Jeff Williams - evidence-based chiropractor

New Dietary Ideas & The Doctor’s Words Matter

June 1, 2023 chiropracticforward 00:20:07 0 Comments

CF 282: New Dietary Ideas & The Doctor’s Words Matter

Today we’re going to talk about new dietary ideas and the doctor’s words matter.

But first, here‘s that sweet sweet bumper music

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

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

We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together.

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com

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

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

You have found yourself smack dab in the middle of Episode #282

Now if you missed last week’s episode, we were joined by Dr. Lindsay Mumma and talked about clinical excellence and pelvic floors.

Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

What’s going on in my world these days? It’s interesting always. To say the least.

The biggest on our radars at the moment are three things actually.

We have always leased our space and I would love to own the property for obvious reasons. But prices are just ridiculous, honestly. So it’s been a challenge when we’re looking at property. We still have one year on our current lease but just had this building come open that is looking pretty good both size-wise and price-wise. So it has to be looked at. We know our current space is going to go up in a year and our monthly nut on the building will probably be about the same so, why not? But there’s still the process of moving everything, the IT stuff, the making it all work stuff, setting up a clinic/gym hybrid and all that gobbled gook. Geez. It’s daunting.
The second thing we’re looking at is hiring an associate. But can both of these be done at the same time? Hiring an associate and moving into a new building. I don’t think they can be done simultaneously without putting us in a precarious position financially. The extra info on that thought is that it doesn’t seem to matter because associates are getting out of school and they’re going to work for a franchise and aren’t really doing associate-ships anymore. Every chiro I know out in the world that is looking for an associate tells me they’re not to be found and in the last 7 months or so that I’ve been looking, they’re exactly right. Plus, living in Amarillo, TX isn’t as appealing as living in Dallas or Houston or wherever. A person has to almost be from the Texas Panhandle to see my job offering as a blessing. So, if the associate situation continues the way it is, it’ll be no question. We’ll just move into the new building. Lol.
The third thing is that there is a company out of the Houston, TX area that is an investment gropu and they’re buying 60% of practices that qualify within their metrics and they take over all of the soul-crushing parts of your clinic. They do the HR, the billing, and the collecting. The clinics keep their name and nobody but the owner and the staff will ever even know that part of the practice was sold. Dentists have been doing this model for years. Clinic owners make a solid salary and make their 40% commission. They can bill on the medical E&M scale and get paid at a higher level than we could on our own DC codes so the same work for more money. Plus they help bring in medical if you want and they help bring in PT if you want. And they’ll help bring in associates as well. My colleagues working with the company tell me they’re working less and making more and it was the best decision they ever made. So, I’m looking at seriously. With a little side eye but the wife is on board, which is the most important thing. I just need to get the price I’m looking for. Then we shall see.

So, there are 3 biggies that are weighing me down because not a one of those are small decisions. They’re actually monumental decisions and they’re all sitting on my plate currently. I’ll let you know how it unfolds as it unfolds.

Stay tuned. For now, let’s dive into the research.

Item #1

The first one today is called “Dietary recommendations for cardiovascular health challenged by new evidence on saturated fatty acids’ effects on LDL-C and Lp(a) levels” by Dr. Chinta Sidharthan and published in News Medical Life Sciences on May 15, 2023. Dayum. That’s hot.

Why They Did It

The study was conducted to investigate the effects of dietary modifications on cardiovascular health, specifically focusing on the impact of reducing saturated fatty acid intake on lipid profiles and the risk of cardiovascular diseases.

How They Did It

The research on the relationship between dietary modifications, lipoprotein A, and cardiovascular disease risk is based on a review of existing scientific literature and studies.

The research involved analyzing and synthesizing data from multiple studies that investigated the effects of dietary modifications, particularly the reduction of saturated fatty acids, on lipoprotein A and LDL-C levels.

To assess the impact of dietary modifications on lipoprotein A and LDL-C levels, the researchers collected and analyzed data from participants, including their dietary intake, lipoprotein A and LDL-C levels, and potentially other relevant markers or risk factors for cardiovascular disease. Statistical was performed to determine the associations between different variables and to assess the significance of the findings.

What They Found

Despite the lack of data for conclusive inferences, it appears that the risk of cardiovascular disease depends on a relative balance between the levels of the two lipoproteins — LDL-C and lipoprotein A — and the baseline values of both in each individual.

Furthermore, while reducing cardiovascular risk due to high LDL-C levels through the modulation of saturated fatty acid intake remains important, the clinical LDL-C measurements also include the cholesterol component from lipoprotein A.

Wrap It Up

Overall, the evidence indicated that the standard recommendations for a heart-healthy diet which includes reduced consumption of saturated fatty acids, might have a negative impact by increasing the lipoprotein A levels despite lowering the LDL-C levels.

Since dietary changes are the most prevalent non-pharmacological form of disease prevention, tailored recommendations for dietary changes after considering individual lipid profiles might be required.

Furthermore, additional cardiac health markers such as lipoprotein A cholesterol content are necessary to assess cardiovascular disease risk accurately.

Before getting to the next one,

Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.

When you decide you can‘t live without those products, send me an email and I‘ll give you the hookup. They will 100% differentiate your clinic from your competitors.

I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. drop-release.com and the discount code is HOTSTUFF. Go do it.

Item #2

Our last one this week is called, “ The enduring impact of what clinicians say to people with low back pain” by Ben Darlow, Anthony Dowell, G David Baxter, Fiona Mathieson, Meredith Perry, Sarah Dean published in PubMed on December 11, 2013. Hot potato!

Why They Did It

The purpose of this study was to explore the formation and impact of attitudes and beliefs among people experiencing acute and chronic low back pain.

How They Did It

Semistructured qualitative interviews were conducted with 12 participants with acute low back pain (less than 6 weeks’ duration) and 11 participants with chronic low back pain (more than 3 months’ duration) from 1 geographical region within New Zealand. Data were analyzed using an Interpretive Description framework.

What They Found

Participants’ underlying beliefs about low back pain were influenced by a range of sources. Participants experiencing acute low back pain faced considerable uncertainty and consequently sought more information and understanding.

Although participants searched the Internet and looked to family and friends, health care professionals had the strongest influence upon their attitudes and beliefs. Clinicians influenced their patients’ understanding of the source and meaning of symptoms, as well as their prognostic expectations. Such information and advice could continue to influence the beliefs of patients for many years.

Many messages from clinicians were interpreted as meaning the back needed to be protected.

These messages could result in increased vigilance, worry, guilt when adherence was inadequate, or frustration when protection strategies failed.

Clinicians could also provide reassurance, which increased confidence, and advice, which positively influenced the approach to movement and activity.

Wrap It Up

Health care professionals have a considerable and enduring influence upon the attitudes and beliefs of people with low back pain. It is important that this opportunity is used to positively influence attitudes and beliefs.

