evidence-based chiropractic

CF 176: Car Crashes and Research To Go Along With It (Part Two)

CF 176: Car Crashes and Research To Go Along With It (Part Two) Today we’re going to continue to talk about car wreck research. It’s good stuff and useful for all clinics and docs that deal with personal injury patients.  But first, here’s that sweet sweet bumper music
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Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #176 Now if you missed last week’s episode, we talked about Car crashes and awesome research around that topic. Part one I guess. Today’s episode is pretty much part two. So, make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. On the personal side of things, we are still going down the path towards having the medical entity completed. I made a hire that I feel confident in. The nurse practitioner was referred to me by another nurse practitioner here in town who was his preceptor or teacher for his clinical hours when he was going through school. She told me that he is super smart, excellent with patients, eager to learn, and his wife is an amazing cook. So I was sold. And just taking the time to get to know him, I’m even more confident that I have made a good decision going forward. The majority of the work on this is going to be in the first 3 to 6 months I think. We have to get systems in place, I have to teach the nurse practitioner the exam I do. How do you teach somebody how to do the exam that an ortho fellowship practitioner does? Well, we shall find out.  I’ve already loaned him one of my dr. Stuart McGill books to get started on. I’ve been sharing with him a lot of the information that I learned in the Neuromusculoskeletal program, I’ve talked to him about McKenzie protocols and migrating the disc, and started him on the path of different ways to think of chronic pain. Including the up-regulated and sensitized central nervous system as well as the biopsychosocial aspect of chronic pain. Yellow flags, words matter, limiting MRIs, and all of the associated Tom Foolery.   He was unfamiliar with quite a bit of what I have been teaching him and showing him. But very receptive and very interested in learning about that side of pain and newer ways of thinking about it and approaching it. I think we’re going to be a great team.  Outside of that part of my life, I’ve started with the book launch. Not really the launch itself as much as getting the book ready for launch and putting together a launch team. What does a launch tram do exactly? Well, let me tell you. Basically, I’m going to be uploading it to Amazon once it’s formatted for it and everything is in place. Then, it’ll be free for the first 3 days. That’s when everyone on my launch team will go download it. Then, leave a review for it…..because my launch team is cool and they know that’s part of the launch process.  The free downloads and the Amazon book reviews give the book a little Amazon juice which will propel it up the charts a bit. That way, when the initial 3 days are over, and I can start charging money for it, the Amazon Juice has it set up for success and sales.  So, that’s the plan and guess what?? I’d love it if you regular listeners would like to be on my launch team. If so, just send me an email to dr.williams@chiropracticforward.com and make sure you tell me you’re on the launch team. It’s that easy. Or, send me a message through our Facebook group or the Facebook page or through smoke signal.  Whatever means you can get me a message that you want to help us, that’ll work for me.  It would be rude of me to not thank a couple of folks. I need to thank Dr. Chris Howson and Dr. Steven Roffers for helping me with the editing process. Dr. Howson is the inventor of the Drop Release tool, he’s smarter than hell, and he’s a good person on top of all of that. Go check out the Drop Release tool and show Dr. Howson some love won’t you? Dr. Roffers is the group admin of the Facebook group called Chiropractic Research Alliance with over 8,000 members, he’s a certified medical editor and serves on the editorial boards of 14 journals. Dr. Roffers offered to help me edit the draft as well.  So, these two pros need to be thanked and properly recognized for their efforts and their generosity. I appreciate you two and just appreciate you.  I honestly thought I’d ask for launch team members and there’d be crickets. In the first post I made on my Facebook properties, I’ve now got about 25 super awesome people that want to help support and promote the project. And in the process, they’re supporting and promoting evidence-based, patient-centered healthcare.  It’s a win-win and I thank you all. More to come as I get further down the road.  Now, on with the research.  CHIROUP ADVERTISEMENT As I mentioned last week, this podcast episode was inspired by a recent episode of the Chiropractic Science podcast hosted by Dean Smith. It was episode number 55.  His guest was Dr. Michael Freeman who I talked about in last week’s episode. These papers are papers they talked about on that episode so, if you want it from the horse’s mouth, go over to Chiropractic Science and find the recent episode with Dr. Michael Freeman and hit play. Then come back here and get my take on it.  Now let me pause just a second and say that if you haven’t jumped into personal injury, don’t. Unless you plan on getting the education it takes to do a good job. Take courses. Make yourself the expert. Know your worth. It pays well but the stakes are high for your patients. You have to deal with attorneys. You might have to testify under oath in court. Do you REALLY want to do that if you’re education and experience are not up to snuff? When I jumped in back in 2007, I had a basic Chiro education but I was not specialized in car wrecks or whiplash. I could have been better. So I made myself better. I recognized my shortfalls and I filled the gaps. I got the Advanced Certification in whiplash biomechanics and Traumatology through the SPINE Institute out in San Diego, CA. I got the certification from the Personal Injury Institute through Matthew DeGaetano who was also a Croft Commando.  I have attended CE hours on PI specifically. I ended up compiling all of the experience and education into a macro for ChiroTouch. If you want to check that out, go to personalinjurymacro.com but you’re not going to want to buy it unless you’re using ChiroTouch. It’s like gold though if you have ChiroTouch.  It’s got all of the Croft stuff in there, the research citations, crash descriptions, risk assessments, the whole thing. Plus all of my customization after I went through the Fellowship for the Neuromusculoskeletal program. IT’s gold, folks.  Anyway, my point was that you do your reputation and you do your patients a disservice if you are in the PI arena but you don’t know what the hell you’re doing. Plain and simple. It’s lucrative but dammit, get educated or get out. And understand that you’re not going to get 100% on every case.  To demonstrate my point, as I said, I’m a specialist now with the Fellowship, I have the cert in whiplash biomechanics and Traumatology, and I’ve been recognized as an expert in whiplash at the District Court level. Because of my macros I created, I can make narrative reports that nobody I’ve met can beat.  And YET…..I still don’t get 100% of my bills. Don’t think you’re going to get 100% either.  Because that’s the way PI works. Not all cases are created equally. Some fall apart completely. Some attorneys are truly awful people so stay on your toes. Some are amazing people and those are the ones you want to work with. Sometimes, the patient disappears. Sometimes they get in trouble and go to jail. Sometimes the insurance company just won’t budge and the attorney doesn’t feel there’s a strong enough case to go to court on.  At those times, you better be willing to wheel and deal. Otherwise, you might get that one bill paid but that attorney won’t be sending you any more clients and guess what? Attorneys talk to each all of the time. They’re mostly all good friends.  Some of my best friends professionally are attorneys. Some of my biggest enemies professionally through the years have been attorneys. One still owes me $42,000 and I don’t expect I’ll ever get it out of him because he’s a worthless, useless, terrible human being. But, it’s part of the dangers of swimming in this particular lake. Some of the fish have no souls.  But again, some are amazing people that I have forged solid friendships with.  I went off the rails a bit there but the point again is this; either get educated and do it at a high level or leave it to others that did actually put the work in to get the extra education. Plain and simple.  Item #1 Our first paper is called, “A systematic approach to clinical determinations of causation in symptomatic spinal disk injury following motor vehicle crash trauma”’ by Dr. Michael Freeman, et. al. (Freeman MD 2009)  and published in Physical Medicine and Rehabilitation back in 2008.  Why They Did It This is a really long description of the objective here so follow along and we’ll discuss, “Clinical determinations of causation in cases of intervertebral disk (IVD) injury after a motor vehicle crash (MVC) are often disputed in court settings.  No published systematic guidelines exist for making such determinations. This has resulted in nonclinical people determine injury causation and performing the evaluations. This is traditionally a clinical activity.  The result is causal determinations that are potentially disconnected from clinical observations of injury. Meaning, when non-clinical people are doing the evaluation, they get it wrong a lot.  The purpose of this review was to evaluate the current literature on causation, causal determinations after trauma and intervertebral disk injury after a motor vehicle crash, and to develop a practicable, logical, and literature-based approach to causation determinations of symptomatic intervertebral disk injury after a motor vehicle crash. That was almost all quoted from the paper’s abstract but I tried to make it even more basic and less confusing.  What They Found
  • The results of the review indicate IVD injury can result from any MVC regardless of magnitude, thus meeting the first criteria of causation, biologic plausibility.
  • Individual determinations of causation depend entirely on the temporal association between the collision and the symptom onset (the second criterion) and a lack of a more probable explanation for the symptoms (the third).
  • When these causal elements are met, clinicians can assert causation on a “more probable than not” or “reasonable probability” basis.
  • You may have heard me mention I’m currently undergoing the Forensics Diplomate program right now. That is legal speak there. Probably meaning ‘greater than a 50% chance.”
Wrap It Up For the conclusion, they say, “Because of a lack of an established or reliable relationship between collision force and the probability of IVD injury the investigation of collision parameters is not a useful adjunct to causal determinations.” Item #2 Our last one today is called “Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma” by Freeman et. al. (Freeman MD 2020) and published in the International Journal Of Environmental Research and Public Health in 2020 and that’s still got some smoke! Now….if you don’t know, what is Videofluoroscopic examination? It’s basically x-rays (and video) that are dynamic. X-rays that are moving. So you can see the patient go into cervical flexion. It’s cool as hell. But you can accurately see when there is ligament injury or ligament laxity as well because in real time, you can observe the one vertebra slide forward on the one under. It’s crazy and a bit spooky.  When you see one vertebra slip forward on the one underneath as the patient goes into cervical flexion, it’ll make you anxious in your belly. It might make you pee a little. Anyway, look it up. See if you can find some videos through your Google machine.  Why They Did It Intervertebral instability is a relatively common finding among patients with chronic neck pain after whiplash trauma. Videofluoroscopy (VF) of the cervical spine is a potentially sensitive diagnostic tool for evaluating instability, as it offers the ability to examine relative intervertebral movement over time, and across the entire continuum of voluntary movement of the patient. At the present time, there are no studies of the diagnostic accuracy of Videofluoroscopy for discriminating between injured and uninjured populations. How They Did It
  • Symptomatic (injured) study subjects were recruited from consecutive patients with chronic (>6 weeks) post-whiplash pain presenting to medical and chiropractic offices equipped with Videofluoroscopy facilities.
  • Asymptomatic (uninjured) volunteers were recruited from family and friends of patients. 
  • Three statistical models were utilized to assess the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of positive Videofluoroscopy findings to correctly discriminate between injured and uninjured subjects.
What They Found
  • A total of 196 subjects (119 injured, 77 uninjured) were included in the study.
  • Videofluoroscopic examination of the cervical spine provides a high degree of diagnostic accuracy for the identification of vertebral instability in patients with chronic pain stemming from whiplash trauma.
Wrap It Up “Videofluoroscopic examination of the cervical spine provides a high degree of diagnostic accuracy for the identification of vertebral instability in patients with chronic pain stemming from whiplash trauma.”     Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.    Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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  The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!   Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!   Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.    Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.   Website
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  Social Media Links https://www.facebook.com/chiropracticforward/   Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/   Twitter     YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q   iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2   Player FM Link https://player.fm/series/2291021   Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through   TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/   About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Freeman MD, C. C., Kohles S, (2009). “A systematic approach to clinical determinations of causation in symptomatic spinal disk injury following motor vehicle crash trauma.” PM R. 1(10): 951-956.   Freeman MD, K. E., Rosa S, Gatterman B, Strommer E, Leith W, (2020). “Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma.” Int J Environ Res Public Health 17(5): 1693.  

