evidence-based chiropractic podcast

Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain

CF 322: Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain

Today we’re going to talk about Young Athletes With CTE & Catastrophizing, Fear Avoidance, and 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  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, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #322 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9).  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I’m recording on a Monday and we have the big West Texas Conference coming up this Friday for the Texas Chiropractic Association. It’ll be in Lubbock, TX so about an hour and 45 minutes south of where I’m at here in Amarillo.  I’ve paid for our Parker intern, Dontae, to come with. I think it’s up to the older folks to get the younger folks engaged in our state associations. If you listen long enough, in every podcast, at the end, I say that the ACA and our state associations need bus in the leadership positions if this profession is ever going to continue gaining integration into the system as a whole. If we’re ever going to achieve 1st or 2nd referral status for a non-complicated msk issue, we damn well better start behaving like part of the team instead of part of a fringe cult from outer space. 

Here’s a thought, hey clinic owners and lead doctors with associates, if you don’t require your associates to be a part of their state associations, you are absolutely, undeniably part of the problem. It’s as much Your responsibility to bring them up correctly as it is theirs to start getting involved in their profession.  Oh, I’m getting fired up this morning, damnit!! I’ve held enough positions in the TCA at this point that I’ve lost count and ever since my first year of involvement, our membership has been the issue. We have about 25% of our licensed DCs in the state of TX as actual members in the TCA. So, if we have 6,500 DC in the state, then about 1600 or so are members. Not active members. Just dues-paying members.

Minimal effort members, you might say. 

Consider that the state of TX has around 70,000 physicians and the vast majority are required to be paying members of their predatory state association. The official name is Texas Medical Association but we call them the Evil Empire.  Tell me…..how in the hell are 1600 chiropractors, of which only about 50 are actually active, supposed to turn the tide or battle effectively against an Evil Empire of approximately 60,000 or more? Then throw in lead chiropractors and clinic owners that are sitting on their asses not giving a squirt one way or another and not showing their associates how to give back to their profession and how to protect their rights?

Come on…..it’s almost too ridiculous to even talk about. Why do we have to say this stuff?  it’s disappointing and astonishing.  I sat in a Board Of Directors meeting many years ago. It cost us money to be there and cost us money to be out of our clinics to be there. Fighting an uphill battle that the majority of the DCs in the state don’t care about. It’s self-defeating. But one of my colleagues and friends said, “If not us, then who?” And then it’s OK. Fight the battles nobody else is willing to fight.

Get in, impose your will. Make sure evidence-based, patient-centered practice models are at the forefront of your state association’s initiatives and influence and get the crazy aliens off of the stages at your states continuing education conferences. 

Literally, about 20 people run your associations at any point in time. Hop in. One person can make a world of difference.  Raise your hand. Send an email. Just show up and be there. 

Item #1 Our first one this week is called “Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts” by McKee et. Al and published in JAMA Neurology on August 28, 2023 and that’s blisterin’ hot!! Remember, the citations can be found at chiropracticforward.com under this episode. 

McKee AC, Mez J, Abdolmohammadi B, et al. Neuropathologic and Clinical Findings in Young Contact Sport Athletes Exposed to Repetitive Head Impacts. JAMA Neurol. 2023;80(10):1037–1050. doi:10.1001/jamaneurol.2023.2907

Why They Did It Young contact sport athletes may be at risk for long-term neuropathologic disorders, including chronic traumatic encephalopathy (CTE). They wanted to characterize the neuropathologic and clinical symptoms of young brain donors who were contact sport athletes.

How They Did It This case series analyzes findings from 152 of 156 brain donors younger than 30 years identified through the Understanding Neurologic Injury and Traumatic Encephalopathy (UNITE) Brain Bank who donated their brains from February 1, 2008, to September 31, 2022.  Neuropathologic evaluations, retrospective telephone clinical assessments, and online questionnaires with informants were performed blinded. Data analysis was conducted between August 2021 and June 2023.

Exposures  Repetitive head impacts from contact sports.

Main Outcomes and Measures  Gross and microscopic neuropathologic assessment, including diagnosis of CTE, based on defined diagnostic criteria; and informant-reported athletic history and informant-completed scales that assess cognitive symptoms, mood disturbances, and neurobehavioral dysregulation.

What They Found Among the 152 deceased contact sports participants included in the study, CTE was diagnosed in 63 (median age, 26 years).  Of the 63 brain donors diagnosed with CTE, 60 were diagnosed with mild CTE (stages I or II).  Brain donors who had CTE were more likely to be older  Of the 63 athletes with CTE, 45 were men who played amateur sports, including American football, ice hockey, soccer, rugby, and wrestling; 1 woman with CTE played collegiate soccer.  For those who played football, duration of playing career was significantly longer in those with vs without CTE  Athletes with CTE had more ventricular dilatation, cavum septum pellucidum, thalamic notching, and perivascular pigment-laden macrophages in the frontal white matter than those without CTE. 

Cognitive and neurobehavioral symptoms were frequent among all brain donors.  Suicide was the most common cause of death, followed by unintentional overdose; there were no differences in cause of death or clinical symptoms based on CTE status.

Wrap It Up This case series found that young brain donors exposed to repetitive head impacts were highly symptomatic regardless of CTE status, and the causes of symptoms in this sample are likely multifactorial. 

Item #2 Our second one this week is called, “Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain” by Ryum et al and published in Pain Reports in September of 2023 and it’s hot to the touch!

Ryum T, Stiles TC. Changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy mediate changes in pain intensity on disability in the treatment of chronic low back pain. Pain Rep. 2023 Sep 13;8(5):e1092. doi: 10.1097/PR9.0000000000001092. PMID: 37719924; PMCID: PMC10501475.

Why They Did It Treatment of chronic low back pain (CLBP) based on the fear-avoidance model (FAM) has received support in randomized controlled trials, but few studies have examined treatment processes associated with treatment outcome.  This study examined changes in pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy as mediators of the relation between changes in pain intensity and disability in exposure-based treatment of CLBP.

How They Did It Data from a randomized controlled trial with 2 treatment arms (which were the fear avoidance model with/without in-session exposure)  Change scores (pre to booster session) were computed for all variables, and the indirect effect of change in pain intensity on change in 3 measures of disability, through change in the proposed mediators, was tested in parallel mediation analyses.

What They Found Decreases in pain catastrophizing and fear-avoidance beliefs, as well as increases in pain self-efficacy, mediated a unique proportion of the relation between changes in pain intensity and disability, depending on the outcome measure.  The direct relation between changes in pain intensity and disability was absent when indirect effects were controlled.

Wrap It Up The results suggest that the way pain is interpreted (pain catastrophizing, fear-avoidance beliefs), as well as pain self-efficacy, are all more critical for reducing disability in exposure-based treatment of CLBP than symptom relief per se. You’ve been hearing this from you Ol’ Uncle Jeffro since about 2019 now. Since I went through the Diplomate of the Neuromusculoskeletal Medicine program. Which used to be called the DACO or the ortho diplomate.

It was the DACO when I started and changed in the middle of my education.  I wondered why but it became quickly apparent. There was as much Neuro in the process as there was ortho and yellow flags, upregulated CNS, fear avoidance and all kinds of Neuro tidbits were front stage. So, an ortho diplomate no longer adequately described what we were learning. 

Anyway, pay attention to this stuff. It will absolutely get your patients better when you understand it! Alright, that’s it.

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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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  

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9)

CF 321: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9) 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 Chiro ractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  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, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #321 Now if you missed last week’s episode, we talked about PT For Sciatica & Laser For Neck Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I just got back from VO Atlanta, the world’s largest VoiceOver conference. I have to say that there are a lot of regular Joe’s like me walking about that place and in the industry but, oh my goodness….there are a lot of strange folks too as you might imagine.  A very diverse group and I’m not talking just about race. Just lots of different types of folks that the mainstream of our country wouldn’t recognize as being normal. I’ll just say it that way.  So, that was fun and useful and tiring. I’m glad I went but was glad to be back home. It’s a lot like going to chiropractic conferences.

Before I got involved in the Texas Chiropractic Association, I was a long\e wolf. I’d be out there on the fringe, not a member of the TCA, and almost proudly and defiantly uninvolved.  Compare and contrast that with me now. I’m a member of just about everything I can be a member of. Including the ACA, the TCA, FTCA, the MCM Mastermind, the Texas Orthopedic group, the national Orthopedic group, the national Forensics group and on and on and on.  My network then vs. now. I had a couple of folks I went to school with. Now, I have hundreds of trusted friends in the industry to learn from, ask questions, and bounce things off of.  There’s no comparison. The voice over thing reminds me of the fact that it’s not always the learning you get inside those classrooms that is the most valuable aspect of an industry conference.

Most of the time, it’s the one-on-one connections you make over dinner or over drinks and conversations you have with random folks throughout the weekend that pay the most dividends. Don’t get into conversations asking yourself, “what can I get from this person’ though. If you’re genuine and authentic and interested in others and what YOU can do for THEM, then it’s a natural instinct that they wonder what they can do for you in return.  That’s where the value of conferences comes in. It’s the network you build over years of going to these things that pay dividends. So, if you don’t see immediate ROI on the Monday you return, not to worry. Stick with it. Plant the seeds and reap the harvest down the road. 