When a patient is standing on the ledge of chronic pain, we can push them in or pull them back literally based on what we say and how we behave. If you make a big deal out of ddd, they’re gone, echoing as they fall into the pit. If you tell them that everyone has ddd at some point and usually zero pain associated with it, you start pulling them back. Certainly after you encourage them to move, go for a walk, hurt doesn’t mean harm, and you get some pain free movement wins through your treatment and exercises…..well then we’re having two completely different outcomes altogether now, aren’t we?

Be smart with your words and your behavior. It’ll make you look like you’re up on your research and education and it’ll make all the difference in the world in your patients.

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

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

Store

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

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

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can‘t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

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

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

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

Key Point:

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

That‘s Chiropractic!

Contact

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

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

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

Connect

We can‘t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Website

Home

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TuneIn

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About the Author & Host

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

Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment

November 24, 2021 chiropracticforward 00:19:25 0 Comments

CF 205: Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment Today we’re going to talk about research backing the use of spinal manipulative therapy for neck pain. A systematic review and meta-analysis even! Big stuff. Then we’ll talk about treatment for lumbar radiculopathy. What extra tips can you pick up? But first, here’s that sweet sweet bumper music

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

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

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

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

You have found yourself smack dab in the middle of Episode #205 Now if you missed last week’s episode, we talked about The Case Of The Disappearing Disc & Vitamin D And Back Pain. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Alright, we got some stuff shaking folks. So, let’s talk about it. First thing, Drake leaving. Who the hell is Drake you might ask? Well, that’s our Parker university intern that’s been with us since last August. We’re spoiled as hell having Drake with us these days. We’re going to miss his help and honestly, he’s just a good guy. We’ll miss him personally as well. Yes, I tried to hire him but not everyone wants to move to Amarillo so getting associates in this area can be a bit of a challenge. So I’m saying it, if you want to come to Amarillo, you’re always more than welcome to send me a resume at dr.williams@chiropracticforward.com and I’m happy to take a look.

We have fun. We get people better. And life is good. I mentioned a couple of weeks ago that we had a turnover and we’d be having a new front desk staffer coming on board. Well, this is the week and here we go. We may have gotten lucky on this one people.

First, we hire off of Indeed. I’m sure they think I’m a bit of a prick but I use the assessment tools. They have to fill out a couple of assessments that test their knowledge. One is on EHR, another is general office procedure and stuff like that. Well, so many of them just go down the line clicking jobs and submitting without understanding that the assessments weed that out. If they don’t take the time to fill out the assessments, they didn’t care enough about the job to read about it. Which means I don’t care enough about them to waste my time learning more about them. So I move right past them.

This girl has worked for an urgent care and only looked elsewhere because they didn’t have a full-time position like she needed. My friends actually work at the urgent care and vouched for her. We have the ones we’re interested in come in for a working interview. All of the staff agreed she was the clear choice both in experience as well as in personality. Our office culture is one defined by fun. We jump scare each other. We laugh. We kid. We are always appropriate but there are times we could be more professional but….again…we have fun. And Our patients love it.

They commonly comment in our Google Reviews about how they love that everyone is so happy, having fun, and enjoying their work. It’s easy when you have the crew I have. We do work. We work hard. Some days suck. Some days fly by. But think about it, we spend more time with our staff than we spend with our own families for the most part. Right? So why not having fun? Why not have a sense of family, of belonging, and a sense of being a team? Why not? So we’ll be making a new teammate this week. She’s going to be amazing. I just have a feeling.

Also, I believe it was last week we discussed side gigs. I mentioned my recent success in the voice over industry and that I’ve been schooling up on real estate investing and all that good stuff. I mentioned that I planned on parlaying that voice over success into real estate investments. Well, I’ve been analyzing houses and I’ve been learning about remote management of short-term rentals and the pros and cons vs having a long-term rental and all of that good stuff. Well, I identified 9 properties down in Lubbock TX. Lubbock is about an hour and a half to the south of Amarillo. It’s the home of Texas Tech and Buddy Holly. It’s also where one of my kids goes to college. It’s also the place where my other kid who is currently an 8th grader will likely go if I haven’t retired and moved to Florida when she goes to college.

Lots of football games, basketball games, baseball games….lots of visits to the medical school there in town….lots of big-name concerts. It’s all good news for having a short-term rental.

Go back and listen to last week’s episode if you want to know why short-term rentals make more sense for tax reasons than other investments right now. Anyway, I found 9 houses that my wife went to look at last week. She made an offer on one and, once we refi our rental house here in Amarillo, we’ll be able to pull out about $150,000 to put on 1-2 others. One of which is a flip we think we can profit $30k in about three months if there are no surprises or hiccups. So…..I’m a fact finder. I’ve been finding facts for about a year now. Watching YouTubes. Taking little classes. Listening to podcasts. Reading books. Meeting people and building a small network. So, we’re on it. We’re excited. We’re pumped. We’re busy as hell.

It’s kind of crazy the faith I have in my wife’s decisions. In lots of ways, she’s the smartest person I believe I’ve ever met. Our first house we bought together, I was on the road traveling with my band somewhere down in south Texas when she made an offer on it. I’d never even seen the house.

The one I live in now, I actually saw and agreed on.

The 2-3 down in Lubbock, I haven’t seen either. But I’m buying them. Lol. It’s crazy but she’s a hell of a teammate on this stuff and her vision of what she can do with a house has blown me away. She has some serious skills and I can’t wait to see what happens when she puts them to use on these investments.

OK, on to the first paper. Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials – PubMed

Item #1

The first one is called “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials” by Chaibi et. al. (Chaibi A 2021) and published in the Journal of Clinical Medicine in October 2021 and that’s got some smoke on it! Let me say that I’ve been yelling for some research on the effectiveness of SMT for neck pain for 4 years here on this podcast. I’ve talked to different researchers about it. They said they couldn’t get funding for it. Now, here we are with a small step for a chiropractor but a giant leap for chiropractor-kind…..or something like that.

Why They Did It

Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs);

How They Did It

To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain.
Data extraction was done in duplicate and formulated in tables.
Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the (GRADE) criteria
Six studies were included.

What They Found

The overall pooled effect size for neck pain was very large -1.37 (95% CI, -2.41, -0.34), favoring treatments with SMT compared with controls.
They had a single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment.
Minor transient adverse events reported included increased pain and headache, while no serious adverse events were reported

Wrap It Up

SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings. So, once again, researchers….please listen. We have enough information on the low back. We know we knock it out of the park on low back pain. Even our haters mostly know we kill it on low back pain. Those douches over at sciencebasedmedicine.whatever mostly admit we’re good on low back pain. And trust me, if you change their damn minds, you’re on to something. So, let’s expand to the neck, please. Pretty please? Dr. Goertz, Dr. Pohlman, Drs influential with Chiropractic Compass, can we please continue down this path of exploring our effectiveness and low risk for adverse events in the neck because honestly, THIS clinically is what is holding us back.

