evidence-based chiropractic podcast

w/ Dr. Anthony Houssain – Choosing the Right Location, Clinic/Gym Hybrids, & The Value Of Masterminds

CF 258 w/ Dr. Anthony Houssain – Choosing the Right Location, Clinic/Gym Hybrids, & The Value Of Masterminds Today we’re going to be joined by my good friend, Dr. Anthony Houssain and we’re going to be talking about several relevant topics that can make a difference for any chiropractor. We’re covering Choosing the Right Location, Clinic/Gym Hybrids, & The Value Of Masterminds 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, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #257 Now if you missed last week’s episode , we talked about Tensile Force On Vertebral Artery During Adjustments & Exercising For Pain. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Just got through the Thanksgiving holidays and I learned something. For the first time in 24 years, I took off the day after Thanksgiving. What I learned is that I probably want to do that every year. Wow, it was nice to have those 4 days.  Here’s the thing, most people don’t really expect you to be open on that Friday anyway so it’s pretty much OK to take it off. I loved being able to just hang out and enjoy myself and my family. Not only that but I caught up on some projects that ahve been sitting for a while.  I also started some new projects as well. I am diving headfirst into Gray Cook’s FMS program and we’ll see what happens. I saw Gray talk at Forward ’19 right before COVID came along and ruined the world for a little while. He’s a great speaker and lots of evidence-based folks rave about FMS and SFMA so, I’m going a step beyond my Orthopedics fellowship and adding FMS to it to see where I wind up.  It can’t do anything but fill some holes in my knowledge and skills. More tools for the toolbox. Always learning, always getting better. Moving forward or falling behind.  We’ll get started soon but I need to tell you about tecnobody.com if it’s in Italian, just click on the English button. Look these products are above and beyond anything else you’ll find out there and will separate your clinic from all of the rest. I own the ISO Free so I’m not talking about something I don’t know anything about. I train balance and proprioception as well as concussion evaluation and even shoulder rehab. Once you check it out and you decide you can’t do without one, email me at creekstonecare@gmail.com and I’ll get you with the dude that can hook you up one on one. Tecnobody.com I’m done talking, I want to get to it with my buddy, Dr. Anthony Houssain. If you aren’t already familiar with Dr. Houssain, I want to tell you a bit about him first.  Dr. Anthony Houssain is a lifetime learner. Which is probably why we get along so well. He got is DC degree from National University of Health Sciences, achieved Diplomate status from the American Academy of Pain Management, has done over 100 hours in Chiropractic Rehabilitation from Souther California University, and is trained in McKenzie as well.  Dr. Houssain is also certified in post-surgical management of the cervical and lumbar spine, ART, FMS, SFMA, Racket Fit, and Dry Needling.  He’s also a former President of the North Alabama Chiropractic Society and has been a guest lecturer at UAB School of Medicine and at the UAB College of Nursing.  Now that you know why he’s here, let’s get to it with Dr. Anthony Houssain. 
  1. Tell me, Anthony, how’s Huntsville, Alabama today?
  2. Since chiropractic isn’t the typical first answer when someone is deciding what they want to be when they grow up, tell us why you chose chiropractic as your profession. 
  3. Now, you’re not originally from Alabama. Now leaving out metrics and specifics (that’s next) give us all a brief history of where you went to school, where you started out, and how you migrated down South. 
  4. Now, for providers that may be a bit younger and might can use a little advice on where to set up shop, besides your in-laws being in Huntsville, can you share a little about why you and your wife knew Huntsville was going to work out?
  5. Share with us a bit about what your practices look like? What all do you have your fingers in right now and how did you get there?
  6. As you just mentioned, you have entered the clinic/gym hybrid model and now that’s up and running. Tell us what gave you the idea to make that transition, what the buildout process looked like, and how it’s going so far since it got up and running. 
  7. If you could go back and start the clinic/gym process over again from the start, what would tell yourself and what would you change about how you did things the first time?
  8. Tell us how you lead someone from simple pain relief and then transition them into functional and interested in being a part of the gym and the strengthening process. Does that take a lot of sales? Or do you have specific tools that show the patient how it all fits together and why they can benefit. 
  9. We’re in Dr. Kevin Christie’s MCM Mastermind and we’ve gotten to know each other fairly well over the last year. Have you been part of a mastermind group before this one? 
  10. Other than the weekend we just spent in Key Largo, what value have you gotten out of our current mastermind?
  11. All masterminds are different, of course, but, in general, what do you see as being the best arguments for finding and joining a mastermind or accountability group?
  12. Next year, our mastermind is sold out and has no open spots available but we will be visiting Ft Lauderdale, Naples, Tampa, and maybe Orlando…..maybe back to the Keys. I figure there will be some smoked Negronis on our menu along the way but other than camaraderie, what are you hoping to get out of year 2?
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    

Aspirin And Fall Risk & Caffeine And Child Growth

CF 256: Aspirin And Fall Risk & Caffeine And Child Growth Today we’re going to talk about Aspirin And Fall Risk & Caffeine And Child Growth 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, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. 

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

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

You have found yourself smack dab in the middle of Episode #256 Now if you missed last week’s episode , we talked about Nonpharmacologic Treatment In The ER & Spinal Manipulative Therapy For Non-musculoskeletal Conditions. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

As I’m typing this out, I am in a hammock on the beach at the Playa Largo resort in Key Largo. Which is in the Florida Keys. I wanted to go ahead and get this part of the episode done because I wanted the weekend and the mastermind meeting here fresh in my mind.  First, if you don’t know about Dr Kevin Christie’s MCM Mastermind group, it’s 15 or so of the nation’s top chiropractors. We meet four times per year to network, learn, and problem solve. The cost, if I remember correctly, was $8k for the year not including travel and hotels. As the first year wraps up, the group has made me roughly $150,000 or more. That’s no lie. You could say that monetarily it was worth every penny. 

Then professionally, I was given the opportunity to build lifelong relationships with colleague as in the profession that are too producers and earners. This weekend we learned about delegating tasks to free up our time and our energy to creat a more free and enjoyable work week. We also learned about 10x-Ing our practices and what that needs to look like to make it happens We exchanged lots of ideas on automating things. Even down to having no front desk staff if we do choose.  Lots to consider and think over. This mastermind is closed for the 2023. Because it’s limited to only 25 people and 25 people are members for next year.

However, my point is, if you find a mastermind group, join. If you don’t, think about creating one yourself.  The learning is incredible inside and outside of the clinics. The community you find is incredible. And let’s be honest, sometimes, it’s nice to just have someone that knows your life and has been through similar stuff listen To you and bounce back some ideas and suggestions.  Alright. On to the research.

Item #1 Our first one this week is called “Daily Low-Dose Aspirin and Risk of Serious Falls and Fractures in Healthy Older People: A Substudy of the ASPREE Randomized Clinical Trial” by Barker et. al. (Barker AL 2022) and published in JAMA Internal Medicine on November 7, 2022 and it sizzles where it sits. 

Why They Did It To determine if daily low-dose aspirin (100 mg) reduces the risk of fractures or serious falls (fall-related hospital presentations) in healthy older men and women.

