evidence-based chiropractic

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.

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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

 

 

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

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

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

  • 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

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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

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

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

  • 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/

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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
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
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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

Spinal Instability Clinical Pearls & Degeneration and Facets

CF 152: Spinal Instability Clinical Pearls & Degeneration and Facets

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

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Item #1

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

Why They Did It

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

How They Did It

Retrospectively recruited 62 patients from 60-70 years old

They evaluated the following: 

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

What They Found

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

Wrap It Up

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

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.

Website

Home

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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

  • 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).

w/ Dr. Chris Howson: Chiropractors In Hospitals & Drop Release

CF 140: w/ Dr. Chris Howson:  Chiropractors In Hospitals & Drop Release

Today we’re going to be joined by Dr. Chris Howson of the great state of North Dakota where we’ll be talking about chiropractic integration in a hospital setting as well as his new invention called Drop Release. 

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. 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 #140

Now if you missed last week’s episode , we talked about chiropractors affected by COVID, 2019 opioid overdoses, and insurnace compensation for chiropractic. 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 am writing this on 8/17/20 which means I’m taking my son to college this afternoon for his freshman year. It’s my first kid to fly the coop and we’ll see how it goes. Many of you did this same thing years ago. Many of you don’t even have kids so I won’t dwell on it long. 

I’ll just say, especially to the young ones, there’s no time to waste. Whether it’s starting your own retirement account, starting your kids a college fund, or asking that girl on a date. There’s no time to waste because landmarks like I’m going through this week…..they arrive before you know it. Almost by surprise even. 

Before you know it, you’ll look up and you’ve been in business 20 years, your kids are graduating, you looking at retirement in the next 10-15 years and you don’t know exactly how it all happened. But it did and if you’re not a forethinker, it’ll punch you square in the nose and make your eyes cross. 

Just a word from your wise ol’ Uncle Jeffro. 

I don’t want to talk too much because we have a guest today. Before we welcome him, I want to do a proper introduction. 

  • 2004 graduate of Northwestern. 
  • Practicing in Grand Forks ND, 
  • has spent the last 9 years in an integrated practice setting. 
  • Has a strong background in sports and applies that “get em back on the field” mentality to all his patients.  
  • Member of FTCA, NDCA, and ACA.   
  • Currently pursuing the orthopedic diplomate.  
  • Inventor of the Drop Release.

Tell me a little bit about yourself and your family.

I always say that chiropractic isn’t something that immediately comes to mind when one is deciding what they want to be when they grow up. So how did you come to be a chiropractor?

Where did you go to school?

What in your background or your schooling best prepared you for your current practice setting? Did you have any mentors that were particularly impactful along the way?

We have talked at length on this podcast about integrating into the Federally Qualified Health Centers or FQHCs but your situation is a little bit different. Can you explain what you’re doing and how you got there? And how it’s different from an FQHC.

What kind of patient is your typical patient in the hospital setting? Are you just confined to acute low back or what? 

Have you had any issues or had to stand your ground when it came to those in the medical field that don’t necessarily love the chiropractic profession? 

Numbers

Do you see your model as something that can be repeated in TX, NC, CA, to Florida? And how? How could those interested start on the path you’re blazing up in ND?

Do you see your current way of practicing as your life long way or do you have plans to be in the private sector down the line?

So, we get along very well because we are both go getters and entrepreneurs. If people have been listening, lately, I’ve been giving them a code for a discount on a new little invention called Drop Release. You happen to be the inventor of Drop Release. I actually first met you in person at the Forward ’19 event in St. Louis when you were working your Drop Release exhibit booth. Tell us all how you came up with the idea. How did you take it from concept to reality? That’s the biggest hurdle most folks don’t get over. 

We might as well give them the code to save some money on Drop Release if they want one, don’t you think?

Thanks for joining us, Chris. I appreciate it. 

Alright, 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. 

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

Getting Patients Returning, Shoulder Impingement, Cervical Manipulation, & X-rays and Neurodegenerative Disease

CF 133: Getting Patients Returning, Shoulder Impingement, Cervical Manipulation, & X-rays and Neurodegenerative Disease Today we’re going to talk about getting your patients back in your office, we’ll talk about shoulder impingement, cervical manipulation research, and we’ll talk about low dose x-rays being the cause of neurodegenerative disease.  But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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

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

  • 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 #133 Now if you missed last week’s episode, we talked about giving, we talked about maintenance care, dry needling, and we also talked about vitalism.

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….. The last two episodes have had a talk about vitalism and all of that. I got red in the face and gripey and some would even say…..disagreeable.  None of that this week. Fun and positivity. I made the mistake of going back to recording the personal part of the podcast….this part of the podcast….two weeks in advance. Well, it bit me in the butt an episode or two back. I should know by now that that damn COVID’s going to change the program. Lol. I said it was looking good and numbers were great and by the time we get to air time, 2 weeks down the road, the roadmap was different and crap was firing up everywhere again.

It sounded silly for it to be firing up everywhere and there I am on a fresh episode talking about how good it’s looking. Lol. So…..I’m not going to mention anything like that again.  Besides, you guys are probably not in the mood to hear more about it anyway. Instead, I’ll tell you that I’m at about 81% of where I want to be. The least I want to see per week is about 180 appointments. Each week. 13 – 15 new patients per week. That’s the LEAST I want to see.  As of this recording, last week I saw 146 and 15 patients.

