evidence-based chiropractic podcast

Manual & Passive Therapies For The Neck and Acupuncture For Post-Surgical Pain

CF 210: Manual & Passive Therapies For The Neck and Acupuncture For Post-Surgical Pain

Today we’re going to talk about Manual & Passive Therapies For The Neck and then we’ll talk about Acupuncture For Post-Surgical Pain But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

You have found yourself smack dab in the middle of Episode #210 Now if you missed last week’s episode, we talked about Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Just getting ready for Christmas. We talked a little last week about marketing and how we’re trying to set up our nurse practitioner for success.  I am currently going through a couple of different Fiverr sellers and creating a sales funnel. We are going to test it on our hormone pellets. Let’s keep our fingers crossed because if a sales funnel works on hormone pellets, then why wouldn’t it work for IV Therapy? PRP injections? Car Wreck patients? Spinal decompression patients? Just regular ol’ family practice patients? And on and on and on. 

You could conceivably and easily figure out your services that offer the highest ROI and then you could create a sales funnel for each.

Or….as in my case, have a Fiverr salesperson that knows more about it create it. Wouldn’t that be amazing if you could spend maybe $1000 per month on all of these ads funneling people into your different systems? Then they get the automated email trickles for whichever Funnell they happen to be in? And then they start calling and making appointments?

As we all know, this is a very real thing in lots of industries. Including healthcare. I’m certain I’m not the first to consider it but it’s kind of new thinking for me personally and I’m hoping that my hormone pellet funnel test bears fruit because if it does, it’s on like Donkey Kong.

I’ll be all over it and I’ll already have the people in place that can help me do it.  So, that’s exciting. 

No interns from Parker picked our office here in Amarillo, TX to come to visit for the Spring so looks like we’re on our own for the first 1/3 of 2022. But that’s OK, I’ve been on my own for like 24 years so I think we’ll be alright. 

On the side gig part of things, voice-over is still absolutely killing it. I never would have imagined what was possible for me in the voice-over industry. I’m still small potatoes when compared to what some of the guys make but for someone that’s only been in it for about a year, it’s been a game-changer when you consider keeping my life the same and still being able to fund other interests like real estate investing.

This year’s voice-over activities more than doubled the down payment we made on the investment property we just closed on in Lubbock, TX.  If you ever need a voice-over for your phone system, an online ad, podcast, TV/Radio ad, just holler. I got you. Send me an email at [email protected] or visit my voice-over website at www.jeffwilliamsvoice.com and we’ll connect. 

Speaking of investment property, if you’ve been listening, we bought a small house in Lubbock, TX, and closed on it last week. We are turning it into a short-term rental, we’ll call it an STR for short. That’s an Airbnb or Vrbo house. And they pay very well. 

Now, why live an hour and a half away from your STR? Won’t that be difficult?  The answer to the first question is because, while I love my hometown of Amarillo, TX, we don’t have a Division I college with a medical school and a law school.

Lubbock has Texas Tech there so they have the concerts and the graduations and the big football games and sports and traveling professors and all of that good stuff. Things that Amarillo just doesn’t have. And it’s only an hour and a half from here so we can still get there to handle any issues.  Besides that, most issues are not truly emergencies so as long as you have a dependable cleaner and a dependable handyman to be your eyes and ears on the ground and to take care of things when necessary, you don’t need to live in the same market.

People live in Ohio and self-manage their STRs in Florida or the Smokie Mountains.  Self-managing remotely should not be difficult at all. The ones doing it say that it takes about 15-20 minutes per week per house to self-manage. If there’s a plumbing issue, you’d call a plumber just like you would for your own house, give them the door code to get in and handle things, and voila! 

These days they have smart houses. Wireless thermostats, deadbolts, external property cameras, and water controls for the garden. You don’t have to have any contact with anyone. Just give them the code to the door. That goes for the guests as well.  You can buy STRs already furnished, which is my preference. This one was not so we’re having to purchase everything new for the house. They say count on $10,000 per bedroom if you’re furnishing it. So a 3 bedroom house, we would budget $30,000 in furnishings.

Truthfully, I think we’re coming in at about 1/3 lower than that benchmark. Because I have shopper of a wife and she knows how to find the deals. 

Anyway, we spent Saturday down in Lubbock setting it up and building furniture and all that good stuff. We didn’t even get close to getting it ready but we got further than we were. We’ll head back down this weekend and keep grinding until we can get it up and running and ready for our guests to have an excellent experience. 

Then, we have a long-term rental here in Amarillo that we used to live in ourselves. Once we moved out, we just held onto it and rented it out. We are refinancing it currently. We will take out the money that is there with the increased value of the home and we’ll put that down on an STR in the Florida area. We’re getting our system of self-management down with this closer Lubbock property. Then we’re taking the show on the road and going bigger.

People will always go to the beach and they’ll always go to Disney so that’s the plan.  Keep listening in for updates. I tend to share everything with y’all so you know I’ll be talking about it. 

Now on with it. 

Item #1

Let’s start off with this one called “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration” by Wong et. al. (Wong JJ 2016) and published in Spine Journal in December of 2016,  As a side note, this may be the longest of any title anywhere. They should work on their naming prowess. 

Why They Did It

In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD.

How They Did It

  • This was a systematic review and best evidence synthesis.
  • The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention.
  • They systematically searched five databases from 2000 to 2014
  • Studies with a low risk of bias were stratified by the intervention’s stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. 
  • They screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias.

What They Found Evidence from seven exploratory studies suggests that 

  1. for recent but not persistent NAD grades I-II, thoracic manipulation offers short-term benefits; 
  2. for persistent NAD grades I-II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and 
  3. for NAD grades I-II, strain-counterstrain treatment is no better than placebo. 

Evidence from 15 evaluation studies suggests that  (1) for recent NAD grades I-II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice;  (2) for persistent NAD grades I-II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture;  (3) for WAD grades I-II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and  (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits.

Wrap It Up

Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counter strain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain I don’t know what to think about this one, to be honest.

In one part it seems they don’t assign any effectiveness to manipulation but then in the conclusion, they say it’s an effective intervention. What gives? Who the hell knows. All I have access to is the abstract.  I can tell you that while anecdotal, you can’t convince me that manipulation doesn’t provide significant relief. Sometimes immediately. You’ve seen them come in with a locked up neck and one adjustment increases their range of motion immediately and pain levels are reduced fairly quickly.  Combined with some exercise and strain/counterstrain, they leave the office skipping down the street and singing along with Louie Armstrong on ‘What a wonderful world.” I know systemic reviews are high-level research. I’ve just seen so many other papers showing impressive effectiveness that this one doesn’t really move me one way or the other. 

Item #2

Last one today is called, “Effects of Acupuncture on Postoperative Pain After Total Knee Replacement: Systematic Literature Review and Meta-Analysis” by Ko et. al. (Hsing Fang Ko 2021) and published in Pain Medicine on June 21, 2021…damnit….so hot. 

Why They Did It They wanted to identify the analgesic effectiveness of acupuncture after total knee replacement by systematic review.

How They Did It

  • A search of randomized controlled trials was conducted in five English medical electronic databases and five Chinese databases. 
  • Two reviewers independently searched in five English medical electronic databases and five Chinese databases. 
  • Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. 
  • Meta-analyses were performed with all-time-points meta-analysis.
  • A total of seven studies with 891 participants were included.

What They Found

  • The meta-analysis results indicated that acupuncture had a statistically significant influence on pain relief. 
  • The subgroup analysis results showed that acupuncture’s effects on analgesia had a statistically significant influence. 
  • Electroacupuncture frequency ranged between 2 and 100 Hz.

