evidence based chiropractic

Change Your Mind About Pain

CF 239: Change Your Mind About Pain Today we’re going to talk about changing your mind when it comes to pain and how looking at it differently can help our patients get in control of it. But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are 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 #239 Now if you missed last week’s episode , we talked about Benzopdiazapines and Mirror Therapy. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Folks, not a lot going on right now in practice. It seems like I’m just in a holding pattern of sorts at the moment. You’ve probably heard me mention that we’ve been slower lately. For whatever reason. That’s true. I’m not sure why. The economy, gas prices, who knows?

This week though, sitting here on a Monday morning, and counting, I have 162 patients set up for the week and we know more will jump in as the week progresses. That’s 17 new patients set up so far this week as well. That will usually bump up to about 23-25 if I’m guessing.  Whack-a-mole people. So, now that numbers are back on the rise, another hole will appear in the bucket. Another mole will pop up and have to be whacked on the noggin with my oversize sledgehammer. 

So what’s it going to be?

Patients failing to stay on their schedules because we didn’t have the time available to educate them about the schedule? Not chasing A/R with any real intention? Where’s it going to be? Who knows? It’s always a great mystery but, as one thing improves, the pipes start busting elsewhere. 

You better believe I have my eyes out too. At the ChiroTexpo event in Frisco a few weeks ago, I met a vendor that does billing, chases A/R, and things of that nature. They’re spending this week auditing our EHR billing records to make sure we’re up to speed and on target.  I’m paying particular attention to the report of findings. I don’t do anything elaborate but when I get in a hurry, I tend to simply gloss right over it and keep scooting.

Not this time. Being in the Florida Mastermind has helped me slow down and give it the importance it deserves.  And patient care will not take a step back regardless so….. We’ll see where the next a-hole mole comes popping up but believe me, I’m waiting and ready with binoculars!! Alright, let’s dive in

Item #1

Our first one this week is called, “A clinical perspective on a pain neuroscience education approach to manual therapy” by Louw et. al. (Adriaan Louw 2017)and published in the Journal of Manual and Manipulative Therapy on May 22, 2017 It’s 5 years old but I included it because it’s relevant to a lot of what I teach and talk about here on the podcast.

Before we get into these two papers today, I want you to understand that I don’t for a second discount the biomedical aspect of pain and I fully believe hands-on chiropractors are in an amazing spot and well-placed to handle the biopsychosocial pain model. But only if we understand it and know how to leverage our tools in our favor.  Otherwise, we make it worse. 

Why They Did It

In recent years, there has been an increased interest in pain neuroscience education (PNE) in physical therapy. There is growing evidence for the efficacy of PNE to decrease pain, disability, fear-avoidance, pain catastrophization, limited movement, and health care utilization in people struggling with pain. So what is PNE? PNE teaches people in pain more about the biology and physiology of their pain experience including processes such as central sensitization, peripheral sensitization, allodynia, inhibition, facilitation, neuroplasticity and more. 

PNE’s neurobiological model often finds itself at odds with traditional biomedical models used in physical therapy.  Traditional biomedical models, focusing on anatomy, pathoanatomy, and biomechanics have been shown to have limited efficacy in helping people understand their pain, especially chronic pain, and may in fact even increase a person’s pain experience by increasing fear-avoidance and pain catastrophization.  Trust me, from the stories I get from my patients, the traditional bio-medical model doesn’t just cause catastrophization, it causes downright fear and terror in some patients.  An area of physical therapy where the biomedical model is used a lot is manual therapy. I would add chiropractic to the discussion here as well. 

This contrast between PNE and manual therapy has seemingly polarized followers from each approach to see PNE as a ‘hands-off’ approach even having clinicians categorize patients as either in need of receiving PNE (with no hands-on), or hands-on with no PNE. In this paper, the authors explored the notion of PNE and manual therapy co-existing. 

PNE research has shown to have immediate effects of various clinical signs and symptoms associated with central sensitization. Using a model of sensitization, they argue that PNE can be used in a manual therapy model, especially treating someone where the nervous system has become increasingly hypervigilant. You guys and gals….if you have chronic pain patients, you have to start listening and paying attention to central sensitization, upregulated central nervous systems, cognitive behavioral therapy, mindfulness, yellow flags, fear avoidance, catastrophization, oh my.

Seriously, if these terms are unfamiliar to you, please do yourself and your patients a favor and go get the smarts. You can start the smarts right here in our podcast episodes. I talk about this stuff non-stop and have been for years here so dive in. 

It’s not one thing over the other. Either….or. It’s a broad management protocol that includes PNE, SMT, exercise, massage, yoga, tai chi, low level laser, and some other stuff all piled on top. Oh, and a good provider that communicates in a hopeful and encouraging manner.  Put the puzzle together. Start by getting the smarts. And quit being confusion as the kids would say. Do research about it. Lol. 

 

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 second one is called “Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study” by Hill et. al. (Renee J. Hill 2017) and also published in The Journal of Manual and Manipulative Therapy on May 4, 2017.  Again, yes, old man river here as far as research goes but relevant 

Why They Did It

The primary purpose of the current study was to assess the effects of a mindfulness-based stress reduction (MBSR) program, facilitated by non-psychologist clinicians, for improving psychosocial well-being.  A secondary purpose of the current study was to explore the role of self-compassion as a potential underlying factor for improvements in emotional distress.

How They Did It

  • 130 participants with a variety of medical complaints completed an eight-week mindfulness-based stress reduction program at Vanderbilt. 
  • Before treatment and at the 8-week time point, participants completed measures for emotional distress, stress, mindfulness, and self-compassion. 
  • Linear model estimation using ordinary least squares was used to evaluate the association between changes in self-compassion with changes in emotional distress.
  • I’m not going to lie….I’m ignorant of that last part. Made be feel stupid. Which, of course, isn’t hard to do. 

What They Found

  • Following mindfulness-based stress reduction, participants reported significant reductions in emotional distress. 
  • Additionally, participants reported improvements in mindfulness and self-compassion. 
  • Linear regression model revealed that changes in self-compassion were significantly associated with changes in emotional distress.

Start getting the smarts. Research at least once per day. 

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

Bibliography

Adriaan Louw, J. N. E. J. P. (2017). “A clinical perspective on a pain neuroscience education approach to manual therapy.” Journal of Manual & Manipulative Therapy 25(3): 160-168.

Renee J. Hill, L. C. M., Li Wang & Rogelio A. Coronado, (2017). “Changes in psychosocial well-being after mindfulness-based stress reduction: a prospective cohort study.” Journal of Manual & Manipulative Therapy 25(3): 128-136.      

The Importance of Movement & Steps

CF 221: The Importance of Movement & Steps Today we’re going to talk about The Importance of Movement & Steps 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 #221 Now if you missed last week’s episode, we talked about Sleep, Energy, and Pain & Depression and Rehab. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Business is still slowly creeping back up to where we’d like to see it. Now if the employee aspect of it will follow. So, I told you all we’d been a month since the 7-week front desk staffer we had quit.  So we’ve been hiring for a damn month. We found one but she needed to give her two-week notice. So we’ve been waiting on her to start.  So the Thursday before the Monday she’s supposed to start, she calls to let us know that she took another job. Holy guaca freakin moly.

Ya can’t make this stuff up. So we get in the horn….two weeks after we closed out the hiring process and started calling some of the old resumes. 

Luckily, our #2 answered and still wanted the job and she can start on Monday. The day the loser was supposed to start anyway. 

Hallelujah crap fire, save the queen, the new Batman is too damn emo and God bless America.

I’ll let you know if she lasts more than 7 weeks. I don’t have high hopes by this point in time. As the great Texas singer/songwriter Ray Wylie Hubbard once said, let’s rock n roll and hootchie coo. Here we go

Item #1

This one is called “Estimated Number of Deaths Prevented Through Increased Physical Activity Among US Adults” by Saint-Maruice et. al.  ( Saint-Maurice PF 2022) and published in Jama Internal Medicine on January 24, 2022……schiza!! It’s muy Caliente on my plate. That’s three languages right there people. 

Why They Did It

Previous studies suggest that a substantial number of deaths could be prevented annually by increasing population levels of physical activity. But they say previous attempts at quantifying it have been lackluster.  They accelerometer measurements 

  1. to examine the association of physical activity and mortality in the US
  2. to estimate the number of deaths prevented annually with modest increases in moderate-to-vigorous physical activity (MVPA).

How They Did It

It doesn’t matter. Lol. Well, technically, of course, it matters. But, you’re not going to want to hear it. Sometimes, it’s like sausage. You really don’t want to see how it’s made. You just want to enjoy the results so….let’s just enjoy the results so y’all don’t tune out on me. 

Wrap It Up In this cohort study, we estimated that approximately 110,000 deaths per year could be prevented if US adults aged 40 to 85 years or older increased their moderate-to-vigorous physical activity by a small amount (ie, 10 minutes per day). 

Item #2 Our last one this week is called, “Steps per Day and All-Cause Mortality in Middle-aged Adults in the Coronary Artery Risk Development in Young Adults Study” by Paluch et. al.  and published in JAMA Network Open on September 3, 2021. 

