evidence-based chiropractor

Thoughts on Chiropractic Groupon, Gabapentin, & Weight Loss Research

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

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

But first, here’s that sweet sweet bumper music

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

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. So feel free to crack one wide open would you?

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

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

  • Like our facebook page, 
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  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. 

Do it do it do it. 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Item #1

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

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

That’s got some sizzle on it!!

Some key points in the article are that 

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

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

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

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

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

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

Item #2

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

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

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

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

Why They Did It

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

How They Did It

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

Wrap It Up

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

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

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

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

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

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

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

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

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

That’s magic time dreamland stuff. 

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

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

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

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

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

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

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

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

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

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

Highlight of the article include:

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

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

I couldn’t agree more with them. 

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

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

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

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

Store

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

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

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

Chiropractic evidence-based products
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The Message

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

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

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

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

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm. When it comes to non-complicated musculoskeletal complaints….

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

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

Connect

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

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About the Author & Host

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

Bibliography

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

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

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

Forward ’19, Decompression Research, Curveball or Pitch Count?

CF 094: Forward ’19, Decompression Research, Curveball or Pitch Count?

Today we’re going to talk about my Forward ’19 experience, we’ll talk about decompression research, and we’ll cover some new research on whether it’s the curveball or the pitch count that injures young players on the baseball diamond. 

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 and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have rattled and rolled into Episode #94

Now if you missed last week’s episode on the bigger the disc the better and what early improvement in treatment tells you, make sure you don’t miss that info. Every episode offers some good take-aways so make sure you’re up to date and not falling behind the rest. 

I like to look at this podcast as an ongoing, fun way of learning and making each other just a little bit better every week so don’t just hop in for one episode. Stack them up one after another and, before you know it, you’re going to start retaining the info and you’re going to start recalling something we talked about down the road when you’re interacting with a patient and they ask you a question. 

You’ll see. Even though I’m the host, it happens to me. Someone will ask me a question and I’ll remember an episode we did on that topic and BOOM!! Pow!! There it is, the answer comes to me. Pretty cool. 

Forward ’19 – For you newbies here you’re probably wondering what the hell Forward ’19 is. A quick rundown is that it is a yearly seminar/conference that was born from an online Facebook group called the Forward Thinking Chiropractic Alliance aka FTCA. They have a website as well. 

The group is very much evidence-based or evidence-informed. Whichever is your preferred verbiage. The group has about 7800 or so doctors in it and they are interacting on a daily basis mostly to try and make each other better. Overall, it’s a good group. I’ve heard people griping because they see griping here and there in the group but, in general, it’s a very positive, very smart, and very helpful group. I encourage you joining it if you’re a doctor or student. 

Anyway, Forward 19 – What an event. The group puts on several events through the year but this is the key event put on by the FTCA every year. This is year #2. It was in St Louis at the campus of Logan Chiropractic College.

First thing is, holy smokes what a campus man. I bet they pay a fortune just to mow the grass. Just wow. The landscaping, the tower in the middle, and Purcer Center where it was all held. Just gorgeous. Having gone to Parker, that was the Chiro campus I’d been on and don’t get me wrong, Parker is impressive. I’d say Logan most definitely is as well. Kudos.

Speakers:

Gray Cook SFMA – SFMA stands for Selective Functional Movement Assessment – I have to admit that this was my first exposure to Gray Cook but it won’t be my last. I had heard of SFMA but was not all that familiar with it. I really enjoyed his talk and some of the concepts he puts forward. I can’t wait until I get through with my Diplomate program – hopefully in November – so that I can dive into Gray Cook’s stuff and just keep building on the knowledge pile. 

Greg Kawchuk – He is the Research Chair for the World Federation of Chiropractic. 

So, outside of the FTCA, I had little knowledge of Greg Kawchuk. But, Greg gave a speech at the World Federation of Chiropractic last year in Berlin that got some people a little fussy and some people elated. It definitely got the attention of chiropractors around the world to say the least. He gave the same speech last weekend in St. Louis and it had people on the edge of their seats. 

Backing up a bit, Greg is a dynamic speaker. One of the more humorous and engaging speakers I’ve seen in maybe forever. He’s immediately like-able and that make for a good speech from the top. The talk was all about putting the ACT back in Chiropractic. A play on the way the philosophy guys use the TOR and the TIC garbage. You know….the principled vs. un-principled hoohah. 