Now remember we are continuing our series on why the WHO has designated spinal manipulative therapy at the level of very low confidence which is the same they designated ultrasound. I went and found all of the citations for all of the papers they used to make the determination. From what we’ve covered and from what I’m seeing, they haven’t used a lot of high-quality research to make the determination. This makes me wonder if there’s an agenda at the WHO to keep the man down. Keep the chiros in their place. Who knows? But it seems sus, as the kids say these days. 

Item #1 Our first paper this week is called, “Spinal manipulative therapy and exercise for older adults with Chronic Low Back Pain: a randomized clinical trial” by Schulz et. Al and published in Chiropractic Manual Therapy on May 15, 2019.  Remember, the citations can be found at chiropracticforward.com under this episode.  Schulz C, Evans R, Maiers M, Schulz K, Leininger B, Bronfort G. Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial. Chiropr Man Therap. 2019 May 15;27:21. doi: 10.1186/s12998-019-0243-1. PMID: 31114673; PMCID: PMC6518769.

Why They Did It Low back pain (LBP) is a common disabling condition in older adults which often limits physical function and diminishes quality of life.  Two clinical trials in older adults have shown spinal manipulative therapy (SMT) results in similar or small improvements relative to medical care; however, the effectiveness of adding SMT or rehabilitative exercise to home exercise is unclear.

How They Did It We conducted a randomized clinical trial assessing the comparative effectiveness of adding SMT or supervised rehabilitative exercise to home exercise in adults 65 or older with sub-acute or chronic LBP.  Treatments were provided over 12-weeks and self-report outcomes were collected at 4, 12, 26, and 52 weeks.  The primary outcome was pain severity.  Secondary outcomes included back disability, health status, medication use, satisfaction with care, and global improvement.  Linear mixed models were used to analyze outcomes.  The primary analysis included longitudinal outcomes in the short (week 4-12) and long-term (week 4-52).  An omnibus test assessing differences across all groups over the year was used to control for multiplicity.  Secondary analyses included outcomes at each time point and responder analyses.  This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration.

What They Found 241 participants were randomized and 230 (95%) provided complete primary outcome data.  The primary analysis showed group differences in pain over the one-year were small and not statistically significant.  Pain severity was reduced by 30 to 40% after treatment in all 3 groups with the largest difference (eight percentage points) favoring SMT and home exercise over home exercise alone.  Group differences at other time points ranged from 0 to 6 percentage points with no consistent pattern favoring one treatment.  One-year post-treatment pain reductions diminished in all three groups.  Secondary self-report outcomes followed a similar pattern with no important group differences, except satisfaction with care, where the two combination groups were consistently superior to home exercise alone.

Wrap It Up Adding spinal manipulation or supervised rehabilitative exercise to home exercise alone does not appear to improve pain or disability in the short- or long-term for older adults with chronic low back pain, but did enhance satisfaction with care.

Item #2 The second paper today is called, “Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study” by Rasmussen et al published in Joint Bone and Spine in December of 2008.  Rasmussen J, Laetgaard J, Lindecrona AL, Qvistgaard E, Bliddal H. Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study. Joint Bone Spine. 2008 Dec;75(6):708-13. doi: 10.1016/j.jbspin.2007.12.011. Epub 2008 Nov 22. PMID: 19028434.

Why They Did It Both exercises and manipulation are recommended as basic therapy in back diseases, while a possible synergistic effect of these treatments have not been clarified.  This study was conducted to test a possible further effect of manipulation as adjunct to extension exercises for unspecific LBP.

How They Did It 72 patients with chronic LBP (mean 12 months) were examined by a specialist in manual medicine, who detected localized binding between the lumbar segments.  All patients were instructed in extension exercises, while randomized to either pretreatment with specific manipulation or control.  The patients were blinded to the manipulation, which was performed at the end of the manual examination, and repeated after two and four weeks.  The manipulator only knew the group of the particular patient just before manipulation by the end of the examination.  The primary end point was pain, measured by a visual analogue scale.

What They Found Pain in both back and leg decreased without differences between groups. Segmental binding of the low-back was associated with persisting clinical symptoms at four weeks.

Wrap It Up No additional effect was demonstrated of manipulation, when extension exercises were used as basic therapy. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website 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    

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8)

CF 319: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8).  If you haven’t been following along, the World Health Organization has recommended spinal manipulative therapy for back pain, however, they rated it at very low confidence.

Which is the same rating they gave ultrasound. We know SMT is more effective than that so I went into the recommendations, I found the papers the WHO cited as their references for their rating of SMT, and now I’m covering each and every one of them. We’re doing this every other week and now we’re on Part 8.  Also if you’re following along, you’ll know that a lot of these papers are extremely old compared so newer more impressive and more favorable papers that have emerged in more recent years.

You’ll also, if you’re like me, continue to get more and more certain that there is an agenda in the WHO leadership that keeps SMT from taking its rightful step forward in the treatment of noncomplicated Neuromusculoskeletal issues.  Stick with me, we’ll talk more about it.  But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  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, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #319 Now if you missed last week’s episode, we talked about How Specific Are Adjustments & Nerve Flossing Effectiveness.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

As I’ve discussed in recent episodes, my house, meaning my clinic, got in a bad way in 2023 and I believe we are finally on the upswing.  We have slowed down in our new patients because of Google SEO and website companies and changes. I think I’ve corrected that.  We have had inconsistent team culture in the clinic because of constant turnover. I still have work to do here but I feel like we have a more dependable team at the moment than I’ve had in the past 18 months so I’m encouraged.  Speaking of an incredible amount of turnover, our billing has been inconsistent. Inexperienced staff just let rehab and other services walk out the door without getting done. That adds up really fast and shows up in our monthly collections.

Now that my wife is up at the front desk and now that it’s become a focus for us, this is getting under control. Basically, staff knows that their comfort comes secondary to the financial health of the clinic. Meaning, whether we feel like it or not, the patients need to be doing the services we have prescribed them. We’re getting there. That’s not a black and white thing there but we are doing more of the services prescribed than we have been.  We are now on our 4th billing and collections company in the past 5 or 6 years. We just haven’t been able to find a dependable one that just does their damn job. I think we have one now.

They started in November and we hope to see the benefits in the next few weeks. I think we already are.  So, you can see what I’ve been up to. It was a swim or swim option. Not a sink or swim. Sink is never in the list of options. So we’ve been swimming and it’s showing up in progress and that makes this old man happy. 

Now, something I’ve always struggled with is treatment recommendations. I like standardization. I like Being able to tell someone confidently, I need to see you 3x/week for 2 weeks or whatever the recommendation might be. I don’t want to make it up from patient to patient. Standardization is something our profession desperately needs in my opinion.  As my colleague and friend, Dr. Brandon Steele once said in our DACO class…..if you go to the doctor with an ear infection in Dallas, NYC, Chicago, LA, or Seattle, you’re going to always get pretty much the same thing. The Standard for that profession.  If you go to a chiro, you don’t know what the hell you’re going to get.

X-rays for no reason and BAM, bait and switch….now you need 70 visits in one year to fix a curve that 20-year longitudinal studies show doesn’t really mean much of anything. You got a neck problem, bam, you need 50 visits to boost your immunity and make sure all nerve impulses are fully expressed because how can God’s full potential for you be realized if your spine is out of alignment. Yes….true story folks. True story. 

You have back pain, BAM, x-rays show degenerative spurs and if you see me 3x/day for 2 weeks, we’ll reduce the size of those spurs. Yes….true story. And that crew is holding seminars trying to teach crap like that to other suckers in our profession.  Or on the other end of the spectrum, you’ve had pain for 10 years and have a disability associated with it so it’s technically high-impact chronic pain….BAM….you can be fixed in 2 visits with a course of exercises for you to be using at home. 

It’s just not standardized.

So, through my association with Dr. Jay Greenstein from Washington DC and who is a mover and shaker in the industry and who has been active in Clinical Compass, I eventually formulated a standardized treatment protocol for my office that you might find useful as well. It’s really pretty simple. 

If it’s acute or less than 4 weeks in duration, I’ll see the patient 3x/week for 2 weeks. 

If it’s subacute, or between 4 and 12 weeks in duration, I’ll see the patient 2x/week for 3 weeks. 

If it’s chronic, or anything lasting beyond 3 months, I’ll see them 2x/week for 4 weeks. 

At the end of the protocol at each level, acute, subacute, or chronic….if the patient is doing great, we then start to stairstep the frequency out and slowly withdraw from treatment to prevent the return of the injury.

If there is not improvement or the patient gets worse at any time, we will either change treatment and try something different, or we will find a provider that has a better chance at helping the person recover. 

Now, of course, PI patients don’t fit into this schematic well so I use the Quebec Task Force on WAD for them but most of my patients will fit very well into this protocol.  It’s simple. It’s a way to standardize recommendations in my clinic from the owner to any associates. It’s an easy way for associates to get comfortable recommending treatment. And I like it so much that I made a poster out of it that you can find in the Chiropractic Forward private Facebook group.  I’ll send you one here in the US for $55 if you want one.

