evidence-based chiropractic podcast

Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic

CF 194: Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic Today we’re going to talk about how lumbar fusion compares to no surgery, we’ll talk about a 30 year study on discs, and we’ll talk about PT vs. Chiro  But first, here’s that sweet sweet bumper music

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #194 Now if you missed last week’s episode , we talked about patellofemoral pain, sleep for pain, and physical disuse. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. OOOWEEEE…..If you’ve been listening, you know I’ve been goind through my second fellowship program. This second one is the Forensics fellowship. Several hours are taken on ChiroCredit. There’s a 20 hour course on the AMA Guides on Impairment. And there’s a 20 live course I’ll be doing to wrap this dude up. It’s in Chicago in October. Then I’m done.  Then, I can turn my full attention to making our new Nurse Practitioner famous locally, making sure our Parker intern is set up for success, and getting life back to some sense of normal.  I got the COVID booster shot last week and am headed to Washington DC for the Labor Day weekend. This will probably air just after I get back so updates on the scene in DC on the next episode. Hopefully the covid resurgence hasn’t made the experience a soup sandwich. We shall see.  I was 8 months out from when I got the vaccine. The booster came from a nurse practitioner friend of mine. The first shot I got back in December……I felt nothing at all. The second shot 23 days after that, my arm got sore. That’s it. Nothing else at all. This booster shot, my arm got sore as expected. I got it on a Thursday afternoon. She brought it over here to my clinic and gave it to us. Because she’s super sweet and more than awesome.  I went to work on Friday. I had almost 40 patients between 8 am and 1 pm and, while I didn’t necessarily struggle, I didn’t love life that day. I was tired. I really wanted to be in bed pretty much. I didn’t feel absolutely awful or anyhting like that. I just didn’t feel particularly good and didn’t really want to be here in the clinic, answering the same questions we always answer, and acting like I felt great and was a happy happy dude when all I really wanted was to just be in bed taking a nap.  Then I did go home and take a nap after work. I slept for a couple of hours and woke up feeling much better.  Then I woke up the next day and felt great again. No issues. All back to normal. People act like we are sheeple if we get it. Like we are the experiment. Maybe we are. I don’t give a damn. I have a thriving, successful practice with no partner or associate to fill the gap if I get sick and have to stay home.  First of all, I like feeling good. I don’t want to be sick. If I can do something that the data shows clearly prevents the virus and/or severe illness from the virus, I’m going to do it. When your clinic bills what mine bills each month, and you don’t care at all about losing that income for 2-4 weeks…..maybe a lot more than that…..then you can call me names. You can call me an experiment.  For me, I’m making smart business decisions. Not to mention the fact that after millions and millions of vaccinations globally with very few issues, I’m a hell of a lot more concerned about a proven killing and/or long-term debilitating virus like COVID than I am the vaccine.  So, my opinions and what’s right for me may not be right for you annd that’s OK. But I’ll be damned if anyone is going to act smarter, wiser, or more high and mighty than I because I got a freaking vaccine. Those that behave that way can straight up stick it in your ear or whatever other place you can think of.  On the other hand, if you got the vaccine, don’t be a jackhole if someone you know doesn’t want it. It’s new. People are scared of it. They’ve been misled in many situations. They’ve been misdirected on social media. It is what it is. You do you. Let’s all do us and realize we share this space. I’d a lot rather see disagreement with an undercurrent of love instead of disagreement with a smoggy fog of hate and disdain.  It’s 2021. Let’s all grow up and evolve.  Item #1 This first one this week is called, “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis” by Xu et. al. (Xu W 2021) and published in World Neurosurgery in February of 2021….hot mama, stand back.  Why They Did It They wanted to evaluate the efficacy and safety of lumbar fusion versus nonoperative care for the treatment of chronic low back pain associated with degenerative disk disease. How They Did It

  • A comprehensive search for papers was done in PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure  up to June 30, 2020. 
  • The main outcomes including clinical results, complications, and all-cause additional surgeries were presented in the form of short- and long-term follow-up results. 
  • Six prospective studies involving 159 patients for short-term follow-up and 675 for long-term follow-up were included

What They Found The 2 interventions exhibited little difference in regard to short- and long-term Oswestry Disability Index and visual analog scale scores for back and leg pain, except that lumbar fusion might bring about lower additional surgery rate, and higher complication rate in the long term. Wrap It Up The present meta-analysis determined that fusion surgery was no better than nonoperative treatment in terms of the pain and disability outcomes at either short- or long-term follow-up. It is necessary for clinicians to weigh the risk of complications associated with fusion surgery against additional surgeries after nonoperative treatment. Item #2 This second one is called, “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi (Sääksjärvi S 2020) and published in Spine Journal in 2020. It’s steamy….but not that hot anymore.  Why They Did It The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up. How They Did It

  • In an earlier study, 75 patients aged 20 years with LBP had their lumbar spine examined by MRI. 
  • At a follow-up of 30 years, the subjects were contacted; 35 of 69 filled a pain and disability questionnaire, and 26 of 35 were also reexamined clinically and by MRI. 
  • The images were evaluated for decreased signal intensity and other degenerative changes. 
  • Association between decreased signal intensity of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed 
  • Association between decreased baseline signal intensity and pain/disability scores from the questionnaire was analyzed

What They Found

  • The total number of lumbar discs with decreased signal intesity increased from 23 of 130 (18%) to 92 of 130 (71%)
  • Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs
  • Discs that had even slightly decreased signal intensity at baseline were more likely to have severely decreased signal intensity at follow-up, compared to healthy discs
  • The best of the best news, as you may have guessed if you’ve listened to this podcast for any amount of time, Severity of DD at baseline did not have a significant association with current pain or disability.

Wrap It Up In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms. Hallelujah.  Item #3 This last one is called, “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation” by Nima Khodarkarami ´(Khodakarami N 2020) and published in Healthcare journal in 2020.  Why They Did It Given that there are costs and benefits with either PT or Chiropractic for the treatment of low back pain, the remaining question is in a short period of time which of these treatments is optimal?  A decision tree analytic model was used for estimating the economic outcomes. The findings showed that the total average cost in the chiropractic group was $48.56 lower than the PT group.  The findings also showed that the daily adjusted life years (DALY) in the chiropractic group was 0.0043 higher than the PT group.  Chiropractic care was shown to be a cost-effective alternative compared with PT for adults with at least three weeks of LBP over six months. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website https://www.chiropracticforward.com Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Khodakarami N (2020). “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation.” Healthcare 8(1): 44.   Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347.   Xu W, R. B., Luo W, Li Z, Gu R, (2021). “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis.” World Neurosurg 146: 298-306.    

