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Do Chiropractors Cause Disc Herniations & Family Doctors Still Don’t Get It

CF 178: Do Chiropractors Cause Disc Herniations & Family Doctors Still Don’t Get It

Today we’re going to talk about if chiropractors cause lumbar disc herniations and how primary doctors still don’t understand guidelines that are 4 years old at this point.

But first, here’s that sweet sweet bumper music

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.

If you haven’t yet I have a few things you should do.
Like our Facebook page,
Join our private Facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
We also have an evidence-based brochure and poster store at chiropracticforward.com
While you’re there, join our weekly email newsletter.

You have found yourself smack dab in the middle of Episode #178

Now if you missed last week’s episode, we talked about spinal manipulative therapy effectiveness and chiropractic for colic. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..
It’s dragging. Don’t think for a second that you’re going to set up a medical entity in just a week or so. Lol. Goodness gracious. I went through my orthopedic diplomate in 6 months for a reason. It’s not because I’m smarter than anyone else or that I have more extra time than anyone else. Far from it.
I went through it so quickly because I hate stuff just lingering out in the ether unfinished or waiting or on hold or whatever. It drives me crazy to have unfinished ideas or projects. Literally crazy.
So, this new growth thing is making me crazy because it’s still not tied up and we’re in a holding pattern until the papers are signed and we are credentialing. Which we aren’t doing just yet.

But, I think we’re close.

My book will be launching on Tuesday, June the 8th. Be looking for it, y’all! I’m beyond excited about it!

Business is slowly picking back up. Texas is wide open at this point. Its rarer to see someone wearing a mask than it is to see those not wearing masks. Concerts have returned. Crowds have returned. And Texas had the second slowest growth of COVID last month. What does that say exactly?? Hell if I know. But I see the University of Massachusetts penalizing kids for not wearing masks off-campus and I see Texas with little COVID growth yet we’re wide open with basically no masks.

Who’s right? To me, it looks like Texas and states like Texas are right at this point in time. All of the lockdowns were important and needed and effective. Now, it appears to be time to loosen up considerably and proceed with less fear and more science.

I’m not an expert in that field. But there has to be some science coming out of what’s happening and the differences between states still locked down and states that are wide open. Between kids that have been going to school since August of 2020 and kids that just started a week or two ago because their schools have been closed all year.

It’s all interesting. That’s for sure. As for me, in my area, the sense of a return to the old normal is refreshing. In a city area of about 270,000 people, we added 19 new cases yesterday. Again, I’m 100% honest when I tell you there are basically zero masks to be seen with 100% capacity everywhere you go.

You be the judge.

Item #1
This first one is called “Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study”’ by Hincapie et. al. [1] and published in European Spine in July of 2018.

Why They Did It
“Our objective was to investigate the association between chiropractic care and acute lumbar disc herniation with early surgical intervention, and contrast this with the association between primary care physician care and acute lumbar disc herniation with early surgery.”

How They Did It
195 cases of acute lumbar disc herniation with early surgery (within 8 weeks) were identified in a population of more than 100 million person-years.
Self-controlled case series design and population-based healthcare databases in Ontario, Canada
They investigated all adults with acute lumbar disc herniation requiring emergency department (ED) visit and early surgical intervention from April 1994 to December 2004.
The relative incidence of acute lumbar disc herniation with early surgery in exposed periods after chiropractic visits relative to unexposed periods was estimated within individuals, and
compared with the relative incidence of acute lumbar disc herniation with early surgery following primary care physician visits.

What They Found
Strong positive associations were found between acute lumbar disc herniation and both chiropractic and primary care physician visits.
The risk for acute lumbar disc herniation with early surgery associated with chiropractic visits was no higher than the risk associated with primary care physician visits.

Wrap It Up
“Both chiropractic and primary medical care were associated with an increased risk for acute lumbar disc herniation requiring ED visit and early surgery. Our analysis suggests that patients with prodromal back pain from a developing disc herniation likely seek healthcare from both chiropractors and primary care physicians before full clinical expression of acute lumbar disc herniation. We found no evidence of excess risk for acute lumbar disc herniation with early surgery associated with chiropractic compared with primary medical care.”

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Item #2
The last one today is called “Initial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care Providers” by Roseen et. al. [2] and published in the Journal of Alternative and Complementary Medicine in March of 2021 and we got a hot one folks!

Why They Did It
They say, “In April 2017, the American College of Physicians (ACP) published a clinical practice guideline for low back pain (LBP) [3] recommending nonpharmacologic treatments as first-line therapy for acute, subacute, and chronic LBP.”

Listeners of this Chiropractic Forward Podcast know this because I have been riding that horse nonstop since it came out. I mention damn near every single episode.

The objective here is “To assess primary care provider (PCP)-reported initial treatment recommendations for LBP following guideline release. “

How They Did It
Cross-sectional structured interviews.
Interviews were completed between December 2017 and March 2018.
Convenience sample of 72 primary care providers from 3 community-based outpatient clinics in high- or low-income neighborhoods.
The PCPs were interviewed about their familiarity with the ACP guideline, and how they initially manage patients with acute/subacute and chronic LBP.
PCPs were also asked about their comfort in referring patients to nonpharmacologic treatment providers, and about barriers to referring.

