evidence-based

Three Year Anniversary Top Ten Countdown

CF 156: Three Year Anniversary Top Ten Countdown

It’s our THREE YEAR ANNIVERSARY episode!!! We’re going to cover our All-time Top Ten episodes spanning over our first three years on the air.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #156 Now if you missed last week’s episode, we talked about the crazy and very suspicious shake-up with the research committee earlier this year at the World Federation of Chiropractic. Make sure you don’t miss that info. I believe it is vital for you as an evidence-based, patient-centered practitioner. Listen to it anyway because it’s important to keep up with the class. 

On the personal end of things…..

Well, no hate mail from last week’s episode or from the week before that when we highlighted a vitalist bragging about seeing 99 patients and 9 new patients in the span of 3 hours. Dammit, my eyes just about rolled out of my head yet again. It’s like every time I say that I gotta keep an eye on my eyes so I can keep them in my noggin. And, I have to step back a bit to keep from throwing up.  Not getting hate mail is a good thing.

Of course, there’s the very solid chance I’m simply speaking to an echo chamber here, and honestly, that’s OK too. I’d much rather be able to build this among my brethren without being molested by the ones that don’t agree with me.  The more like-minded folks we have listening, the better. The best thing I can say is to tell someone about us. I’m serious. I appreciate every single listen. But if all you do is listen and consume a free product, that’s not helpful in growing it and putting back into the thing you find value in. 

So, please. Tell someone about this podcast and the messages we convey every single week. Let’s build this message. Like I said in last week’s episode, this profession is in a battle. Not just between vitalists and evidence-based chiropractors but in a battle for integration, progress, and overall respect.  A battle for professional standardization. a battle over our research community. As I said last week, the ICA won the battle with the WFC research committee. They know there’s a battle. Now it’s time for evidence-based chiropractors to realize that fact and proceed accordingly. Yes, go read your research papers but then go and defend the evidence-based, patient-centered practice. Advocate for it.  Outside of that mess, things have been slower at the office. With this second spike, we’ve taken a step back. And it’s making my butt pucker a bit. I hate taking steps back. I like only progress. Only movement forward.

I’m seeing the number that I saw 5 or 6 years ago or more. Probably more. We are paying the bills but we’re not profiting right now. We’re just surviving. It can’t be over soon enough.  So that I don’t sound too spoiled; I understand I have it better than a lot of folks. Bar owners, full-time musicians, bartenders, servers, restaurant owners. That’s just for starters. I don’t know how these people survive without forgiveness plans and things like that. It’s insane where we are but I’d rather be sitting here in December than back in March, April, or May.  That’s for damn sure. As of the typing of this episode, the first vaccines are projected to be taken by Americans in about 5 days. Bring it on!! Let’s start getting life back to normal and then sit back and watch the comeback!

Before we get to our Top Ten list and before we get to our sponsor spot, I have to tell you, I’m about to give you a code for discounts on ChiroUp. People sometimes think ChiroUp is one thing or another but in all honestly, it’s a little too much to describe in one spot. It does A LOT!! It helps you implement rehab confidently. It writes reports to those in the medical community. It teaches you what exam protocols are appropriate for regions of the body. It teaches you how you should treat certain diagnoses. It does your report of findings for you. It gets you Google reviews. It tracks your patients’ progress after 30 days so you know how good you’re doing with your patients. It sends emails to your new patients full of recommendations, patient education, and videos of the exercises you recommended for them. It gives you marketing plans for different aspects of healthcare. And it does a hell of a lot more than that.  I could go into every single one of these topics and speak on each of them for half an hour but you’ll just have to trust me here. It is worth so much more than what ChiroUp charges. So, here’s the spot, take my code, use it, and then get better and love your life. You can thank Ol’ Uncle Jeffro later. 

CHIROUP ADVERTISEMENT

Just do it, folks. It’s worth every penny and much much more. It’s literally changed my practice from top to bottom for the better. There’s not another product out there I can say that about. 

Now, let’s get to our all-time 3rd anniversary top ten most listened to episodes, shall we? If you go to the show notes at chiropracticforward.com, find this episode….#156….and you scroll down through the transcription of the episode, you will find the links to each of these episodes so you don’t have to scroll through and find them on your own.

Number Ten Coming in at Number 10: Our 10th most listened to episode was episode #137. We had a special guest for that episode. Dr. Aric Frisina-Deyo and we talked about chiropractors treating in an FQHC setting and we talked about setting the bar high. Higher than chiropractors typically set the bar for themselves or their profession. This guest….wow. Young, bright, driven, and very very impressive. There’s absolutely a good reason that one had so many listeners.  https://www.chiropracticforward.com/2761-2/

Number Nine It’s nice to see this one still in the Top Ten after so much time has gone by. It’s called What’s Good In A Chiropractor. It was way way back in Episode 101. Keep in mind here that we’re now on #156. This episode is more than a year old now so it’s good to see that the principles I covered in this episode are still resonating with our listeners. In this episode I discussed some key characteristics I feel make up a good chiropractor. We talked about things like honesty, being evidence-based, networking, listening, your office presentation, and things of that nature. It’s excellent to see this stuff staying relevant and meaningful.  https://www.chiropracticforward.com/what-makes-a-good-chiropractor-9-characteristics/

Number Eight Number eight is called Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack of Attention On The Boards for Biopsychosocial Matters. Our listeners gobbled this one up. I think because we need current thinking and information on things like adjusting in the region where we know there’s radiculopathy. We need to understand that just because a person is a kid doesn’t mean they don’t hurt. This episode covered that very well, in fact. And the biopsychosocial aspect of pain has been a big big topic over the last couple of years. I think people are struggling to learn more and more about it and how it can help their patients.  https://www.chiropracticforward.com/cf-145-kids-still-hurt-manipulation-for-lumbar-radiculopathy-lack-of-attention-on-the-boards-for-biopsychosocial-matters/

Number Seven Our 7th most listened to episode was a more recent one with one of my very favorites, Dr. Katie Pohlman who will be on again in the very near future. And will hopefully be on our podcast about a hundred times beyond that. Hell, maybe she’ll just be my co-host eventually. Lol. Anyway, this episode was number 147 and was called New Research, Upcoming Research, And the Need For It All. Dr. Pohlman is the head of research at Parker University and you’re starting to see her name anywhere and everywhere with regard to chiropractic research. She is a star and I’m happy that Parker has hitched their wagon to her shooting star. This episode was full of thoughts on chiropractic research, what she’s currently working on, and where it’s all going.  https://www.chiropracticforward.com/w-dr-katie-pohlman-new-research-upcoming-research-and-the-need-for-it-all/

Number Six Our sixth most listened to episode was episode number 113 with my friend, Dr. William Lawson. This one was called Brand New Guidelines On Neck Pain Treatment. Dr. Lawson had a hand in the new paper we discussed and it was basically an entire episode walking you through new guidelines on treating neck pain. It’s one of my favorite episodes because it laid out very clearly what we should be doing, what we should be thinking, and how we should be approaching case management for neck pain. Very informative and Dr. Lawson is always on the top of his game. https://www.chiropracticforward.com/w-dr-william-larson-brand-new-guidelines-on-neck-pain-treatment/

