a lesson for me and for listeners. As far along as you are, whether in the beginning, in middle, or toward the end, you can always learn. Now, instead of saying 3x/week for a couple of weeks, and then we’ll see where you’re at….instead of that, I have firm, research-based, Clinical Compass-approved recommendations for what I tell them.
My biggest gap is patient stick-to-it-iveness. I may see 80 new patients a month but still only see 650 visits that month. Because my new patients don’t typically make it to the first re-exam. It’s not like I don’t know this problem. It’s always been an issue. Some of us have money issues. We do the stuff to make more money but we’re not always sure we deserve more money or deserve to live well, blah blah blah. That’s the mental health aspect of dealing with money.
I turned financial talks over to the staff because I’m not good with money discussions when it comes to people paying me. I’m fine when I’m talking about stuff I’m doing to try to make money. I’m not good when we’re talking about me making money from someone. It’s just what it is. Here’s the thing though, if I know it’s backed and supported and even encouraged as far as guidelines, then it’s on. I have no problem with making the recommendations and making them stronger. So, there you are. Once my recommendations are better, my income improves immediately. This means I can easily training those under me and comfortably hire more providers, etc.
All from one thing; more effective communication with my new patients from the get-go.
Also, I’m reading the book Traction: Get a Grip on Your Business by Gino Wickman. This was recommended by several in the MCM Mastermind so I’m already in Chapter 6 on this sucker and wondering why I didn’t read it years ago. It’s there to help identify issues, communicate more effectively with your team, and get the right people in the right seats. What are you working on professionally this week? Email me at dr.williams@chiropracticforward.com.
I’d love to hear it.
Let’s hop in Item #1
The first one today is called “Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment” by Sedrak, et. al. (Sedrak 2021) and published in Sports Health on Feb 10 of 2021 and only a year old is still significantly steamy.
Why They Did It
The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major concern, and thus comparing surgical with nonoperative care is essential to guide practitioners and athletes, not just in terms of recovery rates but also the speed of recovery. The purpose of this systematic review is to provide an update on RTP outcomes for elite athletes after lumbar discectomy versus nonoperative treatment of lumbar disc herniations.
How They Did It
Systematic review and meta-analysis
A search of the literature was conducted using 3 online databases (MEDLINE, EMBASE, and PubMed) to identify pertinent studies.
What They Found
Twenty studies met the inclusion criteria and were included in this review.
Overall, 663 out of 799 patients (83.0%) returned to play in the surgical group and
251 out of 308 patients (81.5%) returned to play in the nonoperative group.
No statistically significant difference for return to play rate was found
The mean time to return to play for patients undergoing lumbar discectomy was 5.19 months, and 4.11 months for those treated conservatively.
Wrap It Up
There was no significant difference in return to play rate between athletes treated with operative or nonoperative management of LDHs, nor did operative management have a faster time to return to play.Athletes should consider the lack of difference in return to play rate in addition to the potential risks associated with spinal surgery when choosing a treatment option. Clear enough on that, folks? You don’t even need my commentary on it. That’s as plain English as you can get right?
Item #2
The second one today is called “Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain A Randomized Clinical Trial” by Peng et. al. (Peng M 2022) and published in JAMA Network Open on January 7, 2022, booyah it’s on fire.
Why They Did It
To assess the long-term effects of therapeutic aquatic exercise on people with chronic low back pain.
How They Did It
This was a 3-month, single-blind randomized clinical trial with a 12-month follow-up period
A total of 113 people with chronic low back pain were included in the experiment.
Participants were randomized to either the therapeutic aquatic exercise or the physical therapy modalities group.
The therapeutic aquatic exercise group received aquatic exercise, whereas the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy.
Both interventions were performed for 60 minutes twice a week for 3 months.
What They Found
Compared with the physical therapy modalities group, the therapeutic aquatic exercise group showed greater alleviation of disability, with adjusted mean group differences after the 3-month intervention, at the 6-month follow-up, and at the 12-month follow-up
At the 12-month follow-up point, improvements were significantly greater in the therapeutic aquatic exercise group vs the physical therapy modalities group in the number of participants who met the minimal clinically important difference in pain
Wrap It Up
The therapeutic aquatic exercise program led to greater alleviation in patients with chronic low back pain than physical therapy modalities and had a long-term effect up to 12 months. This finding may prompt clinicians to recommend therapeutic aquatic exercise to patients with chronic low back pain as part of treatment to improve their health through active exercise rather than relying on passive relaxation. 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 the 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.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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/
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
Peng M, W. R., Wang Y, (2022). “Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain: A Randomized Clinical Trial.” JAMA Netw Open 5.
Sedrak, P., Shahbaz, M., Gohal, C., Madden, K., Aleem, I., & Khan, M, (2021). “Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment.” Sports Health 13(5): 446-453.
CF 183: Factors Leading To Surgery For Some Discs & Disc Innervation
Today we’re going to talk about the innervation of the disc and we’re going to talk about some factors that can lead to surgery for lumbar disc herniations. But first, here’s that sweet sweet bumper music
Purchase Dr. Williams book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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.
While you’re there, join our weekly email newsletter.
You have found yourself smack dab in the middle of Episode #183 Now if you missed last week’s episode , we talked about Adjustments as immune boosters and we talked about pain. Is it mind or is it matter? Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
It’s been a bit of a whirlwind these last few weeks. I’ve talked a little more recently about launching my very first book. It’s out. It’s available on Amazon. It’s called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. And I’d love for you to go pick up a copy for yourself. You can get either ebook or a paperback sent to your front door. Your call. Here’s why I think you need it. All of the research we talk about here and lots before I started the podcast, has been categorized for you into conditions and body regions. So, if you need some research on neck pain, flip to the section and there you go. Migraines? SI joint issues? Go to those sections and there you go. This comes in handy when you have a talk to give and don’t have the time to go searching through pubmed all day.
Or when a patient asks you a question on something specific. Or a host of any other reasons. It’s a reference for your practice for your education, patient education, and community education. So go grab that up while you’re thinking about it.
As mentioned in a previous episode, we visited New Orleans, Then we were home for one weekend. Then the next weekend we were off to Dallas for the Texas Chiropractic Association’s ChiroTexpo event which is our state’s convention basically. Two board of directors meetings for me plus some networking, classes, and problem-solving. Essentially.
I have seen him speak before. I went to Forward 19 in St Louis before the Rona came along and saw Brett Winchester talk. We had him in Dallas at this event and he did not disappoint. I was able to better connect with Brett here in Texas. We will absolutely have him on a future podcast and in the meantime, if you want to learn more about Dr. Winchester, check out his podcast at Gestaldt Podcast. The dude is sharper than a tack, has worked with the St. Louis Cardinals, and is one of those on the top and on the edge so check him out if you’re smart.
Then, even though Dr. Kevin Christie was already a friend, we really got to hang out and shoot the proverbial shoo shoo in Dallas, along with Dr. Winchester. And it was just a good time had by all.
I used to be lone wolf, folks. I used to not care about the profession. I just cared about my office, my numbers, my business. Me, me, me. I got a bit shamed into joining the TCA. Then, they had a vacancy on the Board of Directors due to the director in my district having cancer. Well, how can you say no? I was thrown into the fire with no context, no history, no experience, and little idea of what to say or how to act. But I was thrown in with a group of about 20 people that lead the profession and develop leaders from scratch. That’s what they did for me. We got there. We made it happen.
Fast forward about a decade or so and I was on the Board of Directors for about 5 years, been the Chiropractic Development Initiative Chair, served as the Public Relations Chair, and am now going into the second year as the Department Coordinator for Scientific Affairs. I help steer the speakers we have at our events among other things.