Professionally, it’s the vitalists in our profession. But clinically, it’s the perception that we do harm when treating the neck. Can we do harm? Well hell yes we can. Do we commonly do harm and are we likely or probable to do harm? Oh hell no. Why would you ask such a dumb question?

Item #2

https://pubmed.ncbi.nlm.nih.gov/30521781/

This one is called “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial” by Satpute et. al. (Satpute K 2019) and published in Archives of Physical Medicine and Rehabilitation on December 3rd of 2018. It’s mushy…not solidified but not as warm as we like.

Why They Did It

To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy.

How They Did It

A double-blind randomized controlled trial.
The setting was in a General hospital.
60 adults with the mean age of 44 years old were included
They were al diagnosed with subacute lumbar radiculopathy
They were randomly allocated to receive spinal mobilization with leg movement exercise and electrotherapy or exercise and electrotherapy alone.
All participants received 6 sessions over 2 weeks.
The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM)
Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up

What They Found

Significant and clinically meaningful improvement occurred in all outcome variables.
At 2 weeks the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability.
Similarly, at 6 months, the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability.
The spinal mobilization with leg movement group also reported greater improvement in the global rating of change and in SLR range of motion.

Wrap It Up In patients with lumbar radiculopathy, the addition of spinal mobilization with leg movement provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

Tweets by Chiro_Forward

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

Chaibi A, S. K., Russell MB (2021). “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.” J Clin Med 10(21): 5011.
Satpute K, H. T., Bisen R, Lokhande P, (2019). “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial.” Arch Phys Med Rehabil 100(5): 828-836.

The Case Of The Disappearing Disc & Vitamin D And Back Pain

November 18, 2021 chiropracticforward 0:19:12 0 Comments

CF 204: The Case Of The Disappearing Disc & Vitamin D And Back Pain Today we’re going to talk about The Case Of The Disappearing Disc & Vitamin D And Back Pain. But first, here’s that sweet sweet bumper music

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

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

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

You have found yourself smack dab in the middle of Episode #204 Now if you missed last week’s episode, we talked about Reduced Access To Chiropractic & The Ideal Diet. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. The clinic numbers have cooled a bit. Still busy but more manageable. Since things have cooled a bit on that end of things, let’s switch focus to side gigs. I see questions about side gigs periodically in the forward-thinking chiropractic alliance group. We chiros are doing all kinds of different things from being real estate agents and hunting guides to selling stuff on eBay and Etsy. Here’s some of what I do and why. First, I’m very happy with my income from chiropractic but, as with anything, I don’t like my eggs being in one basket, and let’s face it, we’re in a business where if something were to happen to us, it’s game over. If we are not at work and able to perform, then we can kiss all of those years of hard work goodbye. In our profession, we are literally on a knife’s edge and it could go good or bad in a heartbeat. Literally. So, I like other options. Do you know what else I like? Success, freedom, achievement, and wealth. All of that gives you a better chance at happiness. People say you can’t buy happiness. Well, that’s what people with no money tell themselves so they feel better. It’s like someone saying it’s not all about looks. Well….that’s true but looks sure as hell to help land a suitable partner. Wouldn’t you agree? In the say way, wealth helps you have more security and security helps you have a better chance at happiness. So, for all of those reasons, I do a lot of stuff. I’m an artist as many of you might know. I just finished up a series of several Charlie Chaplin watercolor paintings and a sculpture of a horse and jockey in the middle of a race. They’re flying down the track! You can see all that stuff on Facebook at Jeff Williams Art. I have a band and have been a traveling musician in my past. It seems like another life at this point. You can check that out on Facebook at Flying Elbows Perspective. Can you imagine another band would have the band name Flying Elbows? Well they do. It’s a fiddle band from Massachusetts. That’s not us. We’re the ones from Amarillo, TX I created evidence-based posters and brochures for you guys over at chiropracticforward.com Then I create live edge furniture. But I like to be honest, nobody has ever bought any of the pieces but that’s not because they’re not good. It’s because they’re expensive! You can see that on Facebook at Amarillo Furniture – Live Edge and Customs. It’s fun. My office and home are full of these original pieces. The idea is to be able to retire and still be comfortable. Still have income in retirement. How are you going to accomplish that and what is your exit number? What do you have to have at the end that allows y But here’s where things have freaking gone nuts. It’s in the land of voice-over. Holy cow, y’all. Now, my results are not normal as I’m coming to find out. But, just in the last 10 months, I’ve made about $50,000 I never planned on having in my life. I’ve done over 400 commercials in the last 10 months in about 22% of the countries throughout the world and landed talent agencies that represent California, Texas, Indiana, Ohio, Kentucky, and New Jersey/New York. How at the age of 49 this voice over thing has just come into my life is a twisted tale but briefly, the drummer for my very first band way back in college in Natchitoches, LA became a Lieutenant Colonel in the Army and we stayed in touch. Well, he became the voice of Hand Unit in the video game called Five Nights At Freddie’s. He got to do a bunch of other really cool stuff too but when the pandemic came along, it got me thinking that I need to have options. That’s when I hit him up about voice over. A year and a half later, here we are it’s crazy. Now, what do we do with the extra money? Well, we put it to work. That’s what we do. I’ve also spent the last 6-12 months educating myself on real estate investing. Long-term rentals, multi-plexes, short-term rentals, vacation rentals, flipping, wholesaling, and things like that. So, you may have guessed it, voice over will be funding down payments on investment properties. What a deal. Right?!? The problem in this market if finding a good deal but we’re on some good ones and are hoping to land them in the next week or two. Here is a little real estate tip for you. Two tips actually. First, money has always been in real estate and it always will be. Through ups and downs, the money is still there. Secondly, losses in your real estate business can offset gains in your chiropractic business come tax time. That’s if you can qualify as a real estate expert. Well…..they made it really hard to qualify so basically, if you have a job like we all have, you can’t. Your loophole, however, is this; short-term rentals don’t count. Short-term rentals can offset tax gains without you having to qualify as a real estate expert. So, if you’re a chiropractor, short-term rentals probably make a lot of sense so that real estate losses and depreciation can offset the money you make in your chiropractic business so that you can reduce or eliminate taxes. As a disclaimer, I am not a lawyer nor a CPA so make sure you run that by them. OK, just some tips from you Ol’ Uncle Jeffro. Now to the good stuff. Item #1 This first one is called “Relationship between Vitamin D and Nonspecific Low Back Pain May Be Mediated by Inflammatory Markers”’ by Xu et al (Xu HW 2021) and published in Pain Physician in November of 2021 and that’s a steamy as a sizzling sirloin. I believe I got this one from my esteemed colleague, Dr. David Graber who always always posts great research findings. He’s a fountain of knowledge nuggets so go search him up on Facebook and follow his page. One of the smartest guys you’ll find out there. Why They Did It To explore the mediating effects of inflammatory markers on the relationship between vitamin D levels and pain outcomes. How They Did It

This study was done at the Department of Spinal Surgery of a hospital affiliated to a medical university.
It was a cross-sectional study
They selected patients with non-specific acute low back pain and non-specific chronic low back pain,
The study included 60 people without Ns-LBP as controls,
The study was done from January 2018 to January 2019.
Serum 25(OH)D and inflammatory marker levels were examined.
Regression and causal mediation analysis were used to evaluate the mediating effects of inflammatory markers on the association between vitamin D and pain.