Number Five Our 5th most listened to episode of all time is number 140 with Dr. Chris Howson. It was called Chiropractors In Hospitals and Drop Release. Not only does Dr. Howson work in an outpatient hospital setting in North Dakota, but Dr. Howson is also the inventor of a newer chiropractic tool on the market called the Drop Release. Pretty cool stuff and Dr. Howson knows his stuff, folks. If you want to know how to integrate into a hospital setting and want to know what it’s like, this is the episode for you. Plus we talk a bit about the drop release, what it’s for, and all the goodies. Plus a discount code you can use if interested.  https://www.chiropracticforward.com/cf-140-w-dr-chris-howson-chiropractors-in-hospitals-drop-release/

Number Four Our 4th most listened to episode is number 144 and is called Common Surgeries Aren’t Well-Researched & Chiropractic Wins Again.  This one was a stroll through a current paper that really spotlighted the fact that the most common musculoskeletal surgeries that we see being performed today don’t have much research behind them. Especially research that tested having the surgery vs. not having it at all. You’d think that research would have been done but sadly it hasn’t in almost every case. In fact, they looked at 6,735 studies and only 64….less than 1% of them….only 64 compared a surgical intervention to not having surgery at all. And, get this, of that 64 that actually did compare the two, only 9 of them were actually favorable to having the surgery. Go to episode 144 for more on that. It’s astonishing to me.  https://www.chiropracticforward.com/common-surgeries-arent-well-researched-chiropractic-wins-again/

Number Three Alright, we’re in the top three now. Our 3rd most listened to episode of all time is number 143 and is called Spinal Manipulation Has No Effect On Chronic Pain – Our Experts’ Rebuttal. This one dealt with a paper that came out recently in JAMA and it was not favorable at all to chiropractors or spinal manipulative therapy. This episode went through our own experts thoughts on the paper and how you can rebut any mention you might get from this down the road as you navigate your relationships within the medical community. Very interesting and extremely useful episode right here. This one can actually help protect your bottom line in the right situation.  https://www.chiropracticforward.com/new-paper-spinal-manipulation-has-no-effect-on-chronic-pain-our-experts-rebuttal/

Number Two Number 2 on our top ten list is episode number 142 and is called Nonoperative Disc Treatment, D3 for Depression, and The Biopsychosocial Part Of Chronic Pain. This one really spoke to chiropractors because it was loaded with research. Of course, most of our episodes are loaded with research but this one had a paper about treating discs without operation. Well, who the heck doesn’t want to do that? It was very comprehensive and showed how 97% of 269,713 patients were treated without surgery. Good good stuff. Things look worse and worse for musculoskeletal surgery these days honestly. And, again, this paper covered the biopsychosocial aspect of pain and that’s a popular topic these days. Something for everyone in this episode! https://www.chiropracticforward.com/nonoperative-disc-treatment-d3-for-depression-the-biopsychosocial-part-of-chronic-pain/

Number One And our number one most listened to episode of all time for our 3rd Anniversary is one that actually surprised me. It’s episode number 141 and is called Lancet Low Back Update & Movement Disorders Mean Pain. Now why this one got all of the listens? I have no idea. The Lancet is well-respected and should absolutely be paid attention to. I’m glad it’s getting all of the listens, to be honest. It was basically an update on the original Lancet series on low back pain that we covered way back when. It’s top-level research having relevance to our chiropractic community and I’m glad to see so many of you appreciating it and paying close attention to it. It’s important. It’s not the sexiest topic we cover so that’s why I found it a bit surprising but it’s a great episode to catch the number one spot for sure. Very deserving.  https://www.chiropracticforward.com/lancet-low-back-update-movement-disorders-mean-pain/

An episode or series of episodes that fell off of the top ten list just this year is still important and one worth giving honorable mention to. Episodes 13, 14, and 15 are called Debunked, The Odd Myth That Chiropractors Cause Strokes.  If you don’t know the research on this topic, please, for the love of everything, go listen to those three episodes starting with 13. It’s knowledge fuel and it’ll give you more confidence if you happen to lack it.  https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/

Alright, that’s it. We made it through all ten of the most listened to episodes in the three-year history of The Chiropractic Forward podcast. I want to truly thank you all from the bottom of my heart for listening and being a part of this little part of the world. For being a part of this podcast. When I’m sitting down to type out an episode, you are who I have in mind. I try to identify things I’m interested in but I also try to identify tough conversations that are not being had that desperately need to be talked through. 

We aren’t as big and as widely listened to as I’d like to be but we are growing steadily. If I can get you all on my team and talking about it and sharing episodes with your buddies and interacting in the private group, this thing can begin turning into even more of what I envisioned when I first started it.  With your help, we can get the message out on evidence-based, patient-centered practice.  Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website http://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Vegans & Broken Bones, Daily Step Count, Medical Cannabis

CF 155: Vegans & Broken Bones, Daily Step Count, Medical Cannabis

Today we’re going to talk about new research for vegans and the risk of broken bones, we’ll cover new information pertaining to a patient’s daily step count, and we’ll talk about a study on medical cannabis and it’s effectiveness in treating chronic pain. Good stuff today, folks.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #155 Now if you missed last week’s episode , we talked about the shake up with the World Federation of Chiropractic and all of the goings on that went on with that. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

As of the typing of this, it is the Monday following Thanksgiving. I hope you all had a good one. I have a nice back patio, outdoor kitchen area with a fireplace and quite a bit of room to move around.  I have my mom and my stepdad over as well as my brother and his wife. With the four of my regular crew, that made 8 of us. Nobody went inside. We all just gathered outside on the patio and ate outside. It was great. It was safe. And we still got to have Thanksgiving. 

We had two separate tables. One for my crew and one for the other four. We had my crew at one table because I work with 140 or so appointments per week, my son goes to a high infection rate college, and my daughter goes to junior high with over 1,000 kids every day. So, my crew was the wildcard in that crowd. So we sat separated just a bit to be sure we were protecting the others from any asymptomatic hoo ha.  It seemed to work very well. Again, I hope you all did well and stayed safe and happy and healthy.

It was different for sure, right? Definitely one to remember. No doubt.

Think of all of the things we took for granted before this mess. I know many of you have but I haven’t taken a trip or vacation or anything since February when we went to Key Largo.  I’m used to going on little vacays about once per quarter just to preserve my sanity. I think that’s important. Getting out of the office and getting some sea air or some mountain air in your face.

But we haven’t been able to do any of that in the last 9 to 10 months and I’m missing it. I’m a traveler.  This has really taught us what we do and what we do not have control over. We do not have control over nature from what I can tell. Certainly not this virus. At least not yet we don’t.  This second spike has been severe where I live. Over 1,000 new cases in one day on the last count, over 750 FEMA staffers here helping our healthcare system keep up with the hospitalized patients. I haven’t seen this week’s numbers yet but we lost 24 residents to COVID in just two days last week. 24 deaths in two days. That was unheard of just a couple of months ago. I have lost a couple of patients to it.