Associations need your membership dollars and you need to be members. But that’s just a mostly passive notion. The REAL benefit is realized when one becomes active and plugged into the association. Meaning, through being active and involved at just about every step, I have developed a network of close friends and colleagues from around the entire state of Texas that, even though some practice differently than I, would still go to bat for me, support me, and back me. And I them.
We have developed brothers and sisters, camaraderie, and family with each other. I cannot begin to share with you how many times I’ve had questions or issues that I was able to just call up one of my TCA buddies and get a solid answer for it. This medical integration I’m going through right now. Do you think I just up and decided to do it and jumped into the fire? Hell no.
I called all of my TCA buddies who have done it previously.One is now my consultant on it. The attorney that wrote the law that allows for this integration is TCA’s lobby team. He’s the one that has created the paperwork and contracts for me. Literally, none of what I am today is possible to the degree it’s been possible if not for being active, plugged in, and a solid member of the TCA leadership.
I don’t say this to brag that I’m active or brag about my positions in the TCA or to boast in any way. I say this to let you know that there is a difference between being a member and being an active member. Between building something larger than yourself and your own practice and doing your own small thing. Between being an influential leader and being a bench warmer. Get into the game. Raise your hand. You can thank me later.
Our profession needs evidence-based, patient-centered leaders like you. Don’t bitch about our profession if you’re not willing to step in and do something to change it.
Item #1
This one is called “Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System” by Anderson et. al. [1] and published in Spine Journal on March 15, 2021 which means it’s got the hot spread all over it.
Why They Did It
To determine surgery-free survival of patients receiving conservative management of lumbar disc herniation (LDH) in the military healthcare system (MHS) and risk factors for surgical intervention
How They Did It
The Military Data Repository was queried for all patients diagnosed with lumbar disc herniation from 2011-2018
Follow-up time to surgical intervention was defined as the time from diagnosis to first encounter for lumbar microdiscectomy or lumbar decompression in either a military treatment facility or in the civilian sector.
The Military Data Repository was also queried for history of tobacco use at any time during military healthcare system care, age at the time of diagnosis, sex, military healthcare system beneficiary category, and diagnosing facility characteristics.
Multivariable Cox proportional hazards models were used to evaluate the associations of patient and diagnosing facility characteristics with time to surgical intervention.
A total of 84,985 military healthcare system beneficiaries including 62,771 active duty service members were diagnosed with lumbar disc herniation in a military treatment facility during the 8-year study period.
A total of 10,532 (12.4%) military healthcare system beneficiaries failed conservative management onto surgical intervention with lumbar microdiscectomy or lumbar decompression.
What They Found
Among all healthcare beneficiaries, several patient-level (younger age, male sex, and history of tobacco use) and facility-level characteristics (hospital vs. clinic and surgical care vs. primary care clinic) were independently associated with a higher risk of surgical intervention.
Wrap It Up
Lumbar disc herniation compromises military readiness and negatively impacts healthcare costs. military healthcare system beneficiaries with lumbar disc herniation have a good prognosis with approximately 88% of patients successfully completing conservative management. However, strategies to improve outcomes of conservative management in lumbar disc herniation should address risks associated with both patient and facility characteristics.
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Item #2 Our last one today is called “Innervation of the Human Intervertebral Disc: A Scoping Review” by Groh et. al. [2] and published in Pain Medicine in June of 2021 and that’s current hot. As in present-day, burning up the face of the Earth as we speak, hot.
Why They Did It
Changes to the intervertebral disc (IVD) have been associated with back pain, leading many to postulate that the IVD may be a direct source of pain, typically referred to as discogenic back pain. Yet despite decades of research into the neuroanatomy of the IVD, there is a lack of consensus in the literature as to the distribution and function of neural elements within the tissue. The current scoping review provides a comprehensive systematic overview of studies that document the topography, morphology, and immunoreactivity of neural elements within the IVD in humans.
How They Did It
Articles were retrieved from six separate databases in a three-step systematic search and were independently evaluated by two reviewers.
What They Found
Three categories of neural elements were described within the IVD: perivascular nerves, sensory nerves independent of blood vessels, and mechanoreceptors. Nerves were consistently localized within the outer layers of the annulus fibrosus. Neural ingrowth into the inner annulus fibrosus and nucleus pulposus was found to occur only in degenerative and disease states.
Wrap It Up
While the pattern of innervation within the IVD is clear, the specific topographic arrangement and function of neural elements in the context of back pain remain unclear. I mostly included this because, in our Neuromusculoskeletal Diplomate program, they were clear about the innervation encroaching into a disc injury and how that makes re-injury somewhat easier and sometimes more painful. Because the nerves are further into the structure of the disc once the injury has occurred and then subsequently resolved. Very interesting stuff. That’s all I have the time for today folks. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats 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/
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
1. Anderson AB, B.M., Pisano AJ, Watson NI, Dickens JF, Helgeson MD, Brooks DI, Wagner SC,, Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System. Spine (Phila Pa 1976), 2021. 46(6): p. E392-E397.
2. Adam M R Groh, M., Dale E Fournier, MSc, Michele C Battié, PhD, Cheryle A Séguin, PhD,, Innervation of the Human Intervertebral Disc: A Scoping Review. Pain Med, 2021. 22(6): p. 1281-1304.
CF 150: The Fate Of An OxyContin Producer & The Outdated Use of MRI Diagnosing Cervical Dysfunction Today we’re going to talk about the outdated use of MRI to diagnose cervical dysfunction and then the fate of an oxycontin producer. But first, here’s that sweet sweet bumper music
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.
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!!
You have found yourself smack dab in the middle of Episode #150 Now if you missed last week’s episode, we talked about the costs of preventable disease, and then we’ll talk about whole-body vibration for function and bone mineral density in postmenopausal, osteoporotic women. Make sure you don’t miss that info. Keep up with the class. While we’re on the topic of being smart, did you know that you can use our website as a resource?
Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function
On the personal end of things…..
On the personal side of things, it’s an alright week. Nothing too crazy other than the rise in the Rona around the nation. We got my biggest week last week since Rona hit us. We had 170 visits last week. Still down from my average of 182 pre-Rona but way up from an average of 135-145 post-Rona.
So progress. Then this week, we’re having three days of snow, ice, and sleet. So….it’s a Texas Two-Step. Two steps forward and one step back. Patience is a virtue. Blah. Such is life.
I thought I’d share a recent experience with you all in an effort to let you know you’re not alone, we can’t make them all happy, and how I handled it.
So last weekend I got an email. It wasn’t positive. In fact, it was a bit combative. Let’s just say it wasn’t flattering. Now, I’d like to be fair to myself here. In 22+ years, I’ve had conflict or whatever you want to call it….let’s call it miscommunication. I’ve had a miscommunication with patients only 3-4 times. Five if I’m pushing it. But this goes to serve as an example, you’re never too old or in practice too long to be above being questioned. In fact, in today’s culture of disrespecting ‘experts’ for lack of a better word, questioning authority, and an overall culture of lacking mutual respect…..well, I think it makes sense that we’re all more likely to have some miscommunication issues here and there.
Then, online reviews throw a whole other kink into the plan, doesn’t it? So, due to respect for this person and HIPAA, I will be very vague here but in general, this person had significant cervical disc radiculopathy. Sometimes you make a diagnosis and you’re not 100% sure but you’re heading that direction. Not with this one. There was no doubt. They were very upset. Crying. Nauseous. Not feeling well and rating the pain at a 7 out of 10 on the VAS scale.