What They Found

After adjustment for clinical factors, vitamin D deficiency was associated with Ns-LBP
however, when the interleukin 6 (IL-6) level was added to the multivariable models, the association was no longer significant in Ns-CLBP patients

Wrap It Up Patients with Ns-LBP had lower vitamin D and higher inflammatory marker levels. This association between hypovitaminosis D and Ns-CLBP may be mediated by IL-6. Very interesting findings. They do say there are some limitations to the study. They say a retrospective study may include inevitable bias. More sensitive biomarkers were not investigated in this study. Pain intensity evaluation using the visual analog scale is inevitably subjective. Item #2 Alright, item 2 is called “Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study” by Sucuoglu et. al. (Sucuoğlu H 2021) and published in Medical Principles and Practice in February of 2021 and that’s got my glasses fogged up! Why They Did It The authors wanted to assess radiological changes and clinical outcomes of patients with sequestered lumbar disc herniation (LDH) and evaluate the relationship between them. How They Did It

Patients diagnosed with sequestered LDH were followed up in 2 groups: operated (within the 1st month after diagnosis) and nonoperated.
Visual analog scale (VAS) and Oswestry Disability Index (ODI) scores at baseline and 1st , 3rd, and 6th-month visits were used.
Radiological evaluation was performed by measuring the sequestered herniation level and herniation volume using 2 MRIs spaced out between 1st and 4th months
After the second MRI, patients in the nonoperated group were divided into 3 groups: non-regression, partial regression, and complete resolution

What They Found

Signifi
cant improvements were observed in VAS and Oswestry scores at month 2 and month 3 in all groups and at month 4 in partial regression and complete resolution groups.
VAS and Oswestry score improvements at months 2 and 3 were significantly higher in the operated group than in other groups.
At month 4, there were no significant differences in VAS and ODI scores between the operated group and partial regression and complete resolution groups.

Wrap It Up

Spontaneous regression was observed in the 6th month post-MRI in most of the nonoperated sequestered herniation patients with conservative treatment.
Improvements in pain and disability scores were higher among the operated patients at the early stage, whereas they were not significantly different compared to patients with spontaneous regression at the 6th month.

If you remember, I did a whole episode on disappearing discs. Here’s the deal. You have to know this. The more a disc herniates, protrudes, or extrudes into the spinal canal and migrates either cephalad or caudal, the more likely the body is to recognize it as foreign and gobble it up like the cookie monster. What I thought was instant surgery several years ago, I now know may be a waiting game that ends up being non-surgical. Here’s the thing that episode taught me though; the disc material can be dissolved but the symptoms remain. At least for a while while the nerve tissue in the region undergoes the healing process. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

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

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

Home

Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter Tweets by Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography Sucuoğlu H, B. A. (2021). “Clinical and Radiological Follow-Up Results of Patients with Sequestered Lumbar Disc Herniation: A Prospective Cohort Study.” Med Princ Pract 30(3): 244-252. Xu HW, Z. S., Yi YY, Chen H, Hu T, Wang SJ, Wu DS, (2021). “Relationship between Vitamin D and Nonspecific Low Back Pain May Be Mediated by Inflammatory Markers.” Pain Physician 24(7): E1015-E1023.

Predicting Frailty & A 30-Year Study On Disc Degeneration

July 1, 2021 chiropracticforward 00:18:12 0 Comments

CF 184: Predicting Frailty & A 30-Year Study On Disc Degeneration Today we’re going to talk about using bone or musculoskeletal parameters to predict frailty and then we’ll cover a 30-year study on disc degeneration. Sit tight and chew on the morsels of knowledge we’re about to dish up for you. But first, here’s that sweet sweet bumper music

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

The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host

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

Bibliography

Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347.

Tembo, M. C., Mohebbi, M., Holloway-Kew, K.L, (2021). “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study.” Calcified Tissue Int.

Working Class Rising Death Rates & Nutrition Affects Chronic Pain

May 26, 2021 chiropracticforward 0:20:35 0 Comments

CF 179: Working Class Rising Death Rates & Nutrition Affects Chronic Pain Today we’re going to talk about the fact that there are rising death rates among folks that are of working-class age. Not just the elderly. Why is that happening? Then we’ll talk about diet and chronic pain. But first, here’s that sweet sweet bumper music