Fortunately, I haven’t lost any friends as of yet. I hope your friends are all staying safe and weathering the storm the same.  PRactice is just there. Nothing special going on right now. We are running a radio spot for this holiday season but I’m not sure how smart that is. Luckily, they gave us a killer deal on the run so we couldn’t resist. They made us a deal we couldn’t refuse. I’m not sure all of the ads in the world will get everyone out of the mental and financial funk any time in the next several months.  But I’ll report back. If it works, I’ll share what we did so you can do the same.

On the other hand, if you’re doing something that is working for your clinic and getting people back in the numbers you want to see, send me an email at dr.williams@chiropracticforward.com and let us know so we can let others know and help everyone out with getting their numbers back closer to normal. 

Item #1

Let’s start with one called “Medical Cannabis for the Management of Pain and Quality of Life in Chronic Pain Patients: A Prospective Observational Study” by Safakish, et. al. (Safakish R 2020) published in Pain Medicine in November of 2020. And it sizzles and steams as it sits.  

Why They Did It

To evaluate the short-term and long-term effects of plant-based medical cannabis in a chronic pain population over the course of one year.

How They Did It

  • 751 chronic pain patients initiating medical cannabis treatment.
  • A longitudinal, prospective, 12-month observational study.
  • Study participants completed the Brief Pain Inventory and the 12-item Short Form Survey (SF-12), as well as surveys on opioid medication use and adverse events, at baseline and once a month for 12 months.

What They Found

  • Medical cannabis treatment was associated with improvements in pain severity and interference (P < 0.001) observed at one month and maintained over the 12-month observation period.
  • Significant improvements were also observed in the SF-12 physical and mental health domains (P < 0.002) starting at three months.
  • Significant decreases in headaches, fatigue, anxiety, and nausea were observed after initiation of treatment
  • In patients who reported opioid medication use at baseline, there were significant reductions in oral morphine equivalent doses (P < 0.0001), while correlates of pain were significantly improved by the end of the study observation period.

Wrap It Up

Taken together, the findings of this study add to the cumulative evidence in support of plant-based medical cannabis as a safe and effective treatment option and potential opioid medication substitute or augmentation therapy for the management of symptoms and quality of life in chronic pain patients. Alright, I’ll be upfront; I don’t like marijuana. I know some of you love the sweet sweet weed. I’ll never understand it. Trust me, I’ve been around it so many times I can’t count. I’m a former traveling muscian. For 10 years I traveled the circuit so you can only imagine.  I’ve been against its legalization from Day 1.

I’ve seen it turn famiily members into lazy, unmotivated bums. I hate it. I hate the smell. I hate what it does to people and I hate the culture surrounding it.  But, I can’t argue with research and this says it helps. I’ve seen other reports that it works. Regardless, I’m for pill form, chewables, or gels. I will never before inhaling it. There is no amount of evidence on the planet that will make me think it’s OK to take smoke into your lungs. Especially when there are other options for it’s utilization.  So, this is encouraging.

I hope its medical use becomes more widespread and more common because it sure as hell looks like it works for chronic pain and, at the end of the day, that’s what we’re here for. 

CHIROUP ADVERTISEMENT

Item #2 This second one is called, “Association of Daily Step Count and Step Intensity With Mortality Among US Adults” by Saint-Maurice et. al. (Saint-Maurice P 2020) and published in JAMA in March of 2020. Dammit it’s hot enough. 

Why They Did It

Describe the dose-response relationship between step count and intensity and mortality.

How They Did It

  • Representative sample of US adults aged at least 40 years in the National Health and Nutrition Examination Survey who wore an accelerometer for up to 7 days ( from 2003-2006). 
  • Mortality was ascertained through December 2015.
  • Accelerometer-measured number of steps per day and 3 step intensity measures 
  • Accelerometer data were based on measurements obtained during a 7-day period at baseline.
  • They adjusted for for age; sex; race/ethnicity; education; diet; smoking status; body mass index; self-reported health; mobility limitations; and diagnoses of diabetes, stroke, heart disease, heart failure, cancer, chronic bronchitis, and emphysema.

Wrap It Up

Based on a representative sample of US adults, a greater number of daily steps was significantly associated with lower all-cause mortality. There was no significant association between step intensity and mortality after adjusting for total steps per day. I personally found it interesting that they found no big association between step intensity and mortality. Very interesting. So, let’s make sure we’re all moving. No matter the age. 

Item #3

This one is an article by Rupert Steiner(Steiner R 2020) called “Vegans and non–meat eaters are more likely to suffer broken bones, Oxford University research show” and it was published in Market Watch on November 24, 2020 and it’s it’s hotter than the burning sun!

  • We just hit the highlights for the articles so here we go:
  • They start right off getting into the meat and taters by saying, “Non–meat eaters, especially vegans, are at higher risk of breaking their bones due to lower intakes of calcium and protein, according to new research by the University of Oxford published on Monday
  • The EPIC-Oxford study, which involved almost 55,000 British people, concluded: “Non–meat eaters, especially vegans, had higher risks of either total or some site-specific fractures, particularly hip fractures
  • Participants were categorized into four diet groups composed of 29,380 meat eaters, 8,037 fish eaters, 15,499 vegetarians and 1,982 vegans.
  • The results showed over an average of 17.6 years of follow-up, researchers observed 3,941 cases of total fractures.

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few.

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

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

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

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

Website http://www.chiropracticforward.com

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

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

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

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

Bibliography

  • Safakish R, K. G., Salimpour V, Hendin B, Shoanpal I, (2020). “Medical Cannabis for the Management of Pain and Quality of Life in Chronic Pain Patients: A Prospective Observational Study.” Pain Med 21(11): 3073-3086.
  • Saint-Maurice P, T. R., Bassett D, (2020). “Association of Daily Step Count and Step Intensity With Mortality Among US Adults.” JAMA 323(12): 1151-1160.
  • Steiner R (2020). “Vegans and non–meat eaters are more likely to suffer broken bones, Oxford University research show.” MarketWatch.

 

Some Chiropractors Could Be Better

CF 153: Some Chiropractors Could Be Better Today we’re going to talk about chiropractors, the subluxation – vitalistic group in our profession and we’ll probably make some grumpy vitalistic enemies out of these chiropractors in the process.  But first, here’s that sweet sweet bumper music

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

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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #153 Now if you missed last week’s episode , we talked about spinal instability clinical pearls and we tal ked about degeneration and the facets. That was some good stuff you need to to have in your back pocket. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function

On the personal end of things…..

I’m doing hte same stuff you’re doing for the most part. I’m just struggling through this second wave of COVID. Trying to stay smart and trying to stay healthy. I wish I could say the same for everyone around me.  For example, I just had a staff member start this week off by telling me she started working a part time job on the weekends because she got an apartment she thought she could afford but it’s not as easy as she thought.  Anyway, at this part time job, her buddy drank out of her drink. She’s like, oh well, it’s just my friend. No big deal. Yeah, no big deal friend called her today…..2 days after that…..and is feeling bad and going to get tested. Now, does that mean my girl has it? Of course not. The friend wasn’t even symptomatic so the chances are low she has it in the first place and if she does have it now, the chances she was shedding the virus then are low. 