We tried some over-the-door traction but it really made the person nauseous so that was out. I tried some retraction/extension exercises and started them on nerve gliding exercises to try to make some headway. The second treatment comes and we are able to do a little more. Now they’re rating it at a 4 out of 10. Looks like we’re on easy street right? We got this!!
We did very light decompression and the patient said it felt good and they were doing better. OK. Whew. Another one on the road to avoiding surgery. Not so fast. For whatever reason, this patient never showed up again. I don’t always think about my patients but I did think about this one because they were so severe on day one. I wondered how they were doing and why I never saw them again.
Well, this weekend’s email answered that for me. There’s no need to read the whole email just because there’s no need but the sentiment of it was that I had a conversation with them that they characterized as saying that anxiety was causing the pain and that I told them I couldn’t help them. What they took from the conversation was that I should have ordered an MRI on day one basically, that I blamed mental and emotional issues on the part of the patient for their pain and they felt that was unprofessional and uneducated. And potentially ego-driven on top of all of that. They mentioned they sought out an MRI, went to a neurosurgeon, and had a two-level fusion, and are on the road to recovery with the help of PT.
Oh….you know I’m always honest with you folks because honestly, that’s not flattering stuff. Nobody wants to look into themselves and say, “Does this person have a point? Where did I go wrong and how can I prevent that from happening again with someone else? But here’s the truth, I literally don’t recall that conversation whatsoever. I have a thousand different conversations every week. But I know me. I’ve never in my life told a patient that they have mental or emotional problems and those are the source of their pain. Nor have I ever insinuated that anxiety is the pain source when it’s clear as a bell that it’s radiculopathy secondary to a disc issue. My staff has heard me repeat the same discussions, the same lines, and the same jokes day after day, month after month and they’ll be the first to tell you I’ve never said anything of the sort.
So, flummoxed as I have been, I slept on that email for the rest of the weekend thinking about it. The last thing you want to do is respond out of anger. You definitely don’t want to respond out of a defensive posture. Especially when you’re reasonably sure you did nothing uneducated or ego-driven. A response like that will only make us look more unprofessional than they already think we are and maybe even potentially provoke.
So, in short, I did not address the ego comment because I felt it was unnecessary. I’ll just take my lumps on that one. I mentioned how happy I was to hear from them and hear they are recovering. I genuinely was glad. Even if the email was less than flattering.At least they got some aspect of a resolution. Even if I wasn’t the end solution. I don’t feel there’s any ego on my part in that sentiment.
I explained that we typically do a trial treatment of a week or two before deciding on advanced imaging and that would have definitely been in the considerations had we treated beyond two appointments. That’s appropriate. Some can make an argument that there was radiculopathy so we could have gotten an MRI on day one. But, if we’re honest, how many patients do you have that have radiculopathies that you are able to clear fairly quickly without resorting to an MRI? My guess is quite a few because that’s my experience. We just don’t have to get very many. But again, we have to have the chance to find out, right?
I discussed briefly that I am very much on top of current research and thinking with regards to pain and neuromusculoskeletal issues and may have been assessing yellow flags. I discussed briefly what the biopsychosocial aspect of treatment entails these days but didn’t want to dwell on it much. Mostly because I never felt it was anxiety, mental, emotional driven thing to start with. It was clearly a disc. But I hope the mention somehow rebuts the idea that I need more education.
I offered that as a potential reason we may have had some miscommunication. I also mentioned that there have been very few patients over the years that I would just straight up tell them “I can’t help you.” I told them that I’m typically one of the most stubborn practitioners and will hold on until it’s crystal clear I’m not helping. That, for me, has never happened after only two visits. In a nutshell, I said that being patient-centered, evidence-based, and having high patient satisfaction was the most important thing to me and that I don’t recall the exact conversation or the wording but that I can learn from the email and can use it to make me better at my job and that I appreciated them taking the time to share their thoughts with me.
In the end, I was glad to hear about them feeling better and I apologized for any miscommunication on my end. While that sounds like a very long email, it wasn’t and I took the time to make sure it was hopefully as eloquent as a guy like myself can generate. Without arrogance, ego, combativeness, or being defensive. But WITH being caring, being professional, and being thoughtful.
Even though it may not be reciprocated, I respect this person and I DO hope they are feeling better. And, whether we feel like these things are our fault or whether we think we did anything wrong or not, we can ALWAYS always learn from stuff like this. We can always be better. I can promise you, I learned to not be lackadaisical when it comes to speaking to patients about central nervous system upregulation or sensitization. Or when discussing the biopsychosocial aspect of pain.
People don’t know what we know about that stuff and we shouldn’t assume that it’s an easy topic and everyone ‘gets it.’ Or will get it. I really cannot explain what happened there but, I do know it made me step back and think through it though. It made me check my communication.
Again, I don’t tell you all this stuff because I love it or love to talk about it. I don’t tell you all my patient numbers weekly because I love it. I share this stuff with you because what is happening with me is real. It’s real life. And if it’s happening to me, then it IS happening to many of you. And if it’s not currently happening to you, it CAN or WILL and you may learn from me. Not as a mentor per se but as that Ol’ Uncle Jeffro.
Alright, enough with the stress talk. Geez. Not very often at all. Maybe once every 5 years or so but when it happens……geesh. I take it personally, I take it home, I dwell on it, and I’m not too proud to admit that it affects me.
I care.
I truly do.
If you get anything from this podcast and all of these episodes, it should be that I care. I care about chiropractic patients, our profession, ethics, morals, professionalism, education, and doing it the right way.
I care.
Item #1 Let’s start out with this article that was in CNN Business last week. It’s an article by Chris Isidore called, “OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company”(Isidore 2020). It was published on October 21, 2020, it’s cold as hell in Texas but that….that’s hot. The highlights of the article are that Purdue Pharma, the maker of OxyContin, has agreed to plead guilty and to pay more than $8 billion. Not only pay $8 billion but to also close down the company. What? Yeah, they say the money will go to opioid treatment and abatement programs. “Purdue Pharma actively thwarted the United States’ efforts to ensure compliance and prevent diversion,” said Drug Enforcement Administration Assistant Administrator Tim McDermott. “The devastating ripple effect of Purdue’s actions left lives lost and others addicted.” They say, “The company doesn’t have $8 billion in cash available to pay the fines. So Purdue will be dissolved as part of the settlement, and its assets will be used to create a new “public benefit company” controlled by a trust or similar entity designed for the benefit of the American public.
The Justice Department said it will function entirely in the public interest rather than to maximize profits. Its future earnings will go to paying the fines and penalties, which in turn will be used to combat the opioid crisis.” Maybe it’s just me but that sounds Big Brother as hell to me. Don’t get me wrong, pharma companies, in many instances, are of the devil but to dissolve them, then recreate them and they be basically government run? I don’t know about all that but to me, that’s what this sounds a bit like.
They go on to say, “That new company will continue to produce painkillers such as OxyContin, as well as drugs to deal with opioid overdose. “The company, which filed for bankruptcy in 2019, pleaded guilty to violating federal anti-kickback laws, as it paid doctors ostensibly to write more opioid prescriptions.” What a-holes. Paid doctors to write more opioid prescriptions. And what a-hole of a doctor do you have to be to take payment to write addicting prescriptions in the first damn place? Honestly. Meanwhile, we recently crossed the 450,000 dead mark.
Dead from opioid-related overdoses. All the while we evidence-based chiropractors sit and watch stuff we could help treat just spiral out of control. We’re sitting on the bench waiting for the coach to put us in the game but we just rarely get our number called. If they want to make surgeons the quarterback of the football team, at least we could be the running back or tight end or something. Geez.