I happened to think that evidence-informed docs are the principled ones and if you need more info on why I think that, just go back about 3-4 episodes and listen to my podcast on the topic of Closing Patients. A principled, ethical person doesn’t carry themselves in that manner and the philosophy folks are much more likely to be out there closing patients than offering responsible treatment plans that are based on commonly accepted guidelines. In my experience at least. It’s always made me a bit hot under the collar when someone asks whether another chiropractor is principled or not. 

Makes me want to principle them in the forehead…..with a mighty slap. 

Anyway, putting the ACT back in chiropractic: he asked what are we doing right now? What are you doing right now to move the needle forward? To bring chiropractic into this current century we are in? He suggests we do a lot of sciencing and consume at least 1 science per day and I agree with him. 

Hell, here at the Chiropractic Forward podcast, we distribute about 3-4 sciences per episode so we almost got you covered for the whole week if you’re a regular listener. 

I think the part of his presentation that some took exception to was the part where he feels the evidence group may, at some point, consider a divorce from the philosophy geared group. He said it may not be an official divorce but could be very much a divorce in the way we act, carry ourselves, communicate with our patients, and things of that nature. 

He says, at the end of the day, it could be something similar to….. we went out for a pack of smokes and…..just never came back. 

Now, as you sit in your car or truck or your office hearing me say that, you can take that all in as you will. I’m going to tell you that, as a doctor that considers himself very much on the research end of things and very little on the philosophy end of it, and as a doctor that does everything he can to be ethical, honest, and all that…..it is so hard to sit and hear patients talking to me about being forced to sign of on a contract for thousands of dollars for a year long schedule for umpteen visits based on a curve correction that research suggests isn’t that big of a deal. 

It’s hard to hear about the knuckleheads in Oakland claiming they can reverse degenerative spurring by seeing someone 3x/per day for 3 weeks. It’s hard to watch Mr. man bun top not from the coffee house talking about fixing kids with no research to back his claims. 

It’s hard to hear about chiropractors scaring the crap out of patients with x-rays and convincing them that they are somehow damaged and in a dire circumstance unless they undergo 60 visits and another 3 sets of x-rays….

These are just a few of the stories. There are so so so many of them and at some point, I just don’t want to be associated with that anymore. At all. If that’s not understandable and that makes no sense to you and that makes you mad at me, well….I’d say I’m sorry but I’m just….I’m just not. 

Even though I don’t smoke in the physical meaning of the word, I think I went out for a pack of smokes and never came back about 15 years ago. 

Christine Goertz – If you are a regular listener of our podcast, you know Dr. Goertz has been on our show before and you know I’m a nerdy fan of her and her contribution to our profession. Any chance to listen to Dr. Goertz is a chance that should be seized upon. She’s a giant in our industry. 

Annie O’Connor – World Of Hurt – OK, I’m admitting something again. I wasn’t familiar with Annie O’Connor. Annie is fun and vivacious and really another very dynamic speaker but she is full of knowledge nuggets. The kind that you can really put to use. She spoke on how words can harm so how key communication can be for some patients. She talked about yellow flags and she talked about classifying pain patients so that we can help them with more efficiency. You can believe that World Of Hurt is on my reading list after Forward ’19. 

Greg Friedman – documentation  documentation. Greg is Greg. Smart, laid back, fun, and just likable immediately. It was great to get to meet him in person and share a good discussion prior to his documentation class. He’s full of excellent information and not just on documentation so, if you get a chance and you need the hours, search out a class. He’s flying all over the nation every weekend. 

Mike Massey – he shared teaching duties with Greg on the documentation class. He told me he’s a listener of our podcast and he’s an active member of the FTCA so I’ve been a fan of his for a while now. It’s always a cool deal to put the online world into a 3D context and it was sure nice to meet Dr. Massey. Hopefully next time I’ll get to sit and speak a while with him. I think our personalities probably match up pretty closely from what I can tell. 

Some of the others I got to see and speak with are Brandon Steele

Kevin Christie

Jon Morrison

Robert Jones, President Of The ACA was there the whole weekend sitting in on the classes himself. What a super guy.

Budweiser tour

Meeting people

Kris Anderson

Chris Howson

Rob Pape

Bobby Maybee

Bobby Mozafari

Mike Massey

Greg Friedman

Dale Thompson

Kevin Christie

Anne Maurer

My biggest regret is that I didn’t get any real one on one time with very many of these folks but That’s OK. All’s well.