Wrap It Up

As an adjunct modality, the use of acupuncture is associated with reduced pain and the use of analgesic medications in postoperative patients. In particular, ear acupuncture 1 day before surgery could reduce analgesia. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Hsing Fang Ko, C.-H. C., PhD, Kai-Ren Dong, Hsien-Chang Wu (2021). “Effects of Acupuncture on Postoperative Pain After Total Knee Replacement: Systematic Literature Review and Meta-Analysis,.” Pain Med 22(9): 2117-2127.
  • Wong JJ, S. H., Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G, Carroll LJ, Ameis A, Ammendolia C, Brison R, Nordin M, Stupar M, Taylor-Vaisey A, (2016). “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration.” Spine J 16(12): 1598-1630.

Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability

CF 209: Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability

Today we’re going to talk about the cost-effectiveness of chiropractic and we cover how getting MRIs too early can lengthen the time of disability a patient goes through. Interesting stuff! But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

You have found yourself smack dab in the middle of Episode #209 Now if you missed last week’s episode, it was our 4 year anniversary and round up episode. We covered the top ten all time listened to episodes from the 4 years and it was fun to reminisce. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

So on the personal side of things we are currently getting ready to have our official welcome reception for our nurse practitioner. And I thought I would talk about it briefly just to get your wheels turning about how you do internal marketing. We have done a lot of stuff to try to get the word out about our nurse practitioner. We started by making a list of all of the new services we would be adding and we had fire sitting all around the office. Every time I had a patient come in I would grab one and hand it to them and make sure that they knew what we had come up before he even started his first day.

We send out a weekly email to our patient base. You better believe they heard over and over and over again about the medical integration that was on the horizon. We just started a radio campaign. Somewhere in there we won best of competition in our city which has about a population of 300,000 or so. So that was a pretty big deal. Obviously, anytime I’m working on somebody and we have a conversation I am thinking about whether they need to be seeing our nurse practitioner at the same time.

If they have pesky trigger points I tell them about trigger point injections. If they’re fussing about being tired I tell them about hormone replacement or IV therapy. If I ask them if they have had a bone scan because it’s an older female and they say they don’t have a primary, boom they do now. I think you understand what I’m saying but that is the ultimate in internal marketing. We also have a sign at the front door saying make your appointment for our new medical services today. We also have another one in the lobby. We have hormone replacement banners in the rehab room. This is an ongoing thing. And, slowly, he’s getting busier Last week our nurse practitioner had about 28 to 30 appointments for the week. When he started out in August, obviously it was zero. Two weeks ago it was 18 or 19 appointments for the week. So we are getting there. I am also creating weekly blogs and corresponding YouTube videos and most of them right now I have to do with the Nurse Practitioner and the new services we offer.

And as a side note I have to say, it has been really nice to have another provider in the office. I can’t wait to be able to hire an associate to take over my day to day stuff. But in the meantime, if a case is being particularly pesky, it’s nice to be able to broaden my approach even further than before. If you don’t know much about my clinic, we have me, medical, exercise rehab, three massage therapists, acupuncture, and even an esthetician in the spa side of the building. We are fully integrated and a broad approach is the name of the game Medical was just the next logical step and though it was hard to get set up, we are well on our way now. Let’s be clear.

Still not profitable. But we’re no longer hemorrhaging. Mucho mejor mi amigos Outside of setting up the welcome reception this Friday, we are creating the FB event and inviting doctors and lawyers and any other potential referral source. I am experimenting with creating opt in lead pages with a trickle email campaign and a Google Ads, Facebook Ads, and Instagram ad campaign to lead them there.

Marketing is like treating pain. It’s a broad management type of thing. Hit it from all directions but whatever you do….you have to market. You can’t do business sitting in your ass as Dan Kennedy says. You can’t just be a doer of what you do. You have to be a marketer of what you do. Before we dive in, I want to thank ChiroUp for asking me to guest on their blog and video recently.

I joined Dr. Brandon Steele for a conversation on chronic pain and all the topic entails. It was an excellent talk and Dr. Steele and partner Dr. Tim Bertlesman are just top-notch examples of what chiropractors can be. I can’t say enough about both or them or ChiroUp. They’ve changed our profession for the better.  Alright, let’s get going with the research

Item #1

I first want to thank Dr. David Graber, our esteemed New Jersey-an colleague and contemporary for posting this study in the Forward Thinking Chiropractic Alliance group. He’s got a ton of great research. He’s on top of it all. Go look up Dr. Graber if you get a minute and add his professional page on Facebook. You won’t regret it. 

This first one is called “The association between use of chiropractic care and costs of care among older Medicare patients with chronic low back pain and multiple comorbidities” by Weeks et. al. (Weeks 2016) and published in the Journal of Manipulative Physiological Therapeutics

Why They Did It

The purpose of this study was to determine whether use of chiropractic manipulative treatment (CMT) was associated with lower healthcare costs among multiple-comorbidity Medicare beneficiaries with an episode of chronic low back pain (cLBP).

How They Did It

  • The authors conducted an observational, retrospective study of 2006–2012 Medicare fee-for-service reimbursements
  • The project included 72,326 multiply-comorbid patients aged 66 and older with cLBP episodes and 1 of 4 treatment exposures 
  • The exposures were chiropractic manipulative treatment (CMT) alone, CMT followed or preceded by conventional medical care, or conventional medical care alone. 
  • The researchers used propensity score weighting to address selection bias.

What They Found

  • The total and per-episode Medicare reimbursements during the cLBP treatment episode were lowest for patients who used CMT alone; 
  • These patients had higher rates of healthcare use for low back pain but lower rates of back surgery in the year following the treatment episode.
  • Expenditures were greatest for patients receiving medical care alone; 
  • Patients who used only CMT had the lowest annual growth rates in almost all Medicare expenditure categories. 

Wrap It Up

This study found that older multiple-comorbid patients who used only chiropractic manipulative therapy during their chronic low back pain episodes had lower overall costs of care, shorter episodes, and lower cost of care per episode than patients in the other treatment groups. Further, costs of care per episode were lower for patients who used a combination of chiropractic manipulative therapy and conventional medical care than for patients who did not use any chiropractic manipulative therapy. 

Item #2

Our last one here is called “The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis” by Shraim et. al.  and published in BMC Musculoskeletal Disorders in November of 2021…..sizzle…I can’t touch it. Because it is too hot for me to handle.  Why They Did It They start the abstract by saying that clinical guideline recommendations are against early magnetic resonance imaging  within the first 4 to 6 weeks of conservative management of acute low back pain (LBP) without “clinical suspicion” of serious underlying conditions. Otherwise known as red flags. 

There is some limited evidence that a significant proportion of patients with low back pain receive early MRI non- indicated by clinical guidelines, which could be associated with increased length of disability The aim of this systematic review was to investigate whether early MRI for acute low back pain without red flags is associated with increased length of disability. The length of disability was defined as the number of disability days (absence from work

How They Did It

  • Medline, EMBASE, and CINAHL bibliographic databases were searched from inception until June 5, 2021. 
  • Two reviewers independently assessed the methodological quality of included studies using the Newcastle-Ottawa scale and extracted data for the review. 
  • The search identified 324 records, in which seven studies met the inclusion criteria. 
  • Three of the included studies used the same study population.

What They Found

  • All included studies were of good methodological quality and consistently reported that patients with acute low back pain without red flags who received early magnetic resonance imaging had increased length of disability compared to those who did not receive early magnetic resonance imaging. 
  • Three retrospective cohort studies reported that the early magnetic resonance imaging groups had a higher mean length of disability than the no early magnetic resonance imaging groups ranging from 9.4 days to 13.7 days at the end of 1-year follow-up period. 
  • The remaining studies reported that the early magnetic resonance imaging groups had a higher hazard ratio of work disability when compared to the no early magnetic resonance imaging groups.

Wrap It Up

Early magnetic resonance imaging is associated with increased length of disability in patients with acute low back pain without red flags. Identifying reasons for performing non-indicated early magnetic resonance imaging and addressing them with quality improvement interventions may improve adherence to clinical guidelines and improve disability outcomes among patients with low back pain.

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations.