So, I’m not at 180 yet but I’m more comfortable with my new patient count. Let’s keep that rocking and the other numbers should take care of itself sooner than later. It’s a Monday afternoon and I have 120 on the books. That’s before Wednesday gets booked up, Thursday, and Friday. So, starting a Monday with 120 already booked for the week, that tells me we have a good chance at a continued recovery.  What are your numbers looking like? Is your practice starting to get back to normal and stabilize?

What are you doing to make sure your business survives this mess? I want to hear about it so I can share it with our audience. If you’ll share with us on the Facebook page, in the Facebook group, or by sending me an email at dr.williams@chiropracticforward.com…..I’ll make sure and share with the rest of our listeners. This can be an excellent way to help others that are struggling right now.  Last week I talked about giving. Well, this is a great way to give back to your profession and colleagues that may not be doing as well as we are.  I’ll start.  I doubled down on Social Media Instead of one post a day, we went to 3 per day and 4 per day on the weekends.  We went from just talking about chiropractic to fun posts with a little bit of chiropractic here and there.

About every 4th or 5th post.

We want to entertain. I don’t know that anyone wants to be sold anything right now but, I don’t personally mind commercials or being interrupted if I’m simultaneously being entertained. So that’s what we did. We started entertaining our crowd We asked for people to help us by inviting their friends to our page. And they did! We hit numbers that would have taken us 3 years to build. We hit them in only about 4 days. I was amazed. Just because we asked and, it seems that at this time, more people are willing to help others.  Of course, that’s if they’re not bitching at each other about masks.  I got back to my weekly emails to my patients.

I had fallen off to emailing only once every 3-4 weeks. Now I’m back on a weekly schedule.  I revamped my To-Do list to include everything thing that I need to accomplish every day so I don’t forget or let things lapse. I want to stay on point with getting our message out every day, every week, every month.  I decided to try a professional company for Facebook ads. We still have a lot of really mixed results on that sucker right now so I haven’t talked much about it but I’ll let you know how we do down the road. 

In the meantime, as if I needed something else to occupy my time, I started a voice-over career on the side. Lol. To go along with my sculpting, drawing, and art career. To go along with my furniture building career. Which will go along nicely with my singer/songwriter/guitar-playing career?  Geez….is that the very definition of A.D.D. or what? But yeah, if you need any commercials voiced for you, holler at me. I’m happy to help. 

Back to the office, I got back to doing weekly YouTube videos. Every week like clockwork. That made me get back to writing my own weekly blog. That’s work I used to hire out to a guy in South Africa but I took it back over for a bit and it’s been fun actually.  So, as you can see, I’ve made A LOT of changes to get back on track and get this sucker not just where it was this time last year, but 10% or bigger. Why the hell not? Overall, I have made it a point to highlight what we are doing to help keep them as safe as we can. If COVID is the barrier, then we need to do everything we can to remove that barrier. 

Alright, as I said, you guys and gals send me your suggestions of things you are doing to get your patients back in your clinic. 

Item #1 This first one this week is called ‘Relationship between shoulder impingement syndrome and thoracic posture’ by Hunter et. al.(Hunter D 2020) and published in Physical Therapy journal in April of 2020 and that means that that is one hot son of a mother!!

Why They Did It They say that shoulder impingement is the most common form of shoulder pain and a persistent musculoskeletal problem and that we have had limited success in treating it. They wanted to test whether or not thoracic posture has anything to do with it. 

How They Did It

  • This was a case-control study. 
  • Thoracic posture of 39 participants with shoulder impingement was measure using the modified Cobb angle from a lateral x-ray. 
  • They accounted for age, gender, and dominant arm
  • T-sp range of motion was measured with an inclinometer

What They Found

  • Individuals with shoulder impingement had greater thoracic kyphosis and less active thoracic extension
  • Greater thoracic kyphosis was associated with less extension ROM

Wrap It Up “Individuals with shoulder impingement had a greater thoracic kyphosis and less extension ROM than age- and gender-matched healthy controls. These results suggest that clinicians could consider addressing the thoracic spine in patients with shoulder impingement.”

Item #2 Item #2 this week is called “The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review” by Giacalone et. al.(Giacalone 2020) published in Cureus in April of 2020 which makes it too hot to handle for me!

Why They Did It They say that cervical manipulative techniques are mostly used for the treatment of biomechanical joint dysfunction, but little is known about possibly using them in order to achieve better performance on a healthy subject

How They Did It

  • A systematic search was carried out on the Pubmed electronic database from the beginning of January to March 2020.
  • Two independent reviewers conducted the screening process through the PRISMA diagram to determine the eligibility of the articles.
  • The inclusion criteria covered randomized controlled trial (RCT) manuscripts published in peer-reviewed journals with individuals of all ages from 2005 to 2020.
  • The included intervention was thrust manipulation or HVLA directed towards the cervical spine region. 
  • After reviewing the literature, 21 of 74 articles were considered useful and relevant to the research question.