What They Found
Of 72 participating PCPs, over three-fourths indicated being familiar with the ACP guideline
For acute LBP, PCPs typically provided advice to stay active and pharmacologic management (97%; primarily nonsteroidal anti-inflammatory drugs).
For chronic LBP, PCPs were more likely to recommend nonpharmacologic treatments than for acute LBP
The most common nonpharmacologic treatments recommended for chronic LBP were physical therapy (78%), chiropractic care (21%), massage therapy (18%), and acupuncture (17%)
The cost of nonpharmacologic treatments was perceived as a barrier.
However, PCPs working in low-income neighborhood clinics were as likely to recommend nonpharmacologic approaches as those from high-income neighborhood clinics.

Wrap It Up
“While most PCPs indicated they were familiar with the ACP guideline for LBP, nonpharmacologic treatments were not recommended for patients with acute symptoms. Further dissemination and implementation of the ACP guideline are needed.”

So, what’s it going to take? Well, for one, the more fringe and crazy part of our profession needs to cut their crap. No, I don’t want to be a medical doctor or I would have gone to med school.

What I DO want is to be a respected part of an integrated healthcare team. Like it or not, the PCP is the gatekeeper and if the PCPs trust us, we get more patients, and at the end of the day, aren’t more patients the name of the game? Come on, of course, it is.

If our profession moves into the year 2021 instead of 1896 or whatever year Palmer got the idea from the osteopaths, then we can move forward with becoming a part of the community. Rather than separate and distinct. I do like not being under the state medical boards and all that good stuff. That’s necessary while there’s still such a divide.

But we can become more and more of the team if we stop thee more fringe assertions and ideas. Nepute, to my understanding, the chiro out in St. Louis…..the dude that has been, in my view, an absolute lunatic all over social media, is the first person getting nailed under the new covid laws and just happens to be a chiropractor.

Not a good look. In my opinion, he’s done chiropractors zero favors and really bruised us up quite a bit. Why in the hell would a PCP…….or a circus worker…or anyone else in the damn world…..see someone like NePuke and associate them with all other chiropractors and decide they’ll never send a patient or a friend to whackos like chiropractors?

Raise the game folks. Raise the game. Get current. Get smart. Make sure you’re sciencing once or twice per day. It’s not hard to do. Get a Diplomate. Specialize. Raise the game

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

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

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

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.

And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

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

That’s Chiropractic!

Contact
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.

Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.

We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

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

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About the Author & Host

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

Bibliography
1. Hincapie C, Chiropractic care and risk for acute lumbar disc herniation: a population-based self-controlled case series study. European Spine Journal, 2018. 27(7): p. 1526-1537.
2. Roseen EJ, C.F., Atlas SJ, Mehta DH,, Initial Management of Acute and Chronic Low Back Pain: Responses from Brief Interviews of Primary Care Providers. J Altern Complement Med, 2021. 27(S1): p. S106-S114.
3. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2017. 4(166): p. 514-530.

They Still Have Low Back Pain Management WRONG

CF 170: They Still Have Low Back Pain Management WRONG Today we’re going to talk about some personal observations from two different patients I saw today and we’ll cover a new article on what should be done with low back pain patients. Hint, many are still getting it wrong over there in the medical profession.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #170 Now if you missed last week’s episode , we talked about living with chronic pain, screen time for the kiddos, and low back pain delivery. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

The wheels turn slow on the medical integration front. Which is probably a good thing honestly. You don’t want to get out over your skis too far now, do you?? It’s like wading into the water a little at a time so you can get used to it. Some people just jump right out into the middle of it all. I’m a gradual guy. I like to slowly get in and get the lay of the land. That’s kind of how this integration is proceeding right now.  We have the medical director.

He’s been a long time friend of mine and was actually a chiropractor back before he went to medical school. He’s an excellent human being and should be a great fit with me and my way of approaching healthcare.  I got to see a veteran today as a new patient. This is a guy that has had chronic pain that has suffered for years. He just got out of the Army in 2019. He’s been in it for 25 years so you can imagine.  He gets cortisone shots 3-4 times per year. He’s never been told about yellow flags. Warned against allowing doctors to treat from an MRI. He’s only been given shots and turned loose every time he has a flare-up.

He has slipped into fear avoidance.  Now, I had the opportunity to teach him about fear avoidance, about CNS upregulation, about how over 60% of asymptomatic in his age group have disc-related findings on their MRI that means nothing, I got to teach him about stabilizing his low back instead of always popping hit on his own for through a chiropractor. I got to teach him about the difference between hurt and harm. I got to give him a recommendation for Back In Control by Dr. David Hanscum. I got to teach him McGill’s Big 3. I got to teach him how the medical doctors are still turning the treatment tree upside down when they do shots and medication first instead of movement, exercise, manipulation, massage, and all of that good stuff. I think…..I THINK….I got to help give him a roadmap to change his life today.  For an appointment that could have taken 30 minutes, I probably spent well over an hour with him.

First, because he was a really pleasant dude and I instantly liked him on a personal level.