Still…..come on man. Be smart. My daughter goes to school with 1000 plus kids every day and I don’t let her take a sip of my drink or anything like that. Much less a buddy at my part time job. Hell no. hell no.  So those are the things we get to battle with, right? We can control everything about what we personally do but we can’t control our kids at school with their friends. We can’t control my other kid at college and his behavior. We can’t control our staff when they’re not here at work.  We just do our best, keep our fingers crossed, and keep working diligently. And hopefully safely.  Not because I’m necessarily scared of getting it. Mostly because I don’t want to shut my practice down for 2 weeks minimum. Who can afford that? So let’s get on with pissing people off, shall we? 

If you don’t understand by this point that there is a divide in our profession that simply cannot be healed, tied together, or unified, well….I don’t know what to do for you. You just need to pay more attention.  If at any point you have thought the two groups could come together, you are fooling yourself. This profession either needs to be split into two completely different degrees and entities or the vitalists need to practice their minimal practice and sit in the back seat and shut the hell up.  Yep….shots fired. I know. I’ll explain more as we go. Every now and then I get fired up and this is one of those times. I’m triggered. I’m the grumpy old ‘get the hell off of my lawn’ guy. More specifically, I’m ‘raise your damn game and quit actiing like fools’ guy. 

I should tell you why I’m triggered first. As our listeners are well-aware, I am a member of lots of Facebook groups but the most notable would be the Forward Thinking Chiropractic Alliance. Most friends and family would classify me as conservative in finances and life in general but when it comes to my profession, I’m all about progressive change and forward momentum. So this group fits me very well.  Anyway, one of the members posted a screenshot of a doctor  – trust me – I use that ‘doctor’ term extremely loosely here – it was a post of this guy claiming that with one table, by himself, he treated 99 chiropractic patients and 9 new patient exams all in 3 hours.  I did the math for you all. That’s right at 2 minutes per patient.

Well, for many of us, that’s not too far off of the mark for established patients. Some of you are boutique practices and spend 30 minutes to an hour with each patient and charge out the wazoo for that. But, for most of us, we are adjusting, passing off to our staff for therapy and rehab and moving on to the next patient.  I want to be fair here. My face to face time is typically 3-5 mintues with an established just depending on what questions I have to answer, if there’s a new complaint popping up that needs evaluated, new patient education, and things like that. Some slightly less than 3 mintues, some quite a bit longer than 5 minutes. 

Now, my patients’ whole visit will clock in on average around 20-30 minutes after therapy and/or rehab but that is delegated to the staff.  Here’s the real kicker for me on this joke. The new patients. I can not get past the new patients. Now I’ve seen 7 or 8 new patients in a day while juggling another 50 or more established patients. But damn man…that’s over the course of a 7 hour day. And, while I don’t think it makes me particulary any more special than anyone else, I have a Fellowship in neuromusculoskeletal medicine. I can come to a diagnosis somewhat quickly when compared to others.  Still, my exam, unless it’s a simple rib complaint or something easy like that, it’s going to take 30-45 mintues. Easy. And that’s with staff doing their history and intake part.

Them filling out OATS takes time on top of that. Plus, I recorded a 7 minute, ‘Welcome to our practice’ video they all watch.  Look, there’s no damn way on this damn planet anyone calling themselves doctor works that many new patients through in 3 hours while juggling 99 established patients and claims they’re doing a good job. No way now how. Nope, no, negatory, NO! Worst of all, he’s a vitalist, practice management guru so he’s offering to show other, impressionable knuckleheads how to mistreat patients all on their own.

Solo crappery if you will. Crappy treatment all by themselves. With his crappy guidance. What a crappy deal.  I have 34 mutual friends with this person and that’s just disappointing. It truly is. Many of you know who I’m referring to but I see no point in mentioning names because the last thing I want is to bring him even more attention. Especially when I don’t see the reason even one person would pay him any at all.  I have no way of knowing how long they’re spending with new patients but let’s just agree that it’s not 30-45 minutes.

There’s no way. I know this because if he spent 30 minutes with each of the 9 new patients, that would be about 4 and a half hours. Much more than the 3 hours he talked about in the post.  We are forced to assume it is much less than that. So let’s play with the math. Three hours is 180 minutes. I think we can all agree on that. A former attendee to one of his seminars said he bragged in the seminar that he could adjust a patient top to bottom in just 30 seconds. As a sidenote, he taught how to have the trash can right next to the door so that he could tear the face paper and grap the door knob in one smooth motion so as to have the door open and showing the person out before they’re even off of the table. That way, you don’t have to talk to them.  So you don’t have to talk to the patient……you get that?

Good Lord, can you imagine a doctor having to speak to their patient after treatment is provided? The horrors!!! Anyway, let’s say 30 seconds is his record but it actually takes one minute on average per patient. If 30 seconds is the fastest, can’t we assume there will at least be some greeting involved in the appointment? Some questions from time to time? There may be some 30 second appointments in there but there may be some minute and a half and some two minute appointments as well. I think that’s fair. 

So, if each of the 99 established takes an average of one minute, which is stillsubstandard care by the way, if they all average one minute, then that leaves 81 minutes to examine and evaluate 9 new patients. That means he has roughly 10-15 minutes for each new patient to do the following if he’s going to adequately assess the patient and have a specific diagnosis outside of subluxation slaying and spine whispering.  He’s got to:

  • Review the history taken by the staff before he came in
  • Review the range of motion if taken in advance by the staff
  • Review the vitals 
  • Meet the patient and listen to their story
  • Assess gait
  • Assess standing posture
  • Check yellow flags and discuss any that are present with the patient
  • Check for red flags – not everyone needs x-rays
  • Check reflexes
  • Check dermatomes
  • Check muscle strength (not freaking AK)
  • Check neurodynamic positions for radiculopathy
  • Assess for Ehler-Danlos and hypermobility
  • Check orthos
  • Check neuro testing
  • Check for extension/flexion bias positions in some cases
  • Come up with an accurate diagnosis
  • Educate the patient on their diagnosis
  • If chronic pain is part of the case, he has to educate on CNS upregulation and the biopsychosocial aspect of pain which is at least a 5 mintues conversation. 
  • Teach proper movement and biomechancis to remove the daily pain triggers
  • He has to answer questions the patient may have

Hell, I wonder if he’s ever had someone lay on their stomachs propped on their elbows for 3 minutes to see if they can identify a home self management strategy for their low back pain? Hell no. Three minutes wouldn’t fit into this doctor-centered model.  I have no way of knowing but I’m guessing the exam consists of ‘checking subluxation’ and telling them to lay down.

Pop, pop, pop, the ridiculous power is on, see you tomorrow for you next life-saving adjustment. It’s silly. And it’s insane. And it’s not evidence-based. And it’s not patient-centered. It’s not special. It doesn’t take talent other than being able to sell targets garbage. It’s the lowest common denominator and nothing more. 