Car Crashes And Awesome Research To Go Along With It

CF 175: Car Crashes And Awesome Research To Go Along With It Today we’re going to talk about car wreck research and it’s pretty cool. Especially if you treat PI patients and you ever find yourself testifying. I’m going to give you a couple of caveman clubs that you can use to figuratively bash a rabid attorney with.  But first, here’s that sweet sweet bumper music.

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #175 Now if you missed last week’s episode , we talked about ow back disability and osteoarthritis research. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

We hired a nurse practitioner. I have to say that there are so many scary talented and scary smart people out there in the world, folks. We got to meet several of them while going through the interview process. If everyone comes out of school highly trained, it’s hard to use that as a measuring stick.  So, I fell back to my core need; which was to hire a good person. It wouldn’t be helpful to hire someone that would come in and feel superior to everyone else in the office. It wouldn’t be helpful to hire someone highly trained but they don’t treat my staff with respect and even love. That would kill office culture dead in its tracks and I like my office culture. 

I tease my staff. I tease my patients. They tease me back. I love the atmosphere. I don’t want to hire a stick in the mud. So I didn’t. When it comes down to it, you can train everything that needs to be trained. But you can’t make a miserable person a good person. You can’t make an introvert an extrovert. You can’t make someone that has a sense of entitlement into someone that is full of gratitude.  You just can’t do it. I think the one we hired is the closest of all that we interviewed to me and who I am and how I carry myself.

He’s new so there won’t be any bad habits. He’s eager to learn. I love that. I’m afraid I’m not the best teacher but we’re going to do it anyway! So, that’s my big news this week, the NP is on and this train is rolling down the tracks now.  Now, I’m going to tell you that here in Texas, masks are no longer mandated. Not even in the schools. So, as you might imagine, if COVID were still a huge concern here, there would be people piling up in the hospitals.

There aren’t. In fact, your hospital load just continues to dwindle. We are in an area of about 275,000 people or so. And the last number I saw last week was that we added 15 new cases that day.  That’s with kids going to school and interacting with each other. In BIG schools. When you go to a restaurant, the places are packed with people. I’m telling you, here in Texas, there is no ‘new normal’. There is the old normal.

You’d never even know that anything was ever different for a year, honestly.  Yet, numbers are continuing to go down. So, why are other states back on the rise? What does it all mean? Has Texas reached herd immunity through infections and vaccines? Maybe. Texas has been a problem state for COVID for months until more recently.  I don’t know all of the answers. But what I feel is that the states that are still on serious lockdown are doing their population an injustice when you compare them to Texas. If their kids aren’t in school, they should be. They’re doing more damage than good from what I can tell. At this point anyway. 

Trust me, I’ve been all about being safe and smart and taking care of each other. Especially those most at risk. But, at this point, everyone that wants to be vaccinated in my area is vaccinated. At this point, in my state, if you get sick, it’s because you chose to risk it. Plain and simple.  Alright, let’s dive in. But first, I want to drop in a word about our amazing sponsors and give you a way to save a little money. 

CHIROUP ADVERTISEMENT

This podcast episode was inspired by a recent episode of the Chiropractic Science podcast hosted by Dean Smith. His guest was Dr. Michael Freeman who I’ll talk about here in just a minute. These papers are papers they talked about on that episode so, if you want it from the horse’s mouth, go over to Chiropractic Science and find the recent episode with Dr. Michael Freeman and hit play. Then come back here and get my take on it. 

Item #1

This one is called “Is Acceleration a Valid Proxy for Injury Risk in Minimal Damage Traffic Crashes? A Comparative Review of Volunteer, ADL and Real-World Studies” by Nolet, et. al. (Nolet PS 2021) published in International Journal of Environmental Research and Public Health in March of 2021 and I can’t even….wouldn’t even try to touch it…..

Why They Did It

Let me preface this by saying that Dr. Michael Freeman is an author on this paper and he’s just a phenomenal asset to chiropractic, health in general, and personal injury research. If you aren’t familiar with Dr. Freeman, we’re talking about the fact that he’s a DC, an MD, and Ph.D. and a whole bunch of other stuff one single person has any business being.  Also on this paper is Dr. Art Croft. I have the advanced certification through Dr. Croft’s SPINE Institute in San Diego and I have to tell you that he’s one of the most impressive individuals I’ve ever personally met.  In the paper, they say, “Injury claims associated with minimal damage rear impact traffic crashes are often defended using a “biomechanical approach,” in which the occupant forces of the crash are compared to the forces of activities of daily living (ADLs), resulting in the conclusion that the risk of injury from the crash is the same as for ADLs.” 

To put that in me and you talk…..what they’re saying is that it’s common in court for attorneys to say that being in a 5mph low-speed rear impact is similar in force to just stepping off of a sidewalk curb. Or some other ridiculous analogy like that.  They go on to say, “The purpose of the present investigation is to evaluate the scientific validity of the central operating premise of the biomechanical approach to injury causation; that occupant acceleration is a scientifically valid proxy for injury risk.”

To put that in me and you talk…..they just want to see if common every day events are truly like a low-speed rear impact car wreck. 

How They Did It

  • Data were abstracted, pooled, and compared from three categories of published literature: 
      1. Volunteer rear-impact crash testing studies, 
      2. ADL studies, and 
      3. Observational studies of real-world rear impacts. 
    • We compared the occupant accelerations of minimal or no damage (i.e., 3 to 11 kph speed change or “delta-V”) (2 mph up to 7 mph. ) rear-impact crash tests to the accelerations described in 6 of the most commonly reported ADLs in the reviewed studies. 
    • As a final step, the injury risk observed in real-world crashes was compared to the results of the pooled crash test and ADL analyses, controlling for delta-V.
    • OK in me and you speak, Delta V just means the change in speed that was experienced. Anytime you are in a wreck, you essentially go from one speed to another in a millisecond. That’s not conceptually, that’s literally. Delta V helps to describe that change in speed. 

What They Found

  • The results of the analyses indicated that average peak acceleration forces observed at the head during rear impact crash tests were typically at least several times greater than average forces observed during activities of daily living.
  • In contrast, the injury risk of real-world minimal damage rear impact crashes was estimated to be at least 2000 times greater than for any activities of daily living. So defense attorneys can stick that in their hat and smoke it up twice.

Wrap It Up

The results of our analysis indicate that the principle underlying the biomechanical injury causation approach, that occupant acceleration is a proxy for injury risk, is scientifically invalid. The biomechanical approach to injury causation in minimal damage crashes invariably results in the vast underestimation of the actual risk of such crashes and should be discontinued as it is a scientifically invalid practice. That also seems like a mic drop if the attorney pulls it out and uses it in a case. And should be appropriately accompanied by superhero comic noises like

Slap! Pow! Snap! Kazaam! Fwaaaap!! I love it.

Item #2

Item #2 is called “Estimating the number of traffic crash-related cervical spine injuries in the United States; An analysis and comparison of national crash and hospital data” by Michael Freeman and Wendy Leith (Freeman MD 2020) and published in Accident Analysis And Prevention in July of 2020 and that’s still got some steam to it. 

Why They Did It

In the intro, they say, “Cervical spine injury is a common result of traffic crashes, and such injuries range in severity from minor (i.e. sprain/strain) to moderate (intervertebral disk derangement) to serious and greater (fractures, dislocations, and spinal cord injuries). There are currently no reliable estimates of the number of crash-related spine injuries occurring in the US annually, although several publications have used national crash injury samples as a basis for estimating the frequency of both cervical and lumbar spinal disk injuries occurring in lower speed rear impact crashes.”

In me and you speak, they’re saying that many defense attorneys want to use estimates on neck injury and severity prevalence from national databases but it doesn’t make sense to do it that way and you can’t use these databases as a proper defense in a court case.  They say the purpose is, “To develop a reliable estimate of the number of various types of cervical spine injuries occurring in the US by comparing data from national crash injury to national hospital emergency departments and inpatient samples.”

Well, that makes sense to me….let’s see how it came out. 

How They Did It

Comparative cross-sectional METHODS: Cervical spine injury data were accessed, analyzed, and compared from 3 national databases; the 

    1. National Automotive Sampling System-Crashworthiness Data System (NASS-CDS), 
    2. Nationwide Emergency Department Sample (NEDS), and the 
    3. Nationwide Inpatient Sample (NIS).

What They Found

  • It is estimated that there are approximately 869,000 traffic crash-related cervical spine injuries seen in hospitals in the US annually, including around 
      • 841,000 sprain/strain (whiplash) injuries, 
      • 2800 spinal disk injuries, 
      • 23,500 fractures, 
      • 2800 spinal cord injuries, and 
      • 1500 dislocations.
  • Because of highly restrictive inclusion criteria for both crash and injury types, as well as a very small sample size, the NASS-CDS underestimated all types of crash-related cervical spine injuries seen in US hospital emergency departments by 84 %
  • The injury type with the largest degree of underestimation in the NASS-CDS was cervical disk injuries, which were estimated at an 88 % lower frequency than in the Nationwide Emergency Department Sample
  • National insurance claim data, which include cases of cervical disk injury diagnosed both in and outside of the ED, indicate that the Nationwide Emergency Department Sample likely undercounts cervical disk injuries by 92 %, and thus the NASS-CDS correspondingly undercounts such injuries by 99 % or more.

Do you see why it’s so good to have people like Dr. Michael Freeman and Dr. Art Croft on our side? Holy smokes. Who else is out there putting attorneys in their place like these folks have done for years?

Wrap It Up

They end it by saying “Because of a limited sample size and restrictive criteria for both crash and injury inclusion, the NASS-CDS cannot be used to estimate the number of crash-related spinal injuries of any type or severity in the US. The most inappropriate use of the database is for estimating the number of spinal injuries resulting from low-speed rear impact collisions, as the NASS-CDS samples fewer than 1 in 100,000 of the cervical spine injuries of any type occurring in low-speed rear impact collisions.” Smack, Kowapow, Thunk! As I said, I love this kind of research. I remember Dr. Croft speaking about being an expert and attorneys starting to come at him and how he was able to just draw them out into deeper water before putting ‘em under!! I love it. 

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

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

Website http://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

Freeman MD, L. W. (2020). “Estimating the number of traffic crash-related cervical spine injuries in the United States; An analysis and comparison of national crash and hospital data.” Accid Anal Prev 142(105571).  

Nolet PS, N. L., Kristman VL, Croft AC, Zeegers MP, Freeman MD, (2021). “Is Acceleration a Valid Proxy for Injury Risk in Minimal Damage Traffic Crashes? A Comparative Review of Volunteer, ADL and Real-World Studies.” Int J Environ Res Public Health 18(6): 2901.      

