evidence-based chiropractor

Predicting Frailty & A 30-Year Study On Disc Degeneration

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  

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Chiropractic evidence-based products

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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. We’re the Metallica of chiropractic research……if there is such a thing. 

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 #1844

Now if you missed last week’s episode , we talked about the factors leading to surgery for some discs and then we talked about recent information concerning disc innervation and what happens when a disc is injured. 

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

On the personal end of things…..

So for personal happening this week, we are getting the training set up for a nurse practitioner down in Dallas. Our medical Director is good enough that he would like to be trained on what the nurse practitioner is doing as well. That means good things for us. 

When the medical Director is on board with the nurse practitioner, nothing but good happens. 

I’m still promoting and pushing my book. The one I’d love for you to purchase called “‘The Remarkable Truth About Chiropractic: A Unique Journey Into The Research’. It’s on Amazon and you can find the link on my homepage at chiropractscforward.com so go give it a look-see and a purchase. You can get it in paperback and as an ebook. 

This is an amazing resource for you practitioners in the field. Definitely for you content creators. Whether you’re looking for info to post on your social media, whether you’re teaching your patients and need material, or it you’re putting together a speech you need to give to a group……THIS is your resource to make your life easier and to save time. Seriously. Just flip to the topic and pick out the papers you like. BOOM….done. 

I noticed that the forward thinking chiropractic alliance had their fire event this past weekend. With all of the things I’m involved in, I was unable to attend either live or online. 

But, I purchased the online package so will be reviewing it when it is available online. It was all about implementing rehab into your practice and making money doing it. I love rehab and exercise being a part of my every day practice so I’m looking forward to waiting through all of the information. I am still trudging through the forensics fellowship and I have to say, it is not material that I enjoy. In fact, it’s pretty awful. 

But, with the forensics fellowship being a subsidiary of the orthopedics fellowship that I already went through, I only have to do 100 hours rather than 300 so there’s no reason to not do it. So, I am begrudgingly going through it. It feels like I would assume running through quicksand feels. I hate the material but I plan on enjoying The final results. 

Also, as part of the Parker CBI program, I have an intern coming on board. He’s going to move out to Amarillo for a semester and follow us around and work in the office starting in September. 

Throw that in on top of a nurse practitioner starting full-time with us on August 2, and I should have my hands full. This podcast is getting more and more challenging to write produce and record every week. Depending on how all of this goes in the fall, I may be forced to begin releasing an episode every two weeks rather than every week. Stay tuned. That decision is on the horizon. 

Other than all of that, I am involved in all of my extracurricular activities as well.

I am still going to the track and throw in the shot put and discus on the weekends and planning on competing in some masters events next spring and summer. Still trying to lose weight and stay involved in working out and being in the healthy lifestyle. And I’m still busy doing all of my artwork that I’ve been doing all along. 

If you’re interested in any of that you can find it on Facebook at Jeff Williams art. If I was that weren’t enough, I’m busy putting together a new band and music projectWell my voiceover career is also expanding and growing and growing a little bit crazy at the moment. You could say my cup runneth over exponentially. 

For that reason, let’s get on with the research.

Item #1

The first one is called “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi et al. (Sääksjärvi S 2020) and published in Spine Journal in October of 2020 which is cooling off but still pretty damn steamy. Hot enough to eat. 

Why They Did It

The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up

How They Did It

  • A prospective follow-up study.
  • In an earlier study, 75 conscripts aged 20 years with LBP had their lumbar spine examined by MRI. 
  • At a follow-up of 30 years, the subjects were contacted; 
  • 35 of 69 filled a pain and disability questionnaire, 
  • and 26 of 35 were also reexamined clinically and by MRI. 
  • The images were evaluated for decreased signal intensity and other degenerative changes. 
  • Association between decreased signal intensity of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher exact test. 
  • Association between decreased baseline signal intensity and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test.

