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w/ Dr. Christine Goertz – Chiropractic Research, What Does The Science Say, And Where Are We Going?

Today, we have one of the giants of chiropractic research as our guest. I will go further into her background in a moment but we have Dr. Christine Goertz joining us today and, if you do not know who she is, it is time to listen up. Don’t you go anywhere because this is going to be an excellent episode full of great information. 

But first, here’s that “oh how sweet it is” bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have bounced your way into Episode #68 and we are so glad you did. 

Introduction

We’re here to advocate for chiropractic while we also make your life easier. 

Store

Part of that 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. 

Guest Introduction

Christine Goertz, D.C., Ph.D., is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. Prior to joining Spine IQ, she was Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic for eleven years. 

Dr. Goertz received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1991 and her Ph.D. in Health Services Research, Policy and Administration from the School of Public Health at the University of Minnesota in 1999. Her 25-year research career has focused on working with multi-disciplinary teams to design and implement clinical and health services research studies designed to increase knowledge regarding the effectiveness and cost of complementary and integrative healthcare delivery.

She has extensive experience in the administration of Federal grants, both as a PI and as a program official at the National Institutes of Health (NIH). Dr. Goertz has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers. Her primary area of focus is the investigation of patient-centered, non-pharmacological treatments for spine-related disorders. Dr. Goertz is a former member of the NIH/NCCIH National Advisory Council and currently serves on the Board of Governors for the Patient Centered Outcomes Research Institute (PCORI), where she has assumed numerous leadership roles. In September 2018 Dr. Goertz was appointed to a 3-year term as Vice Chair of the PCORI Board by the Comptroller General of the United States. 

Welcome to the show Dr. Goertz. I can’t tell you how excited I am to have on our podcast. 

Can I first ask you what was the impetus for your wanting to get into the research end of the profession? How do you come to the decision to dive into research full-time vs. treating patients day-to-day like so many of us do?

I noticed on your CV that you are currently an adjunct professor with the Department of Orthopaedic Surgery at Duke University Medical Center in Durham, North Carolina and also an Adjunct Professor in the Department of Epidemiology, College of Public Health, University of Iowa. All the while, you are working with The Pine Institue for Quality (AKA Spine IQ). Can you tell us what a regular day looks like for you?

Whether you know it or not, you have been a game-changer for this profession. You have, likely unknowingly, played a big part in some of our podcast episodes. I want to start with a paper we covered. I called it The Veterans Paper and it was HUGE. Though I call it the Veterans Paper, you say it was done as part of the Department of Defense. I wonder….did you notice anything BIG after it was published in JAMA? Was it, in your opinion, any more impactful than your other papers?

Here’s what happened as soon as that paper came out from my perspective; almost immediately, we began getting interest from our local VA and, once we completed credentialing, we started seeing referrals. Before that paper…..nothing. No interest. I don’t know if you’re ready to take all of the credit for that but I’m going to give it to your regardless. On behalf of the entire evidence-informed chiropractic profession, thank you for that. 

In emails we have exchanged leading up to our time together today, you mentioned you have a large pragmatic trial funded by the NIH in the VA. Can you tell us anything about that?

In your work called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain – Time for a Change” published in JAMA October 2015, you say there are no policies emphasizing nonpharma treatment at the forefront of the patient experience, no meaningful levels of coverage for care professionals focussing on nonpharma therapy, and no policies providing financial incentives in favor of nonpharma. I have seen your work make huge differences but have to admit, I’m still seeing reimbursements for chiropractors being a challenge. We have folks out here struggling in practice in spite of everything in our favor. Have you experienced any changes after this came out in JAMA? Can we expect these sentiments you describe to gather steam in the next year or so?

In another piece of yours called “What does research reveal about chiropractic costs?” you say something I want to commend you on. You say, “without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery.” I think we can all agree that standardization is likely the biggest hurdle our profession faces in regard to integration. Do you believe chiropractic residency training would better prepare chiropractic providers to offer high quality care within medical facilities?

I’m currently over 2/3 of the way through the Diplomate for the Academy of Chiropractic Orthopedists. I see the value every day but, in your opinion, should Board Certification become the norm for chiropractic providers rather than the exception?

In that same paper, when talking about costs for chiropractic care you point out that we are likely equal or less in cost. You say, “In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.” Do you feel that the medical field is coming to the point they are seeing our potential in improvement as well as our cost-effectiveness on more of a widespread scale or are there just little pockets here and there? Is the medical field starting to catch on but the insurance companies are still not allowing the change? What are you seeing on your end of things?

You recently were part of a paper that was published just this year, 2019, called, “Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial.” I really have to talk to you researchers about trying to shorten the names of these papers. 

Anyway, you all concluded on that one that one session of chiropractic manipulative therapy had immediate effect of reducing the time required for asymptomatic special operations forces to complete a complex whole-body motor response task. Tell me….what are we looking at here? Where is this line of research leading future research?

I personally love it and think it has extremely high value so when I ask you this question, please don’t take it as a negative. Are you responsible for instigating the Palmer-Gallup Poll? What were the main goals for starting it and has it lived up to the original thought process behind its beginning? 

I thought this was an interesting question. A listener and member of our private group on Facebook, Dr. Trent Peng, suggested I ask you which chiropractic adjustment techniques are sufficiently evidence-based in the scientific literature?

In an article by Lisa Rappaport, called “Adding chiropractic to back pain care may reduce disability,” she interviewed you for the article. She had a quote in the article from you that said, “Spinal manipulation (often referred to as chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.” 

The other was, “It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine.” 

The first comment I have on this is that I love the second quote because there is more and more information coming out about what part the central nervous system plays in regard to pain. Pain sensitization, movement dysfunction, joint proprioception and thing of that nature. I thought that quote brought some of that into consideration without getting too complicated for a normal reader. So, kudos on that!

I remember thinking to myself that there are a lot of “may help” and “it is possible” kind of language. I understand that researchers shouldn’t formulate opinions or conclusions in definite terms or absolutes and I completely understand that, but my question to this point is do you ever see a time that all chiropractors can say with a high degree of confidence exactly what happens and exactly why it helps people heal or feel better?

I was sent a paper I believe you have in progress called “Assessment of chiropractic care on strength, balance, and endurance in active-duty US military personnel with low back pain: a protocol for a randomized controlled trial. In the Background section, you all say, Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with low back pain.”

As you probably know, here in Texas, we are in a perpetual battle against the Texas Medical Association. Recently, they won a decision that was upheld on appeal to remove the ‘neuro’ snippet from our scope description of treatment the neuromusculoskeletal system. Essentially, they say we only treat the musculoskeletal system. With the research you have done and are currently involved in, what do you say to this?

What has been your favorite project or finding you have been a part of so far?

What has been your favorite paper, project, or finding that a colleague has written but you were not a part of?

What conclusion have you had to draw at the end of a paper that surprised you the most?

How do you see quality research translating into a greater level of inter-professional collaboration and how do you see the future of chiropractic unfolding in terms of integration into the healthcare system?

A tie-in question here, where do you see the profession in 10 years?

I know that low back is one of the biggest reasons for disability worldwide, if not the biggest. It deserves the attention it has received. We have research on low back pain now to the point that even traditional chiropractic detractors can’t really argue all that much with us on low back pain. But we still have a fight on our hands when it comes to cervical manipulation. My question is why do you think we don’t see more research for cervical manipulation and do you see the spotlight ever changing and the research beginning to focus on cervical manipulation and the benefits for neck pain and headache/migraine?

In the private Chiropractic Forward Facebook Group, we are curious….what are you up to right now? What are you working on? 

Apart from what you are working on right now, what are your goals in regard to research in the next 10 years?

Thank you so much for taking time out of your day to join us. I hope our listeners got as much use out of our talk as I did. I truly believe that our profession is where it is and going the direction it’s going in large part because of you an d your efforts. 

And I thank you so much. 

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 that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors 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.

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. 

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


Government-Regulated Rehab, Do Rotator Cuffs Need Repair, Carpal Tunnel

Government-Regulated Rehab, Do Rotator Cuffs Need Repair, Carpal Tunnel

Today we’re going to reach into my bag of papers that have been sitting and gathering a little dust waiting for their time in the sun. We’re talking about government-regulated rehab. Is it any more effective than doctor-regulated? Do you send rotator cuff issues straight to a surgeon and is that the smartest thing? We’ll also skim over some new info on carpal tunnel syndrome. 

But first, here’s that “goes down so smooth” bumper music.

Chiropractic evidence-based productsIntegrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have Frankenstein-shuffled into Episode #63 all creepy like

Introduction

Why does this podcast even exist? We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time through your week by giving you confidence in your recommendations and in your treatments. 

This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  I’m no guru but I do believe I was blessed with some amount of common sense that somehow continues to keep me in the game. You are ABSOLUTELY going to pick up some nuggets that you can use in your own practice. 

Evidence-based Chiropractic Store

Part of saving you time and effort 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. My goal is to get enough pre-orders to pay for all of the initial order before the end of March. If you guys will go to chiropracticforward.com…..Just click the STORE link at the top right of the home page and you’ll be off and running. 

https://www.chiropracticforward.com/shop/

We can order any of the posters whenever but, I want to get pre-orders in place for the brochures since they have to be ordered in bulk. With pre-orders helping me do that, I can get them ordered at the end of March, get them to me in about a week and then get them to you in a week so, they’d be in your hands roughly mid-April. So, if you’re team Chiropractic Forward, go check them out and order up. I’ll make it happen for us all. 

I’m getting them for my office as well ya see. I can’t wait to get them. And, I have a ton more I’m working on. But, I’ll be using funds from the first batch, to fund the next batch of these brochures. Rome wasn’t built in a day, folks, cut me some damn slack. Help me out with the first batch and we’ll be up and running. Who knows what we can get done around here together?

DACO

DACO talk, hell yeah. I’m back to rocking and rolling thanks to the guys down under in Australia. They are very intuitive and really do go out of their way to make sure you’re enjoying the courses and getting what you can out of them. 

Recent courses for me have been Acute Torticollis in the Adult and Osteoporotic Compression fractures – Recognizing the Clues. 

I dreaded stepping into the whole idea of 300 hours added to an already full load of work, family, and hobbies. Honestly, I’ve said before, I see 60-70 new patients a month, wife and two kids, I build live edge furniture, I’m a musician many weekends, and a sculptor who’s trying to teach himself to paint and…well…I like to get ornery and have a beer here and there on the weekends too. (you need to grow up)

I don’t say that to brag and say Oh look at me look at me. I’m trying to make the point that, if I can do it, you can do it.

Here’s the deal, I was always learning and adding and reading research papers and all of that stuff anyway. I thought I’d take one live class and get some continuing education hours. Hell, I figured I’d sit in the class for a couple of hours and then go have lunch with my wife. 

Yeah, that didn’t happen. In fact, I’m blaming it all on Dr. Tim Bertlesmen for getting me into it. He and Dr. Brandon Steele are the partners in ChiroUp and he was teaching a class here for the Texas Chiropractic Association’s state convention last summer. I saw him in the expo hall and he told me to come check the class out.

I said I’ll check it out for a bit. He said, “You’ll like it. You’ll stay for the whole thing.” Dammit if he wasn’t right. Lol. Just amazing information that could be used immediately and I literally feel that way about every class I’ve had since then.

So, you see, it hasn’t been stressful. It hasn’t really been any work. It’s just been enjoyable learning that I would have been doing anyway. I might as well get something out of what I was already doing anyway, right?

When the hell do I have time to add 300 hours to my plate? Well, I take off about 2:30 on Tuesday afternoon to do a class. I usually take one on Saturday morning when I’m up before the rest of the family. Sometimes I’ll take another on Sunday. That puts me at about 9 hours a week.

Easy peesy. 