If I didn’t come up and speak with you but you saw me there, please don’t take it personally, believe it or not, I have a bit of a shy streak. Once I’ve had a conversation with someone, it’s all good. But, if I don’t know you yet….ugh….I have a podcast. I was a traveling musicians for 7 years. Why would a guy like me be shy at all? Yeah I don’t know. I’m in control in those other situations. Maybe it’s when I’m not in control or I’m a newbie….who knows?

Anyway, if you ever see me at an event, regardless of the event, please come say hi. I’d love to meet you.

We are about to get to our two articles. One is new research on traction/decompression information for low back discs and the other is on young baseball pitchers and how the curveball isn’t the culprit. 

First though, we have backed off and rather than having two show sponsors, we have one and it’s a company you all know how much I love. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

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

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

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

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

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

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

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

Item #1

The first article today is called “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis” by Cheng, et. al(Cheng Y 2019). and published in Clinical Rehabilitation in August 28, 2019. Smoking hot folks. Stand back. Watch your eyebrows!

First thing, recognize in the title there, this is a systematic review and meta-analysis. That’s at the top of the research pyramid. 

Why They Did It

To evaluate the effectiveness of traction in improving low back pain, functional outcome, and disk morphology in patients with herniated intervertebral disks.

How They Did It

  • They did a big time search PubMed, Scopus, Embase, and the Cochrane Library and they did this search from the earliest record all the way up to July 2019. 
  • They included RCTs that involved adult patients with low back pain associated with herniated disc confirmed by MRI or CT
  • RCTs that compared lumbar traction to sham or no traction
  • RCTs that provided quantitative measurements of pain and function before and after intervention. 
  • The initial search came up with 3,015 records which they whittled down to 7 involving 403 patients.

What They Found

Compared to the control group, the patients that had traction showed significantly greater improvements in pain and function in the short term

The differences were not significant enough to support the long-term effects on pain and function, nor the effects on herniated disc size. 

Wrap It Up

Compared with sham or no traction, lumbar traction exhibited significantly more pain reduction and functional improvements in the short term, but not in the long term. There is insufficient evidence to support the effect of lumbar traction on herniated disk size reduction.

Here’s where I’m at on that. I use decompression. I just need to know more about this study. Did they do simple traction? Did they do a cycling pull phase from a pull to a rest phase? How much weight was the pull? How long did they do each treatment and how many treatments did they do?

There’s also patient preference and clinical experience factoring into using decompression.

Reading down through this sucker, it’s just too varied to make any assumptions. The intervention programs differed among the studies from 10 sessions to 60. The treatment protocols varied from 2 weeks to 10 weeks. Some of the studies included had no information on the weight of the pull while a handful went up to 50% of the body weight. Some of the studies used continued traction while others had intermittent traction. Some even used self-suspended, inversion table type traction. 

Are you getting a whiff of what I’m dumping here? 

Out of the 7 studies they included, only 2 measure the disc height and one measured the disc ratio. 

Overall, when you read through the paper, these authors freely admit, this is a tough one but they wanted to start somewhere. They suggest several ways to go forward and say that there are a couple of studies out there that show a trend toward long-term decompression reducing the size of a disc herniation but no longer papers have been done to investigate it. 

It’s anecdotal as hell but I’m going to go ahead and anecdote the hell of you. Right to your face. Or….to your ears as it may be. I’ve been doing decompression for about 7 years and I’ve yet to see anything as effective. Including exercises, McKenzie, all of it. In some cases, it has absolutely amazed me. But, like I said, that is anecdotal but I hope some of these really super smart researchers out there in the profession start to dial down into it and figure it out. Mostly because I know it works. I’ve just seen it too many times. 

Item #2

This last item is called “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers” by Oliver et. al(Oliver G 2019). and was published in Journal of Pediatric Orthopedics in September of 2019. Wait, it’s September of 2019 right now right? Steaming pile of fresh knowledge nuggets, big platter, sizzling. 

Why They Did It

The purpose of this study was to examine differences in pelvis, torso, and upper extremity pitching mechanics and muscle activations between the fastball, change-up, and curveball pitches in youth baseball pitchers following a simulated game.