Why They Did It

To estimate the association of steps per day with premature (age 41-65 years) all-cause mortality among Black and White men and women.

How They Did It

  • It was a prospective cohort study. 
  • Participants were aged 38 to 50 years and wore an accelerometer from 2005 to 2006. 
  • Participants were followed for a mean of 10.8 years. 
  • Daily steps volume, classified as 
  1. low (<7000 steps/d), 
  2. moderate (7000-9999 steps/d), and 
  3. high (≥10 000 steps/d) and 
  • Stepping intensity classified as 
  1. peak 30-minute stepping rate and 
  2. time spent at 100 steps/min or more.
  • All-cause mortality was the outcome measure.
  • A total of 2110 participants from the CARDIA study were included, 

Wrap It Up

This cohort study found that among men and women in middle adulthood, participants who took approximately 7000 steps/d or more experienced lower mortality rates compared with participants taking fewer than 7000 steps/d. There was no association of step intensity with mortality. So get moving rock n roll and hootchie coo. Like you know you’re supposed to do.  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

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

Cholewicki J, P. J., Reeves NP, DeStefano L, (2021). “The Effects of Osteopathic Manipulative Treatment on Pain and Disability in Patients with Chronic Neck Pain: A Single-Blinded Randomized Controlled Trial.” PM R.  

Saint-Maurice PF, G. B., Troiano RP (2022). “Estimated Number of Deaths Prevented Through Increased Physical Activity Among US Adults.” JAMA Intern Med 182(3): 349-352.      

w/ Dr. Kevin Christie – Practice-Changing Chiropractic Masterminds

CF 218: w/ Dr. Kevin Christie – Practice-Changing Chiropractic Masterminds Today we’re going to be joined by Dr. Kevin Christie of the Modern Chiropractic Marketing podcast and also the originator of the MCM Mastermind group you’ve been hearing me talk about in the last few weeks. We’ll get to it all. The whys, wheres, goods, bads, and beauty of being in a mastermind group.  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 #218 Now if you missed last week’s episode, we talked about Telerehabilitation Effectiveness & What A Patient Really Really Wants. Make sure you don’t miss that info. Keep up with the class.     

Questions for Dr. Kevin Christie

  • Have you been a part of a mastermind in the past?
  • What is, in your mind, the real value of a Mastermind group?
  • What gave you the idea to create your own?
  • I’ve had several of my colleagues ask me what is the purpose or the mission statement
  • What kind of chiropractor is a good fit for the MCM Mastermind?
  • Do they need to be at a certain point in their career?
  • I know you did a survey of the members after the first meeting a few weeks ago down in Delray Beach. What did you get from the surveys as far as everyone’s impression of the first meeting?
  • Tell me what you like about the MCM Mastermind specifically. Other than it was your brainchild.
  • As far as the MCM Mastermind, will it stay in Florida or will you be taking it on the road in the years to come?
  • What would like to see come of it all and what are you hoping to get out of it personally and professionally?
  • Are there still a few seats at the table left?
  • How does a person that’s interested in learning more about this particular mastermind go about connecting with you on it?    

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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Chiropractic And Colicky Babies & Breathing With Thoracic Outlet Syndrome

CF 211: Chiropractic And Colicky Babies & Breathing With Thoracic Outlet Syndrome Today we’re going to talk about chiropractic and colicky babies and we talk about thoracic outlet syndrome and breathing.  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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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

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

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s 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 #211 Now if you missed last week’s episode, we talked about Manual & Passive Therapies For The Neck, and then we’ll talk about Acupuncture For Post-Surgical Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, it’s the new year now. What do you do to prepare for the New Year?? Do people still do the resolutions….new year, new me type of thing? That just seems so 10 years ago doesn’t it? For me, people ask me about that and I’m like, I just think of stuff as I go along and I just do them. I wish it were all more contrived or planned out but it’s just not. I took up painting last year and I took up investing in real estate last year as well.

Those weren’t things I planned out and storyboarded or something smart like that.  For painting, I saw a painting I really liked and thought, “” Wouldn’t that be amazing if I could do that myself?” So I started watching YouTube videos to learn and I joined a bunch of Facebook groups. I sat back and soaked in everything painting and once I was confident, we were off and running.  Real Estate, money has always been in real estate and it always will be. It’s like the saying, “ Real Estate….they’re not making any more of it.”

One day I stumbled on a podcast that changed my thinking and gave me tools to be confident. For free. It was inspiring so I soaked up podcasts and private FB groups and away we went. I just spent all day yesterday working on our short-term rental in Lubbock TX and evaluated some property in Orlando this morning.  I think there are planners and then there are do-ers. I’m a do-er. Sometimes it may seem a bit haphazard but for the most part, I noticed an opportunity or I get some inspiration, then I go into the fact-finding part of it. I identify the places I can soak up education, and I attack it trying to get all of the knowledge I can get.

I did the same with music, and sculpting, voice-over, and furniture building. I’m definitely a fact finder. 

Once I have the facts and have some confidence, I act. THAT’s the key. Acting upon your knowledge. Paralysis by analysis is a very real thing and if you simply sit on the bench studying, you miss the opportunities and watch as others are doing. It’s not fun to get lapped because you were too nervous Nelly to get into the game.  I’ve been frightened to get a nurse practitioner but have wanted to do it for years. I finally made the time to get educated on the process, I signed up for some help and mentorship, and I hired a lawyer that knew the process and the legalities of the whole thing. And here we are.

Now I have a medical clinic. I was stuck in the analysis phase for 5 or more years. Don’t do that folks. Those that win act with some level of boldness. Not stupidity or ignorance. But boldness.  So, storyboard it, vision board it, whatever works for you the best. But don’t sit on your hands thinking. Search out the knowledge, get smart on your topic of interest, and then act.  If you’re going to have a resolution this year, make the simple idea of ‘Acting’ as part of it. “”

I will lose weight, I will get more exercise in 2022, I will be a better husband, brother, son, Dad in 2022, and will grow my business in 2022, and I’ll do it all because I act upon the education is search out.” So do that. 

Item #1 This first one is called, “Respiratory dysfunction in individuals with thoracic outlet syndrome” by Saglam, et. al. (Saglam M 2020) and published in Journal of Manipulative and Physiological Therapeutics in July of 2020.

Why They Did It

The purpose of this study was to compare pulmonary function and respiratory muscle strength and endurance in individuals with thoracic outlet syndrome (TOS) and healthy participants.

How They Did It

  • Sixty-two individuals with TOS and 47 healthy individuals participated in this study. 
  • Pulmonary function testing was performed using a spirometer. 
  • Respiratory muscle strength (maximal inspiratory pressure [MIP] and maximal expiratory pressure [MEP]) were measured using a mouth pressure device. 
  • Respiratory muscle endurance was tested at 35% maximal inspiratory pressure and measured as the time in seconds from the start of the test to voluntary exhaustion.
  • Age distribution and physical characteristics were similar between the groups

What They Found

If I go through this information as it is written, you’ll get glossy eyes, start thinking about why you drive in a parkway and park in a driveway, why apartments are buildings that are all mostly attached, and I’ll lose you so we’re hopping to the wrap-up. I told you, we’re the AC/DC of chiropractic research people. 

Wrap It Up

Expiratory flow rate and respiratory muscle strength and endurance may be adversely affected in TOS. Trunk muscles perform both postural and breathing functions. Therefore, disruption in one function may negatively affect the other. Item #2 The last one today is called, “Clinical Evidence of Vestibular Dysregulation in Colicky Babies Before and After Chiropractic Treatment vs. Non-colicky Babies” by Hoeve et. al. (Hoeve’ J 2021) and published in Frontiers in Pediatrics in May of 2021 and bam, lets kick the heat up on this mamma jamma. 

Why They Did It

To date, after 65 years of research that was primarily directed at differentiating between normal and colicky crying, the cause of infantile colic remains elusive and no definitive cure has been found. Given the general absence of pathology, colicky crying is widely considered the extreme end of a spectrum of normal crying behavior.  However, evidence gleaned from scattered sources throughout the literature suggests that infantile colic may be the behavioral expression of physiological brainstem dysregulation, particularly of the vestibular and autonomic systems.  The purpose of this study is to present a five-point clinical index of vestibular (hyper) activity and its application to investigate vestibular dysregulation in colicky and non-colicky babies.

How They Did It

  • One hundred and twenty consecutive colicky babies were evaluated using this index, before and after a very gentle vibratory treatment, and compared to 117 non-colicky babies.

What They Found

  • Again, this results information isn’t audio friendly, it’s very technical, and you’ll be wandering off in your brain asking yourselves all of the great mysteries like Why isn’t phonetic spelled the way it sounds? Why are there interstate highways in Hawaii? Why are there flotation devices under plane seats instead of parachutes?

Wrap It Up

Colicky babies are not just infants who cry a lot. They also show clinical evidence of vestibular dysregulation. Treatment aimed at relaxing tight sub-occipital musculature by means of gentle vibrational stimulation may be effective in decreasing vestibular hyperactivity, signifying an improvement in brainstem regulation. The vestibular index opens the prospect for development into a tool toward an objective and practical clinical diagnosis of infantile colic. 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

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  

Bibliography Hoeve’ J (2021). “Clinical Evidence of Vestibular Dysregulation in Colicky Babies Before and After Chiropractic Treatment vs. Non-colicky Babies.” Front Ped.  