Secondly, he’s a vet and that’s just amazing. But beyond that, I knew it would take some time to change his life. After all….that’s what we’re here for, right? Some time ago, I did an episode of the podcast that had to do with a vitalist nut job from Oklahoma City that posted on social media that he had treated 99 patients and 9 new patient exams within 3 hours. One table, one doctor, blah blah vitalist BS blah blah. Then telling others he could teach them how to do the same if they pay him as a consultant/mentor/guru.  I broke down the time constraints in that episode but I believe it boiled down to about 10 minutes per new patient.

For a vitalist that believes the source of all of the Earth’s imperfections boils down to a subluxation, I suppose you could bounce around down the spine and find 6 sore spots, hammer ‘em back down and go on about the day. I suppose a new patient could take even less than 10 minutes if done that way, quite honestly.  But, in my opinion, and compared to evidence-based docs in the profession, you’d be a piss poor doctor.

One I wouldn’t want anything to do with. One I’m embarrassed is in my profession. 

You have to take the time it takes to fully evaluate someone orthopedically, neurologically, and cognitively. There is no way around it if you’re going to be a next-level practitioner. It’s not optional. Ever. And 10 minutes won’t get it. It just won’t.

I had to adjust a couple of patients that showed up and then return to the vet to keep talking and teaching but we got it done. He’s my new project. It was cool to see him nodding his head and understanding what I was telling him.  I think I saw the light bulb come on. And that’s just pretty damn cool. I’m a little jazzed. A little energized that I think I can take this lifelong veteran and lifelong pain sufferer and turn his situation into a positive one.  We shall see but it should be a lot of fun if my plan comes together. I guess the point is; be a doctor. Be their advocate. Take the time that it takes. Their lives depend on us to function on a higher level than just pounding down the sore spots. 

On a separate note, I had a young girl come in for a consult. I’ve known her and her family for several years. She had a car wreck 9 months ago and fractured L1. You could see where the posterior/superior corner of the vertebra was broken off and the spinous process was broken off completely.  No paralysis, no dysfunction neurologically.  A neurosurgeon fused her spine. Not just 2 segments. Or 3 segments. He fused 5 segments. He told them it was because it was the T/L junction and fusing that many would give it more stability.

Now….who am I to argue about that?? I’m not a surgeon. But it seems drastic. Once that is stabilized and healed, can they go and remove some of the fused areas? I have no idea. But damn. 5 vertebrae when only one was fractured? Beyond that, he told her no twisting. Her understanding was forever. He has her in a back brace with no recommendations on when to quit wearing the back brace. He has the crap scared out of her as far as moving and having any activity really. It’s been popping down low lately and that kind of hurts.

He told her to go on 6 weeks of bed rest.  I think I’m dealing with incompetence here. That’s what I’m building up to. 6 weeks of bed rest for and 18-year-old girl that is functional. Bracing with no end in sight. Scaring her out of even twisting. She was afraid to do nerve flossing for her leg and low back. Fusing 5 segments instead of 2 or 3.  So, I’ll never pretend to be the smartest dude on the planet but can I really know more than a freaking neurosurgeon? Certainly not about surgery specifically. But the follow-up, the rehab, and the future…..yeah, I think we can actually know quite a bit more than they do.  And now here we have another patient from today that we are charged with changing their lives. I’m all about spinal manipulative therapy but this one will be through exercise, movement, biomechanics, cognitive work, confidence building, support, and most importantly, through finding an orthopedic expert for the second set of eyes and another set of recommendations. Except I’m going to be the one picking this one out. We have to save these people.

Don’t get me wrong. The medical complex saves lives every day all day. Thank God for them. But we can save their lives too. When they hurt too bad to go shopping or play a part in their own lives, that’s no life at all is it? When we turn that around, on some level, we absolutely save their lives. We keep them from slipping into depression, pills, chronic pain, fear avoidance, inactivity, and everything that goes along with all of it.  We save lives too and every chiropractor knows exactly what I’m talking about.  Let’s get on with it, shall we?

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Item #1 This first one is called “Pathways for managing low back pain. The collaborative effort of four PM PIs Yield a Paper and a call to action.” (1) and published in Pain in December of 2020. Hotter than Hell.  First, Dr. Christine Goertz was cited at the end for further reading. Because she’s amazing and awesome and a chiropractic treasure if you ask me. if you don’t know of and absolutely adore Dr. Christine Goertz, then you are insane or don’t value chiropractic research. 

Second, this is an article so we’ll do what we do and hit the high spots.  They start by saying that many of the best practice guides for low back pain involve evidence-based therapy that is not typically integrated into a single clinical setting.  They bring up the examples of physical therapy and chiropractic and mention how they are typically delivered outside of the majority of first-line access points in the US.  They say this leads patients to fall through the gaps. Which is understandable.

We, chiropractors, see this all of the time. Every week. Think about it, they mention here how PCPs will order tests and imaging but the pain is complex and harder to coordinate the diagnosis and effective treatment and care management outside of an integrated setting.  Now, pay attention to the last line in this quote from the paper, “All of the Pain Management Collaboratory trials are focused on delivering non-drug options to effectively ease the experience of pain in Veterans and Active service members. No matter the type of patient, or where the patient enters the system for their pain, treatment options need to be organized and delivered in such a way that it is easy for patients to receive and comply with treatments, and for providers to follow up.  Hastings, a clinician with a focus on geriatric care as well as a researcher, poses the question, “Is it really realistic for every individual primary care provider to be the expert on how to access all of these different types of therapies, you know, in his or her community?”