Patellofemoral Pain, Sleep For Pain, and Physical Disuse

CF 193: Patellofemoral Pain, Sleep For Pain, and Physical Disuse Today we’re going to talk about patellofemoral pain, sleep for pain, and physical disuse But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #193 Now if you missed last week’s episode , we talked about To Do lists, frailty, and we talked about pain and lost work days. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

This one will be a bit short today. My time will loosen up eventually and I’ll be able to dive deeper into some of the things going on around the office that you may relate to. But today ain’t that day. If you listened last week, you know that I believe in a To Do list and I believe in making it the priority if you’re going to be productive and if you ever hope to complete your epic saga of world domination. I’m stepping on the gas on the AMA Impairment Rating course because the national conference in Chicago is in October. That’s not too far off so it’s time to get down to bidniz. I’m elbows deep researching and generating a medical weight loss protocol for my clinic. Not only that, but I’m researching and creating a protocol for PRP Hair Restoration.

It’s pretty dang cool and the research has shown how effective it is. But, the main reason I need to be a bit brief this morning is that today is our first day and onboarding of our Parker University intern. He’ll be with us through the end of November so he gets plenty of time to find all of my screw-ups.  Admit it. You don’t do everything perfectly. Research tells us that we can’t adjust as precisely as we were taught. Yet, in our documentation, we’re supposed to notate the very specific levels of adjustment. We all must reconcile these things within our way of functioning. 

Academia is one thing. Real-life is quite another.  For example, the college dinged my records when I sent them a sample for auditing purposes. One of their reasons was that on a PI, I didn’t provide a full robust diagnosis on the first visit. Well, what they didn’t ask me was why. The reason being that most PIs have been nowhere prior to showing up at our clinics. They’ve not had x-rays. They had traumatic onset so, with regards to Choosing Wisely, we should be getting x-rays.  What if I did an exam right away without imaging just because academia says I need that dx on day one? I’ve had a fractured neck in my office before. We didn’t have a clue until the Xrays. What if I go pushing, pulling, and tugging on a fractured Cervical vertebra? Nope…..not here academia. Ding those notes all you want but I’m going to put a generalized place keeping dx like cervicalgia on the file until the x-rays come back clear. Then I’ll do the exam safely. Then I’ll assess a more appropriate diagnosis.  So there! Now, how to responsibly teach these things to an intern while still keeping within academic teachings and parameters?  We shall see. Let the adventure begin.

Item #1

This first one this week is called, “Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial” by Zago et. al. (Zago J 2020) and published in the Journal of Sports Rehabilitation on in December of 2020 and that’s hot because I said it’s hot…

Why They Did It

The authors say that the effects of an exercise program for the treatment of patellofemoral pain syndrome are well known. However, the effects of osteopathic manipulative treatment (OMT) are unclear.

Their objective was to evaluate the effects of OMT versus exercise on knee pain, functionality, plantar pressure in middle foot (PPMF), posterior thigh flexibility (PTF), and range of motion of hip extension in runners with patellofemoral pain syndrome.

How They Did It

  • It was a randomized controlled trial
  • It was performed in a human performance laboratory
  • There was a total of 82 runners with patellofemoral pain syndrome that participated
  • The participants were randomized into 3 groups: OMT, EP, and control group. 
  • The OMT group received joint manipulation and myofascial release in the lumbar spine, hip, sacroiliac joint, knee, and ankle regions. 
  • The EP group performed specific exercises for lower limbs. The control group received no intervention.
  • The main evaluations were pain through the VAS, functionality through the Lysholm Knee Scoring Scale, dynamic knee valgus through the step-down test, PPMF through static baropodometry, PTF through the sit and reach test, and range of motion through fleximetry. 
  • The evaluations were performed before the interventions, after the 6 interventions, and at 30-day follow-up.

What They Found

  • There was a significant pain decrease in the OMT and EP groups when compared with the control group. 
  • OMT group showed increased functionality, decreased plantar pressure in middle foot, and increased posterior thigh flexibility. The range of motion for hip extension increased only in the EP group.

Wrap It Up

Both OMT and EP are effective in treating runners with patellofemoral pain syndrome. 

CHIROUP ADVERTISEMENT

 

Item #2

This second item is called, “Machine learning suggests sleep as a core factor in chronic pain” by Miettinen et al. (Miettinen T 2021) and published in Pain in January of 2021 and it sizzles…

Why They Did It

The authors say that patients with chronic pain have complex pain profiles and associated problems.  Subgroup analysis can help identify key problems.

How They Did It

They used a data-based approach to define pain phenotypes and their most relevant associated problems There were 320 patients in the study undergoing tertiary pain management. They identified 3 patient phenotype clusters

Wrap It Up

If I try to get into the particulars of this paper, most of which I don’t understand and I’m relatively sure 90% of the rest don’t understand either if I get into it, our eyes will gloss over and we’ll question our life choices.  Instead, we’re going to skip to the important part of the conclusion. They say, “Machine learning suggested sleep problems as key factors in the most difficult pain presentations, therefore deserving priority in the treatment of chronic pain.” We have talked about it here before but, if you are not lining your chronic pain patient out with some very solid sleep recommendations, you’re not sign everything you can to help them. It’s clear that getting good sleep is key to getting on top of chronic pain. I commonly recommend a book to my chronic pain patients that says the same. It’s called ‘Back In Control’ by David Hanscum, MD. He’s a chronic pain sufferer but he’s also an orthopedic spinal surgeon so…..he’s no dummy walking around bumping into walls.  Sleep is part of the process. So make sure you’re recommending it to your chronic pain patients.