What They Found

  • HVLA techniques, on subjects with musculoskeletal disorders, are able to influence pain modulation, mobility, and strength both in the treated area and at a distance.
  • Cervical manipulations are effective in the management of cervicalgia, epicondylalgia, temporomandibular joint disorders, and shoulder pain.
  • With regard to results on strength in healthy subjects, given the divergent opinions of the authors, we cannot yet state that manipulation can significantly influence this parameter.

Item #3 Our last one is called ‘Low-dose x-ray imaging may increase the risk of neurodegenerative diseases’ by Caroline Rodgers(Rodgers C 2020) and published in Medical Hypotheses in April of 2020…..look at April…..not just bringing us COVID…but also bringing us a bunch of plates of steamy hot stuff. 

As the journal says, this is a hypothesis. The hypothesis presented in this paper explores the possibility that X-ray imaging commonly used in dental practices may be a shared risk factor for sporadic dementias and motor-neuron diseases. As the evidence will suggest, the brain is ill-equipped to manage the intrusion of low-dose ionizing radiation (IR) beyond that which is naturally occurring.

When the brain’s antioxidant defenses are overwhelmed by IR, it produces an abundance of reactive oxygen species (ROS) that can lead to oxidative stress, mitochondrial dysfunction, loss of synaptic plasticity, altered neuronal structure and microvascular impairment that have been identified as early signs of neurodegeneration in Alzheimer’s disease, Parkinson’s, amyotrophic lateral sclerosis, vascular dementia and other diseases that progressively damage the brain and central nervous system.

Common assumptions regarding the risks of low-dose IR will be addressed, such as 1) comparing rapid, repeated bursts of man-made IR sent exclusively into the head to equivalent amounts of head-to-toe background IR over longer periods of time; 2) whether epidemiological studies that dismiss concerns regarding low-dose IR due to lack of evidence it causes cancer, heritable mutations or shortened life spans also apply to neurodegeneration; and 3) why even radiation-resistant neurons can be severely impacted by IR exposure, due to IR-induced injury to the processes they need to function. 

If X-ray imaging is found to be associated with neurodegeneration, the risk-versus-benefit must be reevaluated, every means of reducing exposure implemented and imaging protocols revised. So…..we here at Chiropractic Forward will be following along here. Because if this turns out to confirm that radiation causes neurodegenerative disease, you know what that means for the chiropractors shooting x-rays on each and every patient and then doing several follow up x-rays on them?  They won’t be happy campers. But, maybe they’ll start following more guidelines that say no x-rays outside of red flags. I’ve said several times that I’m not against chiropractors that shoot initial x-rays. I’m really not.

Some are just more comfortable working on people when they’ve seen what they can see.  My issue is using the initial x-rays as a scare tactic and communicating in a catastrophic way to achieve a long treatment schedule out the patient. One they likely don’t need at all.  My other issue would be repeating x-rays several times through treatment.

That’s not evidence-based and the patient doesn’t need them. 

Alright, that’s it. Y’all be safe. 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. 

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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography Giacalone A, F. M., Magnifica F, Ruberti E, (2020). “The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review.” Cureus 12(4): e7682. Hunter D, R. D., McKeirnan S, (2020). “Relationship Between Shoulder Impingement Syndrome and Thoracic Posture.” Phys Ther 100(4): 677-686. Rodgers C (2020). “Low-dose X-ray Imaging May Increase the Risk of Neurodegenerative Diseases.” Med Hypotheses 142(109726).

American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements

CF 111: American Academy of Family Physicians Warming To Chiropractic For Chronic Pain & Evidence Behind Supplements

Today we’re going to talk about how the American Family Physicians may be warming up to chiropractic for chronic pain and what supplements actually have some evidence behind them.

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 #111

Now if you missed last week’s episode , we talked about Dry Needling vs. Massage and even more importantly, we talked about the topic of “What is your exit number?”. What are you looking to get out of it all in the end? I feel like there were points made in there that could really get you to contemplating and thinking going forward. So, make sure you don’t miss that info. Keep up with the class. 

That reminds me, did you know that you can use our website as quite a resource? I do it all of the time. If you think I can keep every one of these papers in my noggin and pull them out of my brain files on demand, that’s a big nope. But I can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever I 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. 

On the personal end of things…..

Rinse and repeat man, rinse and repeat. If you’re friends with me on Facebook, then you know life has been crazy and there’s no slow down in site. 

Some really positive stuff happening though too. For example, I was interviewed for two different articles in Chiropractic Economics recently. They published an article called “Chiropractic for prevention: the latest research on maintenance care” by Michele Wojciechowski. Michele used my comments exclusively in this article and that’s just a big honor. 

I remember when I was new in practice. I remember reading articles in Dynamic Chiropractic and Chiropractic Economics and thinking that would be cool to be in that one of these days. Now…..now…I’ve been fortunate enough to be in Reader’s Digest, on the ACA Blog a couple of times, and now Chiropractic Economics. It’s pretty damn exciting and it’s an honor. 

Thank you Michele for finding value in my comments and sharing them with everyone else. I’ll leave a link to that article at this point in the show notes if you’re interested in giving it a read through. 