If I can get you started, email me at dr. williams @chiropractic forward.com

Personal Happenings

In personal happenings, it’s been a little crazy around here as you all might can gather if you follow along. If you remember we had a front desk issue back in August and just couldn’t get the position filled. Well, my amazing wife stepped in, got trained on insurance, billing, and all of that lovely mess of crap. She is literally the smartest person I’ve ever met in my life. Some may question her decision to marry me and her intelligence in making that decision but, I think she’s freaking Einstein basically. 

Anyway, that has turned into us getting to work at 8 am and now, because she’s a perfectionist and still maintains her work responsibilities from her other job….which she does from home….we’re literally here until about 8 pm every night and I’m just about done with that people. Being busy is a good problem to have but there is a point where it’s just too much. 

I think a nurse practitioner can take some of the load off and I think maybe bringing in a new young hungry associate would be really nice. But, while I can talk about evidence and research, I’m afraid I’m not particularly skilled at hiring associates or setting up a medical entity but, that’s the direction I’m moving in because this workload is not sustainable for me to have a happy life. It’s just not. Example: on Wednesday of last week, in one day, as a solo practitioner, we had 12 new patients. Now, 6 were just intakes from one car wreck and it went efficiently but, you get the point. 

While it is do-able, for me, it’s not necessarily desirable to have the stress of being piled up on. I’m more like 3 or 4 new patients per day spread evenly throughout the week with some periodic re-exams and a bunch of happy patients just getting better and better every time I see them. THAT’S my idea of a happy workday. That’s not what we have right now. Lol. Good problem to have, admittedly but, still stressful. 

We’re hiring right now to help take some load off of the wife and, before long, I’ll be turning my attention to integrating. You know I’ll be sharing my experience as we go through it all. 

Item #1: Government-regulated Rehab

This first item we’re going to talk about is titled “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial(Cote P 2019)” written by Pierre Cote, Eleanor Boyle, Heather Shearer, and a plethora of others. It was published in the British Medical Journal Open in 2019 and is cited in our show notes for episode 63. 

Why They Did It

They wanted to evaluate the effectiveness of a government-regulated guidelines line when comparing it to education and activation by general practitioners and to a preferred-provider insurance-based rehab program on self-reported global recovery from acute whiplash-associated disorders Grades 1-2. 

As mentioned in the title of the paper, it was a pragmatic randomized controlled trial. 

What They Found

Here’s what they decided, “Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life.”

Item #2: Rotator Cuffs & Need For Repair

This one is called “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears(Boorman RS 2018).” Twas written by RS Boorman, KD More, RM Hollinshead, and a gaggle of others. Published in Journal of Shoulder and Elbow Surgery in March of 2018. 

Why They Did It

They wanted to look at the 5-year outcomes in patients enrolled in a nonoperative rotator cuff tear treatment program. What happened with them?

How They Did It

They took patients with chronic, defined as greater than three months, full-thickness rotator cuff tears on MRI that were enrolled in the nonoperative study from 2008-2010. 

They started a nonoperative, home-based treatment program and they were followed up with after different time intervals. 

What They Found

Check this out, at 5 or more years follow-up, approximately 75% of patients remained successfully treated with nonoperative treatment and had a quality of life score of 83 out of 100. 

Between years 2 and 5, only 3 patients thought to have a successful outcome regressed and had surgery

The operative and the nonoperative groups at the 5-year follow-up were not significantly different. 

Wrap It Up

The authors concluded, “Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time.”

Pow. Snap. Bam. Smash. Kapow!

I don’t know why I take such joy in seeing that surgeons have less reason to do surgery but it give me a tickle in my belly and a warm fuzzy feeling. Who wants a hug, people? I’m feeling the spirit here. 

Item #3: Carpal Tunnel Syndrome

Our last item here is called “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial(Wolny T 2018)” and is written by T Wolney, et. al., published in Journal of Manipulative and Physiological Therapeutics in October of 2018. 

Why They Did It

They wanted to check the influence of manual therapy, including neurodynamic techniques, when compared to no treatment on overall health status in those with mild to moderate carpal tunnel syndrome. 

Again, as the title says, it was a randomized controlled trial with 189 subjects. 

They underwent treatment twice weekly. 

What exactly is meant by the term ‘Neurodynamic Technique’? Well, have you ever heard of nerve flossing? That is a type of neurodynamic technique. Gliding or sliding the median nerve in the case of carpal tunnel. Tensioning, relaxing basically. Pull out your Google machine. You’ll find some great YouTube examples of Neurodynamic Techniques to help you with your carpal tunnel patients. 

Now, what did they find?

The authors were able to conclude the following, “Manual therapy, including neurodynamic techniques, had a positive effect on overall health status in this group of individuals with carpal tunnel syndrome.”

Key Takeaways

  • The government doesn’t do a particularly better job than you can do on your own if you’re educated and stay evidence-informed
  • Even full-thickness tears of the rotator cuff do not mean surgical intervention in most patients
  • Carpal Tunnel Surgery doesn’t require surgical intervention in most mild-moderate patients if you learn some take-home exercises and implement neurodynamic techniques
  • Surgeons are going to need to start down-sizing those houses and maybe forego buying that private plane as they will be less and less busy in the years to come. 

Again, before you disappear this week, consider going to chiropracticforward.com and clicking on Store and pre-ordering our spanking brand new evidence-informed brochures. We are looking to gather up pre-orders and ordering all of them in bulk around March 29th. We would appreciate your help in making this happen. Team Chiropractic Forward!

https://www.chiropracticforward.com/shop/

 

Chiropractic evidence-based productsIntegrating Chiropractors

The Evidence-based Chiropractic 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 that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors 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.

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.

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

 

Bibliography

  • Boorman RS, M. K., Lollinshead RM, (2018). “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.” J Shoulder Elbow Surg 27(3): 444-448.
  • Cote P, S. B., Shearer HM, (2019). “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial.” BMJ Open 9(e021283).
  • Wolny T (2018). “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial.” J Manipulative Physiol Ther 41(8): 641-649.

CF 033: Did You Need Proof That Chiropractors Help Headaches?

CF 041: w/ Dr. William Lawson – Research For Neck Pain

 

 

 

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

CF 061: Faith-based Chiropractic, Ohio Lawmakers, & Chronic Neck Pain

Today we’re going to talk about another aspect or group that I find particularly troubling in my profession I call faith-based chiropractic, we’ll talk about some lawmakers in Ohio, and then we’ll gloss over a paper on chronic neck pain and balance. Stick around, it might get interesting. 

But first, here’s that ‘yummy in your tummy’ bumper music


Chiropractic evidence-based productsIntegrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have streamed you way into Episode #61

Before I make people mad, let’s talk a bit about the DACO program which is the Diplomate of the Academy of Chiropractic Orthopedists. I’m on it, I’m on it. I’m on it like stink on my teenager’s socks. You know what I’m talking about. I won’t even enter his room. It just has a certain smell that I want no part of. 

Continuing on with the eLearning episodes through the CDI group, I recently wrapped up one on Lateral Epicondylalgia just this morning and a few days ago finished up one on Fibromyalgia. Did you know the literature is pointing to those two conditions as being partly due to the central nervous system and what is termed central sensitization? 

It’s excellent information. If you want some guidance getting started on it, shoot me an email at dr.williams@chiropracticforward.com No, I don’t get a thing out of helping you or out of talking about it. Nothing at all. It’s just something I’m currently doing so it’s top of mind and I see the incredible value daily and am sharing that information with you. That’s about the total of it. 

I want everyone, as soon as you get to a computer, to go to chiropracticforward.com and click on the STORE link. You will find Posters and Brochures. The posters have some of my favorite and often-used sayings from the podcast. The brochures are evidence-based and are something I have been working on for some time now in my spare time. Now, if I can get some pre-orders ready to rock, we’ll get them ordered and sent on their way to you. 

I’d love to get your feedback on them at dr.williams@chiropracticforward.com

Introduction

Everyone on the planet knows there are two things you don’t talk about and they are POLITICS and RELIGION. 

For me, this here, what we’re about to go into….it has very little to do with the nuts and bolts of religion but more to do with the use of it. I’m going to touch on a very touchy subject and I hope that you won’t do the “poor me, I’m offended by everything on the planet” bit and get mad and leave and never return.

Rather, I hope you’ll hear what I have to say and hear it objectively and then, we either agree or disagree and we move on with our days with a common goal of getting people better. In the end, it’s just one dude’s opinion so let’s not get too worked up, OK? 

Faith-based Chiropractic

OK, let’s talk openly and honestly and hope we don’t make everyone mad. Here’s my deal people, I’m a Christian and have been all of my life. In fact, when I was younger as in junior high and high school, typically if the doors were open, I was there. Sunday morning, Sunday evening, and Wednesday night. Yep. Southern Baptist even although, now, I’m non-denominational. I found out I’m not as much of a fan of organized religion as I am of religion in general. When it gets too organized, I get less interested if that makes sense. 

Anyway, I’m a proud Christian but I’m not a loud or a bully Christian at all. If you come to my office, I’m not sure I have one cross in the whole place. That doesn’t mean I frown on you if you have Christian music playing through the speakers and you have scripture written on the walls. I honestly have no problem with that if it’s there for the right reasons. I don’t believe people are coming to my office for religion so it’s not right for me personally. 

I will admit, I’m a sculptor so several of my pieces are here. One of my pieces is called Road To Damascus and is about a story found in the Bible. I’ll post a picture in the show notes at www.chiropracticforward.com and you can just go to episode 61 if you want to check it out and see it. 

 

Damascus apostle paul bronze

saul apostle paul damascus sculpture

 

I feel like, since I AM one, I can talk about other Christians.

Lately, I’m seeing more and more posts and have been hearing more and more about Christian Chiropractors. I think the idea or concept of being a Christian Chiropractor is just fine. Honestly, I do. There are indeed people that would rather go to a like-minded practitioner rather than a Satan-worshipping chiropractor for example. Wouldn’t you agree? ‘Birds of a feather flock together’ is more than just a saying.

Much in the same way that some patients would just as likely AVOID a Christian Chiropractor if they themselves are not Christians. If someone wants to identify themselves as Christian, honestly, I’m cool with that. I don’t but I don’t care if you do. Not at all. 

Fair play to ya. That’s why we have different strokes for different folks and I’m so OK either way. There are Christian MDs, Muslim plumbers, Christian brothers car mechanics, Jewish this, and Buddhist that…. Whatever melts your butter and feathers your fancy. 

My Issue

My issue today isn’t one of religion vs. non-religion in all honestly. My problem lies in practitioners USING their religion to build their businesses and, in a most undesirable move, using religion to manipulate vulnerable patients for the purpose of padding their wallets. 

That’s a next level no-no in my book. Who cares about my book, right? Maybe nobody at all. Maybe around 8,000 people so far though so, it’s possible some actually DO care about my book so let’s keep rolling here. 

I want to make a distinction here. a Christian, according to the New Testament is charged with going and preaching the gospel. Save souls. There are some that truly feel that, if they are not doing that, they’re not fulfilling their mission. 

OK, fair enough. Who am I to argue that you’re wrong and who the hell am I to judge? If I were to say you’re wrong, I’d be arguing against the Bible and I’m certainly not going to do that. I have faults so I do what I can to stay in the good graces when at all possible. 

If it is honest and well-meant and you feel it in your heart to save your patients, rock on brothers and sisters. Amen & Hallelujah. 

But, if you mix religion into your business practices and protocols as a way to build your business by manipulating desperate and many times scared patients into seeing you, that’s where our paths go separately.

I cannot reconcile it in my mind how it would ever be right or permissible. I’ve never in my life gone to church to pick up business. I’m not there for that. It would be disingenuous and would defeat the purpose of being in the building in the first place. 

In the same way, I don’t use it to build my business in my office. I would not feel honest. I wouldn’t feel genuine. At the end of the day, if I’m anything, I’m those two things. Again, we’re all different but for me personally, it just doesn’t feel right. 

Example

Let me give you exhibit #1 for an example so you can see for yourself what I’m talking about. Here is an actual script folk.