Useless Research & Insulin or Inflammation

CF 172: Useless Research & Insulin or Inflammation Today we’re going to talk about how I treat my staff, we’ll talk about insulin vs. inflammation, and we’ll talk about some trash research that came out in JAMA recently that you may wind up being confronted with at some point so listen up.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #172 Now if you missed last week’s episode , we talked about going the way of the non-pharma world. If we could just get the the medical world to take a look at it. We also talked about insurance coverage trends and how they’re not very favorable to chiropractors. As you probably already feel. 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, we’re still interviewing nurse practitioners and still getting our ducks in a row. We have the attorney that is setting up the medical entity meeting with our CPAs out in St. Louis to make sure it is set up in the most tax-advantageous as well as the most ideal legal way.  Any time you have your CPA and your attorney working together, you’re probably in a good place me thinks. I have a meeting with the medical director this week to go over what services he’s going to be OK with us offering. When appropriate, we’ll be looking at things like intra-joint injections, trigger point injections, low-level scripts but no narcotics.  Basically, anything we offer here will be very low risk. Not only because it inherently lowers our risk to adverse events, which makes me sleep better every night, but it also helps to keep a happy medical director. If it all works right, this is almost mailbox money for the medical director while providing an awesome gig for a nurse practitioner that is at least halfway motivated to build their practice. 

Think about it, nurses and nurse pracs are used to 12-hour shifts. They’ve missed important holidays and important events in their personal life due to having to work. Here, there are no weekends, there are not holidays spent working, vacation time, it’s all good in the hood at my place. Plus, they get to learn as much about orthopedics as they want to learn and a whole bunch they maybe don’t want to learn but is required to learn in order to work here.  That’s the deal though right?

Gotta pick the right NP because it all hinges on that one decision. Pick the wrong one and you’re out of business until you can get another hired. Doesn’t sound like a big deal until you factor in the 3 months it takes to get a new one credentialed. Speaking of, I have to get re-credentialed under the new medical entity. That’s because of Stark and anti-kickback laws.  This isn’t something to go into lightly. It’s like I said last week or two weeks ago here on the podcast, the wheels on this thing turn slowly and I’m OK with that. That way I don’t get out over my skis and lose control.  So, that’s where we’re at on that. 

Currently, I’m taking the opportunity to type this out on a Sunday afternoon. We are up at the office throwing a staff member her baby shower. No, I’m not a baby shower kind of dude as you may have guessed. I’m a Bud Light and guitars kind of guy. But, my wife decided we’re throwing our staff member a baby shower so here I am at the office recording this while the chicks and the hens are out there clucking and cackling. And I don’t mean that in a misogynist way. I mean it in a funny, playful kind of way so take it that way. 

It brought up a thought; do you treat your staff members like workers? Or do you treat them more like family? Right or wrong, as a result of my nature and my heart, we treat ours like family when appropriate. I’ve had staff ask me advice on deep dark stuff they were struggling with. I’ve had staff whose family was going to prison, the whole town knew, they were ashamed, and they just need some love, a little extra consideration, and a few big hugs. That one still gets me a little emotional when I think about it.  I’m going to give you a few more examples here but before I do, I don’t want you to misunderstand anything here. I’ve learned over the years that you cannot buy loyalty from your staff. They’re either with you every step of the way, or they are not. And that’s OK. Everyone is coming from different places, experiences, and motivations. Not a thing wrong with that.  But don’t do things for the wrong reasons. Don’t think you’re going to do a bunch of things for staff thinking it’ll ensure they stay with you forever. That’s just not reality and it’s a good way to allow yourself to get hurt on some level.  If you’re going to treat staff like family, you do it for all of the right reasons. Love, appreciation for them and their character, admiration for a job well done, team building, and things like that.  Getting back to it, I’ve sold a car to a staffer that was coming out of a bad relationship and had no transportation. I sold it to them for about $4,000 less than I could have gotten for it and let them pay it out $50 a paycheck and zero interest.  I’ve created a new, extra job for a staffer that was about to lose their house. It cost me an extra $1500/month for the following 2-3 years but that’s the way I am. 

I’ve sponsored kids sports for staffers more times than I can even start to recall.  In the end, money will come and go. It can be lost and it can be made. But it’s the relationships that stay with us.

Were we put on the planet just to make money and take care of our families? 

Or were we put on this planet to make ALL of our immediate relationships prosper and make the world, or at least our part of it, a better place?  You probably know where I come down on all that. It may sound a little hippy-dippy there, which I’m not at all, but I do see it that way. Money is nice and I see it as a challenge. A challenge to make it and see how much I can make ethically and morally. It’s fun to make money! But money really isn’t my main motivation any more.

I’m a huge stats person and track stuff like crazy. I balance my own bank statement every month. But I don’t count pennies anymore. I just don’t. I’m more into people, smiles, and all the good feels. Making people’s lives better when possible.  Alright, enough mushy stuff. 

Item #1 This first one today is called “Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation: A Systematic Review and Meta-analysis” by Wiebe et. al. [1] and was published in JAMA on March 12, 2021 and that so hot it’s got my glasses all steamy. I can’t see a thing. 

Why They Did It The authors wanted to answer the question of “What are the temporal associations among higher body mass index (BMI) and chronic inflammation and/or hyperinsulinemia?” They say that Obesity is associated with a number of noncommunicable chronic diseases and is supposedly a cause of premature death. They wanted to summarize evidence on the temporality of the association between higher body mass index (BMI) and chronic inflammation and hyperinsulinemia.

How They Did It

  • MEDLINE (1946 to August 20, 2019) and Embase (from 1974 to August 19, 2019) were searched
  • The data analysis was conducted between January 2020 and October 2020.
  • Longitudinal studies and randomized clinical trials that measured fasting insulin level and/or an inflammation marker and BMI with at least 3 commensurate time points were selected.
  • Of 1865 records, 60 eligible studies with 112 cohorts of 5603 participants were identified

Wrap It Up

The finding of temporal sequencing (in which changes in fasting insulin level precede changes in weight) is not consistent with the assertion that obesity causes non-communicable chronic diseases and premature death by increasing levels of fasting insulin. Meaning that that adverse consequences currently attributed to obesity could be attributed to hyperinsulinemia (or another proximate factor). Which is interesting in my book. I thought you all might like it. 

CHIROUP ADVERTISEMENT

Item #2 And our last item today is called “Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial” by Nguyen et. al.  [2] and published in JAMA Internal Medicine on March 15, 2021 which is indeed too hot to manipulate by one’s hand. 

Why They Did It They say that Osteopathic manipulative treatment (OMT) is frequently offered to people with nonspecific low back pain (LBP) but never compared with sham OMT for reducing LBP-specific activity limitations. Knowing this, they wanted to compare the efficacy of standard OMT vs sham OMT for reducing LBP-specific activity limitations at 3 months in persons with nonspecific subacute or chronic LBP.

How They Did It

  • This prospective, parallel-group, single-blind, single-center, sham-controlled randomized clinical trial recruited participants with nonspecific subacute or chronic LBP in France starting February 17, 2014, with follow-up completed on October 23, 2017. 
  • Participants were randomly allocated to interventions
  • Six sessions (1 every 2 weeks) of standard OMT or sham OMT delivered by nonphysician, nonphysiotherapist osteopathic practitioners.
  • The primary end point was reduction in LBP-specific activity limitations at 3 months as measured by the self-administered Quebec Back Pain Disability Index. 
  • Secondary outcomes were mean reduction in LBP-specific activity limitations; mean changes in pain and health-related quality of life; number and duration of sick leaves, as well as number of LBP episodes at 12 months; 
  • and consumption of analgesics and nonsteroidal anti-inflammatory drugs at 3 and 12 months. 
  • Adverse events were self-reported at 3, 6, and 12 months.

What They Found

Overall, 200 participants were randomly allocated to standard OMT and 200 to sham OMT, with 197 analyzed in each group

Wrap It Up In this randomized clinical trial of patients with nonspecific subacute or chronic LBP, standard OMT had a small effect on LBP-specific activity limitations vs sham OMT. However, the clinical relevance of this effect is questionable. So, look…..this paper and these researches absolutely wasted time, effort, and money in an attempt to make spinal manipulative therapy look bad. Who in the h e double hockey sticks sees new patients once every 2 weeks for only 6 visits?? Especially in a chronic pain sufferer. Trash, garbage.

Or since it was in France…..garbage.  It’s dumb, useless, and meaningless and I’m almost offended that this is even a paper. I’m starting ANY brand new case with 3 per week for a week or two minimum. Minimum. Combined with other appropriate ancillaries including exercise, soft tissue stuff, maybe acupuncture, maybe laser, maybe a referral to cognitive-behavioral therapist, maybe biomechanics coaching, and on and on and on. 

Papers like this and authors like this should give it up and get out of the game if they’re not going to be able to throw something together that’s better than this heap of trash.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

And, if the patient treats preventativly 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

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

TuneIn

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About the Author & Host

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

Bibliography

1. Wiebe N, Y.F., Crumley ET, Bello A, Stenvinkel P, Tonelli M,, Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation: A Systematic Review and Meta-analysis. JAMA Netw Open, 2021. 4.

2. Nguyen C, B.I., Zegarra-Parodi R,, Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med, 2021.

My Insane Life, Hip & Knee Osteoarthritis, Risks For Acute to Chronic Pain

CF 167: My Insane Life, Hip & Knee Osteoarthritis, Risks For Acute to Chronic Pain Today we’re going to talk about hip and knee osteoarthritis and we’ll talk about the risks for back pain going from acute to chronic pain. Interesting couple of papers. Plus all my current ongoings.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.   We’re the fun kind of research. The Bon Jovi and Def Leppard kind of research.  Not the stuffy, high-brow, high and mighty, better than you kind of research.  We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #167  Now if you missed last week’s episode, we talked about dry needling, types of exercises that count, motor skills for chronic low back, and the relationship between high blood pressure and dementia. Keeping you folks smart! Check it out.  Keep up with the class.  

On the personal end of things…..

Alright, you wanna talk about juggling a bunch of balls in the air, I’m here to tell you about having balls in the air. Let’s go through it a bit, shall we? Then you can find yourself and your situation and maybe my path helps you on yours. 

    • I lost my office manager of over 11 years – here’s what I’m doing about that. 
    • Setting up a medical entity – what’s that about?
    • Looking at RHC’s – explanation to follow
    • I have finished my book – The Remarkable Truth About Chiropractic: A Unique Journey Into The Research.  – What’s that process like so far?
    • I have a virtual Assistant helping me build a website to help you all succeed – what’s the timeline? 
    • I started my second Fellowship/Diplomate program last week. Maybe I’ve lost my mind
    • Here in Texas, we went through SNOWVID 19
    • We are switching CPAs. Maybe this group gets it right. 
    • The Voice Over career has started going a little crazy here lately – I’ll explain
    • I’m about to head to Florida because…..well….because my life.
    • My main computer that holds my life has been dead for two weeks now. 

Hell yeah, folks. Lol. It’s a wonderful life, right? Let’s start at the top. As I’ve mentioned a time or two, my main employee, my OG staffer, over 11 years, and basically almost family member actually quit me and went to work elsewhere making a little more money with the change of making even a bit more next year. 

So, my main right-hand wo-man is adios but Jiminy crickets people….do you have a clue how much money I’m saving on this? She got raises every year for 11 years in her normal capacity and we created an extra marketing position for her as well at a considerable amount monthly as well.  Now, that means I’m out a marketing position but it also means I can take that money and try some different marketing for a while. Because, if I’m being honest, I’m not sure how much what we were doing was actually helping.  Plus, with the money I’m saving here, I can transition.