The point being made here is that one cannot do an adequate, responsible, and appropriate exam in this amount of time. And assuming they average only one minute per patient face to face, that’s substandard as hell. Would you want your kid or brother or sister or mom or dad shuttled through an office like a bullet from a gun? Or would you want them to go to someone that cares, connects with them, slows down a tad and takes their time to listen and work with them? The answer is obvious and if you tell me you’d rather your family go to this guy or anyone like them, then you’re just being obstinate and disagreeable.

It’s obvious which style is superior in healthcare.  Maybe working on an assembly line you’d like to see fast, efficient, and little attention given to the specifics. But not in healthcare. This model, I’m sorry to be blunt here….this model is garbage when we are working with the breathing, ever-changing human body.  And….oh this guy loves him some of him. Oh my goodness. If someone likes to look in the mirror every morning, it’s probably this guy. Now, he’s selling his unique brand of BS to others. He’s doing a good job of it too. He’s got sycophants all over now learning how to shuttle them out of the office without having to speak to them. 

They’re in the comments section of this post proclaiming him a rock star! BS. Rock on! I can’t wait to do this when I get out of school! You’re an inspiration. How awesome!!! Blahditty freaking blah. BS, BS, BS. I would comment, “What an embarrassment to our chiropractic community! What a fool! What about exercise and rehab? What about quality over quantity? You give our profession a bad name. You’re one of the reasons we have zero cultural authority and can’t pass a bill in the legislature because you and your followers are irresponsible!!!”  You know….things like that.  Now, I’ve been asked why I talk bad about other chiropractors.

Running them down and such. I don’t call it that at all. I call it policing our own and calling out BS when it’s right under your nose. I don’t know about you but I don’t want BS under my nose. It stinks. And not only can I smell it, but everyone else I come into contact with smells it as well. So, basically, these people’s actions reflect on me, my business, and my livelihood. And yours as well. So if you’ve been going along to get along thinking it doesn’t matter, it does matter. It matters to your bottom line. 

Can you imagine if we were to have more cultural authority and more integration into a regular healthcare protocol…..can you imagine how full our offices would be? Low back pain is the number one reason for disability globally folks. Yet we only see 10% of the damn population. It’s obvious why and the Palmer Gallup poll laid it out. The biggest reason people don’t go to chiropractors is because they don’t freaking trust us. Because of fools like this.  Lots of high volume clinics like this slay subluxations non-stop for weeks and weeks. Some see people every week for life. Think about a self-adjuster. The more they did it, the easier it got to the point they created instability in their neck, they have consistent chronic pain, and now they’re a mess.

Can we see this happen in patients that are adjusted too often for too long? Of course we can!!  These spine whipering TORs are many times creating instability and causing chronic pain. Which is the damn thing the knuckleheads are supposed to be treating in the first place. But they were too lazy to get educated beyond college and some continuing education each year about proper documentation and how to adjust an elbow.  What if they have a hypermobile EDS patient that really needs weight training but they just keep hammering away at what they call subluxations? This is low quality garbage for people that aren’t taking the time to properly evaluate their patients in the new patient exam.  In one of his videos he says, “The patient doesn’t care about anything other than does the doctor care and can he help me?” Again, I use that doctor term exceedingly loosely. I have to just say that he is 100% wrong. Yes, patients do care about those two things but you know what else they care about?

They also care that their doctor is smart. Is on top of his game. Is making decisions in the best interest of the patient and not the clinic or the doctor’s wallet. They care about proper biomechanics so they don’t re-injure their back. They care that if they’re hyper mobile, maybe they shouldn’t be adjusted and should focus on weight training instead. They care that a slight decrease in neck curvature isn’t really the harbinger of death and disease some chiros act like it is. They want to know their doctor is making decisions on their care based on accurate diagnoses. Is making decisions on their care based on research and not philosophy. Trust me, they care about a hell of a lot more than How incredibly arrogant of this supposed doctor to think he has the only answer to what patients care about. They’re not freaking sheep with little to no thought processes.

They’re smart as hell in many cases and they absolutely care about a whole lot of stuff is missing. Saying they don’t is selling them short and it’s unfortunate that he’s going around teaching that. One more example of him being doctor-centered rather than patient-centered. “I….the doctor….knows what the patient really wants and cares about. They can’t think for themselves.” Garbage.  Of course patients don’t care about the biopsychosocial aspects of pain. They don’t even know what the hell that is. But we as professionals should absolutely know and absolutely care and leverage it to our advantage. We should know about upregulated CNS and educate patients about it. Because it matters. The question might be, “Why would people keep going back?”

Well a lot don’t but, in general the ones that do have typically had the crap scared out of them based on x-rays that usually shouldn’t have even been taken in the first place. “Looky here, loss of curvature, that is so concerning. I’m really worried about this and what it means for your future if we don’t get that fixed. That’ll be 58 visits this year at a cost of $4800. That’ll be upfront and here’s the contract to hold you to it.”  Predatory, unbelievably unethical, astoundingly unprofessional, and embarrassing.  Fro every patient referred to a clinic like this, I’d guess they lose one that thinks they and every other chiropractor on the planet is insane.

Thank you vitalists. I really appreciate it. So much. thank you.  Clinics like this only see their successes. So they think they’re amazing. I’ll be honest, I see A LOT of patients coming to see me from practices like this because patients can’t stand being shuttled through like cattle, not being listened to, feeling that the care is substandard, being scared by the doctor into treatment, being scared into contracts, and things of that sor They feel taken advantage of and they don’t like it. And I don’t blame them. I just appreciate them for giving me a chance to show them that the majority of chiropractors don’t engage in foolish crap.

That we can play an integral part in resolving their pain. I have heard the most embarrassing stories about chiropractors from patients that escaped clinics like this. A chiropractor can still focus on subluxations but do it in an evidence based, patient-cantered way. Wanna help more people? Hire more docs to handle that patient load and be able to have the time it takes to spend with the patients to do a proper job. Serve more people.  Just hire more people to do it. I just want better from this guy and people like him. I want a standard in our profession. I want more from our profession. I want to have a conversation with someone in the medical field or someone that knows very little about chiropractic and not feel the need to apologize for guys like this.

He’s clearly a talented guy and a leader on some level. I just wish the talent was more focused on evidence-based, patient-centered endeavors. Basically, I don’t have a problem with people practicing under the subluxation model when they’re not advising against vaccines. We didn’t learn enough about them to be a damn authority on it. Stay out of the conversation either direction. It is not ours to have. Can you imagine telling a mother not to get a baby vaccinated and then the baby gets measles? Steer clear of that conversation.  Anyway, I don’t mind people practicing that model. At the end of the day, we are all moving bones. The adjustment is the cornerstone of my practice but it’s only a piece of my practice. IT’s not the end-all-be-all. IT’s a puzzle piece but the piece is the biggest piece of my puzzle and it’s right in the center of the puzzle. Nothing more nothing less.