“Mary, I’m concerned. I’m really concerned about you. When you don’t continue your plan to remove the subluxations that are interfering with God’s life force allowing it to innately flow from above down through your body in order to heal you, you’re not allowing God to do his part and heal your body. I understand that it’s hard getting here…but I have an opening at 5:30 tonight so we’ll see you then and let’s get you that life-saving adjustment tonight ok?”

That is a script used by a  popular company. They tell their members to say stuff like that. I’m not even kidding and, as I said, that’s some next level BS for me personally, in my practice. 

As a Christian myself I’m telling you, someone says something like that to me while I’m trying to get my issues resolved, the next thing they’re seeing is my ass as I walk out the door. 

First, I’m not there to be preached to. I go to church for that. Second, it’s obvious you’re trying to manipulate me into treatment using my religion and that just straight up pisses me off. Third, if God wants to heal a patient, why on Earth would he need a chiropractor to make that happen? 

Honestly. Think about it honestly. God moved heaven and earth. All-knowing. All powerful. But needs a chiropractor to facilitate your improved health? That’s insane in the membrane to me. 

What If

What if they said, “Mary, I’d never try to tell someone how to spend their money or how to take care of themselves because that’s none of my business. My job is to tell you what I think would be the best for you based on the idea that you live right next door and have no travel concerns, and you have all of the time and money in the world. What would I think would be best for you? Then there’s reality and my job is to be here for you however you want to use me. We don’t hassle our patients about their recommendations. Just do me a favor if you can’t do what I recommend, don’t tell people that chiropractic didn’t work. OK? Tell them you weren’t able to do what the chiropractor recommended. Is that fair?”

And all the people said, Amen. Literally, every single one of them agrees that it is indeed fair. 

Of course, I also tell them that if they love what we do for them and they get to feeling better, we’d love a great review on Google and Facebook but, if you don’t like us, just keep your mouth shut.” Of course, they know I’m kidding. Or am I?…..

The way I see it, I’m a specialist in what I do and that’s why a patient is here to see me and that’s what they will get. They’re not going to get politics and they’re not going to get religion either. 

As I said in episode #56 when I talked about the magical mystical disappearing arthritic osteophytes, although in many areas of the world it’s getting better, we are still in a battle with a medical community that wants to do away with us. We need to ask ourselves an honest question. Does this sort of stuff, put us at risk of continued ridicule? 

I doubt medical doctors are sitting around all over the country saying, “Mary, I’m concerned about you. If you don’t get this chemo followed by months of radiation, God can’t express himself fully in your body and your healing will not be complete, and you’re going to die.” “Mary, if you don’t take this oxcy, God won’t be able to calm down that issue long enough for us to make any progress in your healing.”

And, if you ever DO find one that does (there are always exceptions to the rule right?) if you find an MD that does that, the whole world is going to think he’s a coo coo loco and you might even see him on 60 Minutes one Sunday night. 

God, faith, religion, and spirituality are wonderful things. They’re the #1 things in the lives of so many people including ME. Just don’t dirty them or the profession by using them as marketing and worse of all….tools to work patients and manipulate them. Please….

I love your religion and I love your passion as long as it’s genuine. Once it becomes about business and becomes a tool to work people, you lose me. That’s all I’m saying. 

Hopefully, not too many of you lost the cheese off of your cracker on that. Let’s keep moving. 

Resource #1

I want to cover a recent article I noticed from WSAZ NewsChannel 3 up in Charleston, WV. It was written by Kaitlynn LeBeau called Ohio Lawmakers, doctors suggest chiropractic care instead of opioids(LeBeau 2018) and was posted on March 21, 2018. 

https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html

It’s in WV but talking about Ohio and here’s what they had to say. The Ohio Attorney General and lawmakers held a press conference last March to talk about the need for alternatives to pain meds. The Attorney General, Mike DeWine, said: “More and more people are looking for new and innovative ways to treat pain.” 

Yes, we already know this but he also went on to speak about community health centers that include medical, fitness, social and educational services. We’ve already talked about chiropractors getting integrated into the Federally Qualified Health Centers and, yes….you have one near you whether you know it or not. Just Google the term “FQHC” and then the name of your city or region and see what pops up. 

Here’s what I really wanted to point out: we chiropractors have a powerful ally in American soldier, Staff Sergeant Shilo Harris. If you are not familiar with Sgt. Harris, he is located in San Antonio, TX last I heard unless he’s relocated. 

Anyway, on his second deployment to Iraq, he was injured by a roadside bomb. When I say injured, I mean big time. Go do a google search on Shilo Harris and you’ll see immediately what I’m talking about. 

Bless his heart and thank you for your service, Sgt. Harris. Heroes don’t play on a basketball court or football field. They fight selflessly and give of themselves for our freedom. For complete strangers, many of which don’t even like them. They fight for the love of country too, right? Just amazing people. 

He is quoted in the article as saying, “I’m here to tell you that chiropractic care saved my life. I became addicted to my medications, naturally, in a sense because I had had so many back to back surgeries.”

Sgt. Harris has presented at Texas Chiropractic Association’s events and will be at another TCA event in just a couple of weeks down in Austin that I’ll be at. I’m looking forward to hopefully meeting him myself. 

Resource #2

OK, next item: this one called “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests(Gomes P 2018)” It was authored Amy Pamela Karine Alvino Gomes, et al. and published in October of 2018 in the Journal of Manipulative and Physiological Therapeutics. 

Why They Did It

The purpose of this study was to correlate measurements of chronic neck pain with the balance and mobility of the lower limbs and to compare these variables between individuals with chronic neck pain and asymptomatic participants.

How They Did It

It was a blinded, cross-cross-sectional study

They had chronic neck pain patients as well as asymptomatic people. 

Outcome assessment tools were used to measure the difference in the groups. 

What They Found

“Young adults with chronic neck pain present changes in static balance measured by means of the Functional Reach Test; that is, the higher the intensity of pain, the lower the anteroposterior excursion of the body during the execution of the test.

This week, I want you to go forward with this: again, I’m all for religion. Ultimately, you do you. Just do it proudly, honestly, and genuinely. Always try to be someone your family can be proud of and be above reproach. 

I want you to know that Staff Sgt. Shilo Harris is awesome and he’s on our team so look him up and book him for your next association event or seminar or legislative effort. 

Chiropractic evidence-based productsIntegrating Chiropractors

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 that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors 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.

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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TuneIn

About the Author & Host

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

Bibliography

Gomes P (2018). “Evaluation of Postural Balance and Articular Mobility of the Lower Limbs in Chronic Neck Pain Patients by Means of Low-Cost Clinical Tests.” Journal of Manipulative and Physiological Therapeutics 41(8): 658-664.

LeBeau, K. (2018). https://www.wsaz.com/content/news/Ohio-lawmakers-doctors-suggest-chiropractic-care-instead-of-opioids-477447883.html. WSAZ News Channel 3.

CF 052: Chiropractic Forward Podcast Year One Review

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

 

 

 

CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

CF 058: The Patient Experience, Lumbar Stenosis, & Fibromyalgia 

Today we’re going to talk about the patient experience being more important than your marketing, we’ll talk about some research from JAMA on lumbar stenosis, and some research on upper cervical manipulative therapy on fibromyalgia. 

But first, here’s that bumper music

Integrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have clumsily stumbled into Episode #58 knocking lamps off of the end tables and generally making a mess of the place.

DACO

As with every week, let’s talk a bit about the DACO program and my progress. I was doing the Communication Drills but they kept referring to eLearning Episodes. So let’s break that down a bit real quick for those interested in the program. The bulk is made up of 40 Diagnostic Drills, 46 Communication Drills, and 17 eLearning Episodes. 

You get 2 hrs credit for each Diagnostic or Communication Drill and you get 3 hours credits for each eLearning Episode. 

Now, since Communication Drills kept referring to eLearning Episodes, I figured I would switch focus and go through them and then return to the Communication Drills. Still with me?

The eLearning Episodes are very much video based on a downloadable worksheet to take notes on. I take notes digitally though so I’m still getting my angle of attack down on these and how I want to best tackle them and have great notes I’m getting it figured out. 

DACO Classes

So far, I’ve taken classes on Adjusting locally and thinking globally about how a cervical adjustment can affect even the low back. The neurology is amazing. A class on blurry vision from a pain in the neck. Again, the neurology people. I don’t know how I made it day to day before this stuff. Then last weekend I took one on making sense of a headache. 

Outstanding information and all lined up to make you better, make you wiser in your decision-making, and making you a better communicator with your patients and colleagues. 

If you’re waiting to get started on the DACO, get started. I’ll be glad to help you if you’ll email me at dr.williams@chiropracticforward.com

I’m about wrapped up with some cool stuff that you all may be interested in on our website at chiropracticforward.com. If you’ll go there and sign up for our newsletter on our home page, I’ll be able to let you know all about it when it’s ready to roll out.   

Great week for listens Y’all. Thank you for tuning in. Everyone loved Dr. James Lehman’s episode. That was a big one for us! If you missed it, it’s episode #55. Candy for your ears. I see that sucker being the number one listened to podcast pretty quickly. 

Onto the Discussion

Let’s get to trying to make your practice better. This first one we’ll discuss is titled, “Patient experience five times as likely to drive consumer loyalty as marketing” by Christopher Cheney with HealthLeaders(Cheney C 2018). It was published on December 28, 2018. Once again, I know you dig the new stuff. 

If you’re getting after it. If you’re hustling, then you’re marketing. Marketing isn’t something you do once, is it? Oh no, it isn’t. It’s something you do every damn day if you’re doing it effectively. It’s exhausting, isn’t it? But it can be fun too. 

Marketing

Isn’t it fascinating that just changing the color of the border on your marketing material has the potential to elicit a different behavior from the recipient? Or changing the color of the shirt that the person in the ad is wearing affects the response rate? It’s amazing. But, it’s also exhausting to contemplate all of the different combinations of possibilities of words, colors, placements, and all of that crap. 

Good grief. You could make yourself crazy and how many chiropractors usually have the budget to hire a full-time marketing person that actually had a marketing degree? Not many would be the answer you’re looking for if you were confused on that. It was more rhetorical than anything. 

Here in this article, Mr. Cheney says that the patient experience while in your office is the primary driver of patients’ consumer loyalty at health systems, hospitals, and physician practices. He based this information on a recent Press Ganey report I would normally link for you in the show notes but it looks like a bit of click bate. As in leave your email and get the report crapola and I’m not doing that to my peeps. Ain’t nobody got time for that. 

Hell, I can hardly get you guys to give ME your email address and most of you are loyal listeners! Lol. 

Consumer Loyalty

Anyway, he says that consumer loyalty is vital for not only your profit at the end of the month but also helps you take better care of long-term patients with multiple chronic illnesses. 

Hell, that’s why we got into this business; taking care of people. I have to say that if you got into this business to get rich, you’re taking the long way around buddy. Lol. Most of us got into this business to take care of people when nobody else was able to get results with them. And then hopefully keep them that way!

Here’s what raised my antennae straight up, he said, “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

WHAT?

What was that? Let me repeat that just in case my DACO talk put you to sleep. Hey, wake the hell up and listen to this. “Patient experience is FIVE TIMES more likely to influence brand loyalty than conventional marketing tools such as billboards, or television, print, or radio ads.”

That is astounding. Of course, some of you already had this figured out and being 20 + years into this dealio, I have it figured out to an extent as well but FIVE TIMES more effective than billboards, TV, print, or radio?

I did NOT have that much figured out. Do you know how I know I didn’t have all of that figured out? Well, it’s because I am spending too much damn money on all that crapola. They interviewed over 1,000 adults on this survey. 

I do have it figured out to the extent that I tell my staff that we are certainly in the healthcare business but they’re fools if they think we are not also in the customer service business. You better believe it. I tell them that I’d much rather a patient leave feeling the same but feeling great about the people they met and the experience they had here and feeling hopeful about what we can accomplish with them as opposed to them leaving my office sore because I either rushed through the appointment or thought we’d equate appointment success with a popping noise and pushed so hard that I finally got a pop sound but ended up making the patient feel worse. 