Saglam M, F. T., Vardat-Yagli N, (2020). “Respiratory dysfunction in individuals with thoracic outlet syndrome.” J Man Physiol Ther 43(6): P606-611.          

Year Four Chiropractic Forward Roundup

CF 208: Year Four Chiropractic Forward Roundup Today we’re going to re-hash the last 4 years of the Chiropractic Forward podcast on this, the 4 year anniversary of the first episode.  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 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #208 Now if you missed last week’s episode , we talked about Does Imaging Mean Better Outcomes & Melatonin Slowing Down Disc Degeneration. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

On the personal end of things nothing too crazy we’re just scooting right along as usual our new front desk car is coming along swimmingly. In fact, I don’t know what we ever did without her. She is absolutely phenomenal and makes life so much easier for my wife and myself. Which is a lesson to me. You can either hire experienced, or you can train. If you’re going to hire experience it’s going to cost you. Or does it? I had an inexperienced person that I tried to get trained over and over and over, and it ended up costing me around $750,000 over the course of three years. So wouldn’t I have been better off getting somebody who is experienced in billing and coding? And just paying a little more?

The answer is Hell yes.

This girl has been experienced she’s been a coder and a builder and a front desk staff member. And it shows. We couldn’t be happier. If you’ve been listening very long, then you know that my new side gig is investing in real estate. As such, we close on our very first investment property at the end of this week and then starts the task of placing all of the things that we have bought for it over the past two months into the house and getting it all set up and ready for VRBO and Airbnb. The first month of owning a short term rental is a bit tricky from what I’m told. We’re about to find out. But once it’s up and running finally, it’s typically fairly straight forward and somewhat self sustaining. No need to lay someone a 20% property Management fee to run it for you.

They typically take about 15-30 minutes per week to manage and it can all be done from afar since everything in a smart home is WiFi these days. Thermostats, deadbolts, alarms, ring cameras, etc. it’s awesome. I’ll continue to share as we get further into it but as of now, we’ve got about $20,000 or so into above and beyond the down payment.  Setting them up and outfitting them for travelers is a chore. For my personal life, my daughter has her first dance this week. If you don’t have any cute kids this age then you probably haven’t thought about it. She’s in eighth grade. I had my first junior high dance when I was in sixth grade. But these kids have had Covid to deal with this entire time and now, in eighth grade, are just now getting their very first dance. Crazy to think about right?

My son happened to be in high school they were the class of 2020. They didn’t get a graduation or a prom. They didn’t get a senior trip or anything like that. His first year in college was anything but normal. Kids in school these days have had a lot of challenges. On top of the regular awkwardness of being a kid. There are a good generation of kids. If nothing else, they are going to be resilient as hell and they were going to understand but the future is not a given. Things can change on a dime and it will serve you well to be adaptable. These kids will know that without a doubt

So let’s get to the top ten all time episodes shall we?

First I want to take a second to say, thank you. If you’ve been with me on this journey for the last 4 years, then we’ve had some fun and you know me a lot better than I know you but that’s totally ok and not creepy at all. Or is it? Anyway, In the last four years, I’ve missed one week back when my dad had a stroke a couple of years ago. I’ve shared my struggles with you and I’ve shared my triumphs with you. I’ve shared my goals, my side gigs, my staff stories, and even my family stories with you. I’m all in.  This is all going somewhere, folks.

I want to change this profession. I want it to be better. I want to better myself in the process. Many times, I’m learning right alongside with you. Sometimes, I’m teaching you from what I know. Two Fellowships and 24 years in the trenches will teach you a few things you can then turn around and share with others.  Not only that but a book has come of the last 4 + years. Hopefully some speaking, mentorship, and guru-ism will come out of it. Guru-ism in the best sense of the vernacular. Part of making this profession better and raising its game is teaching others and the goal is that that comes about in more and more opportunities in the years to come.

If you need a speaker for your organization or association, send me an email at [email protected]. Let’s connect and discuss.  So, thank you.

Thank you for sharing this podcast and helping us grow. Thank you to those that have had me on your podcasts or promoted me in some way. Thanks to those that sponsored and supported this show in one way or another. My appreciation for your confidence, support, and friendship cannot be put into words.  And thank you to all of my mentors and influences along the way. You’ve shown a special interest in me and what I do for some reason and my goal is to consitently validate that.  Now, here we go. 

#10 – Episode #189 w/ Dr. Brett Winchester: Chiropractic Excellence, Inspiration, & Being The Best Evidence-informed Chiropractor You Can Be

This is a big deal that this episode made it to the top ten because it was just recorded on August 5th. So, in 4 months, it’s cracked the top ten of a list that’s four years in the making. And deservedly so because Dr. Winchester is the tip of the sword when it comes to chiropractic. Dr. Brett Winchester lectures throughout the world, teaching his functional approach to patient care.  Combining manual therapy, including joint manipulation and neuromuscular stabilization, with therapeutic exercise, Dr. Winchester effectively treats functional pathologies and acts as a catalyst for patients working to enhance their performance. Dr. Winchester is the founder of Winchester Spine & Sport located outside  St. Louis, Missouri. He worked with the St Louis Cardinals at the tip top level of what a chiropractor can do for several years. So much can be learned from him. I hope you’ll go find episode 189 and give it a spin. You’ll learn something. 

#9 – Episode #118  w/ Dr. Stuart McGill – Clinical Jazz, Treating Kids Like Pros, Thoughts On Posture, and Being A Low Back Pain Ninja 

What do you say about Dr. McGill other than wow. He’s a master, he’s a gentleman, and he has a moustache that is unrivaled. But seriously, we covered all kinds of topics that included chronic pain, posture, assessing new patients, corrective exercise vs. gamification, multi-sport athletes, and more. This is one of my favorite episodes. Hands down. 

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

We talked about the ins and outs of working in an FQHC and I have to say that if Dr Frisina-Deyo is the future of chiropractic, then the future is as bright as the sun. Super smart and excellent information. 

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

Not only is Katie one of the brightest rising stars in the chiropractic realmn but she’s also cool and one of my newest besties. I don’t know if she knows we’re long distance besties but I’ve deemed it to be a reality that she’ll just ahve to come to be OK with. She is the head of research at Parker University so we talked about her projects, chiropractic, the future, and all kinds of wonderful and relevant topics. You HAVE to listen to this episode. She’s just a joy and you’re going to love listening to her. 

#6 – Episode #113 – w/ Dr. William Lawson – Brand New Guidelines On Neck Pain Treatment

My buddy and the next President of the Texas Chiropractic Association. This episode shot to the top of our top ten almost immediately. It was way back on episode 113 and here we are on 208 and it’s still #6. That’s how popular this one was. We spent the time covering a paper that Dr. Lawson played a part in on guidelines for treating neck pain. What’s appropriate. What’s not appropriate? Are you doing it right or are you an outlier?? That’s what we talked about. Give it a try and see what you think. 

#5 – Episode #140 – w/ Dr. Chris Howson:  Chiropractors In Hospitals & Drop Release

I love that Dr. Howson is still on our top ten list because he’s been one of the most supportive chiro buddies out there. He’s smart, he’s talented, he invented the Drop Release tool, which we talk about in this episode, and he edited my book. Other than being a Minnesota Vikings fan rather than a fan of my beautiful blue and silver Dallas Cowboys, Dr. Howson is just doign everything about right, folks. Not only that but he’s in a hospital out-patient clinic and is really doing his part to elevate the profession. You can’t go wrong with this wildly popular episode. 

#4 – Episode 142 – Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

I went through about 4-5 weeks of just killer episodes that people ate up and consumed in big numbers so you’ll notice all of these top episodes all came out pretty close to one week right after the other. This one covered research on treating discs without surgery, Vitamin D3 as a treatment for depression, and the biopsychosocial aspect of treating chronic pain. 

#3 – Episode #144 – Common Surgeries Aren’t Well-Researched & Chiropractic Wins Again

Another one of my favorites that I have quoted and used in my day to day practice more than you can imagine. This one is popular for a reason. It shocked me to go through the main paper in this episode. It covered how A very low proportion of the RCTs on the selected procedures compared the procedure to not performing the procedure at all. 

  • 64 from the more than 6,735 studies. Less than 1% if you’re keeping track. Is that not stunning? And infuriating?
  • Of those 64, only 9 were favorable to surgery. 
  • When considering individual surgical procedures, the majority of comparative trials did not favor surgery 
  • None of the studies using patient blinding for any procedure found it to be significantly better than not having the surgery at all. 

Wrap It Up

We conclude that many common surgical procedures performed for musculoskeletal conditions causing chronic pain have not been subjected to randomized trials comparing them to not performing the procedure. Based on the observation that when such studies have been performed, only 14% (on average) showed a statistically significant and clinically important benefit to surgery; there is a need to produce such high-quality evidence to determine the effectiveness of many common surgical procedures.  Furthermore, the production of high-quality evidence should be a requirement before widespread implementation, funding or professional acceptance of such procedures, rather than the current practice of either performing trials after procedures have become commonplace, or not performing comparative trials at all.” 