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

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

You have found yourself smack dab in the middle of Episode #179 Now if you missed last week’s episode , we talked about whether chiropractors cause disc herniations or not and we talked about how family doctors still aren’t getting the message. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. This medical integration thing is about to take off. Wee ahve the contracts all drawn up, questions answered, and ready to get them all signed. New EIN, new credentialing for me and the NP, and full steam ahead. Did you know that I have to re-credential under the new entity as well? What a pain in the backside, right? Hell yeah it is. I’m OK referring patients back and forth within the same group. You start to run into risk of getting in trouble with the Stark, anti-kickback laws when you are referring patients back and forth across different entities. So, yeah….there’s that. I won’t bore you with the particulars but it’s definitely a ride we’re on and it’s go time. Everything I’ve seen and experienced thus far tells me that we’re in a good spot and things are proceeding fairly smoothly. Slowly but smoothly. Next will be credentialing and that will slow everything down for a couple of months but that’s probably a good thing I’m guessing. I’m fortunate to have a genius for a wife that understands a lot of the legal end of things that I’m just not talented at. Plus we have an attorney in Austin that literally wrote the integration law that has set it all up for us. And we have Dr. Tyce Hergert with Southlake Physical Medicine consulting us so we have a talented and very smart team. Surrounding yourself with good people is the first step to success. We can’t be expected to be the smartest expert on everything that we encounter in our personal or professional lives. We need good people in our lives and our network. Good and talented people who have the right kind of heart for our style. That’s exactly what I have right now so I’m very confident going forward. I don’t take big risks. I take measured, smart risks. That’s exactly where I’m at. Alright, busy busy this week so let’s get scooting with this episode. Item #1 This one called “High and Rising Working-Age Mortality in the US. A Report From the National Academy of Sciences, Engineering, and Medicine” by Mullan Harris, et. al. [1] published in JAMA on May 10, 2021. Servin em up steamy and saucy. Why They Did It They say, “Life expectancy has increased in the US and in the world for the past century. In 2010, life expectancy plateaued in the US while continuing to increase in other high-income nations. In the US, life expectancy declined for 3 consecutive years (2015-2017) due primarily to an increase in mortality among working-age adults (those aged 25-64 years).¹ Although the increase in mortality was first described among White middle-aged adults, mortality is now increasing among young and middle-aged adults and in all racial groups. This increase in premature death, claiming lives during the prime working ages, has important implications for individuals, families, communities, employers, and the nation.” They found that average working-age mortality rates decreased after 2010 in 16 high-income countries but increased in the US. Three causes of death were identified as chiefly responsible: (1) drug poisoning and alcohol-induced causes, (2) suicide, and (3) cardiometabolic diseases. The first category includes mortality from mental and behavioral disorders, which often involve drugs or alcohol. Cardiometabolic diseases include endocrine, nutritional, and metabolic diseases (eg, diabetes, obesity); hypertensive heart disease; and ischemic heart disease and other diseases of the circulatory system (eg, arrhythmia, cardiomyopathy, heart failure). Drug and alcohol use were the largest contributors to increasing mortality among working-age adults, accounting for 8% (an estimated 1.3 million) of deaths in this population between 1990 and 2017 (an average of 44 869 per year). The increase was largest among White male adults and older Black male adults. They go on. They say, “The drug crisis was the product of 2 influences: an increase in access to legal and illegal drugs and the vulnerability of certain populations. The licensing of OxyContin in 1996, subsequent flooding of the market with prescribed opioids, and waves of highly potent heroin and fentanyl that coincided with growing demand for these substances have been described as a perfect storm.³ The drug supply expanded with limited government oversight, substantial marketing by the pharmaceutical industry, and overprescribing by physicians.” With regards to Suicide, they say, “Suicide, which accounted for 569 099 deaths among working-age adults during 1990-2017 (an average of 20 325 per year), increased primarily among White adults, especially White men, and in less populated, rural areas. Few studies have established a cause for this trend. Economic stresses are a possibility; suicide is associated with economic downturns, wage stagnation, weak health care safety nets, and foreclosures.⁴ Another potential contributing factor is declining social support from churches, civic organizations, and families. Such social supports, which protect against self-harm, have declined in recent decades, especially among lower-educated White adults. Easier access to firearms is associated with increased suicide rates; however, the greater increase in nonfirearm suicides during this period suggests other causes. Other risk factors for suicide include mental illness, comorbid conditions, disability, and substance use.” With regard to cardiometabolic disease they say, “Cardiometabolic diseases caused more than an estimated 4.8 million deaths among working-age adults during 1990-2017 (an average of 173 062 per year). The largest relative increases in cardiometabolic mortality occurred among younger adults (aged 24-44 years) in all racial/ethnic groups, White men and women, Black men (in recent decades), and those living in rural areas. Cardiometabolic mortality rates increased after 2010 for 2 reasons: (1) mortality from endocrine, nutritional, and metabolic diseases and hypertensive heart disease generally increased during 1990-2017 and (2) after a period of substantial reductions in mortality from ischemic heart disease and other circulatory diseases from the 1970s onward, progress stalled after 2010.” “The report discusses 3 explanations for this trend. First, the most important was the increased prevalence of obesity and its cardiometabolic consequences. Obesity rates increased in the early 1980s as a period-based phenomenon that affected the entire population, but the related cardiometabolic consequences occurred in a cohort fashion; younger cohorts born in the 1970s-1990s experienced obesogenic environments their entire lives, whereas exposure in older cohorts was limited to older ages.⁵ As a result, many young adults are entering their work lives with a high prevalence of chronic diseases associated with obesity. “ “The recent increase in mortality among working-age adults shows no signs of receding. Obesity rates are unrelenting, drug- and alcohol-related deaths and suicide rates, already high among working-age adults, increased during the COVID-19 pandemic” So what does all of that mean? Well, it means we are providers and we need to know this stuff and be aware of it. We need to be able to refer to specialists when we see the signs of drug or alcohol abuse, suicidal tendencies, or nutritional concerns. It’s not just a, “‘hey he should get his crap together while he still can.” It’s a little more immediate than that I think . CHIROUP ADVERTISEMENT Item #2 Item 2 today is called “Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis”” by Field et. al. [2] published in Pain Medicine on November 17, 2020 and that’s a bit roasty. Why They Did It The standard Western diet is high in processed hyperpalatable foods that displace nutrient-dense whole foods, leading to inflammation and oxidative stress. There is limited research on how these adverse metabolic drivers may be associated with maladaptive neuroplasticity seen in chronic pain and whether this could be attenuated by a targeted nutritional approach. The aim of this study was to review the evidence for whole-food dietary interventions in chronic pain management. How They Did It

A structured search of eight databases was performed up to December 2019.
A meta-analysis was performed in Review Manager.
Forty-three studies reporting on 48 chronic pain groups receiving a whole-food dietary intervention were identified

What They Found

A visual analog scale was the most commonly reported pain outcome measure, with 17 groups reporting a clinically objective improvement
Twenty-seven studies reported significant improvement on secondary metabolic measures.
Twenty-five groups were included in a meta-analysis that showed a significant finding for the effect of diet on pain reduction when grouped by diet type or chronic pain type.

Wrap It Up There is an overall positive effect of whole-food diets on pain, with no single diet standing out in effectiveness. This suggests that commonalities among approaches (e.g., diet quality, nutrient density, weight loss) may all be involved in modulating pain physiology Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

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

Home

Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter Tweets by Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography 1. Harris KM, W.S., Gaskin DJ,, High and Rising Working-Age Mortality in the US: A Report From the National Academy of Sciences, Engineering, and Medicine. JAMA, 2021. 2. Rowena Field, M.P., Fereshteh Pourkazemi, PhD, Jessica Turton, Kieron Rooney PhD,, Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis. Pain Med, 2020. 22(3): p. 694-714.