It’s not spiritual. It’s just a really big, very effective tool I have.  My issue is the thought that a thorough and comprehensive exam is not necessary. That connecting with patients is not important. That talking with them, answering their silly questions, and educating them is not important.  It all is very important and all of it, like it or not, takes time. It just does and time is a constant we must all contend with and work within the contraints of.  So….that’s me, folks. Raw. And mostly censored because trust me, I cuss like a sailor when I’m not on this podcast. I could make this discussion so much more colorful and it’s deserving of the cuss words.  I know many of you know this guy and you think he’s the bees knees and you’ll probably tune out here and think I’m just an awful person because

I’m talking this way about him but here’s the deal, we cannot let quackery and foolishness not only permeat what should be an evidence-based, patient-centered healthcare discipline…..but it is pervasive. Not only is it permeating, but it’s pervasive. You don’t have to look far to find a sycophant.  I have 34 nutual friends with this knucklehead afterall. What more do I need to say? So, more akin to the medical field, we should recognize BS, we should call it out, and we should educate against it. And that’s what I’m doing. Every week.  It’s not the subluxation-based thing that gets me. I’m used to that. It’s the culture around it that is insane.

Don’t vaccinate, as long as you stay adjusted, don’t worry about COVID, or any other disease, I say a knucklehead guru in school telling me adjstements pushed cancer out of guy’s body. Come on, man. When New Mexico had a shortage of practitioners and allowed chirorpactors to go to two extra years of education to get an advanced practitioner certificate to help prescribe and help handle the patient load, you know who showed up to testify against their own colleagues? Vitalist, subluxation-based, crazy-eyed imbecile chiropractors holding on to green books, the words of BJ, and a philosophy created in the late 1800’s.

Yeah, great look folks.  You know who is against the ACA’s push for Medicare parity? Yeah, not just the usual suspects like the AMA. Nope, hell, the AMA’s best teamates against chiropractic are the vitalists. Yeah, I’ve seen the sychophants of Matthew McCoy railing against us being treated equally under Medicare. Explain that for me….someone….please explain that.  Again, it’s not the subluxation. I don’t personally use or care for that word or philosophy but that’s not it. IT’s the insane leaders of that cult and the culture surrounding it that makes me want to punt baby bunnies into the damn stratosphere.  So, if you’re a subluxation person, my beef is not with you as long as you’re not scaring and taking advantage of your patients. As long as you’re not telling them to see you 80 times this year to keep them healthy and all that. I have no beef with you. 

Especially if you’re a Christian. Telling a patient that they were made imperfectly by a God you put every bit of your faith in makes no sense. at all. Y’all I’m a Christian. God makes no mistakes. He didn’t put us on Earth imperfect and in need of a chiropractor every week of our lives or be a miserable wreck of a person just waiting around on death’s doorstep. What a foolish concept for the faith-based models out there. The Body By God group. It’s silly. Sure be faitful, no problem there. But don’t tell people that they need you.

Otherwise, God can’t express himself fully without you. Yes, that is one of their talking points in case you were wondering. Insanity.  Current guides tell us to use spinal manipulative therapy for movement dysfunction, use exercise and rehabilitation, use low level laser, use heat, yoga, acupuncture, and soft tissue manual therapy, use balance and proprioceptive training as well. These are all ways of leveraging modalities to great effect in resolving pain. They also teach us to NOT create dependency in the patient upon us.

They shouldn’t depend on us. We should be teaching them ways to self manage ongoing pain at home and see them for periodic flare-ups.  That’s evidence-based and that’s patient-centered. 180 degrees opposite of what this practice I’m speaking about is doing.  There are so many amazing chiropractors in the world that have raised their games to such a level that they can command respect and money for their opinions and treatment. Then…..there just aren’t. They’re educationally lazy but they can sure talk a great game.  I’d like to see eveyrone raising the level. Raising the standard and taking this profession into an era of growth, progress, and respect. 

Item #1

It’s called “The disappearance of the primary care physical examination – losing touch” by Dr. Paul Hyman(Hyman P 2020), and MD and it was published in JAMA on August 24, 2020.  Damn the sizzle!!

It’s an article so high points we will hit upon He starts out by asking, “What is a physica examination worth?” He says he’s noticed that physical exams seem to be falling by the wayside in recent years and that fact has been highlighted for him since looking at the daily schedule and determining which will be see face to face in the days of COVID.  He says that an exam is clearly needed at times for a diagnosis but that he’s realizing other ways he commonly uses exams as well. He says it is a means through which he pauses and physically connects with patients. It’s a way to demonstrate his knowledge and authority to the patient.

He says it’s also a chance to persuade patients and reevaluate their narrative.  On the part about demostrating your knowledge, what are you demonstrating when you do a minimal, piss ant exam? Whether you know it or not, you may be demonstrating your lack of knowledge, right? Especially when that patient has had enough of your crap and goes to someone that knows what they’re doing. When the patients say, “This is awesome! The other chiropractor didn’t do any of this,” well, we have a pretty good idea of where you’ve been before getting to us.  He goes on to say, “When patients and I disagree on a plan, the physical examination not only provides data, it also acts as an arbiter.” 

He makes an excellent point here when he says, “In an admission of my own insecurity, the physical examination remains one of the few domains where I maintain a sense of professional skill and authority. I have never been much of a proceduralist. The mainstay of what I offer to patients is the ability to listen to them, to use critical thinking skills, and to offer my knowledge and experience. But those skills are sometimes challenged in a world where patients research their own health and develop their own medical narratives.

The physical examination remains a place where I offer something of distinct value that is appreciated.” You cannot make a difference in patients’ lives when you don’t know what the hell is wrong with them because you didn’t have the knowledge it takes to be accurate or because you only took 10 minutes to examine them.  CHIROUP ADVERTISEMENT

Item #2

This second item is called “Chiropractic, one big unhappy family: better together or apart?” by Leboeuf-Yde et. al. (Leboeuf-Yde C 2020) from February 2019 and published in Chirorpactic and Manual Therapies. 

Again, it’s an article so hittin the high spots.  They say that the profession has a long history of internal conflict. Today, the division is between the ‘evidence-friendly’ faction that focuses on musculoskeletal problems based on a contemporary and evidence-based paradigm, and the ‘traditional’ group that subscribes to concepts such as ‘subluxation’ and the spine as the centre of good health. This difference is becoming increasingly obvious and problematic from both within and outside of the profession in light of the general acceptance of evidence-based practice as the basis for health care. They argue here that the situation within the chiropractic profession corresponds very much to that of an unhappy couple that stays together for reasons that are unconnected with love or even mutual respect.  We also contend that the profession could be conceptualised as existing on a spectrum with the ‘evidence-friendly’ and the ‘traditional’ groups inhabiting the end points, with the majority of chiropractors in the middle. I personally call the ones in the middle agnostics.

They take a little subluxation/innate talk to heart but think evidence-based is the way to go but are not motivated about learning any of the evidence and research. Or just don’t know where to go to find it.  They say this middle group does not appear to be greatly concerned with either faction and seems comfortable taking an approach of ‘you never know who and what will respond to spinal manipulation’. We believe that this ‘silent majority’ makes it possible for groups of chiropractors to practice outside the logical framework of today’s scientific concepts. In their conclusion they say, “There is a need to pause and consider if the many reasons for disharmony within the chiropractic profession are, in fact, irreconcilable. It is time to openly debate the issue of a professional split by engaging in formal and courageous discussions.

