evidence based chiroractor

Giving, Maintenance Care, Dry Needling, and Vitalism

CF 132: Giving, Maintenance Care, Dry Needling, and Vitalism Today we’re going to talk about Giving, Maintenance Care, Dry Needling, and Vitalism

 

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.  

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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #132

Now if you missed last week’s episode , we talked about 5 principles to change clinical practice. There was some great information in that one all based on a recent paper that came out. 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…..

One foot in front of the other. I’ve been thinking a lot lately. I know this concept but I don’t do it intentionally. Still….I definitely do it. I give away stuff and help others when I like them, their product, or service. I promote them without expecting anything in return. Because I don’t expect anything in return. I do it because of the reasons stated. 

Then, what happens is that through giving to others, things come back around and are given to you. That’s the way it works. Again, I don’t give to get something back.  To me, that’s just not how it works. You have to give because you have a giving heart. Not a greedy heart just giving to get. 

I talk about people that I believe in and things that I use because I like them and I think they’d be useful to you. I talk about other people’s stuff more than I talk about my own stuff. I have some awesome evidence based patient education brochures and posters on our website but I talk more about Forward Thinking Chiropractic Alliance than you hear me talk about my stuff. 

If you’re evidence-based, I firmly believe you need to be a part of the FTCA. It’s that simple. We had Kevin Christie with Modern Chiropractic Marketing Podcast on a couple weeks ago. He does it right. That’s why he was on. I believe in Dr. Christie, I like Dr. Christie, and I support him. 

ChiroUp, not only do I really like the co-owners personally, but I don’t know what I ever did without the product. Honestly, I have no idea. I was less than before I had ChiroUp in my office. 

It’s why you always hear me speak about the diplomate/fellowship through the international academy of neuromusculoskeletal medicine. I’m not sure I’ve ever professionally believed in anything more than the education you get through them. 

It’s why I talk often about involvement with the Texas Chiropractic Association. It’s because I hope you’ll see the value in being active and involved in your own associations. Doing so was one of the key gamechangers in my professional life. You can count on that. 

Same goes for philanthropy. If you’re not giving back to your local non-profits monthly, you really should consider doing so. It’s easy and it’s fun. We’ve made it a cornerstone of my personal business. 

This isn’t a ‘oh look at me and how awesome I am’ thing here. It’s just an honest conversation about something I was thinking the other day. Does any of this come back to benefit me financially? I don’t know. I really don’t have a clue. And honestly, I don’t care. Once again, that’s not why we give. We give because we have a giver’s heart. Not only do I like and believe in the people and the products or the causes, but I also think that our listeners will find value in it. If I’m providing you value, then you know you’ll get the best, most valuable information through this podcast. 

So, maybe, even if others aren’t necessarily talking us up or pumping our tires, it still comes back, huh? Either way, there’s nothing better than giving. At least for me. I came across a quote that made some sense recently. Pablo Picasso said that the meaning of life is to find your gift. The purpose of life is to give it away.” That’s a giver’s heart. Exactly what I’m talking about. Seems like it worked out for Pablo. 

I think about give vs. take and I think of people that are takers. Taking money from patients when they don’t need the treatment. But a doctor scared them into a ton of extra visits because it’s good for stats and the bottom line. That’s a taker. 

Being in a position to help but deciding to never do anything to help anyone unless it benefits them personally or financially. That’s a taker. 

Just being in the world to see what you can get out of it instead of what you can contribute. That’s a taker. What can you do to make your space better? How can you spread a little love and kindness? 

Just some random thoughts today. Hope it meant something to you. 

Item #1

Let’s get started with this one called “The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain – a secondary analysis of a pragmatic randomized controlled trial” by andreas Eklund et al(Eklund A 2020) and published in Chirorpactic and Manual Therapies in April 2020. Hot cakes coming up, hot cakes people. 

Why They Did It

Eklund has shown in two previous papers the benefit of treating preventatively but thae benefit varied across psychological subgroups. 