#2 – New Paper: Spinal Manipulation Has No Effect On Chronic Pain – Our Experts Rebuttal

A paper came out last year in JAMA that basically said that spinal manipulative therapy has not utility in treating chronic pain. I knew that couldn’t be the final answer. Oh hell no. We see this stuff resolve all of the time so what gives? I went to the experts and got their thoughts on the paper and a proper rebuttal in case you’re ever confronted with it. A lot of you took my advice because it’s #2 all time for us. I’m glad to see you found it valuable. 

#1 – Lancet Low Back Update & Movement Disorders Mean Pain

For the second year in a row, this paper retains the title as the most listened to of all of our episodes. In 2018 or so, The Lancet released a series of papers on Low Back Pain. It was big and gave us great information and a direction forward for treating it. This episode covered the update to that paper with more current information using the original series as a basis to build on. It’s great information for those striving to be low back ninjas. Learn from the experts. Learn from the best. 

So there you have it. Our Chiropractic Forward all time Top Ten most listened to episodes. Pretty cool.

We’ve come a long way from having a handful of listeners to where we are today. It’s been slow but it’s been steady growth.

Let’s face it, chiropractic research isn’t all that sexy and it’s certainly niche-y but for the narrow target audience it’s aimed at, we have a solid listenership regularly tuning in to hear me make stupid jokes and share some educational knowledge nuggets with you.  We’re learning together and I’m glad to have you along for the ride. Don’t forget to share with your friends that might find it useful as well. I sure would appreciate it. 

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

 

The Message

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

Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment

CF 205: Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment Today we’re going to talk about research backing the use of spinal manipulative therapy for neck pain. A systematic review and meta-analysis even! Big stuff. Then we’ll talk about treatment for lumbar radiculopathy. What extra tips can you pick up? 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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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

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

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

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s 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 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #205 Now if you missed last week’s episode, we talked about The Case Of The Disappearing Disc & Vitamin D And Back Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, we got some stuff shaking folks. So, let’s talk about it. First thing, Drake leaving. Who the hell is Drake you might ask? Well, that’s our Parker university intern that’s been with us since last August. We’re spoiled as hell having Drake with us these days. We’re going to miss his help and honestly, he’s just a good guy. We’ll miss him personally as well.  Yes, I tried to hire him but not everyone wants to move to Amarillo so getting associates in this area can be a bit of a challenge. So I’m saying it, if you want to come to Amarillo, you’re always more than welcome to send me a resume at [email protected] and I’m happy to take a look. 

We have fun. We get people better. And life is good.  I mentioned a couple of weeks ago that we had a turnover and we’d be having a new front desk staffer coming on board. Well, this is the week and here we go. We may have gotten lucky on this one people. 

First, we hire off of Indeed. I’m sure they think I’m a bit of a prick but I use the assessment tools. They have to fill out a couple of assessments that test their knowledge. One is on EHR, another is general office procedure and stuff like that. Well, so many of them just go down the line clicking jobs and submitting without understanding that the assessments weed that out. If they don’t take the time to fill out the assessments, they didn’t care enough about the job to read about it. Which means I don’t care enough about them to waste my time learning more about them. So I move right past them. 

This girl has worked for an urgent care and only looked elsewhere because they didn’t have a full-time position like she needed. My friends actually work at the urgent care and vouched for her. We have the ones we’re interested in come in for a working interview. All of the staff agreed she was the clear choice both in experience as well as in personality.  Our office culture is one defined by fun. We jump scare each other. We laugh. We kid. We are always appropriate but there are times we could be more professional but….again…we have fun. And Our patients love it.

They commonly comment in our Google Reviews about how they love that everyone is so happy, having fun, and enjoying their work.  It’s easy when you have the crew I have. We do work. We work hard. Some days suck. Some days fly by. But think about it, we spend more time with our staff than we spend with our own families for the most part. Right? So why not having fun? Why not have a sense of family, of belonging, and a sense of being a team? Why not? So we’ll be making a new teammate this week. She’s going to be amazing. I just have a feeling. 

Also, I believe it was last week we discussed side gigs.  I mentioned my recent success in the voice over industry and that I’ve been schooling up on real estate investing and all that good stuff. I mentioned that I planned on parlaying that voice over success into real estate investments.  Well, I’ve been analyzing houses and I’ve been learning about remote management of short-term rentals and the pros and cons vs having a long-term rental and all of that good stuff.  Well, I identified 9 properties down in Lubbock TX. Lubbock is about an hour and a half to the south of Amarillo. It’s the home of Texas Tech and Buddy Holly. It’s also where one of my kids goes to college. It’s also the place where my other kid who is currently an 8th grader will likely go if I haven’t retired and moved to Florida when she goes to college. 

Lots of football games, basketball games, baseball games….lots of visits to the medical school there in town….lots of big-name concerts. It’s all good news for having a short-term rental.

Go back and listen to last week’s episode if you want to know why short-term rentals make more sense for tax reasons than other investments right now.  Anyway, I found 9 houses that my wife went to look at last week. She made an offer on one and, once we refi our rental house here in Amarillo, we’ll be able to pull out about $150,000 to put on 1-2 others. One of which is a flip we think we can profit $30k in about three months if there are no surprises or hiccups.  So…..I’m a fact finder. I’ve been finding facts for about a year now. Watching YouTubes. Taking little classes. Listening to podcasts. Reading books. Meeting people and building a small network. So, we’re on it. We’re excited. We’re pumped. We’re busy as hell. 

It’s kind of crazy the faith I have in my wife’s decisions. In lots of ways, she’s the smartest person I believe I’ve ever met. Our first house we bought together, I was on the road traveling with my band somewhere down in south Texas when she made an offer on it. I’d never even seen the house. 

The one I live in now, I actually saw and agreed on. 

The 2-3 down in Lubbock, I haven’t seen either. But I’m buying them. Lol. It’s crazy but she’s a hell of a teammate on this stuff and her vision of what she can do with a house has blown me away. She has some serious skills and I can’t wait to see what happens when she puts them to use on these investments. 

OK, on to the first paper.  Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials – PubMed

Item #1

The first one is called “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials” by Chaibi et. al. (Chaibi A 2021) and published in the Journal of Clinical Medicine in October 2021 and that’s got some smoke on it! Let me say that I’ve been yelling for some research on the effectiveness of SMT for neck pain for 4 years here on this podcast. I’ve talked to different researchers about it. They said they couldn’t get funding for it. Now, here we are with a small step for a chiropractor but a giant leap for chiropractor-kind…..or something like that. 

Why They Did It

Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs); 

How They Did It

  • To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. 
  • Data extraction was done in duplicate and formulated in tables. 
  • Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the (GRADE) criteria
  • Six studies were included. 

What They Found

  • The overall pooled effect size for neck pain was very large -1.37 (95% CI, -2.41, -0.34), favoring treatments with SMT compared with controls. 
  • They had a single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment. 
  • Minor transient adverse events reported included increased pain and headache, while no serious adverse events were reported

Wrap It Up

SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings. So, once again, researchers….please listen. We have enough information on the low back. We know we knock it out of the park on low back pain. Even our haters mostly know we kill it on low back pain. Those douches over at sciencebasedmedicine.whatever mostly admit we’re good on low back pain. And trust me, if you change their damn minds, you’re on to something.  So, let’s expand to the neck, please. Pretty please? Dr. Goertz, Dr. Pohlman, Drs influential with Chiropractic Compass, can we please continue down this path of exploring our effectiveness and low risk for adverse events in the neck because honestly, THIS clinically is what is holding us back. 

Professionally, it’s the vitalists in our profession. But clinically, it’s the perception that we do harm when treating the neck. Can we do harm? Well hell yes we can. Do we commonly do harm and are we likely or probable to do harm? Oh hell no. Why would you ask such a dumb question?

 

Item #2

https://pubmed.ncbi.nlm.nih.gov/30521781/

This one is called “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial” by Satpute et. al. (Satpute K 2019) and published in Archives of Physical Medicine and Rehabilitation on December 3rd of 2018. It’s mushy…not solidified but not as warm as we like. 

Why They Did It

To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy.

How They Did It

  • A double-blind randomized controlled trial.
  • The setting was in a General hospital.
  • 60 adults with the mean age of 44 years old were included
  • They were al diagnosed with subacute lumbar radiculopathy
  • They were randomly allocated to receive spinal mobilization with leg movement  exercise and electrotherapy or exercise and electrotherapy alone. 
  • All participants received 6 sessions over 2 weeks.
  • The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM)
  • Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up

What They Found

  • Significant and clinically meaningful improvement occurred in all outcome variables. 
  • At 2 weeks the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability. 
  • Similarly, at 6 months, the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability. 
  • The spinal mobilization with leg movement group also reported greater improvement in the global rating of change and in SLR range of motion.

Wrap It Up In patients with lumbar radiculopathy, the addition of spinal mobilization with leg movement provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term. 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.

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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  

Bibliography

  • Chaibi A, S. K., Russell MB (2021). “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.” J Clin Med 10(21): 5011.
  • Satpute K, H. T., Bisen R, Lokhande P, (2019). “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial.” Arch Phys Med Rehabil 100(5): 828-836.  