This item should be prioritised on the agendas of national associations, conferences, teaching institutions, and licensing/registration as well as accreditation bodies. However, for this to happen, the middle group of chiropractors will have to become engaged and consider the benefits and risks of respectively staying together or breaking up.” No matter where you stand on it, it’s though-provoking and I’m sure to find email inbox filling. Lol.

I’m sure I get plenty of hate mail on this episode but I’ll get a lot of support as well. I cannot simply sit by and see BS and sweep it up under the rug. We have to meet it and stand boldly in front of it, and turn it away. For the betterment of ourselves, our profession, and our patients. 

 

Alright, that’s it.

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website http://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

  • Hyman P (2020). “The Disappearance of the Primary Care Physical Examination—Losing Touch.” JAMA Internal Med 180(11): 1417-1418.
  • Leboeuf-Yde C, I. S., Young K, Kauchuk G, Hartvigsen J, (2020). “Chiropractic, one big unhappy family: better together or apart?” Chiropr Man Therap 27(4).      

Chiropractic Integration Into A Medical Setting

CF 151: Chiropractic Integration Into A Medical Setting Today we’re going to talk about chiropractic integration into a medical setting But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research.

We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #151 Now if you missed last week’s episode , we talked about the fate of a big pharma company and we talked about the outdated use of MRI diagnosis of cervical dysfunction. That’s not necessarily the way to do it anymore in 2020. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function

On the personal end of things…..

Well….how’s your week? Mine? It’s just eh… If you listened to a couple of weeks ago, I had a big week with some good numbers that looked like we were getting back to pre-COVID numbers. I was sniffing that level once again. Then, a three-day snow and ice storm decided that things were going a little bit too smoothly around here and shut us down for basically Monday, Tuesday, and Wednesday of last week. 

As a result, we went from 172 visits the week prior down to last week only seeing 71. So….roughly 100 visits just pissed off last week. Which left me pissed off. It’s been a mess this year and I’m no different than most. For that reason, I’m not going to sit here and gripe about it. We’re back in the ’70s this week so here’s to trying to reclaim those lost appointments and keeping our patients on track to getting better. 

Where we started the great week with 50+ patients on a Monday, this Monday we’re starting out the week with 26. Blah. But 4 new patients so, let’s hang our hats on the good stuff, shall we? And yes, we shall. 

This has absolutely been the year of making lemonade out of lemons. If you’re not strong mentally, this year is a bruiser, man. And let’s be honest, I’ve had ups and downs. I’m still having them. 

Hell, this week, as in many places, now that it’s time to rebuild after three lost days to weather, now the second COVID spike is in full swing. Yep, a bad day around here used to be 70 new cases. It was that way for 6 months or more. Now, in the last 2 weeks, we’re looking at averaging 240 or more cases per day. The hospitals are full and they’re bringing help in from out of town. I could let that work my head over but I won’t. Or…..at least I’ll try not to let it work me over. 

Have you ever watched The Secret? I sort of recommend it if you can absorb things in the right context. OR, I can just summarize it for you. Basically, it’s all about having a vision so strong that you basically will something to happen. If you believe it enough, the world will bend itself to make it happen for you. For example, from the movie, if you believe that there will always be a close parking spot available for you when you go shopping at different places, then you will indeed find close and wide-open parking spots. 

Or, if you really want a Ferrari, and you dream about it, feel yourself sitting in the seat, and feel the rev of the engine while you grip the steering wheel, etc….well, then surely, eventually you will indeed have yourself a Ferrari. Lol. 

Well, if you listen to this podcast enough, then you know damned well that I don’t buy into that kind of garbage. But there is a message in it that I do like and support. That message is that our lives are built on and based on our ability to be positive or negative basically.

I have an example from today for you. On the way to work this morning, not 2 blocks from my house, I almost got into 3 car wrecks within a time span of about 2 minutes. Seriously. At one point I had to stand on my brakes and throw everything into the floorboards. This while I was simultaneously yelling and hollering at this fool stopped in front of me. 

I could go into particulars on how it happened but that wouldn’t matter. What matters is that at that point in my day, I made a conscious decision. Was I going to let that ruin my day or was I going to see it for what it was and move on from it?

In The Secret, they say that our mentality from day to day affects our relationships with others. From our business interactions to our personal and family interactions. And it’s true. If you extrapolate that further, our mentality will either draw people TO us or push them AWAY from us. 

So, if I let that close encounter affect my mood from there on throughout the day, potentially, whether I was conscious of it or not, it could have affected my interactions with patients, staff, and then later at home. 

Alternatively, if I kick it out of my head and try to have a positive take on it….I didn’t get in a wreck after all!!! It could have been worse, right? 

That was my decision and I decided that it was over and I’m going to forget about it, not dwell on it, not be mad about it, and just move forward. 

On a larger scale, while I talk and share a lot about my business’s progress post-COVID here, for the most part, I’ve tried to adopt the ‘can do’ attitude. My generation Gen X is known for it. It is what it is. Let’s put on a smile, strap up our belts, and put one foot in front of the other. 

And that’s what’s making it happen here. We’re like Rocky in Rocky III. Clubber COVID Lang keeps slapping me around and punching me in the nose and when it’s not Clubber, it’s Thunder Lips throwing me out of the ring. Lol. Sometimes it’s like you just can’t win. And if you dwell on that crap, well, you know what happens. It affects everything you do and all of your connections. 

So, if Clubber Lang and Thunder Lips keep kicking your ass every week, put a smile on, stay doggedly determined, and come out swinging. All of this crap has a time limit. It will end eventually. Make sure you’re on top of the heap when it does.  Everyone loves an underdog. 

Item #1 First one of the day is called “Implementation of musculoskeletal specialists in the emergency department at a level A1 VA hospital during the SARS-Cov-2 pandemic” by Schielke et. al(Schielke A 2020). and published in The American Journal of Emergency Medicine on October 8, 2020,

Schiza….piping hot pile of poblanos!!

https://www.ajemjournal.com/article/S0735-6757(20)30894-9/fulltext?fbclid=IwAR1MFEaKmyTj990CjD3URlQP7Tnu45OSqsySUyQ7WZKmgcwxDP3RAnBSBQw

It’s not a research paper as much as an article so let’s get going with the highspots. 