With the closing of doors, we usually get to experience the opening of other doors. And that’s what we’re doing. As mentioned, we are using some of the funds we are now saving to move our practice into a medical entity, hire a nurse practitioner, and move toward being finally truly integrated.  This has been a goal for years but I’ve just never pulled the trigger. Now, with PPP in place to help us pay for our payroll, it makes sense to use our existing resources, in addition to what we are now saving, to go ahead and get it done.  I’ll update you on the process as I make my way.

So far, we’ve signed paperwork with the attorneys to create the entity, we have our attorney in communication with our new CPA, which I’ll talk about later, and I’ve started reaching out. I’ve also signed up with a consulting firm on it to try to make sure I have a head start and I’m not trying to re-invent the damn wheel. I don’t like making costly mistakes. My wife and I call them ‘dummy taxes.’

If you’ve been a regular listener here, you know I’ve paid some MONSTROUS, CATACLYSMIC dummy taxes.  First, I have some fairly close relationships in the medical community. So, not only to put them all on notice of what we have planned but also to test the waters of who may be interested in being a part of it….I started reaching out. Here’s how: Hey Friend! I’m in the process of transitioning to a medical entity and hiring a nurse practitioner eventually. I’ll need to have a medical director (MD/DO) to serve in that capacity.

As I go through the process of finding one, would you be willing or able to serve as a potential character witness on my behalf if the MD or DO wants to talk to people in healthcare that know me, have experience with me and my clinic, and can speak to how I approach healthcare? I just want to be sure and ask first before I get too much further into the process. Hope you’re doing well and having a good Monday. Now, my MD/DO friends may just step up and say, “Hey I’ll be your medical director!” They may not. We’ll see. I have one in mind but it’s always good to have more than one or two options, me thinks. Also, when I reach out to my NP friends, one may raise their hands to sign up. Either way, I’m being polite, I’m putting all my friends and network on notice of intentions, and who knows, maybe it serves as some sort of guerrilla marketing. I don’t see a downside.  So, that’s the process there so far.

We almost looked at a Rural Healthcare Clinic before we decided on going the NP route. And we may still eventually. We had a call with a consulting and management firm for the RHCs and it was alright but it was also clear that the ROI wasn’t where we had heard it was and it was clear that it’s quite an endeavor and even more regulated than the medical entity endeavor would be.  It made sense to go with what my colleagues and network is the most familiar with and potentially stray off into the RHC thing if the interest is still kicking around our brains in a couple of years. 

Next on my list, the book. Being an author has always been a big goal of mine.

I love books, I love reading, and I love the idea of facilitating learning. It’s a natural progression for me. As mentioned, it’s called ‘The Remarkable Truth About Chiropractic: A Unique Journey Through The Research’. It’s essentially all of these papers I go through every week organized into their relevant categories so that they’re all in one resource and are easy to find for quick reference. Some just have the Why They Did It, How They Did It, What They Found, and The Wrap It Up sections for each paper. Some topics go further into discussion and talking points.  I believe the way to do it these days is to self-publish. I’m still figuring it out right now while it is off being edited. You wanna know who’s editing it? It’s my good friend, literary scholar, and inventor of the Drop Release tool, and hospitalist chiropractor extraordinaire from the frozen tundra of North Dakota, Dr. Chris Howson! Thank you sir. This will give you all something to look forward to in the near future. I hope you’ll all need your very own copy! So…..that’s exciting. 

On top of that, I’ve had a virtual Assistant helping me build something I think some of you will be interested in. I don’t want to give to say too much until it’s built. First, I don’t want anyone beating me to the idea, and second, I don’t want to move in that direction and then figure out I can’t make it work and then it was for nothing. Nobody wants their failure in the shop’s front window….right there on Main Street! Lol. So I’ll just say that it is something that if you need it and haven’t used it before, will 100% help you be more successful and more cognizant of what’s going on with your business from day to day. So….that’s exciting as well. 

I started my second Fellowship/Diplomate program last week. Maybe I’ve lost my mind. I probably have. Or….I’m secretly a genius. Here’s what I’ve always said; I may get beat. I may not be the best ever. And that’s OK. But I can damn sure guarantee you that it will not be due to a lack of effort. It most certainly won’t be because someone else out-worked me. Maybe they were unethical. Maybe they were lucky. Maybe they inherited something I did not. But it won’t be because I got outworked or because I didn’t try hard enough. Maybe that’s just me. Maybe it’s totally Gen-X. I don’t know. But that’s the way it is in my life. 

Here in Texas, we went through SNOWVID 21. First, you have to know that my area of Texas is very used to snow and ice and blizzards and all of that good stuff. I grew up in it. What South Texas is not used to is the ice and blizzards and snow. That was rough on them but the real kicker was losing power for not only hours but for days. Losing electricity led to losing water. Then water pipes busting and homes and offices ruined. It’s a mess. Chiropractors and Texans, in general, are trying to recover but it wasn’t any little thing. It was the worst Winter Weather event since 1890 or something like that. People can figure out -30 degree wind chill. What they can’t figure out is no power, no water, and no food. It was that real for some folks. 

We are still going through the intro phases of the Wealthability program with the Tom Wheelright group, new CPAs, the whole thing. Part of that was figuring out that our previous CPAs have been wrong and we have to figure out how to get right and part of that answer is money so…..fun fun fun.

What a wonderful life.

I’ve been without my main computer for about two weeks due to Snowvid but it’s getting up and running today which means my life is going to be up and running just a bit smoother within a day or two. Yay!! The voice-over side gig is going a little crazy at the moment. I’ve found a way to get another full-time job I think. I’ll keep you updated as that goes along but, in short, I signed with a talent agency called Heyman Talent in Cincinnati Ohio and they cover Ohio, Indiana, and Kentucky. I signed with Crown North out of San Francisco some time back as well so it’s an interesting adventure. I’m 48 years old and signing with talent agents. What the hell is that about exactly? Who knows but I’m a do-er. Let’s see what happens. 

OK, let’s get to the papers.

Only two this week because the personal side of things took a little longer than usual. Before we get to the papers though, let’s recognize my friends and this show’s amazing sponsors. 

CHIROUP 

Item #1 This first one is called “Diagnosis and Treatment of Hip and Knee Osteoarthritis – A Review” by Katz et. al. (1) and published in JAMA on February 9 of 2021, Hot off the press, smokin’ stack of steam.  What we have here on our hands…..on our meaty little mitts….is a good ol fashioned learnin’ sesh on Osteoarthritis. This is truly some good stuff, folks. Where in here can you find an opportunity to help patients and, in turn, make a living and be the expert in your community?

  • Osteoarthritis (OA) is the most common joint disease, affecting an estimated more than 240 million people worldwide, including an estimated more than 32 million in the US. Osteoarthritis is the most frequent reason for activity limitation in adults. This Review focuses on hip and knee OA.
  • Patients with OA typically present with pain and stiffness in the affected joint(s). Stiffness is worse in the morning or on arising after prolonged sitting and improves within 30 minutes. Pain is use related early in the course but can become less predictable over time. Although OA is sometimes viewed as a disease of inexorable worsening, natural history studies show that most patients report little change in symptoms over 6 years of observation.
  • Nearly 30% of individuals older than 45 years have radiographic evidence of knee OA, about half of whom have knee symptoms.
  • Osteoarthritis leads to substantial cost and mortality. Forty-three percent of the 54 million individuals in the US living with arthritis (most of whom have OA) experience arthritis-related limitations in daily activities
  • Persons with knee OA spend an average of about $15 000 (discounted) over their lifetimes on the direct medical costs of OA.
  • Osteoarthritis can involve almost any joint but typically affects the hands, knees, hips, and feet. It is characterized by pathologic changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat, leading to joint dysfunction, pain, stiffness, functional limitation, and loss of valued activities, such as walking for exercise and dancing
  • Risk factors include age (33% of individuals older than 75 years have symptomatic and radiographic knee OA), female sex, obesity, genetics, and major joint injury.
  • Persons with OA have more comorbidities and are more sedentary than those without OA. It has been estimated that 31% of persons with OA have at least 5 comorbid conditions.2 Persons with hip and knee OA have approximately 20% excess mortality compared with age-matched controls, in part because of lower levels of physical activity. They become sedentary
  • The reduced physical activity leads to a 20% higher age-adjusted mortality. 
  • Several physical examination findings are useful diagnostically, including bony enlargement in knee OA and pain elicited with internal hip rotation in hip OA. 
  • Radiographic indicators include marginal osteophytes and joint space narrowing. 
  • The cornerstones of OA management include exercises, weight loss if appropriate, and education—complemented by topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) in those without contraindications. 
  • Intra-articular steroid injections provide short-term pain relief and duloxetine has demonstrated efficacy. 
  • Opiates should be avoided. 
  • Clinical trials have shown promising results for compounds that arrest structural progression (eg, cathepsin K inhibitors, anabolic growth factors) or reduce OA pain (eg, nerve growth factor inhibitors). 
  • Persons with advanced symptoms and structural damage are candidates for total joint replacement. 

Conclusions and Relevance  

  • Education, exercise and weight loss are cornerstones of management, complemented by NSAIDs for the right patients, corticosteroid injections, and several adjunctive medications. 
  • For persons with advanced symptoms and structural damage, total joint replacement effectively relieves pain.

Item #2

Our second and last one today is called “Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care” by Stevans et. al. (2) and published in JAMA Network Open on February 16, 2021. Pop goes the weasel it’s fresh outta the oven!

Why They Did It To figure out the transition from acute to chronic low back pain using a tool to assess and predict the transition; demographic, clinical, and practice characteristics; and whether treatments that did not fit within common guidelines were partly to blame. 

They termed these treatments as nonconcordant. Treatments like opioids. Additionally, prescriptions that included benzodiazepines and/or systemic corticosteroids alone without the presence of nonsteroidal anti-inflammatory drugs or short-term skeletal muscle relaxants were considered nonconcordant. Nonconcordant diagnostic imaging consisted of an order for lumbar radiograph or computed tomography/magnetic resonance imaging (CT/MRI) scan. Nonconcordant medical subspecialty referral included referrals to nonsurgical or surgical specialties (eg, PTs, orthopedists, neurologists, neurosurgeons, or pain specialists). That was all considered nonconcordant care

How They Did It It was a cohort study with 5233 patients having acute low back pain Nearly half of the patients were exposed to at least one treatment recommendation that was not actually recommended within the first 21 days after the first visit   

What They Found

  • Patients were significantly more likely to transition to chronic low back pain as their risk on the prognostic tool increased and as they were exposed to more bad recommendations
  • Overall transition rate to chronic LBP at six months was 32%
  • Patient and clinical characteristics associated with the transition to chronic LBP included obesity, smoking, severe baseline disability, and depression/anxiety.
  • Patients exposed to 1, 2, or 3, bad recommendations in the first 21 days of pain were about 2 times more likely to develop chronic low back pain

Wrap It Up

This large inception cohort study found that the transition from acute to chronic LBP was substantial and the SBT was a robust prognostic tool. Early exposure to guideline nonconcordant care was significantly and independently associated with the transition to chronic LBP after accounting for patient demographic and clinical characteristics, such as obesity, smoking, baseline disability, and psychological comorbidities.