How They Did It

  • It was a double-blind, randomized, placebo-controlled trial 
  • studied older adult men and women in 16 major sites across Southeastern Australia. 
  • The ASPREE-FRACTURE substudy was conducted as part of the Australian component of the ASPREE trial.
  • Between 2010 and 2014 
  • Aged 70 years or older
  • Participants in the intervention group received a daily dose of oral 100 mg enteric-coated (low-dose) aspirin. 
  • The control group received a daily identical enteric-coated placebo tablet.

What They Found

  • In total, 16,703 people with a median age of 74 years were recruited
  • 9,179 (55.0%) were women. 
  • There were 8,322 intervention participants and 8,381 control participants included in the primary and secondary outcome analysis of 2,865 fractures and 1,688 serious falls over the median follow-up of 4.6 years. 
  • While there was no difference in the risk of first fracture between the intervention and control participants, aspirin was associated with a higher risk of serious falls. 
  • Results remained unchanged in analyses that adjusted for covariates known to influence fracture and fall risk.

Wrap It Up

In this substudy of a randomized clinical trial, the failure of low-dose aspirin to reduce the risk of fractures while increasing the risk of serious falls adds to evidence that this agent provides little favorable benefit in a healthy, White older adult population.

Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2 Our second one is called, “Association of Maternal Caffeine Consumption During Pregnancy With Child Growth” by Gleason et. al.  (Gleason JL 2022)and published in JAMA Network Open on October4 31, 2022. Bam a lama that’s some hot mama jama. 

Why They Did It Question  Is maternal caffeine consumption associated with child growth, and are such associations present in low-consumption groups?

How They Did It

  • I’m not going to bore you with the deets here because your eyes will gloss and you’ll be thinking about why you drive in parkways and park in driveways. 
  • Let’s just say that Child z scores for body mass index, weight, and height were evaluated, as well as fat mass index and percentage and obesity risk measured at 1 time between age 4 and 8 years 
  • In a secondary analysis of one of the cohorts, child z scores and obesity risk longitudinally through age 8 years were evaluated.

Wrap It Up

Intrauterine exposure to increasing levels of caffeine and paraxanthine, even in low amounts, was associated with shorter stature in early childhood.  The clinical implication of reductions in height and weight is unclear; however, the reductions were apparent even with levels of caffeine consumption below clinically recommended guidelines of less than 200 mg 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 https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

Barker AL, M. R., Thao LTP, (2022). “Daily Low-Dose Aspirin and Risk of Serious Falls and Fractures in Healthy Older People: A Substudy of the ASPREE Randomized Clinical Trial.” JAMA Intern Med.  

Gleason JL, S. R., Mitro SD, (2022). “Association of Maternal Caffeine Consumption During Pregnancy With Child Growth.” JAMA Netw Open 5(10).    

Gluteal Tendinopathy – You Don’t Know What You Don’t Know

CF 254: Gluteal Tendinopathy – You Don’t Know What You Don’t Know Today we’re going to talk about Gluteal Tendinopathy – You Don’t Know What You Don’t Know 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, look down your nose at people kind of research.

We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #254. Now if you missed last week’s episode, we talked about Spinal Cord Stimulators vs. Placebo & we talked about Low Back pain, Chiropractic, And Opioids. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

You may have heard me talk about it a time or two but I’m really impreessed with a contraption that we have in our office. When I bought mine it was only the third purchased in Texas. Texas is a big place, folks!  One had been sold to a research lab, one had been sold to a Physical Therapy outfit, and then mine. Definitely we’ve been ahead of the curve. When I have a car crash patient or a chronic pain patient, we can run the BESS test and the mCTSIB tests to test for concussion and proprioception.  Not just test proprioception but train it as well. Balance training, rehab training, movement evaluation, and excellent shoulder rehab as well. It’s called the ISO Free by Tecnobody and it’s cool and it makes me different from the rest of my colleagues by giving us capabilities nobody else has.  Check out these products and see what you think.

Go to https://www.tecnobody.com/en/products. Once you decide you have to have more information, email me at creekstonecare@gmail.com and I’ll hook you up with the people that can get you a deal on it.  This week I’m really starting to look forward to a little trip we’ve been planning for a while. Remember, you should take a solid trip about once per quarter. It’s the only way to preserve your sanity. You have to get out of your office and spend time on your loves or risk losing your mind completely.  Our trip this go around is part of Dr. Kevin Christie’s Florida Mastermind. We are all meeting in the Florida Keys. Key Largo to be specific. Which is the first Key south of the mainland.

Kevin picked this resort because my wife and I went there in February 2020. Just one month before the pandemic set in on the world.  People were just starting to think seriously about masks and all of that stuff back then. It was a blast and this resort called Playa Largo was the bees knees. Massages every day, drinks poured in cored pineapples on the beach at sunset, ,dining on the beach and being served funny umbrella drinks as you lounge in the hammock reading Stu McGill’s Back Mechanic book was amazing.  Check it out.

Just Google up Playa Largo and see what you find. It’ll make you consider Key Largo instead of Key West.  So that’s coming up November 11-13 or somewhere around there. We’re taking my daughter with us and I believe all other Mastermind members are bringing wife and kiddos so it should be a really special time of bonding, swapping ideas, and growth.  Speaking of growth, you’ve been hearing me fuss about being slow. We’re still slower than I want but it looks to be picking up a bit. Just in time to go to Key largo, right?

I have anxiety about it but I’m going and I’m not letting business worry me or stress me out. I have to compartmentalize that stuff and step away from it. Which I am. 

What do you have coming up that you’re looking forward to? I talked about the Tecnobody products earlier. Are you using anything new and cool? I’d love to hear about it and check it out. I love new gadgets that get patients better! Email me at dr.williams@chiropracticforward.com and tell me all about it.  Let’s hop into the research

Item #1

Let’s talk about Gluteal Tendinopathy, shall we. My friends at ChiroUp recently put out an awesome rundown of GT through their email list. Check the show notes for the link to their rundown on it at this poin in the show notes. https://chiroup.com/blog/what-is-the-most-common-cause-of-hip-pain After going through the Ortho Diplomate, GT has been on my radar and it’s amazing. Once you know to look for it, you’re going to find it EVERYWHERE!

Literally everywhere.

You just don’t know what you don’t know and I didn’t know before the Ortho Diplomate.  First, Why do people get it? They say it’s from excessive tension or compression of the area.  Secondly, what does it look like? GT is lateral hip pain and is tendinopathy of the glute medius or minimus. It hurts to walk but very tellingly, it hurts to lay on that side because of the compression but it also hurts to lay on the other side because we always stretch the leg over the other one so there is tension on the area. Pain on going up and down stairs for sure. One of our patients could barely get into and out of their RV and she was unhappy. 

Also, there is usually significant pain on palpation of the area. You can get their attention very quickly by poking around on it.  Current thinking is away from bursitis and more toward GT. If bursitis is present, it’s probably more a symptom of GT.  This thinking is fresh enough that I found myself in a pissing match with an ortho surgeon about whether it’s bursitis or it’s GT.