We could be a key part of the pain team and research has told the stakeholders several times. But nope. We’re stuck riding the pine. A little further down in the article, my worries are actually hit on when they say, “So some states are objecting to the settlement. Twenty-five state attorneys general wrote to US Attorney General William Barr last week arguing against the plan to create a government-controlled company out of the assets of Purdue Pharma, arguing that the government should not be in the business of selling OxyContin.”
And I agree with the 25 state attorneys general. That, to me, is not what American was built on. Again, don’t get me wrong, I’m all about punishing the hell out of a corrupt and evil company like Purdue Pharma. I’m even all about putting them out of business. Hell, the Statler family that runs this business pulled $10 billion out of the company and placed into family trusts before filing bankruptcy. It’s a bad group of people. Lop they’re damn heads off if you think they deserve it…..OK, maybe not to that extent but you get my point.
But, putting a company out of business and then stepping in as the government to take it over and run it…..no. I don’t like it. But that’s just me.
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Item #2
Alright, my last one today is called “Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI” by Anton Bowden(Bowden 2018) and published in the Journal of Spine Surgery in September of 2018 and it goes a little sumpin’ like dis.
Why They Did It
Bowden starts by saying “Studies dating back several decades have failed to show a strong correlation between abnormal MRI scans of the intervertebral discs and clinical symptoms. Which you know if you’ve been following along. This is part of why the patient I mentioned earlier was mad at me for not immediately ordering an MRI.
He continues, “The recently published 20-year prospective longitudinal study of cervical spine disc degeneration” by Daimon et al.(Daimon K 2019), is perhaps the strongest confirmation to date affirming that intervertebral discs naturally degenerate with age, and that evidence of degeneration alone is insufficient information with which to make a conclusion regarding the root cause of a patient’s symptoms.” We have covered that paper here on the Chiropractic Forward Podcast before. They discuss the study at length saying, “Daimon et al. found that while MRI signal intensity longitudinally decreases across all cervical disc levels, there is a peak in structural degeneration that occurs at the C5–C6 level, with C4–C5 and C3–C4 having progressively lower degeneration rates. Since the C5–C6 level also corresponds with the highest flexion-extension range of motion of the cervical spine, a mechanical component of the degeneration process appears to be highlighted by the study.
Once the C5–C6 level has been destabilized due to degeneration, sequential acceleration of degeneration at adjacent levels was observed. This insight has relevance to current discussions regarding adjacent-segment disease subsequent to arthrodesis and arthroplasty. The authors also observed that 95% of subjects experienced degenerative progression over the 20-year study period, while only 67% developed clinical symptoms. This observation lends strength to the argument that trying to fight all forms of disc degeneration is an insolvable fight against nature, at least for the foreseeable future.” I was happy to see him mention this, “As a biomechanist, I would be remiss to point out that imaging alone is missing fundamental information regarding the dynamic function of the spine. Spines that look very similar while lying down in the MRI may move very differently while going about activities of daily living—and the consequences can be dramatic for mechanical loading and pain in the discs and adjacent spinal structures “ Here on the show in some of the earlier episodes, we covered the fact that discs that show little to no issues in the supine position can look very different when seated or standing.
Significantly different as a matter of fact. The research has been done on this yet I’ve had discussions with two separate radiologists and both of them guessed there would be little to no change in the disc with position change. That’s just not the case, is it? I’m happy to see this author recognize the fact. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world.
Keep taking care of yourself and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Website 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
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
Bowden, A. (2018). “Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI.” J Spine Surg 4(3).
Daimon K, F. H., Nishiwaki Y, (2019). “A 20-year prospective longitudinal MRI study on cervical spine after whiplash injury: Follow-up of a cross-sectional study.” J Ortho Science 24(4): 579-583.
Isidore, C. (2020) “OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company.” CNN Business.
CF 145: Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters Today we’re going to talk about how kids can hurt, SMT for chronic lumbar radiculopathy, lack of testing on biopsychosocial matters. But first, here’s that sweet sweet bumper music
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.
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. https://www.chiropracticforward.com/chiropractors-affected-by-covid-2019-opioid-overdoses-insurance-compensation-for-chiropractic/ You have found yourself smack dab in the middle of Episode #145 Now if you missed last week’s episode , we talked about some of the most common musculoskeletal surgeries and the incredible lack of research backing them up. We also talked about how chiropractic performs when lined up against multidisciplinary treatment. Check it out after this one. 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….. I think I’m getting busier. Feels like it anyway. 143 last week and the new patients are staying steady. Which is a good thing. I have the kind of practice that depends on new patients. When you’re evidence-based and you don’t make a ton of long-term recommendations…..you don’t make patients think they need to depend on you every week for the rest of their lives….well then, you have a constant turnover of patients. My longest recommendation is for about a 3 month plan. Honestly, most people are feeling so good that they don’t wrap up a 3 month plan. Some of you agree with that and some of you will say I should be holding them to the program but, research is clear on this. We should be teaching patients to self-manage at home. Not depending on us. And that’s part of it. Once they start self-managing and they’re feeling great, where’s the motivation to pay someone to mostly do what they’re doing at home already? I get it. And I don’t fuss with patients over their schedules when they’re doing amazing in the first damn place. There’s a point where that type of fussing and borderline bullying starts to look like greed. And I’m sure none of us want to look greedy. At least I don’t. That’s the epitome of being patient-centered, right? But the point is, patient-centered, evidence-based chiropractors need a steady stream of new patients. Now don’t get me wrong; I have wellness patients. They just aren’t the bulk of my practice. If I just depended on wellness/maintenance patients, we’d be in a world of hurt up in here, up in here. Not long ago, evidence-based chiros threw monkey poo at maintenance. Then Andres Eklund came around and cleaned up the monkey mess. Then a systematic review recently came out saying maintenance care can now be considered evidence-based. It felt like slipping into a warm coat in the winter, ya know. Lol. Now, that doesn’t mean once a week for life like the subluxation slayers lay on people. For the right population, once every month or two….or maybe every three months….that does indeed make difference and make some sense. If you’re unfamiliar with Andres Eklund, just go to our episodes link at chiropracticforward.com and use the search function there to search for maintenance care or Nordic papers and dive in. It’s wonderful stuff. I love it when the hard work has already been done by people smarter than me. It’s good stuff. Outside of all that boring stuff, still just trying to stay strong and healthy. I’m exercising much more regularly and really watching what I’m eating. It’s paying off too. I lost 7 pounds last week. Yeah, I know what you’re thinking…..how could Jeff get any sexier than he already is but I’m just going to say, hold my beer and watch. My michelob ultra beer that is…..because, you know….I’m on a diet and all. Lol. I have one kid at Texas Tech where COVID is spreading like a bad STD and then I have another in person in junior high. So far in the first 5 weeks they’ve had 2 teachers and 2 kids out with the Rona. That may sound like a lot but, honestly, this junior high has about 1400 kids so……that’s not much. The kid at Tech thinks he wants to come home every 2 weeks for the weekend. I love seeing the little knucklehead but another part of me is like…..you stay over there on that side of the house…..I’ll be on this side. He’s a big hugger. I’m normally good for a hug and all but…..Rona has me trying to stay healthy. You can’t turn down a hug from your kiddo though. Still……it’s a bit nerve wracking. I tell people and you may have heard me say it but, most folks do fine if they get COVID and I expect I’ll do fine as well. Other than being out of shape and overweight, I’m not particularly unhealthy. Most folks, if they get it, they just stay home in bed, fluids, all that rigamarole but no big deal really. Me….and most of you….we have to close down out businesses essentially. I have 14 employees, y’all. They have families. We bill out anywhere from $20k-$25k per week typically. At minimum, I’m probably out for 2 weeks. That means missing out on up to $50k in billing. One word, two syllables….Day-um….Hell no. I’ll just do everything I can to stay healthy in the first place. Even if some knuckleheads don’t understand or get it. Speaking of…..These anti-maskers….good Lord. I don’t know how they are where you live but here in Texas, did you know all kinds of degrees have morphed into now allowing the owner of the degree to now be an expert on epidemiology? Very powerful degrees. I’ve never heard of a degree that morphs into epidemiological expertise but evidently, it’s a fact these days. I saw a great quote from a fellow chiro that went something like this, “I guess I just don’t understand the argument anti-maskers make in general. Regardless of anything, for me, as a healthcare professional, I need to be flexible and consider being wrong as part of my logic. Simply put, maybe masks work, maybe they don’t but it really doesn’t matter what you believe. The question sreally is, if you’re wrong can you live with the consequences? I wear a mask because I believe it reduces the risk of exposure for me and to those around me, but more importantly, if I’m wrong I won’t hurt anybody at all. Including myself. If you don’t wear a mask and you’re wrong, then the effects can be devastating during a really off day when things go they way they’re not supposed to go. Or, how about the sneeze test? Have someone sneeze on you with a mask on and then have them sneeze on you without a mask on. Which do you prefer? End of story. Let’s get on with it. We have some pretty cool stuff to breeze through today.Item #1 Let’s start with this one called “Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8–16 years” by Fuglkjaer et. al. it also has Jan Hartivigsen on it as well. It was published in Chiropractic and Manual Therapies in August of 2020(Fuglkjaer S 2020). Hot tamale, hot tamale, that tamale….it’s hot… Why They Did It The objectives were to group children aged 8 to 16 according to their distribution of pain in the spine, lower- and upper extremity, determine the proportion of children in each subgroup, and describe these in relation to sex, age, number- and length of episodes with pain. How They Did It Data on musculoskeletal pain from about 1,000 Danish schoolchildren was collected over 3 school years (2011 to 2014) using weekly mobile phone text message responses from parents, indicating whether their child had pain in the spine, lower extremity and/or upper extremity. Result are presented for each school year individually. What They Found
Around 30% reporting no pain, around 40% reporting pain in one region, and around 30% reporting pain in two or three regions.
