evidence based

Benzodiazepines and Mirror Therapy

CF 238: Benzodiazepines and Mirror Therapy  In today’s episode, we cover Benzopdiazapines and Mirror Therapy  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are 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 #238 Now if you missed last week’s episode , we talked about Chronic Pain and current thinking. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I usually type up the podcast ideas and outline on a Monday. Well, we were off this Monday for July 4th so I’m short a day this week which means that this personal happenings part of the podcast has to be short so I can make everything happen in this short week.  So here we go. I’m still on the hunt for an associate chiropractor. One who is a go-getter determined to be successful.

One that understands they can go to work for the Joint and get paid more currently. In the now and here. But there will be a cap and they will not be able to exceed that cap. One that understands that there is no cap with me. The more they bring in and grow the clinic and themselves, the more I want to take good care of them. Plain and simple. If that’s you, email me at [email protected].

I want to get to know you. 

I am getting ready and looking forward to being in Sarasota with the Florida MCM Mastermind for the weekend of July 22nd. It’s a good time of networking with my fellow mastermind people and helping each other build our businesses. Hell yeah. I thrive in masterminds. Even if I don’t necessarily have the time to implement everything I want to implement. I get inspiration, ideas, and actionable steps I can take almost immediately most of the time.  Lots of little tips and tricks and I learn as much or more from the Mastermind members outside of the classroom at the hotel bar as I learn in the classroom. If you’re interested in joining, send me a message, and let’s get you connected with Dr. Kevin Christie and hopefully get you plugged into the group ASAP. I mean really, we’re meeting in Sarasota on July 22nd and there’s still room for you but in November, we’re meeting a Playa Largo in Key Largo, FL. Everyone’s bringing their family too so you know you don’t want to miss that one. Reach out and let me help you get plugged in.  You have to be grossing $350,000 per year and growth-minded to play so holla.  Let’s get started today. 

Item #1

Our first one today is called “Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA” by Trager et. al. (Trager RJ 2022) and was published in BMJ Open on June 13, 2022. The sizzle…..it’s hot

Why They Did It

Although chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions.  We hypothesize that utilization of CSMT for newly diagnosed radicular LBP is associated with reduced odds of benzodiazepine prescription through 12 months’ follow-up.

How They Did It Retrospective cohort study. National, multicentre 73-million-patient electronic health records-based network (TriNetX) in the USA 2003 – 2021

What They Found

  • Odds of receiving a benzodiazepine prescription were significantly lower in the CSMT cohort over all follow-up windows prematching and postmatching (p<0.0001). 
  • Sensitivity analysis suggested a patient preference to avoid prescription medications did not explain the study findings.

Wrap It Up

  • These findings suggest that receiving CSMT for newly diagnosed rLBP is associated with reduced odds of receiving a benzodiazepine prescription during follow-up. 
  • These results provide real-world evidence of practice guideline-concordance among patients entering this care pathway. 
  • Benzodiazepine prescription for rLBP should be further examined in a randomized trial including patients receiving chiropractic or usual medical care, to reduce residual confounding.

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

Item #2

The last one today is called “3D augmented reality mirror visual feedback therapy applied to the treatment of persistent, unilateral upper extremity neuropathic pain: a preliminary study” by Mouraux et. Al. (Dominique Mouraux) and published in the Journal of Manual and Manipulative Therapy in 2017.

Why They Did It

The authors assessed whether or not pain relief could be achieved with a new system that combines 3D augmented reality system (3DARS) and the principles of mirror visual feedback.

How They Did It

Twenty-two patients between 18 and 75 years of age  All of whom suffered of chronic neuropathic pain.  Each patient performed five 3DARS sessions treatment of 20 mins spread over a period of one week.  The following pain parameters were assessed: 

  1. visual analogic scale after each treatment session 
  2. McGill pain scale and DN4 questionnaire were completed before the first session and 24 h after the last session.

What They Found

  • The mean improvement of VAS per session was 29%. 
  • There was an immediate session effect demonstrating a systematic improvement in pain between the beginning and the end of each session. 
  • They noted that this pain reduction was partially preserved until the next session. 
  • If we compare the pain level at baseline and 24 h after the last session, there was a significant decrease of pain of 37%. 
  • There was a significant decrease on the McGill Pain Questionnaire and DN4 questionnaire.

Wrap It Up

Our results indicate that 3DARS induced a significant pain decrease for patients who presented chronic neuropathic pain in a unilateral upper extremity.  While further research is necessary before definitive conclusions can be drawn, clinicians could implement the approach as a preparatory adjunct for providing temporary pain relief aimed at enhancing chronic pain patients’ tolerance of manual therapy and exercise intervention.

You can decide how well-related this is BUT, with phantom limb pain, in addition to cognitive behavioral therapy, they have treated using mirror therapy. 

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Key Point:

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

Contact

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

The Inflammatory Response’s Effect On Chronic Pain & The Entry Point For Low Back Pain

CF 235: The Inflammatory Response’s Effect On Chronic Pain & The Entry Point For Low Back Pain Today we’re going to talk about the inflammatory response’s protection from chronic pain, which is fascinating.. and we’ll talk about where patients should be starting their journey for low back pain.  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are 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 out 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 your 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 #235 Now if you missed last week’s episode, we talked about Chiropractic saving Medicare patients money and adverse events and a better position for preventing strokes when adjusting the neck. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I had a big weekend in Frisco, Tx. If you don’t know where Frisco, TX is, it is basically North East Dallas. It’s the home of the Dallas Cowboys training facility. It’s where all of the people you hear about moving to Texas are moving to. The place has growth that is just almost unreal.  They have to be continually building high schools and highways because they can hardly keep up with their growing population.  Anyway, it was the location of the Texas Chiropractic Association’s annual state convention, which is called ChiroTexpo. 

This year, I was asked to teach a 2-hour course. My course is called Chronic Pain And The Up-regulated Central Nervous System. Those of you that are regular listeners here are probably familiar with some of what I cover in the course. My main goal for attendees of my course is more responsible in managing of their patients and more responsible in communicating with them.  I’m trying to kill the habits some have of catastrophizing imaging findings and scaring patients into a ton of treatment by using harmful words, phrases, and analogies.  I had a patient last week whose primary told her that her spine was like a dry twig from osteoporosis.

Seriously?

The daughter was scared to death and the patient didn’t want to move an inch because she had a picture in her mind that her spine was going to start splintering. How awful.  But, you get what I’m saying. I’m trying to use guidelines and research to show why words matter and how we can help solve more chronic pain patients’ issues through good communication and broad management protocols.  So there. Good times in the metroplex.  I got to meet a lot of folks and hang out with some buddies. I got to see Mike Massey from Tennessee. He was speaking on Mastering Medicare. I got to hang out with Jay Greenstein and have some dinner and drinks. He was in town speaking on technology in the profession.

Excellent as always.

I hung out and had dinner with Brandon Steele, his wife and daughter, and my other good friend Craig Benton from Lampasas Texas. I also spent plenty of time with my regular TCA family, Tyce Hergert, Devin Pettiet, Max Vige, Bill Lawson, the new President of the TCA and Todd Whitehead, the new Secretary/Treasurer of the TCA, and always a favorite, Stephen Foster who is the President of Texas Chiropractic College. What a wonderful individual. TCC is fortunate to have him at the helm. 

These connections are important to me and I value them greatly.  I also got to meet a couple of fellow speakers and get to know them better. Kristi Hudson from ChiroHealthUSA out in Mississippi. She’s just got amazing good vibes and energy. You can tell when people are good at heart and she’s great. I also met Dr. Cindy Howard, a functional medicine mastermind, ninja, and Jedi. She’s just simply a force to be reckoned with. Very impressive, excellent attitude, and a new connection I’m excited to have made. 