We’re always going to have less authority than the ortho in this case so, I told the patient what the research shows and said that ultimately, the terminology doesn’t matter because it will be treated the same. That worked out fine. Try to avoid pissing matches on GT because it’s just not widely known about right now.  Orthos are injecting corticosteroids into the hip joints of these GT patients and they’re stunned that it has no effectiveness. That’s because the problem isn’t in the joint. It’s in the connection on the posterior aspect of the greater trochanter.  How do we test for it and treat it?

  1. Hip Lag Sign
  2. FaberEx
  3. Palpation

What I do in my office is I use the Drop Release, which was invented by my friend, Dr. Chris Howson of the Great State of North Dakota, to beat it up just a little bit. I use regular SMT to make sure things are moving well. Then I recommend they do some cold laser on the insertion to work down some inflammation. We combine that with targeted rehab exercises from ChiroUp.  We have also combined my side with trigger point injections from our Nurse Practitioner.

It has been an awesome combination for us here at my clinic and we are helping these people get past GT a lot faster.  Recent research is showing, that PRP injections at the site show promise in helping chronic GT recover quickly as well. That’s exciting because we do PRP here at my clinic! I have the luxury of those not responding to the trigger points and my help to also try PRP now.  So, let’s cover that paper briefly before wrapping up for this week’s episode.  It’s called “The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection” by Fitzpatrick et. al. (Fitzpatrick J 2018) and published in the American Journal of Sports Medicine and was published on January 2, 2018. 

Why They Did It

There would be no difference in the modified Harris Hip Score (mHHS) between a single platelet-rich plasma (PRP) injection compared with a corticosteroid injection in the treatment of gluteal tendinopathy.

How They Did It

  • Randomized controlled trial;
  • There were 228 consecutive patients referred with gluteal tendinopathy who were screened to enroll 80 participants; 
  • Participants were randomized (1:1) to receive either a blinded glucocorticoid or PRP injection intratendinously under ultrasound guidance. 
  • A pain and functional assessment was performed using the mHHS questionnaire at 0, 2, 6, and 12 weeks and the patient acceptable symptom state (PASS) and minimal clinically important difference (MCID) at 12 weeks.
  • Participants had a mean age of 60 years, a ratio of female to male of 9:1, and mean duration of symptoms of >14 months.

What They Found

  • Pain and function showed no difference at 2 weeks or 6 weeks
  • The mean mHHS was significantly improved at 12 weeks in the PRP group compared with the corticosteroid group 

Wrap It Up

Patients with chronic gluteal tendinopathy for greater than 4 months, diagnosed with both clinical and radiological examinations, achieved greater clinical improvement at 12 weeks when treated with a single PRP injection than those treated with a single corticosteroid injection Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger https://traffic.libsyn.com/chiropracticforward/CF_-_Ep._254.mp3

Bibliography Fitzpatrick J, B. M., O’Donnell J, McCrory PR, Zheng MH, (2018). “The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection.” Am J Sports Med 46(4): 9336-9939.  

Night Owls Diabetes And Heart Disease & Medical Marijuana And Pain

CF 250: Night Owls Diabetes And Heart Disease & Medical Marijuana And Pain Today we’re going to talk about Night Owls Diabetes And Heart Disease & Medical Marijuana And Pain

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #250 Now if you missed last week’s episode , we talked about Vertebrogenic Pain. Time for A Thought Shift & Leisure time Physical Activity Effects On Mortality. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

As part of my post as an intern clinic for Parker, I get a new email fairly often requesting I update my profile. I will be honest, it’s a little much for a solo guy that’s busting his hump to stay above water and lives out in Amarillo. Which is an area of Texas that doesn’t have a plethora of interns and associates scrambling to get to, by the way.  So, in the year and a half or two years since we got onboarded, we have only hosted one intern and he moved back home near Tulsa, OK after his graduation. I wanted to keep him here but this isn’t his home.  I got an email recently that my CPR cert had to be updated to stay in the program. I feel like I just got it renewed last year but, what do I know? I’m busy.

So I decided the whole clinic could use it too. We took Tuesday off and went off-site. We met up at the CPR training place and spend an hour or two getting that re-newed. The staff actually enjoyed it; it was a bit of a teambuilding experience. We got out earlier than we expected so I took the girls to breakfast and it was another opportunity to spend time together outside of work.  That was last Tuesday. Then on Saturday, we all met up in downtown Amarillo for the Walk To End Alzheimer’s so had another opportunity for a little team building outside of the job site.  Good stuff and a great week. Still slower from the back-to-school slowdown but that’s the way it be. Just trying to get the marketing dialed in and make things happen to spur business back to where it needs to be.  I have to mention something kind of cool in my personal life; many of you know I’m a voice-over talent on the side. It’s not just fun. It’s turned into quite an amazing thing. I’m not going to go into financial aspects but let’s say it’s been far beyond anything I ever expected. 

I landed my very first video game recently! Google it up. It’s called God Of Rock by Modus and it’s coming out on Xbox and Playstation this Winter. And I cannot wait! It’s so exciting! I played an Elvis-esque character called King. He’s actually one of the main characters of the game. I connected with a group from San Francisco on Zoom and spent a little time recording phrases like Elvis would say them pretty much. It was fun and now, I’m going to have to buy 20 copies of this xbox fighting game! Lol.  Anyway, something fun in my life. 

I was thinking the other day; I’ve lived so many lives in this one life of mine. I swear. I was a traveling musician for over 8 years a record promoter, a radio station owner, and a venue booking agent. I am a sculptor, sketch artist, and painter. I was a college athlete. My chiropractic career. Hubby and dad. Real estate, VoiceOver….my life is often beyond insane.  So, let’s dispense with the chit-chat and get on with it. 

Item #1

My first one today is called, “Night owls more likely to develop diabetes, heart disease than early birds” by Study Finds (Allingham 2022) and published on September 20, 2022 bing bang boom pop freakin pow. It’s hot.  This is an article more than a research layout so let’s hit the high points and summarize this bad boy.  We all like to stay up late. Some of us, like myself, for example, are better at it than others. You’re talking to an ex-traveling musician. A road warrior. A freaking troubadour people. Lots of poor sleep decisions made in my past and in my current, folks.  Anyway, they make a statement at the top that says night owls are more like to develop Type 2 Diabetes or heart disease than people who go to bed and wake up early. 

They say that researchers have found that night owls are less active than early birds and less sensitive to insulin. I can’t answer the insulin point but I’ll tell you that I’d like to see any early bird more active than me. I’m all over the place all damn day long.  I could be the exception to the rule, however. I make myself and my family crazy so I probably am. 

Here’s my problem, fatty coming through!

They say that staying up late means we are worse at using fat for energy and this fat can build up in the body and contribute to the risk of disease. Meanwhile, “early birds” appear to be more reliant on fat for energy, more active in the day, and more aerobically fit. Probably true but I feel attacked. Again, I’m not having trouble fitting through the door and I don’t have to buy two airplane seats but damnit, I’m 6’4” and 280. I need to drop some baggage. 