I’m putting one in my exam room so that when I’m doing the ROF, they’ve already read it and all I have to do is point to it and say, “‘You’re right here, and here is your recommendations. See you on M, W, and F.” Alright, good to go on all that, let’s hop in. 

Item #1 Our first one that the WHO used to keep the chiros down today is called, “Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial” by Nejati et. Al. published in Pain Physician in January of 2019. Not new, not old. Remember, the citations can be found at chiropracticforward.com under this episode.  Nejati P, Safarcherati A, Karimi F. Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019 Jan;22(1):53-61. PMID: 30700068.

Why They Did It The sacroiliac joint dysfunction (SIJD) has been found to be the primary culprit for lower back pain (LBP), but it is still overlooked and treated as LBP. There are no guidelines or appropriate therapeutic protocols for SI dysfunction. Thus, there is a need for an effective treatment strategy for SI dysfunction.

Objective: To compare exercise therapy (ET), manipulation therapy (MT), and a combination of the 2 (EMT) in terms of their effectiveness in treating SI dysfunction.

How They Did It Study design: A comparative, prospective, single-blind randomized controlled trial .

Setting: Sports Medicine Department of Rasoul Akram Hospital.

Methods: A total of 51 patients with lower back or buttock pain resulting from SI dysfunction were randomly assigned to 1 of 3 study groups: exercise therapy, manipulation therapy, or a combination of the 2.  The exercise therapy group received posterior innominate self-mobilization, sacroiliac joint stretching, and spinal stabilization exercises.  The manipulation therapy group underwent posterior innominate mobilization and SI Joint manipulation.  Lastly, the combination group received manipulation maneuvers followed by exercise therapy. Pain and disability were assessed at 6, 12, and 24 weeks after the intervention

What They Found All 3 groups demonstrated significant improvement in pain and disability scores compared to the baseline (P < 0.05).  The difference among these therapeutic protocols was found to be a function of time.  At week 6, manipulation therapy showed notable results, but at week 12, the effect of exercise therapy was remarkable.  Finally, at week 24, no significant difference was observed among the study groups. A major limitation of the present study is lack of a control group receiving a type of intervention other than the experimental protocols. Another limitation is the short duration of follow-ups.

Wrap It Up Exercise and manipulation therapy appear to be effective in reducing pain and disability in patients with Si dysfunction. However, the combination of these 2 therapies does not seem to bring about significantly better therapeutic results than either approach implemented separately.

Item #2 The last one today is called, “Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study” by Nambi et. Al published in European Journal of Physical Rehabilitation Medicine in December of 2018. Not new, not old.

Nambi G, Kamal W, Es S, Joshi S, Trivedi P. Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study. Eur J Phys Rehabil Med. 2018 Dec;54(6):880-889. doi: 10.23736/S1973-9087.18.05005-0. Epub 2018 Apr 24. PMID: 29687966.

Why They Did It Low back pain (LBP) is a common musculoskeletal disorder causing pain and disability in most of the countries. In recent years, new approaches such as Spinal manipulation and laser therapy have been considered as an alternative to conventional exercise and also found contradicting results in terms of its effectiveness.

Aim: A study to compare the combined effects of spinal manipulation, Laser and exercise versus Laser and exercise alone in chronic non-specific low back pain (cnLBP).

How They Did It Design: Randomized control study.

Setting: Subjects with cnLBP were treated with spinal manipulation, Laser and exercise in outpatient department for four weeks.

Population: Three hundred and thirty subjects who fulfilled the selection criteria were randomized (1:1:1 ratio) into spinal manip-laser-exercise (N.=110), Laser-Exercise (N.=110) and control group (N.=110).

Methods: The outcome measurements were Visual Analog Scale (VAS), Modified Modified Schober Test (MMST) Roland and Morris Disability Questionnaire (RMDQ), Physical Health Questionnaire-9 (PHQ-9) and Health Related Quality of Life-4 (HRQOL-4).  Baseline and follow-up measurements were measured at 4 weeks, 6 and 12 months by a blinded investigator.

What They Found Three hundred and twenty-six subjects completed the intervention and 304 completed the 12-month follow-up.  Demographic variables show homogeneity between the groups and ANOVA analyses showed significant improvement (P<0.001) in pain reduction (VAS), flexion range of motion (MMST), functional disability (RMDQ), depression status (PHQ-9), and quality of life (HRQOL-4) in spinal manipulation-laser-exercise group compared to the other two groups at one-year follow-up.

Wrap It Up Spinal manipulation combined with laser therapy and conventional exercise is more effective than laser therapy and conventional exercise alone in chronic non-specific low back pain. I mean….isn’t this one by itself enough to raise SMT above that of the level of ‘very low confidence’? That one alone? That randomized controlled trial? No? No wonder so many mistrust the WHO on so many different issues. It makes no sense to me.    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

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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    

How Specific Are Adjustments & Nerve Flossing Effectiveness

CF 318: How Specific Are Adjustments & Nerve Flossing Effectiveness Today we’re going to talk about How Specific Are Adjustments & Nerve Flossing Effectiveness But first, here’s that sweet sweet bumper music        

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    OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  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, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #318 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7).  We’re building a fairly clear picture of what the WHO has based their opinon of SMT on and it’s pretty shaky ground in my opinion. Basically, I think there’s an underlying agenda. There’s no way in my mind that ultrasound is equal in effectiveness to SMT, which is what the WHO is essentially saying  and we’re showing that the research they’ve used to base that opinion on pretty much sucks compared to more current research literature.  ake sure you don’t miss that info. Keep up with the class.  On the personal end of things….. We just flew back from The Bahamas last night and boy are my arms tired.  This was our first time to The Bahamas and we decided to give it a try because something in Mexico is always on fire or someone has just lost their head or something cartel crazy. So Mexico is a no for us. Lots of my friends still visit but not this gabacho. No siree.  So we figured with The Bahamas being just about 30 minutes on teh other side of Florida, that would be a nice little trip. So…..of course,….a few weeks before we go, news trickles in that 18 people ahve been murdered there within a month and the US Embassy raised the travel alert level for the Bahamas. That’s purely because we decided to book a trip there, by the way. In case you were wondering.  So, we were a little concerned but we shouldn’t have worried. We went straight from the airport to the resort with a transportation service and never left the resort on purpose. We could tell it was a bit sketch so we had no desire to explore. Plus, the resort/casino had tons of restaurants, tons of pools, a water park, fountains, the beach and ocean….all of it was pretty much right there so there was no need to explore really.  We stayed at Baha Mar and we really won’t be going back for a couple of reasons. We want to go somewhere that we don’t really need to worry about our safety. Like the Caymans, Costa Rica, Virgin Islands, or the Florida Keys. Also, except for a few places, we don’t usually return. Once we’ve seen it and done it, it’s time to explore something new.  This resort had a rave, dance party until 3:15 am on Friday night. I was furious. I guess with it being partly a casino, that’s appealing to someone but it’s not a non-gambling 51 year old that came to The Bahamas for rest and relaxation. Furious is an understatement but I got over it.  Everyone was great, the resort was mostly pretty impressive, and the getaway was a nice change. No work. Just hanging out and I enjoyed it.  Now, back to work and a day short this week so let’s get on with it.  Item #1 Our first one this week is called, “Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific?” By ross et. Al and published in Spine Journal in July of 2004.  Remember, the citations can be found at chiropractscforward.com under this episode.  Ross JK, Bereznick DE, McGill SM. Determining cavitation location during lumbar and thoracic spinal manipulation: is spinal manipulation accurate and specific? Spine (Phila Pa 1976). 2004 Jul 1;29(13):1452-7. doi: 10.1097/01.brs.0000129024.95630.57. PMID: 15223938. Why They Did It Clinicians utilizing spinal manipulative therapy (SMT) claim to be very specific and accurate with the delivery of their dynamic thrust.  It has been suggested that the clinical success of SMT is dependent on the accurate delivery of that therapy to the target spinal joints. The purpose of this study is to first locate the joints that produce an audible sound in response to manipulation (cavitation) during spinal manipulative procedures so that the accuracy and specificity of manipulation can be assessed. How They Did It Sixty-four asymptomatic participants, ranging in age from 22 to 49 years, volunteered to act as patients for the study.  Twenty-eight different clinicians performed thoracic and lumbar spinal manipulative procedures.  The range of clinical experience was 1 to 43 years. Asymptomatic participants received SMT to either the thoracic or lumbar regions of their spine.  Accelerometers were secured to the skin over the spinal column, and the relative time at which each accelerometer detected the vibration from the cavitation associated with the SMT was used to calculate the source of the vibration.  The site of cavitation was then compared with the target location. What They Found For lumbar SMT, the average error from target of 124 cavitations in lumbar procedures was 5.29 cm (at least one vertebra away from target), with a range of 0 to 14 cm.  Of these cavitations, 57 were deemed to be accurate and 67 were deemed to be inaccurate.  The average error from target of 54 cavitations in the thoracic spine was 3.5 cm, with a range of 0 to 9.5 cm.  Of these cavitations, 29 were deemed to be accurate and 25 were deemed to be inaccurate.  In most cases, individual manipulative procedures were associated with multiple cavitations ranging from 2 to 6. Wrap It Up In the lumbar spine, SMT was accurate about half the time.  However, because most procedures were associated with multiple cavitations, in most cases, at least one cavitation emanated from the target joints.  In the thoracic spine, SMT appears to be more accurate. Item #2 Our last one today is called “Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis” by Lascurain-Aguirrebena et. Al. and published in Pain in March of 2024.  That’s so hot it’s still on the damn burner! Lascurain-Aguirrebeña, Iona,b,*; Dominguez, Laurac; Villanueva-Ruiz, Ikerc,d; Ballesteros, Javiere,f,g; Rueda-Etxeberria, Mikele; Rueda, Jose-Ramónc; Casado-Zumeta, Xabatd; Araolaza-Arrieta, Maialend; Arbillaga-Etxarri, Aned; Tampin, Brigitteh,i,j. Effectiveness of neural mobilisation for the treatment of nerve-related cervicobrachial pain: a systematic review with subgroup meta-analysis. PAIN 165(3):p 537-549, March 2024. | DOI: 10.1097/j.pain.0000000000003071   Why They Did It Neural mobilisations (NM) have been advocated for the treatment of nerve-related cervicobrachial pain; however, it is unclear what types of patients with nerve-related cervicobrachial pain (if any) may benefit.  How They Did It Medline, Web of Science, Scopus, PeDro, Cinahl, and Cochrane databases were searched from inception until December 2022. Randomised controlled trials were included if they assessed the effectiveness of Neural mobilisations in nerve-related cervicobrachial pain, and outcome measures were pain intensity and/or disability.  Meta-analyses with subgroup analyses were performed.  Twenty-seven studies were included. What They Found For pain and disability reduction, Neural mobilisations was found to be more effective than no treatment, increased the effectiveness of standard physiotherapy as an adjuvant when compared with standard physiotherapy alone but was no more effective than cervical traction.  For disability reduction, Neural mobilisations was found to be more effective than exercise Wrap It Up In most comparisons, there were significant differences in the effectiveness of Neural mobilisations between the subgroups.  Neural mobilisations was consistently more effective than all alternative interventions (no treatment, traction, exercise, and standard physiotherapy alone) in 13 studies As I’ve heard my friend and esteemed colleauge, Dr. Brandon Steele say before, “If a patient has radiculopathy and there’s only one thing I can do for them, it’s nerve flossing.” And I agree.  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
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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        