So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

  • Shraim BA, S. M., Ibrahim AR, Elgamal ME, Al-Omari B, Shraim M (2021). “The association between early MRI and length of disability in acute lower back pain: a systematic review and narrative synthesis.” BMC Musculoskelet Disord 22(1): 983.apple
  • Weeks, W. B., Leininger, B., Whedon, J. M., Lurie, J. D., Tosteson, T. D., Swenson, R., O’Malley, A. J., & Goertz, C. M, (2016). “The Association Between Use of Chiropractic Care and Costs of Care Among Older Medicare Patients With Chronic Low Back Pain and Multiple Comorbidities.” J Manipulative Physiol Ther 39(2): 63-75.

 

Year Four Chiropractic Forward Roundup

CF 208: Year Four Chiropractic Forward Roundup Today we’re going to re-hash the last 4 years of the Chiropractic Forward podcast on this, the 4 year anniversary of the first episode.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

On the personal end of things…..

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

The answer is Hell yes.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Wrap It Up

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

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

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

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

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

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

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

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

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

 

The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Home

Social Media Links

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

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

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Reduced Access To Chiropractic & The Ideal Diet

CF 203: Reduced Access To Chiropractic & The Ideal Diet Today we’re going to talk about reduced access to chiropractic and we’ll talk about the ideal diet.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

You have found yourself smack dab in the middle of Episode #203 Now if you missed last week’s episode, we talked about Pain And Clumsiness & Treatment Escalation. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

The resurgence continues in my clinic’s numbers. I believe we had 26 new patients this last week and about 183 or so patients. Our Nurse Prac is still building slowly. Honestly, a little slower than I expected. He is averaging around 15-20 appointments per week. Some are as simple as trigger points. Some are as extensive as hormone pellets and PRP injections. I’m telling you I’ve railed against cortisone injections for years and I still do. But lidocaine trigger points …..now that’s a different deal. I’ve been floored at how much they can make a difference for some of my patients that have been on the more pesky side with regard to some nagging pain.

Good stuff and it’s a $50 cash service so it’s not out of reach for most patients and it seems, so far, to be very effective for most. 

As with everything in life, nothing can stay good for too long, can it?

It seems the answer is no. It can’t. I left work on Friday after a great, busy, fairly stress-free week. As I was walking out the back door, my front desk employee for the last year and a half or so gives me her 2-week notice. Yep, we just got everything up and running and kicking some butt, and boom.

There are lots of reasons behind the scenes as to why she made the decision but the end story is that there was a bit of internal conflict, we’ve had some difficulties in the past with how this person handled some patients or situations, and….though we’ll miss this person’s incredible attention to detail, it’s probably a good move for all involved. We wish her the very best.

She’s a great person and a hard and dependable worker. Just a bad fit I suppose 

Now, you all know how valuable a front desk employee is. They are simply hard to replace but, it is what it is. Fortunately, and you all might listen up here, my wife took classes and became a front desk billing guru. So, she can train new front deskers, She can get them up to speed quicker than anyone I know because she’s smarter than anyone I know.  I mention this because my wife being trained so well takes a lot of burden off of us when it comes to replacing the front desk staff. It’s going to happen sooner or later and why be held hostage by employees because the owners don’t know what’s going on?

Now let’s be honest, I don’t know the front desk. That’s why at one time in my career, I absolutely WAS held hostage by the front desk. That’s why, several years ago, I found out that I lost an incredible amount of money over a 3-year time span. And when I say ‘incredible’, I’m talking around $750,000 over three years. I don’t like saying it but I’m always honest with you all. That’s the best way to be a coach or mentor or adviser.

It’s with honesty.

It wasn’t stolen or embezzled. It just wasn’t collected on and then the time passed to where it could no longer be billed and collected on. So…all of that work was just gone.  It’s not every day you find out you’ve lost around $750,000. Time and Bud Light helped me through and I’m doing OK today. You have to move beyond the things that will bring you down and keep you down if you allow them to.

But yeah, that’s why you can’t be held hostage by employees.  That’s also exactly WHY my wife got trained. So that we’d never be in that position again. And….we aren’t this time either.  We have the luxury of being able to pick and choose by personality type rather than strictly experience because we can train the skills ourselves.

So, to Indeed we go. Wading through hundreds of resumes that won’t show up when we schedule interviews. It’s insane. But, it’s a necessary evil and, I’m a Christian, so we pray for the perfect person to be led our way.  What do you need in a front desker? Personality! They are the first impression a person gets when they call on the phone. They are the first person a patient encounters when they get there and the last person they encounter on the way out. That’s as important and vital as anything.

Pain is weird and responds differently in everyone. so I don’t care if someone leaves feeling better immediately. Obviously that’s the goal but not the most important thing. What I really care about is how they feel about their experience being in our clinic and how they felt about the people they came into contact with while they were there. THAT’s what matters the most. Especially in the first visit or two. 

They can be practice builders and they can be practice killers.

This one, very key person. So…..let’s make it count shall we?? Let’s dive into the research this week. 

Item #1

This first one is called Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review” by English et. al. (English LK 2021) and published in JAMA Open Network on August 31, 2021, and that’s hotter than that the Texican sun in the Summer. 

Why They Did It

They wanted to answer the question, “What is the association between dietary patterns consumed and all-cause mortality?”

How They Did It

  • It was a systematic Review but of only one randomized clinical trial but 152 observational studies 
  • Participants were from 17-84 and from 28 different countries
  • They were all on the topic of dietary patterns and all=cause mortality

What They Found

  • They found a lot of what you’d probably expect they’d find. 
  • Evidence demonstrated that dietary patterns characterized by increased consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) among adults and older adults were associated with decreased risk of all-cause mortality. 
  • These healthy patterns consisted of relatively LOW intake of red and processed meat, high-fat dairy, and refined carbohydrates or sweets.

Wrap It Up

Despite the different approaches, study designs, dietary assessment methods, geographical regions, and dietary pattern labels, the evidence demonstrated that dietary patterns associated with lower all-cause mortality risk were consistently characterized by higher intake of vegetables; legumes; fruits; nuts; either whole grains, cereals, or non-refined grains; fish; and unsaturated vegetable oils.  These patterns were also characterized by lower or no consumption of animal products (red and processed meat, meat and meat products, and high-fat dairy products), refined grains, and sweets (ie, higher in added sugars).  Labels that were assigned to the dietary patterns varied widely (eg, Mediterranean, prudent, Healthy Eating Index, DASH, and plant-based), highlighting that high-quality diets with nutrient-dense foods are associated with better health, regardless of diet type or dietary pattern name.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783625?guestAccessKey=cea01652-195e-4ee2-ac19-d204e60b224f&utm_content=weekly_highlights&utm_term=091221&utm_source=silverchair&utm_campaign=jama_network&cmp=1&utm_medium=email

Item #2

This second one is called “The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults” by Davis et. al. (Davis M 2021) and published in the Journal of Manipulative and Physiological Therapeutics in June of 2021 and toastier than a hot toddy!

Why They Did It

The purpose of this study was to examine the extent to which access to chiropractic care affects medical service use among older adults with spine conditions.

How They Did It

  • They used Medicare claims data to identify a cohort of 39,278 older adult chiropractic care users who relocated during 2010-2014 and thus experienced a change in geographic access to chiropractic care. 
  • National Plan and Provider Enumeration System data were used to determine chiropractor per population ratios across the United States. 
  • A reduction in access to chiropractic care was defined as decreasing 1 quintile or more in chiropractor per population ratio after relocation.
  • Using a difference-in-difference analysis (before versus after relocation), they compared the use of medical services among those who experienced a reduction in access to chiropractic care versus those who did not.

What They Found

  • Among those who experienced a reduction in access to chiropractic care (versus those who did not), they observed an increase in the rate of visits to primary care physicians for spine conditions 
  • An annual increase of 32.3 visits per 1,000 
  • And the rate of spine surgeries (an annual increase of 5.5 surgeries per 1,000). 
  • Considering the mean cost of a visit to a primary care physician and spine surgery, a reduction in access to chiropractic care was associated with an additional cost of $114,967 per 1,000 patients
  • That’s to the tune of $391 million nationally

Two syllables – one word…..Day-um. 