Evidence based chiropractic forward podcast

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

May 6, 2021 chiropracticforward 00:30:07 0 Comments

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

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

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

You have found yourself smack dab in the middle of Episode #176 Now if you missed last week’s episode, we talked about Car crashes and awesome research around that topic. Part one I guess. Today’s episode is pretty much part two. So, make sure you don’t miss that info. Keep up with the class. On the personal end of things….. On the personal side of things, we are still going down the path towards having the medical entity completed. I made a hire that I feel confident in. The nurse practitioner was referred to me by another nurse practitioner here in town who was his preceptor or teacher for his clinical hours when he was going through school. She told me that he is super smart, excellent with patients, eager to learn, and his wife is an amazing cook. So I was sold. And just taking the time to get to know him, I’m even more confident that I have made a good decision going forward. The majority of the work on this is going to be in the first 3 to 6 months I think. We have to get systems in place, I have to teach the nurse practitioner the exam I do. How do you teach somebody how to do the exam that an ortho fellowship practitioner does? Well, we shall find out. I’ve already loaned him one of my dr. Stuart McGill books to get started on. I’ve been sharing with him a lot of the information that I learned in the Neuromusculoskeletal program, I’ve talked to him about McKenzie protocols and migrating the disc, and started him on the path of different ways to think of chronic pain. Including the up-regulated and sensitized central nervous system as well as the biopsychosocial aspect of chronic pain. Yellow flags, words matter, limiting MRIs, and all of the associated Tom Foolery. He was unfamiliar with quite a bit of what I have been teaching him and showing him. But very receptive and very interested in learning about that side of pain and newer ways of thinking about it and approaching it. I think we’re going to be a great team. Outside of that part of my life, I’ve started with the book launch. Not really the launch itself as much as getting the book ready for launch and putting together a launch team. What does a launch tram do exactly? Well, let me tell you. Basically, I’m going to be uploading it to Amazon once it’s formatted for it and everything is in place. Then, it’ll be free for the first 3 days. That’s when everyone on my launch team will go download it. Then, leave a review for it…..because my launch team is cool and they know that’s part of the launch process. The free downloads and the Amazon book reviews give the book a little Amazon juice which will propel it up the charts a bit. That way, when the initial 3 days are over, and I can start charging money for it, the Amazon Juice has it set up for success and sales. So, that’s the plan and guess what?? I’d love it if you regular listeners would like to be on my launch team. If so, just send me an email to dr.williams@chiropracticforward.com and make sure you tell me you’re on the launch team. It’s that easy. Or, send me a message through our Facebook group or the Facebook page or through smoke signal. Whatever means you can get me a message that you want to help us, that’ll work for me. It would be rude of me to not thank a couple of folks. I need to thank Dr. Chris Howson and Dr. Steven Roffers for helping me with the editing process. Dr. Howson is the inventor of the Drop Release tool, he’s smarter than hell, and he’s a good person on top of all of that. Go check out the Drop Release tool and show Dr. Howson some love won’t you? Dr. Roffers is the group admin of the Facebook group called Chiropractic Research Alliance with over 8,000 members, he’s a certified medical editor and serves on the editorial boards of 14 journals. Dr. Roffers offered to help me edit the draft as well. So, these two pros need to be thanked and properly recognized for their efforts and their generosity. I appreciate you two and just appreciate you. I honestly thought I’d ask for launch team members and there’d be crickets. In the first post I made on my Facebook properties, I’ve now got about 25 super awesome people that want to help support and promote the project. And in the process, they’re supporting and promoting evidence-based, patient-centered healthcare. It’s a win-win and I thank you all. More to come as I get further down the road. Now, on with the research. CHIROUP ADVERTISEMENT As I mentioned last week, this podcast episode was inspired by a recent episode of the Chiropractic Science podcast hosted by Dean Smith. It was episode number 55. His guest was Dr. Michael Freeman who I talked about in last week’s episode. These papers are papers they talked about on that episode so, if you want it from the horse’s mouth, go over to Chiropractic Science and find the recent episode with Dr. Michael Freeman and hit play. Then come back here and get my take on it. Now let me pause just a second and say that if you haven’t jumped into personal injury, don’t. Unless you plan on getting the education it takes to do a good job. Take courses. Make yourself the expert. Know your worth. It pays well but the stakes are high for your patients. You have to deal with attorneys. You might have to testify under oath in court. Do you REALLY want to do that if you’re education and experience are not up to snuff? When I jumped in back in 2007, I had a basic Chiro education but I was not specialized in car wrecks or whiplash. I could have been better. So I made myself better. I recognized my shortfalls and I filled the gaps. I got the Advanced Certification in whiplash biomechanics and Traumatology through the SPINE Institute out in San Diego, CA. I got the certification from the Personal Injury Institute through Matthew DeGaetano who was also a Croft Commando. I have attended CE hours on PI specifically. I ended up compiling all of the experience and education into a macro for ChiroTouch. If you want to check that out, go to personalinjurymacro.com but you’re not going to want to buy it unless you’re using ChiroTouch. It’s like gold though if you have ChiroTouch. It’s got all of the Croft stuff in there, the research citations, crash descriptions, risk assessments, the whole thing. Plus all of my customization after I went through the Fellowship for the Neuromusculoskeletal program. IT’s gold, folks. Anyway, my point was that you do your reputation and you do your patients a disservice if you are in the PI arena but you don’t know what the hell you’re doing. Plain and simple. It’s lucrative but dammit, get educated or get out. And understand that you’re not going to get 100% on every case. To demonstrate my point, as I said, I’m a specialist now with the Fellowship, I have the cert in whiplash biomechanics and Traumatology, and I’ve been recognized as an expert in whiplash at the District Court level. Because of my macros I created, I can make narrative reports that nobody I’ve met can beat. And YET…..I still don’t get 100% of my bills. Don’t think you’re going to get 100% either. Because that’s the way PI works. Not all cases are created equally. Some fall apart completely. Some attorneys are truly awful people so stay on your toes. Some are amazing people and those are the ones you want to work with. Sometimes, the patient disappears. Sometimes they get in trouble and go to jail. Sometimes the insurance company just won’t budge and the attorney doesn’t feel there’s a strong enough case to go to court on. At those times, you better be willing to wheel and deal. Otherwise, you might get that one bill paid but that attorney won’t be sending you any more clients and guess what? Attorneys talk to each all of the time. They’re mostly all good friends. Some of my best friends professionally are attorneys. Some of my biggest enemies professionally through the years have been attorneys. One still owes me $42,000 and I don’t expect I’ll ever get it out of him because he’s a worthless, useless, terrible human being. But, it’s part of the dangers of swimming in this particular lake. Some of the fish have no souls. But again, some are amazing people that I have forged solid friendships with. I went off the rails a bit there but the point again is this; either get educated and do it at a high level or leave it to others that did actually put the work in to get the extra education. Plain and simple. Item #1 Our first paper is called, “A systematic approach to clinical determinations of causation in symptomatic spinal disk injury following motor vehicle crash trauma”’ by Dr. Michael Freeman, et. al. (Freeman MD 2009) and published in Physical Medicine and Rehabilitation back in 2008. Why They Did It This is a really long description of the objective here so follow along and we’ll discuss, “Clinical determinations of causation in cases of intervertebral disk (IVD) injury after a motor vehicle crash (MVC) are often disputed in court settings. No published systematic guidelines exist for making such determinations. This has resulted in nonclinical people determine injury causation and performing the evaluations. This is traditionally a clinical activity. The result is causal determinations that are potentially disconnected from clinical observations of injury. Meaning, when non-clinical people are doing the evaluation, they get it wrong a lot. The purpose of this review was to evaluate the current literature on causation, causal determinations after trauma and intervertebral disk injury after a motor vehicle crash, and to develop a practicable, logical, and literature-based approach to causation determinations of symptomatic intervertebral disk injury after a motor vehicle crash. That was almost all quoted from the paper’s abstract but I tried to make it even more basic and less confusing. What They Found

The results of the review indicate IVD injury can result from any MVC regardless of magnitude, thus meeting the first criteria of causation, biologic plausibility.
Individual determinations of causation depend entirely on the temporal association between the collision and the symptom onset (the second criterion) and a lack of a more probable explanation for the symptoms (the third).
When these causal elements are met, clinicians can assert causation on a “more probable than not” or “reasonable probability” basis.
You may have heard me mention I’m currently undergoing the Forensics Diplomate program right now. That is legal speak there. Probably meaning ‘greater than a 50% chance.”