The Case Of The Disappearing Disc & Vitamin D And Back Pain

CF 204: The Case Of The Disappearing Disc & Vitamin D And Back Pain Today we’re going to talk about The Case Of The Disappearing Disc & Vitamin D And Back Pain. But first, here’s that sweet sweet bumper music  

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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 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #204 Now if you missed last week’s episode, we talked about Reduced Access To Chiropractic & The Ideal Diet. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. The clinic numbers have cooled a bit. Still busy but more manageable. Since things have cooled a bit on that end of things, let’s switch focus to side gigs. I see questions about side gigs periodically in the forward-thinking chiropractic alliance group.  We chiros are doing all kinds of different things from being real estate agents and hunting guides to selling stuff on eBay and Etsy.  Here’s some of what I do and why. First, I’m very happy with my income from chiropractic but, as with anything, I don’t like my eggs being in one basket, and let’s face it, we’re in a business where if something were to happen to us, it’s game over. If we are not at work and able to perform, then we can kiss all of those years of hard work goodbye.  In our profession, we are literally on a knife’s edge and it could go good or bad in a heartbeat. Literally.  So, I like other options. Do you know what else I like? Success, freedom, achievement, and wealth. All of that gives you a better chance at happiness. People say you can’t buy happiness. Well, that’s what people with no money tell themselves so they feel better. It’s like someone saying it’s not all about looks. Well….that’s true but looks sure as hell to help land a suitable partner. Wouldn’t you agree? In the say way, wealth helps you have more security and security helps you have a better chance at happiness.  So, for all of those reasons, I do a lot of stuff. I’m an artist as many of you might know. I just finished up a series of several Charlie Chaplin watercolor paintings and a sculpture of a horse and jockey in the middle of a race. They’re flying down the track!  You can see all that stuff on Facebook at Jeff Williams Art.  I have a band and have been a traveling musician in my past. It seems like another life at this point. You can check that out on Facebook at Flying Elbows Perspective. Can you imagine another band would have the band name Flying Elbows? Well they do. It’s a fiddle band from Massachusetts. That’s not us. We’re the ones from Amarillo, TX I created evidence-based posters and brochures for you guys over at chiropracticforward.com Then I create live edge furniture. But I like to be honest, nobody has ever bought any of the pieces but that’s not because they’re not good. It’s because they’re expensive! You can see that on Facebook at Amarillo Furniture – Live Edge and Customs. It’s fun. My office and home are full of these original pieces.  The idea is to be able to retire and still be comfortable. Still have income in retirement. How are you going to accomplish that and what is your exit number? What do you have to have at the end that allows y But here’s where things have freaking gone nuts. It’s in the land of voice-over. Holy cow, y’all. Now, my results are not normal as I’m coming to find out. But, just in the last 10 months, I’ve made about $50,000 I never planned on having in my life. I’ve done over 400 commercials in the last 10 months in about 22% of the countries throughout the world and landed talent agencies that represent California, Texas, Indiana, Ohio, Kentucky, and New Jersey/New York.  How at the age of 49 this voice over thing has just come into my life is a twisted tale but briefly, the drummer for my very first band way back in college in Natchitoches, LA became a Lieutenant Colonel in the Army and we stayed in touch. Well, he became the voice of Hand Unit in the video game called Five Nights At Freddie’s. He got to do a bunch of other really cool stuff too but when the pandemic came along, it got me thinking that I need to have options.  That’s when I hit him up about voice over. A year and a half later, here we are it’s crazy.  Now, what do we do with the extra money? Well, we put it to work. That’s what we do. I’ve also spent the last 6-12 months educating myself on real estate investing. Long-term rentals, multi-plexes, short-term rentals, vacation rentals, flipping, wholesaling, and things like that. So, you may have guessed it, voice over will be funding down payments on investment properties.  What a deal. Right?!? The problem in this market if finding a good deal but we’re on some good ones and are hoping to land them in the next week or two.  Here is a little real estate tip for you. Two tips actually. First, money has always been in real estate and it always will be. Through ups and downs, the money is still there. Secondly, losses in your real estate business can offset gains in your chiropractic business come tax time. That’s if you can qualify as a real estate expert. Well…..they made it really hard to qualify so basically, if you have a job like we all have, you can’t. Your loophole, however, is this; short-term rentals don’t count.  Short-term rentals can offset tax gains without you having to qualify as a real estate expert. So, if you’re a chiropractor, short-term rentals probably make a lot of sense so that real estate losses and depreciation can offset the money you make in your chiropractic business so that you can reduce or eliminate taxes.  As a disclaimer, I am not a lawyer nor a CPA so make sure you run that by them.  OK, just some tips from you Ol’ Uncle Jeffro.  Now to the good stuff.  Item #1 This first one is called “Relationship between Vitamin D and Nonspecific Low Back Pain May Be Mediated by Inflammatory Markers”’ by Xu et al   (Xu HW 2021) and published in Pain Physician in November of 2021 and that’s a steamy as a sizzling sirloin.  I believe I got this one from my esteemed colleague, Dr. David Graber who always always posts great research findings. He’s a fountain of knowledge nuggets so go search him up on Facebook and follow his page. One of the smartest guys you’ll find out there.  Why They Did It To explore the mediating effects of inflammatory markers on the relationship between vitamin D levels and pain outcomes. How They Did It
  • This study was done at the Department of Spinal Surgery of a hospital affiliated to a medical university.
  • It was a cross-sectional study
  • They selected patients with non-specific acute low back pain and non-specific chronic low back pain, 
  • The study included 60 people without Ns-LBP as controls, 
  • The study was done from January 2018 to January 2019. 
  • Serum 25(OH)D and inflammatory marker levels were examined.
  • Regression and causal mediation analysis were used to evaluate the mediating effects of inflammatory markers on the association between vitamin D and pain.
What They Found
  • After adjustment for clinical factors, vitamin D deficiency was associated with Ns-LBP
  • however, when the interleukin 6 (IL-6) level was added to the multivariable models, the association was no longer significant in Ns-CLBP patients
Wrap It Up Patients with Ns-LBP had lower vitamin D and higher inflammatory marker levels. This association between hypovitaminosis D and Ns-CLBP may be mediated by IL-6.  Very interesting findings. They do say there are some limitations to the study. They say a retrospective study may include inevitable bias. More sensitive biomarkers were not investigated in this study. Pain intensity evaluation using the visual analog scale is inevitably subjective. Item #2 Alright, item 2 is called “Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study” by Sucuoglu et. al. (Sucuoğlu H 2021) and published in Medical Principles and Practice in February of 2021 and that’s got my glasses fogged up! Why They Did It The authors wanted to assess radiological changes and clinical outcomes of patients with sequestered lumbar disc herniation (LDH) and evaluate the relationship between them. How They Did It
  • Patients diagnosed with sequestered LDH were followed up in 2 groups: operated (within the 1st month after diagnosis) and nonoperated. 
  • Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores at baseline and 1st , 3rd, and 6th-month visits were used. 
  • Radiological evaluation was performed by measuring the sequestered herniation level and herniation volume using 2 MRIs spaced out between 1st and 4th months
  • After the second MRI, patients in the nonoperated group were divided into 3 groups: non-regression, partial regression, and complete resolution
What They Found
  • Signifi
  • cant improvements were observed in VAS and Oswestry scores at month 2 and month 3 in all groups and at month 4 in partial regression and complete resolution groups. 
  • VAS and Oswestry score improvements at months 2 and 3 were significantly higher in the operated group than in other groups. 
  • At month 4, there were no significant differences in VAS and ODI scores between the operated group and partial regression and complete resolution groups.
Wrap It Up
  • Spontaneous regression was observed in the 6th month post-MRI in most of the nonoperated sequestered herniation patients with conservative treatment.
  • Improvements in pain and disability scores were higher among the operated patients at the early stage, whereas they were not significantly different compared to patients with spontaneous regression at the 6th month.
If you remember, I did a whole episode on disappearing discs. Here’s the deal. You have to know this. The more a disc herniates, protrudes, or extrudes into the spinal canal and migrates either cephalad or caudal, the more likely the body is to recognize it as foreign and gobble it up like the cookie monster.  What I thought was instant surgery several years ago, I now know may be a waiting game that ends up being non-surgical.  Here’s the thing that episode taught me though; the disc material can be dissolved but the symptoms remain. At least for a while while the nerve tissue in the region undergoes the healing process.  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 YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography Sucuoğlu H, B. A. (2021). “Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study.” Med Princ Pract 30(3): 244-252.   Xu HW, Z. S., Yi YY, Chen H, Hu T, Wang SJ, Wu DS, (2021). “Relationship between Vitamin D and Nonspecific Low Back Pain May Be Mediated by Inflammatory Markers.” Pain Physician 24(7): E1015-E1023.      