That’s a metric crap-ton of green cheese. A gob of Benjamins. A Gaggle of American greenbacks. 

https://pubmed.ncbi.nlm.nih.gov/34376317/

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

  The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host

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

 

Bibliography

  • Davis M, Y. O., Liu H, Anderson B, Bynum J, (2021). “The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults.” J Manipulative Physiol Ther 44(5): 353-362.
  • English LK, A. J., Bailey RL, (2021). “Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review.” JAMA Netw Open 4(8).

 

Pain And Clumsiness & Treatment Escalation

CF 202: Pain And Clumsiness & Treatment Escalation Today we’re going to talk about pain that causes clumsiness and we’ll talk about treatment escalation.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

 

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

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

You have found yourself smack dab in the middle of Episode #202 Now if you missed last week’s episode , we talked about breast plan illness and treating chronic pain centrally. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Things may have leveled out last week. We shall see. Still busy as can be but instead of 215 in a week, I believe last week was more around 185. This is exactly what we averaged weekly before COVID so I can live with that. I didn’t feel 100% overwhelmed. Tired, yeah. But not overwhelmed.  Let’s talk about the staff.  Have you ever hired a staff member that started out as a kid and just blossomed into something pretty darn special? Wouldn’t it be nice if we could predict these things? Unfortunately, hiring can be a bit of a crapshoot. The ones that look the best turn into clowns. Then you have the ones that are meh and stay meh. Then you have the ones you kind of aren’t sure about and they either sink or swim.  I found a swimmer.

I hired the daughter of one of my long-time friends. I didn’t want to hire her because I didn’t want to treat her differently because of my friendship with her mother and I also didn’t want to risk losing a friend because a problem popped up and I had to fire her daughter. Or something of that nature. You never know what’s going to happen but that was my thought process.  Anyway, she was the best applicant so I hired her. I had an office manager that had been there for roughly 11 years. She trained her up well. Her only job had been with Kohl’s so she’d been in retail and was only about 19 I think. Maybe 20. She was a kid. It took her a bit to settle in I think but once she did, she blossomed.  Fast forward a year or two and my long-time office manager got an offer for more money and she took it. This could have been catastrophic. But then this girl the had started as a kid stepped up and said, “I got it.” 

And no kidding…..she had it. She started marketing. She started setting up meetings with the staff where the weekly meetings and training had kind of fallen off. She started going to networking events. Now, a year after taking over as office manager, she’s the ‘go to’ for the entire office, she’s worked every position including billing and the front desk, and at 23 years old, I have every bit of confidence in that girl.  I told that story for no real reason but to just say ‘isn’t it a bit hinky?’ Wouldn’t it be nice to be able to bottle that up and figure out how to tell who’s going to crash and who’s going to soar? I know everyone has a different opinion on relationships in the office but my opinion, and my personality, is for my staff to be funny, professional, a little bit ornery, and a bit like family.

I care about my staff.  I root for them and they root for me. We tease each other non-stop but we are a family. I spend more time with those girls than I spend with my own family. That’s a big deal. Why would I want a boss-employee relationship with people I basically spend my entire life with? I’d rather them be bought in. Be like family. And when they’re no longer on my team, they’re still on the team to an extent because they became part of the family.  I could be wrong but of all of the people that have worked for me over the years, I can only think of maybe 3 that left on bad terms. Out of maybe 30 or more people.

That sounds like a high turnover rate but honestly, I’ve been in the job for 24 years almost and right now alone I have 13 employees. So, there have been plenty come and go over the years for different reasons. Going back to school, leaving to have babies, moving out of town. It is what it is. 

Most just don’t leave on bad terms and that’s the way I’d like to keep it. I hear horror stories about other chiropractors throwing fits, kicking furniture, yelling down at their staff, and basically acting like children in a grown-up’s body. That’s embarrassing for them.  Leaders come in all shapes and sizes but for me, funny, professional, friendly, respectful, and family sum it up. And love. I love most of the staff that has worked for me. Yes, I paid them.

But they also dedicated themselves to my clinic. That means something and I value it.  Alright, let’s hop in

Item 1    

https://www.frontiersin.org/articles/10.3389/fpain.2021.756771/full?fbclid=IwAR1LIiNtb03NVWKifKRNNnefXg2CYDjWcUynCfIFU3WcnoqzIX58m_Rzw3Y

This one is called “Does my neck make me clumsy? A systematic review of clinical and neurophysiological studies in humans” by Harman et. al. (Harman S 2021) and published in Frontiers in Pain Research on October 11, 2021 and that’s spectacularly steamy. 

 

Why They Did It

Clumsiness has been described as a symptom associated with neck pain and injury. However, the actuality of this symptom in clinical practice is unclear. The aim of this investigation was to collect definitions and frequency of reports of clumsiness in clinical studies of neck pain/injury, identify objective measures of clumsiness and investigate the association between the neck and objective measures of clumsiness.

How They Did It

Six electronic databases were systematically searched,  records identified and assessed including a risk of bias.  Heterogeneity in designs of studies prevented pooling of data, so qualitative analysis was undertaken. Eighteen studies were retrieved and assessed;  the overall quality of evidence was moderate to high.  Eight were prospective cross-sectional studies comparing upper limb sensorimotor task performance and ten were case series involving a healthy cohort only. 

What They Found

Clumsiness was defined as a deficit in coordination or impairment of upper limb kinesthesia.  All but one of 18 studies found a deterioration in performing upper limb kinesthetic tasks including a healthy cohort where participants were exposed to a natural neck intervention that required the neck to function toward extreme limits.

Wrap It Up

Alterations in neck sensory input occurring as a result of requiring the neck to operate near the end of its functional range in healthy people and in patients with neck pain/injury are associated with reductions in acuity of upper limb kinesthetic sense and deterioration in sensorimotor performance. Understanding the association between the neck and decreased accuracy of upper limb kinesthetic tasks provide pathways for treatment and rehabilitation strategies in managing clumsiness. In the Fellowship program for Neuromusculoskeletal Medicine, we actually learned a great deal about this.

Which is why I’ve included it this week. We know that when sensory information comes in if there is an alteration in the signal or in it’s processing, there will be alterations in the motor portion of the sensorimotor capability leading to aberrant movements and motion.  What if incidental pops and clicks were due to faulty sensorimotor and aberrant movement? It can be due to instability, sure. But it can also be to a smudged brain map. We know that when patients have chronic low back pain, the brain map can be smudged. Our brains have a map of our bodies.

Every joint, its capabilities, and it’s limitations. Chronic pain smudges that map. We also know that a large portion of our proprioception and sensory information also comes from our deep upper cervical muscles. In combination with the inner ear and eyes.  It doesn’t take a stretch of imagination to see chronic pain, either in low back or neck, or neck dysfunction being the source of issues for balance, proprioception, and accurate motor function.  It’s all fascinating, folks! Good stuff. 

Item #2

https://www.jmptonline.org/article/S0161-4754(21)00035-X/fulltext?dgcid=raven_jbs_etoc_email

This one is called “Risk of treatment escalation in recipients vs. non recipients of spinal manipulation for musculoskeletal cervical spine disorders; an analysis of insurance claims.” by Anderson et. al (anderson BR 2021) and published in June of 2021 so hot! 

Why They Did It

The purpose of this study was to evaluate the relationship between treatment escalation and spinal manipulation in a retrospective cohort of people diagnosed with musculoskeletal disorders of the cervical spine.

How They Did It

  • They used retrospective analysis of insurance claims from 2012-2018 from a single Fortune 500 company.
  • They categorized 58,147 claims into 7,951 unique patient episodes.
  • Treatment escalation included claims where imaging, injection, emergency room, or surgery was present.