What They Found

  • The total number of lumbar discs with decreased signal intensity increased from 23 of 130 to 92 of 130 
  • Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased signal intensity at baseline were more likely to have severely decreased signal intensity at follow-up, compared to healthy discs. 
  • Other degenerative changes were also more common in these discs. 
  • Severity of DD at baseline did not have a significant association with current pain or disability.

Wrap It Up

In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.

CHIROUP ADVERTISEMENT

Item #2

Our last one today is called “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study” by Tembo et. al. (Tembo 2021)       and published in Calcified Tissue International in 2021….ouch….don’t touch it…..it sizzles. 

And honestly….who the hell knew there was an entire damn journal called calcified tissue international?? How damn niche can you get?? For reals. And don’t tell me it’s pronounced nish because I’m just going to kick you in the shin if we meet in person. I’m going with niche because there are riches in niches. Not in nishes so don’t do it. 

Why They Did It

How They Did It

  • This longitudinal study included 287 men aged ≥ 50 yr at baseline (2001–2006) from the Geelong Osteoporosis Study
  • Baseline musculoskeletal measures included femoral neck bone mineral density (BMD), appendicular lean mass index (ALMI, kg/m2) and whole-body fat mass index (FMI, kg/m2) and lower-limb strength
  • Frailty at the 15 yr-follow-up (2016–2019) was defined as ≥ 3 and non-frail as < 3, of the following: unintentional weight loss, weakness, low physical activity, exhaustion, and slowness
  • Potential confounders included anthropometry, smoking, alcohol, FMI, socioeconomic status and comorbidities

What They Found

  • Forty-eight (16.7%) men were frail at 15 yr-follow-up.
  • Musculoskeletal models were better predictors of frailty
  • Musculoskeletal parameters improved the predictability model for frailty after 15 years

Wrap It Up

In general, muscle models performed better compared to bone models. Musculoskeletal parameters improved the predictability of frailty of the referent model that included lifestyle factors. Muscle deficits accounted for a greater proportion of the risk for frailty than did bone deficits. Targeting musculoskeletal health could be a possible avenue of intervention in regards to frailty.

And now you know…..the rest of the story….

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. 

 

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

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message

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

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

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

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

Website 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

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
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #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. 
Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

Integrating Chiropractors

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

Integrating Chiropractors

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

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

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

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

But first, here’s that sweet sweet bumper music

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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.

CHIROUP ADVERTISEMENT

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

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

Store

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

Subscribe Button

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

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

TuneIn

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About the Author & Host

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

 

 

Spinal Instability Clinical Pearls & Degeneration and Facets

CF 152: Spinal Instability Clinical Pearls & Degeneration and Facets

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

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Item #1

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

Why They Did It

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

How They Did It

Retrospectively recruited 62 patients from 60-70 years old

They evaluated the following: 

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

What They Found

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

Wrap It Up

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

CHIROUP ADVERTISEMENT

Item #2

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

Why They Did It

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

How They Did It

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

What They Found

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Key Point:

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

Contact

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

Connect

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

Website

Home

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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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

What They Found

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Check your JUNK folder!! Do it do it do it. You have found yourself smack dab in the middle of Episode #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.

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

That’s Chiropractic!

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it.  You have found yourself smack dab in the middle of Episode #133 Now if you missed last week’s episode, we talked about giving, we talked about maintenance care, dry needling, and we also talked about vitalism.

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

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

 

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

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

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

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

About every 4th or 5th post.