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

The Message 

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

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

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

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

Website  http://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

  1. Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA. 2021;325(6):568–578. doi:10.1001/jama.2020.22171
  2. Stevans JM, Delitto A, Khoja SS, et al. Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care. JAMA Netw Open. 2021;4(2):e2037371. doi:10.1001/jamanetworkopen.2020.37371

 

w/ Dr. Bobby Maybee – (Part Two) Everything Evidence-Based Chiropractic, Insight, Instruction, & Inspiration

CF 162: w/ Dr. Bobby Maybee – Everything Evidence-Based Chiropractic, Insight, Instruction, & Inspiration (Part Two)

Today we’re going to be joined by Dr. Bobby Maybee for Part Two of our conversation. Dr. Maybee is the leader and originator of the Forward Thinking Chiropractic Alliance and co-founder of the Chiropractic Success Academy. Full of insight, instruction, and inspiration. Stick around.

But first, here’s that sweet sweet bumper music

Subscribe button

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

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

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

If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #162

Now if you missed last week’s episode , we talked about lumbar spinal fusion surgery. This was new, current, and very much in favor of conservative, non-pharmacological, nonsurgical care.. Keep up with the class. 

On the personal end of things…..

I have the second shot of the two vaccines coming up in two days. I had absolutely zero reaction to the first one. I keep hearing that the second is worse than the first. However, several of my friends that had a miserable first shot experience had a much more pleasant second shot experience. 

So, here’s to an easy second shot. If you’re not getting yours because you want to see if everyone else grows a forehead horn first, that’s reasonable. I don’t blame you. I’m a lone wolf in a sense. My business does not run without my presence. Therefore, I need to be here. I need to be healthy. So, the vaccine makes sense to me. 

I covered a book called Peak Performance for you in the last episode or two on relaxation and visualization. Further back, I talked about a book called Quit Like A Millionaire I would absolutely recommend. Wow, what a great book. I’ve told you about Back In Control by David Hanscum MD about chronic pain and the biopsychosocial side of it. That’s a book I recommend all of my chronic patients. Check it out. 

This episode, I’ll tell you about one I’m going down the path on by Tom Wheelwright called ‘Tax-Free Wealth: How to Build Massive Wealth by Permanently Lowering Your Taxes 

https://www.amazon.com/Tax-Free-Wealth-Permanently-Lowering-Advisors/dp/1937832058

It’s in the Rich Dad Poor Dad netword o fproducts and I can’t say enough about it. If you’re like me, you’re sending upwards of $100k to the IRS every year regardless of how much you try to not do just that. What if we could spend that money on building our business or businesses rather than sending it to Washington where we have a bunch of corrupt politicians that have no idea what compromise even means anymore?

Politicians that go into office middle to upper class but come out multi-millionaires. Yeah, I’m more interested in figuring out how to keep it at home and working for me instead of letting those knuckelheads decide what to do with my money. That’s a big hell no. 

That’s what this book is about. Tom will also tell you about his ‘Wealthability’ program that costs a hell of a lot of money. My wife and I are doing it. We just started. You know I’m always honest with you all and I’ll tell you how it goes. For the most part though, you get all the info you need inside his book. I’m just lazy and need someone to do it for me so that’s why I went with the program. 

Actually, I’m not lazy. I think listeners here know that I’m not lazy. I just have too many irons in the fire to figure it all out myself. That’s not where my talent lies. So, people like me have to pay people like them to give me their talent and expertise and it typically comes at a price. And it does. 

I’ll keep you updated. 

Alright, let’s get to the meat and taters here. We have Part Two coming up with THE Dr. Bobby Maybee of the Forward Thinking Chiropractic Alliance. First thing’s first, if for some reason you missed Part One last week, stop..collaborate and listen….Sorry, anyone from the 80s and 90s can’t say the word STOP without adding those words to the end…..Anyway. Stop and go listen to Part One with Dr. Maybee and then come back for Part Two

Just as a refresher from last week, I want to run through some key aspects of Dr. Maybee once more. 

Dr. Maybee initially began the Forward-Thinking Chiropractic Alliance (FTCA) in 2014 as an attempt to change the landscape and conversation of the chiropractic profession of social media.   

Since then the FTCA has gone on to create evidence-based content in a grass roots nature.  This content is typically for the internet, and in an educational format through continuing education courses, and is staunchly evidence based.  

Dr. Maybee hosts “Forward, The Podcast of the Forward-Thinking Chiropractic Alliance.”  As well, he was just elected Chair of the Oregon Board of Chiropractic Examiners Peer Review Committee, and is a member and supporter of the American Chiropractic Association.  

Dr. Maybee is a 2004 graduate of Western States Chiropractic College.  In his free time, he co manages a household of 5 children, 2 dogs Jett and Abbie, and a cat named Goober.

And the best reason we can ever have to thank someone for something, Dr. Maybee is a veteran of the US Air Force which no doubt lends itself to him being such a good and effective leader. 

Alright, let’s hop into Part Two and pick it up where we left off last week. 

  • What is your vision for the FTCA and what does the group to to move closer and closer to accomplishing them?
  • I was at the Forward 19 event in St Louis and really enjoyed it. Tell us about what goes into creating something like that? How do you pull it off?
  • Recently, I have been on a rant. I see vitalists say kooky stuff and I’m physically and mentally unable to ignore it. I have a recent episode on a guy that wants to teach other chiropractors how to treat 9 new patients and 99 established patients within three hours. Then I had an episode on the shake up of the WFC Research committee. As I mentioned in the episode, you were there in Berlin when it all started going sideways. Can you walk us through it all as far as you know it to be?
  • I think I’ve seen you vacillate on the topic of unity or not. Where do you stand on the whole deal? Is it possible the two sides can continue to live together? Or do you see groups like the Primary Spine Practitioner start to gain steam?
  • Tell us about the CSA that you and Dr. Kevin Christie have put together.

CHIROUP ADVERTISEMENT

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

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

Store

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

Subscribe Button

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 preventativly 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

 

 

w/ Dr. Bobby Maybee – Everything Evidence-Based Chiropractic, Insight, Instruction, & Inspiration (Part One)

CF 161: w/ Dr. Bobby Maybee – Everything Evidence-Based Chiropractic, Insight, Instruction, & Inspiration (Part One)

Today we’re going to be joined by Dr. Bobby Maybee who is involved in so many things chiropractic but most notably he’s the leader of the Forward Thinking Chiropractic Alliance and co-founder of the Chiropractic Success Academy. This is going to be an excellent episode folks. Full of insight, instruction, and inspiration.  But first, here’s that sweet sweet bumper music.

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. 

  • 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 #161 Now if you missed last week’s episode , we talked about lumbar spinal fusion surgery. This was new, current, and very much in favor of conservative, non-pharmacological, nonsurgical care.. Keep up with the class.  On the personal end of things….. I’d like to hear how some of you are busier than normal or how some of you have only dropped off a bit during COVID. I wrapped up my stats from 2020 and it was a bit of a blood bath around my joint if I’m being honest and I’m always honest with you all. That’s they only way we move forward. Honesty.  So, let’s cover a few of the key stats. By the way, if you’re not keeping good stats and measuring all of your office metrics, I can’t tell you what a mistake it is that you’re making. My office turned around when I started accurately tracking my metrics. How can you know where you’re going or measure success in a quantifiable way if you’re not measuring it? As you’ll find out more and more in the coming months, I’m very big on keeping stats because it turned my office around. I know the value. Anyway, let’s get to some of my take-aways from my 2020 stats. 

  • One of the big kickers for me is that my new patients were down 36.1% from 2019. Yeah, that hurt like hell, folks. That’s in spite of picking up in our marketing efforts, posting and boosting about our cleaning and disinfecting efforts, and growing our social media following. Our area was hit hard with COVID. On the New York Times site, Amarillo, TX at different times and even recently has been #13 nationwide in areas hit the hardest. At one time, we were #2 on their list of the areas with the most new cases. People just did not feel comfortable going anywhere around here at different times during the year. Some times were more comfortable than others of course but overall….uncomfortable.
  • As a result of the new patient issue, my overall visit numbers suffered and were down 33.8%. So, we saw 33.8% less visits over the course of the year in 2020. When you consider the value of one visit in my office, well…..let’s just say that adds up to a considerable amount of income lost.
  • You’ll start to see a theme here when I tell you that my total services billed were down 36.6% and net services when we remove our write-offs sat at about 40% down. Ugh, right? But, we worked hard on our billing, of course. When you have extra time, you turn to billing and collections efforts. As a result, our total collections were only down 25.4%. Funny how that happens. 
  • We could go through a whole bunch of different metrics but I have an amazing guest today we need to get to. The most important stat is the final overall total. When we include all of the things that make us money like chiropractic, rehab, laser, decompression, acupuncture, massage, and on and on….when we combine it all, our total collections across the board were down 25.4% in 2020. While that’s a tough pill, I’m not alone. Many of you have had the same difficulties. Many of you have had it worse. And I’m sorry. It’s been difficult for us all. But the good news is that I think it’s lightening up and if improvement and progress makes us all feel good, it won’t take much to improve and show progress over 2020. Will it? I think not so here’s to all good things in 2021. Let’s get all of our practices back on track and help some folks get out of pain and avoid surgery. 

Now, without further adieu, let’s get to our guest today.  Today we are joined by the always interesting and talented Dr. Bobby Maybee hailing from the Pacific Northwest. Portland, Oregon to be exact. Dr. Maybee initially began the Forward-Thinking Chiropractic Alliance (FTCA) in 2014 as an attempt to change the landscape and conversation of the chiropractic profession of social media.   

Since then the FTCA has gone on to create evidence-based content in a grass roots nature.  This content is typically for the internet, and in an educational format through continuing education courses, and is staunchly evidence based.   Dr. Maybee hosts “Forward, The Podcast of the Forward-Thinking Chiropractic Alliance.”  As well, he was just elected Chair of the Oregon Board of Chiropractic Examiners Peer Review Committee, and is a member and supporter of the American Chiropractic Association.  

Dr. Maybee is a 2004 graduate of Western States Chiropractic College.  In his free time, he co manages a household of 5 children, 2 dogs Jett and Abbie, and a cat named Goober. And the best reason we can ever have to thank someone for something, Dr. Maybee is a veteran of the US Air Force which no doubt lends itself to him being such a good and effective leader. 

Welcome to the show Bobby, tell me how Portland is this morning.

How’s the weather? 

Introduction

  • Tell me your chiropractic story. Why chiropractic for you?
  • Tell me what got you to the place where you are the expert in the clinic that you are. What experiences or certifications built that person?
  • Tell me about your practice in Portland
  • With as many kiddos as you have and as many things as you’re involved in, what does a typical week look like for you.
  • How did the FTCA get started?
  • I see here and there online that some vitalists have really started to make the term ‘evidence-based’ a keyword, a trigger word, or a point of conterntion. Have you noticed that as well and how do you think a healthcare profession come to mock evidence and research?
  • What is your vision for the FTCA and what does the group to to move closer and closer to accomplishing them?
  • I was at the Forward 19 event in St Louis and really enjoyed it. Tell us about what goes into creating something like that? How do you pull it off?
  • Recently, I have been on a rant. I see vitalists say kooky stuff and I’m physically and mentally unable to ignore it. I have a recent episode on a guy that wants to teach other chiropractors how to treat 9 new patients and 99 established patients within three hours. Then I had an episode on the shake up of the WFC Research committee. As I mentioned in the episode, you were there in Berlin when it all started going sideways. Can you walk us through it all as far as you know it to be?
  • I think I’ve seen you vacillate on the topic of unity or not. Where do you stand on the whole deal? Is it possible the two sides can continue to live together? Or do you see groups like the Primary Spine Practitioner start to gain steam?
  • Tell us about the CSA that you and Dr. Kevin Christie have put together.