That goes for the front desk too, doesn’t it? They’re the first point of contact and the last point of contact. If they’re not friendly when people come in and greet them warmly and are very welcoming, well….we’re already behind the 8-ball there and had better make up some ground in the back of the office. And when they leave…..oh nobody likes to pay their own money out of their own pocket and they damn sure don’t like to pay it to someone they don’t like personally. 

Here is a quote from the report, “Healthcare organizations can tap the power of patient experience, the report says. “To harness that influence, providers should capitalize on the power of word-of-mouth marketing by viewing the patient experience as an essential part of their acquisition strategy. By gaining a deep understanding of what gets people talking about positive patient experiences, identifying opportunities to advance the conversation and disseminating key information, healthcare systems can naturally align the mission of delivering safe, high-quality, patient-centered care with the business of acquiring and retaining consumers.”

The Big 4

They went on to line our 4 Big One’s that should be a part of any healthcare facility’s strategy for getting and keeping patients. They were:

  1. Give every patient a voice – They’re not just talking about listening to them when they visit your office and tell you about their conditions. They describe delivering surveys via text and email as well as the standard outreach protocols. 
  2. Identify factors that drive and erode patient loyalty. They say to really know where you can improve, you gotta know positive loyalty metrics on things like the likelihood to refer or recommend your office to their network of people. Imagine man, being a former member of BNI, they teach that each person, whether they know it or not, has a network of 250 people in their lives. I get 55-65 new patients per month. That’s 13,750-16,250 potential work of mouth contacts that can either hear the good about our office or, if we allow them to catch us on bad days….that’s up to 16,250 people that can hear bad things about us. You can see why it’s so important to have positive patient experiences in your office just as often as you possibly can. Especially in the days of social media. There is no room for ego, for talking down to your patients or scolding your patients, or any of that crap. Patient-centered is more than an idea, it’s how you’d better be carrying yourself. 
  3. Use natural language processing to analyze comments. What the hell does that mean? Well, they say that it is language that allows aggregation of comments into clear brand equities and liabilities, allowing for proactive management of both experience and brand. That sounds like an overly wordy and annoying resume if I’m being honest. Basically, it’s using computers to analyze emails, customer feedback forms, surveys and things like that to identify the root cause of customer dissatisfaction or, we hope, customer satisfaction. I’d like to lead you further down this path but, obviously, I have more to learn on it myself. 
  4. Post ratings and reviews in physician profiles. Ensure that future patients have the most convenient access to all information they seek by including comments – both positive and negative. I can’t deal with negative comments. They hurt. Lol. 

Reviews

They also say that you need to be earning quality reviews online for Yelp, Google, Facebook, and all that good stuff. If you don’t know the value of reviews at this point, you just might be a lost cause. Lol. 

They also say you must address negative reviews online in a professional way while understanding that negative reviews are an opportunity to learn and improve. 

But, when it’s not right and borderline illegal, I believe it’s OK to have your attorney contact the person leaving that negative review. Here’s what happened. We offer a service. Not chiropractic but a service that a girl that treated here for some time decided she would begin offering here in town without being certified in any way to perform. 

OK, annoying for sure but then she, one of her little buddies and her boyfriend go online and leave us bad reviews for the exact same service. So there we were with 80 or so 5-star reviews. Not one negative review. And then three 1 star reviews popping up out of nowhere. Nope, she got a call from my attorney and they went away very quickly. 

Ain’t nobody got time for that crap, right? I know I don’t and I have little tolerance for people that want to try to tear down something others have built just to try to further themselves. 

Before my face gets too red and I start to stutter, let’s move onto the next topic. 

Next Paper

This next paper is called, “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” The lead author on this one is Ibrahim Moustafa and it was published in Rheumatology International in July of 2015(Moustafa I 2015). 

And can we just stop a second appreciate the last name Moustafa? Can we do that? Holy cow, if I had a good head of hair and a last name like Moustafa, I’d have the world on a leash ya know. But I don’t have good hair and my name is Williams (so boring) so let’s move on. 

Why They Did It

The aim of this study was to investigate the immediate and long-term effects of a one-year multimodal program, with the addition of upper cervical manipulative therapy, on fibromyalgia management outcomes in addition to three-dimensional (3D) postural measures.

It was a randomized controlled trial with a one-year follow-up. 

What They Found

The addition of the upper cervical manipulative therapy to a multimodal program is beneficial in treating patients with fibro.

I threw that one in for you Upper Cervical guys. You’re getting some love when it comes to treating fibro and I know fibro sufferers will appreciate that. 

I think, after learning more about the upper cervical spine in the DACO course, that it’s fascinating to think about. There is so much going on in the upper three segments in terms of sensorimotor and proprioception that it just blows your mind. 

Last Paper

OK, on to the last paper. This one is called “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial(Schneider M 2019)”. It was authored by Michael Schneider, DC, Ph.D., Carlo Ammendolia, DC (who we have covered here before for stenosis), and Donald Murphy, DC et. al. It appeared in JAMA on January 4, 2019, and here’s how it goes. 

Why They Did It

The question to answer for them was, “What is the comparative effectiveness of 3 types of nonsurgical treatment options for patients with lumbar spinal stenosis?”

Now the 3 types of protocols they tested were medical care, group exercise, and manual therapy/individualized exercise. 

The medical care consisted of medications and/or epidural injections. 

The group exercise classes were supervised by fitness instructors in senior community centers. 

The manual therapy/individualized exercise consisted of spinal mobilization (because it works and is awesome I assume), stretches, and strength training provided by chiropractors and PTs. 

A combination of manual therapy/individualized exercise provides greater short-term improvement in symptoms and physical function and walking capacity than medical care or group exercises, although all 3 interventions were associated with improvements in long-term walking capacity.

Integrating Chiropractors

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 that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient.

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors 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.

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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TuneIn

About the Author & Host

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

 

Bibliography

  • Cheney C (2018) “PATIENT EXPERIENCE FIVE TIMES AS LIKELY TO DRIVE CONSUMER LOYALTY AS MARKETING.” HealthLeaders.
  • Moustafa I (2015). “The addition of upper cervical manipulative therapy in the treatment of patients with fibromyalgia: a randomized controlled trial.” Rheum Inter 35(7): 1163-1174.
  • Schneider M, A. C., Murphy D, (2019). “Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis A Randomized Clinical Trial.” JAMA Network Open 2(1): e186828.

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

 

CF 052: Chiropractic Forward Podcast Year One Review

CF 052: Chiropractic Forward Podcast Year One Review

One year. I started this podcast exactly one year ago. 52 weeks. 52 episodes. We’re going to talk about the highlights of the first year. We’re going to talk about chiropractic today vs. chiropractic when I started a year ago. Has anything changed? The short answer is yes. Quite a bit has changed in just a year. 

But first, here’s that sweet like honey bumper music

Integrating Chiropractors

Welcome

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #52 and it feels good to say that. To be able to do anything consistently for a year straight, every single week, it’s an accomplishment for sure and it sure as hell feels good folks. 

DACO Program

Before we get into the highlights. let’s talk a bit about the DACO program. For those new to the Chiropractic Forward Podcast, I have been going through the Diplomate of American Chiropractic Orthopedists. I’m 92 hours into a 300-hour course. Ugh…that hurts just to say it. Lol. I don’t even feel close to being done. 

I figured it out that at the rate I’m going now, which is about 8 hours per week, I can be done around May I believe. While it seems way off, you know what? I’d be learning and educating myself anyway. Why not get something out of it, right? That’s the idea and May will be here before you know it. 

Hell, it seems like it was Summer just a couple of weeks ago. Lol. 

Products

I have been fast at work preparing some new options for you. I have noticed  a lack of what I would want in my office when it talks 

One-Year Anniversary

Let’s get on to talking about our one-year anniversary. I want to start by talking listen out our top 10 episodes so far and what we talked about that made everyone listen to each of them. I’m linking them all for quick reference in the show notes. So away we go!

Number 10

Episode #30 – Integrating Chiropractors – What’s It Going To Take? We discussed the medical field and what they are looking for in a chiropractor in regard to integrating that individual into the system. We went over The Lancet papers as well. Great episode to check out. 

CF 030: Integrating Chiropractors – What’s It Going To Take?

 

Number 9

Episode #25 – Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone. This episode revolved around a paper in JAMA from Dr. Christine Goertz where she and her co-authors showed additional support for including chiropractic as part of a multidisciplinary team for treating low back pain. Great paper by a great asset for chiropractic. 

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

Number 8

Episode #28 – Will Chiropractic First Finally Take Its Place? In this installment, we went through a paper that showed non-pharma and non-opioid therapies are now the preference. Well, that’s chiropractic, right? We talked about some GREAT resources in this episode including the President’s Commission on Combating Drug Addiction and The Opioid Crisis report as well as a great paper by Jon Adams Ph called The Prevalence, Patterns, and Predictors of Chiropractic Use Among US Adults. That one had some marketing nuggets for the nugget pouch.

CF 028: Will Chiropractic First Finally Take Its Place?

 

Number 7

Episode #27 – Wanted – Safe, Nonpharmacological Means of Treating Spinal Pain. This episode went through treating spinal pain, thoracic manipulation, lumbar manipulation, guidelines from Canada, and the perceptions of our profession. We discussed a paper about how some in the medical profession think chiropractors go around herniating discs all the time. Pfft… 

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

 

Number 6

Episode #9 – With Dr. Tom Hollingsworth of Corpus Christi, TX called The Case Against Chiropractic In Texas. We talked with Dr. Hollingsworth about the Texas Medical Association’s attacks on Texas Chiropractors and our rights. We talked about the latest in the current court case and the appeal process. 

Just a couple of weeks ago, in fact, this case had a decision that was reached and it wasn’t good for chiropractors. And I’m talking about chiropractors nationwide. We’ll have to do an updated episode with Dr. Hollingsworth because what may be on its way down the pike for all chiropractors…..well….let’s just say it’s no bueno. 

CF 009: With Dr. Tom Hollingsworth: The Case Against Chiropractic In Texas

 

Number 5

Episode #26 – Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues. The title is accurate. And researched fact. There are some that don’t like that language. Can’t we all get along? That type of deal and yes, we can all get along. Most certainly. My issue is with PTs being the first referral for non-complicated musculoskeletal issues when research shows they have decreased effectiveness when compared to chiropractic care. 

They have less patient satisfaction when compared to chiropractic care as well. In addition, research shows chiropractic care to be a lot less expensive. So why in the hell is a practitioner that is exponentially more expensive, much less effective on their outcomes, and patients don’t like as much…..why the hell are they the first referral? That still makes my pee hot when I really really think about it. It’s dumb. 

I don’t think we should be doing post-surgical rehab unless we take specific training in that. I think PTs and DCs can work very well together but there should be lanes and I don’t think PTs stay in their lane. Not when they’re out there taking a weekend course on adjusting. It’s BS and that doesn’t stand for Bad Students. 

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

 

Number 4

Episode #29 – With Dr. Devin Pettiet of Tomball, TX, still the President of the Texas Chiropractic Association. This episode was titled Is Chiropractic Integration Healthy For the Profession? We talked with Dr. Pettiet all about chiropractic integration into a medical based case management or medical team. 

This one was one of my favorites too. For sure. Devin is a great resource and a great personality. He’s all energy and has an awesome amount of information and experience.

CF 029: w/ Dr. Devin Pettiet – Is Chiropractic Integration Healthy For The Profession?

 

Number 3

Episode #6 with Dr. Tyce Hergert from Southlake, TX. This episode is called Astounding expert Information on Immediate Headache Relief. This one was all about headaches and highlighted one service that was dressed up and parading around as another. Yes, those pesky PTs are moving in on us and this episode talked about little bit about that along with some great papers showing chiropractic’s effectiveness with treating headaches. Fun episode. 