Item #3

This last one has the longest name ever given to a research paper in the known history of mankind. It is, “Physical disuse contributes to widespread chronic mechanical hyperalgesia, tactile allodynia, and cold allodynia through neurogenic inflammation and spino-parabrachio-amygdaloid pathway activation” by Ohmichi et. al.  (Ohmichi Y 2020)and published in Pain in August of 2020 and that’s just hot enough people! And can I just say that with a title this long, this Ohmichi had to of been trying to compensate? You know, like when a small person buys a huge truck. Something like that. I feel like these folks could work on their naming process a bit. That’s all I’m saying. 

Why They Did It

Physical disuse could lead to a state of chronic pain typified by complex regional pain syndrome type I due to fear of pain through movement (kinesiophobia) or inappropriate resting procedures.  However, the mechanisms by which physical disuse is associated with acute/chronic pain and other pathological signs remain unresolved. We have previously reported that inflammatory signs, contractures, disuse muscle atrophy, spontaneous pain-like behaviors, and chronic widespread mechanical hyperalgesia based on central plasticity occurred after 2 weeks of cast immobilization in chronic post-cast pain (CPCP) rat model.

Wrap It Up

As with the last paper we discussed, this one really gets into the weeds and my goal here is to make research more palatable so we’re going to go to the conclusion because that’s what really matters the most here.  They conclude that physical disuse contributes to dystrophy-like changes, spontaneous pain-like behavior, and chronic widespread pathological pain-like behaviors in chronic post-cast pain rats after 2 weeks of cast immobilization. Once upon a time, they’d tell pain sufferers to go home and get some rest. Take the pain killers and muscle relaxers and ‘ride it out’. Now, people will have laminectomies and they’ll be walking the hospital hallways the next day.  Movement is healing. As Liebenson says, ‘motion is the lotion for the joints’. Those not moving are those that are not healing. Be active if you want to stay active.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

Key Point:

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

Contact

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

Connect

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

  • Miettinen T, M. P., Hagelberg N, Mustola S, Kalso E, Lötsch J, (2021). “Machine learning suggests sleep as a core factor in chronic pain.” Pain 162(1): 109-123.
  • Ohmichi Y, O. M., Tashima R, Osuka K, Fukushige K, Kanikowska D, Fukazawa Y, Yawo H, Tsuda M, Naito M, Nakano T (2020). “Physical disuse contributes to widespread chronic mechanical hyperalgesia, tactile allodynia, and cold allodynia through neurogenic inflammation and spino-parabrachio-amygdaloid pathway activation.” Pain 161(8): 1808-1823.
  • Zago J, A. F., Rondinel T, Matheus JP, (2020). “Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial.” J Spot Rehabil 30(4): 609-618.

 

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

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

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

But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioners as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #192 Now if you missed last week’s episode, we talked about chiropractic preventing opioids and chiropractic adverse events. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

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

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

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

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

Item #1

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

Why They Did It

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

How They Did It

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

What They Found

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

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

CHIROUP ADVERTISEMENT

Item #2

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen.

Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 
Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Website https://www.chiropracticforward.com
Social Media Links https://www.facebook.com/chiropracticforward/
Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/
Twitter https://twitter.com/Chiro_Forward
YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q
iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link https://player.fm/series/2291021
Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography Gaspar FW, T. M., Wizner K, Hegmann K, (2021). “Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system.” PLoS One 16(6).   Tembo, M. C., Mohebbi, M., Holloway-Kew, K.L, (2021). “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study.” Calcified Tissue Int.  

 

Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment

CF 190: Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment

Today we’re going to talk about obesity in youth and chronic pain, we’ll talk about fibromyalgia and hyperbaric oxygen chambers, and we’ll talk about chronic pain and the healing journey.  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #190 Now if you missed last week’s episode , we were joined by the amazing Dr. Brett Winchester from the St. Louis area. This doctor is just phenomenal in everything he does and says and we are all fortunate to have him in this profession. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Day 1 of our nurse practitioner starting is today. This morning has, of course, had its hiccups. We have the EHR where we have him set up but he has to have his own login and password and all that good stuff so that’s been one challenge so far.  Just getting oriented with where all of the stuff is, lidocaine, lab tubes, swabs, blah blah blah. Still waiting on the autoclave and still getting the malpractice policy in place this morning. What a process that’s been.  But we knew there’d be hiccups, and we’re getting them addressed. Then I have my regular life to contend with. I have patients to treat and a podcast to write so here we go. Short and sweet on this one because my cup is running over this morning.  Item #1 Our first item today is called “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves” by Hainsworth et. al. (Keri R Hainsworth 2021) and published in Pain Medicine in June of 2021 and day-um…..that’s hot! Why They Did It The aim of this commentary is to review the current science on co-occurring chronic pain and obesity in children and adolescents. In so doing, we also highlight some of the current gaps in knowledge. It is our hope that this commentary will draw attention to an overlooked area of research and clinical endeavors within the field of pediatric pain. The authors note that it is becoming increasingly clear that we should be familiar with this research. Both chronic pain and obesity have been rising in children for some time and studies are showing that obesity exacerbates the negative outcomes associated with chronic pain.  In addition, accumulating research exists on all facets of the co-occurrence of chronic pain and obesity in adults. Given all this, the paucity of research in this area of pediatric chronic pain and obesity is at a minimum, disheartening, and at a maximum, unconscionable. Ooooweee! That’s like putting a white glove on and smacking some clown around the room a little bit, isn’t it? I like it. It give me a little tickle.  Here are their main points:
  • On average, it can take 2 years longer for youth with obesity to be referred to a pediatric pain clinic than it does for youth with a normal weight
  • Pediatric patients with CPO have health-related quality of life that is more impaired in every domain than patients with chronic pain and a healthy body mass index percentile
  • Although systemic inflammation is commonly elevated in youth with obesity, patients with CPO have significantly higher levels of systemic inflammation than those with chronic pain alone or obesity alone 
  • Children with CPO are at increased risk of being treated as though they bear more responsibility for their health (and by extension, their pain) than youth without obesity and are at increased risk of pain dismissal and biased medical care
  • CPO in children and adolescents is associated with more impaired physical functioning and lower levels of physical activity than youth with chronic pain alone or obesity alone Further, parents report that their children with CPO (particularly girls) have greater functional disability (one of the most important outcomes in our field) than parents of youth with chronic pain and a normal body mass index
  • While multidisciplinary pain management programs work well for patients with a healthy weight, this is not true for those with comorbid obesity. Patients with a healthy weight improve in functional disability within 3 months of intake, whereas patients with CPO stagnate
First, even though we as clinicians and researchers need to address obesity in the context of chronic pain, we must be extremely thoughtful about how we move forward. Weight is a very sensitive subject, therefore, the call for more research in this area must strongly consider the need for sensitivity. CPO is the co-occurrence of a typically “invisible,” debilitating condition coupled with a condition so visible that it is sadly associated with victimization from important people in the child’s life, including peers, parents, and teachers Second, we would do well to closely follow the admonitions and advice of our colleagues whose primary clinical and research focus is on obesity and stigma. Suggestions from these experts include first recognizing that weight bias exists even among pediatric health care providers [20]. Additionally, language must be very carefully considered. Puhl et al. [20] offer the practical and sensitive suggestion to ask the patient and family about preferred words or terms in discussions about weight-related health Third, like other health care professionals, we would benefit from a greater understanding of the complexity of obesity and the “potential benefits and disadvantages of introducing weight-management discussions with patients” [14](p865). Certainly, there will be times when weight-related discussions would be contraindicated by the patient’s and/or family’s psychological or emotional state. However, when weight needs to be raised in relation to a child’s chronic pain, it may be best received in the context of health implications. Obesity is a multifactorial disease with strong genetic contributions. It is also associated with systemic inflammation, metabolic syndrome, and increased risk for diabetes and cardiovascular disease, as well as chronic pain. In fact, most are unaware that obesity is a risk factor for migraines in pediatric populations. That said, weight-related health or weight-related pain discussions cannot focus entirely on losing weight. For many, it is a struggle to change their weight status, and even if it is possible, this process takes time. We must not ignore managing pain while we wait for possible weight reduction. CHIROUP ADVERTISEMENT Item #2 Our second one today is called “Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia” by Curtis et. al.(K Curtis 2021)  and published in Pain Medicine in June of 2021…….pork chops and apple sauce.  Why They Did It To evaluate the feasibility and safety of hyperbaric oxygen therapy (HBOT) in patients with fibromyalgia (FM). How They Did It
  • A total of 17 patients completed the study
  • A cohort study with a delayed treatment arm used as a comparator.
  • Hyperbaric Medicine Unit, Toronto General Hospital, Ontario, Canada.
  • Eighteen patients diagnosed with FM according to the American College of Rheumatology and a score ≥60 on the Revised Fibromyalgia Impact Questionnaire.
  • Participants were randomized to receive immediate HBOT intervention (n = 9) or HBOT after a 12-week waiting period
  • HBOT was delivered at 100% oxygen at 2.0 atmospheres per session, 5 days per week, for 8 weeks
  • Both groups were assessed at baseline, after HBOT intervention, and at 3 months’ follow-up.
What They Found
  • HBOT-related adverse events included mild middle-ear barotrauma in three patients and new-onset myopia in four patients
  • The efficacy of HBOT was evident in most of the outcomes in both groups
  • This improvement was sustained at 3-month follow-up assessment.
Wrap It Up HBOT appears to be feasible and safe for individuals with FM. It is also associated with improved global functioning, reduced symptoms of anxiety and depression, and improved quality of sleep that was sustained at 3-month follow-up assessment. I don’ tank about you but I’m not going to go out and buy an oxygen chamber this afternoon but, it’s interesting and I’ve always heard positive things about them so this one peaked my interest a bit. I figured it would with you as well.  Item #3 The last one is called “A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies” by Toye et. al. and also published in Pain Medicine in June of 2021….Smoke show!! You know, it’s almost like I got an email from Pain Medicine last week highlighting some of their newest research in their June edition. Weird how all of these articles were all in the same month and in the same episode here. Right? Why They Did It There is a large body of research exploring what it means for a person to live with chronic pain. However, existing research does not help us understand what it means to recover. We aimed to identify qualitative research that explored the experience of living with chronic pain published since 2012 and to understand the process of recovery. How They Did It
  • A synthesis of qualitative research using meta-ethnography.
  • We used the seven stages of meta-ethnography. 
  • We systematically searched for qualitative research, published since 2012, that explored adults’ experiences of living with, and being treated for, chronic pain. 
  • We used constant comparison to distill the essence of ideas into themes and developed a conceptual model.
  • We screened 1,328 titles and included 195 studies.
Wrap It Up The innovation of our study is to conceptualize healing as an ongoing and iterating journey rather than a destination. Health interventions for chronic pain would usefully focus on validating pain through meaningful and acceptable explanations; validating patients by listening to and valuing their stories; encouraging patients to connect with a meaningful sense of self, to be kind to themselves, and to explore new possibilities for the future; and facilitating safe reconnection with the social world. This could make a real difference to people living with chronic pain who are on their own healing journeys. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography
  • K Curtis, P., J Katz, PhD, C Djaiani, BSc, G O’Leary, MD, FRCPC, J Uehling, MS, CCRP, J Carroll, BHA, D Santa Mina, PhD, H Clarke, MD, PhD, FRCPC, M Gofeld, MD, PhD, FRCPC, R Katznelson, MD, FRCPC, (2021). “Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia.” Pain Med 22(6): 1324-1332.
  • Keri R Hainsworth, P., Monica L Gremillion, PhD, W Hobart Davies, PhD, Stacy C Stolzman, PT, MPT, PhD, Steven J Weisman, MD, (2021). “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves.” Pain Med 22(6): 1243-1245.
       

w/ Dr. Rob Pape – Quadrant Analysis & Practice Mechanics

CF 188: w/ Dr. Rob Pape – Quadrant Analysis & Practice Mechanics Today we’re going to be joined by Dr. Rob Pape.