CHIROUP ADVERTISEMENT

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

Chiropractic evidence-based products

Integrating Chiropractors

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 preventativly 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 http://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  

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

CHIROUP ADVERTISEMENT

Item #2

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

Item #3

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

Why They Did It

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

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

What They Found

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

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Key Point:

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

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

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

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

Bibliography

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

 

The Shake-Up With WFC’s Research Committee

CF 154: The Shake-Up With WFC’s Research Committee Today we’re going to talk about the research committee shake-up at the WFC. I’ve wondered for months now what exactly happened with shake-up and it hasn’t been easy to figure it out either. Who is to blame and what companies are to blame as well? We’ll get knee deep into it in this episode.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it.  You have found yourself smack dab in the middle of Episode #154 Now if you missed last week’s episode , we talked about how some chiropractors could be better and being careful which guru you’re going to place your faith in. Some are just absolute loons and only driven by profit, not results and not the patient.

The saying is, when you’re focused on the outcomes, you’ll never have to worry about the income. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function

On the personal end of things…..

Chugging along. Making friends and influencing people. That’s how we do it here. Actually, that’s not true. I’m sure I got the vitalists all fired up last week and probably will this week as well. I’ll probably get some companies fired up too.  We’ll see. It doesn’t have a thing to do with anything chiropractic but I’ve mentioned a time or two here that I’m branching out and, as a retirement plan, I’m working on a little side gig in the voice over / voice artist industry. This stuff is fascinating y’all. It really is. 

So I went through the steps you’re supposed to go through in getting yourself all set up and now, here I am, I got a commercial demo done. If you’re just feeling goofy and bored, go to jeffwilliamsvoice.com and there’s a demo there you can listen to. Turns out I have the John Deere, Ford truck, eat this burger type of voice and I’m totally OK with that.  Anyway, after you get a demo, you start submitting to talent agencies around the world. Well, hell….I don’t have all day to spend on doing this stuff so I can only get a few per day and there are tons of them.

But, in just the first round or so of submissions, I already got signed up with a talent agent out in San Francisco and Los Angeles as well as interest from a talent agency in Barcelona Spain and potentially a marketing firm down in Dallas/Ft. Worth. . So….how damn cool is that? Maybe, one of these days, my side gig takes over my day job. I’m not holding my breath though. But, seriously, my buddy has done it for about 7 years and he’s making six figures. Can you imagine making a good 6 figure salary but no employees, no overhead, you can make that money in your basement in your underwear (sorry for the visual there), and you can do it from anywhere in the world as long as you have an internet connection?

Well, it’s a cool idea and a lot of folks get to do it that way. Who knows? It’s a lot of luck and all that stuff but I’ve never been one that was afraid to take chances or afraid to fall on my face.  Either way, it’s exciting and isn’t that what it’s about? Keeping life interesting and exciting? That reminds me, if you need a voice over for a youtube video, your podcast intro, or any commercial you’re doing, remember ol Uncle Jeffro here. I got you covered!

Item #1

Now, let’s get to spilling the tea shall we? I have to start by saying, I don’t love talking about this stuff. I don’t at all. It makes me uncomfortable. Mostly because some of my friends won’t like it. I work with a lot of chiropractors around the nation in different capacities and to be honest, while we work FOR the chiropractic profession, we don’t see eye to eye with each other on WHAT chiropractic is.  Still, they’re my friends. So what do I do? Do I just say nothing about things I know they won’t agree with? Or do I talk about it and give my view point on them?

Well, I have a podcast so I guess I talk about it. I could stay out of the messiness of our profession and avoid tough subjects all together I guess. But who ever changed anything by taking that sort of stance? That’s not really any kind of stance at all is it? You change things by standing up, somewhere, and supporting your convictions. So that’s where i’m at. I don’t like. I’m uncomfortable with it, honestly. But the show must go on.  Let’s start with what happened. Dr. Greg Kawchuk was the head of the World Federation of Chiropractic. I’m a fan of Dr. Kawchuk. so when I saw on Facebook or Twitter or somewhere that he resigned his post as head of the WFC research committee, it had me a bit miffed. Not only that but a lot of HUGE chiropractors on the committee left with him. Researchers on the level of Jan Hartvigsen for example. 

To be specific, those that resigned are

  • Greg Kawchuk DC PhD Canada – Chair
  • Simon French, PhD, MPH, BAppSc(Chiro) Australia
  • Iben Axén DC PhD Sweden
  • Jan Hartvigsen DC PhD Denmark
  • Martin Descarreaux DC, PhD Canada
  • Carolina Kolberg DC PhD Brazil

Every single one of these researchers has been in the episodes we have released. They are big time for our profession. The vitalists, unfortunately, have labeled them subluxation deniers. I label them scientists but….whatever.  I say tomato, they say dumb stuff. Their statement of resignation went like this, “Effective immediately, we (Greg Kawchuk (Chair), Iben Axen’, Martin Descarreaux, Simon French, Jan Hartvigsen, and Caroline Kolberg) resign from the World Federation of Chiropractic (WFC) Research Committee.

We no longer feel it is possible to function as independent academics in our roles on the committee. We urge the WFC to continue to promote the EPIC principles (Evidence-based, People-centered, Interprofessional and Collaborative), and to protect its core values from potential conflicts and outside influence. We wish the best for the WFC and our colleagues who serve on its Research Committee.” Now, it wasn’t all bad because they put Dr. Christine Goertz into the post as the head of the WFC committee and if you’re a listener here at the Chiropractic Forward evidence-based chiropractic podcast…..well then you know what a fan of Dr. Goertz we are. She’s a chiropractic treasure. 

But, when I first heard the news, as you can imagine, and as you probably felt when you heard, it was a bit concerning for our profession to lose so many high profile, top-level researchers at once. What’s that going to mean for our profession and why did this happen in the first place? I started paying attention. I started looking for information. What the heck happened? But nothing. Not only nothing on the story but nobody was talking about it either. Like….it was just another event that happened on just another day. No big deal. When, in reality, at least to research consumers such as myself, it was a huge deal! Why did this happen and what the hell is the story?

Well, I’m going to give away the ending here before we really dive in, I’m not 100% sure but at least now I have an idea. A generaly idea.  When I decided I was going to do this episode, I put it in our private Facebook group. We only have around 450 members approximately. Again, in case you don’t know, we have a public Chiropractic Forward page. That’s just to get the word out about the podcast and market the podcast.  Then we also have a Chiropractic Forward private group where we can share research papers, we can discuss amongst ourselves, and all that good stuff and we can do it privately. I encourage you all to join the private group.

Not if you’re a vitalist. That’s not the group for you. But if you’re evidence-based and patient-centered, then you’re a good fit.  Anyway, I posted in there that I wanted to do this episode and if anyone had the back story, please send me a private message about it. That I wanted to get it figured out and tell our audience. 

There was a lot of interest in the episode but nobody knew the story about what happened. I asked elsewhere. Nobody knew but everyone wanted to know. I even asked Dr. Kawchuk himself and he was tied up in a research project. Dangit.  Unfortunately, the research community’s lack of open communication on this matter has left this up to others to define the narrative. For example, when Googling up this story, I got an article by Matthew McCoy. The ever-so-nutsy vitalist out in Georgia. The townhall crier and huckster of woo. Yes, he’s one of them setting the narrative. 

Also, one of the top hits was by our global hater for the ages, Edzard Ernst. What a toolbag. Yes, our global hater sets the narrative on what is happening in the chiropractic world. But nothing from the evidence-based, patient-centered side of the profession. What in the hell is going on here, people? Why in the hell are you all sitting on your hands? Why are you not talking about this, writing about this, yelling about this, or at least pushing back on this? Are we spineless? No pun intended by the way. 

It’s just astonishing to me that so little is written about it and that the only information you can find on it is created by flat-earthers or by the apex of chiropractic haters.  Finally, one of my colleagues here in the U.S. contacted me through text and we set up a phone call. They gave me the story as well as they understood it and that’s what I’m going to give you. Thank you to this colleague for shedding as much light on this story as you could. I really do appreciate it and I’m pretty sure the rest of our audience does as well. 

If we are being fair, a small part of it appears to be Dr. Kawchuk’s fault, a very large part of it seems to fall on the vitalist, subluxation or nothing, rah rah rah crowd, and an even bigger aspect of the whole enchilada I believe can be directly pointed at the WFC’s corporate sponsors that backed the vitalist, subluxation is the only way crowd. I personally blame the companies. Without them bullying the WFC with sponsorship dollars, this wouldn’t have happened regardless of the rest of the dominoes that fell. 

Let’s back up a bit.  It sounds like it all begin in Berlin in 2019. Those of us paying attention know that it goes back much further than that though don’t we? Oh yeah, with the evidence-based, patient-centered model becoming more and more prevalent and moving the vitalists more and more to the fringe of the world, the louder the minority has become.  Still, it appears, Berlin 2019 at the WFC conference was the final straw. Dr. Greg Kawchuk, who again, I’m a fan of, was one of the speakers at the event. His presentation was not vitalist/subluxation friendly.

Word on the street is that his speech was met with cheers but was also met with water bottles being thrown up on the stage and antics like that. Because, you know….our profession is divided in two in case you’ve been hiding in a cave. So, cheers makes sense. I don’t know what makes the other side think it’s OK to throw stuff on the stage but who knows? Maybe that’s just a dumb little European quirk.  I had the opportunity to see almost the exact same speech at the Forward ’19 event in St. Louis a little over a year ago. I absolutely loved it. And, no….it was not subluxation friendly.  Here was the difference in the speech I saw in St. Louis and the one that was given in Berlin.

Dr. Kawchuk, it is suggested, made a quip during his speech that taking a child to a vitalistic chiropractor is similar to taking a child to a Catholic priest.  There are no recordings in existence of this version of the speech but I believe the basic gist of the comment was that if you’re willing to take your kid to a vitalist for 60+ visits, then you should leave your kids with a Catholic priest.  OK, let’s address this because this one comment is what the ICA hung their hat on so I think it’s a pivotal thing. I think it’s also why this part of the speech was dropped when I heard it in St. Louis.  It is my understanding, first of all, that Dr. Kawchuk wrote a letter of apology but it was perceived as having some “Yeah, but…” sentiment attached so maybe it didn’t come off as sincere as his detractors would want.

But here’s the thing, it wouldn’t have mattered how sincere the apology was, they found something to hang their hat on. They found an achilles heel and they weren’t going to let go of it. Regardless of what Greg said to them about it.  Can I just say that I’m a Christian and I’m used to getting made fun of by so many out there in the world. It almost doesn’t even affect me anymore. Notice I said ‘almost’.

Now, I’m not Catholic. But Catholics are Christians so, by association, I should be rather offended as well right? I suppose if I were of the easily offended mindset, I would be. But I’m not because I see it all for what it’s worth.  Number one: the Catholic church has had quite a well-chronicled issue in the past with priests and misconduct. I don’t know how you could argue with that and someone bringing it up has become VERY commonplace. That doesn’t make Greg’s comment any more out of place than the 100 other people I have seen mention or make fun of it on Facebook over the past 3-5 years. It’s become very common. Doesn’t make it right but it does make it common. 