CF 006: With Dr. Tyce Hergert: Astounding Expert Information On Immediate Headache Relief

 

Number 2

Episode #13 – DEBUNKED: The Odd Myth That Chiropractors Cause Strokes. My favorite episode and my favorite endeavor as far as really putting together information to stick a fork in an anti-chiropractic idea or myth. This is actually a three-part series consisting of #13, 14, and 15. All three episodes really paint a picture of foolishness on the part of the medical field and a coordinated attack that is easily put to rest through common sense, correct context, and research. 

It’s really so simple when you take the time to listen, learn, and just think about it for a minute. They are the three episodes I encourage you to share the very most out of all of them I have created. 

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

 

Number 1

Episode #11 – called It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring.

The most listened-to episode for our first year was Episode #11 once again with my old friend and colleague Dr. Tyce Hergert down in Southlake, TX. He has TWO episodes in the top 10 from our first year. That’s because he’s smart, he’s the ex-President of the Texas Chiropractic Association, and he’s entertaining if he’s had his coffee. 

In this one, we talked about current healthcare guidelines, why they matter to chiropractic patients and even non-patients, and whether MDs are getting it or not. Guess what? They’re still ignoring these guides!

CF 011: With Dr. Tyce Hergert: It’s Here. New Guides For Low Back Pain That Medical Doctors Are Ignoring

 

Wrap Up

So….there you have it, folks. That’s our Top 10 in a nutshell with all of the links in the show notes. We have had a great first year. We hope you have enjoyed the content we have been bringing to you as much as we have enjoyed gathering it for you. 

There is so much going on in our profession. Both good and bad. It’s important to stay plugged in now more than ever. We’ll talk about it in a future episode but the Texas Chiropractors lost their appeal and the medical kingdom will bring their dog and pony show to your state before you know it. Believe me. 

But, for evidence-based chiropractors, there’s still no better time than today to be a doctor of chiropractic. I firmly believe that to be the truth.

Integrating Chiropractors

 

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 that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors 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.

That’s Chiropractic!

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. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

Today we’re going to talk about the reliability of clinical tests assessing the cervical spine, what is happening when adjusting a neck as far as the integrity of the cervical spine, and what the CDC says about opioids. It’s all fascinating all the time here at the Chiropractic Forward Podcast 

But first, here’s that bumper music

Integrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have drifted all slow and gently into Episode #51

DACO

As has become the tradition, let’s talk a bit about the DACO program. DACO stands for Diplomate of American Chiropractic Orthopedist. Trudging along. I’m up to I believe 84 of the required 300. Classes this last week were on frozen shoulder, piriformis syndrome, Important aspects of lumbar MRI, and inguinal pain. 

This stuff is just invaluable, folks. I’m an organizational freak but at the end of each course, I’ll make myself a quick sheet that I can reference when something like that comes through the door. I think making these little quick sheets will really help to get some of the more rare or difficult cases figured out quickly. 

I’ve already put the lumbar differential diagnosis sheet to use a few times as well as the dizziness quick sheet I created. I have shared several times here that I don’t sit around a lot either at work or at home. I’m a busy bee. 

Vacation & Hobbies

Going on vacation, don’t even try to take me to a beach. If my wife wants to go to the beach, that’s all her. I’ll tag along and I’ll check in on her out there reading a book from time to time but, for the most part, I’ll be off doing, seeing, and experiencing. The ability to sit still and just relax…..that’s an ability I did not receive in this lifetime. 

As a result, I make live edge furniture. Go to Facebook and look up Amarillo live edge and custom furniture. I am a sculpture and charcoal artist. Go back to Facebook now and look up River Horse Art Gallery. I’m in the process of teaching myself to paint right now too. I also am a singer/songwriter. Go back to Facebook once again. Yes, once again and look up Flying Elbows Perspective.

Crazy name indeed. 

So, here’s the point. It’s not to brag or pump my tires. The point is that this is how important I’ve found the DACO program to be. While I haven’t completely put everything else on hold, the DACO has taken priority of my time. One reason is that I want to motor through it quickly and efficiently. The next reason would be that I’ll be the only DACO in all of Texas West of the Dallas/Ft. Worth metroplex. 

What does that get me? Maybe a pat on the back. Maybe a part time or full-time gig on staff at an FQHC. As we have mentioned in previous episodes, there are reports of DCs on FQHC staffs making as little as $120/visit up to $300/visit on even Medicaid visits. Unbelievable. But you have a better shot at getting into the system when you are specialized AKA – a Diplomate. 

Just a part of making us all better. You guys and gals need to be looking at this stuff. 

Before we hop into the papers for the week, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. I think I have some pretty cool stuff coming down the pike you’ll be interested in. That’s in you enjoy evidence-based education.

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Paper #1

The first paper here is called “Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration” It was done my Madege Lemurnier et. al. and published in the European Spine Journal in September 2017[1]. 

Why They Did It

With a title as long as that one, what the heck are they doing here? They say they were hoping to determine the reliability of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. 

How They Did It

They updated the systematic review of the 2000-2010 Bone and Joint Decade Task Forst on Neck Pain and Associated Disorders. 

They searched the literature for studies on the reliability and validity of Doppler velocimetry to evaluate the cervical arteries. 

They had two independent evaluators look through it all

What They Found

  • Preliminary evidence showed that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joint. Or rule in I suppose. Just in case you are unaware of the cervical extension-rotation test, it’s exactly as it sounds. Have the patient extend and then rotate toward the side you’re testing. When you combine this maneuver with palpation you can typically get a good idea of whether the patient is suffering from a facet issue. You need to know that this test is also effective in sniffing out a low back facet issue as well. Lumbar extension and then rotation can give you some good clues sometimes.
  • The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling’s and the upper limb neurodynamic tests.
  • No evidence found for doppler velocimetry. 

Wrap It Up

Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension–rotation test, neurological examination, Spurling’s and the upper limb neurodynamic tests.

Paper#2

On to our second paper. This one is called “Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation” and appeared in Spine Journal in August of 2018 and was authored by Dr. William J. Anderst, et. al[2].

Why They Did It

Since cervical manipulation is such a common intervention for neck pain, the authors wanted to characterize the forces involved and the facet gapping that takes place during manipulation. 

How They Did It

It was a laboratory-based prospective observational study

It included 12 patients 

Each patient had acute mechanical neck pain

One of the outcome measurements was the neck pain rating scale (NPRS)

Other measurements were taken for amount and rate of cervical facet joint gapping 

What They Found

The authors concluded, “This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”

Pretty cool stuff. 

Paper #3

Our last paper for this episode is called, “CDC: Drug overdoses hit new record.” It’s an article on thehill.com written by Nathaniel Weixel and was published on August 15th of this year, 2018[3]. 

The article leads off saying that 72,000 Americans died from drug overdoses in 2017 and that’s based on information provided by the Centers for Disease Control and Prevention. That is a new record folks and we have our friends in the medical realm to thank for it. 

Who’s To Blame?

Now, that, of course, doesn’t mean pharmacists and medical doctors are bad and there was a mass conspiracy to cause this deal. But it does mean that SOME of them are bad. SOME doctors are doing time in an orange outfit right now because they knew better but the dollar was mightier than common sense and common decency. 

There were pharmacies dispensing 100x more than their population could ever consume but they want to not refer to us and talk about the integrity of the cervical spine. That kind of crap is what got us here.

But, it’s also what has brought chiropractors from the shadows into the light. When you have the mess the medical field has created, then you have to start looking for the non-pharma solutions and we are it. 

Comparison

72,000 deaths. You ever heard of the Vietnam War? Of course, you have. We all have. Some either remember or have seen what a big deal it was. The deaths, the protests, the loss. I’ve been to the Vietnam Wall in Washington DC several times. It’s profound. It’s stunning to see all of those names. 

Just to compare, the total number of those lost in Vietnam stands at 58,220. Now keep in mind, that takes into account deaths from as early as 1956 all the way up to as late as 2006 and comes from Defense Casualty Analysis System Extract Files from The Vietnam Conflict Extract Data File. 

I did my homework. I’m not giving you fake numbers here. 

Essentially, 13,780 more deaths happened because of opioids, In just one year. In just 2017. That doesn’t even begin to scratch the surface when you start totaling up 2016, 2015, and further back. Unbelievable isn’t it? 

If we look at it, 2014 had 28,647 deaths, 2015 had 33,100 deaths, 2016 saw 63,632 deaths…..and then 72,000 in 2017. 

I’m guessing you can see the trend. Hell yes, it’s an epidemic.

The Math

I’ll do the math for you because I love you and I’m glad you’re here and I don’t want you to have to think too hard while you’re giving me your time. Over the last 4 years, that’s approximately 200,000 opioid-related deaths. 197,379 to be more specific. 

The genie seems to be out of the bottle.

While we can’t put the genie back in, we can offer solutions for the future. Many of those addicted to opioids became addicted due to spinal surgery. Many of those surgeries were unnecessary. One paper I reviewed showed that approximately 5% of lumbar fusions are necessary making about 95% of the unnecessary. Yeah….95%. 

The Answer

We have the answer people. The American College of Physicians, The White House, The Lancet, 2 papers in JAMA, Consumer Report surveys, The Joint Commission, The FDA…..seriously, there is not one reason that we aren’t inundated by spinal pain referrals at this very moment. No reason at all. It actually makes me mad as hell that we are not. 

Exactly what the hell does it take to make general practitioners, neurosurgeons, orthopedic surgeons, nurse practitioners, and physician assistants understand that an evidence-based chiropractor is best situated to help these people as a first-line therapy?

Integrating Chiropractors

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 that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors 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.

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. 

Website

http://www.chiropracticforward.com

Social Media Links

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author and Host:

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

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 012: Proven Means To Treat Neck Pain

CF 041: w/ Dr. William Lawson – Research For Neck Pain

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

 

 

 

Bibliography

1. Lemeunier N, Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. Euro Spine J, 2017. 26(9): p. 2225-2241.

2. Anderst W, Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine (Phila Pa 1976), 2018. 0(0).

3. Weixel N. CDC: Drug overdoses hit new record. The Hill 2018  5 August 2018]; Available from: https://thehill.com/policy/healthcare/401961-cdc-drug-overdoses-hit-new-high-in-2017.

 

 

CF 049: The Palmer/Gallup Poll 2018 Discussion On Chiropractic Marketing

CF 049: The Palmer/Gallup Poll 2018 Discussion On Chiropractic Marketing

Today we’re going to talk about the 2018 version of the Palmer Gallup poll that has some great info including some chiropractic marketing nuggets for your nugget pouch so stick around as we get into the details

But first, make way for that sweet sweet bumper music

Integrating Chiropractors

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Introduction

You have crumpled into Episode #49. Info to help with your chiropractic marketing. We are moving in on a solid year of Chiropractic Forward episodes and that feels good. Every single week. We haven’t missed one week this past year. There is most certainly a sense of accomplishment and doesn’t it feel good to feel good? Of course, it does. 

The Diplomate of American Chiropractic Orthopedists (DACO)

Let’s talk a bit about the DACO program – Same as last week. Just trudging along. Last week I took classes on benign paroxysmal positional vertigo, poster canal, anterior and horizontal canals, Epley’s maneuver and all that goes along with that. I also had a class on Lumbar spinal stenosis that I learned some new tidbits on. Great stuff. My offer stands, if any of you want to start looking at it, I’d be glad to give you a little guidance in getting yourself started. 

Newsletter

How’s about youse guys head over to chiropracticforward.com and get yourself on our newsletter. I have some cool stuff coming down the pike and I want you to be the first to know about it and I want you to save money because you were cool enough to be on our email list. No more than once a week. That’s my guarantee. It’s just an email address folks. Not a big deal. 

Personal happenings

You have heard my woes and my front desk worries over the past month or two. I told you last week that it appears my wife has herself a new full-time gig and guess what? With her help, we had not only one of the best Octobers we have ever had, but we also had one of the best months (numbers-wise) that we have ever had in 20 years. 