Wrap It Up For the conclusion, they say, “Because of a lack of an established or reliable relationship between collision force and the probability of IVD injury the investigation of collision parameters is not a useful adjunct to causal determinations.” Item #2 Our last one today is called “Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma” by Freeman et. al. (Freeman MD 2020) and published in the International Journal Of Environmental Research and Public Health in 2020 and that’s still got some smoke! Now….if you don’t know, what is Videofluoroscopic examination? It’s basically x-rays (and video) that are dynamic. X-rays that are moving. So you can see the patient go into cervical flexion. It’s cool as hell. But you can accurately see when there is ligament injury or ligament laxity as well because in real time, you can observe the one vertebra slide forward on the one under. It’s crazy and a bit spooky. When you see one vertebra slip forward on the one underneath as the patient goes into cervical flexion, it’ll make you anxious in your belly. It might make you pee a little. Anyway, look it up. See if you can find some videos through your Google machine. Why They Did It Intervertebral instability is a relatively common finding among patients with chronic neck pain after whiplash trauma. Videofluoroscopy (VF) of the cervical spine is a potentially sensitive diagnostic tool for evaluating instability, as it offers the ability to examine relative intervertebral movement over time, and across the entire continuum of voluntary movement of the patient. At the present time, there are no studies of the diagnostic accuracy of Videofluoroscopy for discriminating between injured and uninjured populations. How They Did It

Symptomatic (injured) study subjects were recruited from consecutive patients with chronic (>6 weeks) post-whiplash pain presenting to medical and chiropractic offices equipped with Videofluoroscopy facilities.
Asymptomatic (uninjured) volunteers were recruited from family and friends of patients.
Three statistical models were utilized to assess the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of positive Videofluoroscopy findings to correctly discriminate between injured and uninjured subjects.

What They Found

A total of 196 subjects (119 injured, 77 uninjured) were included in the study.
Videofluoroscopic examination of the cervical spine provides a high degree of diagnostic accuracy for the identification of vertebral instability in patients with chronic pain stemming from whiplash trauma.

Wrap It Up “Videofluoroscopic examination of the cervical spine provides a high degree of diagnostic accuracy for the identification of vertebral instability in patients with chronic pain stemming from whiplash trauma.” Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

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

Home

Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter Tweets by Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography Freeman MD, C. C., Kohles S, (2009). “A systematic approach to clinical determinations of causation in symptomatic spinal disk injury following motor vehicle crash trauma.” PM R. 1(10): 951-956. Freeman MD, K. E., Rosa S, Gatterman B, Strommer E, Leith W, (2020). “Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma.” Int J Environ Res Public Health 17(5): 1693.

Dr. Bobby Maybee - Forward Thinking Chiropractic Alliance

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

January 28, 2021 chiropracticforward 00:52:20 0 Comments

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

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

But first, here’s that sweet sweet bumper music

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

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

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

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

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

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

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

On the personal end of things…..

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

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

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

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

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

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

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

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

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

I’ll keep you updated.

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

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

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

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

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

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

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

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

What is your vision for the FTCA and what does the group to to move closer and closer to accomplishing them?

I was at the Forward 19 event in St Louis and really enjoyed it. Tell us about what goes into creating something like that? How do you pull it off?

Recently, I have been on a rant. I see vitalists say kooky stuff and I’m physically and mentally unable to ignore it. I have a recent episode on a guy that wants to teach other chiropractors how to treat 9 new patients and 99 established patients within three hours. Then I had an episode on the shake up of the WFC Research committee. As I mentioned in the episode, you were there in Berlin when it all started going sideways. Can you walk us through it all as far as you know it to be?

I think I’ve seen you vacillate on the topic of unity or not. Where do you stand on the whole deal? Is it possible the two sides can continue to live together? Or do you see groups like the Primary Spine Practitioner start to gain steam?

Tell us about the CSA that you and Dr. Kevin Christie have put together.

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

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

Store

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

Subscribe Button

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

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About the Author & Host

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

Spinal Instability Clinical Pearls & Degeneration and Facets

November 19, 2020 chiropracticforward 00:26:06 0 Comments

CF 152: Spinal Instability Clinical Pearls & Degeneration and Facets

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

But first, here’s that sweet sweet bumper music

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

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

Do it do it do it.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Item #1

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

Why They Did It

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

How They Did It

Retrospectively recruited 62 patients from 60-70 years old

They evaluated the following:

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

What They Found

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

Wrap It Up

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

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Item #2

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

Why They Did It

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

How They Did It

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

What They Found

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The Message

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

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

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

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

Key Point:

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

Contact

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

Connect

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

Website

Home

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TuneIn

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About the Author & Host

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

Bibliography

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

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

October 1, 2020 chiropracticforward 00:35:01 0 Comments

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

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

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

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

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

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

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

What They Found

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

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

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

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

Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

July 30, 2020 chiropracticforward 00:23:24 27 Comments

CF 136 Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture

Today we’re going to talk about Chiropractic’s Effect On Strength and More, Status of Muscle Relaxers, And The Best Recovery Posture But first, here’s that sweet sweet bumper music

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

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

Check your JUNK folder!! Do it do it do it. You have found yourself smack dab in the middle of Episode #135 Now if you missed last week’s episode, we talked about adjusting in the areas of known disc complications, bulges, herniations..things of that sort. Make sure you don’t miss that info. Keep up with the class. While we’re on the topic of being smart, did you know that you can use our website as a resource?

Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.

On the personal end of things….. Nothing new to report really. We aren’t growing in our visit count week to week but, at the same time, we aren’t shrinking either. We’re holding steady at about 80% of where we were before the COVID train wreck and here’s what I’ve sort of decided. I’m just going to be OK with 80%.

Like I said last week, while we’re billing out less and collecting less, we’re also spending less both in the practice as well as in my personal life. Some of you aren’t. Some of you think it’s a hoax and all that stuff. You’re going out and traveling and vacationing and all that jazz. We aren’t. We are not afraid but we also do want to be smart and be diligent. I’ve come to the mindset that if I wind up getting it, I’ll probably do just fine with some time but regardless of how severe or mild symptoms are, I’ll STILL have to shut my office down.

Now, how many of us can afford to just shut the doors for 2-4 weeks without any issues? Honestly, I’m a saver so I could actually do it and survive but I damn sure don’t want to. I have other plans for that money don’t you know. It wasn’t saved so that I could cover my practice financially if I get sick for a month. Hell no. It was saved to invest. So, we are being smart, we are wearing our masks and no….I don’t give one damn what anyone thinks about masks. Honestly. This has been the most disappointing aspect of human observation in recent memory.