On top of all of that, I won an award at the awards gala. I won the Executive Director’s award which is amazing and quite an honor.  So, overall, it was a great weekend. I’m recovering from all of the festivities but it was well worth it and I’m looking forward to the next one.  Again, it’s mid-June 2022 and I’m still looking for a chiropractor to come in here and treat in my clinic and grow my clinic. If interested, send me an email and a CV to [email protected] please.

I want to get to know you. But, understand, I’m a go-getter. You’ll need to be as well. But for the right person, this might be the place you’ll want to spend the rest of your career. 

Alright, let’s dive in. But before we do, let’s pay some bills real quick. 

Doctors:  I’ve been telling you about a system that once obtained will help you get more  PI cases.  This system was created by an attorney who exclusively handles accident cases. He got tired of lame approaches by doctors wanting his referrals, so he created this system to teach you how to get the attention and then the love of PI attorneys.  You know these cases are the GOLD of our business.  Very few no-shows, full payment … not health insurance caps or Medicare or Medicaid. Go to: http://www.gettingpicases.com/cs Over 500 doctors nationwide are now using this system…. don’t be left out…  improve your practice, gain free time because of the added income you’ll realize, and appreciate that the attorney, Paul Samakow, is still offering a 100% Money Back Guarantee …  if you give his ideas a fair shake and it doesn’t work, he’ll refund your money…  you have nothing to lose here…

Go to:  http://www.gettingpicases.com/cs

Item #1

The first one is called “Acute inflammatory response via neutrophil activation protects against the development of chronic pain” by Parisien et. al. (Parisien M 2022) and published in Science Translational Medicine on May 11 of 2022 and it’s a hot potato, coming through. 

Why They Did It

They say, “The transition from acute to chronic pain is critically important but not well understood. Here, we investigated the pathophysiological mechanisms underlying the transition from acute to chronic low back pain” On a quick side note, there is the suggestion that neuroplasticity may partially explain the slip from acute to chronic. Isn’t it an interesting thought; tissue has a healing time? If we can get the pain to cease after healing occurs, thus preventing the slip from acute to chronic….imagine how much time, money, and suffering we save the system. Low back pain is the leading cause of disability globally and I would venture a guess that the vast majority of that pain is not acute. It’s chronic. 

How They Did It

  • They performed the transcriptome-wide analysis in peripheral immune cells of 98 participants with acute LBP, followed for 3 months.
  • Transcriptomic changes were compared between patients whose LBP was resolved at 3 months with those whose LBP persisted

What They Found

  • They found thousands of dynamic transcriptional changes over 3 months in LBP participants with resolved pain but none in those with persistent pain. 
  • Transient neutrophil-driven up-regulation of inflammatory responses was protective against the transition to chronic pain. 
  • In mouse pain assays, early treatment with a steroid or NSAID also led to prolonged pain despite being analgesic in the short term; such a prolongation was not observed with other analgesics. 
  • Depletion of neutrophils delayed resolution of pain in mice, whereas peripheral injection of neutrophils themselves prevented the development of long-lasting pain induced by an anti-inflammatory drug.

Wrap It Up

Analysis of pain trajectories of human subjects reporting acute back pain in the UK Biobank identified elevated risk of pain persistence for subjects taking NSAIDs. Thus, despite analgesic efficacy at early time points, the management of acute inflammation may be counterproductive for long-term outcomes of LBP sufferers. You can’t tell me that’s not somewhat exciting. I also read an article last week asking if we’re close to curing cancer and, based on some more recent results from the immunotherapy strategies they’re using and studying, they’re optimistic that an end for a lot of cancers may be in sight. 

That’s worth having some excitement over. If we can cure cancer and figure out how to prevent pain from slipping into chronic pain…..damn. Imagine how our world changes. Almost immediately. I’m a dreamer and I’m dreaming right now. What a party that’ll be if they can get it done.  Before getting to the next one, I have to tell you, that Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase.

Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

The last one today is called, “Where to start? A two-stage residual inclusion approach to estimating the influence of the initial provider on health care utilization and costs for low back pain in the US” by Harwood et. al.   (Harwood 2022)and published in BMC Health Services Research on May 23, 2022 and that’s hotter than Texas in June and July.  For real, folks. It was already hitting 105 and 108 in Amarillo and Dallas this last weekend. That’s nuts. 

Why They Did It

Diagnostic testing and treatment recommendations can vary when medical care is sought by individuals for low back pain (LBP), leading to variation in quality and costs of care. We examine how the first provider seen by an individual at initial diagnosis of LBP influences downstream utilization and costs.

How They Did It

  • They used national private health insurance claims data on  3,799,593 individuals, 
  • Subjects were individuals aged 18 or older 
  • They were retrospectively assigned to cohorts based on the first provider seen for their low back pain
  • They excluded those with back pain, serious conditions, or opioid script in the 6 months prior to the study
  • Outcome measures included imaging, back surgery rates, hospitalization rates, emergency department visits, early- and long-term opioid use, and costs (out-of-pocket and total costs of care). 

What They Found

  • Cost and utilization varied considerably based on the first provider seen by the patient. 
  • The frequency of early opioid prescription was significantly lower when care began with an acupuncturist or chiropractor, and highest for those who began with an emergency medicine physician or advanced practice registered nurse (APRN). 
  • Long-term opioid prescriptions were low across most providers except physical medicine and rehabilitation physicians and APRNs. 
  • The frequency and time to serious illness varied little across providers. 
  • The total cost of care was lowest when starting with a chiropractor ($5093) or primary care physician ($5660), and highest when starting with an orthopedist ($9434) or acupuncturist ($9205).

Wrap It Up

The first provider seen by individuals with LBP was associated with large differences in health care utilization, opioid prescriptions, and cost while there were no differences in delays in diagnosis of serious illness. Frequency and time to serious illness varied little across providers and the total cost of care was the lowest when starting with a chiropractor.  Superhero sounds engaged. 

 

Boom, snap, slap, kachow, frickin’ face chop. 

So why in the holy mother of common sense are we not being flooded with pain patients coming from the medical community? How is it possible? We keep seeing papers just like this. This just happens to be the newest one. We’ve seen multitudes of this same result.  Evidence-based and patient-centered chiropractic saves money, get patients equal or better outcomes, patients are more satisfied with chiropractic care, and we save the patient and the system money. 

That’s it, the end of the story. It’s time for a profession that acts as they stand on the shoulders of mother evidence and research….like the medical profession, for example….. to begin paying attention to its own damn research and making it mandatory for spinal and joint pain patients to go to an evidence-based, patient-centered chiropractor first for 2 weeks before they even think of making a different move.  If they’re not doing that, they’re 100% ignoring just about every bit of research I’ve seen on this topic in the past 10 years.

Dr. Christine Goertz once told me that it takes on average 18 years for research to filter down to the everyday provider in the field.  So…..just like 8 more years before our offices are inundated, right? That is if they don’t cure chronic pain first.  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. 

Store

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

The Message

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

Key Point:

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

Connect

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

Harwood, K. J., Pines, J.M., Andrilla, C.H.A., (2022). “Where to start? A two stage residual inclusion approach to estimating influence of the initial provider on health care utilization and costs for low back pain in the US.” BMC Health Serv Res 22(694).  

Parisien M, L. L., Dagostino C, (2022). “Acute inflammatory response via neutrophil activation protects against the development of chronic pain.” SCIENCE TRANSLATIONAL MEDICINE 14(644).    

Exercise For Depression & Manipulation For Tendinopathy

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

 

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

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

In our Mastermind Group we have: 

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

Remember, it’s not HOW….it’s WHO.