I believe there’s something to this “wife working the front desk” idea people. Something to think about for sure. If you can work with your wife or husband that is. You may have to pee strategically around the office just to mark your territory and let it be known this is your domain but, nobody will work as hard for the office as someone that has a vested interest in it. I’m a firm believer in that. 

Into The Information

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

This week I want to talk about the Palmer/Gallup poll that has been coming out annually for a couple of years now. I think it’s two years but cannot recall off the top of my head. 

Regardless, let’s talk about the 2018 version. I look forward to its release every year because you can get some chiropractic marketing ideas from it if you’re looking at it the right way. 

The Ideal Patient

Any time you start a new generic chiropractic marketing program, they have you create your ideal avatar or your ideal customer. The customer that not only comes in and you love to see them come through the door but the customer that is coming in and paying good money to see a good doctor. The people that love you and go out into the world to tell everyone every good thing they can about you and the ones that are the first to leave you a great Google review. 

THAT’S the ideal patient, isn’t it? If we could only fill up our offices with that specific, amazing person all day every day. We’d never even think about giving up our practices and moving to an exotic place with umbrellas and funny drinks. Chiropractic marketing would be non-existent. 

Well, we may still think about doing that but it wouldn’t occupy as much brain space if these people were all that ever came through our door. 

Don’t we just love seeing these perfect patients? Smiles, good vibes, and excitement. And sometimes food!! I have one bring us pumpkin spiced cake and sugar cookies last week. We need to work on a nutritional talk for sure but you get the point. 

On To The Poll

I am linking the poll in the show notes so go check it out Episode 49 at chiropracticforward.com

http://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup/palmer-gallop-annual-report-2018.pdf

The first thing we really get into here is the Summary and I think that’s really where we are going to stay instead of going too deep in because we’ll wind up with a 4 hour episode and I don’t want that any more than you do so let’s hit the high spots and call it good. 

  1. Neck and back pain is common among adults in the US – yes, we knew that now didn’t we? They say about 2/3 of US adults (62% to be specific) have had neck or back pain that was significant enough that they saw a healthcare professional for care at some point in their lifetime, including 25% who did so in the last 12 months. 
  • 25% of the population sought care in the last year for pain. I bet 25% did not seek care for wellness. 

2. 80% of American adults prefer to see an expert in spine care for neck and back conditions rather than a general medicine professional who treats anything and everything. I think we all know who the experts are right? It’s us….

He’s a problem though, 67% of them prefer to see someone that can prescribe medication or surgery to treat neck or back pain.  Only 28% want to see someone that does not use prescription medication or surgery. That one is a bit of a kick to the nether region. I thought we were making more progress on that front. 

I can’t tell if the next point contradicts the previous one or not. You decide. They say that prescription pain meds aren’t preferred as first-line care for about 79%. I can only guess they are preferring a practitioner that can prescribe just in case it declines to the point of needing it but they don’t necessarily want to start with pills? Maybe…..

3. When it comes to healthcare providers, people say that chiropractic doctors and medical doctors are the top choices for neck or back pain care. In the last year, 62% say a medical doctor while 53% saw a chiropractic doctor. 

Peel Back The Layers

Going a little deeper there, 34% say a PT and 34% visited a massage therapist. 

I think it’s of important note here that half of the people that went to the chiropractor went because they said that chiropractors provide the most effective treatment for their pain. That’s pretty damn awesome right there. We’ll get to the other half here in just a minute. 

The overwhelming feeling in this subsection is the keyword is “EFFECTIVENESS.” Can you say, “Chiropractic Marketing Nugget?” How effectively can you relay your effectiveness? 

I would offer to you the idea that this podcast is an EXCELLENT way to speak about your effectiveness as well as to back up your effectiveness. You just have to listen and you have to take what you learn and turn that into kick-butt content and marketing material. 

Since not everyone is particularly gifted at chiropractic marketing or creating content, we are working on helping you out in that aspect. Stick with us. It’ll happen. Just go to  chiropracticforward.com and get on the email list to stay on top of that. 

Outside of ‘effectiveness,’ SAFETY was another reason people chose chiropractors and PTs for their back and neck pain. In fact, about half of those coming to the chiropractor said safety was why they chose chiropractic.

So, we have the big TWO reasons. Only two. That people go to chiropractors nationwide. They are Effectiveness and Safety. That should be useful information for you guys and gals to take and run with. Chiropractic marketing at its best. 

Next point

4. The fourth point of the summary was types of care. They found a lot of people utilizing self-management at home, as they should. They say 53% of American adults went to get massages to control pain. They say 47% had chiropractic care for their pain. And 42% went to a PT. 

That means we have a lot of people doing more than one thing right? It would make perfect sense to not be a one-trick pony in your practice. For instance, the subluxation guys and gals only adjust. They’ll see a patient 100 times a year and only adjust. Nothing else.

Oh wait, I lie. There’s a local guy here that will pray over each one before using the activator on them all so I guess it’s a little more than just the adjustment. 

I don’t want to make light of prayer. I’m a Christian and am well aware of the power of prayer but when it’s done after joining Body By God type management programs, well, it just seems a bit disingenuous doesn’t it? If we’re being honest?

Anyway, if you have to see someone that many times a year, you’re probably a terrible chiropractor and you’re probably doing more damage than you are doing good.

Diversifying

Back to doing more than one thing: it’s clear that patients are not looking for just an adjustment. It appears they’re looking for chiropractic, they’re looking for massage, they’re looking for some exercise/rehab considering 72% were looking into yoga. 

Although it’s not in this article, I believe many are looking for acupuncture these days. As discussed earlier, they may potentially be looking for meds so why couldn’t you offer anti-inflammatories like turmeric or Boswellia just to name a few. I say this because this poll showed that 73% of people took an over the counter medications like acetaminophen or ibuprofen. Definitely food for thought. 

5. Patient Experiences

Patients that visited a chiropractor, a PT, or an MD over the last year said they received a high level of care. That’s good news. 

For chiropractors specifically, 9 out of 10 patients said

  • The chiropractor listened to them
  • DCs provided convenient and quick care
  • We demonstrated caring and compassion
  • The chiropractor explained things well
  • And they spent the right amount of time with them

Approximately 90% of patients had all of that to say about chiropractic doctors. That’s outstanding news, folks. That means that we can fight amongst ourselves and, while I would argue the straights are keeping us from full integration, in the eyes of patients, almost ALL of us are doing a good job!

For Physical Therapists, overall, they were hitting around the 83%-86% area. 

For MD’s, they didn’t do too well honestly. But didn’t we expect that? Here’s how they fared:

  • 72% say their MD listens
  • 67% said they often explain things well
  • 66% said they demonstrate care and compassion
  • 53% said they have quick access and are convenient

No surprise there. In fact, the surprise comes when we see that so many are still going to the GP for non-complicated musculoskeletal pains. That’s the real surprise. 

Point 5 Discussion

When you consider that chiropractors hit around 90% for all of those and you see MDs around 64% for the same metrics, well…..that’s not so good, right?

I see A LOT of opportunities here. If you are of the marketing mind, I’m sure you see the same!

This podcast isn’t just for listening to some mindless drivel folks. I am trying to give you stuff that you can use immediately after you listen. If you pay attention to what I’m telling you every week, you can turn around and communicate FACTS to your patients, your staff, and to those in the medical field in your region. 

I’m friends with a neurosurgeon and a vascular surgeon because I’m not freaking crazy. I can communicate research to them in an effective way that they understand. I’ve taught them a ton they didn’t already know. Plus we all like a Cerveza here and there so that works out well for us. 

Research helps you communicate

What I’m saying is that you should be listening to this podcast to learn for sure. But you should also be listening to it with the mindset of, “How am I going to take this information and use it in either my marketing or in my communication with my community?”

Believe me or don’t. I hope you believe me. The information I am bringing to you is the information you should be using. Not the subluxation stuff. Not the philosophy stuff. Literally, straights in our profession are the only people on this Earth that give a damn about that stuff. 

Nobody else knows or cares. Nobody. 

But research, safety, and effectiveness, well…..when you’re talking in those terms, then you are getting somewhere. 

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

Contact

Send us an email at dr.williams@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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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/groups/1938461399501889/

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

http://www.palmer.edu/uploadedFiles/Pages/Alumni/gallup/palmer-gallop-annual-report-2018.pdf

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

 

CF 034: Chiropractic Information To Help You Form Your Practice

 

CF 032: How Evidence-Based Chiropractic Can Help Save The Day

 

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

CF 045: Harvard Health, Low Back Stenosis, Allergy Autism

As the title this week indicates, I’ve taken some files that have been gathering a little bit of dust in the dark corner and I’m bringing them out into the light.

Today we’ll talk about an article in Harvard Health, we’ll talk about low back stenosis research (something that doesn’t get a lot of attention), we’ll talk about a JAMA article on allergies and autism, and we’ll hit on a paper attempting to explain why some patients respond while others do not. 

Integrating Chiropractors

 

But first, you know what’s up, I wrote and recorded our jingle so you might as well just sit back and enjoy this candy for your ears. When you do create something, it’s going to be in EVERY show don’t ya know!! Here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #45

OK, first thing, we should probably talk about the Texas vs. Oklahoma game that just happened this last weekend. By the time this posts, it’ll be two weeks ago but, still need to brag. What a game that was. I’m a Texas boy but either way would have been fine since most of OU’s players are from Texas anyway. I go for all of the Texas teams. 

I want to thank Kyle Swanson for the shout out on the Forward Thinking Chiropractic Alliance group a couple weeks ago. He’s a Texas A&M Aggie. Look, like I said, I root for A&M too so we would probably be buddies in the real world if I’m guessing out loud. 

Front Desk Staffing

Let’s get to the ongoing saga of hiring a new front desk staff. If you’ve been following along, you’ll remember that hiring a new front desk staff member has been nothing but a soup sandwich. 

Messy. Gloppy, Unreal and confusing. Those are just some words I’m laying on you. I have more words for what we’ve been through on this deal but then my podcast would have an explicit designation and I try to keep it clean around here. 

But, I believe progress has been made. We seem to have a new one that seems to be on top of her game. If she’s a “sticker,” then the search may very well be over. Of course, she’s not young which is probably why she’s a sticker so far. She’s closer to my age than any of the others have been. I’m not saying that young people have no work ethic…..I’m just saying that all of the young people that we interviewed for this job have no work ethic. 

That sounds like I’m against young people, millennials, blah blah blah. I’m not. I have had some VERY intelligent and capable young people come through here as employees over the years. There are very smart, very talented young folks out there. We just didn’t encounter any of them for this round of hiring. That’s all I’m saying. 

Moving on

October has really taken off in terms of listens for the podcast. I can only guess you’re sharing episodes here and there with your network. To that, I say thank you. If I ever see you somewhere and you tell me you have been sharing my stuff, and hold your hands out like, “bring it in big boy,” well then…you’re getting a hug my friend.

I’m a hugger. Which can probably be scary if you don’t know me. I’m 6’4” and like 280 so….big guy coming through! But, those that know me know that I’m a teddy bear. Unless you try to steal my food. Then it’s pretty much on at that point. 

On to the research

Let’s get on with trying to make your practice better. When your practice is better, your life is better. 

Let’s start with the Harvard Article. It was published in November 2017. I have it linked at chiropracticforward.com for you all in the show notes for episode 45. The name of the article is “Where to turn for low back pain relief[1]” and I couldn’t find the name of the author so there ya go. 

https://www.health.harvard.edu/pain/where-to-turn-for-low-back-pain-relief

The subtitle of this Harvard Medical journal….medical journal……is this: in most cases, a primary care doctor or chiropractor can help you resolve the problem. What the hell??? It seriously says that in a Harvard Medical article. I’m trying to catch my breath here. Sorry…..

It was published in November of 2017. The article says that there are many causes of low back pain and some of the most common is an injury to muscles or tendon which we know is called a strain and then injury to back ligaments which we call a sprain. And then there are herniated or bulging discs. 