I’ll get into his bio a bit deeper in the interview and introduction but Dr. Pape is the creator of Quadrant Analysis improving patient assessment by breaking down the evaluation process. He is also a co-creator of Practice Mechanics. Along with one of our previous podcast guests, Dr. Michael Massey, they have created Practice Mechanics to help their doctors hit that next level. We’ll get into it here shortly.  But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #188 Now if you missed last week’s episode, we talked about hypermobile patients, sports-related concussions, and obesity’s pain connection. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Still in the middle of medical integration. Our nurse practitioner starts on August 2nd so, we’re pretty close at this point. I just ordered the centrifuge for the PRP therapy. I have heard of PRP for a little while now but mostly for hair loss. I have a close family member that has a little hair loss going on so he and his mother were asking me about PRP for hair loss.  I didn’t know much about it. In case you aren’t familiar, PRP stands for plasma-rich platelets. They draw your blood, spin it down in the centrifuge, extract the platelets, and then inject it into the problem.  I literally spent 2 hours this weekend going through research on PRP therapy.

I filtered PubMed to only show me randomized controlled trials. I don’t need a lot of BS. Let’s just go further up the research pyramid for the good stuff, right? So what I found was actually surprising as hell. While I could find 2, 3, maybe 4 papers tops that showed equal effectiveness to cortisone or something like that…..the large majority of the papers were clear that PRP is showing impressive effectiveness for just about damn near anything they try it on including ACL surgery recovery, hair loss, plantar fasciitis, general osteoarthritis, shoulders, knees, hips, ankles, carpal tunnel, and the list goes on.  I have me a big ol’ file on my computer full of them all now. I can really get behind things like this that I can find a ton of positive research on. Just like everything else in my practice.

If I can find support in the literature, I have no problem encouraging it. Notice I didn’t say, “Sell it.” I’m a healthcare provider. Not a salesman. We should always be honest and tell our patients about the cool research behind something you think will truly help them but then we should shut up and be there for them however they want to use us. Plain and simple.  So, again, I have no problem encouraging and educating on something that has shown such effectiveness. It’s pretty amazing actually so I’ll keep you updated on that. If you’re integrating or considering doing it, it’ll come in handy for you. If you’re not, it might give you some direction on what to do with those patients that have some stubborn conditions. More to come on that.  OK, let’s get to today’s guest so we don’t go too long here. I want him to have plenty of time.  Before we do that though, let’s hear a word from our sponsors, shall we?

CHIROUP ADVERTISEMENT

Dr. Rob Pape is our guest today. He is a long-time innovator in clinical evaluation and treatment instruction. He created Quadrant Analysis, which combines a sub-classification system with practical biomechanics. Quadrant Analysis improves and simplifies patient assessment, breaking the body down into traceable patterns which chiropractors can utilize to get better and faster patient results. 

The Practice Mechanics resources include detailed information about Quadrant Analysis and specific techniques so you can help your patients get the results you want for them. Rob graduated from Life Chiropractic College West in 1996 and has been in successful practice ever since. His clinical approach is full body and generally combines joint and soft tissue work with movement therapy.

Welcome welcome Rob. Tell me where you are living these days, tell me about your family, and how long you’ve been in the trenches. What’s your story? Why are you a chiropractor today? What does your regular workday look like these days? You went to Life, a school that is notorious for being very philosophy-heavy, shall we say? With that as your initial base of knowledge and influence, what pointed you down the evidence-based/evidence-informed path? What’s your take on the profession today? What are we getting better at? Where are we losing ground? Where can we improve? If you could wave a wand and change one thing about the profession forever, what would you change? What would other chiropractors say is your best attribute? And what would the ones that know you really well say is your worst? What is the goal for Practice Mechanics? Outside of the obvious, which is building business, what do you hope to achieve by growing it?

How can doctors that are interested get in contact with you for more information? Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection

CF 187: Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection

Today we’re going to talk about Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #187 Now if you missed last week’s episode , we talked about the western diet and its effects and we talked about some pretty cool acupuncture research. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Our nurse practitioner starts on August 2nd but we are having a hard time getting our malpractice person to respond to us and get that in place. We can’t get credentialing until that happens. Credentialing takes at least 2 months typically.  So, you see the issue. That was an unplanned obstacle.  We are in the process of changing our signage on the front of the building as well. We have one big sign out on the main street so that’s two inserts…..one for each side. 

Then we have two suites here so we have two doors. Which means we have two signs on the front of the building. So, added up, we get to order 4 inserts. Signs aren’t cheap if you’ve had to put one in lately.  Those are just some of the things that we’re messing with lately.  Clinic numbers, we are in week 3 with some good solid numbers. Not pre-COVID numbers but getting there. I’ll be honest with you, I’m not sure I want pre-COVID numbers. There were weeks I was at 220 appointments for the week. 25 new patients, re-exams running out my ears.  Now, that’s not bragging. I’m not there anymore. What I’m saying is that sometimes, it’s too much. In healthcare, you really can be too busy. Things start falling through the cracks.  My mom had a bone density test misread because her primary is simply too busy. He took responsibility and, other than putting her back surgery off longer than it should have, no harm was done. But the point is, we can get too busy.  I am extremely conservative in my finances. I don’t like taking big chances. I don’t like huge what-ifs. I like small, measured, and reasonable risks. You cannot eliminate risks. But we can mitigate them. We can make them minute instead of big gaping holes.  I should have hired an associate. And to be fair, we started to do that. It just simply fell through. And it was a blessing in disguise when you consider what COVID did to our practice. Now we get a chance to potentially say, “‘If I could go back and do that all over again…..” 

At this time, I’m at a point in my caseload that it’s all fairly easily manageable. We’re at probably 165-170 per week. That’s manageable for evidence-based, patient-centered practice. We are rehab-heavy. Rehab takes time and I have an excellent staff and ChiroUp to help me make it all happen.  However, if we get to the 190-200 appointments per week range, it’s time to start shopping for an associate. It’s too much and too many other things I’m trying to accomplish both personally and professionally suffer from that caseload.  And my brain space is just destroyed if I’m being honest. It’s not fun to go to work when you’re overwhelmed every day. It’s unpleasant. Even when the majority of your patients are amazing people. Nobody wants to go to doctors that are overwhelmed like that and I don’t want to be one of those doctors either.  So, just a little brain dump there and some free-flow thought for you. I have an intern coming in from Parker College in September. That’ll be my first intern to have onboard so who knows….maybe that ends up being a long-term thing.

Maybe not.