How They did It

  • 14 youth baseball pitchers with no history of injury were included
  • All major muscles and mechanics were measured
  • The pitchers were instructed to throw with max effort during a simulated game that provided random game situations
  • They were limited to 85 pitches
  • Data from 3 fastballs, curveballs, and change-ups thrown in the first and last innings were selected for analysis

Wrap it up

The principle findings of this study revealed that pitching to the age-restricted pitch count limit did not result in altered pitching mechanics or muscle activations, and no differences occurred between the 3 pitches. These results support previous research that indicate the curveball pitch is no more dangerous for youth than the other pitches commonly thrown. This is supported by the pitcher’s ability to maintain a proper arm slot during all 3 pitches and indicates that they are obtaining the spin on the ball from their grip and not by altering upper extremity mechanics.

So….it is not the curveball it seems but, rather, it’s the pitch count in young pitchers, it’s treating them like professionals when they’re still developing, it’s that they tend to play only one sport aka specialize, and that they need to be treated like developing children and human beings rather than the Dad’s lost glory or a future paycheck for the whole family. 

Store

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

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

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

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Cheng Y, H. C., Lin Y, (2019). “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis.” Clin Rehabil.
  • Oliver G, P. H., Henning L, (2019). “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers.” J Pediatr Orthop 39(8): 387-393.

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

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

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

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


Chiropractic evidence-based productsIntegrating Chiropractors

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

You have streamed you way into Episode #61

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

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

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

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

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

Introduction

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

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

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

Faith-based Chiropractic

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

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

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

 

Damascus apostle paul bronze

saul apostle paul damascus sculpture

 

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

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

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

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

My Issue

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

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

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

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

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

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

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

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

Example

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

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

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

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

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

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

What If

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

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

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

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

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

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

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

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

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

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

Resource #1

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

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

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

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

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

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

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

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

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

Resource #2

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

Why They Did It

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

How They Did It

It was a blinded, cross-cross-sectional study

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

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

What They Found

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

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

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

Chiropractic evidence-based productsIntegrating Chiropractors

The Message

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

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

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

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

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

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

Connect

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

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

About the Author & Host

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

Bibliography

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

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

CF 052: Chiropractic Forward Podcast Year One Review

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

CF 046: Chiropractic Effectiveness – Chiropractic Integration – Chiropractic Future

 

 

 

CF 053: Healthy New Ideas For Physical Activity

CF 053: Healthy New Ideas For Physical Activity

Today we’re going to talk about updated guidelines for physical activity as well as some research that the more vitalistic in the profession may not dig too much. Don’t kill the messenger people. 

But first, here’s that delicious bumper music

Integrating Chiropractors

Introduction

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

You have toppled into Episode #53, the first episode of year #2. I am committing to doing a second year as long as we show continued growth. If we stop growing, I may change my approach at some point but, I absolutely want to do a second year to see where this thing of ours can go. 

Talking DACO

Let’s talk a bit about the Diplomate of American Chiropractic Orthopedist program also known as the DACO. I’m just keeping you apprised of my progress. At this point, I have 68 online hours down and 40 live hours done. So, I’m 108 hours into the 300 I need. 

I have literally knocked out 24 hours online in the last two weeks. That’s a gob of information. It is literally changing how I practice every single week. It’s almost indescribable but, I see patients coming in every day now that have something I would have missed without having gone this far into the DACO. 

The more recent classes I’ve been through include plantar heel pain, Diagnosing idiopathic scoliosis and assessing the risk of progression, anterior knee pain in an adolescent, lateral knee pain and th IT band, as well as recognizing meniscus tears and essential of reading knee MRIs. 

I honestly wonder how on Earth I’ve gotten anyone well over my 20 years in practice without the knowledge that I’m gaining here. In the end, I guess doing SOMETHING is always going to trump doing nothing and, it’s not like I’ve been a dummy for 20 years. 

CEs

I’ve always been a big proponent of continuing education and have consistently gotten 30-50 CEs every year rather than the 16 required so, I’m not going to beat myself up over it but, sincerely here, this information you get in the DACO program is beyond anything I’ve gotten in any seminar anywhere. 

Now, with that being said, I haven’t been to one of McGill’s or Liebenson’s talks so I need to make that clear. By the way, both of those giants will be at Parker Vegas in February if you are ready for some learning of the highest caliber. 

Newsletter

Right now, while you’re thinking about it, go to chiropracticforward.com and sign up for the weekly newsletter. It’s just once per week, it’s easy and fast and I’m in the process of making some pretty cool stuff that I think can be useful in helping you in practice. 