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

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

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

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

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

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

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

How They Did It

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

What They Found

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

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

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

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

How They Did It

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

What They Found

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

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

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

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

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

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

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

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

Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

New Information On 5 Actions To Change Clinical Practice

CF 131: New Information On 5 Actions To Change Clinical Practice Today we’re going to talk about moving toward being patient-centered. There are 5 actions recommended. What does it even mean? I might just ruffle some feathers here but a damn I do not giveth. But first, here’s that sweet sweet bumper music  
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #131 Now if you missed last week’s episode , we were joined by Dr. Kevin Christie with The Modern Chiropractic Marketing podcast and author of a new book that’s coming out on chiropractic marketing. Kevin is a rising star in chiropractic and is a must-not-miss. 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….. Still climbing in the patient numbers. Where I’m located here in Amarillo, TX, there is a population of approximately 280,000 people. Last week, on Thursday and Friday we added 3 total cases of COVID on Thursday and only 2 cases on Friday. Then the following Monday, we added 11.  So, as you can see, the numbers here are no longer high. People are sort of ‘over it’ and you can see that and hear it when you talk to the patients. Hell, I’m sort of over it but still being smart. I’m having friends to the house again but we stay outside by the pool and have a couple of adult beverages.  I have a friend that is a musician. Last weekend, he played a rodeo on Woodward, OK. He said there were probably 1,000+ people at the event and it was indoors. So, in Woodward, OK at least, they are REALLY over it. No way in hell I’m grouping up with that many people indoor or outdoor right now. It just doesn’t make sense to me for now.  I guess if I were 28 and at the top of my game physically it wouldn’t make any difference to me either. But going to an event where people are yelling and cheering right behind, beside, and in front of me….big nopers right now. Ain’t happnin’ I noticed that while cases seem to be leveling off across America, they’re not increasing or decreasing as much as you’d like but, what I noticed is that the deaths are going down. Fairly signficantly. So wouldn’t that fit with the news that started coming out a couple weaks ago about the virus losing some potency?  People are still getting it but not as many dying from it. Another explanation could be that we’ve gotten better at treating it. Either way, that’s not my lane so I’m not going to act like the expert. I’ll just say hell yay-us and keep the good news coming so we can all get back to life as it was meant to be lived.  I hope you’re all well and staying healthy. As always, if you care about the kind of information I share every week and you listen consistently, I’m proud of you. I think you care about the right stuff and even though I don’t know you all, I consider you my friend.  Item #1 Let’s kick this week’s research reviews off with this one called ‘It is time to move beyond body region silos to manage musculoskeletal pain; five actinos to change clinical practice’ by Caneiro et. al(Caneiro JP 2020). published in British Journal of Sports Medicine in 2020. We got a hot one over here!! This paper actually has a lot of big names in the industry like Caneiro, O’Sullivan, O’Sullivan and Jan Hartvigsen. If you don’t know Jan’s name, you just haven’t been a regular listener.  Why They Did It They say that current clinical research, education, and practice approaches musculoskeletal pain and conditions in silos. Basically it’s a focus on body regions like the knee, hip, neck, shoulder, etc.  But current thinking actually shows that the pain disorders are frequently comorbid and share common biopsychosocial risk profiles for pain and disability.  They say that a shift to focusing on the person is what is needed and that this would encourage the doctors to:
  1. focus on the patients’ context and modifiable biopsychosocial factors that influence their pain and disability
  2. Use education to facilitate active management approaches (targeted exercise therapy, physical activity, and healthy lifestyle habits) thus reducing reliance on passive interventions
  3. Consider evidence-based surgical procedures only for those with a clear indication and where guideline-based non-surgical approaches have been rigorously adhered to. 
Well who the hell can’t get behind all of that? Honestly, it’s odd when you think about it that in the year 2020, we’re still saying that surgery should be evidence-based and follow certain guides and that conservative treatment should be first basically. How’s that not just common sense and common procedure in 2020? We’re supposed to have freaking flying cars by now but the medical field doesn’t have this stuff down they way they should just yet?  It’s money. I know. I understand it. But it’s frustrating as hell all the same.  In this paper, the authors say to be truly patient-centered, they have five actions they recommend for managing a person with musculoskeletal pain, irrespective of body region. 
  1. Screen for biopsychosocial factors and health comorbidities. Notice this is #1 on their recommendations. If you’re just getting them in a pop a crack a lack and sending them on without this step, your results are going to be less than you or the patient desires. They say we need to communicate clearly with the patient to identify potential biopsychosocial drivers of the pain and then provide the therapy to fill that gap. These things include pain beliefs, emotional and coping responses to pain, social contest, physical and lifestyle factors and the presence of comorbidities. They recommend using the Orebro Musculoskeletal Pain Questionnaire. 
  2. Embrace patient-centered communication. This one is huge and this is one of the key things we learned in the Fellowship training for the neuromusculoskeletal medicine program. Clinicians should use open and reflective questioning to elicit the patient’s understanding of factors, which include the pain experience (tell me your story), causation beliefs (what do they think is the cause of the pain?), coping (what do you do when the pain increases?), impact (Tell me how your symptoms affect your ability to move and function), concerns (do your symptoms worry you?), beliefs (why do you think you shouldn’t bend/lift, or run?), social factors (tell me about your home life or work life), goals (what are you rgoals?), and expectations. Yes, to an extent, updated research and thinking has us behaving a bit like a psychologist I think. It’s not my favorite stuff. But, when you learn and consider how much pain is held in the brain due to these yellow flag indicators, then you start to realize that pain, certainly chronic pain, cannot just be treated at a peripheral source. You have to address the pain from a central sensitization perspective at least equally or you risk never being able to help these patients. 
  3. Educate beyond words using active learning approaches. doctors have to embrace education as a central part of patient care if we are going to change behavior. We have to dispel myths about pain, imaging findings, and activity engagement (for example, hurt does not equal harm). They say that behavioral learning like exercise therapy can be used to bust myths that are unhelpful. Myths and beliefs that lead to things like fear avoidance. 
  4. Coach towards self-management. A large portion of the chiropractic profession wants and desires patients to depend on them week after week, month after month and that’s just not real world stuff. And it’s not helpful for the patient’s recovery either. We should be empowering patients to engage in exercise, valued activities and a healthy lifestyle with confidence. Can you feel the difference here? “Mary, I know you’re only 35 but you already have some degenerative discs in your neck and I’m so concerned about it. This should be considered urgent and I’m going to need to see you 5 million times for the rest of your life.” Is that helpful or is this helpful? “Mary, I know you read on your rad report here that there is a finding of a degenerative disc in your neck but the truth is, that’s very common and not something you should be concerned with. Certainly not over-concerned with. I actually prefer the word ‘deconditioned’ over ‘degenerative.’ A good percentage of 30-40 year old patients have some mildly deconditioned discs but these rarely ever cause any issues. You’re young, you’re strong, and you’re healthy. We’re going to get everything moving correctly and then I’m going to give you some excellent exercises to really focus on the region and build plenty of support. You’re going to do great.” When you stack those two next to each other, it’s easy to see how harmful one is as opposed to the other more positive, more hopeful one. I got a little side tracked there, the point is, help them take control and self manage. Active amnagement relieves pain and improves function across pain conditions and health comorbidities. 