Going through the DACO program tells me that the prevalence between disc, facet, and SI joint pain stands at 40% for the disc, 30% for the facet, and 22.5% for the SI joint pain. BUT….over the age of 50 years old, it flips a little and the Facet joint gains prevalence over disc or SI pain. Just some nuggets to tuck away in your nugget pouch. 

This article just blows me away when it gets to the “Where to Turn” subtitle. Beneath this subheader, it says, “Since you shouldn’t try to diagnose your own back pain, make your first call to a professional who can assess your problems, such as a primary care physician or a chiropractor.”

Both can serve as the entry point for back pain says Dr. Matthew Kowalski who serves as a chiropractor with the Other Clinical Center for Integrative Medicine at the Harvard-affiliated Brigham and Women’s Hospital. 

What the hell is happening here? Am I in the Twilight Zone where everything is flipped and the medical world finally gets it?

The article goes on to say “A well-trained chiropractor will sort out whether you should be in their care or the care of a physical therapist or medical doctor.”

And here’s the difference between evidence-based/patient-centered chiropractors and those that are not. 

The more not evidence-based amongst us, the ones that drive a billion people through their doors for everything from allergies to whatever…..they will not typically be turning those patients over to the medical doctor or the PT. 

Moving to the next paper, it’s called “Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial” authored by Carlo Ammendolia, et. al. It’s all about low back stenosis. This paper is co-authored by DCs, AND MDs. It was published in the Archives of Physical Medicine and Rehabilitation on October 27, 2017[2]. 

Why They Did It

They wanted to the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in low back stenosis.

How They Did It

  • It was a randomized controlled trial
  • It was done in an Academic hospital outpatient clinic
  • Participants suffered neurogenic claudication
  • MRI confirmed lumbar spinal stenosis
  • Subjects were suffering low back stenosis and randomized

What They Found

The conclusion stated, “A comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS”

Low back stenosis can be helped

Dr. Ammendola has an amazing lumbar spinal stenosis program and training course. I have not personally taken it just yet but, it’s on my list after I finish up the DACO program. It comes HIGHLY recommended and this paper shows us why. 

Trucking on, this one is called “Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls?” It was published in Spine Journal in September of 2015 and authored by Wong, et. al. [3]

Why They Did It

To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated. Some, but not all patients with low back pain report improvement after a visit to the chiropractor. Why does that happen?

What They Found

After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups.

Wrap It Up

Quote, “Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT responders not present in all patients with LBP.”

And our last one this week comes to us from JAMA, also known as the Journal of the American Medical Association. This one is called, “Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children.[4]” It was authored by Guifeng, et. al. and published in 2018. Again, these papers are cited in the show notes at chiropracticforward.com under episode 45 so check them out yourself please. 

The question they attempt to answer here is, “What are the associations of food allergy and other allergic conditions with autism spectrum disorder (ASD) in children?”

They say in the paper that Common allergic conditions, in particular, food allergy, are associated with autism among US children, but the underlying mechanism for this association needs further study.

The study was a population-based, cross-sectional study used data from the National Health Interview Survey collected between 1997 and 2016

The conclusion was quote, “In a nationally representative sample of US children, a significant and positive association of common allergic conditions, in particular, food allergy, with ASD was found.”

They now need to find out the cause and underlying mechanisms so they can attempt to reverse the upswing of autism here in America. 

So….it appears maybe it’s not all due to vaccines after all. 

Integrating Chiropractors

That wraps it up for us this week. I hope you enjoyed it. Research can be boring but, it can be fascinating too when you allow it to help guide your thought process when you are approaching your daily tasks and deciding on treatment options for your patients. 

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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/groups/1938461399501889/

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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

 

Bibliography

1. School, H.M., Where to turn for low back pain relief. Harvard Health Publishing, 2017.

2. Ammendolia C, Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial, in North American Spine Society Meeting. 2017, Archives of Physical Medicine and Rehabiliation: Orlando, FL.

3. Wong AY, Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls? Spine, 2015. 40(17): p. 1329-37.

4. Guifeng X, Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children. JAMA, 2018. 1(2).

 

CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)

CF 044: w/ Dr. Dale Thompson – Why I Like Being An Evidence-Based Chiropractor

CF 044: w/ Dr. Dale Thompson – Why I Like Being An Evidence-Based Chiropractor

Today we’re going to talk about being an evidence-based chiropractor. What does it mean to be practicing evidence-based chiropractic and we’re going to be talking about with Dr. Dale Thompson from Iowa. USA.

Dale Thompson - Evidence-based Chiropractor

Integrating Chiropractors

But first, here’s that bumper music you’ve come to know and love. 

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have mosied Old West style into Episode #44

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live when someone new signs up it makes my heart leap a little, and in the end, it’s just polite and we’re polite in the South.  

We are really starting to pick some steam. Thank you to you all for tuning in. If you can share us with your network and give us some pretty sweet reviews on iTunes, I’ll be forever grateful.

By now, we all know how the interwebs work. You have to share and participate in a page if you are going to see the posts or if the page will be able to grow. 

My Week

How has your week been? Mine has been great. I attended my third DACO class and this one with the man, the myth, the legend, Dr. James Lehman. And he was excellent. Which isn’t surprising but sort of is and here’s why.

Being the head of the DACO program for the University of Bridgeport Connecticut, Jim was just there to audit the class which was originally to be taught by Dr. Miller who I’m not familiar with just yet. 

Well, we had a huge storm come through the Dallas/Ft Worth metroplex that screwed everything up including my drive into town all the way from Amarillo. I literally got dumped on by gallons of water per second for about 4 hours to get there. 

Pure misery Y’all, and that’s not exaggerating. In fact, all of the rivers, lakes, and low lying streets were flooded. The word of the day for the newscasters on TV was the word “Swollen.” All of the bodies of water were quote, Swollen. 

Anyway, the storm made it impossible for Dr. Miller to get to Dallas but, good fortune was shining on the DACO program in Dallas and it’s participants. Dr. Lehman was there to audit his first class in over a year and he was able to simply step in and teach instead of Dr. Miller. 

So, I got some good solid learning from the man himself who, as luck would have it, has agreed to be a future guest on the Chiropractic Forward podcast so just hold onto your britches because we’re going to make it happen. 

Introduction

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

I want to start by introducing this week’s guest. You have likely heard me talk all about the Forward Thinking Chiropractic Alliance Facebook group as well as the Evidence-based Chiropractic Facebook.

I’m pretty fond of the two groups as well as our own Facebook group I’d invite you to called oddly enough the Chiropractic Forward Facebook group. We have a Chiro Forward page where we update everyone on new episodes but we also have the group where we post the research papers and discuss and connect outside of the podcast. 

Getting back to the first two groups I mentioned, Dr. Thompson is a very active member of those two groups….. 

There are a lot of other terms thrown around that mean nothing to others like TORS and medi-practors and all that fun stuff. But, I thought this would be a great time to just sit and talk about the differences. 

Welcome

Welcome to the show Dr. Thompson. Thank you for joining us today. How’s the Iowa weather this fine Fall Thursday morning?

I already went through your introduction and am wondering, How do you make the leap from embalmer and the mortuary all the way to being an evidence-based chiropractor? Tell me about that. 

Dr. Thompson, can you tell me a bit about your practice? What does it look like?

Have you always been an evidence-based chiropractor?

What initially got you into the research side of things in the profession?

As an evidence-based chiropractor, you post so much research, I’m not sure how you have the opportunity to find it all and go through it all. How in the heck do you do it?

Dr. Thompson, back on September 16th, you posted something for the newer members of the group to read. Your post was called Practicing Chiropractic Wisely: Why I Like Being an Evidence-Based Chiropractor

I thought it would be interesting if we simply spent our time together going through your list together and explaining or expounding where appropriate if you’re OK with that. 

  1. I can go to a conference and know if the speaker is generally telling the truth or is trying to sell a lie. Tell us why this one made your list if you don’t mind.
  2. I know it’s better to say “I don’t know” than to make something up. Do you feel that the philosophical-minded chiros in the crowd tend to make up things on the spot? Or is this more a point that they explain everything with the term subluxation and start pounding down the high spots?
  3. I know the best chiropractic related books were written in the last 10 years… not 100 years ago. I’m guessing this one is aimed at the green books from Palmer as well as the books those spawned over the years?
  4. I can sit down with a layperson or an orthopedic surgeon and explain what I do…and they both get it. It’s possible to tell them what research says about our effectiveness and they’ll get it. For me, I dumb it down. This is imbalanced, weak, or doesn’t move very well. We are going to try to balance, strengthen, and move it. Pretty simple. Maybe too simple. How exactly do you approach it that works best for you?
  5. I can read a research paper and know if it’s good or bad and how it may apply to what I do. What criteria do you use to determine it’s worth? I’m guessing meta-analysis, systematic reviews, and randomized controlled trials are at the top of your list. Sample numbers? Journal impact? What all do you take into account? In this context, I’m assuming you are using it to insinuate that the more philosophical subluxations crowd points to research but you would argue it is not good research. Am I correct in that assumption?
  6. I can take the best evidence and apply it and yet also have the freedom to find novel ways to approach a problem. This reminds me of a previous guest we had on the podcast a few episodes ago. Dr. Brandon Steele. He was making the distinction between evidence-based chiropractor vs. evidence-informed. It sounds like you are describing evidence-informed here. Is that correct?
  7. I have several tools in my tool bag and they will not be exactly the same next year as they are not the same as last year. Can you expand on that for us, Dr. Thompson?
  8. I can take a seemly complex problem and find a simple solution as well as understand the complexity of an apparently simple problem. Explain your intent on this one and the purpose for your including it, please. 
  9. I am more comfortable having questions I can’t answer than having answers I will not let be questioned. Oh, man….if the others weren’t fuel for the subluxation crowd, this one certainly is. Discuss from an evidence-based chiropractor point of view.
  10. I understand my patients want their problems fixed in a cost-effective and within a reasonable time, that they don’t want long-term care. Wouldn’t you agree that you are a terrible chiropractor if you have to see someone 100 times in a year to get them well or keep them well? Evidence-based chiropractors don’t see their patients that often.
  11. I know my clinical strengths and limitations as well as the strengths and limitations of other healthcare professionals. Can you tell me some of the claims you have personally witnessed that leads you to this being on your list? 
  12. I can make a good living without sacrificing patient-centered care to achieve it. “I tell people that I could make a heck of a lot more money but I sleep very well at night. In addition, it’s a point of mine in my practice to never put my staff in a position that, should my ethics or way of practicing ever be called into question for some reason, I’d never want them to feel like they had to, or needed to lie for me.  That’s a bit of a guiding principle for me. As an evidence-based chiropractor, another principle I find myself following daily is that, if I’m giving my patients the same recommendations I would give my mother, brother, father, or sister, then we will always be going in the right direction. Tell me what being patient-centered means to you personally.
  13. I do not have to jump on board the latest health fad but I can, and may, scrutinize it using logic, reasoning and supporting evidence. Fill me in. Where does this one come from? 
  14. I can respect my colleagues desire to practice different than me but I still demand they do so in an evidence-based chiropractor and ethical manner. To play Devil’s Advocate, what if they’re told they ARE actually evidence-based chiropractor? What if they have papers they can point to? What if they have some gurus throwing together research to form a diagram and brain lamp to charge $800 a pop ala Dan Sullivan?  
  15. I can appreciate that sometimes positive and unpredictable changes can occur in other body systems while under my care but I won’t use that to try to lure people in to see me. Examples?
  16. My patients come first, my profession second and I am last. Now THAT is the true definition of a patient-centered practice and I think most would agree that every evidence-based chiropractor. should follow this mantra.  

Continuing

Switching focus a little bit from evidence-based chiropractors vs. subluxation-based chiropractors, what is your opinion of or how do you deal with people like Stephen Barrett or Edzard Ernst or any of the knuckleheads over at that science-based website? 