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

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

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

Go to gettingpicases.com/cs

That’s gettingpicases.com/cs

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

Item #1

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

Item #2

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

Why They Did It

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

What They Found

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

Wrap It Up

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

Store

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

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

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

Nerve Flossing Carpal Tunnel & Catastrophizing

CF 227: Nerve Flossing Carpal Tunnel & Catastrophizing Today we’re going to talk about Nerve Flossing Carpal Tunnel & Catastrophizing But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are 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 #227 Now if you missed last week’s episode , we talked about Cognitive Behavioral Therapy & Restless Leg Syndrome. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

Well if you listened to me last week, then you heard me struggling through an episode. My voice was a straight up mess, I felt pretty dang rough, and really just wanted to be at home in my bed. That business went on for a few more days. I finally figured out that I had COVID. What the hell. Isn’t COVID over? Apparently not.  At this point, I’m 8 days out from the first day I felt crummy. I just have a stuffy nose and coughing some stuff out of my chest here and there but doing pretty good overall.  I’m just glad I got the omicron brand rather than the DeltaVID or the OG-VID I was beginning to think I was immune.

I had an employee that had the antibodies but never got sick. I figured that was me. I guess not. So, I should be good to go with the Rona for like six months before I get it again. Lol So last week was a bust and I have a short week this week as I head to Florida to meet my buddies in St Augustine fir the MCM Mastermind that Kevin Christie began.  It’s an outstanding group of providers. I don’t know if there are any seats left in the group but if you’d like to join the group, gimme a holler.

The next trip and meeting is July 22 in Sarasota. Let’s get to it. Before we do though, I recently connected with a dude.  we all know that the number one type of case that we want is a personal injury case – they are gold because the clients are more compliant, and we get paid at rates far above insurance or Medicare or Medicaid. The patient’s attorney tells them to go for treatment as doing so enhances their legal case and gets them more money. That’s on their end of it but we know less medical providers will accept their cases and they need treatment. And we can help. 

The problem is, how do we get PI cases?  Attorneys don’t generally respond to your invitation for lunch. And let’s face it, they’re a touch bunch. I have the answer. An attorney I know has put together a system, that is both in written and video form, that shares how to approach attorneys and get them to send their PI clients to you. This is the real deal. Attorney Paul Samakow’s system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment. Go to gettingpicases.com/cs That’s gettingpicases.com/cs One more time so you get it right:   gettingpicases.com/cs 

Item #1

The first one is called “Peripheral and Central Adaptations After a Median Nerve Neruomobilization Program Completed by Individuals With Carpal Tunnel Syndrome: An Exploratory mechanistic Study using Musculoskeletal Ultrasound Imaging and Transcranial Magnetic Stimulation” by Paquette et. al. (Paquette P 2020) and published in the Journal Of Manipulative and Physiological Therapeutics on August of 2020. It’s just steamy….not too enfuego on this day.  Why They Did It The authors say, “This exploratory and mechanistic study aims to evaluate the potential peripheral and central adaptations that may result in individuals with CTS who have completed a neuromobilization program.” How They Did It

  • Fourteen individuals with CTS were evaluated 
  • Evaluation were before and 1 week after the completion of a 4-week neuromobilization program that incorporated median nerve sliding exercises. 
  • Pain and upper limb functional abilities were assessed using standardized questionnaires. 
  • The biological integrity and mechanical properties of the median nerve and the corticospinal excitability were quantified using musculoskeletal ultrasound imaging and transcranial magnetic stimulation, respectively.

What They Found

  • Upon completion of the program, participants reported both large and moderate improvements in pain and upper limb functional abilities, respectively. 
  • The biological integrity and mechanical properties of the median nerve remained unchanged, whereas a small significant increase in corticospinal excitability was observed.

Wrap It Up The proposed neuromobilization program appears promising to improve pain and upper limb functional abilities in individuals with CTS. These improvements may be preferentially mediated via central, rather than peripheral, adaptations. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

The last one today is called, “Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up” by Schumann et. al. (Matthew E Schumann 2021) and published in Pain Medicine in September of 2021 and THAT one is enfuego today. 

Why They Did It

“To prospectively evaluate interdisciplinary pain rehabilitation outcomes, as well as to evaluate the mediating effects of both pain catastrophizing and pain self-efficacy on outcome.”

How They Did It

  • 315 patients with chronic pain participated
  • They completed a 3-week interdisciplinary pain rehabilitation program. 
  • Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, depressive symptom questionnaires, and measures of physical performance were assessed before and after treatment. 
  • Follow-up questionnaires were returned by 163 participants. 
  • Effect size and reliable change analyses were conducted from pre- to posttreatment and from pretreatment to 6-month follow-up. 
  • Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome.

What They Found

  • Significant improvements from pre- to posttreatment in pain outcomes were observed, and more than 80% evidenced a reliable change in at least one pain-relevant measure. 
  • Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes.

Wrap It Up

Interdisciplinary pain rehabilitation is an effective treatment, and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains. So when you’re managing your words and managing the patients’ yellow flags as much as you’re managing the bio aspect of the condition, then you’re on the right track.  If you only manage the bio part and ignore the psychosocial parts, you only get 1/3 of the equation and potentially only 1/3 of the improvement.

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

 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

Matthew E Schumann, P., Brandon J Coombes, PhD, Keith E Gascho, Jr., Jennifer R Geske, Mary C McDermott, APRN, CNP, DNP, MS, Eleshia J Morrison, PhD, Andrea L Reynolds, PT, Jessica L Bernau, RN, Wesley P Gilliam, PhD, (2021). “Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up.” Pain Med 23(4): 697-706.  

Paquette P, H. J., Gagnon D, (2020). “Peripheral and Central Adaptations After a Median Nerve Neuromobilization Program Completed by Individuals With Carpal Tunnel Syndrome: An Exploratory Mechanistic Study Using Musculoskeletal Ultrasound Imaging and Transcranial Magnetic Stimulation.” J Man Physiol Ther 43(6): P566-578.    

Kids’ Mental Status & Zero Calorie Drinks

CF 223: Kids’ Mental Status & Zero Calorie Drinks Today we’re going to talk about the children, how are they doing lately? And then we’ll talk about whether low or no calorie beverages have any real use for us.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are 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 #223 Now if you missed last week’s episode, we talked about Forward Head Posture And Spinal Manipulative Therapy Effectiveness. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Let’s talk about marketing. I always share what I’m doing and how it’s working with you folks and while business is coming back, that’s just the natural flow. We expect to start getting busy again in March. I’m looking for marketing that moves the needle.  I’ve tried social media marketing campaigns that cost me in excess of $4500. For basically nothing. I might as well stuffed that money into my ears and lit it on fire and did a rain dance. It was useless.  Here’s something to know about me……I can be talked into just about anything.

I believe people and always look for the best in them. Or at least try to. So, yeah….I can either be talked into anything or, as is often the case, talk MYSELF into anything.  Here’s my life; I create all of our social media posts. I write my own blog every week. I record my own video and edit it every week for YouTube and Facebook. That’s in between 40+ patients a day and 20+ new patients per week and writing and recording a podcast, real estate, voice-over, and anything else in there including being a husband and a dad.  It’s time for some help and hopefully some effective help. 

I told you how I started with a new idea of lead magnets a few weeks ago. Not a lot happening there. As expected. I hoped…..but feared not much would come of it outside of an absence of my money. So far, it’s an absence of my money but I’m stubborn and not giving up just yet.  This lead magnet is for our testosterone hormone pellets. My thinking is that if it works for the pellets, then we will expand the concept and keep trucking with different products and services for the lead magnets. Still testing there and will update as needed.  I’m also starting with a new crew from England on social media marketing. I got the welcome packet today. My thinking is that my consultation payments for this medical integration are finished this month.