What They Found

  • Treatment escalation was present in 42% of episodes overall: 2,448 (46%) associated with other care and 876 (26%) associated with spinal manipulation. 
  • The estimated risk of any treatment escalation was 2.38 times higher in those who received other care than in those who received spinal manipulation

Wrap It Up

Among episodes of care associated with neck pain diagnoses, those associated with other care had twice the risk of any treatment escalation compared with those associated with spinal manipulation.  In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic; therefore, these findings are relevant and should be considered in addressing solutions for neck pain. Additional research investigating the factors influencing treatment escalation is necessary to moderate the use of high-cost and guideline-incongruent procedures in people with neck pain. So, how many times have you seen patients that had fusions that they should have never had?

Many or most times based on MRI images from MRI’s they probably should have never had. Conservative care first, folks.  Failure to respond to conservative care. Conservative care being spinal manipulative therapy, exercise, laser, massage, acupuncture, yoga, tai chi, cognitive behavioral therapy, and I will add one from the anecdotal observation that is backed by non enough research….and that’s spinal decompression. I’ve never seen anything like it for discs and radiculopathy. Plain and simple.  Once those have been tried and failed, then you look at meds. Then you look at injections. Then you look at surgery. 

Understanding that cauda equina and progressive neurological deficits are really the main reasons for surgery. Pain, by the way, is not a reason for surgery.  No cauda equina? No altered sensory, motor, or reflexes? No surgery. 

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

  The Message

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

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

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

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

Website 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

Anderson BR, M. W., Long CR, (2021). “Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims.” J Manipulative Physiol Ther 44(5): 372-377.

Harman S, Z. Z., Kendall J, Vindigni D, Polus B, (2021). “Does My Neck Make Me Clumsy? A Systematic Review of Clinical and Neurophysiological Studies in Humans.” Front Pain Res 2: 756771.      

Breast Implant Illness & Treating Chronic Pain Centrally

CF 201: Breast Implant Illness & Treating Chronic Pain Centrally

Today we’re going to talk about breast implant illness and then we’ll talk about chronic pain and new research around treating it centrally vs. peripherally.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

 

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

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

You have found yourself smack dab in the middle of Episode #201 Now if you missed last week’s episode, we talked about the state of chiropractic through ChiroUp and Chiropractic Economics. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Last week, you heard me mention spending time in Chicago at the American Council of Chiropractic Consultants and Chiropractic Forensic Sciences conference. I also mentioned getting to hang out with Dr. Michael Massey and talked a little about who Dr. Massey is and what he does. What I failed to mention is that he and Dr. Rob Pape, together, started a practice management group called Practice Mechanics. Along with that, they have a Practice Mechanics podcast and they had me on as a guest recently.  It was a lot of fun and it was me answering questions rather than asking them. It was really just a great conversation about the profession, this podcast, the book I recently released, my future goals, and all kinds of other goodies. Go to the Practice Mechanics podcast and pull the trigger on episode 10. Then sit back and laugh at my dumb answers!  It really was a great conversation and I was fortunate to have Mike and Rob bring me on and lead me through it. These last couple of months have truly been a whirlwind. As mentioned, I was just in Chicago.

At the beginning of September, I was in Washington DC.  In August we integrated with the nurse practitioner. Late August we got an intern from Parker College. Future doctor Drake Gardner from the Tulsa, OK area. Good dude with a bright future. Then, about early September our new patient per month count exploded and rose back to where it was back before the Rona invaded our lives. In fact, I broke a record. We had somewhere around 85-90 new patients in September. In just one week I had 31 new patients. By myself. And I do a thorough exam. It’s not one of those vitalistic  “live and die by the subluxation” knock down the high spot exams.

It’s not one of those exams oh crazy Chiro out in Oklahoma that tries to teach others to do like 9 new patients exams and 99 patients in 3 hours with one table. Durrr.

It’s one you would expect from an Ortho Diplomate.  Anyway, the point is not to brag but to say damnit…., I’ve been cooking. And cooking hot with gas. And also to discuss what happens when you get so busy you are running the risk of not being able to keep up.

When your schedule is full I have been told you need to either hire help or raise prices to thin the herd. How do we feel about that? I don’t know. I’m a capitalist. I don’t like turning away business. But I’m also empathetic. I don’t want to price myself out of the market and I don’t want people to wait a week to come to see me.

And….it’s only been this way for about 4 weeks. Who’s to say it’ll be this way in six months? I could hire someone and they stop piling in and then I’m screwed.  The safer bet is to raise prices a touch. You can always backtrack that by simply putting them right back where they were.

But here’s what’s going to happen. Nothing.

I’m going to be overworked and half crazy for a while until I am 100% clear that the surge in business is here to stay. Then I’m going to try to hire an associate. And I’ll be overworked like crazy until that happens. So work work work is on my horizon. I will try my best to continue this podcast as long as I can.

Right now, I’m having to type it up on a Saturday night because I simply won’t have time during the week. We’ll see how it goes. Right now, my commitment to pumping new episodes out every week is strong. I’d offer a Patreon page and maybe try to generate some income from the podcast itself but guess what? I don’t have time!! Lol.

This all sounds doom and gloom but it’s all good. I’m blessed. I hope you are blessed as well. Griping about busy makes a guy feel guilty. But I’m not griping about being busy. I’m griping about being overwhelmed and having no time to do the things I need to do every week outside of hands-on patient treatment.  That’s really what it comes down to. So stick with me. I’ll keep doing what ai do and we’ll see what comes of it, my friends.

What I do know is that I appreciate you all. Your time and attention to this podcast make it worth every second. That all turned out a little fussier than I meant. I’m usually very positive and I am positive. I’m just sharing what’s going on. I think I’m in a transition period basically. These points that stress us force us into change. My responsibility is to make certain that the change is positive and productive. 

Let’s dive in!

Item #1

The first one is called “Assessment of Silicone Particle Migration Among Women Undergoing Removal or Revision of Silicone Breast Implants in the Netherlands” by Dijkman et. al. (Dijkman HBPM 2021) and published in JAMA Open on September 20, 2021 and that’s a lotta hot!

First, if you don’t know anything about this topic, I think you might be shocked. 

Secondly, let’s talk about why I would include this paper on this podcast.

What does silicone breast implant leakage have to do with us as chiropractors? Well, one of my Facebook friends was openly discussing silicone leakage and illness and how she was getting her removed, and what a miserable time she had been having recently due to this leakage.  I’d never heard of this being an issue so I started looking into it a bit. While some older research was pretty meh about it all, more recent research has shown an association between silicone breast implants and certain autoimmune diseases.  Healthline says, “These studies suggest that silicone breast implants potentially raise your risk of developing an autoimmune disease such as rheumatoid arthritis, Sjögren’s syndrome, scleroderma, and sarcoidosis.”

They also add, “The World Health Organization and the U.S. Food and Drug Administration have identified another possible  This relates breast implants to a rare cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Additionally, breast implants are known to cause other potential risks such as:

  • scarring
  • breast pain
  • infection
  • sensory changes
  • implant leakage or rupture”

In addition to what Healthline shared, the body of this paper says, “Breast implant illness is used to describe various complications associated with silicone breast implants, ranging from brain fog, hair loss, fatigue, chest pain, sleep disturbances, irritable bowel syndrome, headaches, chronic pain all over the body, and autoimmune diseases, such as lupus and fibromyalgia.” How many of these people do we see every day? So, it’s been on my radar way out on the periphery and when I saw this paper come through JAMA recently, it made sense to put it on your radar screens as well. How many patients do we have that could potentially be going through this and just never made the connection in their minds?

Why They Did It

To evaluate the existence of silicone gel bleed and migration over a long time period, including the period in which the newer cohesive silicone gel breast implants were used.