When it’s ready to roll out, you’ll save because you were cool enough to be on the list, cool enough to be an early adopter, and cool enough to basically be a founder of what we’re trying to build here. I’ve never believed that I can build it by myself. It has to be a team of like-minded, motivated individuals. 

If you are evidence-based I’d love to have you on the team. Reach out and let’s talk about what we can do to build build build. 

Meat n’ Taters

Alright, onto the meat n taters today. Let’s start with this paper that just came out in the Journal of the American Medical Association. It’s authored by Dr. Katrina Piercy et. al[1]. and is called The Physical Activity Guidelines for Americans. It was published on November 20, 2018. It doesn’t get a whole lot more recent than that does it?

The 2018 Physical Activity Guidelines Advisory Committee conducted a systematic review of the science supporting physical activity and health. They came up with recommendations strictly based on evidence graded as strong or moderate. 

Here’s what they decided:

  • Preschool-aged children from 3-5 need to be active throughout the day
  • Children and adolescents from 6-17 should do 60 minutes or more of moderate to vigorous activity daily. 
  • Adults should do at least 2 1/2 hrs to 5 hrs per week of moderate intensity, or 1 hr 15 minutes to 2.5 hours per week of vigorous aerobic activity, or an equivalent combination of the two. 
  • Adults should also do muscle-strengthening activity on 2 or more days per week. 
  • Older adults need a multicomponent physical activity that includes balance training as well as aerobic and muscle-strengthening. 
  • Pregnant and postpartum females need at least 2.5 hrs of moderate activity a week. 
  • Basically moving more and sitting less will benefit nearly everyone. 

See? And you didn’t even need a trainer to figure it out. You’re welcome. You are so welcome, folks. It’s what I do. I give give give. 

Walking Paper

Let’s move on to a paper that was in Spine Journal in November 2018 called Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-cross-sectional study using the Korean National Health and Nutrition Examination Surveys[2]. 

Again, very new stuff. Only a month or so old. 

They did this one because, while strengthening and aerobic exercise is well-documented and well-founded, there isn’t a lot of information on walking and it effects for low back pain. 

This was a cross-sectional study which means they looked at people differing on one specific characteristic at one specific point in time. The data they collected was from the Korea National Health and Nutrition Examination Surveys from 2010-2015. 

What They Found

The authors wrapped it up by saying, “Our study showed that longer walking duration was associated with a lower risk of LBP. Regular walking with a longer duration for more than 3 days/week is significantly associated with a lower risk of LBP in the general population aged over 50 years.”

Social Prescribing

I wanted to discuss a pretty neat article I came across last week from the Smithsonian. This article is called British Doctors May Soon Prescribe Art, Music, Dance, Singing Lessons and it was written by Meilan Solly[3] published November 8, 2018. Yet again….the newest stuff here this week. 

The article discusses a new initiative on the part of British Health Secretary Matt Hancock and they’re wanting to allow the country’s doctors to prescribe art or hobby based treatment for all sorts of issues. From dementia and psychosis to lung complaints and mental health complications. 

They’re calling it “social prescriptions” and I have to say that I’m a big fan of the idea. For instance, just listening to Otis Redding sing Sittin’ On The Dock of the Bay does something good to me inside and out. One of my all time favorites and you all clearly have good taste because you’re listening to our little podcast here so I’m sure it’s one of your favorites too. If it’s not one of your favorites then you clearly haven’t listened to it yet. 

The health secretary has an excellent quote here when he says, “We’ve been fostering a culture that’s popping pills and Prozac when what we should be doing is more prevention and perspiration.” “Social prescribing can help us combat over-medicalizing people.”

And the heavens opened up and all God’s people said, “Amen.”

The only problem I have with the idea is that they’re not looking at having it up and running until 2023. Which, honestly, isn’t as far away as it once seemed is it? 

Still, you’d think they have that rocking and rolling quicker but look who’s griping? We’re still here in America where our medical profession is still trying to figure out how to get more people on medication and into surgery rather than think out of the box just a tad for a second or two. 

But, back to the point, I think it’s an amazing idea. Music, singing, creating art, and experiencing art in whatever form possible is good for the body and soul. Not one or the other but all of it. Every inch. Laughing too. Laughing is so good for you. 