So that frees up some funds to put toward something else and there are not many things more important than marketing. So, I’m getting going with another group today to test them out and see how we can grow my stuff.  If it’s awesome, maybe I can make them a sponsor of the show and share them with you too. We’ll see.  A little tip from you Ol Uncle Jeffro, if you didn’t do it in January, do it now. Sit down with your key employee and go from month to month to plan out what you’re going to do for marketing.

What key events do you need to have a presence at, etc. Do you want to do a Mother’s Day promotion? What about a July 4th cookout at the office? That type of deal. When it’s planned, you don’t forget about it and it doesn’t sneak up on you.  Since I’m trying to delegate marketing more and more to my staff, I have the global marketing sheet but I also have started a weekly focus sheet.

So my marketing focus this week is to stress ‘no wait times for our NP, social media posts for the whole week, 2x/day, 1-2 videos for the week.  We’ll see, I think I have swimmers and not sinkers so we’ll see.  Continuing in the debacle of trying to find a front desk staffer, we have run into yet another snafu. This time we found a good one. Or so we thought. She worked with us for almost 2 full weeks. Then came St. Patty’s day. She ended up in a ditch running from the police and driving drunk at 2:00 am. She missed work the next day. Not because of a hangover but because she was in jail.  A little more research told us that she didn’t have custody of her kiddo because of 2 previous DWIs and this was her 3rd. So…..while you don’t want to be the one to compound someone’s suffering and misery, we had to cut ties. 

  1. If she lost custody of her kid because of drinking and still didn’t get the message, it’s going to be a long road
  2. If we’re missing work in the first 10 days because of jail, that’s just a bad omen of things to come
  3. If this is her 3rd DWI, she’s going to do jail time and we need an employee that is here and dependable. 
  4. If she miraculously doesn’t do jail time, she’ll be doing rehab, counseling, community services, court dates, and all that good stuff. And all of that equals time out of work. 

There are more reasons but that’s enough. We had to move on. I’ve always shied away from hiring friends because I just see that always going bad and it causing an awkward problem down the road. However, we started having one of our buddies come up to the office on a part-time basis to help us out on some overflow work and Holy guacamole….she’s insane good at the front desk stuff.  So….maybe we have a new front desk person after all. The saga continues and I’ll keep you updated. Stay tuned.  Alright to the research we go!

Item #1

This one is called “Five-Year Trends in US Children’s Health and Well-being, 2016-2020” by Lebrun-Harris et. al. (Lebrun-Harris LA 2022) and published in Jama Pediatrics on March 14, 2022. Holy fires of hell, it’s en Fuego!

Why They Did It

The authors say they aimed to examine recent trends in children’s health-related measures, including significant changes between 2019 and 2020 that might be attributed to the COVID-19 pandemic.

How They Did It

  • 174,551 children included in the study
  • Annual data were examined from the National Survey of Children’s Health (2016-2020), 
  • It was a population-based, nationally representative survey of randomly selected children. 

What They Found

  • Increased Anxiety
  • Increased depression
  • Decreases in daily physical activity
  • Decreases in parent or caregiver mental health
  • Decreases in coping with parenting demands

From 2019-2020 – the pandemic

  1. Increases in behavior or conduct problems
  2. Child care disruptions affecting parental employment
  3. Decreases in preventive healthcare visits
  4. increases in unmet health care needs, and 
  5. increases in the proportion of young children whose parents quit, declined, or changed jobs because of childcare problems.

Wrap It Up

Study findings point to several areas of concern that can inform future research, clinical care, policy decision-making, and programmatic investments to improve the health and well-being of children and their families. People have gone crazy. They were politically crazy and hating on each other prior to the pandemic. So let’s be honest here, shall we? But the pandemic deepened it and while technology is amazing and useful, social media has, in my opinion, destroyed the fabric of our society. Of love and understanding. Of mutual respect.  It’s allowed people to mouth off and insult each other from a distance saying things and in behaving in a manner that they would never behave like if the person they’re disrespecting were standing directly in front of them.  Anyway, kids are resilient but they’ve been affected too. Our world has gotten more stressful and it’s showing. 

Item #2

This second one is called, “Association of Low- and No-Calorie Sweetened Beverages as a Replacement for Sugar-Sweetened Beverages With Body Weight and Cardiometabolic Risk: A Systematic Review and Meta-analysis” by McGlynn et. al. and published in JAMA Network Open on March 14, 2022. Schiza – Steamy

Why They Did It

There are concerns that low- and no-calorie sweetened beverages do not have established benefits, with major dietary guidelines recommending the use of water and not low- and no-calorie sweetened beverages to replace sugar-sweetened beverages. Whether low- and no-calorie sweetened beverages as a substitute can yield similar improvements in cardiometabolic risk factors vs water in their intended substitution for sugar-sweetened drinks is unclear. To assess the association of low- and no-calorie sweetened beverages with body weight and cardiometabolic risk factors in adults with and without diabetes.

How They Did It

  • Data were extracted and risk of bias was assessed by 2 independent reviewers
  • The primary outcome was body weight. Secondary outcomes were other measures of adiposity, glycemic control, blood lipids, blood pressure, measures of nonalcoholic fatty liver disease, and uric acid.
  • A total of 17 RCTs with 24 trial comparisons were included, involving 1733 adults

What They Found

I’m not going to tell you. Because it gets very technical and in the weeds as they say. You’ll start wandering off into the ether and thinking about things like….is there another word for Thesaurus? And if you were to choke a Smurf…..what color would they turn?

Wrap It Up

This systematic review and meta-analysis found that using low- and no-calorie sweetened beverages as an intended substitute for sugar-sweetened beverages was associated with small improvements in body weight and cardiometabolic risk factors without evidence of harm and had a similar direction of benefit as water substitution.  The evidence supports the use of low- and no-calorie sweetened beverages as an alternative replacement strategy over the moderate term in adults with overweight or obesity who are at risk for or have diabetes.

This is amazing because I’ve been off of sodas for a decade but recently discovered a new love for Coke Zero. My wife has been all over me about drinking them and now I can show her research that says maybe they’re not as bad as she thinks.  And at the end of the day, I take some satisfaction in being right. : ) 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. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  Bibliography Lebrun-Harris LA, G. R., Kogan MD, Warren MD, (2022). “Five-Year Trends in US Children’s Health and Well-being, 2016-2020.” JAMA Pediatr.      

Return To Play After Herniation & Water vs. PT Exercises

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!

Chiropractic evidence-based products

Integrating Chiropractors

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

  • 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 [email protected].

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. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

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.        

MCM Mastermind & CAM Acceptance Among Medical Specialists

CF 215: MCM Mastermind & CAM Acceptance Among Medical Specialists Today we’re going to talk about the MCM Mastermind and CAM acceptance in the medical community.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are 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 #215 Now if you missed last week’s episode , we talked about Sitting On Your Butt And The Future Of American Pain . Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I just returned from Delray Beach Florida. I am part of a nationwide mastermind group started and led by Dr Kevin Christie. Kevin has been a guest on our podcast and I on his. He is the host of the Modern Chiropractic Marketing podcast and author of the book as well. Super guy. Super doc. Superhuman being.

He just is and I’m honored to know him and call him a friend. He’s a guy you want to root for, learn from, and help. And get help from I might add. This group is about 15 strong as of now but is going to grow. If I get to talking about it and you are interested in being a part of the group, Kevin told me there are some open spots but it is limited. The group will be limited in size to facilitate a tight knit and highly effective group.

The group is high functioning and the docs are accomplished and doing some pretty cool stuff. The point of the mastermind is to get together and form a solid network. To solve each others’ problems and to sol learn from each other and from the special speakers Kevin has signed up to present.

Four trips to Florida. Delray Beach was #1. In April we meet in St. Augustine, FL. In July it’s Sarasota. And in November we are meeting at the Playa Largo resort in Key Largo in the Florida Keys!