  5. Address comorbid health factors. They say clinicians should refer for co-care in teh presence of comorbid mental and physical health complaints like high levels of emotional distress, eating disorders, and type 2 diabetes. The authors say they contend that multidisciplinary care needs to be integrated, with consistent messages across the team to prevent care fragmentation and patient distress. 
Wrapping up the paper, the authors say Patient-centered care will optimize the value of healthcare provided. Shifting funding to support high-value evidence-based care options and educating society will be critical to enable this transition and will likely be cost-effective. Integrated cross-discipline clinical networds are required for effective co-care. We believe clinicians are ready to change, but they require the support of health systems and payers.  One word….two syllables. Day-um. You day-um right. But, health systems and payers are stuck on the part of our profession that doesn’t care about movement, function, yellow flags, exercise, or proper patient-centered practice. They’re stuck on the portion of our profession that is TIC or TOR or principled or whatever the hell useless drivel they’re using this week.  The hardcore, philosophy, doctor-centered, faith-based rather than evidence-based group of chiropractors are smaller but they’re so much louder. And dangerous. They’re flat-earthers. They’re the reason the evidence-based group will never reach any kind of cultural authority.  You can have a GROUP of guys and girls go through years of continuing education and maybe get a couple of diplomats in neuro or orthopedics or rehab….wahtever….and they can be the smartest chiropractor on the planet and almost 100% of their patients get well.  And then you have just ONE lowsy-ass guy or girl go and bait and switch just ONE patient into 80 visits in a year with a contract and all of the bells and stupid whistles of a doctor-centered practice, and that group that worked so so hard loses every ounce of legitimacy. Because of ONE jackhole that refuses to understand or read research or refuses to sacrifice some money in the interest of their patients well-being.  It’s gross. It’s awful. But it’s chiropractic. We are already looked at with a side-glance untrusting gaze. So any deviance of behavior that would be widely considered normal is magnified. Just one ruins the batch for all of us.  I remember a preacher once saying that you gain trust in drops but you lose it in buckets. The reality in chiropractic is that just one faith-based, doctor-centered jackhole loses trust in ALL chiropractors in buckets. For ALL of us.  My plea is to start sharing this podcast with your subluxation friends. Especially the young students that haven’t yet decided to be ‘principled.’ Maybe we can help lead them down the right path from the very start. The more people are exposed to the research and to the idea of being patient-centered, the more they’ll latch onto it. They have to. One is borderline evil, and the other is not. It’s backed by science. One destroys reputations for the sake of the dollar. One builds reputations and respect. One is built on ideas and theories over a century old that cannot or have not been proven while the other is backed by science and progress. How is it even a damn choice to begin with? We’re either a healthcare profession. Or we are a faith. True healthcare professions do research and then they do more and they change according to what works well and they drop the stuff that doesn’t, and on and on to the point of really being on the cutting edge of the science and on the health of our patients.  I’ll never understand how such a percentage of our profession can’t get on board with that. Whatever the answer to that question might be, it’s that answer that keeps us at the bottom of the cultural authority ladder.  Unfortunately, I don’t see if changing any time soon. Not until the governing boards decided it’s time to change once and for all.   Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Caneiro JP, R. E., Baron CJ, et. al., (2020). “It is time to move beyond ‘body region silos’ to manage musculoskeletal pain: five actions to change clinical practice.” Br J Sports Med 54: 435-443.