The researchers regulated their diet to make sure that was not a factor. The team used advanced imaging, and assessed body mass, body composition, insulin sensitivity, and fat and carbohydrate metabolism using breath samples of each participant’s sleep trends. Over a week, the team monitored participants to figure out their daily activity patterns. Scientists discovered early birds use more fat for energy, both when resting and during exercise. They were also more insulin sensitive.

They end the article by saying, “We also found that early birds are more physically active and have higher fitness levels than night owls who are more sedentary throughout the day. Further research is needed to examine the link between chronotype, exercise and metabolic adaptation to identify whether exercising earlier in the day has greater health benefits,” Before getting to the next one, go to https://www.tecnobody.com/en/products 

That’s Tecnobody as in T-E-C no H. Tecnobody.com. They literally have the most impressive clinical equipment I’ve ever seen and that’s saying a lot because I like toys and gadgets for the clinic.  I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors.

Item #2

Our second one this week is called, “Effect of Medical Marijuana Card Ownership on Pain, Insomnia, and Affective Disorder Symptoms in Adults: A Randomized Clinical Trial” by Gilman et. al. (Gilman JM 2022) and published in JAMA Network Open and published on March 18, 2022 and that’s a steamy stack of stuff. 

Why They Did It

  • Despite the legalization and widespread use of cannabis products for a variety of medical concerns in the US, there is not yet strong clinical literature to support such use. The risks and benefits of obtaining a medical marijuana card for common clinical outcomes are largely unknown.
  • The authors wanted to answer the question, “What are the risks and benefits of obtaining a medical marijuana card for adults who seek medical marijuana for pain, insomnia, and anxiety or depressive symptoms?”

How They Did It

  • Pragmatic, single-site, single-blind randomized clinical trial 
  • Greater Boston area from July 1, 2017, to July 31, 2020. 
  • Participants were adults aged 18 to 65 years 
  • Chief concern was pain, insomnia, or anxiety or depressive symptoms. 
  • Participants were randomized 2:1 to either the immediate card acquisition group (n = 105) or the delayed card acquisition group (n = 81). 
  • The immediate card acquisition group was allowed to obtain a medical marijuana card immediately after randomization. 
  • The delayed card acquisition group was asked to wait 12 weeks before obtaining a medical marijuana card. 
  • All participants could choose cannabis products from a dispensary, the dose, and the frequency of use. 
  • Participants could continue their usual medical or psychiatric care.

What They Found

  • A total of 186 participants 
  • Compared with the delayed card acquisition group, the immediate card acquisition group had more cannabis use disorder symptoms; fewer self-rated insomnia symptoms; and reported no significant changes in pain severity or anxiety or depressive symptoms. 
  • Participants in the immediate card acquisition group also had a higher incidence of cannabis use disorder during the intervention

Wrap It Up

In this RCT, ownership of a medical marijuana card led to rapid onset and increased incidence and severity of cannabis use disorder in some participants, particularly those with a chief concern of anxiety or depressive symptoms. The self-reported improvement in sleep quality warrants further study into the benefits of medical marijuana card ownership for insomnia and the risk of cannabis use disorder. There were no observed benefits of obtaining a medical marijuana card for pain, anxiety, or depressive symptoms. I know it’s not cool these days. I’m fully aware. But you can continue to keep me in the camp that is in no hurry to completely legalize another drug. Make all of your comparisons to the alcohol you want. I get it and you’re not wrong.

They tried to put the genie back in the box in the 1930s and it didn’t work.  So that makes it smart to let another genie out of the bottle? No, it doesn’t. While I most definitely enjoy a drink or 10 from time to time, if we’re looking at it from a health perspective, then alcohol is a bad idea. It was a mistake on day one. Why make another when you have more and more research showing the harms and the lack of benefits? 

Call me a boomer. Even though I’m Gen X. I care not. My cares were all given out some time ago. 

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

  • Allingham, P. (2022). “Night owls more likely to develop diabetes, heart disease than early birds.” StudyFinds
  • Gilman JM, S. R., Potter KW, (2022). “Effect of Medical Marijuana Card Ownership on Pain, Insomnia, and Affective Disorder Symptoms in Adults: A Randomized Clinical Trial.” JAMA Netw Open 5(3).

 

Vertebrogenic Pain – A Thought Shift & Leisure Time Physical Activity Effects On Mortality

CF 249: Vertebrogenic Pain – A Thought Shift & Leisure time Physical Activity Effects On Mortality Today we’re going to talk about Vertebrogenic Pain. Time for A Thought Shift & Leisure time Physical Activity Effects On Mortality 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, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #249 Now if you missed last week’s episode , we talked about steps per day and how that’s related to dementia and we talked about vets and chiropractic. What a wonderful combination.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Ugh, slow Monday man. I hate it and it give me anxiety but I’m using the extra time to make things happen, my friends. Yes indeed. This is being written on September 19th so we are still in the middle of the yearly back to school slowdown.  When back to school gets us down, what’s the best way to handle it? Frist, as I’ve mentioned in recent podcasts, you get stuff done! Start through all of the things that have been piling up. Get that stack knocked out.  Secondly, marketing wise, what has been successful for you in the past? Have you slowed down on your posting frequency on social media? Pick it up and get to posting. Has it been any community outreach or direct marketing?

Time to re-engage, right? Thirdly, settle the hell down. You didn’t pee on the mayor’s dog and the whole town is not mad at you. Or me. I think this is me talking to me by the way. Lol.  Marketing is the most effective thing we can do for our clinic so we are spending this time calling and checking on patients that are more recent but have not really kept up with their schedule. Not in a bully or harrassing kind of way but a ‘staying top of mind’ kind of way and showing concern.  What are the big things that speak to people? For me and my practice specifically, I think it can be boiled down to 10 things. 

  1. No long waits
  2. Evaluation and treatment on the same day
  3. New patient appointments within 48 hours
  4. They will know the cost before their visit – at least as close as we can get to the cost
  5. Not everyone gets x-rays
  6. No pills and no surgery
  7. Online scheduling
  8. No long treatment plans
  9. Treatment by a Board Certified Orthopedic specialist
  10. Fast and efficient first appointment

These go for our medical side as well as for our chiropractic side. I think hammering these points consistently is an effective strategy. And, they aren’t talking points. It’s how we do things.  Here’s another thing I’ll share with myy patients when appropriate; when I have a difficult decision to make as far as recommendations or treatment, I fall back on one principle. That principle is ‘what would I do with this person if this person were an immediate family member?’ That is a guiding principle that will get you the closest to every right answer out there that you can make.  Alright, that’s enough of the personal side of things. Let’s get to the meat and taters. 

Item #1

The first one is called “Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain” by Conger et. al. (Aaron Conger 2022) and published in Pain Medicine on July 20, 2022. Hot sauce coming up!