Other than that, my family and I took a quick ski-cation to Red River, New Mexico. If you haven’t been, look it up. Here’s why we like Red River, First thing, it’s close. For a Texan to be able to just drive about 4 hours and be in the mountains, that’s pretty exciting. 

Next thing, it’s just gorgeous. And, the ski slope comes right down into the town so you don’t have to drive out to a mountain which is nice. 

Let’s talk about why I retired from skiing myself though shall we? This may make you think a bit about some of the stuff you do in your offtime. Maybe it won’t but it’s important to think about things which is the whole point of me bringing it up.

I used to ski a lot back in high school and junior high. I was pretty decent at it too. Then I went off to play football and be a college kid. Well, Louisiana for a bit and Dallas for a bit…..those areas aren’t very conducive to learning to snow ski. It’s too damn far. Especially when you’re still a kid and broke as hell. Skiing just doesn’t happen at that point in life unless you have parents taking you. I didn’t.

So then you start life and you’re building a business and there’s never time to go then either. 

Well by the time I got back around to going skiing again, I hadn’t done it in about 20 years give or take. So, i got a private coach for a morning just to get me back on that bicycle and rocking and rolling again. I have to tell you, it was hard as hell!! It was NOT like riding a bike. Nothing at all like it as a matter of fact!!

But, I took it slow, I didn’t fall at all, and was fairly happy with my progress over the weekend. HOWEVER, I got to thinking when I got home. I went back to work and had about 45 patients that next day. What if I had twisted a knee, broken and elbow, or dislocated a shoulder while I was skiing? What would I have done?

You know this sounds stupid when you say it but, “They call them accidents because you don’t plan them.” But you can avoid them sometimes. I got to thinking long and hard enough about the risk vs. rewards for continuing to ski and……honestly, on paper, it wasn’t worth the risk. 

So, I retired. Maybe if I had an associate. Maybe I could make more sense of it but, the truth is, I don’t have an associate. It’s just me although I’m thinking of hiring one just as soon as it makes sense. Anyway. I took the kids skiing while the wifey and myself enjoyed the mountains, some brewskis, and some playoff football games. 

What are you involved in as far as physical activity outside of your practice that puts you at risk and puts your ability to earn a living at risk? Do you have disability insurance? Life insurance? Long term care insurance? I have all of that. Do you need it?

Start thinking about these things. Certainly, the more successful you get and the busier your practice gets. Risking an injury just might not be worth it at some point. 

Before we dive into the reason we’re here, it’s good to support the people that support evidence-informed practitioners. Well, ChiroUp certainly does just that. 

If you don’t take advantage of the deal I’m about to offer you, I think you just might be crazy.

Regular listeners know I’ve used ChiroUp for well over a year now. I’m going to tell you want it is and then share a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, activities of daily living, & for their exercises. 

This saves you so much time – no more explaining & re-explaining your patient’s care because they have access to it right there at their fingertips. 

You can be confident that your patients are getting the best possible care because the reports and exercises are populated based on what the literature recommends and isn’t that reassuring? All of that work has been done FOR you by people that are deep into the research. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice.

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL and, to sweeten the deal, you can use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super saver code is Williams99.

Item #1

Let’s start with this one from American Family Physician. I got this one from one of my amazing colleagues, Dr. Craig Benton down in Lampasas, TX. It’s called “Nonpharmacologic therapies can improve chronic pain outcomes” authored by Michael Devitt and was published in American Academy of Family Physicians on January 15, 2020(Devitt M 2020). Damn it’s hot…..

Not a research paper but more of an article in their publication but has plenty to do with chiropractic. 

They set the stage here by pointing out that chronic pain is something that can cause people to go to extreme measures just to get the pain to go away. Or at least lighten up. They say this includes potentially harmful behaviors like drug and alcohol misuse and/or abuse. 

Then this article in the American Family Physicians journal starts to highlight and promote the nonpharmacologic treatment modalities that are available to family physicians. Honestly, did you think you’d ever see the day? Ever? The battle isn’t over by any stretch of the imagination but research is gradually, inch by inch, turning the tide. 

They say these modalities include simple methods like massage and heat as well as more complex therapy like acupuncture and chiropractic manipulation. They called us ‘complex’ and I’m taking that as a compliment. Lol. What we do can damn sure be complex. 

They say that these nonpharma strategies aren’t only effective for decreasing pain and improving function, but can also be effective for reducing longer-term adverse effects such as substance use disorders and suicide attempts. THAT’S A BIG DAMN DEAL. 

In fact, I got one word, two syllables….day-um. 

One researcher, the lead author from an active-duty US Army service study said “Chronic pain is associated with adverse outcomes such as substance use and suicidal thoughts and behavior,” said Esther Meerwijk, Ph.D., M.S.N., a statistician at the VA Palo Alto Health Care System in California. She added, “It made sense that if nondrug treatments are good at managing pain, their effect would go beyond only pain relief. However, I was surprised that the results of our analyses held, despite our attempts to prove them wrong.”

Despite our attempts to prove them wrong! Haven’t they been trying to prove us wrong for generations now? Lol. I always say that with all of the powers against us, if we were wrong, if we were ineffective, we would have been wiped out years ago. 

In one of her projects, they reviewed the records of more than 275,000 active-duty service members reporting chronic pain.