Number Two: did that belong in this speech? Well, I wasn’t the speaker so how do I know. I know that I saw the same speech last year without the comment and it seemed very effective and very welcome to everyone that was in attendance. So, it appears it would have been just as good and ultimately less offensive to some.  Knowing what we now know, it doesn’t appear that it was a good choice to go with for that particular speech to that particular crowd. I would say that I enjoy a great and entertaining speech and the one I saw in St. Louis by Dr. Kawchuk was just that. It was actually pretty dang amazing.

I became an instant fan and hearing of the Catholic priest comment later on did nothing to dampen my fandom.  I suggest people lighten the hell up and quit being so damned dramatic. Water off a duck’s back. Oh my goodness, someone said something you didn’t like or agree with? Poor thing. Bless your heart.  So, Greg gave them something to hold onto and go on the attack with. OK. Do you think the ICA got irate over the priest comment? Or do you think they got irate because the speech was anti-vitalist, anti-subluxation?

Honestly….think about it. Let’s be smart. Which do you think it was? It should already be clear what I think it is.  So, the speech is made and the vitalists lose their damned minds and the ICA decides to deal with this travesty. Nobody but the higher ups over there know exactly how it all went down but, by all appearances, it looks like they started leaning on sponsors to pull support from the WFC until changes that the ICA deemed appropriate were made.  So, basically, the ICA decided to be a bully and start flexing on the playground.

They could read the tea leaves and with scientists like Kawchuk, Hartvigsen, and the others steering, the future wasn’t so bright for the ICA bullies so they started figuring out how to pull the purse strings. That’s what it looks like to me.  It looks like companies like ChiroHealth and Foot Levelers leaned on the WFC to remove Kawchuk. In advance of that, Greg just resigned. Then, the other top-level researchers resigned in solidarity and, I would imagine, in protest to what was happening. 

And I don’t blame them one bit.  Here’s the thing here; it is my opinion and the opinion of others that these vendors used our money that we paid them to bully the WFC at the urging of the ICA to oust Kawchuk. And it is my opinion that they used one sour comment to do it. When I feel pretty sure that they bullied the WFC simply because they didn’t like that the speech and the research committee seemed anti-subluxation. Here are the companies that pulled support simultaneously at this pivotal time for the WFC:

  • Standard Process
  • ChiroHealthUSA – USA
  • Chiro Diplomatic Corps
  • NCMIC – USA
  • National Chiropractic Council – USA
  • Koala Mattress – Australia
  • Life Chiropractic College West – USA
  • Life University – USA
  • Lloyd Table Inc – USA
  • Breakthrough Coaching – USA
  • Chiropractic Education Australia Ltd. – Australia
  • Da Vinci Labs – USA
  • Integrated Assessment Services Inc. – Canada
  • Japan Federation of Chiropractic Professionals – Japan
  • Mettler Electronics Corp. – USA
  • Tokyo College of Chiropractic (Formerly RMIT University) – Japan
  • Sidecar

It looks like vendors like ChiroHealth, Foot Levelers, and several others used the money we paid them, to then turn around and bully the WFC research committee because they gave a speech that was anti-subluxation. Used. Our. Money.  I repeated that for a reason. They use our money to get rid of the world’s biggest and best researchers because they didn’t like what they said.  On the other hand, these are the companies that continued to financially support and sponsor the WFC:

  • Palmer College of Chiropractic
  • Parker University
  • Logan Chiropractic College
  • New York Chiropractic College
  • Southern California University of Health Sciences
  • University of Bridgeport
  • University of Western States
  • National University of Health Sciences
  • Canadian Memorial Chiropractic College
  • Anglo European College of Chiropractic
  • Madrid College of Chiropractic
  • Nordisk Institute
  • Dynamic Chiropractic
  • The American Chiropractor
  • Chiropractic Economics

I would like to thank this group that chose to continue to support the WFC, thus continue to support research and science. Thank you for not being bullied by the ICA and the loud minority. Now, let’s be fair. Maybe it was just that times are tough. COVID has us all down. I know it’s got me down. Did they pull or reduce support for the WFC because of the ‘Rona? How are we to know? I don’t know. You don’t know either. But it seems pretty danged coordinated in conjunction with Dr. Kawchuk’s resignation doesn’t it? I mean….doesn’t it? It’s your choice to continue working with these companies but I’ll tell you this much, being evidence-based as I am….I will be second-guessing my commitment and participation with them going forward.

Honestly, how could you not? As my colleague so eloquently stated to me, “Their power is our power.” Again, nobody knows the exact motivation of these companies. I sure as hell don’t. I just know what it looks like.  What if enough of us contacted these companies and griped about this? We can collectively tell them we don’t approve of that sort of influence. We don’t approve of them using our money to bully our research community.

What if this were to serve as a rallying cry for activism over apathy? For a bunch of crappy stuff to take place, all it takes is for good people to just sit on their hands and do nothing.  This can be a rally cry for the WFC and Dr. Goertz, for the ACA, CARL, for the FTCA, and for this Chiropractic Forward Podcast. But, as my esteemed colleague said, there’s a cover charge to getting your voice heard and social media doesn’t quite cut it.  Now, how much of all of this was theater and how much was legitimate?

If Kawchuk was going to be let go because of the financial pressure by the ICA and these companies, was his resignation simply to keep the ICA from getting a win? It seems they reduce exposure by just going to their universities and doing their research there anyway. They’re not out front taking all of the heat and they’re still doing all of their research and all that anyway. Makes you wonder why anyone would want to be out front like that anyway, doesn’t it? I don’t think it was theater.

I think Greg got tired of dealing with the vitalist crap and said to hell with you people. I think the ICA bullied these companies and the WFC to push him out under the guise of a priest comment but really because they didn’t like the anti-subluxation sentiment of the research coming out of the WFC. And I think the companies did exactly what the ICA wanted them to do. So, I think the vitalists and subluxation people won at the end of the day.  It’s all looking like a bunch of stinky garbage on the part of the vitalists but, sometimes those unafraid to get down in the slop are the ones that win the battle. Doesn’t mean they win the war. Just the battle. 

Here’s what I believe. I believe right and truth win every single time. Eventually. So, let’s look at it from that perspective. There are mountains of papers supporting spinal manipulative therapy. There is a paucity as the researchers say….a paucity of solid, respectable research backing the vitalistic, subluxation theory that was generated in the late 1800’s. Here in 2020..it just hasn’t formulated into a solid, well-researched fact, folks. I’m sorry. Don’t punish the messenger.  Anecdotal evidence and charismatic gurus with guitars don’t make it true or make it right. 

Here’s something else I believe strongly, when you have people like McCoy and Edzard Ernst setting the narrative for our profession because we’re not willing to discuss something openly, well, then we’re just asking for it, folks. You either want a well-respected profession or you don’t.  Or, do you want a split all together? The Primary Spine Practitioner program through the University of Pittsburgh may be a good first step for some of you that are bent on the separation.  Can’t we all just get along? I don’t see it happening. I really don’t. I don’t see how our profession can be unified.

Vitalists refuse to follow or even notice solid research that doesn’t confirm their bias. Outright refuse. They insist it’s appropriate to see regular healthy people once per week for life.  Evidence says that’s not appropriate so, therefore, evidence-based chiropractors say it’s inappropriate and it gives us a bad name. So, what do you do about that? You can’t fix it. Evidence based folks can’t continue in a profession where part of the crowd makes them appear illegitimate.

Vitalists refuse to conform to any appearances of being evidence-based.  So, what’s the answer? You tell me. I don’t see a clear answer. I think it lies with the middle group that is neither evidence-based or vitalistic. They’re just out there making a living and getting through their days but are pretty much apathetic to either. When something happens that activates that group, I think that’s what will be the deciding factor on where this profession goes. 

I disagree with 99.9% of everything Edzard Ernst says but I agree with this comment wholeheartedly when he says, “In my view, the problem of the chiropractic profession is unsolvable. Giving up Palmer’s obsolete nonsense of vitalism, innate intelligence, subluxation, etc. is an essential precondition for joining the 21st century. Yet, doing so would abandon any identity chiropractors will ever have and render them physiotherapists in all but name, Neither solution bodes well for the future of the profession.”

I would say that he left out the fact that many PTs are now adding spinal manipulative therapy to their arsenal so maybe PTs are rendering themselves chiropractors rather than the other way around? I would also add to Ernst’s comment that a recent nationwide poll showed that people go to chiropractors to get rid of their pain. They do not go for wellness, vitalism, weekly visits, or innate intelligence talk.  In the comments of Ernst’s post a chiropractor chimed in and said that in his opinion, the profession has a better chance of providing a valuable healthcare service without the ICA members which make up only about 5% of the profession tagging along and raising a stink whenever someone challenges their model or views. 

Researchers should have the freedom to speak thei truth without fear of reprisal of companies that we essentially fund. It goes a hell of a lot deeper than a bad joke folks. It’s an attack on evidence-based chiropractic and an attack on the research community. And we’d better all start seeing it that way because now, the ICA has a win and you can believe they’ll be back for more. If these companies reduced or withheld funding to pressure the WFC based on the ICA’s pressure, we should let these companies know how we feel about it.  I see chiropractors going forward in the world treating pain, following current research, and current widely accepted guidelines. Guidelines that are based in the research literature. I see a profession that accepts a certain standard and a profession that hopefully begins to take policing its own seriously. 

Otherwise, we’ll continue to be the pimple on healthcare’s butt. And that’s the way I see it. And before anyone says it, I’ll say it first…no, I do not want to be a medical doctor. No desire at all. But being a chiropractor doesn’t mean that I have to blindly accept and promote a philosophy from the late 1800’s. They are not mutually exclusive. In any way. The adjustment is the cornerstone of my personal practice and the way I treat patients. It’s just not the end-all-be-all of what I do.  And all of this mess when we are at the precipice of actually breaking through in the healthcare industry. I’ve said it so many times on this podcast but there is no better time to be a chiropractor.

Y’all, it’s a perfect storm. The opioid crisis. The research backs every freaking thing we do OUTSIDE of the subluxation theory. Literallly everything we do.  Spinal manipulative therapy, exercise/rehab, low level laser, massage, acupuncture, balance and proprioceptive training, and things like that. Research backs it all up. It just can’t back up the subluxation stuff.  But we are at a point that we can actually get more patients in our doors if we are a respectable, evidence-based, patient-centered profession.  Again, you can disagree with me. You can cuss me. But you’ll always know where I stand and according to me, I stand for what’s right, I stand for the truth, ethics, morality, and I stand for patients and their right to be treated like respected individuals and not targets that have to be closed.