The State Of Chiropractic Via ChiroUp & Chiropractic Economics

CF 200: The State Of Chiropractic Via ChiroUp & Chiropractic Economics

Today we’re going to talk about the state of chiropractic and we’re going to use a couple of more recent articles I’ve come across to do it. One from Chiropractic Economics and one from our friends at ChiroUp. It’s a good one today folks! 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 your patient education and for you. It saves time in putting talks together or just staying current on research. It’s categorized into sections and it’s written in a way that is easy to understand for practitioner and patient. You have to check it out. 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 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #200 Now if you missed last week’s episode, we talked about Fear Avoidance & Opioids and Neuro Changes With Cannabis Use In Adolescence. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I just returned from Chicago from the American College of chiropractic consultants and the chiropractic forensic sciences conference.  It was great I got to hang out with my forward-thinking chiropractic alliance buddy Mr. Dr. Michael Massey. He was probably tired of me by the time we got done hanging out and I had to go home. Honestly, we were there from Wednesday night through Sunday morning. That’s a long time to be hanging out with someone. Hopefully, I didn’t talk his ear off.  But I learned a lot about him and his history. He’s gotten to do a lot of cool stuff and I enjoyed learning more about it. Here in Amarillo, you don’t get a lot of really cool opportunities.  For example, Dr. Massey has gotten to be on the NASCAR circuit treating the drivers.

He’s been on the Rodeo circuit. He’s a certified coder. Which, let’s be honest, that’s not that cool really but, very impressive.  He’s gotten to teach and speak all over and just has a very interesting background. If you don’t know about Dr. Michael Massey from down around the Athens and Chattanooga area of Tennessee and of Practice Mechanics fame, make sure you go check him out.  Practice Mechanics is his and Dr. Rob Pape’s mentoring and consulting group.  Go look into practice-mechanics.com.  As far as the conference itself, it happens the first weekend in October every single year. At the same hotel. The Marriott in Oak Brook Illinois which is basically Chicago.

Just about all of the people there are pretty darn impressive and they’re on both ends of the spectrum from working for the insurance company to working for chiropractors and defendants.  They’re expert witnesses. They’re independent medical examiners. And, yes, some even work for the insurance companies. I have to tell you meeting them humanizes them to an extent even if we may not agree with every opinion they may have.  Most of the continuing education I get through the years involves a 16-hour weekend. I typically end up with 80 to 100 hours a year. Sometimes more, sometimes a touch less. But it’s usually quite a few hours through my activities with the Texas Chiropractic Association.  We have more than one event and I usually go to more than one event every year. At least a couple of the events. Then I have the orthopedic hours. And then I have the other stuff I learn and take here and there. So, I’m usually in the 80-100 hours per year range. 

This weekend was 27 hours of continuing education. These folks are serious about getting some CEs in, man. Crazy. Thursday went from 8 am until 9 pm. Friday was 8-6, and Saturday was 8-4. One-hour lunches. Class…..all day….every day.  On this deal, what had happened was….as my long-time listeners know, I got Board Certified, which means a Diplomate, also known as a Fellowship…..I got that in the Neuromusculoskeletal Medicine program in 2019. Dr. James Lehman with the University of Bridgeport contacted me last year. He said, “‘Ya know…since you already have the Neuromusculoskeletal Fellowship, you can get your Forensic Fellowship a lot easier since it’s a subspecialty of the Neuromusculoskeletal specialty.” That’s about the time that I responded with, “What’s that?” I had no idea what Chiropractic Forensics was. I thought I might be solving some sort of murder mystery or something. Anyway, Dr. Lehman explained to me that it was to bolster experience and credentials in the medicolegal arena. 

The original Fellowship took 300 hours to complete. Since Forensics is a subspecialty of it, this second Fellowship was only 100 extra hours for me to complete.  How do you say no? Well, you don’t. I did it. I got through it. And here we are. Two Fellowships within about 3 years. Where the hell did that come from? When it came to classwork, I didn’t thrive in the classroom. I hated the classroom. Sitting there for hours on end day after day…..yeah. I struggled. I was just a B student at chiropractic school. Not an overachiever. Not an underachiever.  I swore I’d never take another class. Forever and ever amen. And then, things changed. I got into research and evidence and all that good stuff. Hell, I got into learning again and I enjoyed it. I wanted to raise my game all of the sudden and there it went. And here we are. 

Old dogs can indeed learn new tricks, folks. So, keep moving forward. Keep learning. Don’t just knock down the high spots. We’re capable of so much more than that. 

Item #1

This first one is called, “Survey says 1 in 4 Americans would pay up to a $40 co-pay for chiropractic care” by the Chiropractic Economics staff (Staff 2021) and published on their site on October 6 of 2021. Hot tamale, hot tamale….get em while they’re good n hot.  It’s an article so let’s summarize and hit the high spots, shall we? They start the article by saying, “A recent survey of more than 2,000 Americans revealed that roughly 1 in 4 (24%) would “be most likely to pay a co-pay of $40 or less without hesitation.”

This survey was done by ATI Physical Therapy which they say is one of the nation’s biggest providers of PT services. I am unfamiliar with the group but their website says they have 900+ convenient locations They say that 33% of Americans think PT is among the outpatient services they would be most likely to pay a co-pay of $40 or less without any reservation or hesitation.  Other services they would be most likely to pay $40 or less for would be Urgent Care visits at 55%, regular screening or check-ups at 35%, prescriptions at 33%, and chiropractic at 24%. 

I became aware of this one from a post from Dr. Bobby Maybee in his Forward Thinking Chiropractic Alliance group. Also known as FTCA. If you’re not a member and you are evidence-based, patient-centered, I recommend you fix that situation and hop in there.  It’s a group you’ll want to just sit and lurk for a little while before you pop in and start spouting off. They, much like myself, have very little patience for the more vitalistic stuff in the profession. Once you get the lay of the land, you’ll find a group of very welcoming, friendly, productive, and very helpful doctors that you’ll be glad you became a part of. Great group. All groups have their issues but I’ve been a part of the FTCA for several years at this point and it’s a great group with great people. 

Anyway, As Dr. Maybee pointed out, Chiro Economics is looking at this information as a positive while he, and I by the way, see it as a negative. Patients value us at $40. Those that don’t value us at that price point value us as less than $40. Not a good thing. Especially when you’ve gone to the lengths to specialize and get board certified in one or more diplomates.  We’re specialists but still lumped in at $40/visit. And that’s by only 24% of Americans while PTs get 33%. When we know through Palmer/Gallup poll and other research that chiros are more cost-effective, with more patient satisfaction, and with better patient outcomes. 

The schiesters in the profession, I’m convinced, are the reason we aren’t further up the chain. And the lack of standardization. You don’t know what the hell you’re getting when going to a new chiropractor.  About the time I saw that article, I got a great email from ChiroUp (Bertelsman T 2021) with a summary of the ChiroUp dataset. I’m including the link to this in the show notes at this point in the transcript: https://chiroup.com/COPSsynopsis2021 They shared that the percentages of issues chiropractors see are as follows:

  • Lumbosacral at 36% – which makes sense. It’s the leading cause of disability in the world and has only gotten worse over the last 20 years. If you’re not a low-back ninja, that’s your first mission right there. 
  • Neck pain at about 18%
  • Thoracic pain at about 6.5%
  • Then shoulder, hip, knee, foot and ankle, elbow, and last but not least the hand and wrist. 

All of the extremities added up to about 14% of cases. It seems that having some extremity skills is a good addition to your toolbox but the bread and butter is the spine for chiropractors when you see that spinal issues add up to about 60% or more of the cases we see.  They say the most common chiropractic diagnoses are:

  1. Lumbar intersegmental joint dysfunction – or facet
  2. Upper cross
  3. SI Dysfunction
  4. Cervical intersegmental joint dysfunction
  5. Lower cross

Those are the top five but I can tell you from the ortho diplomate that 40% of our low back cases are discs, 30% are facets, and 22.5% are SI issues. This information, when combined with ‘give me one finger and point to one spot where all of the pain comes from’….those two bits of information, for the vast majority of cases, will get you most of the way home for a heck of a lot of patients. 

With Lumbar facet being the top diagnosis code, it makes me wonder how good others are at diagnosing. Or….how bad I am. Do the extension/rotation test on a low back pain patient. If it doesn’t hurt, it’s about 94% or so that the issue is NOT a facet. That’s if the extension/rotation test is pain-free, it’s almost certainly not a facet issue. And a whole bunch of low back pain patients can extend and rotate without pain. So, I’m skeptical of how accurate these numbers are.  Also, a lot of times you see facet pain, it’s secondary to spinal instability. A new research paper recently estimated spinal instability at as much as 60% of low back pain cases.

That’s A LOT!!

You get those vertebrae rattling around a bit, you get sore facets. A clue is asking them if it hurts when they roll over in bed. If it does, why the hell would it hurt to roll over? There’s no weight-bearing on discs or anything like that. Instability may explain. McGill’s Big 3 plus Dead Bug may be your answer rather than continuing to mobilize segments that are already moving more than they should.  Maybe it’s weak hip abductors. If you’re not checking hip abductors with one-legged mini-squats looking for a medial deviation of the knee, then start looking. Weak hip abductors can be a missing puzzle piece to long-standing low back pain.