How They Did It

  • It was a single-center case series, 
  • Capsule tissue and lymph node samples were collected from women who underwent removal or revision of silicone breast implants from January 1, 1986, to August 18, 2020
  • Data were extracted from the pathological reports and revision of the histology if data were missing. 
  • All tissues were examined using standard light microscopy
  • A total of 365 women had capsular tissue removed, including 15 patients who also had lymph nodes removed, and 24 women had only lymph nodes removed. 
  • Exposures  Silicone breast implants.
  • The main outcome was presence or absence of silicones inside or outside the capsule. 
  • 389 women with silicone breast implants

What They Found

384 women (98.8%) had silicone particles present in the tissues, indicating silicone gel bleed.  In 337 women (86.6%), silicone particles were observed outside the capsule (ie, in tissues surrounding the capsule and/or lymph nodes), indicating silicone migration.  In 47 women (12.1%), silicone particles were only present within the capsule.  In 5 women (1.2%), no silicone particles were detected in the tissues.  Patients were divided into 2 groups, with 46 women who received cohesive silicone gel breast implants and 343 women who received either an older or a newer type of breast implant.  There were no differences in silicone gel bleed or migration between groups 

Wrap It Up

In this case series including women with noncohesive or cohesive silicone gel breast implants, silicone leakage occurred in 98.8% of women, indicating silicone gel bleed, and in 86.6% of women, migration of silicone particles outside the capsule was detected.  We did not see differences in silicone gel bleed or migration between women who received the newer cohesive SBIs and those who received noncohesive SBIs. So, now it’s on your radars and this info could give you another avenue toward helping your patients get out of pain. 

Item #2 Our last one today is called, “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial” by Ashar et. al. (Ashar YK 2021) and published in JAMA Psychiatry on September 29, 2021 and it’s bringing the heat! They say, “Approximately 85% of cases are primary CBP, for which peripheral etiology cannot be identified, and maintenance factors include fear, avoidance, and beliefs that pain indicates injury.” I talk to my patients every day all day about beliefs, hurt vs. harm, and fear avoidance. 

Why They Did It

To test whether a psychological treatment (pain reprocessing therapy [PRT]) aiming to shift patients’ beliefs about the causes and threat value of pain provides substantial and durable pain relief from primary chronic back pain and to investigate treatment mechanisms. PRT seeks to promote patients’ reconceptualization of primary (nociplastic) chronic pain as a brain-generated false alarm. PRT shares some concepts and techniques with existing treatments for pain rand with the cognitive behavioral treatment of panic disorder.

How They Did It

  • This randomized clinical trial with longitudinal functional magnetic resonance imaging (fMRI) and 1-year follow-up assessment was conducted in a university research setting from November 2017 to August 2018, 
  • There was a 1-year follow-up. 
  • Clinical and fMRI data were analyzed 
  • The study compared pain reprocessing therapy with a placebo treatment and with usual care in a community sample.
  • Participants randomized to pain reprocessing therapy participated in 1 telehealth session with a physician and 8 psychological treatment sessions over 4 weeks. 
  • Treatment aimed to help patients reconceptualize their pain as due to nondangerous brain activity rather than peripheral tissue injury, using a combination of cognitive, somatic, and exposure-based techniques. 
  • Participants randomized to placebo received a subcutaneous saline injection in the back; participants randomized to usual care continued their routine, ongoing care.

What They Found

Of 151 total participants, 33 of 50 participants (66%) randomized to PRT were pain-free or nearly pain-free at posttreatment,  That’s compared with 20% randomized to placebo  And 10% randomized to usual care.  Treatment effects were maintained at 1-year follow-up

Wrap It Up

The authors concluded, “Psychological treatment centered on changing patients’ beliefs about the causes and threat value of pain may provide substantial and durable pain relief for people with chronic low back pain.” This is why the American College of Physicians included cognitive behavioral therapy in their recommendations for first-line treatments for chronic back pain. You can have all of the issues you can imagine present on an x-ray but the main culprit resides in the noggin.  Ever heard of phantom limb pain? The pain lasted so long that the pain migrated more and more into the central, pain making part of the brain too.

They finally chopped off the peripheral problem; the limb. But it still hurt. They got rid of the peripheral source but did nothing to address the central source. THAT’S what we talking about when we mention the biopsychosocial aspect of pain. It’s no longer just a biomedical approach or issue. It’s much more when we talk about chronic pain. And it’s fascinating. 

Folks, it’s about the up-regulation or sensitized central nervous system in chronic pain patients. It’s about their beliefs about their current and future abilities. It’s about fear avoidance. It’s about de-conditioning. It’s about not understanding the difference between hurt vs. harm. It’s about them being mind screwed by healthcare practitioners that didn’t understand how to properly and optimistically relay findings and a diagnosis to them.  It’s about building them back up. 

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

Store

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

 

The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Ashar YK, G. A., Schubiner H, (2021). “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial.” JAMA Psychiatry.  
  • Dijkman HBPM, S. I., Bult P, (2021). “Assessment of Silicone Particle Migration Among Women Undergoing Removal or Revision of Silicone Breast Implants in the Netherlands.” JAMA Netw Open 4(9).    

Fear Avoidance & Opioids and Neuro Changes With Cannabis Use In Adolescence

CF 199: Fear Avoidance & Opioids and Neuro Changes With Cannabis Use In Adolescence

Today we’re going to talk about fear avoidance behavior and opioids and we’ll talk about cannabis use in adolescence.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

You have found yourself smack dab in the middle of Episode #199  Now if you missed last week’s episode, we talked about MRIs and Clinic Presentation & Surgery vs. Conservative Care For Discs. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

I’m headed to Chicago on Wednesday. I’m going to the American College of Chiropractic Orthopedics conference out there. When you have completed the Forensics course work as I have, you go to the conference and take the final test.  I’m just gonna lay it out there; I haven’t studied. I hope my memory is amazing. More amazing than I think my 49-year-old noggin actually is. In real life. I’ve gotten so damn busy lately, I couldn’t study if I wanted to. So, we’re going to Chicago, we’re hanging out and learning good stuff, and then we’re keeping our fingers crossed that I’m able to kick the Ol clunky car into the driveway and bring the second Fellowship back home to the Williams Estate. Ultimately, if I don’t knock it out, I’m better than I was before.

Honestly, at the price point for this one after having done the Ortho Diplomate, it was a no-brainer.  Just the part of the course that was the AMA course on Impairment was useful. It’s pretty cool how they’ve quantified disability for basically anything and everything.

Crazy crazy

As mentioned, the recovery of the clinic numbers continues. I’m the only Chiro in the clinic and I had 33 new Chiro patients just last week alone. It’s a challenge. I’m probably going to have to be looking to hire an associate sooner rather than later if this stays the way it’s been in the last month. Funny how about 6 weeks ago I was frustrated with the lack of significant recovery from the COVID era numbers. Delta was on the spike. I didn’t see anything but a longer tunnel before we saw the light.  I’m by no means convinced it’s over. But numbers are going down now. And even in the middle of the delta spike, people here were done. 100% done. Restaurants have been full. No masks and no special distancing. Concerts. The whole thing.

Kids in school with no masks.

We had a spike for sure. It didn’t get as bad as the last spike. But bad enough to get everyone’s attention. I lost some folks I know during this last one. One of my buddies is in his fourth week in the hospital with it right now.  But business is back regardless and I’m pleased to see it. 

If you’ve been following along on the NP thing, still slow going. As is expected. Slow growing, slow to get our message heard. Just slow. But busier The hormone pellets have been amazing. We’re doing the IV therapy, PRP injection, trigger point injections, medical weight loss, COVID testing,…..it’s been interesting to get a peek into this world we’ve been essentially locked out of.  Sitting here today though, not one patient on his schedule so, we talk to our current patient load. We introduce our NP to everyone. We make them all aware that he’s here and we remove barriers. Barriers like ‘fear of the unknown by just introducing him. It’s a challenge but it’s one we are fully engaged in. Stay tuned. I’ll keep you updated on our progress. 

Item #1

Item 1 this week 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, 2021, and it’s ablaze!

Why They Did It

To what extent is cannabis use associated with magnetic resonance imaging–measured cerebral cortical thickness development during adolescence?