It’s my hope that, by hearing from evidence-based chiropractor like you, me, the guys from the DACO program, etc…that they will understand. 

Understand that when sitting through those classes or seminars they’re made to sit through….those classes and talks that make them roll their eyes because they’re all about a philosophically based model….those classes. It’s my hope that they’ll understand they don’t have to practice that way and hopefully they understand there is another way to go about it. 

Also, some chiropractors get out of school not knowing what they believe since they’ve been inundated many times with all kinds of information. Some good and some bad. 

Just saying the words, “not knowing what they believe” sounds silly when we have the research out there in piles and piles. I have patients say, “I believe in Choirpracty” all of the time and I’m clear with each of them that we aren’t part of a church and that Chiropractic isn’t something one has to believe in. 

That goes for chiropractors and students as well.  

Dr. Thompson, I want to thank you for coming on the show today and running through it with us.

Integrating Chiropractors

 

Affirmation

It is an absolute certainty that, when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.

It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

Website

http://www.chiropracticforward.com

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TuneIn

About the author:

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

 

CF 032: How Evidence-Based Chiropractic Can Help Save The Day

How Evidence-based Chiropractic Can Help Save The Day

Integrating Chiropractors

Today we’re going to talk about our blessing and our America’s curse, opioids. Why would I ever call opioids a blessing? We’ll get to that. Stick around for some updated info on how evidence-based chiropractic can save the day.

But first, here’s that bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

Now that I have you here, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes it easier to let you know when the newest episode goes live, when someone new signs up it makes my heart leap a little, and in the end, it’s just polite and we’re polite in the South.  

We are really starting to pick up some steam. Thank you to you all for tuning in. If you can share us with your network and give us some pretty sweet reviews on iTunes, I’ll be forever grateful. By now, we all know how the interwebs work. You have to share and participate in a page if you are going to see the posts or if the page will be able to grow. 

We are honored to have you listening. Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

You have Texas two-stepped your way into Episode #32

As I was wondering what the heck I was going to talk about this week, I started looking at having a guest. Well, he was unavailable for a few weeks so now what? 

I started to put some random research papers together for this week’s episode was trying to gather my thoughts on flow, order, and all that good stuff and then…..POOF….it was like divine intervention. In my email box came about 4 or 5 articles on updates having to do with the opioid crisis. ALL IN THE SAME DAY. Pretty much in the same hour if you can believe that!

I’m not one to poo poo blessings or to throw rocks at divine intervention so guess what? We’re going with opioids and the ways evidence-based chiropractic can help save the day by helping our patients avoid them. 

If you have followed the Chiropractic Forward Podcast for any amount of time, or have seen any TV news program, you’ll know that American, and the world, has a bit of an opioid crisis and chiropractic is in the driver’s seat of alternative interventions that have been proven effective in treating the conditions that opioids have been commonly prescribed for. 

I want to start with an article I received from my malpractice carrier and, since I use the largest of chiro malpractice carriers, I’m guessing you all got it too but, if you are like most chiros, just deleted it rather than reading the thing. It turns out that I’m a nerd and I read the thing. It was titled “Opioids Misuse and Addiction: How Chiropractic Can Help(Petrocco-Napuli K)” and written by Kristina Petrocco-Napuli and posted on a site called Clinical Risks on June 13, 2018.

The article started with a story about Megan who was mid 30’s and suffering pain chronic pain four years after being in a wreck. 

As we chiropractors are well-aware of…..evidence based chiropractic care was not offered to her as a viable option for treatment following her car wreck, of course not….right? I mean, the trauma is mechanical in nature so why recommend mechanical solutions? Let’s just go right to the historically ineffective, addictive chemical treatment instead, OK?

So, basically, Megan went through two pregnancies addicted to opioids. She had some success quitting them during different parts of the pregnancies but continued to return to opioids. 

She goes on to cite information from the American Academy of Pain Management that says 100 million Americans suffer from chronic pain. Think about that just a second. Last I remember hearing, there was somewhere around 320 million Americans? That’s about 1/3 of the nation suffering from some form of chronic pain. That’s terrible news but, I’d argue it’s actually great news for chiropractors. Evidence-based chiropractic

It’s like, if we see personal injury patients in our office, we really don’t want people to get in wrecks but, be honest….it’s good for business. It feels dirty just saying that. I know I don’t personally want to see them get hurt but I’m here to help if they need me and that’s how I go about that. Same thing if it’s icy outside. You don’t want people falling and hurting themselves but…….yeah…..it’s good for business. You get my drift. 

We don’t want 1/3 of the nation suffering chronic pain but that also means the opportunities open to evidence-based chiropractic are virtually limitless if we play our cards right.  

I can tell you that we have seen some referrals in my office from a few of the pain doctors in the region that are trying to wean patients off of opioids and can I tell you something? It ain’t pretty. Some are mad at the world. Some are fidgeting all over the place and can’t sit still. Good Lord I’m glad I don’t prescribe and am not getting hit up all of the time for these pain meds. That is a blessing all by itself, isn’t it?

I am an advocate of yours. If you want to practice with adjustment only. Go for it. If you want to integrate…go for it. If you want to further educate yourself, go for it. You should be able to practice and get reimbursed to the extent of your schooling and to the extent of your state’s scope. I’m all for that. 

There was a time I thought it might be cool to prescribe like they do out in New Mexico. Chiropractors over there can go through an extra two years of education and have the ability and right to prescribe some meds to their patients if they feel they need it. I’ve had chiropractors tell me, “That’s not chiropractic.” I get that. That is why it is called an Advanced Practitioner or something of that sort. I don’t recall off the top of my head the official title. Regardless, who am I to hold a brother or sister back that wants to further their education, further their rights, and further their capabilities. You did the work. You deserve the pay-off and I’m on your side. 

However, for me personally, I’m over that. Not only is research showing more and more that that sort of prescription and treatment basically has no more effect than chiropractic, and, on top of all of that research, I don’t want to have to deal with people looking for the meds. I got over that a long time ago. Evidence-based chiropractic

In this article, the author goes on to mention the role of chiropractic which she says are as follows. 

  • Public awareness: Build knowledge on how chiropractic can help with chronic pain as an alternative to medications. We’ve talked about this many times before here on the chiropractic forward podcast
  • Education: Inform other practitioners about chiropractic as a treatment option for patients. This will become increasingly important, given the recent focus on non-pharmacological care. Again, we have screamed this one from the rooftops.
  • Reduce misuse: Help patients locate drug drop boxes for opioid disposal, drug take-back programs, medication lock boxes and testing programs. THIS is one I have not considered. Not at all. I think it’s a great point. If you know how to commonly find these take-back programs and lock boxes, send us an email at dr.williams@chiropracticforward.com and we will be glad to share with others. Right now, without going to Google for more information, I’m assuming a call to your local hospital can probably get this mystery solved for your area. 

Evidence-based chiropractic providers better get off their rears and take action on these points if we’re going to take our place. 

Next, there was this article in the Journal of the American Medical Association titled “The burden of opioid-related mortality in the United States” by Tara Gomes, et. al(Gomes T) and published in JAMA in June of 2018.

Why They Did It

The authors wanted to answer the question, “What has been the burden of opioid-related deaths in the United States over a recent 15-year period?”

How They Did It

  • The study was a cross-sectional design in which cross sections were examined at different time points to investigate deaths from opioid-related causes from January 1, 2001- December 31, 2016. 
  • For the purposes of this study, opioid-related deaths were defined as those in which a prescription or illicit opioid contributed substantially to an individual’s cause of death as determined by death certificates. 

What They Found

Between 2001 and 2016, the number of opioid-related deaths in the United States increased by 345%, from 9489 to 42?245 deaths

Overall, opioid-related deaths resulted in 1?681?359 years of life in 2016

Wrap It Up

Premature death from opioids imposes an enormous and growing public health burden across the United States.

We covered a paper some time ago that mentioned the average age of death has actually decreased in America in the last two years because of opioids. 

Remember the uproar Americans were in when we lost a little over 58,000 soldiers in the Vietnam war? Yeah, another paper we reviewed recently estimates over 64,000 death to opioids just last year. See the issue? But chiropractors have been crazy all these years to offer a sensible, safe, and reasonable alternative for treating these people? Give me a freaking break with that stuff. Now, some chiropractors are crazy OK? It’s the fact but, evidence-based chiropractic care can fix this problem and I have zero doubts about it. 

I want to cover this next one briefly just to highlight how damn tone-deaf these people in the medical kingdom can sometimes be. This one is called “Prescription drug coverage for treatment of low back pain among US Medicaid, Medicare Advantage, and Commercial Insurers.” Written by Dora Lin, MHS and published in JAMA on June 22, 2018(Lin D) this article really highlights the issue we are dealing with in America. 

The question the authors looked to answer here was, “Among US insurers, what are the coverage policies for pharmacologic treatments for low back pain?”

How They Did It

  • A cross-sectional study of health plan documents from 15 Medicaid, 15 Medicare Advantage, and 20 commercial health plans in 2017 from 16 US states representing more than half the US population and 20 interviews with more than 43 senior medical and pharmacy health plan executives from representative plans.
  • Data analysis was conducted from April 2017 to January 2018.
  • Of the 62 products examined, 30 were prescription opioids and 32 were nonopioid analgesics, including 10 nonsteroidal anti-inflammatory drugs, 10 antidepressants, 6 muscle relaxants, 4 anticonvulsants, and 2 topical analgesics.

What They Found

Look who the hell cares what they found, OK? Here’s why NONE of it really matters. All they’re doing here is trying to figure out what drugs insurers carry and how to get drugs to people rather than what is effective, what the current guidelines recommend, what The Lancet papers had to say about opioids and nonopioids, what the American College of Physicians have to say is first-line treatment and what is last line treatment for low back pain. Evidence-based chiropractic

How about they do a little research having to do with….I don’t know…maybe doing away with opioids, and anticonvulsants for low back pain…doing away with steroid shots and surgery for non-complicated low back pain….and knocking down the barriers to patients seeking alternative care. Barriers noted and called out by the White House last year and barriers that were set up by CMS and insurance companies. 

How about we do something effective along those lines instead of wasting more time and paper folks? It could not be more exhausting. 

This week, I want you to go forward with comfort. Comfort in knowing that you are where you need to be and you’re there for the right reasons. You are helping people stay away from these drugs. You saving their lives in many cases whether they….or you….know it. We are saving lives folks. Good on you. Keep it up. Keep making a difference. Stay with evidence-based chiropractic care, be patient-centered rather than doctor driven or numbers driven and the money will take care of itself.

Key Takeaways

  1. Opioids haven’t gone away. Pill pushers haven’t gotten the message yet. The issues are still there and they’re real 
  2. Research doesn’t matter unless we educate the medical professionals around us and educate our patients so spend some extra time talking to your patients about the stuff we go through with you right here. 

Integrating Chiropractors

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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.

The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability. It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.

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.

Being the #1 Chiropractic podcast in the world would be pretty darn cool. 

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

??iTunes

??Player FM Link

??Stitcher:

??TuneIn

 

Bibliography

Gomes T (2018). “The Burden of Opioid-Related Mortality in the United States.” JAMA Network Open 1(2).

Lin D (2018). “Prescription Drug Coverage for Treatment of Low Back Pain Among US Medicaid, Medicare Advantage, and Commercial Insurers.” JAMA Network Open 1(2).

Petrocco-Napuli K. (2018). “Opioids Misuse and Addiction: How Chiropractic Can Help.” Clincal Risks  Retrieved June 13, 2018, from https://www.ncmic.com/learning-center/articles/risk-management/clinical-risks/opioids-misuse-and-addiction-how-chiropractic-can-help/.

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

CF 020: Chiropractic Evolution or Extinction?

CF 026: Chiropractic Better Than Physical Therapy and Usual Medical Care For Musculoskeletal Issues

evidence-based chiropractic

evidence-based chiropractic