And, in ChiroUp’s top DXs per region, for the hip, the number one issue diagnosed is hip abductors. So some of you are doing a good job there.  On their top 3 knee dx’s we see that patellofemoral pain syndrome is #1. However, in our ortho diplomate, we’re taught that the most common knee issue is actually pes anserine. If you’ve never heard of that one, google it up and start putting a thumb on it when you have a knee issue and see what you find.  Here’s one I find quite a bit off-kilter. In the headache section, they have cervicogenic headache as the most commonly diagnosed issue. Now, understand, this is not ChiroUp’s fault. They’re simply reporting what people are diagnosing. ChiroUp is a literal game-changer and you should all be a part of it. I just want you all to be diagnosing better. That’s all.  The breakdown on headaches is as follows:

  1. Tension-type headache at about 40% of cases. 
  2. True migraines only make up about 10% of headache cases. 
  3. Cervicogenic headaches are only about 4% of the headaches that come into our offices. Meaning, if accurately diagnosed, the condition could not possibly come out as the number one issue in the headache category. Yet, it does because chiropractors don’t have a good handle on headaches right now. Tension-type and cervicogenics do both commonly start at the base of the noggin and, ultimately, it doesn’t necessarily matter how it’s diagnosed because we’re most likely going to treat it the same. It’s just the knowledge part of it that matters. Being on top of your game. That’s all. 

Regardless of the accuracy of diagnoses, ChiroUp reports patient satisfaction at a robust and most wonderful 92.7%. Kaya Pow! Understand that includes satisfaction with chiropractic case management for everything from plantar fasciitis and axillary nerve entrapment to the stuff that is in our wheelhouses like spinal pain and headaches.  Then we have that the average chiropractic patient’s likelihood refer others is at a delicious 96.7%. And that’s yummy to my tummy. Lip-smacking fantastic. 

They also share that the average improvement 30 days after initiating chiropractic care for all diagnoses is about 80%, Slap yer mama! That’s some good stuff.  Here was a particularly telling stat from a trial that suggested the percent of patients that resolved after only having standard medical care was only 17%.  That’s in contrast to 73% when chiropractic manipulation was added to standard medical care. 

ChiroUp then ventures into costs. They show a claims analysis of BC/BS of Tennessee’s low back pain claims data. It showed that care initiated with a DC saves nearly 40% on healthcare costs compared with care initiated through a medical doctor. 

Forty Freaking Percent!! Smack! KaChow! Slap!

They go on to say, “The choice of initial provider is significantly associated with the likelihood of subsequent surgery. A Spine journal study found that approximately 42.7% of injured workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.” Most of us have seen that one. I believe it was done by the state of Washington.  All of this while malpractice claims categorized by provider type shows that chiropractors come out on the bottom in a GOOD way.

We are the very least likely profession to have a malpractice claim against at only 0.6% of all claims.  And the Medical Associations always say all of their pushes are in the interest of public safety.  Are you sure? Incidentally, RNs suffered the most malpractice claims at 25.5% of the claims and physicians came in at about 16.1%. We’re way down there at 0.6%. Get out of here with that ‘public safety’ garbage.

Your comment has been found invalid and mostly stupid. 

Their conclusion says, “This 2021 COPS synopsis confirms that chiropractors demonstrate above-average performance for the essential healthcare consumer needs. Evidence-based chiropractors should play a vital role in the future healthcare model because of their ability to safely and cost-effectively deliver excellent musculoskeletal clinical outcomes with high patient satisfaction.” And they’re 100% correct.

They always are by the way. Dr. Tim Bertlesman and Dr. Brandon Steele are two of the brightest chiropractors and human beings you’ll ever meet in your life. The content they put out through ChiroUp is always right, always timely, always good, and always appropriate.  So there you have it, the state of chiropractic. We are absolutely amazing with effectiveness, patient satisfaction, outcomes, cost-effectiveness, and safety. Yet, only see a small percentage of the population, and those that we do see only see us as being worth about $40 per visit……or less.

Thank you, vitalists. Really appreciate you guys and girls.  Y’all are really special.  What a life it is to be a chiropractor. 

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 better it. 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.

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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

  • Bertelsman T, S. B. (2021). “2021 Chiropractic Outcomes & Patient Satisfaction Synopsis.”
  • Staff, C. E. (2021). “Survey says 1 in 4 Americans would pay up to a $40 co-pay for chiropractic care.” Chiropractic Economics.

To Do Lists, Frailty, and Pain & Lost Work Days

CF 192: To-Do Lists, Frailty, and Pain & Lost Work Days

Today we’re going to talk about To-Do Lists, Frailty, and Pain & Lost Workdays

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!

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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 an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioners as well as patient. You have to check it out. 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 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 #192 Now if you missed last week’s episode, we talked about chiropractic preventing opioids and chiropractic adverse events. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I am starting week three of the medical integration. It’s stressful but it’s exciting too. Every day I’m convinced more and more that we picked the right nurse practitioner. Super smart and excellent with patients.  I’m lying if I act like there’s no anxiety in this deal though. Damn. The money flying out the doors in a direction is almost stunning. With little money coming in on the medical side. Everything has to start at ground zero. That’s a given. Everything has to grow from seed. That’s a given.  The trick is to get to maturity and profitability as quickly as humanly possible. That’s what we’re trying to do.  We’ve been doing social media and are about to do a direct Mail piece as well. We’re trying to get this thing on its feet muy pronto! Switching gears here, how do you stay productive? My means of staying productive is really pretty simple.

I keep a ToDo list and I follow it daily. I have it broken down into two sections. One is a grid. The days of the week are along the top of the grid. What HAS to be accomplished are listed below the day it has to be done. Then, I have a simple list outside of the grid. They’re things that need to be done when time allows. Outside of the must-do’s they’re the need to do’s if you will. So, for example, on Mondays, I have to write, record, edit, and upload the podcast. It’s a scramble from start to finish when I also have 40 or more patients to contend with as well. Sometimes I get it all done. Sometimes I just get it written and record it as time allows the rest of the week Don’t forget about email. I get at least 50-100 every day so that’s a job all by itself sometimes. I unsubscribe as often as I can.

I don’t like garbage and minutiae. Can’t have it. No time for that. Tuesdays, it’s my clinic’s blog that has to be written, the corresponding video is recorded, and it’s uploaded to YouTube and Facebook. Again, all accomplished between patients. I get off on Tuesdays around 2 pm. Sometimes that extra afternoon time is used to catch up. Sometimes I go home, work out, do voice-over, and then take classes toward the Forensics Diplomate. As you can see, Monday and Tuesday is go time. Wednesdays I  write and send a mass email to my emailing list with the blog and video I recorded the day before included. Usually, things start to loosen up a bit by the time Wednesday rolls around and I’m able to give attention to the Need To-Dos. Some marketing and all that good stuff. Thursdays I upload the new podcast episode, I post it on Facebook, I send out an email to my list, and lost it in our private Facebook group.

Then marketing, patients, voice-over, another website project I’m working on, and whatever else crosses the desk. Friday, I get off at 1 pm. The afternoon is spent catching up, taking classes, getting in phone calls with people that think they just have to get you on a phone call, or I hit happy hour if I’m lucky. So that’s my week. I don’t get on phone calls. If it can’t be texted or emailed, don’t bother. I don’t talk to salespeople. I don’t entertain anything that takes me off task if I can help it. I can’t. So that’s how I get it all done. The list is my priority and I make sure each item is accomplished. It keeps me on track, it keeps this podcast rolling, it keeps my clinic rolling, and it keeps my brain from exploding. Tel me how you stay on track. I’d love to hear about it. Email me at [email protected]

Item #1

The first one today is called “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study” by Tembo et. al. (Tembo 2021) and published in Calcified Tissue Interrnational……which is as niche-y as niche can be and it was published on May 20 of 2021. Good Lawd….the heat. 

Why They Did It

They wanted to investigate and quantify the predictability of frailty associated with musculoskeletal parameters. 

How They Did It

It was a longitudinal study Involved 287 men over 50 years old Baseline musculoskeletal measures included  femoral neck bone mineral density appendicular lean mass index whole-body fat mass index lower limb strength Frailty at the 15 year follow-up was defined as > or = to 3 of the following 1. Untintentional weight loss 2. Weakness 3. Low physical activity 4. Exhaustion 5. Slowness

What They Found

  • 48 men were frail. That’s 16.7%
  • Musculoskeletal models were better predictors of frailty
  • Musculoskeletal parameters improved the predictability model as measured by AUROC for frailty after 15 years

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

CHIROUP ADVERTISEMENT

Item #2

This one is called “Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system” by Gaspar et. al. (Gaspar FW 2021) and published in PLoS ONE on June 17, of 2021 and that’s stuh, stuh, stuh, steamy people. 

Why They Did It

The authors wanted to quantify the influence of adherence to guideline-recommended interventions in the first week of treatment for an initial low back pain (LBP) injury on lost workdays.

How They Did It

  • It was a retrospective cohort of California’s workers’ compensation claims data from May 2009 to May 2018
  • 41 diagnostic and treatment interventions were abstracted from the medical claims for workers with acute LBP injuries and compared with guideline recommendations.
  • Lost workdays within 1-year post-injury were compared by guideline adherence using quantile regressions.
  • Of the 59,656 workers who met the study inclusion criteria, 66.1% were male and the average (SD) age was 41 (12) years

What They Found

  • The median number (IQR) of lost workdays was 27 (6–146) days. 
  • In the first week of treatment, 14.2% of workers received only recommended interventions, 14.6% received only non-recommended interventions, and 51.1% received both recommended and non-recommended interventions
  • Opioid prescriptions fell 86% from 2009 to 2018
  • Workers who received only guideline-recommended interventions experienced significantly fewer lost workdays (11.5 days; 95% CI: -13.9, -9.1), a 29.3% reduction, than workers who received only non-recommended interventions
  • The percentage of workers receiving only recommended interventions increased from 10.3% to 18.2% over the 9 years.