Most commonly children experienced pain from the lower extremities at about 60%, the the spine at about 30%, and then upper extremities at about 23%.
Twice as many girls reported pain in all three sites
Wrap It Up Danish schoolchildren often experienced pain at more than one pain site during a schoolyear, and a significantly larger proportion of girls than boys reported pain in all three regions. This could indicate that, at least in some instances, the musculoskeletal system should be regarded as one entity, both for clinical and research purposes. Item #2 This one is excellent. It’s called “Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial” by Ghasabmahaleh, et. al. and published in The American Journal of Medicine on September of 2020(Ghasabmahaleh S 2020). Sizzlin, smokin’. some stout stuff, y’all.Why They Did It The authors wanted to evaluate the efficacy of spinal manipulation for the management of non-acute lumbar radiculopathy. How They Did It
It was performed in a university hospital
It was a randomized controlled trial with two parallel arms.
44 patients with unilateral radicular low back pain lasting more than 4 weeks were randomly allocated to manipulation and control groups.
The primary outcome was intensity of the low back pain on the VAS scale
Secondary outcome was the Oswestry Disability Questionnaire score
In addition they measure spinal ranges of motion.
All patients had physiotherapy
The manipulation group got three sessions of manipulation therapy, one week apart.
For manipulation, they used Robert Maigne’s technique.
What They Found
Both groups experienced a significant decrease in back and leg pain
However, only the manipulation group showed significantly favorable results in the Oswestry scores, and the straight leg raise test.
All ranges of motion increased significantly with manipulation but the control group showed favorable results only in right and left rotations and in extension
Between-group analyses showed significantly better outcomes for manipulation in all measurements with large effect sizes
Wrap It Up They wrap it up by saying, “Spinal manipulation improves the results of physiotherapy over a period of three months for patients with subacute or chronic lumbar radiculopathy.” I say hell with that conclusion. Lol. I say that PT ADDS TO spinal manipulation. I’ve told my patients for years now that there is great research for spinal manipulation and there is great research for exercise. It’s not about one or the other. They’re not mutually exclusive. The research is best for combining the two. If you go to a PT and just get exercise, that’s not the full meal deal. You’re a taco or two short of a combo meal there. If you go to a chiropractor and only get adjustments, yes, there should be some relief but, again, you a taco short. You could be better. You don’t want evidence-based chiros out there in the world wishing you didn’t suck so much. Get on the exercise rehab. Learn. I didn’t used to know much about it. Hell, if I’m being honest, there’s A LOT more I still need to learn but I’m a hell of a lot better than I once was. Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex. Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds. Picture a T bar with a built-in drop piece. This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website. It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. Go check Drop Release at droprelease.com and tell Dr. Howson I sent you. Item #3 Last one today is called “The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States” by Gliedt et. al. published in Chiropractic and Manual Therapies on 21st of August 2020(Gliedt J 2020). On the hottest, freshest frijoles for the Forward fans.Why They Did It Chiropractors treat spine complaints and therefore should be trained in the full spectrum of the biopsychosocial model. This study examines the use of psychosocial related terminology in United States doctor of chiropractic program (DCP) curricula, the Council on Chiropractic Education (CCE) standards, and the National Board of Chiropractic Examiners (NBCE) test plans. How They Did It Nineteen academic course catalogs, CCE curricular standards and meta-competencies, and NBCE test plans were studied Wrap It Up Despite evidence suggesting the influential role of psychosocial factors in determinants of health and healthcare delivery, these factors are poorly reflected in United States DCP curricula. This underappreciation is further evidenced by the lack of representation of psychosocial terminology in NBCE parts III and IV test plans. The reasons for this are theoretical; lack of clarity or enforcement of CCE meta-competencies may contribute. So when you hear people ask what we can do to make this profession better, stronger, and more respected…..this is just one more thing that can be done. Our institutions can recognize the biopsychosocial aspect of chronic pain, they can teach it, they can teach yellow flags, and then they can test it. Then we can look at making entrance into the schools a little more stringent and we can look at taking the subluxation slayers and spine whisperer courses out of our colleges. If someone wants to learn how to be doctor-centered and use x-rays to manipulate patients out of thousands of dollars a year, they need to be learning that garbage outside of an accredited chiropractic college. It has no place in our institutes beyond some historical perspective. Over and out. Mic drop, bam, shazam, ala cazam. https://www.chiropracticforward.com/common-surgeries-arent-well-researched-chiropractic-wins-again/ That’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.Key TakeawaysStore Remember the evidence-informed brochures and posters at chiropracticforward.com.
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website 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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography
Fuglkjaer S, V. W., Hartvigsen J, Dissing KB, Junge T, Hestbaek L, (2020). “Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8–16 years.” Chiropr Man Therap 28(45).
Ghasabmahaleh S, R. Z., Dadarkhah A, Hamidipanah S, Mofrad R, Najafi S, (2020). “Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial.” The American Journal Of Medicine.
Gliedt J, B. P., Holmes B, (2020). “The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States.” Chiropr Man Therap 28(43).
CF 048: Do Disc Herniations On An MRI Worsen When Sitting Or Standing (Part TWO)?
Today we’re going to continue our talk from last week on whether or not a disc herniations change as you sit up, stand up, or move around. We went over some pretty good research last week. This week, it’s time for the cherry on the top.
But first, here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have scampered into Episode #48. I use scamper this week because, as my son was playing with his aunt and uncle’s dog named Rowdy down in Dallas last weekend, that was the way he described when the dog would take off after the tennis ball every time. Scamper. Great word that I plan on using more from here on out where appropriate.