They go on to say, “This is where the authors propose a health navigator—a local resource expert who is trained in how to factor in an individual’s previous experiences and preferences when making recommendations—for developing a pain pathway for the individual.  A pain care navigator could be a chiropractor, a nurse, a physical therapist or other health care provider that one might see as the first step in seeking help for their pain. “We are really testing this idea of individualization so that we ensure optimal adoption of therapies for pain,” says Dr. Hastings.  Developing an effective treatment model for pain that takes into account patient preferences, lifestyle, and current needs and is more than just a “cookbook kind of an approach.” This approach acknowledges that patients enter the healthcare system from many different starting points, and so there is a need to train providers from a number of different disciplines to organize, plan, and deliver individualized care options.”

Does that sound anything like the Primary Spine Practitioner program? Yes, it does. It also sounds like the paper we covered some time back where they did a study in a Stanford area ER where the DCs directed the musculoskeletal pain ER patients. They had so much success that they expanded the program.  This really is, in my opinion, the way to do this, y’all. This is the way to effectively treat pain. 

Then our very own Dr. Goertz comes down with the People’s Elbow when she says, “In addition to navigating through different treatment modules, other barriers to effectively managing a pain treatment plan include cost, the need for more providers, and appropriate delivery of treatments.  “One of the biggest barriers right now has to do with payers who are willing to pay high dollars for spine surgeries or injections but are less willing to cover guideline-concordant treatments such as spinal manipulation, acupuncture, cognitive behavioral therapy, and yoga,”  “I think until we are better at embracing payment models that put an emphasis on conservative care and reward all of those involved, we’re going to continue to struggle. Fortunately, I see some signs that our healthcare system is changing in this direction.”

Dr. Goertz addresses the biopsychosocial aspect a bit when she says, ““It’s really important to have the patient involved in the process [of developing a pain management plan],” “When it comes to low back pain, we know that people who are more frightened by their pain can have worse outcomes. Anything that can help patients better understand their pain can paradoxically lead to less pain in the future, which is why patient education is really important.”  Additionally, healthcare providers need to be well-versed in effective communications techniques to ensure that patients understand, feel supported, and are involved in the decision-making process.  Conversations should focus on lessening the experience of pain and increasing understanding, as opposed to exacerbating fear.  “This is important with healthcare delivery in general, but especially important with people who have low back pain,” Goertz says. “

There’s really going to be no reason for y’all to read this yourself because I’m basically going line for line but every line is solid and true so they kind of leave me no choice.  The article continues, “Dr. Goertz also pointed to a Gallup study that asked individuals which types of providers they thought were the safest and most effective for managing back and neck pain.  Participants indicated that physical therapists and chiropractors were the safest and most effective; however, when asked which provider they would see for pain management, more than half said that they’d prefer to see a medical doctor first. “It is crucial that clinicians are aware of coordinated care guidelines for back and neck pain and are able to facilitate access to that care for their patients,” Goertz asserts. “For instance, the American College of Physicians recommends that patients and their clinicians consider nonpharmacological treatments including acupuncture, massage, yoga, Tai Chi and spinal manipulation before prescription medication for low back pain.” 

Historically, these treatments have had less emphasis during clinical training for many health care providers, and facilitating access and coordinating the follow-up can be challenging.  Additionally, a patient’s insurance may not cover all the recommended considerations.” Here’s the last paragraph and pay attention again to the very last line, “At the center of evaluating pathways for pain management is a call to action to put more thought and organization into what happens to patients when they first seek care for pain and the long term consequences of the patient’s earliest experiences with the health care system.  “It takes a really intentional effort to say, ‘What are the first set of decisions that need to be made? And then what are the next decisions that need to be made?’” observes Dr. Fritz. 

To avoid the early intensification of pain care, which results in greater expense and invasiveness escalating rapidly, we need to ensure that the evidence-based guidelines are getting put into practice, and patients understand that managing pain isn’t a linear process where a person goes in to see a provider, gets a diagnosis, gets a treatment, and the pain goes away.

Communication among patient and providers is essential to get on the right pathway for pain management. “If we can be more aligned in our messaging around back pain in the community—before individuals become patients, where they may not yet be experiencing back pain, or before it affects their ability to function—it can help set expectations and set up the conversation with care providers when they do come in,” says Dr. Hastings.  “The first thing we ought to be reaching for are these non-drug therapies, and reserving imaging for specific cases since it’s not going to change what we do in the majority of cases.”” Amen. Researchers and authors, please for the love of everything, keep writing these papers.

Over and over again until it finally starts filtering down to the doctor in the field. The PCP, the VA doc that used to just give pills and shots, the surgeon that is still telling an 18-year-old girl to go on 6 weeks of bed rest and wear a brace while never twisting. Forever.  This garbage has to stop, y’all. There’s little wonder why low back pain is still #1 in the world for global disability. It’s because the primary stakeholders and medical industry can’t get their crap together. Or, worst-case scenario, don’t want to get their crap together due to financial considerations. Why get your crap together if it means you do fewer surgeries and make less money through the year? There’s no financial incentive to do the right thing. 