  • Clinicians and researchers have long recognized that better subgrouping of individuals with CLBP is necessary for more targeted and effective treatments. Commonly described sources of CLBP include the zygapophyseal joints, sacroiliac joints, and intervertebral discs (often termed “discogenic” pain)
  • Historically, the term “discogenic pain” has been associated with disc degeneration and internal disc disruption with the presence of fissures in the annulus fibrosus and associated nociception via branches of the sinuvertebral nerve 
  • Previously, it was thought that pathological neurovascular ingrowth penetrated into annular fissures, leading to increased sensitivity and nociception via the sinuvertebral nerve
  • However, more recent evidence appears to refute the occurrence of such neurovascular ingrowth in many cases
  • In the late 1990s, a team of researchers led by Dr. Heggeness reported that vertebral bodies were richly vascularized by vertebral capillaries and innervated by nociceptors that traced back to a single source, the basivertebral nerve. Basivertebral nerve. Let’s call it the BVN, please and thank you. 
  • It’s a branch of the sinuvertebral nerve and it densely innervates the endplates. 
  • With progressive segmental degeneration or acute injury, altered force transfer and endplate stress can result in changes to endplate morphology and composition with concomitant impairment in permeability and transport 
  • Vertebral bodies demonstrated endplate nociceptor densification in areas of damage that were associated with increased disc degeneration. 
  • They also found that only 30% of annular tears in degenerated discs had pathologic neural ingrowth, compared with 90% of adjacent endplates (which were twice as densely innervated) 
  • This distinction between annular and endplate innervation is likely due to differences in nerve ingrowth potential. For the annulus, nerve ingrowth is inhibited by physical pressure and proteoglycans whereas nerves can easily proliferate in fibrovascular bone marrow adjacent to sites of endplate damage 
  • Accumulated damage to the discovertebral complex may result in chemical and mechanical sensitization of endplate nocioceptors 
  • These histopathological findings led to exploration of an “endplate-driven” model of discovertebral pain, with nociception largely occurring via the BVN to a greater extent than the sinuvertebral nerve
  • This research supports an “endplate-driven” model of anterior column degeneration and existence of a fourth distinct structural source of low back pain, popularly termed vertebrogenic pain

The rest of the article goes on to talk about the research and the benefits of BVN nerve ablation. Of course, that’s not where our minds go immediately when we’re looking at a disc issue, endplate or annular.  We’re looking at movement, functionality, and things of that nature.

But, I thought it was interesting because I have been taught over the years, even more recent years, that when an annulus cracks, it’s easier to become painful again because the nerves grow into that fissure and are deep toward the nucleus pulposus upon healing than they were prior to injury.  So, for that reason, we have assumed that’s why the biggest predictor of future pain is the presence of prior back pain. This updated information seems to, for the most part refute that information. And I’m OK with that. I love new knowledge.

I love updating my education and staying on top of the cutting edge when I’m able to. 

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

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

Item #2

The last one this week is called, “Association of Leisure Time Physical Activity Types and Risks of All-Cause, Cardiovascular, and Cancer Mortality Among Older Adults” by Watts et. al. (Watts EL 2022) and published in JaMA Network Open on August 24th 2022. That’s slapy ya mama hot!

Why They Did It

  • Higher amounts of physical activity are associated with increased longevity. However, whether different leisure time physical activity types are differentially associated with mortality risk is not established.. 
  • They wanted to answer the question, “Are different types of leisure time physical activity differentially associated with mortality risks among older adults?”

How They Did It

NIH Cohort study of 272 550 older adults

What They Found A total of 272,550 participants age at baseline, 70.5 years provided information on types of leisure time activity, and 118,153 died during follow-up of 12.4 years. 

  • In comparison with those who did not participate, 7.5 to less than 15 metabolic equivalent of task hours per week of racquet sports and running were associated with the greatest relative risk reductions for all-cause mortality, 
  • Followed by walking for exercise, 
  • other aerobic activity 
  • golf 
  • swimming
  • and cycling 

Each activity showed a curvilinear dose-response association with mortality risk; low metabolic equivalent of task hours per week of physical activity for any given activity type were associated with a large reduction in mortality risk, with diminishing returns for each increment in activity thereafter.  Associations were similar for cardiovascular and cancer mortality.

Wrap It Up

This cohort study of older individuals found differences between different types of leisure time activities and mortality risk, but there were significant associations between participating in 7.5 to less than 15 metabolic equivalent of task hours per week of any activity and mortality risk. There you have it go jump into some tennis, racquet ball, or pickle ball and then go for a run. You future self with thank your current self.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

Aaron Conger, D., Matthew Smuck, MD, Eeric Truumees, MD, Jeffrey C Lotz, PhD, Michael J DePalma, MD, Zachary L McCormick, MD, (2022). “Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain.” Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain 23: S63-S71.  

Watts EL, M. C., Freeman JR, (2022). “Association of Leisure Time Physical Activity Types and Risks of All-Cause, Cardiovascular, and Cancer Mortality Among Older Adults.” JAMA Netw Open 5(8). s

Upregulated Central Nervous System & Shared Decision Making With The Patient

CF 245: Upregulated Central Nervous System & Shared Decision Making With The Patient Today we’re going to talk about Upregulated Central Nervous System & Shared Decision Making With The Patient. 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, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   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 excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #245 Now if you missed last week’s episode , we talked about Recognizing Cervical Artery Dissection. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Things are clicking along pretty normally for a chaotic clinic. Today, let’s talk a little about your relationships with your employees before we get to the research.  Everyone has different styles of owning or managing their clinics and staff. Mine has always been to treat them like family. Honestly, we spend more time with our staff than we do with our own families. So why not have friendly and almost family-like relationships with them? Why the hell not? I don’t want awkward forced relationships with the people I’m with every day all day. I want fun, happy, and friendly relationships. With people I look forward to seeing every day. 

My staff is hilarious and we have a lot of fun together. 

I’ll give you a little story as an example. My office manager is getting married in September. Probably about the time this episode goes live. She had her wedding shower on August 13th at her mother’s house. It wasn’t the regular boring old wedding shower. They had drinks, men and women, cornhole, and beer pong in the back yard…..you get the picture. Pretty much my entire staff of 12 or 13 was there. Which is nice. They feel like family to an extent. That’ll warm your heart, right? Well, I’m of the age that beer pong wasn’t ‘a thing’ in my college years. We played simple games like quarters or something like that. Anyway, I went to the wedding shower. My wife actually helped host it and run it all. She made a huge table full of charcuterie items and it was just all very well done. 

So that’s point #1; she felt close enough to us to not only want us at her wedding shower but to have my wife help host it.  Then, after gifts were opened and a few filtered out, everyone moved to the backyard and played cornhole and beer pong. My office manager made me be her teammate for a game of beer pong. Now, I told her I can’t play with drinks because I was driving so I just sipped on one beer while we played.  Turns out, I actually have a little talent for beer pong. We won the first game against her fiancee and Boom! Instant respectability amongst the kiddos. 

So, point #2; when your staff likes you and wants you to participate in aspects of their personal life, I say you just do it.  You build friendship, loyalty, camaraderie, and trust the more you just say, “Yes.” Play beer pong. Even when you don’t want to or don’t know how to play it. It’ll pay off in the long run.  If you feel differently, let me know. Send me an email at dr.williams@chiropracticforward.com I want your opinion so I can share with the collective. 