Some of the members are me of course, Ben Fergus of the GRIP method, Mark King of The Motion Palpation Institute, Jay Greenstein of Kaizohealth, Kevin. Lots of key members from all over the nation.

So day 1 we were presented to by Jay Greenstein about teamwork, communications with your team, problem-solving with your team, working through and prioritizing your issues, coming up with ideas for approaching them, and lots and lots of other stuff.

Look folks: real talk here, I’ve been following Jay for a few years now and if you don’t know him, please go figure out who he is and see if you can learn something from him. He couldn’t have been better and this meeting could not have been more timely for me. Good time to get jazzed.

Now, why a mastermind? I tried practice management companies and they suck mostly. They’re mostly vitalistic. They don’t typically follow guidelines and they are doctor-centered. Again for the most part. So….they’re out.

I was a member of a mastermind group in Dallas got a couple of years and my practice growth was awesome. My personal growth was even more significant. My reputation and network in the state in this profession were a result of the mastermind and that has been priceless.

We learned from the group leader but even more magic happened outside of the classroom. In the bars and around the lunch tables. In our interactions with each other after we went back home.

Those folks are still some of my best friends in the profession.

So, when Kevin asked me if I’d like to be a member of his mastermind, and he told me the price, which I thought was right on target, I jumped. Masterminds are good for me. I do better with a network of high achievers than I do floundering solo. I’ve proven that to myself. Plus, when you consider that it’s a group of evidence-based patient-centered docs that align with my style and vision, again it’s a no-brainer

Then, do we even need to discuss how awesome 4 trips to different parts of Florida are? Come on seriously. So, I love this group. I like where it’s headed. If you are evidence-based and patient-centered, you are high functioning and have valuable and creative ideas to share with the group while you learn others’ great ideas, and you’d like to be on the train with us, I hope you’ll reach out to me or Kevin.

My email is [email protected] and Kevin’s is [email protected]

Lemme be clear, Kevin is the leader and will make the decisions on who is right for the group but if you’d like to send me an email, I’ll get y’all connected.

OK, so even though we are onboarding a new back-office staff while in the process of re-hiring front desk staff after the last one only lasted 8 weeks, and even though the real estate investment in Lubbock STILL has lots of work left to get done before we can rent it out,

I’m STILL jazzed and excited from this mastermind weekend. Now, I gotta get to the research so I can go implant some of the stuff I learned this weekend! Since I’m playing catch up from being gone, we’re just covering one paper today.

It’s the best I can do this week! 

Item #1

This one is called, “Acceptance and use of complementary and alternative medicine among medical specialists: a 15-year systematic review and data synthesis” by Phutrakool, et. al. and published in BMC on January 14, 2022 and you can see it sizzle. Foggin up the glasses. Steamy!

Why They Did It

Complementary and Alternative Medicine (CAM) has gained popularity among the general population, but its acceptance and use among medical specialists have been inconclusive. This systematic review aimed to identify relevant studies and synthesize survey data on the acceptance and use of CAM among medical specialists.

How They Did It

  • The authors conducted a systematic literature search in PubMed and Scopus databases for the acceptance and use of CAM among medical specialists. 
  • Each article was assessed by two screeners. 
  • Only survey studies relevant to the acceptance and use of CAM among medical specialists were reviewed. 
  • Of 5628 articles published between 2002 and 2017, 25 fulfilled the selection criteria. 
  • Ten medical specialties were included: Internal Medicine, Pediatrics, Obstetrics and Gynecology, Anesthesiology, Surgery, Family Medicine, Physical Medicine and Rehabilitation, Psychiatry and Neurology, Otolaryngology, and Neurological Surgery

What They Found

  • The overall acceptance of CAM was 52%. 
  • Family Medicine reported the highest acceptance, followed by Psychiatry and Neurology, Neurological Surgery, Obstetrics and Gynecology, Pediatrics, Anesthesiology, Physical Medicine and Rehabilitation, Internal Medicine, and Surgery. 
  • The overall use of CAM was 45%. 
  • The highest use of CAM was by the Obstetrics and Gynecology, followed by Family Medicine, Psychiatry and Neurology, Pediatrics, Otolaryngology, Anesthesiology, Internal Medicine, Physical Medicine and Rehabilitation, and Surgery. 

Wrap It Up

Acceptance and use of CAM varied across medical specialists. CAM was accepted and used the most by Family Medicine but the least by Surgery. Findings from this systematic review could be useful for the strategic harmonization of CAM and conventional medical practice. And surgery doesn’t utilize us because we cost them money. When we are keeping patients from having surgery, they’re not getting paid. Is that really why? I don’t know, of course. But there has to be some financial incentives with surgeons. Those guys and girls are getting tens of thousands of dollars per fusion, discectomy, etc. Is the incentive low for searching out cost-effective ways to avoid surgery?  My off-the-cuff response is…..yeah, the incentive is low. 

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. 

 

Store

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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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    

What Sitting On Your Butt Will Get You & Catastrophizing An MRI Result

CF 180: What Sitting On Your Butt Will Get You & Catastrophizing An MRI Result Today we’re going to talk about sitting on your butt and we’ll talk about catastrophizing from an image.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #180 Now if you missed last week’s episode, we talked about the alarming rising death rate among the working-age population and we discussed the role nutrition can play in chronic pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

It’s going to be a short one this week. I have to fit a full week if work responsibilities into three days because I’m taking off Thursday through Tuesday. My wife and kids and I are heading out to New Orleans to get fat and drink funny drinks.  I love Louisiana. I was in the football team at West Texas State for one semester before transferring to Northwestern Louisiana in Natchitoches. Same town Steel Magnolias was filmed in. Absolutely gorgeous. Going from the Texas Panhandle to Louisiana was a culture shock y’all. Whole different wonderful world. I tell people that you simply cannot spend any amount of real-time in Louisiana without absolutely falling in love with the people, the music, the culture, the food…..the VIBE. It’s special. We like to travel. I’ve told you here several times that you need a trip at least once per quarter. Something to look forward to. Something to work toward.  Once we see a place, it’s time to move on and see something else. There are too many places to see in the world to be going back to the same ol’ places all of the time.

Except for New Orleans. We go back just as often as we get the opportunity to.

It’s somewhat close and we love it So, we’re going this week. And I have to keep it short. The medical integration is going slowly. Business is steady but not Pre- Covid numbers. I’m frustrated with that if Imm. Ring honest and I’m always honest with you all. It’s really kind of pissing me off. But I’m a Christian. It’s not always in my hands. Good luck looks a whole lot like hard hard work. So do what’s right. Treat people right. Love folks. It’ll work out. Just be prepared and try to be a learn it all instead of a know it all. Here we go. But first, let’s hear from our amazing, practice-changing sponsors!

CHIROUP ADVERTISEMENT

Item #1

The first item up is called “The Association Between Leisure-time Physical Activity, Sedentary Behavior, and Low Back Pain: A Cross-sectional Analysis in Primary Care Settings” by Lemes, et. al. [1] and published in Spine Journal on May 1, 2021 Hot tamale, hot tamale….get ‘em while they’re good ’n’ hot!

Why They Did It To investigate the association between leisure-time physical activity (LTPA) and low back pain (LBP) in adults from primary care settings, and to explore how sedentary behavior influences this association.

How They Did It

  • Cross-sectional analysis of an ongoing longitudinal study with adults from Bauru, Brazil – that was 557 individuals.
  • Data on physical activity, sitting time, LBP, BMI, and chronic diseases were assessed by face-to-face interviews, physical evaluation, and medical records. 
  • Sociodemographic, behavioral, and health variables were used as covariables in the multivariable models.