Chronic Pain Central Sensitization & Patient Barriers To Physical Therapy

CF 316: Chronic Pain Central Sensitization & Patient Barriers To Physical Therapy Today we’re going to talk about Chronic Pain Central Sensitization & Patient Barriers To PT and, I would argue….chiropractic care. 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  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, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #316 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Man, we’re going through some stuff at the office recently and it centers around collections. Remember when I said last week that practice is a big long game of whack-a-mole? Well, it’s a fact and what I’m currently dealing with is really a ‘death by a thousand cuts’ type of scenario with one glaringly large issue.  The bright neon sign issue right now is collections. We are billing appropriately but the checks aren’t showing up. We’ve had such a struggle with in-house billing in the past. We lost hundreds of thousands on that years ago so we’ve moved to off-site billers. We are now on our 4th, I believe.  I think we’re in the right spot with this one. However, in the transition, our collections have taken a nose dive and I mean a nose dive. As in, if we billed out $70k+, we had a collections of $28k. Right. Now, carry that out over 3 months with that kind of deficit, your resources that are meant to cover issues start to vanish fairly rapidly.  Remember, I have an overhead of $55k-$60k/month. I remember when I was younger and newer in practice. At the time, my overhead was about $25k. I was talking to an older chiro buddy of mine at a TX Chiro Assoc event and he told me his overhead was $45k/month. And he wasn’t integrated either. It blew me away. I couldn’t imagine having an overhead that high.  And…..well here we are. With 4 full time employees, a full-time NP, an acupuncturist, and 2 massage therapists…..it just sort of happens. All of the medical supplies….holy cow. That’s a pretty penny, folks. Massage supplies, acupuncture needles, 4,000 sq ft. Office, utilities…you get the point. It adds up fast and if you’re not cognizant of what’s up, it’ll get out of hand on you. That’s why I balance my own bank account each month. I know what’s coming in and what’s going out.  It’s why I know that we have a collections issue.  Remember we have death by a thousand cuts, right? Well, other issues of late are that we aren’t performing and charging for codes we could be. We’re letting cold laser patients walk out the door without doing laser. We’re letting exercise patients exit the building without doing their exerrcises. This is happening with patients that are covered under PI or on their insurance plan for rehab.  That’s just a training issue and we’re whacking that mole currently.  Another issue is that we’re still recovering from COVID on some level. In 2019, I had 220 more new patients over the course of that year than I had in 2023. What the hell? So, we’re whacking that mole by ramping up some marketing and website SEO efforts.  I have a call with the collection company today at lunch and I have addressed the other issues. Now, if we can get it happening on the collections, you’ll get to hear happy Jeff in future episodes. Yay!! Why do I share this stuff with you? I like to think this is not just a research article podcast. This is real life. If you know the struggles I’m dealing with and the successes I’m enjoying, you’re either going through the same and can learn, or you WILL be going through the same and can learn from my experiences.  Even when you’re riding the wave of success, things can short circuit and you have to always be paying attention so that you can catch it as quickly as possible so you can avoid disaster. After years of not having to give finances much consideration at all, it’s time to lean on some folks that owe the clinic money, lean on our biller a bit, get ourselves in order, and market.  Easy peasy right? I’ll keep you posted on our progress. Don’t cry for me, Argentina! You’ll be mad at me soon because I’ll be back to seeing 70+ new patients per month. Wait for it. When you’ve got my attention, you’ve got my attention and I have a tendency to really lean in and get focused. That’s where we are right now. While I don’t recommend it, it is a bit exhilerating. I’ll admit.  Item #1 Our first one today is called, “Nociplastic pain and central sensitization in patients with chronic pain conditions: a terminology update for clinicians” by Nijs et. Al. published in Brazillian Journal of Physical Therapy in May of 2023 and that’s hot enough! Remember, the citations can be found at chiropractscforward.com under this episode.  Nijs J, Malfliet A, Nishigami T. Nociplastic pain and central sensitization in patients with chronic pain conditions: a terminology update for clinicians. Braz J Phys Ther. 2023 May-Jun;27(3):100518. doi: 10.1016/j.bjpt.2023.100518. Epub 2023 Jun 14. PMID: 37348359; PMCID: PMC10314229. Why They Did It Acute pain has been tremendously beneficial throughout evolution as it enables us to identify potential harmful stimuli, and as it ensures we protect damaged tissue while it heals.  However, once evolved into a chronic state, its protective role diminishes with a wide range of negative and maladaptive sequelae that massively impact both the individual and society.  Neuroscientific research has significantly advanced our understanding about pain and chronic pain in particular, including the role of central (nervous system) sensitization in the generation and amplification of (persistent) pain experiences. This knowledge innovation created a massive implementation potential but also a challenge for clinicians to remain up-to-date in daily practice.  Particularly the variety of and rapid change in concepts and terminology used can be challenging for clinicians. For these reasons, this second part of the comprehensive pain management editorial series1 provides a terminology update regarding central sensitization and nociplastic pain in a clinically applicable way.  Essentially, central sensitization is the major underlying mechanism of nociplastic pain, which is a pain phenotype. To facilitate the understanding of the concept of central sensitization, it is crucial to understand that central sensitization is a homeostatic mechanism. This implies, similar to inflammation, that central sensitization is adaptive in the short term (e.g., in the days following surgery or following a motor vehicle accident). As such, it avoids further deterioration in acute pain situations.  However, central sensitization becomes maladaptive in the long term, with pain losing its protective value as commonly seen in patients with persistent pain (e.g., months after successful surgery or a motor vehicle accident).  In addition, central sensitization and inflammation – although physiologically very divert mechanisms – share many features, including the notion that multiple biomarkers together rather than a single gold standard are required for assuming its presence, the fact that they are both umbrella terms covering various clinical & biological presentations, that their clinical presentation varies substantially from patient to patient, and that they are both key mechanism in a wide variety of clinical conditions/diseases The presence of clinical features of central sensitization predicts poor treatment outcomes in patients with a variety of chronic pain conditions, at least when the treatment targets local tissues as the presumed source of nociception.  This applies to conservative interventions, but also to surgical interventions. These observations illustrate the need for early recognition of central sensitization in patients with chronic pain, in combination with tailored treatment. Item #2 Our last one today is called, “Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review”’ by Dickson et. Al. and published in Pain Medicine in February 2024 and that one’ll burn your damn eye brows off.  Cameron Dickson, Rutger M J de Zoete, Carolyn Berryman, Philip Weinstein, Kexun Kenneth Chen, Paul Rothmore, Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review, Pain Medicine, Volume 25, Issue 2, February 2024, Pages 104–115, https://doi.org/10.1093/pm/pnad134 Why They Did It To identify and synthesize patient-related barriers to… and enablers of ….the implementation of high-value physiotherapy (HVP) for chronic pain.  Furthermore, to review what patient-related interventions have been used to facilitate the implementation of high-value physiotherapy for chronic pain, as well as their efficacy. How They Did It The authors systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain.  They used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. What They Found
  • Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. 
  • Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient’s understanding of exercise benefits. 
  • Other barriers included fear of movement, fragmented care, and cost. 
  • Ten studies explored interventions, 9 of which aimed to improve exercise adherence. 
  • Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls.
Wrap It Up
  • Patients with chronic pain experience barriers to high value PT, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. 
  • Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. 
  • Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. 
  • Our findings suggest that interventions seeking to enhance implementation of high value PT, need to consider the multifactorial barriers experienced by patients with chronic 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

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    The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

CF 315: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6).