They combed through their files to determine whether they had received any of 13 nonpharmacologic therapies after their deployment. Those therapies were acupuncture or dry needling, biofeedback, chiropractic care, cold laser therapy, exercise therapy, lumbar supports, massage, osteopathic spinal manipulation, other physical therapy, superficial heat, traction, transcutaneous electrical nerve stimulation, and ultrasonography. 

After crunching all of the numbers and outcomes here’s what they came up with:

Specifically, service members who received nonpharmacologic therapies were

  • 8% less likely to experience new-onset alcohol and/or drug use disorders;
  • 12% less likely to experience suicidal ideation;
  • 17% less likely to experience a self-inflicted injury, including attempted suicide;
  • 18% less likely to intentionally poison themselves with opioids, related narcotics, barbiturates or sedatives; and
  • 35% less likely to accidentally poison themselves with the same types of drugs.

The researchers acknowledged several limitations in their research. For example, although most nonpharmacologic therapies were provided after service members were diagnosed with chronic pain, the authors could not determine whether those nonpharmacologic therapies were used specifically to treat that pain.

In the news release, Meerwijk also explained that her team did not study the effects of individual nonpharmacologic therapies.

“We treated them as one,” she said. “Most likely, only some of the therapies that we included are responsible for the effect that we reported, whereas others may have had no effect at all, assuming there’s no other variable that explains our findings.”

Despite these limits, the authors expressed confidence in their research methods and findings.

“Our results suggest that (nonpharmacologic therapies) provided to active-duty service members with chronic pain may reduce their odds of long-term adverse outcomes,” they concluded in the study. “Given known associations of these adverse outcomes with morbidity and mortality, providing (nonpharmacologic therapies) to service members with chronic pain could potentially save lives.”

I’ve been hearing this crashing tidal wave coming. It’s not here yet. But the roar is approaching and it sounds like sweet sweet music to me ears. 

Item #2

I’m going to do everything I can to boil this sucker down and strip it to the bare bones without it getting too long or boring. This one is called “Evidence-based supplements for the enhancement of the athletic performance” by Peeling, et. al(Peeling P 2017). and published in the International Journal of Sport Nutrition and Exercise Metabolism in 2017. 

The authors wanted to put together a review focusing on the available evidence based for performance supplements commonly used in sports and summarizing the when’s and the how’s around their uses.

The ysay there is robust evidence that the following supplements can enhance sports performance when used according to established protocols. 

So let’s motor through this like poop through a goose, shall we?

  1. Caffeine -There exists a lengthy research history on caffeine supplementation across a range of performance protocols, including endurance-based situations, resistance training exercise, short-term supramaximal efforts, and/or repeat-sprint tasks. Reported benefits of caffeine include benefits include adenosine receptor antagonism, increased endorphin release, enhanced neuromuscular function, improved vigilance and alertness, and a reduced perception of exertion during exercise. Low to moderate doses of caffeine (∼3–6 mg/kg BM), consumed 60 min pre exercise, appear to have the most consistent positive outcomes on sports performance in research situations, although a variety of other protocols (as mentioned above) also appear beneficial, and are practiced in real-life. Of note, athletes who intend to use caffeine as a performance aid should trial their strategies during training or minor competitions, in order to fine-tune a protocol that achieves benefits with minimal side effects.
  2. Creatine – widely-researched supplement, with creatine monohydrate (CM) being the most common form used. Creatine loading can acutely enhance the performance of sports involving repeated high-intensity exercise (e.g., team sports), as well as the chronic outcomes of training programs based on these characteristics (e.g., resistance or interval training), leading to greater gains in lean mass and muscular strength and power. When accepted creatine monohydrate supplementation protocols are followed, the expected increase in intramuscular creatine stores is likely to enhance lean mass, maximal power/strength, and the performance of single and repeated bouts of short-term, high-intensity exercise.
  3. Nitrate –  The authors say Nitrate is a popular supplement initially found to improve oxygen uptake kinetics during prolonged submaximal exercise. Great sources are Leafy green and root vegetables (i.e., spinach, rocket, celery, beetroot, etc.
  4. Beta-Alanine – The paper says this is one of the immediate defenses against the accumulation of protons in the contracting musculature during exercise. I can also tell you that this is just something I never nerded out on. Lol. Not my cup of tea but I like to offer something for everyone here at the Chiropractic Forward Podcast. They say it can improve tolerance for maximal exercise bouts lasting 30 s to 10 min and provide small yet significant benefits in both continuous and intermittent exercise tests. Basically, it’s used in order to augment high-intensity exercise performance ranging from 30 s to 10 min in duration.
  5. Sodium Bicarbonate – benefits are generally seen in short-term, high-intensity sprints lasting ∼60 s in duration, with a diminishing return as the effort duration exceeds ∼10 min. However, greater benefits may be realized (>8% improvement) with a greater number of repeated sprint bouts

Go to our show notes at chiropracticforward.com if you’d like to get dosing information and all the little technical tidbits. It’s really interesting. Even to an orthopedic guy like me although, its technical enough to make my eyes glaze over as well. 

There are several others listed in the paper as well but the authors point out that the evidence for their effectiveness is much less clear. They are Sodium citrate, Phosphates, and Carnitine.