What They Found

  • The fully adjusted model showed that active participants were 33% less likely to have LBP when compared with those insufficiently active
  • A significant association was found for active participants who spent less than 3 h/day sitting but not for those who spent 3 h/day or more in sedentary activities
  • An inverse association of LTPA with LBP was observed in obese participants, but not in those with normal BMI and overweight.

Wrap It Up

Leisure-time physical activity was inversely associated with the prevalence of LBP in adults from primary care. This association was influenced by sedentary behavior and BMI.

Item #2

Our last one this week is called, “The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials” by Rajasekaran, et. al. [2] and published in European Spine Journal in March of 2021.  Pork chops and hot sauce. 

Why They Did It Inappropriate use of MRI leads to increasing interventions and surgeries for low back pain (LBP). We probed the potential effects of a routine MRI report on the patient’s perception of his spine and functional outcome of treatment. An alternate ‘clinical reporting’ was developed and tested for benefits on LBP perception.

How They Did It In Phase-I, 44 LBP patients were randomized to Group A who had a factual explanation of their MRI report or Group B, who were reassured that the MRI findings showed normal changes. The outcome was compared at 6 weeks by VAS, PSEQ-2, and SF-12. In Phase-II, clinical reporting was developed, avoiding potential catastrophizing terminologies. In Phase-III, 20 MRIs were reported by both routine and clinical methods. The effects of the two methods were tested on four categories of health care professionals (HCP) who read them blinded on their assessment of the severity of disease, possible treatment required, and the probability of surgery.

What They Found

  • Both groups were comparable initial by demographics and pain. 
  • After 6 weeks of treatment, Group A had a more negative perception of their spinal condition, increased catastrophization, decreased pain improvement, and poorer functional status(p = significant for all). 
  • The alternate method of clinical reporting had significant benefits in the assessment of lesser severity of the disease, shift to lesser severity of intervention and surgery in three groups of HCPs.

Wrap It Up

Routine MRI reports produce a negative perception and poor functional outcomes in LBP. Focused clinical reporting had significant benefits, which calls for the need for ‘clinical reporting’ rather than ‘Image reporting’. Words matter, folks. Words matter. If you’re telling people that they have abnormal degeneration or an abnormally straightened cervical spine and telling them how concerned you are for their future if they don’t spend 70 visits and $5,000 this year to fix it……blah blah blah.  If you’re doing this, you either don’t understand stuff and you need to do a lot more sciencing……or…..or you’re predatory, unethical, and a sorry human being that needs to reconsider how you treat your fellow humans. 

Sorry, I realize that’s harsh. But it’s the truth. If you are taking images and using them to scare people into treatment to build your clinic and your numbers, you are in the wrong business. Go sell cars. This is healthcare and people’s very lives and the quality of their lives are involved.  Learn to communicate in a positive, optimistic manner. Learn to get people moving and functioning.

Learn to address the biopsychosocial aspect of pain. Learn to use it in the patient’s favor, not in your favor. Just learn if you don’t know these things. Raise the game. If you have the chance, and you do, why not just be a big deal then? Let’s all be big deal by being learn it alls. Being ethical, moral, honest, and loving. Oh, and by acting responsibly based on the model of evidence-based, patient-centered care.  We have companies out there teaching chiropractors how to ‘close’ patients. What clowns. That’s clown stuff folks. Don’t do it. Raise the game.  Way too many shenanigans have been going on in this profession for way too long.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

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

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

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

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

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

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

Bibliography

1. Lemes ÍR, P.R., Turi Lynch BC, Codogno JS, Oliveira CB, Ross LM, Araújo Fernandes R, Monteiro HL,, The Association Between Leisure-time Physical Activity, Sedentary Behavior, and Low Back Pain: A Cross-sectional Analysis in Primary Care Settings. Spine (Phila Pa 1976), 2021. 46(9): p. 596-602. 2.

2. Rajasekaran S, D.C.R.S., Pushpa BT, Ananda KB, Ajoy Prasad S, Rishi MK,, The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials. Eur Spine J, 2021.