If you’ve been following along, and I hope you have…The WHO updated their recommendations recently for pain. Spinal maniuplative therapy was include so we’re on the menu. But, they rated SMT at very low confidence, which is the same as what they rated ultrasound. So, in the eyes of the WHO, smt may be about as effective as ultrasound. Yeah, we’re call BS so we are going through each paper they used to make this determination and they all, except for a few, are old, outdated, and pretty much stink. We’ll talk about it…. But first, here’s that sweet sweet bumper music

 

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. 

 

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, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #315 Now if you missed last week’s episode, we talked about Omnivorous vs Vegan and SMT For Chronic Neck Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Another day, another dollar by friends. Here we are at the end of January 2024 and if all works well and if you’re an insurance or hybrid clinic, then you know that you’ve been a little slower because the deductibles re-set in January for the most part and people don’t like to spend their own money.  But, about a month or so is as long as many of them ever want to go without going to the chiropractor and that’s OK.

The point being that hybrid clinics like mine should start seeing increased numbers in February. It may be mid to late February but we should see us start getting busier for sure.  In the meantime, I’ve started focusing more and more on marketing. I feel like I’m pretty dangerous when I have the time to be. Right now, I have the time to be. I used to sit around brainstorming ideas for marketing, memes, content, and all that entails. Then I’d create my own original stuff and post it.  I haven’t done that in forever it seems but here lately, and unfortunately, I’ve had some extra time to give those things attention again. I like a challenge and so I’m on it. I’ve targeted the demographics I want targeted.

The ones I think that the economy and who happens to be the President will have no control over economically. We’ve re-newed our efforts in getting our message to these people.  In addition, we’ve re-newed our efforts in our public outreach. Face to face, person to person outreach. Dan Kennedy says, YCDBSOYA, You can’t do business sitting on your ass. You’re moving forward or falling behind. You’re the window or the bug. You either make things happen in your life or you sit around wonder what the hell just happened.  So that’s what’s up with Creek Stone on this Monday, January 29th.

I have 35 on the schedule when I typically have 45. You carry that out throughout the week, that’s 50 less per week which is 200 less appointments per month. That’s unacceptable.  I’ve had less new patients lately as well. I think my Google SEO has dimished since going with a very reputable company a few years ago so we switched it up and went with a new website company that I know gets results. That’s brand new.  I also got to looking at our new patients demographics and it looks like we’re seeing fewer VA patients recently. That’s worth investigating and diving into.  If you’re not doing these thing regularly, might get on it. It’s whack-a-mole folks. You can never hit the auto-pilot button and sit back and just do the work if you’re the owner. It’s a constant battle. Enjoy the great times and ride that wave. When things start popping up out of nowhere, dig in, have some grit, and wait for that next wave.  Alright, here we go with the research today. 

Item #1

The first one today is called, “Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial” by Krekoukias, et al., published in 2017 in the Journal of Manual Manipulative Therapy.  Remember, the citations can be found at chiropractscforward.com under this episode.  Krekoukias G, Gelalis ID, Xenakis T, Gioftsos G, Dimitriadis Z, Sakellari V. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther. 2017 May;25(2):66-73. doi: 10.1080/10669817.2016.1184435. Epub 2016 Jun 23. PMID: 28559665; PMCID: PMC5430451.

Why They Did It The authors wanted to examine the efficacy of spinal mobilization in subjects with low back pain (LBP) and associated spinal disk degeneration.

How They Did It Seventy-five subjects suffering from chronic LBP were randomly allocated into 3 groups of 25 subjects.  Each group received five treatment sessions with the first group receiving manual therapy (MT) (spinal mobilization), the second a sham treatment, and the third conventional physiotherapy (CP) (stretching exercises, transcutaneous electrical nerve stimulation, and massage).  Subjects were assessed for their pain intensity using the numerical pain rating scale and for their self-reported disability using the Oswestry and Roland-Morris Questionnaire at baseline and after the completion of the five treatment sessions.

What They Found Paired t-tests showed a significant improvement for all outcome measures in the manual therapy and conventional physiotherapy group.  Analysis of covariance revealed that the manual therapy group had significant improvement in all outcome measures in comparison with the sham and conventional physiotherapy group, whereas no significant difference was observed between the sham and conventional physiotherapy group

Wrap It Up Manual Therapy is preferable to conventional physiotherapy in order to reduce the pain intensity and disability in subjects with chronic LBP and associated disk degeneration.  The findings of this study may lead to the establishment of spinal mobilization as one of the most preferable approaches for the management of LBP due to disk degeneration.

Item #2 The last one is, “The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial” by Koes published in Spine journal in 1992 and they’re using 1992 to make this determination in 2024 because there’s no better and more current  Koes BW, Bouter LM, van Mameren H, Essers AH, Verstegen GM, Hofhuizen DM, Houben JP, Knipschild PG. The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial. Spine (Phila Pa 1976). 1992 Jan;17(1):28-35. doi: 10.1097/00007632-199201000-00005. PMID: 1531552.

Why They Did It As you see in the title of the paper, the plan was to test the effectgiveness of manual therapy, physiotherapy, and treatment by a general practitioner on back and neck pain

How They Did It It was a randomized controlled trial The effectiveness of manual therapy, physiotherapy, continued treatment by the general practitioner, and placebo therapy (detuned ultrasound and detuned short-wave diathermy) were compared for 256 patients with nonspecific back and neck complaints lasting for at least 6 weeks. The principle outcome measures were severity of the main complaint, global perceived effect, pain, and functional status. These are presented for 3, 6, and 12 weeks follow-up. 

What They Found Both physiotherapy and manual therapy decreased the severity of complaints more and had a higher global perceived effect compared to continued treatment by the general practitioner.  Differences in effectiveness between physiotherapy and manual therapy could not be shown. 

Wrap It Up A substantial part of the effect of manual therapy and physiotherapy appeared to be due to nonspecific (placebo) effects. From 1992 – Placebo seems to be why smt appears to be effective. We know that placebo can and should play a part in a patient’s recovery. And we can leverage placebo in our favor too. Placebo has a bad name for some reason. In the biopsychosocial construct we should be using to our advantage all of the time.  Encouraging and positive words, little pain free wins….these things play a part in neuroplasticity and moving it in our direction and moving the patient away from chronic pain. 

That doesn’t mean that smt is placebo only and there have been plenty of papers shwoing the effectiveness of SMT beyond placebo in teh last 10 years or more. This paper is liteerally 32 years old. What in the holy hell are they using this paper for in 2024? I can’t explain it.  To be fair, I suppose the Gate Theory from the 1960s is still relevant so why can’t this paper still be relevant, right?/

But I’d argue that the Gate Theory is gamechanging big stuff. This paper, in my opinion, isn’t in the same ball park with regard to impact and effectiveness. As knowledge base expands, more recent and more relevant knowledge replaces outdated knowledge. This paper should be replaced and not be relevant when recommending SMT for treatment.  My two cents.  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

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

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

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1)