The aims of this study were to investigate 

  1. pain trajectories around treatments, 
  2. recurrence of new episodes of LBP, and 
  3. length of consecutive pain-free periods and total number of pain-free weeks, for all study participants as well as for each psychological subgroup.

How They Did It

A secondary analysis of data from a randomized controlled trial of patients seeking chiropractic care for recurrent or persistent LBP used 52 weekly estimates of days with low back pain that limited activity. 

What They Found

  • Patients receiving maintenance care had flat pain trajectories around each new treatment period and reported fewer days with pain compared to patients receiving the control intervention. 
  • The entire effect was attributed to the dysfunctional subgroup who reported fewer days with activity limiting pain within each new LBP episode as well as longer total pain-free periods between episodes with a difference of 9.8 weeks compared to the control group. 
  • There were no differences in the time to/risk of a new episode of LBP in either of the subgroups.

Wrap It Up

Data support the use of MC in a stratified care model targeting dysfunctional patients for MC. For a carefully selected group of patients with recurrent and persistent LBP the clinical course becomes more stable and the number of pain-free weeks between episodes increases when receiving MC.

Item #2

Item 2 is called ‘Dry needling for spine related disorders: a scoping review’ by Funk et. al(Funk MF 2020). published in Chiropractic and Manual Therapies  in May of 2020…..bringin’ the heat people! Bringing the heat!

Why They Did It

The depth and breadth of research on dry needling (DN) has not been evaluated specifically for symptomatic spine related disorders (SRD) from myofascial trigger points (TrP), disc, nerve and articular structures not due to serious pathologies. Current literature appears to support dry needling for treatment of trigger points. Goals of this review include identifying research published on dry needling treatment for spine related disorders, sites of treatment and outcomes studied.

How They Did It

A scoping review was conducted following Levac et al.’s five part methodological framework to determine the current state of the literature regarding dry needling for patients with spine related disorders.

That sound fine and freaking dandy but what the hell is a scoping review vs. a systematic review? Well, I did the work for you and here’s what we have. Within the framework of research methods, a well- done scoping review is considered at a higher level than a straightforward review of literature or an integrative review, but not as in depth as a Cochrane or Johanna Briggs model systematic review

Researchers may conduct scoping reviews instead of systematic reviews where the purpose of the review is to identify knowledge gaps, scope a body of literature, clarify concepts or to investigate research conduct. While useful in their own right, scoping reviews may also be helpful precursors to systematic reviews and can be used to confirm the relevance of inclusion criteria and potential questions.

Although conducted for different purposes compared to systematic reviews, scoping reviews still require rigorous and transparent methods in their conduct to ensure that the results are trustworthy. 

And now we’ve both learned something so that’s awesome. 

Wrap It Up

Back to the paper here; I’m not even going to get into the meat and taters here on this paper because you’ll zone off and might even tune out. I have it cited in the show notes if you really want to find it and dive in. Getting straight to the conclusion, the authors say, “For spine related disorders, dry needling was primarily applied to myofascial structures for pain or TrP diagnoses. Many outcomes were improved regardless of diagnosis or treatment parameters. Most studies applied just one treatment which may not reflect common clinical practice. Further research is warranted to determine optimal treatment duration and frequency. Most studies looked at dry needling as the sole intervention. It is unclear whether dry needling alone or in addition to other treatment procedures would provide superior outcomes.”

We covered a paper on dry needling last year that suggested it had little use. It appears it does indeed have some use. They just don’t know how to best use it yet. If that makes sense.

Item #3

Our last one today is called ‘Vitalism in contemporary chiropractic:a help or a hinderance?” by J. Keith Simpson and Kenneth J. Young(Simpson J 2020) and published in Chiropractic and Manual Therapies June 11, 2020. See the sizzle on that stacks of steaming sizzlers.  