w/ Dr. William Morgan: A Conversation About Excellence, Research, Parker University, and Chiropractic

CF 127 w/ Dr. William Morgan: A Conversation About Excellence, Research, Parker University, and Chiropractic

Today we’re going to be joined by Dr. William Morgan, President of Parker University and over-all impressive human being.  But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it.  You have found yourself smack dab in the middle of Episode #127 Now if you missed last week’s episode, we talked about immunity-boosting, coconut oil failures, and screen time and its apparent association with autism. 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.  When we have a guest, we typically dispense with my personal thoughts and practice experiences over the course of the week. We will do that same this week outside of this; I was with many of you. I closed the shop for 2 weeks. Solid. Closed. Then, I gradually started back with urgent/emergent care just like our governing board in Texas recommended.  At this point, I’m in my 3rd week of being completely re-opened. Even to wellness and maintenance care. While I’m used to 180-220 patient visits per week, I’m now experiencing about 110-120. We’re low. Obviously. But, it’s growing every week. People are beginning to tire of the restrictions on their activities and, I’d assume to some extent, are becoming somewhat numb or less concerned…..or more comfortable I guess with the risk aspect of it all.  Regardless, they’re starting to return. I’m pretty sure those of you that closed and did a gradual re-opening like me are experiencing much the same. Now if we can get the massage therapists back to work safely. We’re still waiting to see what happens on that end of it.  OK, let’s get to our guest today. I tell you sincerely, we are hitting the high spots on this show. WI’m just sitting here thinking about all of the amazing guests we’ve had over the last three years and just in the last few months we’ve had Dr. Stu McGill, Dr. Mike Massey, and now Dr. Williams Morgan. It’s been fun to watch this thing of ours grow and continue to grow. You, the listener, is the main reason for that growth and I just want to continue to thank you and tell you how important you are to me and how much I appreciate you.  Usually, bios and intros can be a bit mundane. Not today, my friends.  When your guest has been the chiropractor to the US Congress, the US Supreme Court, and to the White Hosue, well, you know it’s going to be a good one don’t you? Not only that but Dr. William Morgan, as mentioned, is the President of Parker University, and an active member of the Texas Chiropractic Association and has been testifying on chiropractic issues in the last two Texas Legislative Sessions and is happy and proud to be a Texan. That’s my kind of guy right there!! Our Texan pride is indeed legendary and probably annoying to anyone outside of the state.  At age 17, he joined the Navy and served with an elite Marine Recon company as a hospital corpsman. During that time, he qualified in parachuting, military diving, submarine insertion, jungle warfare, combat swimming, explosives, mountaineering, winter warfare, and Arctic survival. Additionally, he attended anti-terrorist training at the FBI Academy. After leaving active military service and transferring to the Navy Reserves, Dr. Morgan began his educational journey to become a doctor of chiropractic. While at Palmer College of Chiropractic-West, he transferred to a Naval Special Warfare platoon as the unit’s primary hospital corpsman. He was sent to Special Operations Technician training to learn the principles of dive medicine. For the next eight years, he served as a dive medicine corpsman/combat swimmer for a platoon of Navy frogmen in Naval Special Warfare Unit One.   In 1985, Dr. Morgan received his Doctorate of Chiropractic from Palmer College of Chiropractic–West and soon after, married fellow Palmer graduate, Clare Pelkey. They practiced for thirteen years in California. In 1998, Dr. Morgan was chosen to establish the first chiropractic clinic at the National Naval Medical Center in Bethesda, Maryland, which later became Walter Reed National Military Medical Center. In 2015, Walter Reed recognized Dr. Morgan with its highest honor for clinical excellence, the Master Clinician’s Award. During the last 18 years at the military’s most prestigious medical centers, he practiced in an integrative setting, providing chiropractic care to the injured troops returning from the wars in Iraq and Afghanistan.  In the year 2000, Dr. Morgan was appointed as the Chiropractor to Congress at the U.S. Capitol. At the Office of the Attending Physician to Congress, doctors of many specialties care for members of Congress and the Supreme Court. In 2007, Dr. Morgan began serving as the White House Chiropractor. He was appointed chiropractor for the United States Naval Academy football team in 2009 (which never lost to Army while under his care).  In 2011, Dr. Morgan was appointed to the United States Navy Musculoskeletal Continuum of Care Advisory Board, an entity created to address the prevalent injuries sustained by U.S. Armed Forces Personnel during active-duty operations. Dr. Morgan also served on the Spine Subcommittee, which helps develop care algorithms for treating spinal conditions and determining the future of musculoskeletal management in the U.S. Armed Forces.  