IF we can’t agree on that, then maybe you can at least respect me and respect the fact that I’m willing to make a stand for what I believe in. Because honestly, I don’t see a lot of folks standing up on this deal.   Maybe it’s just me. I would assume these things would be common sense. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Chiropractic evidence-based products

Integrating Chiropractors

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The Message
I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly 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 http://www.chiropracticforward.com
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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Spinal Instability Clinical Pearls & Degeneration and Facets

CF 152: Spinal Instability Clinical Pearls & Degeneration and Facets

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

But first, here’s that sweet sweet bumper music

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

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

Do it do it do it. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Item #1

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

Why They Did It

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

How They Did It

Retrospectively recruited 62 patients from 60-70 years old

They evaluated the following: 

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

What They Found

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

Wrap It Up

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

CHIROUP ADVERTISEMENT

Item #2

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

Why They Did It

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

How They Did It

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

What They Found

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Key Point:

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

Contact

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

Connect

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

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About the Author & Host

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

Bibliography

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

Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters

CF 145: Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters Today we’re going to talk about how kids can hurt, SMT for chronic lumbar radiculopathy, lack of testing on biopsychosocial matters.  But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it.    https://www.chiropracticforward.com/chiropractors-affected-by-covid-2019-opioid-overdoses-insurance-compensation-for-chiropractic/   You have found yourself smack dab in the middle of Episode #145 Now if you missed last week’s episode , we talked about some of the most common musculoskeletal surgeries and the incredible lack of research backing them up. We also talked about how chiropractic performs when lined up against multidisciplinary treatment. Check it out after this one. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. I think I’m getting busier. Feels like it anyway. 143 last week and the new patients are staying steady. Which is a good thing. I have the kind of practice that depends on new patients. When you’re evidence-based and you don’t make a ton of long-term recommendations…..you don’t make patients think they need to depend on you every week for the rest of their lives….well then, you have a constant turnover of patients.  My longest recommendation is for about a 3 month plan. Honestly, most people are feeling so good that they don’t wrap up a 3 month plan. Some of you agree with that and some of you will say I should be holding them to the program but, research is clear on this.  We should be teaching patients to self-manage at home. Not depending on us. And that’s part of it. Once they start self-managing and they’re feeling great, where’s the motivation to pay someone to mostly do what they’re doing at home already? I get it. And I don’t fuss with patients over their schedules when they’re doing amazing in the first damn place. There’s a point where that type of fussing and borderline bullying starts to look like greed. And I’m sure none of us want to look greedy. At least I don’t.  That’s the epitome of being patient-centered, right? But the point is, patient-centered, evidence-based chiropractors need a steady stream of new patients.  Now don’t get me wrong; I have wellness patients. They just aren’t the bulk of my practice. If I just depended on wellness/maintenance patients, we’d be in a world of hurt up in here, up in here.  Not long ago, evidence-based chiros threw monkey poo at maintenance. Then Andres Eklund came around and cleaned up the monkey mess. Then a systematic review recently came out saying maintenance care can now be considered evidence-based. It felt like slipping into a warm coat in the winter, ya know. Lol.  Now, that doesn’t mean once a week for life like the subluxation slayers lay on people. For the right population, once every month or two….or maybe every three months….that does indeed make difference and make some sense. If you’re unfamiliar with Andres Eklund, just go to our episodes link at chiropracticforward.com and use the search function there to search for maintenance care or Nordic papers and dive in. It’s wonderful stuff.  I love it when the hard work has already been done by people smarter than me. It’s good stuff.  Outside of all that boring stuff, still just trying to stay strong and healthy. I’m exercising much more regularly and really watching what I’m eating. It’s paying off too. I lost 7 pounds last week. Yeah, I know what you’re thinking…..how could Jeff get any sexier than he already is but I’m just going to say, hold my beer and watch. My michelob ultra beer that is…..because, you know….I’m on a diet and all. Lol.  I have one kid at Texas Tech where COVID is spreading like a bad STD and then I have another in person in junior high. So far in the first 5 weeks they’ve had 2 teachers and 2 kids out with the Rona. That may sound like a lot but, honestly, this junior high has about 1400 kids so……that’s not much.  The kid at Tech thinks he wants to come home every 2 weeks for the weekend. I love seeing the little knucklehead but another part of me is like…..you stay over there on that side of the house…..I’ll be on this side. He’s a big hugger. I’m normally good for a hug and all but…..Rona has me trying to stay healthy. You can’t turn down a hug from your kiddo though. Still……it’s a bit nerve wracking.  I tell people and you may have heard me say it but, most folks do fine if they get COVID and I expect I’ll do fine as well. Other than being out of shape and overweight, I’m not particularly unhealthy. Most folks, if they get it, they just stay home in bed, fluids, all that rigamarole but no big deal really.  Me….and most of you….we have to close down out businesses essentially. I have 14 employees, y’all. They have families. We bill out anywhere from $20k-$25k per week typically. At minimum, I’m probably out for 2 weeks. That means missing out on up to $50k in billing.  One word, two syllables….Day-um….Hell no. I’ll just do everything I can to stay healthy in the first place. Even if some knuckleheads don’t understand or get it.  Speaking of…..These anti-maskers….good Lord. I don’t know how they are where you live but here in Texas, did you know all kinds of degrees have morphed into now allowing the owner of the degree to now be an expert on epidemiology? Very powerful degrees. I’ve never heard of a degree that morphs into epidemiological expertise but evidently, it’s a fact these days.  I saw a great quote from a fellow chiro that went something like this, “I guess I just don’t understand the argument anti-maskers make in general. Regardless of anything, for me, as a healthcare professional, I need to be flexible and consider being wrong as part of my logic. Simply put, maybe masks work, maybe they don’t but it really doesn’t matter what you believe. The question sreally is, if you’re wrong can you live with the consequences? I wear a mask because I believe it reduces the risk of exposure for me and to those around me, but more importantly, if I’m wrong I won’t hurt anybody at all. Including myself. If you don’t wear a mask and you’re wrong, then the effects can be devastating during a really off day when things go they way they’re not supposed to go.  Or, how about the sneeze test? Have someone sneeze on you with a mask on and then have them sneeze on you without a mask on.  Which do you prefer? End of story.  Let’s get on with it. We have some pretty cool stuff to breeze through today.  Item #1 Let’s start with this one called “Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8–16 years” by Fuglkjaer et. al. it also has Jan Hartivigsen on it as well. It was published in Chiropractic and Manual Therapies in August of 2020(Fuglkjaer S 2020).  Hot tamale, hot tamale, that tamale….it’s hot… Why They Did It The objectives were to group children aged 8 to 16 according to their distribution of pain in the spine, lower- and upper extremity, determine the proportion of children in each subgroup, and describe these in relation to sex, age, number- and length of episodes with pain. How They Did It Data on musculoskeletal pain from about 1,000 Danish schoolchildren was collected over 3 school years (2011 to 2014) using weekly mobile phone text message responses from parents, indicating whether their child had pain in the spine, lower extremity and/or upper extremity. Result are presented for each school year individually. What They Found

  • Around 30% reporting no pain, around 40% reporting pain in one region, and around 30% reporting pain in two or three regions.
  • Most commonly children experienced pain from the lower extremities at about 60%, the the spine at about 30%, and then upper extremities at about 23%. 
  • Twice as many girls reported pain in all three sites

Wrap It Up Danish schoolchildren often experienced pain at more than one pain site during a schoolyear, and a significantly larger proportion of girls than boys reported pain in all three regions. This could indicate that, at least in some instances, the musculoskeletal system should be regarded as one entity, both for clinical and research purposes. Item #2 This one is excellent. It’s called “Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial” by Ghasabmahaleh, et. al. and published in The American Journal of Medicine on September of 2020(Ghasabmahaleh S 2020).  Sizzlin, smokin’. some stout stuff, y’all.  Why They Did It The authors wanted to evaluate the efficacy of spinal manipulation for the management of non-acute lumbar radiculopathy. How They Did It

  • It was performed in a university hospital
  • It was a randomized controlled trial with two parallel arms. 
  • 44 patients with unilateral radicular low back pain lasting more than 4 weeks were randomly allocated to manipulation and control groups.
  • The primary outcome was intensity of the low back pain on the VAS scale
  • Secondary outcome was the Oswestry Disability Questionnaire score
  • In addition they measure spinal ranges of motion. 
  • All patients had physiotherapy
  • The manipulation group got three sessions of manipulation therapy, one week apart. 
  • For manipulation, they used Robert Maigne’s technique. 

What They Found

  • Both groups experienced a significant decrease in back and leg pain
  • However, only the manipulation group showed significantly favorable results in the Oswestry scores, and the straight leg raise test. 
  • All ranges of motion increased significantly with manipulation but the control group showed favorable results only in right and left rotations and in extension
  • Between-group analyses showed significantly better outcomes for manipulation in all measurements with large effect sizes

Wrap It Up They wrap it up by saying, “Spinal manipulation improves the results of physiotherapy over a period of three months for patients with subacute or chronic lumbar radiculopathy.” I say hell with that conclusion. Lol. I say that PT ADDS TO spinal manipulation. I’ve told my patients for years now that there is great research for spinal manipulation and there is great research for exercise. It’s not about one or the other. They’re not mutually exclusive. The research is best for combining the two.  If you go to a PT and just get exercise, that’s not the full meal deal. You’re a taco or two short of a combo meal there.  If you go to a chiropractor and only get adjustments, yes, there should be some relief but, again, you a taco short. You could be better.  You don’t want evidence-based chiros out there in the world wishing you didn’t suck so much. Get on the exercise rehab. Learn. I didn’t used to know much about it. Hell, if I’m being honest, there’s A LOT more I still need to learn but I’m a hell of a lot better than I once was.  Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.   Picture a T bar with a built-in drop piece.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website. It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. Go check Drop Release at droprelease.com and tell Dr. Howson I sent you. Item #3 Last one today is called “The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States” by Gliedt et. al. published in Chiropractic and Manual Therapies on 21st of August 2020(Gliedt J 2020).  On the hottest, freshest frijoles for the Forward fans.  Why They Did It Chiropractors treat spine complaints and therefore should be trained in the full spectrum of the biopsychosocial model. This study examines the use of psychosocial related terminology in United States doctor of chiropractic program (DCP) curricula, the Council on Chiropractic Education (CCE) standards, and the National Board of Chiropractic Examiners (NBCE) test plans. How They Did It Nineteen academic course catalogs, CCE curricular standards and meta-competencies, and NBCE test plans were studied Wrap It Up Despite evidence suggesting the influential role of psychosocial factors in determinants of health and healthcare delivery, these factors are poorly reflected in United States DCP curricula. This underappreciation is further evidenced by the lack of representation of psychosocial terminology in NBCE parts III and IV test plans. The reasons for this are theoretical; lack of clarity or enforcement of CCE meta-competencies may contribute. So when you hear people ask what we can do to make this profession better, stronger, and more respected…..this is just one more thing that can be done.  Our institutions can recognize the biopsychosocial aspect of chronic pain, they can teach it, they can teach yellow flags, and then they can test it.  Then we can look at making entrance into the schools a little more stringent and we can look at taking the subluxation slayers and spine whisperer courses out of our colleges. If someone wants to learn how to be doctor-centered and use x-rays to manipulate patients out of thousands of dollars a year, they need to be learning that garbage outside of an accredited chiropractic college. It has no place in our institutes beyond some historical perspective.  Over and out. Mic drop, bam, shazam, ala cazam.  https://www.chiropracticforward.com/common-surgeries-arent-well-researched-chiropractic-wins-again/   That’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Fuglkjaer S, V. W., Hartvigsen J, Dissing KB, Junge T, Hestbaek L, (2020). “Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8–16 years.” Chiropr Man Therap 28(45).
  • Ghasabmahaleh S, R. Z., Dadarkhah A, Hamidipanah S, Mofrad R, Najafi S, (2020). “Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial.” The American Journal Of Medicine.
  • Gliedt J, B. P., Holmes B, (2020). “The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States.” Chiropr Man Therap 28(43).