CF 308: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1) 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  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, smarts, personality, 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 resource for you and is 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • 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 #308 Now if you missed last week’s episode, we talked about Sciatica & Mental Stimulation And Dementia.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Man…..just getting ready for Christmas and all that good stuff. Actually, we are ramping up marketing. We’re doing it the wrong damn way though. Here’s what I mean; we are doing reactive marketing rather than proactive marketing.  I market every week with social media posts, emails, and internal stuff. But REALLY maketing and spending some money to do so, yeah, I haven’t done much of that for one big reason. Because I still have somewhat newer staff. And yes….I’m one of those that doesn’t have a professional marketer or rep. I send our staff out to market.  Here’s the best reason why. We are off on Tuesday afternoons because I’m either doing continuing ed or I’m doing VoiceOver. Instead of warming up a chair in teh clinic doing absoluttey nothing, let’s go spread the word of this amazign clinic in Amarillo, TX called Creek Stone.  I’d rather pay an hourly wage for half-assed marketing than an hourly wage for professional time-killing and trying to look busy.  So yes, we’ve been painfully slow compared to my normal so we are kicking the marketing into high gear and with the help of a coupld of my Mastermind besties, we have some really great ideas that we think can be very effective in getting this clinic back at the top of the game.  The staff overturn in the last year has just been brutal, folks. I’ve never in 26 years experienced anything like it. It has kept us mostly stagnate but beyond valleys are the peaks and I feel pretty good about the peak we’re about to come up on.  We have some great direction with the marketing but also great direction on website SEO and we finally feel that we have solved our billing and collections equation and finally have one that we feel really really good about.  While we have a slow down, it has given us the time to plug some holes and get our house back in order and get ready for the growth that is about to happen.  I want to go on a little trip here with the next several episodes of the podcast so let me lay the base coat for you. At the TCA, one of my buddies and our legislative homey, Dr. Craig Benton from Lampassas, TX, is trying to get movement on the Medicare Equality Bill and we are doing what we can to get more congressmen signed onto the bill.  As part of that initiative, Craig sent an email that had a paper attached showing benefits of spinal manipulative therapy. It was from the World Health Organization. Well, one of our executives from the TCA emailed back wondering why, in 2023 with all of the info on the benefits of smt, there is still a designation of very low confidence for SMT. In fact, if I recall correctly, ultrasound was poor and smt was very poor or something of that nature.  So, this executive asked where the WHO got its information, so I started diving into the paper and found a list of their research for SMT. I thought it would be interesting to go through them to answer our questions and maybe we all learn something.  So…..why the hell not? And remember this. At the end of each and every episode of this podcast I say, “he 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.”  I want you to know that I don’t just say that, I walk that walk and have for around 15 years. If you’re not active, get your ass moving.  Item #1 In that spirit, the first one today iis called “Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial” by Balthazard et. Al. and published in BMC Musculoskeletal Disorders in August 2012.  Remember, the paper citations are in the show notes. Also, this is a pilot study. I don’t include pilot studies in this podcast usually but, the WHO is using it to determine the effectiveness of SMT so we might as well cover what the WHO is using.  Balthazard P, de Goumoens P, Rivier G, Demeulenaere P, Ballabeni P, Dériaz O. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2012 Aug 28;13:162. doi: 10.1186/1471-2474-13-162. PMID: 22925609; PMCID: PMC3518179. Why They Did It Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations.  Current evidence suggests that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels.  The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. How They Did It
  • Forty-two low back patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus exercise, or detuned ultrasound (first intervention) plus exercise. 
  • Eight therapeutic sessions were delivered over 4 to 8 weeks. 
  • Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. 
  • Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.
What They Found
  • Thirty-seven subjects completed the study. 
  • MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session 
  • Independently from time after treatment, manual therapy with exercise induced lower disability and a trend to lower pain. 
  • Six months after treatment, Shirado test was better for the sham treatment group. 
Wrap It Up
  • This study confirmed the immediate analgesic effect of MT over ST. 
  • Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. 
  • These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP.
Item #2 Our last one today is called, “Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain” by Bialosky et. Al. and published in Journal Of Pain in February 2014.  Bialosky JE, George SZ, Horn ME, Price DD, Staud R, Robinson ME. Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999). J Pain. 2014 Feb;15(2):136-48. doi: 10.1016/j.jpain.2013.10.005. Epub 2013 Oct 27. PMID: 24361109; PMCID: PMC3946602. Why They Did It Spinal manipulative therapy (SMT) is effective for some individuals experiencing low back pain; however, the mechanisms are not established regarding the role of placebo. SMT is associated with changes in pain sensitivity, suggesting related altered central nervous system response or processing of afferent nociceptive input. Placebo is also associated with changes in pain sensitivity, and the efficacy of SMT for changes in pain sensitivity beyond placebo has not been adequately considered. How They Did It
  • We randomly assigned 110 participants with low back pain to receive SMT, placebo SMT, placebo SMT with the instructional set “The manual therapy technique you will receive has been shown to significantly reduce low back pain in some people,” or no intervention. 
  • Participants receiving the SMT and placebo SMT received their assigned intervention 6 times over 2 weeks. 
  • Pain sensitivity was assessed prior to and immediately following the assigned intervention during the first session. 
  • Clinical outcomes were assessed at baseline and following 2 weeks of participation in the study.
What They Found
  • Immediate attenuation of suprathreshold heat response was greatest following SMT. 
  • Group-dependent differences were not observed for changes in pain intensity and disability at 2 weeks. 
  • Participant satisfaction was greatest following the enhanced placebo SMT.
Wrap It Up The results of this study indicate attenuation of pain sensitivity is greater in response to SMT than the expectation of receiving an SMT. These findings suggest a potential mechanism of SMT related to lessening of central sensitization and may indicate a preclinical effect beyond the expectations of receiving SMT. 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      

Sciatica & Mental Stimulation And Dementia

CF 307: Sciatica & Mental Stimulation And Dementia Today we’re going to talk about Sciatica & Mental Stimulation And Dementia 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 #307 Now if you missed last week’s episode , we talked about Pain Neuroscience Education & Cannabis And Bipolar Disorder. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I just got back from Colorado Springs yesterday. Many of you know that I do voice over projects in my spare time. Whatever that is. I don’t really have spare time these days. But, I flew from Amarillo, TX, to Las Vegas, then to Colorado Springs…..how dumb is that? I hae to do that same path on the way home too.  I was doing live announcing for a Redline Cheer and Dance competition. The season is here and I’ll be hopping all over to these competitions and meeting all kinds of new people. It’s always interesting and mostly fun. It can be a bit of a grind but it’s mostly fun. The traveling, hotels, and meals…..I always enjoy them. New experiences keep you jazzed. And you can’t hardly beat the view from anywhere in CS.  The week after Thanksgiving was slow. I just didn’t have a good week last week and that can get in your brain if you allow it to. I don’t like being slow and I don’t like what it does to morale. I like a good low grade excited buzz in the office. Not a subdued and draggy feeling. Which is what last week was.  Today is Monday and I have 45 on my schedule so that’s an improvement and I’ll take it. I’m a motivated dude. I need to move forward at all times. Any set back kind of pisses me off and gives me the grumps.  But, as a leader, you can be honest with your manager. But you have to put on the front for the rest of your staff. You can tell you manager, hey, I’m struggling with finances this week and this provider or that provider in the clinic isn’t quite covering their overhead. That gives me anxiety and we need to pay attention to that. Or whatever. Hey manager, I don’t have the extra funds to replace this equipment, let’s figure out a work around until we do. Something like that. You can have those conversations with your manager because that’s why they’re there. Or, it’s supposed to be why anyway.  But when it comes to the rest of the office, you need to have that front on that everything is great, we’re working through a couple of challenges but nothing you’ve never seen, and it’s time to rock n roll. Don’t let them see you sweat. It’s not good for them or for you.  Fake it till you make it. It’s never on autopilot folks. It’s always changing and you have to keep dodging punches and swinging every single day.  So, let’s get to it so I can go back to swinging some punches around here. Metaphorically, of course.  Item #1 Our first one today is called, “I Am Worried I Have Sciatica—What Do I Need to Know?” By Zhang et. Al. and published in JAMA Internal Medicine on November 12, 2023 and Aye crumb! Es muy caliente, mi amigos! Zhang GY, Incze MA. I Am Worried I Have Sciatica—What Do I Need to Know? JAMA Intern Med. Published online November 13, 2023. doi:10.1001/jamainternmed.2023.5990. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2811335 This is more of an article instead of a research project so let’s hit the highlights. 
  • They say, “Sciatica is a type of pain that is caused by irritation of the sciatic nerve. This nerve travels from the low back down the legs. Sciatica most commonly happens when a disk in your spine gets damaged or worn out and presses on the sciatic nerve.”
  • The pain can be sharp and aching. It is often accompanied by numbness, tingling, or shooting pain down the back of one leg. Rarely, sciatica can cause muscle weakness, like having difficulty lifting your foot.
  • A medical professional can usually diagnose sciatica by asking about your symptoms and doing a physical examination. For most people, blood tests and imaging such as x-ray or magnetic resonance imaging are not necessary. If you have had cancer, spine infections, or injection drug use; have a new fever; cannot feel your groin area; cannot control going to the bathroom; have trouble urinating; or your leg feels weak, you should see a medical professional right away.
  • Most people with sciatica fully recover without any treatment. About one-third of people with sciatica recover within 2 weeks, and three-fourths of people feel better within 3 months. It is hard to predict who will get better and who will still feel pain. Sciatica can come and go. If your sciatica lasts more than 12 weeks, it is a good idea to get reevaluated by a health care professional.
  • There are many ways to treat pain related to sciatica. Anti-inflammatory drugs like ibuprofen or naproxen may provide modest, short-term relief. Acetaminophen (Tylenol) can also be helpful for pain. Other prescribed medications such as muscle relaxers, steroids, opioids (eg, tramadol, oxycodone), and gabapentin are not proven to help, and some may have dangerous side effects. Talk with your doctor about what medications are best for you. Maintaining gentle physical activity (eg, walking, light housework) as tolerated is important for recovery. A physical therapist can help to coach you on specific exercises to speed up the recovery process. There is no strong evidence that treatments like back adjustments (eg, from chiropractors), gentle spine stretching (called lumbar traction), or acupuncture work. Doctors sometimes give injections of steroid or numbing medications near the spine to help with pain. These might help relieve pain for a short time, but they do not help to heal sciatica.
  • If treatments like physical therapy and pain medications do not help after 4 months, surgery may improve symptoms for some people. But there is a chance that the pain may return even after surgery. Most surgeries for sciatica use small cuts and special tools to remove the damaged part of the spinal disk. This can relieve pressure on the sciatic nerve. Recovery time from sciatica surgery varies among people but generally takes 6 to 12 weeks. While surgery can help, it has risks, including nerve damage and infection.
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 Last one today is called, “Lifestyle Enrichment in Later Life and Its Association With Dementia Risk” by Wu et al. and published in JAMA Network Open on July 14, 2023 and that’s a steamy stack something good! Wu Z, Pandigama DH, Wrigglesworth J, et al. Lifestyle Enrichment in Later Life and Its Association With Dementia Risk. JAMA Netw Open. 2023;6(7):e2323690. doi:10.1001/jamanetworkopen.2023.23690 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807256?guestAccessKey=eaeccd11-7338-417d-a1b5-70481ff42466&utm_content=weekly_highlights&utm_term=072323&utm_source=silverchair&utm_campaign=jama_network&cmp=1&utm_medium=email Why They Did It Lifestyles enriched with socially and mentally stimulating activities in older age may help build cognitive reserve and reduce dementia risk. Objective  To investigate the association of leisure activities and social networks with dementia risk among older individuals. How They Did It
  • It was a longitudinal prospective cohort study 
  • Used population-based data from the ASPREE Longitudinal Study of Older Persons (ALSOP) for March 1, 2010, to November 30, 2020. 
  • Community-dwelling individuals in Australia aged 70 years or older who were generally healthy and without major cognitive impairment at enrollment were recruited study 
  • A total of 19 measures of leisure activities and social networks assessed at baseline were classified using exploratory factor analysis.
  • Dementia was adjudicated by an international expert panel according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. 
  • Cox proportional hazards regression examined dementia risk over 10 years, adjusting for education, socioeconomic status, and a range of health-related factors.
  • This study included 10,318 participants. Their median age was 73.8 years at baseline, more than half (52.6%) were women, and most self-identified as White
What They Found
  • In adjusted analyses, more frequent engagement in adult literacy activities (eg, writing letters or journaling, using a computer, and taking education classes) and in active mental activities (eg, playing games, cards, or chess and doing crosswords or puzzles) was associated with an 11.0% and a 9.0% lower risk of dementia, respectively. 
  • To a lesser extent, engagement in creative artistic activities (craftwork, woodwork, or metalwork and painting or drawing) and in passive mental activities (reading books, newspapers, or magazines; watching television; and listening to music or the radio) was also associated with reduced dementia risk. 
  • In contrast, interpersonal networks, social activities, and external outings were not associated with dementia risk in this sample.
Wrap It Up These results suggest that engagement in adult literacy, creative art, and active and passive mental activities may help reduce dementia risk in late life.  In addition, these findings may guide policies for geriatric care and interventions targeting dementia prevention for older adults. So, it appears that working the brain keeps the brain working. Basically.  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    