Dr. Morgan has completed a 2,000-hour residency in Integrated Medicine. He served on the Board of Trustees for Palmer College of Chiropractic for ten years. He is a Diplomate of the American Academy of Pain Management and has held adjunct faculty positions at F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, and New York Chiropractic College. Additionally, Dr. Morgan served as a consultant for the U.S. Department of Veterans Affairs (VA), helping to implement the VA’s chiropractic benefit and advocate for chiropractic research  Parker University inaugurated William E. Morgan as their seventh President in 2016. Upon arriving in Texas, he became an active member and supporter of the Texas Chiropractic Association (TCA). Almost immediately, he organized a leadership summit to establish a legislative agenda strategy for chiropractors in Texas. Texas Chiropractors had not won a significant legislative victory in two decades, but in 2017 four bills advantageous to the chiropractic profession passed. Additionally, Morgan has assisted in fundraising, membership recruitment, and awareness for the TCA. As a lifetime member of the American Chiropractic Association (ACA), he has also held several leadership positions in the organization.  Just last year, I was at the TCA President’s Gala when Dr. Morgan was awarded the Keeler Plaque which is awarded to the chiropractor of the year but is also a life time service award of sorts. It’s the most prestigious award the TCA gives so it’s quite an honor. And here in Texas, we are quite honored to have Dr. Morgan on our team. As a side note, I’m honored to know Dr. Morgan personally and really appreciate him agreeing to come on this podcast so let’s hop into it.  Welcome to the show Dr. Morgan, thank you so much for caving to my pestering and agreeing to shut me up by finally coming on the show.  Having the background you have, you’ve spent serious time on both coasts of our great nation. Now you find yourself dead center, right in the middle of the country. What was the allure of Texas for you, how has Texas treated you, and what has been your favorite thing about living here in Texas? Did you have any early perceptions of Texas or Texans when you moved here that proved to be false and did you have any that proved to be absolutely true? Everyone has a chiropractic story, what led you to want to be a chiropractor? Can you share a little about how you got to the point of climbing the ranks and becoming the chiropractor to Congress, the Supreme Court, and the White House? How did it all come about? Can you share some of the legally shareable and more unique stories or experiences of treating those types of patients? You moved to Dallas, TX to take the helm of Parker University as their 7th President. Just a little background on me personally, I was there when Jim Parker was still around. I was there when he passed away and his son Karl took over and I believe Fab Mancini was coming on board about the time I graduated. I’m well acquainted with Parker of yesteryear. When you got to Parker, what was one of the first things you wanted to change? What would you say has/have been the changes you’ve made since arriving that you are the proudest of? When I was in school there, exercise/rehab honestly was not a big aspect of the curricula. I know a bit about you and Parker Fit. Have exercises and rehabilitation taken on a larger role since 1998? Some areas of the country never experience something you all, unfortunately, went through last year. Tell us a bit about the tornado, the aftermath, and going forward from it.  Now, from one awful event to another. Our current global pandemic. How is Parker University handling this event? What can students expect going forward? During this crazy time, there have been a lot of divisions in the country from opening vs. closing to ‘I refuse to wear a mask’ vs. ‘can you please wear a mask’? Our profession, unfortunately, is no different. It’s been divided along clear lines for decades and this pandemic has brought some of the divisions into the spotlight. One of them is between those that promote spinal manipulative therapy as a way to boost immunity and those that do not support that. When this was really first unfolding and our Texas Board of Chiropractic Examiners, the WHO, the WFC, and the ACA were all telling chiropractors the support for immunity boosting is not present in the research literature, you and Dr. Katie Pohlman (I love Katie and need her on the show BTW)…you and Dr. Pohlman recorded a very smart and well-stated video saying that indeed, the research literature cannot support immunity-boosting at this time. Obviously, I was and am 100% on board with it and I said all of that to ask you this, was there any fallout to that? How did you handle it? And what went into the decision to record it in the first place.  Let’s move to legislative issues. What have you felt is our biggest issues in Texas and on the national level when it comes to chiropractic?  I have said repeatedly on this show that due to the opioid crisis and due to the emerging research over the last 5-10 years, I truly feel there’s not been a better time to be a chiropractor since the 1980s. As the President of a chiropractic college, what is the status of our profession right now? Not just in terms of the pandemic but over the course of the last year. Over the course of the next 5 years. Am I right about it being a great time? Am I wrong? Or a little bit of both? Thank you for joining us today! Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Chiropractic evidence-based products

Integrating Chiropractors

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