Working Class Rising Death Rates & Nutrition Affects Chronic Pain

CF 179: Working Class Rising Death Rates & Nutrition Affects Chronic Pain Today we’re going to talk about the fact that there are rising death rates among folks that are of working-class age. Not just the elderly. Why is that happening? Then we’ll talk about diet and chronic pain.  But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #179 Now if you missed last week’s episode , we talked about  whether chiropractors cause disc herniations or not and we talked about how family doctors still aren’t getting the message. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. This medical integration thing is about to take off. Wee ahve the contracts all drawn up, questions answered, and ready to get them all signed.  New EIN, new credentialing for me and the NP, and full steam ahead. Did you know that I have to re-credential under the new entity as well? What a pain in the backside, right? Hell yeah it is. I’m OK referring patients back and forth within the same group. You start to run into risk of getting in trouble with the Stark, anti-kickback laws when you are referring patients back and forth across different entities.  So, yeah….there’s that. I won’t bore you with the particulars but it’s definitely a ride we’re on and it’s go time.  Everything I’ve seen and experienced thus far tells me that we’re in a good spot and things are proceeding fairly smoothly. Slowly but smoothly. Next will be credentialing and that will slow everything down for a couple of months but that’s probably a good thing I’m guessing.  I’m fortunate to have a genius for a wife that understands a lot of the legal end of things that I’m just not talented at. Plus we have an attorney in Austin that literally wrote the integration law that has set it all up for us. And we have Dr. Tyce Hergert with Southlake Physical Medicine consulting us so we have a talented and very smart team.  Surrounding yourself with good people is the first step to success. We can’t be expected to be the smartest expert on everything that we encounter in our personal or professional lives. We need good people in our lives and our network. Good and talented people who have the right kind of heart for our style.  That’s exactly what I have right now so I’m very confident going forward. I don’t take big risks. I take measured, smart risks. That’s exactly where I’m at.  Alright, busy busy this week so let’s get scooting with this episode.  Item #1 This one called “High and Rising Working-Age Mortality in the US. A Report From the National Academy of Sciences, Engineering, and Medicine” by Mullan Harris, et. al. [1] published in JAMA on May 10, 2021. Servin em up steamy and saucy.  Why They Did It They say, “Life expectancy has increased in the US and in the world for the past century. In 2010, life expectancy plateaued in the US while continuing to increase in other high-income nations. In the US, life expectancy declined for 3 consecutive years (2015-2017) due primarily to an increase in mortality among working-age adults (those aged 25-64 years).1 Although the increase in mortality was first described among White middle-aged adults, mortality is now increasing among young and middle-aged adults and in all racial groups. This increase in premature death, claiming lives during the prime working ages, has important implications for individuals, families, communities, employers, and the nation.” They found that average working-age mortality rates decreased after 2010 in 16 high-income countries but increased in the US. Three causes of death were identified as chiefly responsible: (1) drug poisoning and alcohol-induced causes, (2) suicide, and (3) cardiometabolic diseases. The first category includes mortality from mental and behavioral disorders, which often involve drugs or alcohol. Cardiometabolic diseases include endocrine, nutritional, and metabolic diseases (eg, diabetes, obesity); hypertensive heart disease; and ischemic heart disease and other diseases of the circulatory system (eg, arrhythmia, cardiomyopathy, heart failure). Drug and alcohol use were the largest contributors to increasing mortality among working-age adults, accounting for 8% (an estimated 1.3 million) of deaths in this population between 1990 and 2017 (an average of 44 869 per year). The increase was largest among White male adults and older Black male adults. They go on. They say, “The drug crisis was the product of 2 influences: an increase in access to legal and illegal drugs and the vulnerability of certain populations. The licensing of OxyContin in 1996, subsequent flooding of the market with prescribed opioids, and waves of highly potent heroin and fentanyl that coincided with growing demand for these substances have been described as a perfect storm.3 The drug supply expanded with limited government oversight, substantial marketing by the pharmaceutical industry, and overprescribing by physicians.” With regards to Suicide, they say, “Suicide, which accounted for 569 099 deaths among working-age adults during 1990-2017 (an average of 20 325 per year), increased primarily among White adults, especially White men, and in less populated, rural areas. Few studies have established a cause for this trend. Economic stresses are a possibility; suicide is associated with economic downturns, wage stagnation, weak health care safety nets, and foreclosures.4 Another potential contributing factor is declining social support from churches, civic organizations, and families. Such social supports, which protect against self-harm, have declined in recent decades, especially among lower-educated White adults. Easier access to firearms is associated with increased suicide rates; however, the greater increase in nonfirearm suicides during this period suggests other causes. Other risk factors for suicide include mental illness, comorbid conditions, disability, and substance use.” With regard to cardiometabolic disease they say, “Cardiometabolic diseases caused more than an estimated 4.8 million deaths among working-age adults during 1990-2017 (an average of 173 062 per year). The largest relative increases in cardiometabolic mortality occurred among younger adults (aged 24-44 years) in all racial/ethnic groups, White men and women, Black men (in recent decades), and those living in rural areas. Cardiometabolic mortality rates increased after 2010 for 2 reasons: (1) mortality from endocrine, nutritional, and metabolic diseases and hypertensive heart disease generally increased during 1990-2017 and (2) after a period of substantial reductions in mortality from ischemic heart disease and other circulatory diseases from the 1970s onward, progress stalled after 2010.” “The report discusses 3 explanations for this trend. First, the most important was the increased prevalence of obesity and its cardiometabolic consequences. Obesity rates increased in the early 1980s as a period-based phenomenon that affected the entire population, but the related cardiometabolic consequences occurred in a cohort fashion; younger cohorts born in the 1970s-1990s experienced obesogenic environments their entire lives, whereas exposure in older cohorts was limited to older ages.5 As a result, many young adults are entering their work lives with a high prevalence of chronic diseases associated with obesity. “ “The recent increase in mortality among working-age adults shows no signs of receding. Obesity rates are unrelenting, drug- and alcohol-related deaths and suicide rates, already high among working-age adults, increased during the COVID-19 pandemic” So what does all of that mean? Well, it means we are providers and we need to know this stuff and be aware of it. We need to be able to refer to specialists when we see the signs of drug or alcohol abuse, suicidal tendencies, or nutritional concerns.  It’s not just a, “‘hey he should get his crap together while he still can.” It’s a little more immediate than that I think .  CHIROUP ADVERTISEMENT Item #2 Item 2 today is called “Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis”” by Field et. al. [2] published in Pain Medicine on November 17, 2020 and that’s a bit roasty.  Why They Did It The standard Western diet is high in processed hyperpalatable foods that displace nutrient-dense whole foods, leading to inflammation and oxidative stress. There is limited research on how these adverse metabolic drivers may be associated with maladaptive neuroplasticity seen in chronic pain and whether this could be attenuated by a targeted nutritional approach. The aim of this study was to review the evidence for whole-food dietary interventions in chronic pain management. How They Did It
  • A structured search of eight databases was performed up to December 2019.
  • A meta-analysis was performed in Review Manager.
  • Forty-three studies reporting on 48 chronic pain groups receiving a whole-food dietary intervention were identified
What They Found
  • A visual analog scale was the most commonly reported pain outcome measure, with 17 groups reporting a clinically objective improvement
  • Twenty-seven studies reported significant improvement on secondary metabolic measures.
  • Twenty-five groups were included in a meta-analysis that showed a significant finding for the effect of diet on pain reduction when grouped by diet type or chronic pain type.
Wrap It Up There is an overall positive effect of whole-food diets on pain, with no single diet standing out in effectiveness. This suggests that commonalities among approaches (e.g., diet quality, nutrient density, weight loss) may all be involved in modulating pain physiology   Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats 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
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography 1. Harris KM, W.S., Gaskin DJ,, High and Rising Working-Age Mortality in the US: A Report From the National Academy of Sciences, Engineering, and Medicine. JAMA, 2021. 2. Rowena Field, M.P., Fereshteh Pourkazemi, PhD, Jessica Turton, Kieron Rooney PhD,, Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis. Pain Med, 2020. 22(3): p. 694-714.

Breathing Through The Pain, Need For Rehab, & Forward Head Posture And Shoulder Pain

CF 164: Breathing Through The Pain, Need For Rehab, & Forward Head Posture And Shoulder Pain

Today we’re going to talk about the impact of chiropractic care on opioid use and then we’ll talk about garbage marketing in the chiropractic profession. I go off a bit. I can’t help it. They make me nuts. 

But first, here’s that sweet sweet bumper music.

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  If this episode has a different type of sound quality when compared to previous episodes, my main computer died. It choked a little and held it’s belly and rolled around in agony for about a month and then…..sadly, it straight up and died. 

So, I have another ordered and in the meantime, I’m figuring out how to do this through my MacBook Pro. Where there’s a will, there’s a way. We’ll make it happen.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #164 Now if you missed last week’s episode, we talked about opioids and spinal pain and then we talked about vitalists’ scripts. That was about the point that I lost my mind momentarily. Because they make me crazy and all.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Wow, what a week I had last week, y’all. And I’m not talking in a good way. Oh hell no. This was one of those kick you in the face and in the backside. And when you’re falling to the ground, putting a boot in your ribs for good measure.  One word, two syllables. Day-um.  For patients that I’m comfortable with, it’s common for them to ask me how my day’s going and my go-to answer is usually something similar to, “Ah you know….pissing excellence. As usual. It becomes a habit after a while.” Yeah, not last week. I wasn’t the windshield. I was the bug. 

First thing’s first, on last Tuesday, my longest tenured employee and office manager turned in her resignation. Over 11 years, down the drain. She’s not just a staff member. She’s become my little buddy. She’s hilarious. She was also our marketing girl. Definitely a boot to the face. Pow.  But there are a lot of positives there as well. Being my longest employed staffer, she was also my highest paid so we will save a good chunk of money. We just need to make some adjustments on the marketing and things of that nature.  Then, on Wednesday, as mentioned previously, we joined the Wealthability program and we had a meeting with our new accountants they matched us with. They’re out in St. Louis. Well, they found that our previous CPA was wrong and now we have to pay a gob in taxes we weren’t expecting to pay. We can spread it out over an amount of time and it’s fixable but day-um…..

Come on man.

When you hire professionals, you expect a professional job that will prevent you from getting into trouble. Don’t you? That was a kick to the nether regions. Smack.  Then, later that afternoon, my main computer that has my entire life on it straight up died. Luckily, it had slowed a bit and I called my computer guy to come in and back it up so it can be replicated on another computer. Still, that computer won’t be here for 2 damn weeks.  Kick to the shin. Thunk. 

Then, two of my girls got the second vaccine shot and both got sicker than dogs. One missed work on Wednesday. Not that big of a deal. Just kind of sucked.  Then I got a visit from a connection that works in my Dad’s nursing home. She came to my house on Thursday night after work to tell me my Dad is being mistreated and is withering away.  Stomp to the noggin while I’m down. Snap.  There were some other little things here and there but you get the picture. Rough week. But we’re on the mend.

We’re heading the right direction this week I think. We have some good ideas and I think we are going to make some changes.  So, as a learning lesson, bad things can be used for an impetus to change course and go in a positive direction. For example, I’ve begun going down the path of fully integrating. I’m saving enough money with the departure of my manager that I can use that money toward integrating and hiring a nurse practitioner. 