Time will tell.  On the horizon for me, real estate investing!! Regular listeners may have heard me talk about exit strategies. If you’re a thinker, you’re not only thinking about today but what you want out of tomorrow. I’ve been in business for over 23 years at this point and have never taken more than 5-7 days of vacation at a time. I’ve never been to Europe or anywhere outside of the Caribbean.  So, smart moves is what get us there. We are in a business where our presence is mandatory for a business to continue. In essence, our business owns us. Not the other way around. So how do we flip it? Well, we need people in place that fill the gap when we are out. We need to be the CEO instead of the hands-on worker. That’s part of the reason we are bringing in a nurse practitioner. That’s part of the reason we’ll be looking for an associate when the numbers truly rebound.

That’s the reason I started a voice-over side gig, which is going amazingly by the way. What a blessing that has been, y’all. I can’t even begin to tell you how well that’s going. I’ve voiced over 200 spots just since January. That’s over 33 per month. It’s been insane. That’s also the reason that real estate investing is my next mountain.  Mailbox money, y’all. Now, real estate investing takes effort and work so it’s not technically mailbox money but, when done right, is the fastest path to financial freedom. That’s the reason for the book I wrote and the speaking opportunities I’m getting involved in.  These are all potential paths toward early, comfortable, happy, partial retirement. Retirement to me doesn’t mean any work. It means control of my time. So in that context, retirement cannot come quite soon enough.  So, what’s your exit strategy? Are you going to work until you’re 88 and die at your desk in your office?

Which some want…and there’s not a thing in the world wrong with that. Or, do you have other things in your life to accomplish and need to start planning for that? Some say you need to start with the ending in mind. If you want to sell your business someday, shouldn’t you plan for that from the start? How do you build a business that’s ready to sell when it’s your time? Something to think about. I’m not sure I have all of those answers because they continue to unfold as I progress but I’m getting closer to solid ideas and strategies on it.  Alright….on to the research. 

Item #1

Let’s get it started this week talking about hyper mobility, Ehlers-Danlos, and all that good stuff. If you don’t really consider hypermobility in your daily treatment…..please….for the love of everything holy, please listen up and pay attention. This is where so many chiropractors are getting it wrong.  It’s becoming more and more clear every year that a good chiropractor should know when to mobilize and when to stabilize. Some of you are no doubt asking yourselves, what the hell does that mean? Sometimes the spine doesn’t want to be adjusted. There is already a plethora of movement there. Adjusting only increases the motion in an area that the increased motion is what is actually causing the complaint. In these cases, when in the hands of a vitalistic, subluxation, philosophy, doctor-centered chiropractor, this patient is going to get adjustment after adjustment for weeks and weeks.  I’m sure you can predict the eventual outcome here. And it’s not corrections of a subluxation. It’s spinal instability that compounds the issue.  The condition and patient population that is at increased risk here would be self-adjusters but mostly, those suffering from Ehlers-Danlos, which if you are unfamiliar, is a connective tissue disorder that allows these folks to behave a bit like an elastic rubber band. 

A hint of whether someone is EDS is the Beighton Scale. If I stand a new patient up and have them touch their toes and they put their hands flat on the floor, they’re getting put through the Beighton Scale to test for hypermobility. We need to know if they have too much movement in their joints. Because instead of more adjustments and more movement in the segments of the spine, they typically respond better to weight training, supportive activities and strengthening. 

This paper is called “Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review” by Gregory Reychler and Maya-Mafalda De Backer et. al. (Reychler 2021) and published in the American Journal of Medical Genetics on June 19, 2021…. My glasses….they’re steamed up..it’s hot.  Why They Did It The objective of this systematic review was to investigate the effect of the different physiotherapy techniques related to the children and adult patients with hEDS How They Did It

  • PubMed, SPORTDiscus, Cochrane Library, PEDro, Scopus, and Embase databases were analyzed from inception to April 2020.
  • Characteristics of the studies (authors), patients (sample size, sex, age, Beighton score), and non-pharmacological treatment (length of the program, number of sessions, duration of the session, and type of intervention), and the results with the dropout rate were extracted. 
  • From the 1045 retrieved references, 6 randomized controlled trials with a sample size ranging from 20 to 57 patients were included in the systematic review
  • There was a huge heterogeneity in the interventions. The duration of the program were from 4 to 8 weeks

What They Found

  • Pain or proprioception demonstrated significant improvements in the intervention group regardless of the type of intervention. 
  • A benefit of the inspiratory muscle training was observed on functional exercise capacity.
  • The quality of life was systematically improved.

Wrap It Up

Physiotherapy benefits on proprioception and pain in patients with hEDS even if robust randomized control studies are missing. Now, the full paper isn’t available for me to ingest so who the hell knows what all interventions these patients underwent. We don’t know. But, physiotherapy is Europe and Canada and Australia’s term for physical therapy. We know what PT is and in these patients, I’m assuming it is exercise and building strength and proprioception and balance.  All of that also helps clear up the joint and movement map in the brains of chronic pain patients. Which leads to more accurate sensorimotor function, less aberrant movement in the joints, more confidence in abilities and future capabilities, and less pain as an overall result.  And yes, I just tossed a bucket of Neuromusculoskeletal Medicine Diplomate on top of all of your heads. And didn’t it feel warm and fuzzy??

Of course it did and you’re welcome.  Let’s hear from our awesomely amazing sponsors. 

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Item #2 This second one is called “Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry” by Dong et. al. (Dong HJ 2021) and published in the Journal of Pain Research in February of 2021 and that’s holy mother of Hades hot. 

Why They Did It It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥ 30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight. This study investigated whether obese patients with chronic pain lost weight after completing interdisciplinary multimodal pain rehabilitation in specialist pain units. The association of pain relief and weight change over time was also examined.

How They Did It

  • Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used, including baseline and 12-month follow-up after IMMPR from 2016 to 2018
  • Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviors, psychological distress, and health-related quality of life
  • A reduction of at least 5% of initial weight indicates clinically significant weight loss. 

What They Found

  • A significant reduction of pain intensity was found after interdisciplinary multimodal pain rehabilitation 
  • A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss 
  • Significant improvements were reported regarding physical activity behavior, psychological distress, and health-related quality of life, but weight change was not associated with changes of pain intensity.

Wrap It Up

“About one-fifth of obese patients achieved significant weight reduction after interdisciplinary multimodal pain rehabilitation. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.”