How They Did It

  • Cannabis use was assessed at baseline and 5-year follow-up with the European School Survey Project on Alcohol and Other Drugs. 
  • MRIs were done on each
  • The study evaluated 1598 MR images from 799 participants (450 female participants

What They Found

  • At a 5-year follow-up, cannabis use was negatively associated with thickness in the left prefrontal and right prefrontal cortices. 
  • There were no significant associations between lifetime cannabis use at 5-year follow-up and baseline cortical thickness, suggesting that the observed neuroanatomical differences did not precede initiation of cannabis use. 
  • Analysis revealed that thinning in the right prefrontal cortices, from baseline to follow-up, was associated with attentional impulsiveness at follow-up.

Wrap It Up

Results suggest that cannabis use during adolescence is associated with altered neurodevelopment, particularly in cortices rich in cannabinoid 1 receptors and undergoing the greatest age-related thickness change in middle to late adolescence.

Item #2

Number two today is called, “Anxiety and Fear Avoidance Beliefs and Behavior May Be Significant Risk Factors for Chronic Opioid Analgesic Therapy Reliance for Patients with Chronic Pain—Results from a Preliminary Study” by Silva et. al. (Marcelina Jasmine Silva 2021) and published in Pain Medicine in September of 2021 and it’s most certainly en Fuego on this day. 

Why They Did It

To describe differences between patients with chronic, non-cancer pain (CNCP) who were successfully able to cease full use of chronic opioid analgesic therapy (COAT), and those who reduced reliance on opioids,. How They Did It

  • A retrospective review of electronic medical records (EMR) data was organized for preliminary analysis.
  • It was a review of electronic medical records (EMR) data
  • 109 patients participated between October 2017 to December 2019

What They Found

  • Patients who were unsuccessful at opioid cessation reported significantly higher Fear Avoidance Beliefs Questionnaire (FAB) scores. 
  • Pain Catastrophizing Scale (PCS) scores showed a split pattern with unclear significance.

Wrap It Up

Results suggest that fear-avoidance beliefs and behavior play a significant role in refractory chronic opioid analgesic therapy reliance for patients with chronic non-cancer pain. We know this and you know this if you listen to this podcast with any regularity. We’ve covered it 100 times it seems. You should be having an ongoing conversation with your new patients about fear avoidance. 

A normal conversation that I have with new patients suffering from chronic pain sounds similar to this,

“Movement is healing. Motion is the lotion for the joints. Think about when someone has something as serious as surgery; they have them walking the halls that day or the next. Because movement is healing. 

Those that want a bottle of pills and some extra time to sit and wait for it to pass will be waiting longer and, sometimes, it never heals at all. Those that are getting back to their lives and working through the discomfort typically get better and have a better resolution of the injury. Know the difference between hurt and harm. When you’re injured, it can hurt getting back to the grind but that doesn’t mean it’s harmful. In fact, most of the time, hurt doesn’t mean harm.  Work through it and make it happen.  Most experts agree that pain lasting beyond 3 months is turning chronic and harder to treat. Taking control of chronic pain starts with understanding it so I’m going to give you an article I’ve written called Decoding Chronic Pain.

Please read it and we’ll talk about it on the next visit. In that article, there’s a recommendation for a book called “Back In Control” by David Hanscom, MD. He’s a fellow chronic pain sufferer and an orthopedic spinal surgeon. This book will give you some education and some techniques to help you with the cognitive aspect of pain, which my article addresses. You can throw acupuncture, massage, chiropractic, exercises, shot, and/or surgery at chronic pain but, many times, if you’re not also addressing the cognitive aspect of long-term pain, you likely won’t get where you want to be.

Are you familiar with the term ‘phantom limb pain’? How can a limb that is no longer attached and got burned up in an oven still hurt? It’s because they treated the peripheral source of the pain but did nothing to address the central, cognitive aspect of the issue. So the part of the brain that makes up the pain experience continues to make that pain experience happen. Even after it’s gone. That’s also why research has shown that when a chronic pain sufferer has absolutely perfect surgery for anything, they have a 60% chance of developing new chronic pain at the new site of insult or surgery. Because their pain-making mechanism is on high alert and uses pain as the protection mechanism. 

Part of improving and moving past it is to not avoid activities that you love and that feed your soul. If you start backing away from these activities, that’s called fear avoidance, and avoiding things can lead to deconditioning after only about 7 days for most. Not only that, but it takes a hell of a lot longer to re-condition.  So, fight back, move, hurt but work through it, and take control of this.  We’ll help you move, we’ll help work on balance, we’ll help with proprioception, we’ll help you discover what you’re still capable of doing. You do the exercises and move on your own at home.

Go for walks. Just move as much as you can.  Just know that you’re not stuck this way. Do you have any questions? OK, let’s get to work.”

Boom. That’s it.

Or something like that. Sometimes it’s shorter. Sometimes it’s longer and more involved. I’ve sat and talked to patients for an hour or more just to have them go and give me a 3 or 4-star review on Google because I didn’t get a good pop out of their back and they don’t feel any better after one visit. 

You know how it is.

That kind of stuff makes you want to stomp kittens and club baby seals but then there are those that you are able to save their lives on some level.

They’re the ones we’re here for so keep it all in the proper context and do the best you can every day.  Those are the ones that need us to be on top of our games.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to better it. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

The Message

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

  • Albaugh MD, O.-G. J., Sidwell A, (2021). “Association of Cannabis Use During Adolescence With Neurodevelopment.” JAMA Psychiatry.
  • Marcelina Jasmine Silva, D., Zhanette Coffee, MSN, Chong Ho Yu, PhD, Marc O Martel, PhD (2021). “Anxiety and Fear Avoidance Beliefs and Behavior May Be Significant Risk Factors for Chronic Opioid Analgesic Therapy Reliance for Patients with Chronic Pain—Results from a Preliminary Study.” Pain Medicine 22: 2106-2116.

 

Extruded Discs – Surgery or No Surgery?

CF 197: Extruded Discs – Surgery or No Surgery? Today we’re going to talk about extruded discs – surgery or no surgery? This one may surprise some of you.  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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 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 #197 Now if you missed last week’s episode , we talked about How Car Wrecks Contribute To Future Neck and Back Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, I’m feeling pretty good today. Last week was the very first time since February of 2020 that we hit the average weekly visit number that we were doing. I don’t know if that came out right. Before Rona, we were averaging 185 visits per week in 2019.  Rona came along and the best we’ve been able to eke out was about 160. Maybe 165. With the rollercoaster ups and downs of the Rona outbreaks, that number has been down but since February of 2020, it’s never been any higher than that.  Until last week. Last week, by myself, I hit 187. 23 of them were new patients. When you are evidence-based and patient-centered, you don’t hold on to patient unnecessarily for extended visits and treatment schedules so, unfortunately, you live and die by your new patient count. 

Fortunately for me, I’m to a point that new patients aren’t a huge concern. I always have my eye on the count, but it doesn’t give me anxiety these days. We are pretty established here in my community and it tends to mostly take care of itself. Thank my good Lord.  I don’t know if you’ve listened this long but back in February of 2020, the 14th to be exact, my wife and I took a trip to Key Largo. It was amazing.

I left a bustling, busy as hell practice to go on vacation. There was some concern about this COVID stuff but nothing crazy.  In fact, I remember asking my wife on the way to Florida if we should take a mask just in case they told us we needed one. She told me if I brought a mask, that she’d punch me in the nose. Lol. Yes, I have that kind of a wifey. She’s a feisty Texas woman, ya know.  After a week in The Keys, I came back to a ghost town. And then it got worse. I swore I’d never go on vacation again if it was going to tank my practice like that. Well, obviously, it was COVID. And it’s taken a year and a half to start to reclaim our lost business.

But, at 45 patients today as I type this and 5 of them being new patients, this week is looking good too.  Here’s the best news about it all; this is in the midst of a BIG resurgence of COVID here in Amarillo locally. They are adding numbers at the rate they were adding them back in the worst of times. But people are done with it. They just are.  I was one of the first group of providers to be vaccinated here locally. My friends and connections in the medical world here called me when it first came available. They recognized that we work in very close proximity with patients and reached out. Most of my staff and I accepted. I’ve been vaccinated since January 2021. 