I got it….Pay them MORE for the NECESSARY surgeries to offset the loss of income when they quit performing the UNNECESSARY surgeries.  There you go. I just fixed the world.

Bam, snap, thwack, kow-a-pow! Alright, that’s it.

 

Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

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About the Author & Host

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

Bibliography

  1. Pathways For Managing Low Back Pain. Pain. December 2020. https://painmanagementcollaboratory.org/pathways-for-managing-low-back-pain/?fbclid=IwAR1r5H4ZRvQr4Gw9wmIGYbJGSMr9e9aaPybvLujtdjEoE06Q6ppehNEGol8

 

Primary Spine Care, Frozen Shoulder, & Evidence-Based Chiropractic & Cost

CF 158: Primary Spine Care, Frozen Shoulder, & Evidence-Based Chiropractic & Cost

Today we’re going to talk about Evidence-Based Chiropractic, We talk about the primary spine care model integrated into a primary care setting. What happens when that’s the mode of treatment? Then we’re going to talk about some Frozen Shoulder (adhesive capsulitis) research in JAMA recently.   But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #158 Now if you missed last week’s episode, we talked about chiropractors that spread misinformation, we talked about patients needing movement, and we talked about love. I’m a softy at heart believe it or not. Make sure you don’t miss that info. Keep up with the class. Evidence-Based Chiropractic is catching on!

On the personal end of things….. We are sitting here on a Monday 12/21 as of the typing up of this episode. Christmas is upon us. Nothing crazy special going on beyond that.  There are a couple of things I’ll mention. The first is that I got the Mirror gym you hang on a wall. It’s basically like having a trainer in your living room. Lots of you are already used to this sort of a deal with products like Peloton but it’s new to me and it’s pretty awesome. I’m doing stuff like Tai Chi, yoga, boxing, kickboxing, and stuff like that.

Stuff I’d never do otherwise and it’s pretty darn cool.  We turned what used to basically be a dog room into a small gym and it’s been pretty cool so far. I’m enjoying it. I’ve always been a skinny dude stuck in a big dude’s body. So, now that I’m down 33 lbs on weight watchers, and I’ve added the home gym to the mix, I feel like I’m on the way to realizing the skinny dude. Eventually. Lots of work left to do first though. 

Secondly, I’m getting the vaccine in a day or two if everything works out. I have mentioned several times on the podcast that I have very positive relationships with a lot of folks in my local medical community. Through that network, my wife and I will be getting ours this week. I’m ready to get that dude and start moving on with life. 

No, I’m not worried about it. Understanding I have some level of influence and some level of leadership with my friends, family, and patients, I feel it’s important to get out front and set an example on this deal.  Especially being a chiropractor. When you see so many of us disenfranchised because of the vitalists in our profession out there preaching the harms of vaccines when they wouldn’t know how to make it through a research paper on the vaccine to save their lives…..well, wouldn’t it be refreshing to see evidence-based chiropractors stepping up and leading the way on this vaccine? Here’s my stance on it. Maybe it helps you if you’re on the fence. Maybe it doesn’t but here it is anyway.  I’m not an epidemiologist or a maker of vaccines. I have researched masks, COVID, the transmission of Covid, and things like that. Not as much on the vaccine on the vaccine itself though. 

Scientists understand so much more about that sort of research than I’ll ever know. A Fox Poll says 61% of Americans will get the shots while only 23% are strictly against taking it. There were 16% unsure. Probably the ones waiting to see if everyone does OK with it before they step up. And I don’t think that’s unreasonable.  The point is, those getting it like me…..I’m not the minority on it. For me, it’s not only about life or death. I have a 20-something-year-old patient that can’t go back to work because she’s still positive 6 weeks later. I know a nurse that was positive for over nine weeks. I know Patients that had to go to physical therapy for weeks. Long haulers is a real deal. In the end, it’s an easy decision for me. I’m not worried at all really.

There’s risk crossing the road. If I get sick, I have to close my office for at least 2 weeks if not more. That means I lose a lot of money, there will be patients drop off of the schedule, we’ll miss new patients, and I’ll be sick AND anxious the entire time. If COVID doesn’t make me nauseous, the destruction of my business while I’m out sick will.  Besides myself, I have 13 or so other employees and their families depending on my presence. My business depends on my presence and does not run when I’m not there. That’s a little different than a lot of other folks. I’m not doing that if I can prevent it. If a vaccine allows me to prevent it, well then, a vaccine it is.

We chiropractors work within inches of people’s faces and in close contact with them. That puts us at more risk than the average Joe and, if we have it, puts our patients at serious risk of getting it from us.  If you’re like me, we work with a lot of elderly and immunocompromised patients. I’m not willing to put them at risk like that when all I had to do was trust in science and just get the damn vaccine. They ran human trials on 35000-45000 or so people with no unacceptable issues. That’s a huge sample size. I’ve seen this thought on the FTCA group before. It’s probably a Bobby Maybee special quote but, back before Facebook, people would have just taken the vaccine.