The mask debate or debacle. Absolutely a waste of time and energy talking or listening to people on that deal. Anyway, we are wearing our masks. Our patients are wearing their masks. We are still cleaning and having our lobby closed. We are still not allowing visitors in with our patients. We are still using our UV air scrubbers in each room. We are still doing it to keep my most fragile patients safe and confident in us as a clinic, we doing it all to protect the staff, and we’re doing it to protect me as much as possible so we don’t all have to shut down for a month.

Makes perfect sense to me.

We know some things that increase your chances of having a hard time with COVID. Or at least there is some research to back up that low vitamin D puts you at risk. Obesity, underlying conditions like diabetes, low testosterone, smoking, and being of the blood type A. These are just a few things I recall off the top of my head. My question to you is, “What factors under your control are you bolstering or addressing?” I am overweight. I’m naturally a big guy but I’ve gotten a little lazy in the last 5 years. OK…..A LOT lazy.

I started the Couch to 5K program a few weeks ago and am slowly trudging through that. My knees are super pissed at me about it but I’m still doing it. I have addressed any hormone issues I needed to look at. I have gotten on a Vitamin D replacement regimen. I am trying to get more sleep more consistently. I don’t smoke.

Of course, there’s nothing you can do about what type of blood you are but….my point is, what steps are you taking to lower your risk of complications should you wind up with it? I’d love to hear if you’ve changed anything at all or if you’re just like the Russian boxer Drago in Rocky 4…..If he dies, he dies.

Item #1 Let’s get to it. This first one is not sexy. I’m saving the better ones for here in just a minute. Let’s start off nice and simple here with one called “Effects of Two Different Recovery Postures during High-Intensity Interval Training” by Michaelson, et. al(Michaelson J 2019). and published in Translational Journal of the ACSM in February of 2019. Hmmmmmm…..yep… Hot enough. Out of the way.

Why They Did It The purpose of this study was to examine the effects of two different recovery postures, hands on head (HH) and hands on knees (HK), as a form of immediate recovery from high-intensity interval training (HIIT).

How They Did It Twenty female Division II varsity soccer players completed two experimental trials in a randomized, counterbalanced order. Each trial consisted of four intervals on a motorized treadmill consisting of 4 min of running at 90%–95% max heart rate with 3 minutes of passive recovery between each interval. Heart rate recovery was collected during the first 60 seconds of each recovery, where the volume of carbon dioxide and tidal volume were recorded each minute during the 3-min recovery period.

What They Found Results showed an improved heart rate recovery, greater tidal volume, and increased volume of carbon dioxide, with hands on the knees when compared with hands on the head.

Wrap It Up “These data indicate that HK posture may be more beneficial than the advocated HH posture as a form of immediate recovery from high-intensity interval training.”

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument-assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively. This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Its inventor, Dr. Chris Howson, from the great state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2 Item 2 is called “Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016” by Soprano et. al(Soprano S 2020). and published in JAMA Open on June 24, 2020 and that’s damn sure a steaming heaping helping right there.

Why They Did It They wanted to measure national trends in muscle relaxant prescribing over a 12-year period. 2005-2016

How They Did It It was a cross-sectional study It used data from the National Ambulatory Medical Care Survey The study included those with ambulatory care visits with non-federally funded, office-based physicians in the US Included almost 315,000,000 office visits.

What They Found Get this y’all – During the study period, office visits with a prescribed muscle relaxer nearly doubled from 15.5 million in 2005 to 30.7 million in 2016 Although visits for new muscle relaxer prescriptions remained stable, office visits with continued muscle relaxer drug therapy tripled from 8.5 million visits in 2005 to 24.7 million visits in 2016 Older adults accounted for 22.2% of visits with a muscle relaxer prescription. Concomitant use of an opioid was recorded in 67.2% of all visits with a continuing muscle relaxer prescription.

Wrap It Up “This study found that SMR use increased rapidly between 2005 and 2016, which is a concern given the prominent adverse effects and limited long-term efficacy data associated with their use. These findings suggest that approaches are needed to limit the long-term use of SMRs, especially in older adults, similar to approaches to limit the long-term use of opioids and benzodiazepines.” And we wonder how we ended up with an opioid and pill problem. Cheese ’n’ rice people. Godzilla it’s just clear as day but nobody’s listening. Are you inundated with referrals from physicians in 2020? Some of you are. Most of you, the large very vast majority of you are not at all and it’s a shame because we can prevent so much of this garbage.

Item #3 Alright, the last item and my favorite one this week. It’s called “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial” by Vining et. al(Vining R 2020). published in the Journal of Alternative and Complementary Medicine in July of 2020. Another helping of boiling thought nuggets for you to feast upon.

Why They Did It They wanted to investigate whether chiropractic care influences strength, balance, and/or endurance in the active-duty United States military personnel with low back pain

How They Did It It was a prospective randomized controlled trial using a pragmatic treatment approach Participants were randomly allocated to 4 weeks of chiropractic care or to a wait-list control Chiropractic care consisted of spinal manipulation, education, advice, and reassurance Naval Air Technical Training Center branch clinic at the Naval Hospital Pensacola Florida One hundred ten active-duty military personnel 18-40 years of age with self-reported LBP Outcome measurements included Isometric pulling strength from a semi-squat position was the primary outcome. Secondary outcomes were single-leg balance with eyes open and eyes closed, and trunk muscle endurance using the Biering-Sorensen test. Patient-reported outcomes such as pain severity and disability were also measured. Outcomes were measured at baseline and 4 weeks. Linear mixed-effects regression models over baseline and 4 weeks were used for analysis.

What They Found Participants had a mean age of 30 years, 17% were female, 33% were non-white, and 86% reported chronic LBP. Mean maximum pulling strength in the chiropractic group increased by 5.08 kgs and decreased by 7.43 kgs in the wait-list group, with a statistically significant difference in mean change between groups Statistically significant differences in mean change between groups were also observed in trunk muscle endurance and balance with eyes closed, but not in balance with eyes open Differences in mean change between groups were statistically significant in favor of chiropractic for LBP-related disability, pain intensity and interference, and fear-avoidance behavior.

Wrap It Up “Active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control.”

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

The Message

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

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

That’s Chiropractic!

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

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

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About the Author & Host

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

Bibliography

Michaelson J, B. L., Suprak D, McLaughlin W, Dahlquist D, (2019). “Effects of Two Different Recovery Postures during High-Intensity Interval Training.” Translational J ACSM 4(4): 23-27.

Soprano S, H. S., Bilker W, (2020). “Assessment of Physician Prescribing of Muscle Relaxants in the United States, 2005-2016.” JAMA Open 3(6).

Vining R, L. C., Minkalis A, Gudavalli MR, Xia T, Walter J, Coulter I, Goertz C, (2020). “Effects of Chiropractic Care on Strength, Balance, and Endurance in Active-Duty U.S. Military Personnel with Low Back Pain: A Randomized Controlled Trial.” J Altern Complement Med 26(7): 592-601.

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