Pain Neuroscience Education & Cannabis And Bipolar Disorder

CF 306: Pain Neuroscience Education & Cannabis And Bipolar Disorder Today we’re going to talk about Pain Neuroscience Education & Cannabis And Bipolar Disorder 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 #306 Now if you missed last week’s episode , we talked about Hip Pain And Corticosteroids & Chronic Pain After Spinal Surgery. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. First day back from our 4-day Thanksgiving holiday break. Now, let’s just say this; I was going to work the morning of the Friday after Thanksgiving. But, I had a bit of a mutiny with the employees. And, to be honest, I’m not sure how it sits with me.  I didn’t want to work on Friday to start with but, being honest here, we’ve been a little slower than I’m used to lately and I felt like I needed to. Plus I was in Orlando a week or so ago for our Mastermind meeting so that was slow on my return as well.  Anyway, I was approached and the crew feels they’ve been putting in a lot of energy with being shorthanded, etc and they wanted that day off. And wanted it paid I’m assuming. So my conundrum was, stand my ground and risk losing employees and fostering a low-simmering dislike of me and thee job we are here to do? Or submit to a request I already wanted for myself anyway? Right or wrong, I chose to give them the day and I have to say that I thoroughly enjoyed it. And today, the staff seems to be in a better overall mood and, I hope, ready to rock n roll and make it happen this week and get things back to normal. Which means busy busy.  How would you handle that? I didn’t dig it. I can tell you that.  Alright, enough clinic stuff, let’s hop into the research! Item #1 The first on today is called, “Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: A systematic review and meta-analysis of randomized controlled trials” by Lin et. Al. published in European Journal of Pain on September 11, 2023 and BAM! It’s smokin! https://doi.org/10.1002/ejp.2182 Why They Did It Chronic neck pain (CNP) is a common musculoskeletal disorder. Pain neuroscience education (PNE) is a promising nonpharmacological intervention for CNP, however, its effectiveness remains unclear. This systematic review and meta-analysis aimed to evaluate the effectiveness of PNE in treating CNP. How They Did It Electronic databases from inception to February 2023 were searched for randomized controlled trials  The primary outcome was the change in pain intensity, and the secondary outcome was improvement in kinesiophobia,  Two authors independently scrutinized eligible articles, extracted data and assessed quality; a random-effects model was employed for data pooling. What They Found In total, seven RCTs comprising 479 participants were included and demonstrated that PNE significantly reduced pain intensity  Subgroup analysis revealed that the adult group experienced significant pain reduction after PNE, whereas the adolescent group did not.  PNE also reduced kinesiophobia which was evaluated in four of seven RCTs  There was indication that increased intervention duration contributed to greater pain reduction.  No adverse events were reported following PNE or the control treatment. Wrap It Up Pain neuroscience education effectively reduced pain intensity and kinesiophobia in patients with chronic neck pain.  A longer PNE time leads to greater pain reduction and is more effective in adults than in adolescents. According to Physiopedia – Pain Neuroscience Education (PNE) is a strategy that aims to teach patients to reshape their mindset and perception of pain despite these factors. It provides patients a better understanding of their condition and motivates them to become active participants in their treatment programs. Based on a large number of high-quality studies, it has been shown that teaching people with chronic pain more about the neuroscience of their pain produces immediate and long-term changes.  Item #2 Our last one this week is one of these that always makes me uncool and all and yes, alcohol is worse but we already tried outlawing it so here we go, it’s called, “Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder” by Jensen et. Al. and published in JAMA Psychiatry on May 24, 2023 so it’s still nice and steamy and cozy.  Remember that you can find these citations in our show notes on our website at chiropractscforward.com Jefsen OH, Erlangsen A, Nordentoft M, Hjorthøj C. Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder. JAMA Psychiatry. 2023;80(8):803–810. doi:10.1001/jamapsychiatry.2023.1256 Why They Did It They say that Cannabis use is increasing worldwide and is suspected to be associated with increased risk of psychiatric disorders; however, the association with affective disorders has been insufficiently studied. The question they tried to get clarity on is, “Is cannabis use disorder associated with an increased risk of psychotic and nonpsychotic unipolar depression and bipolar disorder?” How They Did It This was a prospective, population-based cohort study using Danish nationwide registers included all individuals born in Denmark before December 31, 2005, who were alive, aged at least 16 years, and living in Denmark between January 1, 1995, and December 31, 2021. Which means 6,651,765 individuals in Denmark that were followed up for 119,526,786 person-years The main outcome was register-based diagnosis of psychotic or nonpsychotic unipolar depression or bipolar disorder.  What They Found Cannabis use disorder was associated with an increased risk of unipolar depression, psychotic unipolar depression, and nonpsychotic unipolar depression.  Cannabis use was associated with an increased risk of bipolar disorder in men and women, psychotic bipolar disorder, and nonpsychotic bipolar disorder in men and women.  Cannabis use disorder was associated with higher risk for psychotic than nonpsychotic subtypes of bipolar disorder but not unipolar depression. Wrap It Up This population-based cohort study found that Cannabis use disorder was associated with an increased risk of psychotic and nonpsychotic bipolar disorder and unipolar depression.  They say that These findings may inform policies regarding the legal status and control of cannabis use. So, do what you will with the info. Don’t punish the messenger.  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