They weren’t worried about this stuff back before Facebook told them to worry about it.  No matter what’s out there these days, you have people casting doubt on it for zero reasons. Maybe it’s a call for attention at all costs. Who knows? But it’s to the point now where science and experts are constantly doubted and discounted. And that’s about as dumb and dangerous as can be.  It was OK to cure smallpox and polio but COVID……nah bruh.

If there were real questions, would basically the entire medical complex be in line taking it? My guess is that they wouldn’t.  What if someone can afford to be out of work or out of their office for 2-4-6 weeks and they want to wait to get it? I think it’s reasonable if someone wants to wait to see if anyone has adverse effects before they take it. I don’t think that’s unreasonable at all. But I think that it’s just delaying the fact that almost everyone is going to do fine with it and most people are going to end up getting it.

They started it in England two weeks ago. Nothing has happened. Because they already did the test trials to make sure nothing would happen. Considering the success of the testing, I think the people not getting it are at far more risk than the people that are getting it. Besides all that, I’m ready to get back in my life. Traveling, doing fun stuff, having a life…..important stuff. Like seeing my mom and step pops and being able to visit my dad in the nursing home for the first time since March.

More power to those that have been doing those things all along but for the above-mentioned reasons, we have not.

So that’s where I’m at. We are all on our own walk and we all need to do what we think is best. Staying healthy, staying open and available, and continuing to provide for my family, my staff, and my patients are what I think is best.  So, I’m out front on this. It’ll be good for my patients and family to see a picture of me getting my vaccine on social media. It’ll be good for my patients to see it.

And it’ll be good for those in the medical community that is friends with me to see it. It’ll reaffirm that no….I’m not one of THOSE chiropractors.  I encourage you to be out front with it if you get one. Be a leader and blaze the trail.  And Merry Christmas, Dammit. 

Item #1 The first one today is called “Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study” by Whedon, et. al. (Whedon JM 2020) and published in the Journal of Manipulative and Physiological Therapeutics on September 1, of 2020. And that’s a blistering blast of hotness.  If you don’t recognize the Whedon name, he is very prolific in chiropractic research. 

Why They Did It

The objective of this investigation was to compare the value of primary spine care with usual care for the management of patients with spine-related disorders within a primary care setting.

How They Did It

  • They retrospectively examined existing patient encounter data at 3 primary care sites within a multi-clinic health system
  • Designated clinicians serve in the role as primary spinal care as the initial point of contact for spine patients, they coordinated the care, and they followed up for the duration of the episode of care
  • A primary spinal care doctor may be a chiropractor, PT, or medical or osteopathic physician trained in primary spinal care for spine-related disorders
  • They had sites where the primary spinal care was implemented as well as control sites where they just stuck with the usual care model
  • They examined clinical encounters occurring over a 2 year period from February 2016 to March 2018. 

What They Found

  • Primary spine care was associated with reduced total expenditures compared with usual care for spine-related disorders
  • At site one, the average per-patient cost was $162 in a year and $186 in year two. 
  • That is compared to site II, a control site, where the cost in year one was $332 and $306 in year two. And in site three, also a control site offering only usual care, where the cost in year one was $467 and year two was $323

Wrap It Up

Among patients with SRDs included in this study, implementation of the PSC model within a conventional primary care setting was associated with a trend toward reduced total expenditures for spine care compared with usual primary care. Implementation of PSC may lead to reduced costs and resource utilization but may be no more effective than usual care regarding clinical outcomes.

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Item #2

Our second item today is called “Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis” by Challoumas, et. al. (Challoumas D 2020) and published in JAMA Open on December 16, of 2020 and it does not get one degree hotter than that people!

Why They Did It

The authors here wanted to know the answer to the question, “Are any treatment modalities for frozen shoulder associated with better outcomes than other treatments?”

How They Did It

  • It was a meta-analysis of 65 studies with 4097 participants
  • They searched Medline, EMBASE, Scopus, and CINHAL in February 2020.
  • Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included.
  • Data were independently extracted by 2 individuals
  • Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome
  • Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up.

What They Found

  • Despite several statistically significant results, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain
  • Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to the intra-articular corticosteroid may be associated with added benefits in the mid-term

Wrap It Up

The findings of this study suggest that the early use of intra-articular corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.

Item #3

Now, on to Evidence-Based Chiropractic. Our third and final one this week is called “Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study” by Whedon et. al. (Whedon JM 2020) and published in the Chiropractic and Manual Therapies on December 14, 2020. Get your red hots right here, get ‘em hot right here.  I told you Whedon was prolific. That’s two papers in this one episode that he’s the lead author on and I did not do that on purpose. I didn’t realize who the authors of the papers were until I started typing. He’s on his A-game. 

Why They Did It

The abstract for our Evidence-Based Chiropractic talk leads off by saying, “Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found to be cost-effective for the treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost-effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain.” How They Did It

  • It was a retrospective cohort design to examine the costs of chiropractic care among patients diagnosed with acute or subacute low back pain.
  • The study time period ranged between 07/01/2016 and 12/22/2017
  • They compared cost outcomes for patients of two cohorts of chiropractors within the health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain.
  • They used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures.
  • A total of 25,621 unique patients were included in the analyses

What They Found

  • The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326
  • Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs.