This would fit my long term plan of being able to remove myself from my day to day practice. It’s a piece of the puzzle. The final piece of the puzzle would be hiring an associate. At that point, I believe my time begins to get freed up a bit.  Hopefully in five years, I’m mentoring my colleagues and teaching them how to accomplish what I’ve accomplished. I’m sharing wisdom with hungry evidence-based chiros and spreading the good news about evidence-based, patient-centered chiropractic care.  We’re going to get there.  In other news, last week wasn’t a total loss. You may have seen where the Texas Chiropractors, after a ten-year battle, put the smackdown on the Texas Medical Association. People’s elbow, Kabam!!

The biggest bully of bullies got slapped the hell around by the Texas Chiropractic Association and the Texas Board of Chiropractic Examiners at the Texas Supreme Court level.  Just briefly, the TMA had sued the TCA and the TBCE approximately 10 years ago over our right to perform the VONT testing. Also known as vestibulo-ocular nystagmus test. Then that morphed into attacking our rights to diagnose and our rights to treat the Neuromusculoskeletal system rather than just the musculoskeletal system. Seemingly silly little things but, if they had won, technically, we couldn’t treat anything having to do with ‘nerve’ and we couldn’t have diagnosed our own patients so we’d depend on referrals from medical professionals……and how do you think that would have turned out in the long run?

Not good for an chiropractor on the planet because other medical associations would have precedence and would have repeated the process. Those of us in leadership positions for the TCA have been well-aware for the last decade that if we lost this case, we would be the first domino and it would effect every other chiropractor.  We lost, then we lost the appeal, then the Texas Supreme Court gave us the win. And the Texas Medical Association, the most predatory state medical association in the United States, has to cover the court costs. Oh, and on top of that, they can suck it.  We are going to have an entire episode where I’ll be joined by my fellow TCA members. Folks that have been the deepest in the trenches on this case and know every in and out of the entire process.  It’s going to be a good one so keep a lookout for that one.  Alright, let’s get to the good stuff shall we?

Item #1

This first one is called, “Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms” by Jafari, et. al. (1) and published in the Journal Of Pain in September/October of 2020. It’s not a lot hot but hot enough!

Why They Did It

This study sought to investigate effects of instructed breathing patterns on experimental heat pain and to explore possible mechanisms of action

How They Did It

  • In a within-subject experimental design, 48 healthy volunteers performed 4 breathing patterns: 
      1. Unpaced breathing, 
      2. Paced breathing (PB) at the participant’s spontaneous breathing frequency, 
      3. Slow deep breathing at 6 breaths per minute with a high inspiration/expiration ratio (SDB-H), and 
      4. Slow deep breathing at 6 breaths per minute with a low inspiration/expiration ratio (SDB-L)
  • During presentation of each breathing pattern, participants received painful heat stimuli of 3 different temperatures and rated each stimulus on pain intensity
  • Respiration, heart rate, and blood pressure were recorded.

What They Found

Compared to unpaced breathing, participants reported less intense pain during each of the 3 instructed breathing patterns.

Wrap It Up

Slow deep breathing is more efficacious to attenuate pain when breathing is paced at a slow rhythm with an expiration that is long relative to inspiration, but the underlying mechanisms remain to be elucidated. Oh…..elucidated. That’s a $5 word for the research crew there. Congrats on elucidated, folks. 

CHIROUP ADVERTISEMENT

Item #2

This one is called, “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019” by Cieza, et. al.  (2) and published in The Lancet on December 19, 2020. Smokin’, sizzlin’, steamy pot of chili pie.  I have learned, by the way, that Frito Pies are not an American thing.  It’s just mostly a Texan thing. I have eaten Frito pies my whole damn life and didn’t figure this factoid out until just a few years ago. I play Call Of Duty here and there on xbox.

I know….I’m a nerd but I’m a killing’ nerd on occasion! I can kill real people in a fake way right there with the best of them when I want to. And I have my glasses on. And I haven’t had any more than a few beers. Lol.  Anyway, I play with a dude from Louisville, KY and he’d never heard of Frito pies. Holy cow people. There are some things you need to get tuned into if you’re not from Texas. They are as follows:

    • Frito Pie
    • Fried Okra
    • Fried squash. 

Yes, all are terrible for you so…..as a priest told me at the bar back when I went to college in Louisiana and was asking him how this whole ‘priest being in a bar’ worked out….he said, “Everything in moderation, Brother.” We should probably get back to the paper, Y’all. 

Why They Did It

Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritized in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury.

How They Did It

To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability of 25 diseases, impairments, etc. 

What They Found

  • Globally, in 2019, 2.41 billion individuals had conditions that would benefit from rehabilitation, contributing to 310 million years of life lived with disability
  • This number had increased by 63% from 1990 to 2019
  • The disease area that contributed most to prevalence was musculoskeletal disorders with low back pain being the most prevalent condition in 134 of the 204 countries analyzed.

Wrap It Up

The authors wrap up their thoughts with this, “To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need.”

I will add that the vitalists that think they can only adjust their way out of every damn condition or complaint need to get in the back of the line and just keep quiet. If you are going to be current rather than look like a dumb dumb, then you need to understand that a good, learned chiropractor knows that we do not only mobilize with adjustments, stretching, and things of that nature. But we also much know when to stabilize through strengthening activities.  If you’re just hitting the high spots on all of your patients, you need to be better and raise you game. Mr. Vitalist…..I’m talking to you. 

Item #3

The last one today is called, “Does forward head posture change subacromial space in active or passive arm elevation?” By Dehqan, et. al. (3) and published in the Journal of Manual and Manipulative Therapy on November 30, of 2020 and that’s about the right amount of hot Why They Did It Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head and neck area and the shoulder girdle. The present study compared the acromiohumeral distance between individuals with normal head and neck alignment and those with moderate and severe FHP in active and passive arm elevation.

How They Did It

  • Based on the craniovertebral angle, 60 volunteers were selected and equally distributed among three groups, including group one with normal head and neck alignment, group two with moderate FHP and group three with severe FHP
  • The space between the humeral head and the acromion was measured in 10°, 45° and 60° of active and passive arm elevation as the acromiohumeral distance.

What They Found

  • The acromiohumeral distance was only different between the three groups at 45° arm elevation angle, and this difference was significant between groups one and three
  • In active and passive arm elevation, increased arm elevation angle reduced the subacromial space significantly
  • Also, in each arm elevation angle, the subacromial space differed significantly between the active and passive arm elevations.

Wrap It Up

They concluded, “The acromiohumeral distance was significantly lower in the severe FHP group than the group with normal head and neck alignment in the 45° active arm elevation angle, which could be due to the changed tension in tissues between active and passive arm elevation and also the maximum muscle activity in the 45° active arm elevation angle.”

Shoulder impingement folks.

I didn’t know anything about it until I went through he DACO program. Which is now the Neuromusculoskeletal Diplomate. It’s a real estate issue and when you have an upper cross type setup, forward head posture, you decrease the real estate.  Increase the real estate, decrease the issue in this sort of a setup.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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The Message

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

Key Point:

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

Contact

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

Connect

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

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About the Author & Host

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

Bibliography

  1. Hassan Jafari, Ali Gholamrezaei, Mathijs Franssen, Lukas Van Oudenhove, Qasim Aziz, Omer Van den Bergh, Johan W.S. Vlaeyen, Ilse Van Diest, Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms, The Journal of Pain, Volume 21, Issues 9–10, 2020, 1018-1030
  2. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vox T, Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. 396 (10267), P2006-2017, December 19, 2020.
  3. Behdokht Dehqan, Cyrus Taghizadeh Delkhoush, Majid Mirmohammadkhani & Fatemeh Ehsani (2020) Does forward head posture change subacromial space in active or passive arm elevation?, Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2020.1854010