Item #3

The last on his called “Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review” by Eliott, et. al. (Elliott 2021) and published in Sports Medicine on June 18, 2021. It’s a big ol’ pot of hot. 

Why They Did It To systematically review the literature to investigate: (1) the relationship between neck strength and sport-related head and neck injuries (including sport-related concussion (SRC); and (2) whether neck exercise programs can reduce the incidence of (a) sport-related head and neck injuries; and (b) sport-related concussion.

How They Did It

  • Five databases and research lists of included studies were searched
  • From an initial search of 593 studies, six were included in this review

What They Found

  • The results of two observational studies reported that higher neck strength, but not deep neck flexor endurance, is associated with a lower risk of sustaining a sports-related concussion. 
  • Four intervention studies demonstrated that injury reduction programs that included neck exercises can reduce the incidence of sport-related head and neck injuries including sports-related concussion.

Wrap It Up

Consideration should be given towards incorporating neck exercises into injury reduction exercise programs to reduce the incidence of sport-related head and neck injuries, including sports-related concussion. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.       

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

  • Dong HJ, D. E., Rivano Fischer M, Gerdle B, (2021). “Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry.” J Pain Res 14(1863-1873).  
  • Elliott, J., Heron, N., Versteegh, T, (2021). “Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review.” Sports Med.  
  • Reychler, G., De Backer, M.-M., Piraux, E., Poncin, W., & Caty, G, (2021). “Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review.” American Journal of Medical Genetics: 1-9.          

High Impact Chronic Pain & Cannabinoids – What’s The Latest?

CF 185: High Impact Chronic Pain & Cannabinoids – What’s The Latest? Today we’re going to talk about…. But first, here’s that sweet sweet bumper music

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

https://www.amazon.com/dp/B096RST3WW

 

 

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #185 Now if you missed last week’s episode , we talked about predicting frailty and we talked about a 30-year study on disc degeneration. Fascinating stuff as always. Make sure you don’t miss that info.  Keep up with the class. 

On the personal end of things…..

This is the season of big. Big stuff happening these days.  I have some cool stuff on the horizon in 2022 I’m looking forward to. It looks like I’ll be joining a high-level group of doctors that’ll be meeting virtually throughout the year and in-person 4 times a year to get the best, most current evidence-based guidelines and to solve each others’ biggest practice issues. More information to follow but I can’t emphasize how pumped I am to get that rolling. The worst part is that I have to wait until 2022.

But honestly, that’ll be here before we know it. If you’ve been following along lately, we are going through this Nurse Practitioner medical integration and our NP starts here in our clinic on August second.

That’s more than HUGE!

I released my first book on June 8th called ‘The Remarkable Truth About Chiropractic: A Unique Journey Into The Research’ which is live and for sale on Amazon and from my website at www.chiropracticforward.com as we speak  It’s a hell of a good reference for practitioners and content creators. It has mostly current research divided into sections for quick reference and it’s some of the most impactful and significant research you’ll find for our profession. Go get a copy. Then we have an intern coming from Parker University to hang out with us through the Fall semester. That’s a first for me. We’ll see how it goes. He seems like a great dude with a cool little family. It should be a good deal.

We also have a trip coming up to Washington DC at the end of August, the TCA. Reds me to put together an hour-long presentation on research for their Leadership Conference, and some friends just asked me to officiate their wedding vow renewal.  So, how’s your Summer going? In terms of numbers, I’m frustrated. I hear Chiros telling me how they’re right back where they were and all that good stuff. Not me. I’m still at about 140 a week right now. I averaged 185 a week before the Rona jacked everything up.  If you had any big breakthroughs as far as getting people to return, email us at [email protected]  and I’ll share in the next podcast. Maybe we can help all of our listeners get back to where they were. 

It sure can’t hurt. I know that. Takers eat well but givers sleep well. Be a giver and I’ll help spread the word.

Item #1

The first one today was spurred because of a question that popped up in our private Facebook group last week. I posted an article I wrote that I give to all of my chronic pain patients in my clinic. It’s basically a dive into chronic pain and the current thinking.  In the article, there is a mention of how pain pathways that are laid down become permanent. One of the questions by a group member was that, if it’s true that the pathways are permanent, then doesn’t that go contrary to the idea of neuroplasticity.

If you don’t know what that is, that’s the ability of our central nervous system to adapt to new normals or adapt to training and to change and function in ways that overcome certain challenges.  So if we have neuroplasticity, how can pathways be permanent, basically. 

What a great question. I hadn’t considered this before. After thinking on it a bit, my response was, “Can’t we have neuroplasticity yet still permanent pathways that give us a tendency toward chronic pain? You can have all kinds of neuroplasticity (thank God) but won’t the CNS still store the information/memory/etc? I went on to add that, “I believe that’s the thinking behind the original teaching.

Dr. James Lehman also describes ‘high impact chronic pain’. These are essentially people who tend to have chronic pain forever and can only control it through periodic treatment/therapy. That would also imply that neuroplasticity is complicated and may have its limitations. Something that we can definite leverage in our favor, but not a cure all?” So, following my comments, Dr. Lehman shared this research article focusing in on High Impact Chronic Pain.

Thank you to Dr. Lehman for the research citation and thank you to Nathan for an excellent question.  If you’re not in our Chiropractic Forward Facebook group, go do that.  IT’s called, “Prevalence and Profile of High-Impact Chronic Pain in the United States” by Pitcher et. al. (Pitcher MH 2019) and published in the Journal of Pain in February of 2019…..it’s a little steamy but not quite hot enough for my beloved sound bite. Damnit. 

Why They Did It

They say, “The multidimensional nature of chronic pain is not reflected by definitions based solely on pain duration, resulting in high prevalence estimates limiting effective policy development.  The newly proposed concept of high-impact chronic pain incorporates both disability and pain duration to identify a more severely impacted portion of the chronic pain population yet remains uncharacterized at the population level.” So it’s basically chronic pain AND disability rather than just chronic pain. 

How They Did It

As such, we used the 2011 National Health Interview Survey (N = 15,670) to 

  1. assess the likelihood of disability in the overall chronic pain population, 
  2. estimate the prevalence of High-Impact Chronic Pain, and 
  3. characterize the disability, health status, and health care use profile of this population in the United States.