OK, on to the research. 

 

Item #1

Our first one is called “Does shared decision making results in better health related outcomes for individuals with painful musculoskeletal disorders? A systematic review” by Christopher et. al. (Yannick Tousignant-Laflamme 2017) published in the Journal of Manual and Manipulative Therapy in 2017. 

Why They Did It

Shared Decision-Making (SDM) is a dynamic process by which the health care professional and the patient influence each other in making health-related choices or decisions. SDM is strongly embedded in today’s health care approaches and is advocated as an ideal model since it renders individuals more control over the health care they choose to receive, and has been shown to improve patient outcomes. The goal of this systematic review was to investigate the added value of SDM on clinical health-related outcomes in patients with a variety of musculoskeletal conditions.

How They Did It

PubMed and CINAHL. To be considered for review, the study had to meet all the following criteria: (1) prospective studies that involved treatment decision-making;  (2) randomized controlled trial design;  (3) involving patients faced with having to make a treatment decision;  (4) comparing SDM with a control intervention and  (5) including one or more of the following outcome measures: well-being, costs, health-related pain or disability measures, or quality of life.

What They Found

We did not find a single study that looked at the true effect of SDM on patient-reported outcomes in a population with musculoskeletal pain.

Wrap It Up

For the management of painful musculoskeletal conditions, in the light of the current evidence (none), we estimate that it would be wise to explore the effectiveness of SDM before forcing its large-scale implementation in rehabilitation. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2

The last one is called, “Mechanisms of chronic pain – key considerations for appropriate physical therapy management” by Courtney et. al. (Carol A. Courtney 2017) and published in the Journal of Manual and Manipulative Therapy in March of 2017.  Rather than a full-blown research project, this one is more of an informational article with some future direction. 

They say the following: “In the last decades, knowledge of nociceptive pain mechanisms has expanded rapidly. The use of quantitative sensory testing has provided evidence that peripheral and central sensitization mechanisms play a relevant role in localized and widespread chronic pain syndromes.  In fact, almost any patient suffering from a chronic pain condition will demonstrate impairments in the central nervous system. In addition, it is accepted that pain is associated with different types of trigger factors including social, physiological, and psychological.  This rationale has provoked a change in the understanding of potential mechanisms of manual therapies, changing from a biomechanical/medical viewpoint, to a neurophysiological/nociceptive viewpoint. 

Therefore, interventions for patients with chronic pain should be applied based on current knowledge of nociceptive mechanisms since determining potential drivers of the sensitization process is critical for effective management.  The current paper reviews mechanisms of chronic pain from a clinical and neurophysiological point of view and summarizes key messages for clinicians for proper management of individuals with chronic pain.”

Now, I don’t know exactly where you’ve been hearing this since 2019. Oh, wait, yes I do. Here!

 

You’ve been hearing it here and research is catching up.  I didn’t invent this stuff, of course. And I’m no smarter than everyone else. I just happened to take the course for the Diplomate of the International Academy of Neuromusculoskeletal Medicine and was taught by Drs. Anthony Nicholson and Matthew Long in that course and THEY are on the cutting edge.  They are the reason I’ve been preaching this stuff for so long now. They’re the reason my patients get better at the rate they 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 leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

Carol A. Courtney, C. F.-d.-l.-P. S. B. (2017). “Mechanisms of chronic pain – key considerations for appropriate physical therapy management.” Journal of Manual & Manipulative Therapy 25(3): 118-127.  

Yannick Tousignant-Laflamme, S. C., Derek Clewley, Leila Ledbetter, Christian Jaeger Cook & Chad E Cook, (2017). “Does shared decision making results in better health related outcomes for individuals with painful musculoskeletal disorders? A systematic review.” Journal of Manual & Manipulative Therapy 25(3): 144-150.  

Recognizing Cervical Artery Dissection

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

On the personal end of things…..

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

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

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

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

Item #1

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

That’s hot!

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

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

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

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

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

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

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

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

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

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

Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain

CF 243: Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain Today we’re going to talk about Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check 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 #243 Now if you missed last week’s episode, we talked about effectiveness Of the Neck Exercise For Disc Herniation and Supine vs. Prone MRIs. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

We have been flying all over the place this year. Honestly, I’m making up for lost time during the pandemic. 3 trips already to Florida this year for Kevin Christie’s MCM Mastermind group and another in November to meet the crew in Key Largo. Pumped about that one! As a part of the Forensics diplomate, I go to Chicago every October so we’ll be up there in a couple of months.  Not to mention trips to Texas Chiropractic Association functions. There are at least two a year for that. One in June and one in February or March.  Now, with my VoiceOver career going little bananas, I have a vo conference that I just go back from in Dallas and one in Atlanta in March.  And then anything we want to do that is not work-related. Like, go to Vegas on September 8th to see Motley Crue, Def Leppard, Poison, and Joan Jett. Can I get a hell yes from my fellow 80’s kids? Plus, I want to start visiting some of the practices of the docs in the MCM Mastermind. I’m interested in seeing what they do to make them so efficient and so successful. I can always learn from others. 

This brings up a point; have any of you considered identifying you colleagues that are highly productive and very successful and asked them if you can go and hang out and visit for a day or two just to see what they do that you could possibly implement in your own clinic? We can sit in a mastermind and exchange ideas and processes but at the end of the day, it’s when you see it all in action that it sticks and effects change in how you practice and how you manage your patients. 

So, I want to start fitting in some trips when I can find some space. Right now, I’m not sure where the heck I can make it fit to be honest. But, it is an investment in my company and in my clinic so I’m going to see if I can make it happen, regardless.  I’ll keep you updated. Getting a mentor is key folks. Even if the mentor come in the shape and form of several of your colleagues. 

Item #1 This first one is called “Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data” by Davis, et. al. (Davis BA 2022) and published in Journal of Chiropractic Medicine in June of 2022, Kapow!! That’s got some heat on it. 

Why They Did It The purpose of this study was to determine whether a sample of older adult male U.S. veterans demonstrated clinically and statistically significant improvement in chronic lower back pain on validated outcome measures after a short course of chiropractic care.

How They Did It

  • There were 217 individuals who met the inclusion criteria. 
  • We performed a retrospective review of a quality-assurance data set of outcome metrics for male veterans, aged 65 to 89 years, who had chronic low back pain, defined as pain in the lower back region present for at least 3 months before evaluation. 
  • We included those who received chiropractic management from January 1, 2010, to December 31, 2018. 
  • Paired t tests were used to compare outcomes after 4 treatments on both a numeric rating scale (NRS) and the Back Bournemouth Questionnaire (BBQ). 
  • The minimum clinically important difference (MCID) was set at 30% change from baseline.