I just got the booster on August 26th. It’s a personal thing for each of us but, when you have had a hit on your business like I have, and you’ve had all of the ups and downs, and you’re just now getting back to where you left off after basically losing a year and a half…….well, I’m not about to take a chance on getting sick and being out for 2-4 weeks and watching my business go to crap again.  Including me, I have 12 employees.

That includes 4 CA’s, 3 LMT’s, an NP, an acupuncturist, an esthetician, a billing pro, and I have an intern from Parker College here. These people have families, mortgages, bills, car payments, and gambling debts just to name a few things.  The point is, when you’re the main provider and breadwinner, for me, it’s up to us to be as responsible as we can to make sure we are able to do our jobs.  For example,  here in Amarillo, TX, we are fairly close to the Colorado and New Mexico mountains. About 3 and a half hours to NM and about 5 or so to Colorado. Pretty close. We grew up going skiing in the mountains.

But it dawned on my during my last trip a few years ago; they call them accidents for a reason.  If I fall and break a wrist or twist a knee up, I could be out of a job for up to 6 weeks or more. Well hell, in most cases, that’s more time out than COVID would take you out. I’m the major provider at this time for this clinic. I can’t allow that. So, I gave up snow skiing. It’s not worth it to me.  Why should the pandemic be looked at any differently? For me, it shouldn’t be.  Anyway, I got a little sidetracked there.

Things are going well. I’m hoping business is back to normal and stays normal. For me and for you. We have all fought hard and deserve it.  Now, let’s get some folks to feeling better shall we? Let’s hop into research having to do with large extruded discs.  Once upon a time, I would send them straight to a Neurosurgeon. Not so quickly these days. Knowledge and clinical experience tell me to think twice. Especially in the absence of progressive neurological deficits. 

Item #1

Item one is called “Spontaneous Regression of a Large Lumbar Disc Extrusion” by Ryu et. Al (Ryu Sung-Joo 2010) and published in the Journal of Korean Neurosurgical Society back in 2010. It’s got a little dust on it but not a ton.  

Why They Did It

They say that Although the spontaneous disappearance or decrease in size of a herniated disc is well known, that of a large extruded disc has rarely been reported. This paper reports a case of spontaneous regression of large lumbar disc extrusion. The disc regressed spontaneously with clinical improvement and was documented on a follow-up MRI study 6 months later. 

How They Did It

  • It’s a case report so it’s not incredibly impactful but still helpful for something like this. You can see it on one MRI and then 6 months later, it’s gone. 2+2=4 so I’m OK with a case report on something like this here. 
  • A 53-year-old woman was referred to our clinic with a 6-month history of low-back and left lateral leg pain with numbness. Six months earlier, her symptoms had developed suddenly as severe left lateral leg pain. 
  • A neurological examination showed no neurological deficits. The straight leg raise test was negative bilaterally. The lumbar spine MRI performed 6 months earlier revealed a left posterolateral herniated nucleus pulposus which was migrated caudally and compressed the left L5 root
  • She received conservative treatment including pain-relieving medication, physical therapy and spinal anesthetic block therapy due to her poor medical conditions

What They Found

  • After conservative treatment, her clinical symptoms subsided gradually but the numbness of her left lateral leg still remained. A second MRI study performed approximately 6 months after the prior examination reveal almost complete disappearance of the extruded fragment that had been located posterolateral to the L5 vertebral body, and no evidence of compression or displacement of the dural sac or nerve root
  • The height of the L4/5 disc space remained decreased compared to the other levels and was unchanged from the previous MRI examination.

Wrap It Up

  • The precise mechanisms of disc regression are unclear. Three hypotheses have been proposed to explain the process of disc regression. 
  •  
  • The first hypothesis, “retraction of a herniated disc”, proposes that the herniated disc retracts back into the intervertebral space17). Theoretically, this can occur if there is a disc bulge or if the disc material protrudes through the anulus fibrosus but is not separated from it6). However, it would be unlikely in cases of completely extruded or migrated fragments. 
  •  
  • The second explanation, “dehydration of herniated disc”, states that the herniated fragment would disappear due to gradual dehydration and shrinkage16). 
  •  
  • The third hypothesis, “inflammatory reaction and neovascularization”, which is the most compelling and studied hypothesis, states that extruded disc material into the epidural vascular space of spine is recognized as a “foreign body” and induces an inflammatory reaction by the autoimmune system. This would cause neovascularization of the cartilaginous tissue along with infiltration by inflammatory cells, such as macrophages, granulocytes, and lymphocytes7,8,10,11,15). Several histopathology studies from surgical specimens and experimental animal research support this theory
  • Nevertheless, it is possible that all 3 mechanisms play a role in the regression and disappearance of herniated disc tissue.
  • Motor and sensory deficits are present in 50-90% of patients with a herniated lumbar disc18). Surgery can be carried out as an emergency when bladder symptoms or progressive motor weakness are present. In the absence of these symptoms, 75-90% of patients with acute sciatica due to a protruded lumbar disc experience a resolution of symptoms without surgery 
  • Conservative treatment should be considered when cauda equina syndrome or progressive motor weakness are absent in the acute stage of the lumbar herniated disc. Surgical intervention should be considered in cases with neurological deficits or intractable low back and leg pain despite the initial conservative treatment

CHIROUP ADVERTISEMENT

Item #2

Our last one is called “Spontaneously disappearing large herniated lumbar disc fragment”’ by Reddy et. al. (Reddy UV 2014) and published in the Journal of Orthopaedics and Allied Sciences in 2014. As impactful as this information is, why do you think there aren’t more studies on it that are recent? Could it because it suggests they shouldn’t be doing surgery on these large extruded discs?

Why They Did It There are reports of spontaneous regression of large extruded disc; however, the exact underlying mechanism and management of such cases remains controversial. We report a 40-year-old female who opted for conservative management for a large extruded lumbar disc. Follow-up magnetic resonance imaging (MRI) showed complete disappearance of the disc fragment; however, there were degenerative changes in the upper and lower adjacent margins of the vertebral body.  Herniated lumbar disc is one of the common causes of low back pain and smaller disc herniations tend to regress over a period of time; and thus, the pain is known to improve with conservative management. 

How They Did It

A 40-year-old female presented with low back pain of 2 year duration. The pain was radiating to lower limbs more to the left side. There was no history of motor or sensory deficits. There was no history of bowel or bladder dysfunction. She was investigated for the similar problem with an MRI 6 months back and it showed a large disc protrusion [Figure 1]. However, she opted for conservative management. On examination, there were no focal motor or sensory deficits. Deep tendon reflexes were normal except bilateral sluggish ankle jerks. Planters were flexor. As the patient was complaining in the severity of the pain with numbness and a repeat magnetic resonance imaging (MRI) was performed. Follow-up MRI showed complete disappearance of the disc fragment;

What They Found

The exact timing for spontaneous regression of the protruded disc material is not known; however, it ranges from few weeks to months. The fastest regression of the fragmented disc material was reported in 2 months.

Wrap It Up

Present case illustrates that a conservative approach can be adopted for a large extruded lumbar disc as it can resolve in a selective group of patients. [24],[38],[39] Spine surgeons should be aware of spontaneous regression of the disc phenomenon as a patient with a large extruded disc who opted for the conservative management initially can have persistence pain, but there may not be an underlying protruded disc. It is important to perform a repeat imaging of the spine to assess the degree and severity of the disc protrusion before making a plan for surgery or any further conservative management.

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

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

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

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website 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

  • Reddy UV, A. A., Hegde KV, Suneetha P, Rao MG, (2014). “Spontaneously disappearing large herniated lumbar disc fragment.” J Orthop Allied Sci 2: 26-28.  
  • Ryu Sung-Joo (2010). “Spontaneous Regression of a Large Lumbar Disc Extrusion.” J Korean Neurosurg Soc. 48(3): 285-287.    

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

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

  The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website 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

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

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

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

  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

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

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

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website 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.