Why They Did It

Chiropractic emerged in 1895 and was promoted as a viable health care substitute in direct competition with the medical profession. This was an era when there was a belief that one cause and one cure for all disease would be discovered. The chiropractic version was a theory that most diseases were caused by subluxated (slightly displaced) vertebrae interfering with “nerve vibrations” (a supernatural, vital force) and could be cured by adjusting (repositioning) vertebrae, thereby removing the interference with the body’s inherent capacity to heal. DD Palmer, the originator of chiropractic, established chiropractic based on vitalistic principles. Anecdotally, the authors have observed that many chiropractors who overtly claim to be “vitalists” cannot define the term. Therefore, we sought the origins of vitalism and to examine its effects on chiropractic today.

Discussion

Vitalism arose out of human curiosity around the biggest questions: Where do we come from? What is life? For some, life was derived from an unknown and unknowable vital force. For others, a vital force was a placeholder, a piece of knowledge not yet grasped but attainable. Developments in science have demonstrated there is no longer a need to invoke vitalistic entities as either explanations or hypotheses for biological phenomena. Nevertheless, vitalism remains within chiropractic. In this examination of vitalism within chiropractic we explore the history of vitalism, vitalism within chiropractic and whether a vitalistic ideology is compatible with the legal and ethical requirements for registered health care professionals such as chiropractors.

They say that despite the obstacle of vitalism, chiropractic has made extraordinary inroads into the health care system worldwide. Having emerged from the pre-scientific health care era in the United States of America (USA) in the early twentieth century it now has a global footprint with representation in approximately 100 countries. It is the third largest regulated primary contact health care profession in the western world

Conclusion

Vitalism has had many meanings throughout the centuries of recorded history. Though only vaguely defined by chiropractors, vitalism, as a representation of supernatural force and therefore an untestable hypothesis, sits at the heart of the divisions within chiropractic and acts as an impediment to chiropractic legitimacy, cultural authority and integration into mainstream health care.

Y’all know by now how I feel about it. When you have someone following current research, updating their procedures and thought process as the knowledge base expands, and taking care of their patients and running their businesses in an ethical way with the highest of morals and love, then you’re my kind of person. I respect you and I’m proud of you. Most of our listeners are that kind of practitioner. 

If you’re scaring people into a bunch of visits based on stuff research says is no big deal, if you’re convincing people they depend on seeing you consistently, if you’re engaging in vaccine discussions when you’ve read a book or two but never been proper educated to do so, when you’re stats and your profits come before the true needs of the patient, then I don’t respect you and I wonder how you sleep at night with the knowledge of how you are screwing and stealing from patients coming to you for your help weighing heavily on your conscience. They come to you for your help. Not to buy you a big house. Not to be lied to. Not to have false, fake, or outdated ideas shoved up their poop shoot and to be taken advantage of. 

Stop it dammit. It’s gross and you give everyone that truly works their asses off a bad name. You’re the reason someone that gets a diplomate or some other significant continueing education ro certification…..you’re the reason they still get laughed at behind their backs. You should be ashamed of what you do to yourselves, your colleagues, and your profession. 

I’m really not a bitchy guy. I’m a fun-loving ‘let’s have a beer’ kind of guy. But very few things grind my geears worse than this stuff. Honestly. It’s the wrench in my gears, the salt in my wound if you will. I think about it and I start breaking out in hives and get all rashy. My eyes about roll out of my damn head onto the floor. 

I’ll be in a better mood next week. I hope. 

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. 

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. 

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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

Eklund A, H. J., Jensen I, Leboeuf-Yde C, (2020). “The Nordic maintenance care program: maintenance care reduces the number of days with pain in acute episodes and increases the length of pain free periods for dysfunctional patients with recurrent and persistent low back pain – a secondary analysis of a pragmatic randomized controlled trial.” Chiropr Man Therap 28(19).

Funk MF, F.-D. A. (2020). “Dry needling for spine related disorders: a scoping review.” Chiropr Man Therap 28(23).

Simpson J, Y. K. (2020). “Vitalism in contemporary chiropractic: a help or a hinderance?” Chiropr Man Therap 28(35).