What They Found

  • The mean NRS score change from baseline was 2.2 points, representing a 34.1% reduction.
  • The mean score change for Back Bournemouth Questionnaire was 14.7 points, representing a 35.9% reduction. 
  • The percentage of participants reaching the minimum clinically important difference for the NRS was 57% and for the Back Bournemouth Questionnaire was 59%, with 41% of the sample reaching the minimum clinically important difference for both the NRS and Back Bournemouth Questionnaire.

Wrap It Up

This retrospective review revealed clinically and statistically significant improvement in NRS and Back Bournemouth Questionnaire scores for this sample of older male U.S. veterans treated with chiropractic management for chronic low back pain. 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

This last one is great and is called, “Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims” by Anderson, et. al. (Anderson BR 2021) and published in Journal Of Manipulative And Physicological Therapeutics on November 1, 2021, and it’s just hot enough!

Why They Did It The purpose of this study was to evaluate the relationship between procedures and care patterns in back pain episodes by analyzing health insurance claims.

How They Did It

  • They performed a retrospective cohort study of insurance claims data from a single Fortune 500 company. 
  • The 3 care patterns analyzed were initial spinal manipulative therapy, delayed spinal manipulative therapy, and no spinal manipulative therapy. 
  • The 3 procedures analyzed were imaging studies, injection procedures, and back surgery. 
  • They considered “escalated care” to be any claims with diagnostic imaging, injection procedures, or back surgery. 
  • Modified-Poisson regression modeling was used to determine relative risk of escalated care.
  • There were 83 025 claims that were categorized into 10 372 unique patient first episodes. 

Wrap It Up

  • For claims associated with initial episodes of back pain, initial spinal manipulative therapy was associated with an approximately 30% decrease in the risk of imaging studies, injection procedures, or back surgery compared with no spinal manipulative therapy. 
  • The risk of imaging studies, injection procedures, or back surgery in episodes in the delayed spinal manipulative therapy group was higher than those without spinal manipulative therapy.

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

Anderson BR, M. S. (2021). “Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims.” J Man Manip Ther 44(9): P683-689.  

Davis BA, D. A., Golley DJ, Chicoine DR (2022). “Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data.” J Chiropr Med 21(2): 77-82.    

Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs

CF 242: Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs Today we’re going to talk about Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs But first, here’s that sweet sweet bumper music

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

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

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

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

You have found yourself smack dab in the middle of Episode #242 Now if you missed last week’s episode , we talked about Does Supplementation Work & Non-Surgical Treatment For Stenosis. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, last week was insanity around my office. I personally saw about 196 appointments and our nurse practitioner had his best week since we integrated and brought medical services into our clinic. He saw 38 appointments not counting me.  I say, “Not counting me,” because I got the hormone pellets. If you’re not familiar, go search up BioT or search up Evexipel. We use Evexipel and it’s a hormone balancing or optimization procedure. The provider does some blood work and finds out where you’re at with some key hormones. 

I’m way low on testosterone which makes me insane because I could drop some weight but I’m not nearly as bad as a lot of folks I see. I’m 6’4” and about 272. Yes, I should ideally be about 220 or even less if you listen to the government. However, I was a college offensive lineman and I’ve been a pretty thick dude my whole life.  I have a dad bod but I’m not waddling around and having a hard time getting through doors is what I’m saying. OK? Anyway, I’m not sedentary either. I get lots of activity from 190+ patients in a week to exercise and throw the discus.

I’m a go-getter so the low T thing makes me a little insane but it is what it be and that’s just me.  So, time to do it. We use Evexipel and when I did BioT, it was in the butt cheek and it was pretty freaking sore for about 5-7 days. Evexipel does the pellets in the flank for men and 4 days later, I have had very little to basically zero pain. It’s been amazing. 

The pellets take about 5 days to start being absorbed in the body so I’m looking forward to the benefits. I’ll keep you updated.  For my practice specifically, you’ve heard me mention that we will patch one hole and another leak will spring and I’m always on the lookout for them. Well, I found one just this morning.  We had 1 96 patients on my side last week. I show up for work this morning and look at the schedule and there are only 36 patients on my schedule today.

I guess this issue didn’t register with any of my staff members because when I asked what happened to my schedule this week, they just acted like it’s normal and the week starts filling out on Mondays.  Oh no no no. That’s not how we need to be looking at it. Let’s do a little high-level, global thinking here.  I saw 25 new patients last week. If they’re all on schedule, that’s at least 25 appointments booked on the following Monday. Remember Monday has 36 currently.

Well, 6 of those are new patients. So, let’s throw out those 6 new patients and that leaves us with 30 today. If we remove the new ones from last week, the 25 that should have been guaranteed…..then that just leaves us with 5 established patients.  5. Cinco. Cinco freaking established patients for a Monday.  So, when we’re looking at it in this manner, well, clearly there’s a problem. Patients aren’t on schedule and we’ve had significant fall-off.

This means I’m either not doing my job educating them on why they need to be consistent, or the staff isn’t encouraging the message and supporting the message, or the front desk isn’t getting them rescheduled.  Or all three.  Either way, we basically bled 25 new patients last week. So, that hole has to get plugged, yet again, this week. Another thing to consider is that it’s basically Back To School time and that’s traditionally a slow-down time for us.  So that something else can go stupid next week. Because that’s the way it goes. 

Item #1

This first one is called “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation” by Wu et. al. (Wu SK 2022)  and published in BMC Musculoskeletal Disorders on July 30 of 2022. Bam!!! Into the frying pain! It’s hot. 

Why They Did It

To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation.

How They Did It

  • Thirty diagnosed C4/5 and/or C5/6 disc-herniated patients
  • 8-week cervical therapeutic exercise program 
  • They were followed up with videofluoroscopic images. 
  • The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements.

What They Found

  • The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients’ intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment. 
  • After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02-8.67%, and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12-9.18% compared to the baseline. 
  • Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82-8.66%. 
  • Active lateral flexion away from the affected side significantly increased the foramen by 3.71-6.78%

Wrap It Up

The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in the intervertebral foramen areas of the patients with disc herniation.

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

Item #2

I saw this one in the Forward Thinking Chiropractic Alliance group on Facebook and it’s pretty darn interesting. It’s called, “Prone Position MRI of the Lumbar Spine in Patients With Low Back Pain and/or Radiculopathy Refractory to Treatment” by Avellanal et. al.  and published in Pain Physician in August of 2022 damnit this Is the first day of August it just doesn’t get any more fire than that heat!

Why They Did It

There are patients with limiting low back pain (LBP) with or without radicular pain in whom conventional supine magnetic resonance imaging (MRI) show no causative pathology. Despite the limitations of dynamic axially loaded MRI examinations, these imaging studies have shown a striking ability to diagnose pathology unrecognized by conventional MRI. The difference in findings between supine and prone MRI with patient symptom correlation has not been studied.

How They Did It

  • Nineteen patients suffering from chronic moderate-to-severe LBP and/or radicular pain 
  • Nonresponsive to conventional therapy or interventional treatment
  • Both supine and prone MRIs were performed and analyzed by a neuroradiologist. 
  • Specific supine and prone measurements were registered, including spinal canal area, lateral recess diameter, foraminal area, and ligamentum flavum thickness. 
  • Three-dimensional MRI reconstructions of varying pathology patterns were created.