Richard Pryor, Rodney Dangerfield, and Eddie Murphy for children of the 80’s such as myself. Dane Cook and Kevin Hart for the 2000’s kids. Laughing your butt off fixes a lot of stuff. 

‘Principled’ May Not Be So Principled

And to our last paper by Guillaume Goncalves, et. al. published in Biomed Central on April 5, 2018 called “Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach[4].”

The authors start out by saying that the chiropractic vitalistic approach to the concept of ‘subluxation’ as a cause of disease lacks any validity nevertheless, some in our profession still claim to prevent disease in general through continuous chiropractic care. 

Don’t send me crappy emails. That’s what the authors said here. 

They go on to say that, if some are going to continue with this model of practice, there must be evidence that it is effective and that’s the reason for the research here. 

How They Did It

They searched PubMed, Embase, Index to Chiropractic Literature, and some specialized chiropractic journals, from inception to October 2017.

They scrutinized 13 articles. 8 were clinical studies and 5 were population studies

They dealt with various disorders of public health importance like blood pressure, blood test immunological markers, and mortality. 

Wrap It Up

The authors concluded the paper by saying, “We found no evidence in the literature of an effect of chiropractic treatment in the scope of primary prevention or early secondary prevention for disease in general. Chiropractors have to assume their role as evidence-based clinicians and the leaders of the profession must accept that it is harmful to the profession to imply a public health importance in relation to the prevention of such diseases through manipulative therapy/chiropractic treatment.”

Now look, don’t kill the messenger. I know that some of you are just going to do what you want to do and what you believe no matter what is thrown in front of you. I know that. Honestly, those people probably aren’t listening to an evidence-based podcast to start with because we won’t confirm that bias. We’ll challenge it from time to time. 

People don’t typically like that. In fact, they may attack those that challenge their bias. 

The information is more useful to confirm the bias of evidence-based chiropractors and to further educate those that are being fed information to the contrary whether it’s by friends or even at school. 

Regardless, for every chiropractor and patient, it’s food for thought. 

Integrating Chiropractors

The Message

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

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

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

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

Key Point: Patients should have the guarantee of having the best treatment offering the least harm.

That’s Chiropractic!

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

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

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

Website

http://www.chiropracticforward.com

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TuneIn

About the author:

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

https://www.smithsonianmag.com/smart-news/british-doctors-may-soon-prescribe-art-music-dance-singing-lessons-180970750/?utm_source=facebook.com&utm_medium=socialmedia&fbclid=IwAR1etMZiV8oe-JbUwgUYmP2gxR5pinJcbLS2W1u1QlMBNISVIxTpFBRmubc

https://jamanetwork.com/journals/jama/fullarticle/2712935?utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email

https://chiromt.biomedcentral.com/articles/10.1186/s12998-018-0179-x?fbclid=IwAR3aJGZBcmMSscPoibtAzIRHok9_RpsMvJDbvx76MnzRJY9YU0x_JMY5FK0

https://www.ncbi.nlm.nih.gov/m/pubmed/30448632/

 

Bibliography

1. Piercy K, T.R., Ballard R,, The Physical Activity Guidelines for Americans. JAMA, 2018. 320(19): p. 2020-2028.

2. Park SM, Walking more than 90 minutes/week was associated with a lower risk of self-reported low back pain in persons over 50 years of age: A cross-sectional study using the Korean National Health and Nutrition Examination Surveys. Spine J, 2018. 18: p. S1529.

3. Meilan Solly, British Doctors May Soon Prescribe Art, Music, Dance, Singing Lessons. Smithsonian.com, 2018.

4. Gonclaves G, Effect of chiropractic treatment on primary or early secondary prevention: a systematic review with a pedagogic approach. BMC Chiro Man Ther, 2018. 26(10).

 

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

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

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

Dale Thompson - Evidence-based Chiropractor

Integrating Chiropractors

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

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

You have mosied Old West style into Episode #44

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

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

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

My Week

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

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

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

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

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

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

Introduction

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

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

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

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

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

Welcome

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

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

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

Have you always been an evidence-based chiropractor?

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

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

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

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

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

Continuing

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

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

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

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

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

That goes for chiropractors and students as well.  

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

Integrating Chiropractors

 

Affirmation

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

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

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

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

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

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

Website

http://www.chiropracticforward.com

Social Media Links

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

iTunes

Player FM Link

Stitcher:

TuneIn

About the author:

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