Diplomate of Chiropractic Orthopedists
The DACO this weekend down in Dallas. The class was with James Lehman. Dr. Lehman, in case you do not know, is with the University of Bridgeport Connecticut. His official title from their website is Associate Professor of Clinical Sciences, Health Sciences, College of Chiropractic.
Dr. Lehman is also one of the main drivers of this DACO program. Through Univ. of Bridgeport Connecticut, he has teamed up with CDI out of Australia and their courses in neuromusculoskeletal online education. It is VERY well done. Very professional and very worthwhile. You can find that at https://cdi.edu.au
We talked a lot about some stuff that I want you to hear straight from him so we’ll do an interview with him very soon but the gist of it all is this: get certified in something other than simply having your doctor of chiropractic degree.
FQHC
I’ve heard a couple of opinions. I’ve heard the Diplomate programs are worthless now and that people are moving away from them. But, I think that’s coming from people that don’t want to take the time or put in the effort. The real story is most likely that our system, for good or bad, is moving away from private practice and TOWARD integrating through the group offices and through the Federally Qualified Health Centers.
There are chiropractors being reimbursed in the system up to $300 for a Medicaid visit and around $150 on the lower end.
I have to thank Dr. Craig Benton once again for bringing this to my attention. Did you guys know that, given the right positioning, you could make that much per appointment from freaking Medicaid?
Here’s the deal though: you have to be a specialist. A Diplomate. So, is it really useless? I say it most certainly is not.
Whiplash Section
Now the course, the course this weekend was on whiplash. I’ve been through Art Croft’s 4 part Advanced Certification on Whiplash Biomechanics and Traumatology so I can say with a lot of honesty that a good portion of the course was a refresher for me.
But, I absolutely learned a solid amount of new stuff as well. Such as Axillary compression. Axillary compression was not a condition of the shoulder that was on my radar screen prior to this course.
That is one simple little example but there was a gob of nuggets for the nugget pouch and as always, I really walked away feeling that I will be better at my job on Monday. But it’s always that way. Even after just a 2-hour online course. It’s phenomenal.
Personal
Continuing the ongoing saga of hiring a front desk staff member in the year 2018. Here’s what all I’m going to say about it. Looks like my wife has found a new full-time job. Lol. Get the picture?
It looks like I may have a cool speaking gig coming up in February. Nothing solid but, if I were to come to your state convention or to some sort of event you are at, what topic along the vein of Chiropractic Forward’s typical content would you like to learn more about?
If you are a regular listener and familiar with what we have been doing here this last year, I’d really appreciate it if you would take just a minute and email me at dr.williams@chiropracticforward.com and give me a little guidance. What topics would you want to see in a presentation?
I’m glad you’re here and hopefully, I didn’t ramble too much before getting to the meat and taters. Here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
On To The Research
Picking up from last week, we want to start in on the changes disc herniations undergo when axial pressure is placed on them. In other words, what happens to disc herniations from the time the MRI is taken laying down to the point where the person sits up.
I have to preface it all by saying go listen to last week’s episode which is #47, please. It tells you how it is very common in the medical field amongst even radiologists to assume or guess that there is no change in the disc or in the herniation when axial pressure is applied. Research tells us differently.
This week we want to start with a paper called “Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines.” It was done by Ferreiro Perez, et. al[1]. and published in the European Journal of Radiology
How they did it
89 Patients studied
45 of them had their low back imaged
44 patients had their necks imaged
The images were done in both the lying down position as well as the sitting.
What They Found
The overall combined recumbent (lying down) miss rate in cases of pathology was 15%
Overall combined recumbent underestimation rate in cases of pathology was 62%
Overall combined upright-seated underestimation in cases of pathology was 16%.
Wrap It Up
Upright-seated MRIs were seen to be superior to recumbent MRIs in 52 of the patients studied for conditions of posterior disc herniations and spondylolisthesis. Recumbent MRIs were only superior in 12% of the patients.
Next, this one is titled, “Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading” by Ahn et al[2].
Why They Did It
The authors in this paper were wanting to determine if disc degeneration will increase the severity of spinal stenosis when the spine is loaded with axial pressure.
How They Did It
They had 51 patients with symptoms of neurogenic intermittent claudication and/or sciatica that had their MRIs loaded as well as non-loaded.
The foramen involved were all measured for changes in sizes.
Wrap It Up
Here’s what they found, “More accurate diagnosis of stenosis can be achieved using MR imaging with axial loading, especially if grade 2-4 disc degeneration is present.”
AKA:” Seated or loaded MRIs are superior for assessing lumbar stenosis.
Next, this one is by Willen[3] and it’s called “Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication.” It appeared in Spine Journal in 1997.
They had 50 people with CTs, 34 were imaged with MRI, the imaging was performed laying down as well as axially loaded.
They closed it up by saying, “Axial loading of the lumbar spine in computed tomographic scanning and magnetic resonance imaging is recommended in patients with sciatica or neurogenic claudication when the dural sac cross-sectional area at any disc location is below 130 mm2 in conventional psoas-relaxed position and when there is a suspected narrowing of the dural sac or the nerve roots, especially in the ventrolateral part of the spinal canal in psoas-relaxed position”
Next Paper
This one is by Kanno, et. al[4]. called “Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography?” It appeared in Spine Journal in 2012.
44 patients, with imaging in the supine position and then with axial load added. The dural sack was measured
“The size of the sack was significantly reduced in the axially loaded imaging and the axial loaded MRI detected severe constriction with a higher sensitivity (96.4%) and specificity (98%) than the conventional MRI.”
Next paper
This one is by Danielson et. al. from 2001 called, “Axially loaded magnetic resonance image of the lumbar spine in asymptomatic individuals.” This paper appeared in Spine Journal in 2001 as well.
MRIs were performed lying down as well as with axial load on the participants. The axial loading was performed lying down, face up with a compression device built for this study specifically. The diameter of the dural sack was measured to check for the differences.
The authors said, “A significant decrease in dural cross-sectional area from psoas-relaxed position to axial compression in extension was found in 24 individuals (56%), most frequently at L4-L5, and increasingly with age.”
Pretty cool stuff right there people.
I want you to go forward this week knowing what you get from listening to this podcast every week. You get things you can absolutely use and implement immediately. Some of you may gain confidence now that you know some research that you maybe didn’t know previously. Some of you may now be able to tell a patient that has a 5mm central posterior herniation that 5mm isn’t telling us the whole story.
It’s telling us part of the puzzle but that discs respond to positioning and various stresses we put on the discs through our activities.
Use it or lose it
This can give you some extra guidance in your recommendations when you consider disc herniations change and get worse, stenosis gets worse when the patient sits up or bends forward.
If you aren’t up on directional preference exercises, McKenzie, and CRISP protocols, it’s time to get there folks. It’s time to get there. The anatomy absolutely responds to movement and positioning.
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.
It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Contact Us!
I want to ask you to go to chiropracticforward.com and sign up for our newsletter. We love to stay in touch and want to offer you discount specials when we get our educational products up and rolling.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services.
Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
1. Ferreiro P, e.a., Evaluation of intervertebral disc herniation and hypermobile intersegmental instability in symptomatic adult patients undergoing recumbent and upright MRI of the cervical or lumbosacral spines. Eur J Radiol, 2007. 62(3): p. 444-8.
2. Ahn TJ, e.a., Effect of intervertebral disk degeneration on spinal stenosis during magnetic resonance imaging with axial loading. Neurol Med Chir (Tokyo), 2009. 49(6): p. 242-7.