Even though that stuff is not my cup of tea, it’s good to know, it’s good to have as a reference, and it’s good to pass on to you because many of you actually do nerd out on that stuff and thank God for that. That means I can call people like you and ask what the hell. On the other hand, if it’s something I nerd out on like orthopedics, you can call me and say what the hell?

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

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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Devitt M (2020). “Nonpharmacologic Therapies Can Improve Chronic Pain Outcomes Reductions in Drug Misuse, Suicide Attempts Reported.” AAFP.

Peeling P, B. M., Paul S, (2017). “Evidence-based supplements for the enhancement of athletic performance.” IntJ sport Nutrition Exercise Metabolism 28(2): 178-187.

Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

CF 105: Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

Today we’re going to talk about some thoughts on Groupon and Chiropractic, if you know me, you probably know where this is going and it’ll probably be fun. We’ll find out. We’ll talk about Gabapentin and we will talk about a couple of papers I encountered recently having to do with metabolism, intermittent fasting, and things of that nature. 

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. So feel free to crack one wide open would you?

Welcome, 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. 

Do it do it do it. 

You have plopped down into Episode #105 just like a comfy easy chair. 

Now if you missed last week’s episode talking about our TWO YEAR wrap up, make sure you don’t miss that episode. It was a lot of fun to put together and to reminisce on some of the amazing episodes we’ve had over the past two years. Good good stuff. 

Something new I found out here…..Did you know that if you have an Alexa product, you can now just say something like, “Alexa, play The Chiropractic Forward Podcast on Apple Podcasts” and kablooey! 

You automatically start to hear the golden throated stylings of yours truly! Lol. You can say skip ahead 30 seconds, play previous episode, and on and on so pretty cool right there. 

On the personal end of things, we just found out that Dad started moving his left leg today for the first time and that’s exciting. It’s the first REAL solid sign of big progress since his first stroke on November 9th. As you can imagine, we are ecstatic about this. Good stuff. Keep on keeping on Pops. Strong like bull!

Before we dive into the reason we’re here, it’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you don’t take advantage of this deal, I just think you might be crazy.

If you’re a regular listener of our podcast, you know I’ve used ChiroUp since about June of 2018. Let me tell you about it because I’m about to give you a way to do a FREE TRIAL and, if you sign up, only pay $99/month for the first six months which is pennies compared to what it’s worth. So listen up!

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Item #1

Alright let’s dive in. We’ll save Groupon until the last because if I know me, it’ll be what I have the most to say out of all of these. 

Let’s start with Gabapentin shall we? The most recent article I’ve come across was in The Atlantic. It was authored by Olga Khazan and called ‘Chronic Pain Is An Impossible Problem’. It was posted December 9, 2019(Khazan O 2019). 

That’s got some sizzle on it!!

Some key points in the article are that 

  • Chronic pain affects about 1/5 of American adults
  • For years those in the medical field thought it could be treated with painkillers like Oxy but that was proven wrong when basically three planeloads of Americans started dying of opioid-related causes each week
  • Now, they’ve turned to Gabapentin, an anticonvulsant, to help treat it. 
  • From 2012-2016 prescriptions of the medication went up 64%
  • There is emerging information that Gabapentin may not be as safe as previously believed. Certainly when combined with other sedating meds. 
  • When taking it long-term, patients can develop tolerance so more and more is required to reach the desired effect. 
  • There is also a withdrawl effect when trying to get off of gabapentin. 
  • People are now starting to use Gabapentin in combination with Baclofen and benzos like Xanax to increase the intoxicating effect. We can see where that is going can’t we?
  • The article goes on to say, “not only does gabapentin appear to exacerbate or create overdose risk, it also doesn’t work well for chronic pain.” They site a study that we’ll cover in a second. 
  • The paper wraps up by saying they’re essentially out of option when it comes to chronic pain. Which to me says they’ve run out of pills basically. That doesn’t mean they’re out of options though. 
  • Arthur Robin Williams, an assistant professor at Columbia University says “The medical community should take a closer look at non-pill remedies such as physical therapy and psychotherapy…I would add evidence-informed chiropractic… These treatments are often not covered by insurance, take longer to work, and take more of providers’ time. But for many, they might be a better option than yet another pill that has yet another pathway to abuse. “The reality is, a lot of the pills that change how you feel in the next 10 to 30 minutes,” Williams says, “carry addictive liability.”

Well…..no kidding? Who would have ever thought that? Hmmm….let’s see. Oh yeah, every chiropractor and PT that ever lived. 

Let’s combine that with a systematic review and meta-analysis from just last year that was in the Canadian Medical Association Journal called “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis”(Enke O 2018)

  • Nine trials compared topiramate, gabapentin or pregabalin to placebo in 859 unique participants. Fourteen of 15 comparisons found anticonvulsants were not effective to reduce pain or disability in low back pain or lumbar radicular pain. 
  • There was high-quality evidence of no effect of gabapentinoids vs. placebo on chronic low back pain. 
  • The lack of efficacy is accompanied by increased risk of adverse events from use of gabapentinoids, for which the level of evidence is high.