Wrap It Up In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care.

So….just who the hell do you all know that’s been preaching this until his face is about to explode? That’s right, listeners of this podcast. One word, two syllables…..Day-um.  Evidence-based and patient-centered care is the future of chiropractic. It is first and foremost, treating our patients with respect and the best care and that’s what they deserve.  Secondly, it’s speaking the language of the medical community. Which is the language of research. When you’re using their language, you’re starting to communicate more effectively.  I think it’s time for superhero sound effects….boom, pow, snap, kawachow!

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Key Point:

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

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

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

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

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

Bibliography

  • Challoumas D, B. M., McLean M, (2020). “Comparison Of Treatments For Frozen Shoulder: A Systematic Review and Meta-Analysis.” JAMA Open 3(12): e2029581.
  • Whedon JM, B. S., Dennis P, Fischer VA, Russel R, (2020). “Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study.” Chiropr Man Therap 28(68).
  • Whedon JM, T. A., Bezdijan S, (2020). “Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study.” J Man Physiol Ther 43(7): P667-674.

 

Spinal Instability Clinical Pearls & Degeneration and Facets

CF 152: Spinal Instability Clinical Pearls & Degeneration and Facets

Today we’re going to talk about Spinal Instability Clinical Pearls & Degeneration and Facets 

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #152

Now if you missed last week’s episode , we talked about chiropractors integrating into a medical setting. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function

On the personal end of things….. We shall see if we are climbing back after the three day ice storm and the resurgence of COVID has hit us in the last two weeks. We are starting the week, I’m writing this on a Monday….with 120 on the schedule. Of course, we haven’t filled in all of Wednesday or Friday appointments….we have fresh injuries that will see us all three days so those will fill in quite a bit more and I’m hoping to at minimum get back up to the 145 mark that has been our average since Rona began. 

Which is way down from my weekly appointment average of 182 from last year. But 145 is decent and I can roll with that until people are more comfortable in getting out and going into public spaces and businesses. Right now, they just aren’t. And that’s understandable. 

Many of you live in places where there is widespread mask use and they take social distancing seriously. Well, Amarillo, TX would not be one of those places. We have some of the kindest and most giving folks on the planet here in Amarillo but there is a reason we’re number 2 on the New York Times list of places that are about to go through a bad time with the Rona. 

People here just don’t want to wear masks and by golly aren’t going to be told to wear them either. It’s disappointing. For example, just today, my wife and I went to a restaurant we know is not typically busy and we have a little table we can usually sit in where nobody else is around us. That table for the first time was not open today. But there was a table I could see that had nobody near it. 

We go to this restaurant often enough that the servers know us and they know we are taking the Rona very seriously. So they sit us away from everyone. We are sitting there eating and when we’re about to finish up, they sit a group of about 7 dudes one table away from us. Not a damn one of them come in wearing a mask. I couldn’t get out of there fast enough. I was disappointed that they didn’t make a choice to wear the masks and I was disappointed that the restaurant didn’t enforce the state mandate to wear them. I was also very disappointed that they chose to sit them next to us. But….while I love my town and I love my people, that’s this area of the country for you. 

It’s frustrating as hell. Our hospitals are full. FEMA is here helping us. They’ve brought in over 750 helpers from outside of our area. Our hospitalization rate is almost 40% right now. Yeah….that bad. And we still have people walking around like it’s a hoax and not wearing masks. It’s insane to me. 

It’s spiking out there everywhere though. Not just here in Amarillo. Stay safe people. Stay vigilant. It’s our responsibility not only to ourselves and our families but to our elderly and immunocompromised patients and our staff. You may be young and athletic yourself but if you get it, even if all you have is a low grade temp or a minor headache and that’s it…..you still have to stay home and lose income for two weeks minimum. 

Be smart. Don’t be one of these vitalists out there thinking they’re freaking superman because they got their adjustment this week. That’s the most insane of all. Sorry vitalists. It’s true. 

Yes….dammit….I’m a bit gripey today!! Why do you ask? 

I’m just done with it honestly. I’m over it. I’m over the election. I’m over everyone being offended about everything. I’m over riots and violent protests. I’m over so much these days and I can’t imagine that you’re any different. 

We’ll get through it. Just hold on. Be kind and be brave. Be kind and be brave. We don’t need much more than that do we?

Item #1

This one is called “Relationship Between Endplate Defects, Modic Change, Facet Joint Degeneration, and Disc Degeneration of Cervical Spine” by Lee et. al(Lee S 2020). and published in Neurospine on June 30, 2020, and it sizzles as it sits!!

Why They Did It

The “disc degeneration precedes facet joint osteoarthritis” hypothesis. in cervical spine degeneration, the multifactorial analyzes of disc degeneration (DD), Modic changes (Mcs), facet degeneration, and endplate degeneration (ED) is still limited. 