3. Willen J, e.a., Dynamic effects on the lumbar spinal canal: axially loaded CT-myelography and MRI in patients with sciatica and/or neurogenic claudication. Spine (Phila Pa 1976), 1997. 22(24): p. 2968-76.
4. Kanno H, e.a., Axial loading during magnetic resonance imaging in patients with lumbar spinal canal stenosis: does it reproduce the positional change of the dural sac detected by upright myelography? Spine (Phila Pa 1976), 2012. 37(16): p. E985-92.
Today we’re going to kick around information on disc herniations, disc bulging, and radiculopathy as a result. Is there anything we can do about it? Well, I’m a chiropractic advocate and research backs us on it so I’ll say, “Hell yes.” Come along with us, won’t you?
First, I feel some sweet sweet bumper music moving in….
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
Now that I have you here, I want to ask you to go to chiropracticforward.comand sign up for our newsletter. It makes it easier to let you know when the newest episode goes live and it makes me feel good. Don’t you like to make people feel good? Of course, you do so….do it do it.
Also, our group on Facebook. It’s called the Chiropractic Forward Group and I think that’s as appropriate of a name as I could come up with. Lol. Just in case you didn’t know, there’s the page on Facebook. That’s for getting the word out and telling people about the podcast. Then there’s the private group. That’s for interacting with each other, learning from each other, posting new papers when they come out, and maybe organizing into a powerful group someday, somewhere down the line. That sort of deal must grow organically. It can’t be forced so we won’t try to do that.
We’ll just let you all know about its existence and hope to start seeing you over there. Let’s start a conversation outside of the podcast!
We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.
You have back-flipped head-on into Episode #35
Before we talk about all of the disc herniations stuff, I want to tell you all about my weekend. I spent Saturday and part of Sunday morning with my butt firmly planted in a chair in a hotel conference room listening to Dr. Brandon Steele talk about shoulder issues. He was the teacher as his company ChiroUp was a sponsor of the event but he was there teaching as part of the DACO program which is run by the University of Bridgeport.
What the heck is DACO right? Well, what used to be called DABCO is now called a DACO which stands for Diplomate of American Chiropractic Orthopedists. I have mentioned before where I sat through the first 10 DACO hours back in June. That was over the low back. These ten were over the shoulder. Topics covered included Scapular Dyskinesis. I knew nothing of this mess and, I already identified and started working with one of these patients the day after I got home. We also covered shoulder impingement, rotator cuff issues, thoracic outlet syndrome, and adhesive capsulitis to name a few.
Good stuff all around and, even if I don’t go all the way through the DACO program, I get better and better every time I take a class. And not just better. I get exponentially better.
In talking with Dr. Steele this weekend, he agreed to come on to the podcast as a guest. We’ll get that all lined up. I have a ton of questions for him. Some questions about the DACO program, some about ChiroUp (it’s really a game-changer and you better use my name if you sign on!!!), and I want to ask him about practice standardization and some things along those lines. It should be a fun conversation so make sure you keep your eyes out for it in the near future.
I encourage you…..a lot of what we talk about here is integrating with the medical community and really stepping up. Part of that is taking the steps to get educated at higher and higher levels. The DACO is in line with that. I have zero association with the people running it other than the fact that I love the product they have created and use it regularly. There is nothing in it as far as reimbursement goes. I just believe in what they’re doing. I encourage you all to look into this DACO program. If you don’t know where to start, just email me at dr.williams@chiropracticforward.com and I’ll get you pointed in the right direction.
Now, on to disc herniations
Have you ever been told we can’t do anything for discs? Have you been told to not adjust if they have a low back disc issue? Do you know how to recognize a disc issue? What’s the best way to treat it? So many questions!!
Here’s the deal for me today. I’m no guru. I’m going to throw research on you but in the end, a lot of it is just experience. So, don’t take my word as the gold standard. I didn’t expect you to anyway but, I wanted to be sure. Lol.
Let’s look first at recognizing disc herniations. There are some simple questions that can get you moving in the right direction on this:
Do you have static position irritation meaning, do you have to move around in your chair often to get comfortable?
Do you have pain going from seated to standing?
Is there a positive Milgram’s
How about a positive Modified Slump test?
Valsalva’s is part of that but some do it separately.
Same with SLR. I was taught that pain on SLR in the first 30 degrees, when the nerve is first tensioned, was indicative of a disc issue but the DACO folks say it’s between 30 and 70 degrees.
Worst position is seated
Best is lying down
Deep buttock pain
Pain in the first 1/3 of trunk flexion or trunk extension that cannot be alleviated by bracing or tightening a belt around the waist.
Radiating pain into the leg
As a general rule of thumb, the further pain radiates beyond the knee, the more likely it is caused by a disc.
Sometime you’ll encounter diminished reflexes or differences in sensory or motor information from side to side.
When should we get an MRI for disc herniations and other issues? Red flags like the history of cancer, fever, chills, recent unexplained weight loss, immunosuppression, and corticosteroid use give you a reason. Symptoms lasting longer than 6 weeks or symptoms showing progressive neurological deficit also give you a reason to get that MRI.
What can we do about it?
Again, that’s going to depend on who you ask. Are we going by The Lancet? Why not go by some chiropractic gurus? We can go by the medical fields recommendation or by physical therapists techniques? I say yes, yes, and yes.
I had a neurosurgeon buddy of mine tell me, whatever the hell works without doing surgery…..do that. I agree. That’s why we are friends coincidentally.
So, knowing all of that, I’m going to tell you what has been effective for me in my practice. The first thing is something that the insurance companies call experimental and investigational. I think they’re full of it. They don’t seem to be in any hurry to pick up new services to have to pay for, do they? But you know what? I’d rather them NOT cover it so we can actually get paid what it is worth.
What I’m talking about here is decompression for disc herniations. This was a game-changer for me in my practice. I have three short stories for you here. They all have to do with guys I tried to send to the surgeon. I’m not going into why we ordered the MRIs or the exam findings. It would take too long for this format so we’re going to jump to the chase in each of their cases.
The first is a dude was in town visiting for work and was only going to be here for a few months before returning home. The MRI showed us that his disc herniations was 14 mm caudal migration. I sent him straight to the surgeon. The surgeon set him up for surgery in 6 weeks. The guy was on board with having surgery but couldn’t wait 6 weeks for some kind of relief. Any kind of relief. He begged me to do decompression. I figured that we could go light. In the end, it’s traction and he had no contraindications to decompression so we did it. This guy was back to working and dancing around in the office in about a week and a half y’all. If you want to say it’s placebo, that’s OK, we’re just going to disagree. If you want to say people just like to be touched and I could have pulled on his big toe and it may have had the same effect, I’m going to tell you to jump in a lake.
The second was a guy that was a truck driver. He was in his 70’s and had had heart surgeries and was on blood thinners. He was a physical wreck honestly. When he came in, he was in a wheelchair and unable to work or function. I got an MRI and his herniation was posterior with 18 mm of caudal migration. That used to be a ticket to the surgeon so off he went. Well, his cardiologist would not take him off of the blood thinners so surgery was out of the question. He came back to me just like the other case we discussed. He had no other options and would I please do decompression on him to try to get him some relief. It had been going for quite some time. OK, sure. I’m a nice guy but I told him, I doubt it’s going to help something like you have going on. Yeah, yeah, yeah, hook me up, please. So we did. Guess what? He came in just a time or two later on a walker instead of a wheelchair. Then, a week or so later, he came in without a walker. Then a month or two down the road, he got a new job and was out there telling everyone that would listen about what we were able to do for him. You can take a long walk off a short pier if you’re going to suggest that was anything other than significant effects due to direct intervention.