Over Manipulation Syndrome

CF 305: Over Manipulation Syndrome

Today we’re going to talk about Over Manipulation Syndrome 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 #305 Now if you missed last week’s episode , we talked about  Interesting Thoughts On Low Back & Degenerative Cervical Myelopathy. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I skipped last week because I was at the MCM Mastermind. Dr. Kevin Chritstie’s group that I’m a part of. We met in Orlando. What a great trip. The kids went with us and I did the Mastermind meeting and then had a day and a half to hit Disney and hit it we did.  We killed ourselves trying to see everything. While that’s impossible, we did see a lot and had a great time. The Harry Potter stuff at Universal is legit folks. Crazy. The Star Wars stuff at Hollywood Studios is incredible. And the Avatar stuff at Animal Kingdom is cool as hell. I’m just saying.  I’ll add that we went about 10 years ago and I hated it. I hated all of it. This time, for whatever reason, was better. I didn’t absolutely hate it. I actually enjoyed most of it. Maybe because the kids are older and don’t have to be watched. Maybe I just knew more about what to expect. I’m not sure. But it was a good time had.  On the Mastermind…..I got some good tidbits and nuggets out of it and had a great time reconnecting with my tribe. These are my people and I can’t tell you how much we enjoy each other. We learn as much from each other at the bar or eating together than we learn from our speakers.  Our Mastermind is full but Dr. Christie started another Mastermind that has openings. If you are at all interested, I cna’t encouurage you enough to email Dr. Christie at drkchristie@gmail.com and see if you can sneak into his new group. Next year they’ll be meeting in San Diego, Denver, Phoenix, and Jackson Hole, Wyoming. All great places to hang out, learn, and network.  Alright, Happy Thanksgiving. Let’s hop into the research.  Item #1 This isn’t really a research paper we’re going to cover here. This is more a conglomeration to demonstrate something I’ve gotten a lot of push back on in private conversations with other chiropractors over the years. Let me start by saying that I Donn’t want to take money out of Chiros’ pockets. The evidence based folks should be mostly fine with what I’m going to talk about today because they’re not doing crazy stuff.  The more non-evidence based folks aren’t going to like this discussion at all. All I can say is that when someone making the right decision affects their financial status, well, you just never know what you’re going to get.  First thing….I’m not about to advocate not adjusting your patients. The adjustment is the cornerstone of my practice for more than 25 years. What we’re going to talk about, over manipulation syndrome or spinal instability, was never for any reason in any shape, form, or fashion on my radar screen before getting the Neuromusculoskeletal medicine diplomate and diving into ChiroUp.  Let’s start with a personal story. I went to the chiropractor first when I was hurt as a freshman in high school. I was hurt badly and nobody else helped me. After months of pain, my mom took me to the local chiro and in two weeks you’d never know I was hurt.  That’s why I ended up becoming a chiropractor in the first place. While that experience was life changing, it also led to my buddy and I being all cool and popping our own necks all of the time. It was hard to do at first. I really had to use both hands and really crank on it to get that pop noise we all covet so much.  But then, after some time of constantly self-adjusting my neck, it got easier. And easier, and easier. To the point that I could just turn my neck and it would pop incidentally for no reason at all. And if I didn’t pop it, it would get irritated and feel like it needed to pop all of the time.  I had created instability by self-adjusting all of the time.  Our spine wants to be stiff and solid without that extra movement. But I had created extra movement consistently enough that I had loosened all of those tiny muscles and connective tissues. As a compensation, because our spine wants stiffness and stability, the larger postural muscles stiffened up to try to make up for all of those tiny ones that went lax and lazy.  So, that sets up a neck that is stiff but hypermobile. You can share this with all of your self-adjustors if you like.  Anyway, that brings up two thoughts:
  1. When you have an older person, discs degenerate, connective tissue gets loosened through manual labor, people have had injuries, or something issues like Elhers Danlos have started to aggravate…..hypermobility starts to take hold
  2. When you have patients that have been going to chiropractors repeatedly over the years, you can create hypermobility where there was none. Like my time self-adjusting. I’m not talking about responsible and appropriate adjusting like you do with a limited, condition focused treatment plan. I’m talking about, “I need to see you once a week for the rest of your life to treat your immune system and help you avoid cancer.” Or, I need to see you 76 times and 10 sets of x-rays this year to make sure you have the right, perfect degree curvature in your neck. As common sense would dictate, this is probably going to be more common with more aggressive adjusters. 
I’ll tell you that I’m out on the cliff a bit on this topic if I’m being honest. When you go searching, you’ll find Over Manipulation Syndrome. But, it’s not a huge topic with 100’s of articles.  One of them is at hur911injurycenters.com, probably not a chiro friendly page if I’m just guessing. They say, “Over-manipulation syndrome can be caused through self-manipulation as well as through high-velocity adjustments from a chiropractor. If you or a chiropractor have over-manipulated a joint through high-velocity treatments, you might experience damage to the ligament structures. This damage can lead to joint instability and worsening of hypermobility.” One I found is by Dr. Mark Saracino, a Board Certified Chiropractic Neurologist from Pennsylvania. I will put the link to his thoughts in the show notes for you.  Dr. Saracino starts out with a funny/not so funny joke, ““How many Chiropractors does it take to change a light bulb?” Answer: “Just one, but it takes 56 visits!”  https://drsaracino.com/PDFs/INFO/TooManyChiropracticVisits.pdf He says, “To my knowledge, no studies have shown that manipulations, once a month or more, are harmful. Just as dependencies on unnecessary drugs and surgeries should be avoided, patients should not become dependent on frequent manipulations- no more than 6 per year to the same spinal bone. Spinal manipulation is an important, but small part of a chiropractic neurologist’s treatment capabilities. It should be employed as infrequently as possible.” I want to go on record here and disagree with him on that point. If he thinks that 6 adjustments with exercises are going to get some of the veterans I see from the VA out of pain after suffering for 40 years…..well, trust me…..6 adjustments Ain’t gettin it done. He’s got a bias. He’s being a proponent of all of the magic outside of an adjustment that a chiropractic neurologist can perform. So I just disagree on that one point.  But I do agree with the point of avoiding unnecessary consistent and frequent adjustments.  To further clarify, there are some suffering from high impact chronic pain, which is chronic pain with an associated disability. They will never be free of pain and seem to only do well seeing a chiropractor every other week or so on a pain management basis. Then, there is a group called Caring Medical in Florida. They also have a bias. They specialize in prolotherapy to tighten lax ligaments. So, it makes sense they’re going to highlight Over Manipulation Syndrome. That doesn’t make them wrong. But I’m being honest as I can be on this. They have a bias and it should be noted.  I’ll put the link in the show notes as well.  https://www.caringmedical.com/prolotherapy-news/manipulation-syndrome-oms/#:~:text=Over-manipulation syndrome is a,or manipulation by a practitioner. Ross Hauser, MD says from the top of the article, “Over-manipulation syndrome is a condition characterized by chronic pain of the joints or vertebrae from instability due to ligament laxity that is caused by excessive self-manipulation or manipulation by a practitioner.”  To keep from pissing everyone off, he says, “In our opinion, a good chiropractic or osteopathic physician is an invaluable asset to a person’s health and care. Many cases of chronic pain, headaches and health ailments can be resolved with manipulation. Yes, overly aggressive spinal manipulation can be the cause of spinal instability, but when done correctly it can cause immediate (or quick) relief of symptoms.” And more to the point I’m making, “We see a large number of hypermobility cases where the patients present with a history of excessive chiropractic manipulations. A short course of manipulation to relieve pain or tension is understandable. However, patients who sign up for long-term chiropractic packages that include thrusting manipulations often find themselves even more unstable after the treatment course. Good chiropractors treat each patient individually and conservatively.” I agree. Reminder – I’m not advocating not adjusting your patients. The adjustment is the cornerstone of my practice for more than 25 years. I’m not advocating only adjusting your patients 6 times per year.  What I am advocating AGAINST….is long, extended, ongoing, maybe never ending treatment protocols to try to treat pain. When what you may be actually doing is causing a greater problem called instability and hypermobility by over manipulating and loosening the structures that hold the spine tight.  How much is too much? Who the hell knows? Certainly not me. Everyone is different, different ages, different work loads, different injuries throughout the years, different chiropractors over the years, etc.  But if all you’re doing is identifying ‘subluxations’ and knocking down the high spots without also considering instability or hypermobility, then you’re at risk of doing your patients and injustice and potentially making them actually worse.  If they already have hypermobility, what good are more adjustments and mobility really going to do for that particular area of their spine? Not much in my opinion. Why not think outside of the box a little and try stabilizing and strengthening the spot instead of mobilizing it? For neck instability, try a contraption called The Iron Neck. It’s great at strengthening the neck in a 360 degree way. It’s outstanding and I’m not sure there is a better strategy out there for neck stability.  For low back instability, we use McGill’s Big Three and add Dead Bug which is also ChiroUp’s protocol for L-sp instability.  If you don’t know how to look for and test for spinal instability, one of the clues for the low back is that it hurts to roll over in bed. Also, sometimes these people bend over to grab something and get a ‘catch’ or a ‘locked up’ back when trying to stand up from that position. They kind of have to work out of it to finally stand up.  With the low back, you can have a patient prone on their stomach. If it hurts when you palpate the l-sp facets, have them do a ‘superman’ position with their legs straight and lifted backward off of the table. If you palpate again while they’re in that position and it feel better, then you are likely looking at a instability patient. When you stabilize that region and palpate it and it feels better, the back is telling you it has too much mobilization and needs stabilization instead.  Simple sudden movements can hurt as well. The Space Mountain ride fired up the instability in my neck last week. It jerked me around on the roller coaster when it was dark and I couldn’t brace or see what was in front of me.  So there you have it. I’ve had some of the smartest chiros in the evidence-based realm tell me I’m crazy. That chiropractors absolutely cannot create spinal instability. I know that for so many, it’s a completely new thought process but I ask that you seriously give it consideration.  How is it that self-adjustors, like I once was, can create instability from adjusting too much but a chiropractor somehow cannot? I’ll also share that I have no bias on this deal. In fact, advocating against constant, frequent, adjusting does me no good whatsoever considering the adjustment is the literal cornerstone of my clinic. I have zero bias. I just follow research, I read, I observe, I talk to others, and I have personal experience and I’m telling you flat out – some patients will do better with strengthening and stabilization because they’re already got too much mobilization and the wrong chiropractor can potentially be the cause of that hypermobilization.  Convince me I’m wrong at dr.williams@chiropracticforward.com. I’d love to hear your thoughts on this topic. I think it’s important.  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