Wrap It Up

When workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.

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 so 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
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TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography Gaspar FW, T. M., Wizner K, Hegmann K, (2021). “Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system.” PLoS One 16(6).   Tembo, M. C., Mohebbi, M., Holloway-Kew, K.L, (2021). “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study.” Calcified Tissue Int.  

 

Chiropractic Prevents Opioids & Chiropractic Adverse Events

CF 191: Chiropractic Prevents Opioids & Chiropractic Adverse Events Today we’re going to talk about chiropractic care preventing opioids and chiropractic adverse events.  But first, here’s that sweet sweet bumper music

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
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  • We also have an evidence-based brochure and poster store at chiropracticforward.com
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You have found yourself smack dab in the middle of Episode #191 Now if you missed last week’s episode , we talked about Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

So, if you’re a regular listener, then you know that I’ve been slowly going through the Forensics Diplomate program. The initial 40 hours through ChiroCredit were not my favorites. Learning about court cases, procedures, and all that stuff…..let’s just say it’s not my skill set.  But, I did it. I sat through it all. Now I’m on to the course for impairment ratings through the AMA. It’s speaking my language a little more. OK….a lot more. It’s still very technical and all that good stuff but it makes a little more sense. However, it is written by medical doctors for medical doctors so there is a section that got me a bit hot. Did you know in the 6th edition of the Guides to Impairment, it says that chiropractors should stick with only assessing impairment of the spine….because….you know……we didn’t spend two full semesters dissecting an entire body or anything like that. Right?

The presenter said he realizes that statement may bring about some discussion but the evaluator must have knowledge, skills, and ability in that organ system or in that region to assess impairment. Otherwise, the impairment rating is likely to be faulty. So…..I guess chiropractors somehow have the inability to learn, know, or understand a shoulder, hip, ankle, etc? Let’s be fair, I get it if they think a chiropractor shouldn’t really be assessing impairment of the liver or GI system.

That’s not within our wheelhouse. But muscles, bones, ligaments, tendons, and joints of all sorts are damn well within our wheelhouse and it’s just dumb to act like a regular impairment doc doing impairment ratings are any more intimately familiar with them than we are.  That’s some elitist BS right there. And it stinks and smells like old outdated dogma. But let’s also be fair to them. Even though they’ve rarely given us the same respect in return. This was reprinted in 2009. I’m not sure when the original printing was. I’m sure the course I’m watching was done around the same time as well.  Think about it; how many changes have you seen in the MD/DC relationship arena in just the last 10 years alone? I’ve seen a lot.

Especially since the American College of Physicians came out in 2016 recommending spinal manipulative therapy for acute and chronic low back pain. On the heels of that The Lancet report on low back pain echoed the recommendation. Then Dr. Goertz’s paper was in JAMA showing how well veterans did when spinal manipulative therapy was added into the treatment protocol.  Plus, I see more and more chiropractors moving in the right direction. The direction of evidence-based, patient-centered care. Where decades ago, an MD wouldn’t bowl against a team that had a chiropractor on it and they wouldn’t even accept referrals from us, to now.

Now, I have a nurse practitioner working hand and hand with me every day. Some of the people I count as buddies are a vascular surgeon, and ER doc, and a neurosurgeon.  So….maybe the course just needs an update. Who knows? But it pissed me off a little and I paid $487 to get pissed off. Lol. This too shall pass. In fact, it may already have passed.  Alright, NP medical integration week #2. It’s getting there. Our NP did hormone pellet procedure last week. That whole process is pretty cool. Patients have to do the lab work first to make sure it’s necessary. But if it is, it can make a big difference for folks. We doing PRP shots, trigger point shots, B12 shots….it’s all pretty darn interesting and it’s multimodal. Which is evidence-based and, as always, I balance it in a patient-centered way. 

So, now in my office, we have me, exercise/rehab, medical services, acupuncture, 3 massage therapists, and all of the other stuff you’d expect in therapies. It’s grown into quite a deal.  I had a patient ask me the other day if I was a franchise. I asked why they’d think that? They just said that we offer so many things that he figured it was a franchise. I said no, we’re not. But I likened it to my step-dad’s shop. He’s got every tool, cord, clamp, and gadget you’d ever want in a shop. But when you ask him how he got it all, he’ll tell you that he got it one at a time. Kind of like Clint Eastwood in El Torino.  You just gather and grow as you need. As the risk makes sense. There was a time when getting a $13,000 decompression table was a big damn deal and came with a lot of financial risks. 

Now, understandably, the risk is different. To expand and grow, it costs more. You have to stick your neck out a little further and hope it doesn’t get chopped off.  There are sinkers and swimmers in this world. I like to think I’m a swimmer. It’s OK to venture out a little further each time you stretch. As long as you know how to swim. And I have the doggy paddle down, folks. Just keep swimming just keep swimming.  Alright, let’s dive into the research. 

Item #1

This one’s called “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain” by Whedon et. Al. (James M Whedon 2020) and published in Pain Medicine in December of 2020 and that’s just hot enough. 

Why They Did It They say “Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.”

How They Did It

  • We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017.
  • They included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain
  • They identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.
  • The total number of subjects was 101,221

What They Found

  • Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients
  • Similar differences were observed for the acute groups.

Wrap It Up

Patients with spinal pain who saw a chiropractor had HALF the risk of filling an opioid prescription.   

CHIROUP ADVERTISEMENT

Item #2 Number two today is called “Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment” by Drew Oliphant (Oliphant D) and published in the Journal of Manipulative Physiological Therapeutics in 2004. Definitely not hot. 

Why They Did It The authors wanted to provide a qualitative systematic review of the risk of spinal manipulation in the treatment of lumbar disk herniations (LDH) and to estimate the risk of spinal manipulation causing a severe adverse reaction in a patient presenting with LDH.

How They Did It

  • They considered relevant case reports, review articles, surveys, and investigations regarding treatment of lumbar disk herniations with spinal manipulation and adverse effects and associated risks
  • Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. 
  • From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. 
  • This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH.

What They Found An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million.

Wrap It Up The apparent safety of spinal manipulation, especially when compared with other “medically accepted” treatments for LDH, should stimulate its use in the conservative treatment plan of LDH.

Item #3 The last one is called “Serious Adverse Events and Spinal Manipulative Therapy of the Low Back Region: A Systematic Review of Cases” by Herbert et. al.  and published in the Journal of Manipulative Physiological Therapeutics in 2015. Again….not hot but that’s OK. It’s a Systematic Review. 

Why They Did It The purpose of this study was to systematically search the literature for studies reporting serious adverse events following lumbopelvic spinal manipulative therapy (SMT) and to describe the case details.

How They Did It

  • A systematic search was conducted in PubMed including MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 12, 2012, by an experienced reference librarian. 
  • Study selection was performed by 2 independent reviewers using predefined criteria. 
  • We included cases involving individuals 18 years or older who experienced a serious adverse event following SMT applied to the lumbar spine or pelvis by any type of provider (eg, chiropractic, medical, physical therapy, osteopathic, layperson). 
  • A serious adverse event was defined as an occurrence that results in death or is life threatening, requires hospital admission, or results in significant or permanent disability. 
  • A total of 2046 studies were screened, and 41 studies reporting on 77 cases were included.

What They Found

  • Important case details were frequently unreported, such as descriptions of SMT technique, the pre-SMT presentation of the patient, the specific details of the adverse event, time from SMT to the adverse event, factors contributing to the adverse event, and clinical outcome. 
  • Adverse events consisted of cauda equina syndrome (29 cases, 38% of total); lumbar disk herniation (23 cases, 30%); fracture (7 cases, 9%); hematoma or hemorrhagic cyst (6 cases, 8%); or other serious adverse events (12 cases, 16%) such as neurologic or vascular compromise, soft tissue trauma, muscle abscess formation, disrupted fracture healing, and esophageal rupture.

Wrap It Up

The anecdotal nature of these cases does not allow for causal inferences between SMT and the events identified in this review.  When chiropractic is done responsibly and appropriately, it’s safer than almost any medical intervention. It just is. Now, when you have people damn near yanking people’s heads off of their bodies, aggressively adjusting patients on YouTube that have had a significant history of stroke, and adjusting 80 year old women with the same gusto you’d use with a 25 year old male…..well….those folks are just asking for it.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world.

The world needs evidence-based, patient-centered practitioners driving the bus so 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.

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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

  • James M Whedon, D., MS, Andrew W J Toler, MS, Louis A Kazal, MD, Serena Bezdjian, PhD, Justin M Goehl, DC, MS, Jay Greenstein, DC (2020). “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain Med 21(12): 3567-3573.  
  • Oliphant D “Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment.” J Man Physiol Ther 27(3): 197-210.