Last and worst of all disc herniations I’ve ever seen. He is actually a good friend of mine. He came in with numbness and weakness all the way into his foot. Limping, the whole deal. He worked in a warehouse and would have to be forklifted to the second floor where his office is because he couldn’t get there any other way. He thinks it was due to a motorcycle wreck several years ago. Whatever the cause, it was pretty crazy. His MRI showed disc herniations of 23mm of caudal migration. Almost all the way down to the next disc below. I had never seen that before and haven’t seen it since. I, of course, told him he needed to go to the surgeon muy pronto. He agreed but his wife, bless her heart, did not. And thank goodness. She was adamant about him not going to the surgeon. She strongly urged him to not go until he at least gave decompression a try. I told him about the first two cases we just talked about but that he was really in a different ballpark than those guys and I really didn’t know how I could help at all. They understood but decided to give it a go anyway. And thank God they did. Sometimes our patients teach us instead of us teaching them, don’t they? It took a couple of months but he started to turn around and never had that surgery. I just checked with him the other day, 2 years later, and he’s doing great. He said he has a little numbness in the outside of his foot but nothing bad and nothing he can’t handle. All’s well and guess who the hero is? Well….his wife. She’s the hero. Lol. I’m still the buddy and buddies can’t be heroes.
These are the worst of the worst disc herniations but what about all of the others that were more minor disc herniations? Think of all of the successes we have had with disc herniations over the years. When I say it’s a game-changer, I damn well mean it and, once again, I care not what insurance companies have to say about it.
Let’s look at some papers on it.
This one is called “Simple pelvic traction gives inconsistent relief to herniated lumbar disc sufferers” by Edward Eyerman, MD. It was published in the Journal of Neuroimaging in June of 1998[1].
Why They Did It
The aim was to do before and after MRIs to correlate improvement in the clinic with MRI evidence in terms of disc herniations repair in the annulus, nucleus, facet joint, or in the foramen as a result of decompression treatment.
Eyerman was testing the effectiveness of decompression in a sample of 12 men and 8 women aged 26-74. No, not a big sample.
His MRI finding was as follows:
Disc Herniations: 10 of 14 improved significantly, some globally, some at least locally at the site of the nerve root compression.
Measured improvement in local or general disc herniation size varied in the range of 0% in 2 patients, 20% in 4 patients, 30% to 50% in 4 patients and a remarkable 90 % in 2 patients that did all 40 sessions.
As far as clinical outcomes of the subjects go, he noted that all but 3 patients had very significant pain relief, complete relief of weakness when present, and of immobility and of all numbness except for in 1 patient with herniation and 2 with foraminal stenosis without herniation.
Summed up, he said “Serial MRI imaging of 20 patients treated with the decompression table shows in our study up to 90% reduction of subligamentous nucleus herniation in 10 of 14. Some rehydration occurs detected by T2 and proton density signal increase. Torn annulus repair is seen in all. Transligamentous ruptures show lesser repair. Facet arthrosis can be shown to improve chiefly by pain relief.
Then we have this one by Thomas Gionis, MD published in the Orthopedic Technology Review in December of 2003[2].
They concluded, “Results showed that 86% of the 219 patients who completed the therapy reported immediate resolution of symptoms, while 84% remained pain-free 90 days post-treatment. Physical examination findings showed improvement in 92% of the 219 patients, and remained intact in 89% of these patients 90 days after treatment.”
When is surgery necessary? Well, that’s going to depend on who you ask but a good general rule I follow is that cauda equina syndrome is a quick trip to a surgeon. I personally don’t like foot drop and am likely to send to a surgical consult. I think any progressive worsening of neuro symptoms is cause to pause and reconsider whatever you’re doing. If what you’re doing ain’t fixing it, change directions.
But there is this paper I found interesting. It’s from 2010 and called “Spontaneous Regression for a Large Lumbar Disc Extrusion[3]” by Ryu Sung-Joo, MD and was published online for the Journal of Korean Neurosurgical Society. I have no idea what the quality of this journal is or what the impact is but it’s interesting and I’ve seen studies before about spontaneous resolution of disc herniations.
The authors say, “Although the spontaneous disappearance or decrease in the size of a herniated disc is well known, that of a large extruded disc has rarely been reported. This paper reports a case of a spontaneous regression of a large lumbar disc extrusion. The disc regressed spontaneously with clinical improvement and was documented on a follow-up MRI study 6 months later.”
The case report was on a 53-year-old female after 6 months of low back pain and left lateral leg pain with numbness. Y’all go to the show notes and get the reference to this paper. The MRI images are great.
They mention, “After conservative treatment, her clinical symptoms subsided gradually but the numbness of her left lateral leg still remained. A second MRI study performed approximately 6 months after the prior examination reveals almost complete disappearance of the extruded fragment that had been located posterolateral to the L5 vertebral body and no evidence of compression or displacement of the dural sac or nerve root.” Wowza.
They go on to explain, “Our patient is an example of the resolution of a large protruded disc without surgery. This phenomenon may be due in part to the fact that larger fragments have a higher water content8) and may regress through dehydration/shrinkage, retraction, and inflammation-mediated resorption.” Meaning….her body ate it and it went bye bye.
They finished up the paper by saying, “Even in patients with large lumbar disc extrusion, non-surgical conservative care can be considered as an option for the treatment when radiculopathy is acceptable and neurological deficit is absent.“
That’s pretty cool. I don’t think surgeons are going to want to hear it but it’s cool. If all they can do is surgery on cauda equina or foot drop, they’re going to have a hard time financially.
Alright, moving beyond decompression or spontaneous resorption, what else can we do?
Here’s one I got from Dr. Tim Bertlesman. It was authored by G McMorland and called “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study[4].” This one was published in the Journal of Manipulative Physiology and Therapeutics in 2010 and goes like this. The authors concluded, “Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of the 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.“
Go check it out in the show notes if you want the nuts and bolts and bells and whistles, please.
Then there are your directional preferences exercises. If you have not familiarized yourself with directional preferences, please do so yesterday. They are based upon the idea of centralization and peripheralization. McKenzie’s program uses it, the CRISP protocol uses it, Kennedy’s decompression system uses it, and the DACO program teaches it. Do you see a pattern of some sort emerging here?
Other things that are helpful are exercise recommendations like McKenzie or Williams exercises depending on the directional preference, core building.
These patients also need strong at-home suggestions like:
Get an inversion table for the house.
Get back to work as soon as possible
Don’t lay up in bed hoping it goes away
Sleep correctly
Work advice like get up and walk every 45 minutes or so
Don’t use catastrophic language and make sure they know it’s not a disease and most disc cases resolve
I don’t have all of the answers but, I’m guessing none of you do either. In the end, it’s experience, isn’t it? For example, without experience, I wouldn’t have known that it COULD be possible to help three guys with caudal migration of a disc from 14mm all the way up to 23mm. Nothing but experience can show someone that.
While we don’t know it all, we DO find means that are effective and help us get the job done and make a difference in our patients’ lives. That’s for sure.
This week, I want you to go forward with the knowledge that, in case you didn’t already know it, you’re powerful. You can take disc herniations that used to be sent straight to surgery and you can treat that complaint with safe, conservative, non-invasive, and non-pharmacologic means. That’s a hell of a deal right there, folks.
We’re not done talking about disc herniations, decompression, and all of that fun stuff. There’s too much left in the tank to be done but, in the interest of time, we’ll get to it on another episode.
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.comand let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Ryu Sung-Joo, Spontaneous Regression of a Large Lumbar Disc Extrusion.J Korean Neurosurg Soc., 2010. 48(3): p. 285-287.
McMorland G, Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study. J Manipulative Physiol Ther, 2010. 33(8): p. 576-584.
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