What They Found

  • In 52.6% of cases, disc pathology or increased disc pathology was seen only on prone imaging. 
  • They observed significant buckling and increased thickness of the ligamentum flavum in 52.6 % of cases in the prone position that was absent from the supine MRIs. 
  • They also documented varying grades of spondylolisthesis and facet joint subluxation resulting in significant foraminal stenosis in 26.3% of prone cases not seen from supine MRIs.

Wrap It Up

  • Four patterns of pathological findings have been identified by MRI performed in the prone position. 
  • These findings were not observed in the supine position. 
  • Prone MRI can be a significant and useful tool in the diagnosis and treatment of patients with back pain refractory to treatment whose conventional supine MRIs appeared unremarkable.

Which I also take as yet another reason you cannot trust MRI’s for definitive diagnosis of the source of pain. 

 

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

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 https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host

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

Bibliography Wu SK, C. H., You JY, Bau JG, Lin YC, Kuo LC (2022). “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation.” BMC Musculoskelet Disord 23(1): 728.      

Does Supplementation Work & Non-Surgical Treatment For Stenosis

CF 241: Does Supplementation Work & Non-Surgical Treatment For Stenosis Today we’re going to talk about if vitamin Supplementation Works for preventing cardiovascular issues or cancer and we’ll talk about  Non-Surgical Treatment For Stenosis But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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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 #241 Now if you missed last week’s episode, we talked about Brain Activity From Spinal Manipulative Therapy & PT Is As Good As Arthoscopic Surgery For Meniscus Issues. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

What an amazing weekend in Tampa Florida, y’all. Seriously. When you think about a mastermind weekend, you think about learning stuff. And yes….absolutely, we’re learning. Friday from 8-5 we’re learning. Saturday from 8-1, we’re learning.  What doesn’t get counted or thought about is the discussion between the members during the classroom time.

We’re not talking about your chiropractor down the street. In some cases, we’re talking about the cream of the crop in the evidence-based chiropractic world.  We’re talking about doctors that have taught around the world. We’re talking about chiropractors that have 6+ associates under them. We’re having discussions with people on that level involved and contributing and sharing.  But what also doesn’t get counted or thought about is what happens outside of the classroom.

The bonds that have been forged over the past 7 months of being in this group. The friendships that have been formed. The networking and the sharing of tools, thoughts, and processes.  Little things like…..have you ever considered charging a small $2.00 admin fee on every checkout so that you can cover ordering a patient’s records, filing and dealing with insurance companies, denials, etc….credit card fees, writing mattress and freaking hot tub notes, and all of the other crap we have to do for free?

Well, that came up in the group, we brainstormed it, came up with a sign for the lobby to warn patients, and knock it out. A $2.00 fee per transaction will bring in an additional $25,000 or so per year and cover my credit card fees with a little left over for other admin costs. Not one word from the patients has been said according to those in the group already doing it. 

That’s just the beginning.

Did you know there are lots of government credits you probably qualify for that you’re not getting? I didn’t either until I joined this group. We estimate most of us have made 20x the return on investment so far. So that’s pretty amazing.  And then….the bonds. I have been fortunate enough to create a network and bonds with these folks that will be with me for the rest of my life. Not just professionally but personally as well. And they don’t just help me with my practice but referrals for speaking engagements and things that are professional but outside of the clinic.  It’s been great, folks. If you’re an earner and go-getter and you want to be a part of it, email Kevin Christie at drkchristie@gmail.com or email me at dr.williams@chiropracticforward.com and we’ll get you connected to see if you’re right for the group. 

Alright, let’s dive in. 

Item #1

Our first one today is called, “Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement” by the US Preventive Services Task Force (Force 2022) and published on June 21, 2022. And it’s hotter than Tampa in July!

Why They Did It

According to National Health and Nutrition Examination Survey data, 52% of surveyed US adults reported using at least 1 dietary supplement in the prior 30 days and 31% reported using a multivitamin-mineral supplement.  The most commonly cited reason for using supplements is for overall health and wellness and to fill nutrient gaps in the diet.  Cardiovascular disease and cancer are the 2 leading causes of death and combined account for approximately half of all deaths in the US annually.  Inflammation and oxidative stress have been shown to have a role in both cardiovascular disease and cancer, and dietary supplements may have anti-inflammatory and antioxidative effects.

Objective 

To update its 2014 recommendation on the evidence on the efficacy of supplementation with single nutrients, functionally related nutrient pairs, or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population, as well as the harms of supplementation.

How They Did It

Community-dwelling, nonpregnant adults.

What They Found

  • The USPSTF concludes with moderate certainty that the harms of beta carotene supplementation outweigh the benefits for the prevention of cardiovascular disease or cancer. 
  • The USPSTF also concludes with moderate certainty that there is no net benefit of supplementation with vitamin E for the prevention of cardiovascular disease or cancer. 
  • The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with multivitamins for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined. 
  • The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with single or paired nutrients (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined.

Wrap It Up

So….nothing firm for beta carotene, Vitamin E, or multivitamins or a combo for preventing cardiovascular disease and cancer. 

 

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 Our last one this week is called, “Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review” by Ammendolia et. al. (Ammendolia C 2022) and published in BMJ Open on January 19, 2022. Sizzle baby. It’s hot. 

Why They Did It

Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication.

How They Did It

  • A systematic review.
  • We only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS.

What They Found

  • Of 15,200 citations screened, 156 were assessed and 23 new trials were identified. 
  • There is moderate-quality evidence from three trials that: 
  • Manual therapy and exercise provides superior and clinically important short-term improvement in symptoms and function compared with medical care or community-based group exercise; 
  • Manual therapy, education and exercise delivered using a cognitive-behavioral approach demonstrates superior and clinically important improvements in walking distance in the immediate to long term compared with self-directed home exercises and 
  • Glucocorticoid plus lidocaine injection is more effective than lidocaine alone in improving statistical, but not clinically important improvements in pain and function in the short term. 

Wrap It Up

  • There is moderate-quality evidence that a multimodal approach that includes manual therapy and exercise, with or without education, is an effective treatment and that epidural steroids are not effective for the management of LSS with neurogenic claudication. 
  • All other non-operative interventions provided insufficient quality evidence to make conclusions on their effectiveness.

We use Dr. Ammendolia’s program for stenosis patients in our office and it’s legit. It really helps. Our patients get outstanding results when they’re on the program, being good teammates and doing the things they’re supposed to be doing.  Stenosis is a lack of real estate. It’s frustrating for patients and practitioners but over the years, Dr. Ammendolia’s course has been the most impressive way of treating it I’ve ever experienced. 

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.

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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

Ammendolia C, H. C., Plener J, Bussières A, Schneider MJ, Young JJ, Furlan AD, Stuber K, Ahmed A, Cancelliere C, Adeboyejo A, Ornelas J (2022). “Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review.” BMJ Open 12(1).  

Force, U. P. S. T. (2022). “Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement.” JAMA 327(23): 2326-2333.