It is painfully obvious (no pun intended) that pills aren’t cure-alls and aren’t curing the pain problem. And they won’t sure the pain problem so isn’t it time to look elsewhere? In the year 2020?

All of this is cited in the show notes at chiropracticforward.com. Go get the article and the paper. Use it to educate your community on gabapentin. Set yourself as the reasonable alternative to it. 

Item #2

Fasting and weight loss. I want to be right up front on this, I’ve always wanted to make nutrition and weight loss a part of my practice in some shape form or fashion but, if I’m being honest, I’m just straight up a big big dude. Like I’m 6’4” and, depending on the time of year, 280+. I was a college offensive lineman. I played center and i anchored that line pretty well with my overall biggness. Lol. 

Cat-like reflexes people but big as a damn house. So, I’m not going to teach you how to implement weight-loss into your practice here but I am going to give you some interesting research I cam across recently that might make you think a bit. 

The first paper on this is called “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis”. It was published in Reviews in Endocrine and Metabolic Disorders, authored by P Marianna, C Iolanda, et. al. and published December 2019. (Marianna P 2019)

Hot to the touch. It’ll burn your  damn finger prints off. 

Why They Did It

Restriction in meal timing has emerged as a promising dietary approach for the management of obesity and dysmetabolic diseases. The present systematic review and meta-analysis summarized the most recent evidence on the effect of time-restricted feeding (TRF) on weight-loss and cardiometabolic variables in comparison with unrestricted-time regimens.

How They Did It

  • A total of 11 studies, 5 randomized controlled trials and 6 observational, were included
  • All selected studies had a control group without time restriction
  • Most studies involved the Ramadan fasting

Wrap It Up

Time restricted feeding regimens achieved a superior effect in promoting weight-loss and reducing fasting glucose compared to approaches with unrestricted time in meal consumption. 

As we’ve covered, systematic reviews and meta-analysis are, ideally, high-level research and, considering the majority of the included studies involved the Ramadan fasting regimen, I went to search it up to see what the what. 

So, what exactly is a Ramadan Fasting Regimen? Well let me tell you. And I’m not going for the fancy stuff because I’m tapped for time here so we’re just going to hit up Wikipedia real quick and Wiki says that the basics are:

  • Fasting from sun up to sun down
  • Abstinence from sex, food, and drink
  • It also means one should refrain from things like
  • violence
  • anger
  • envy
  • greed
  • lust
  • angry/sarcastic retort
  • gossip
  • and you’re supposed to get along with others better than you normally do

In America at least, I’m certain we’ll all just do the food part because everyone’s so busy looking for a reason to be offended that I’m certain being nice and getting along is off the table for now. 

So, if you have any personal experience with intermittent fasting, if you’re an expert on the topic, shoot me an email at dr.williams@chiropracticforward.com Let’s talk about it. Maybe we can set up some guests and do a full episode or two on the topic to educate our community of docs on the matter. Sounds like a great topic so hit me up. 

Now, the last thing I have here I want to talk about is Groupon. 

This one is a bit of a trigger for me honestly. Looky here. I am well aware that people are struggling. I’m well aware that I am fortunate and to sit and judge can seem disconnected and unfair at minimum to some. I definitely get that. 

What I also understand is that a whole bunch of those that are struggling are in a profession they really shouldn’t be in because they’re lazy and want to sit behind their desks and hit a few buttons and be magically transformed into a master chiro with an office stocked full of patients and never ending new patients. 

That’s magic time dreamland stuff. 

There will always be supposed shortcuts. There will always be business hacks or whatever you want to call them. But at the end of the day, shouldn’t you make decisions while keeping several things in mind? Meaning, you have to do what is best for your family. You have to do what is best for your office and your employees. But don’t you feel like you should make decisions based on what is best for your profession and for your colleagues?

I would hate to think that I’ve done something that damages my profession . Obviously I don’t mind calling out BS business practices and unethical chiropractors. If that’s damaging my profession well then, I’m guilty as hell. 

But when you are making the deals some of these guys and gals are making on Groupon, you are demeaning, lessening, and trashing what the rest of us take a great deal of pride in. 

Imagine, you go through chiropractic school, you survive 21+ years in practice while steadily getting more and more education, you take on a Diplomate program and finally complete that, and you are fighting on the state level for your profession and your profession’s image…..and then you open your email. 

Yes, I get emails from Groupon with their best and newest deals. I open it up and BAM….It almost seems like all of that work can just be flushed down the toilet. It’s depressing and it makes me want to club baby seals. 

Before we start talking about the article, I did a quick search for Groupon deals in my area and, right there next to Reflexology deals popped up this:

  • 10% cash back – Sounds like a damn car deal
  • Consultation, exam, x-rays, adjustment, and one full-body vibration plate session for $70. Way to value your services. Great. Way to look awesome. Assuming they actually need vibration plate. Assuming they actually need x-rays, assuming they even need and adjustment. Blah
  • Then this one, it’ll make you tickle – One laser lipo session w/ two vibe plate sessions for $45. See…..in Texas, you can only have laser lipo if you’re trying to increase function. Not just look better. So, that’s not necessarily legal as this implies to me it’s for looks. Unless they have a medical director and I’m here to tell you they do not. 
  • When you go to the bigger cities, it only gets worse. I found a $564 value for only $43.70!!! What a damn deal!!!