How They Did It

Retrospectively recruited 62 patients from 60-70 years old

They evaluated the following: 

  • disc height, 
  • segmental angle, 
  • ossified posterior longitudinal ligament, 
  • endplate degeneration, 
  • facet joint degeneration, 
  • uncovertebral joint degeneration, 
  • disc degeneration, 
  • spinal stenosis, 
  • Modic changes, and 
  • cord signal change 

What They Found

  • The interrelationship of degenerative parameters showed close relation between uncovertebral joint degeneration, spinal stenosis, disc degeneration, ossified posterior longitudinal ligament, Modic change. endplate degeneration, and cord signal change has partial relation with degenerative finding. 
  • Facet joint degeneration only has relation with uncovertebral joint degeneration and Modic changes.

Wrap It Up

They conclude, “Our results may indicate that facet joint degeneration that occurs independently, rather than as a result of other degenerative factors. 

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Item #2

This one is called “A Screening Tool for Patients With Lumbar Instability: A Criteria-related Validity of Thai Version” by Chatprem et. al.(Chatprem 2020) and published in Spine Journal on November 1, 2020, the roof, the roof, the roof is on fire. 

Why They Did It

The aim of this study was to examine the performance characteristics and validity of an existing lumbar instability questionnaire as a screening tool for lumbar instability among chronic low back pain (CLBP) patients.

How They Did It

Lumbar instability screening tool responses and x-ray assessments were reviewed from a sample of 110 patients with CLBP (aged 20-59 years).

What They Found

  • Fourteen (12.73%) patients had radiological lumbar instability. These patients reported a higher mean lumbar instability questionnaire score than those without radiological lumbar instability.
  • A questionnaire score of at least 7 had a sensitivity of 100% and a specificity of 26.04% for detecting lumbar instability when compared with x-ray examination.
  • A lumbar instability screening tool total score of at least 7 was ruled out lumbar instability in CLBP patients. This cutoff score may be used as a marker of conservative treatment response.

Now just to expand on that idea a bit here; many chiropractors have a mental block when it comes to spinal instability.. What I mean is that many are so subluxation-minded that they do not understand that spinal instability is not good and that adjusting too much too often can actually be the cause of spinal instability. 

If I’m speaking to a vitalistic, philosophy-minded chiropractor, I’m going to say, “You’re not always slaying subluxations, Mr. Vitalist. Many times, you’re so eager for the almighty dollar and the awesome sound of pops over and over again that you create the very problem that you hoped to fix in the first place. 

That is the reason our profession has developed scaled back guidelines for treatment. Have you ever encountered a neck self-adjuster? I used to be one when I was kid. It starts off pretty darn difficult to adjust your neck. Then, with repetition, it gets more and more loose to the point that all you have to do is turn your head and it starts popping. 

That is essentially what many vitalists are doing with patients when they see them repeatedly time and time again month after month, year after year. What the hell else would you expect. 

Then the instability causes chronic pain that they think just needs more adjustments which actually cause more instability and more chronic pain. The cycle is perpetual and the vitalist chiropractor isn’t smart enough to figure out why they can’t get this patient feeling better. After all….isn’t it all about the mighty subluxation?

Why do they fuse spinal segments? To reduce the movement in order to reduce the pain. Doesn’t it seem there are patients that benefit more from exercise and support than from adjustments?

It turns out there are. Those that are hypermobile on the Beighton Scale and those that have instability. Just to update your knowledge on spinal segmental instability, the smoking gun of spinal instability would be

  • Vertebral body anterolisthesis
  • Broad-based disc bulging – flat tire vs. aired up
  • Facet joint enlargement
  • Ligamentum flavum hypertrophy
  • Possible Modic changes. 

Facet pain can often get confused with instability as well. A good example is when a patient has pain just to the left of the lumbar spine, over the facet. You push on it and it hurts. You can provoke facet pain by poking on it. But, you can provoke instability by poking on it as well. 

There are a couple of general ways to focus in on what’s going on there and differentiate the two. You can have the patient stand and extend at the waste, the perform extension rotation both ways. If this doesn’t bother the patient, it’s almost certain it’s not a facet issue. Extension rotation is that accurate. 

If when prone, poking on the facet hurts, you can stabilize the low back region temporarily by have the patient perform a super man / reverse plank type of a position and then, while they’re in the position and those low back muscles are good and tight and supportive, poke on the sore spots again. If the reverse plank position helps that pain, there’s a good chance it’s instability. 

Also, if the low back commonly hurts when they roll over in bed, that’s could be a sign of instability as well. You don’t want to adjust instability folks. You want to strengthen it. Make it solid. In my office, we start that by doing McGill’s Big 3, the side plank, modified curl up, and the bird dog exercises. 

Did you learn something? I hope, if you were lacking in this, I was able to shed some light on it for you. If you have any questions on this feel free to email me at [email protected] so we can discuss. 

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

 

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient.

And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

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

Contact

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

Connect

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

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About the Author & Host

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

Bibliography

  • Chatprem, T., Puntumentakul R, Boucaut R, Wanpen S, Chatchawan U, (2020). “A Screening Tool for Patients With Lumbar Instability: A Criteria-related Validity of Thai Version.” Spine (Phila Pa 1976) 45(21): E1431-E1438.
  • Lee S, S. D., Lee JS, Sung SK (2020). “Relationship Between Endplate Defects, Modic Change, Facet Joint Degeneration, and Disc Degeneration of Cervical Spine.” Neurospine 17(2): 443-452.