What They Found

  • Overall, chronic pain, defined as pain experienced on most days or every day in the previous 3 months, was strongly associated with an increased risk of disability after controlling for other chronic health conditions
  • disability was more likely in those with chronic pain than in those with stroke or kidney failure, among others.
  • High-Impact Chronic Pain affected 4.8% of the U.S. adult population, or approximately 10.6 million individuals, in 2011.
  • The High-Impact Chronic Pain population reported more severe pain and more mental health and cognitive impairments than persons with chronic pain without disability, and was also more likely to report worsening health, more difficulty with self-care, and greater health care use.

Wrap It Up

High-Impact Chronic Pain clearly represents a more severely impacted portion of the chronic pain population. Understanding this heterogeneity will contribute to developing more effective legislation promoting safe and cost-effective approaches to the prevention and treatment of chronic pain.  PERSPECTIVE: High-Impact Chronic Pain is a powerful new classification that differentiates those with debilitating chronic pain from those with less impactful chronic pain. By addressing the multidimensionality of chronic pain, this classification will improve clinical practice, research, and the development of effective health policy.

 

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Item #2

OK, I’m about to be uncool…..I get it. Unless you happen to be in pain and benefit from it, I’m about to take a recently unpopular stance here. Old buy coming through. But I’m Gen X so don’t pull that, ‘OK, Boomer,’ BS on me. It’s powerless against the forces of research so don’t even try it.  Look, admit that you can’t follow only the research you like that confirms your biases and ignore and discount only the ones you don’t like that fly in the face of your beliefs or preferences. 

Let’s be clear, if opioids are the only thing that can possibly help with pain, why wouldn’t we use that. It’s a tool, albeit a dangerous one, but a tool we have at our disposal. The same goes for cannabinoids. I support it being used for medical purposes 100%.

So don’t misunderstand. What I cannot get behind is its recreational use. I never understood why folks need to have a completely altered reality by partaking in drug use, really of any kind, all day every day. Now, I get it….some folks have had awful experiences. It calms them. Helps them deal with it. Some have sleeping or anxiety disorders. I get it. And let’s be clear, I like to drink beer on the weekends here and there and I partake in some shots as well too. That’s definitely some altered reality but it’s few and far between. 

I’m talking about the wake and bakes that just have a normal life but they like it so they do it every day? I’m a no on this. You’ll never convince me that inhaling smoke of any kind daily is healthy, good for you, productive, or conducive to a better life long-term. You can’t do it. Because it’s not possible.  Not only that, but you are influencing your children when they go to copying your behavior.  So…..here I go being uncool.  This one is called “Association of Cannabis Use During Adolescence With Neurodevelopment” by Albaugh et. al. (Albaugh MD 2021) and published in JAMA Psychiatry on June 16, of 2021 a smoking steamy plate of Shazam. 

Why They Did It

The authors wanted to answer the question, “To what extent is cannabis use associated with magnetic resonance imaging–measured cerebral cortical thickness development during adolescence?”

What They Found

  • In this cohort study, linear mixed-effects model analysis using 1598 magnetic resonance images from 799 participants revealed that cannabis use was associated with accelerated age-related cortical thinning from 14 to 19 years of age in predominantly prefrontal regions.
  • The spatial pattern of cannabis-related cortical thinning was significantly associated with a positron emission tomography–assessed map of cannabinoid 1 receptor availability.

Wrap It Up

Results suggest that cannabis use during middle to late adolescence may be associated with altered cerebral cortical development, particularly in regions rich in cannabinoid 1 receptors.

 

Item #3

I’m just going to drive the depths of my uncool-ness to new depths here, folks. Don’t mind me.  This one is called, “Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status” by Han et. al. (Han B 2021) and published in JAMA Psychiatry on June 22, 2021. Ouchy wa wa. 

Why They Did It

During the past decade, cannabis use among US adults has increased markedly, with a parallel increase in suicidality (ideation, plan, attempt, and death). However, associations between cannabis use and suicidality among young adults are poorly understood. The authors wanted to answer the question, “Are there associations between cannabis use and suicidality trends in young adults, and do they vary as a function of sex and depression?”

How They Did It

They examined 281 650 adult participants in the 2008-2019 National Surveys of Drug Use and Health data

What They Found

Past-year suicidal ideation and plan along with daily cannabis use increased among all examined sociodemographic subgroups (except daily cannabis use among current high-school students), and past-year suicide attempt increased among most subgroups. 

Wrap It Up

From 2008 to 2019, suicidal ideation, plan, and attempt increased 40% to 60% over increases ascribed to cannabis use and major depressive episode. Future research is needed to examine this increase in suicidality and to determine whether it is due to cannabis use or overlapping risk factors. Alright, that’s it. I’ll try to be cooler next week. In fact, I KNOW I’ll be cooler next week because we have the amazing Dr. Brett Winchester coming up as a guest so don’t miss him. He’s on the top of the mountain. Let’s find out how he got there, shall we? Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

Store

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

https://www.amazon.com/dp/B096RST3WW

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

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

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

Bibliography

  • Albaugh MD, O.-G. J., Sidwell A, (2021). “Association of Cannabis Use During Adolescence With Neurodevelopment.” JAMA Psychiatry.
  • Han B, C. W., Einstein EB, Volkow ND, (2021). “Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status.” JAMA Netw Open 4(6): e2113025.
  • Pitcher MH, V. K. M., Bushnell MC, Porter L., (2019). “Prevalence and Profile of High-Impact Chronic Pain in the United States.” J Pain 20(2): 146-160.

 

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

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

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

But first, here’s that sweet sweet bumper music

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

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

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

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

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

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

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

But, I think we’re close.

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

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

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

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

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

You be the judge.

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

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

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

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

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

CHIROUP ADVERTISEMENT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

That’s Chiropractic!

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

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

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

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

Website

Home

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

About the Author & Host

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

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

They Still Have Low Back Pain Management WRONG

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

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

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

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

On the personal end of things…..

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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About the Author & Host

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

Bibliography

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

 

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

CHIROUP ADVERTISEMENT

Item #2

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

Item #3

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

Why They Did It

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

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

What They Found

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

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Key Point:

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

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

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

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

Bibliography

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