It’s all just shady and sketchy. Luckily, there are only two in my area doing this stuff. And if they keep it up, we may have two less competitors here as well. 

Besides the shady, street corner huckster look it so convincingly creates, it’s potentially illegal based on the idea of fee splitting, Medicare inducement, and dual fee schedules and, if the state boards start getting their acts together and going after this stuff, they will be the ones to go down. 

What started me down this path today was an article I came across called “Legal Implications of Chiropractic Groupons.” It was written and posted on the website for Carlson and Jayakumar – attorneys at law. I’ll have the link in the show notes. https://cjattorneys.com/legal-implications-of-chiropractic-groupons/

Highlight of the article include:

  • Each day, numerous chiropractors contract with Groupon and its competitors to sell certificates for adjustments, examinations, x-rays and massages. 
  • Despite the variety of services offered, these programs all have two things in common: (1) the chiropractor is offering a significant discount –92% in some examples, and (2) the chiropractor is sharing the income from each certificate sale – usually around 50% – with the website. While we are unaware of any state board taking action against a licensee for a Groupon-style offering, we believe these programs could create significant civil and criminal liability for chiropractors.
  • most states have rules prohibiting the offer or acceptance by a chiropractor of any commission, discount, or other consideration as compensation or inducement for referring patients, clients, or customers to any person, irrespective of the practitioner’s membership, proprietary interest or co-ownership in or with that person. I was once offered the opportunity to buy in to an imaging center here in town. As badly as I wanted to do it, I made the mistake of hiring two different attorneys for their opinions. BOTH advised against and this is exactly why. 
  • With Groupon, money is paid by the chiropractor to the website in connection with a patient’s referral. The chiropractor essentially, albeit indirectly pays the website per patient that purchases the certificate. At their base, these agreements require the chiropractor to pay the website for soliciting, referring and/or procuring clients not he chiropractor’s behalf. Stuff you’re not supposed to do and can get in a lot of trouble for. 
  • Medicare’s Anti-Kickback Statute criminalized the payment of kickbacks for patient referrals. Subsequent laws expanded it to all federalpay programs. Kickbacks include “any remuneration,” a very broad definition, which includes coupons. The Office of the Inspector General issued a “Special Fraud Alert” regarding advertisements offering “discounts” given to Medicare beneficiaries. Then a “Special Advisory Bulletin” appeared on offering inducements to Medicare beneficiaries. Essentially, it said a provider could not offer a patient anything worth more than $10, and combined $50 in a year for multiple gifts.
  • Groupon-style deals are unadvisable as they may pose problems with insurance companies. Most insurance policies will not pay for any charges that would not have been made in the absence of insurance. Groupon offerings, which almost always charge a lower fee to the purchaser versus insured patients, could be viewed as creating a “dual fee schedule.”  Insurers believe dual fee schedules constitute fraud and over billing. Some argue that Groupons are merely a version of a prompt-payment discount. While California law expressly permits prompt-payment discounts, such discounts must be reasonable. Given the extreme nature of the discounts typically offered by Groupon and its competitors, such certificates likely would not fall under the prompt-pay exception.

They conclude that “Given their widespread use, it seems unlikely that the Board of Chiropractic Examiners would discipline each and every licensee who engages or has engaged in Groupon-style offerings. That said, there may be a rash of “test case” or “example” disciplinary actions that follow. Eventually, we would expect the Board to adopt a regulation, or the Legislature to pass legislation, that explicitly either proscribes or prohibits the use of these deals. In the meantime, we recommend that chiropractors abstain from these types of marketing campaigns….”

I couldn’t agree more with them. 

When I opened up a new place h ere in Amarillo, I printed flyers at Kinko’s and I walked from one business to another knocking on doors and meeting people and telling them about me and my new place. I marketed anyone that could send me business. For more on that, go back about 5 episodes and listen to our episodes called Big Ideas On Marketing Evidence-Based Practices. Link is in the show notes. 

You must know this just isn’t the way to go. Join BNI, join civic clubs, start working out at a gym and get tight with the managers and personal trainers, spend time volunteering, joint a running club if that’s your gig, combine those things with social media and a solid email list that you continue to build and work on. There are so many things you can do that are above the cuff. That are respectable and raise up you and your profession. 

Groupon isn’t one of them. It does exactly the opposite. It identifies those of us who are racing to the bottom of the barrel and dragging the rest of us down with them. 

If you’re doing Groupon, it’s my opinion that it’s time to stand up, stop doing it. Yesterday..if you catch my drift

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

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

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

And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering 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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Enke O (2018). “Anticonvulsants in the treatment of low back pain and lumbar radicular pain: a systematic review and meta-analysis.” CMAJ(190): E786-793.

Khazan O (2019) “Chronic Pain Is an Impossible Problem A “safe” alternative to opioid painkillers turns out to be not so safe.” The Atlantic.

Marianna P, I. C., Andrea E, Valentina P, Ilaria G, Giovannino C, Ezio G, Simona B, (2019). “Effects of time-restricted feeding on body weight and metabolism. A systematic review and meta-analysis.” Rev Endocr Metab Disord.