  • They mention how the Rona depleted ER resources about the same time that pain management was deemed to be non-essential
  • They say that low back pain presenting in the ER has become more and more common and less traditional providers may be better suited to manage musculoskeletal pain. 
  • Bolstering the idea of alternative providers being involved, are the more current guidelines recommending nonpharmacologic treatment for low back pain. At least initially. 
  • Early conservative management for ED LBP has been associated with reduced pain and disability even when compared to patients with conservative outpatient physical therapy referrals
  • Multiple studies point out integrated ED MSK-specialist (MSK-S) reduced length of stay, imaging utilization, and opioid administration rates, and improved overall ED metrics when compared to patients seen by typical ED providers
  • Additionally, a 2018 systematic review and meta-analysis supports nonpharmacologic interventions for reduction of overall ED utilization and length of stay, and are effective in reducing pain in the ED with the potential to improve patient satisfaction, outcomes, and quality of life
  • VA Palo Alto Health Care System (VAPAHCS) 2019 proprietary data revealed approximately 60% of cases presenting to the ED were urgent/emergent MSK complaints, primarily LBP
  • As the health department postponed non-essential healthcare due to COVID, the plan to integrate non-traditional providers was amped up and happened on March 30, 2020, lasting through June 8th. 
  • Designated MSK-S care was provided during peak hours by chiropractic and physical therapy departments.
  • A “hub-and-spoke” arrangement was developed and per protocol, initial ED triage assessed for any serious spinal pathology, and a medical symptom evaluation was performed (“hub”). If diagnosed as MSK LBP, MSK-S referral was made with direct same-day hand-off (“spoke”).
  • Incorporation of MSK-S was shown, anecdotally, to be effective in treating acute MSK complaints as providers and patients were both able to benefit from the conservative options available in the ED
  • From the ED administration viewpoint, a liaison between ED and other sub-specialties utilizing a hub-and-spoke paradigm shift allows for the delivery of more efficient healthcare. With the positive feedback from the administration, ED providers, staff, and patients, integrated MSK-S clinics continue to develop within that VA system.
  • A 2018 review article by Kim et al. called for the use of an MSK-S in the ED and also provided clinical implementation guidance for any healthcare systems looking to adopt a similar practice.

Wow!! That’s pretty cool. Do you know what I did with this? I sent it to my friends in the medical field. Why not? The worst saying in the history of man is “We’ve just always done it that way.” What if there’s a better way? Of course, we know there is. The trick is in getting them to know there is. 

Item #2 Our last one today is called “Integration of Doctors of Chiropractic Into Private Sector Health Care Facilities in the United States: A Descriptive Survey” by Salsbury, et. al`. and published in the Journal of Manipulative Physiological Therapeutics in February of 2018. Not new but pairs well with our first item. 

Why They Did It The purpose of this study was to describe the demographic, facility, and practice characteristics of doctors of chiropractic (DCs) working in private sector health care settings in the United States.

How They Did It

  • They conducted an online, cross-sectional survey using a purposive sample of DCs working in integrated health care facilities. 
  • The 36-item survey collected demographic, facility, chiropractic, and interdisciplinary practice characteristics, which were analyzed with descriptive statistics.

What They Found

  • The response rate was 76%
  • Doctors of chiropractic reported working in hospitals (40%)
  • multispecialty offices (21%),
  • ambulatory clinics (16%)
  • or other (21%) health care settings
  • Most (68%) were employees and received a salary
  • More than 60% reported co-management of patients with medical professionals.
  • Integrated DCs most often received and made referrals to primary care, physical medicine, pain medicine, orthopedics, and physical or occupational therapy
  • Although in many facilities the DCs were exclusive providers of spinal manipulation (43%), in most, manipulative therapies also were delivered by physical therapists and osteopathic or medical physicians.

Wrap It Up

Doctors of chiropractic are working in diverse medical settings within the private sector, in close proximity and collaboration with many provider types, suggesting a diverse role for chiropractors within conventional health care facilities. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourself and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

Connect

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

Website http://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

  • Schielke A, B. A., Walsh R, Rajagopal P, (2020). “Implementation of musculoskeletal specialists in the emergency department at a level A1 VA Hospital during the SARS-CoV-2 pandemic.” American J Emerg Med.

Preventable Disease And the Impact & Whole Body Vibration For Function and Bone Density

CF 149: Preventable Disease And the Impact & Whole Body Vibration For Function and Bone Density Today we’re going to talk about the costs of preventable disease and then we’ll talk about whole body vibration for function and bone mineral density in postmenopausal, osteoporotic women.   But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #149 Now if you missed last week’s episode , we talked about manipulation for concussion, sleep and cognitive decline, and we talked aobut demential predictors and prevention. Super interesting stuff. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function On the personal end of things….. We were busier last week. If you’ve listened for very long, I’ve tried to be open and honest about my numbers each week so that listeners will know where they stand. They’re either doing better or they’re doing about the same. Some will be doing worse. Either way, maybe I can be a measuring stick of some sort.  The best I have done since COVID reared it’s stupid face is 145 visits in one week. That’s down from an average of 182 per week in 2019. So, that’s quite a difference. I keep immacualte stats so I know that in 2020, I have averaged 117 per week but that includes when we were closed and then when we were emergency only.  Since we finally got up and running full steam back in May, I have averaged 136 per week. That puts me at about 75% of my pre-COVID point. So, I just need to average about 46 more visits per week to get back to 100%. No big deal right? Lol. That’s a solid jump but I’m a do-er and I have positive energy and a healthy amount of confidence.  And, we got a good start last week. Last week for the first time, I beat the 145 mark that I had been limited to and saw 158. Just in time for the Rona to start surging back and freaking people out again. Lol. Such is my luck. We shall keep trudging, keep being smart, and keep doing what we can to stay healthy.  If it all works out, we should be back to 100% by the end of the year. That’s my goal at least. As I type this out, we have 48 on the books today which is about 10-12 more than we’ve been seeing on Mondays. So things are looking up.  Be safe folks, we’re not out of the crap yet. In fact, as of the time I’m typing this, it’s worse than it has been for a while. Just keep being safe, keep working, and do what you can to take care or yourself and those around you.  Item #1 The first one we’re going to talk about today is called, “The cost of preventable disease in the USA” by Galea, et. al(Galea S 2020). published in The Lancet on October 1, 2020. Aye chiuaua. es too mucho caliente.  https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30204-8/fulltext?fbclid=IwAR3VMx1p1cZZTdT9o3_b6GkgSzfbImiOPPKLJFElqMKaHN5Vi-3OpkqwDTg This is more article and discussion so as usual when we cover stuff like this, we’ll just hit the high points and summarize it for you.  They start by stating that a substantial proportion of poor health in populations is preventable and cite the Global Burden of Diseases, INjuries, and Risk FActors Study that suggests nearly half of all health burdern in the US is attributable to a list of 84 modifiable risk factors.  They say that globally, up to half of all deaths fall into the category of preventable deaths. They estimate that more than 1/4 of health-care spending was due to these preventable illnesses. Not only that but the US heatlhcare spending is notoriously expensive spending 16.9% of its GDP on healthcare which is TWICE as much as the average of other similar countries.  In fact, our spending is mroe than the 2019 GDP of 171 coutnries in the world. All but the 19 wealthiest.  They ask a wonderful question, “Why do we continue to accept such a high burden of preventable disease, even when the cost of it is known?” Great question. Especially when you’re looking at it from a chiropractor’s point of view. Fusion surgeries run around $50,000 each, are basically useless, and put the patient at signficant risk of additional, expensive surgery. Epidural injections are useless as well. We have plenty of studies showing how we save money and cost much less than traditional medical care for back pain. We have surveys and research showing that our patient outcomes and satisfaction are superior to PT and general practitoners. We have the American College of Physicians, The Joint Commission, and The Lancet recommending spinal manipulation and exercise as first-line treatments. Yet, we are not inundated with referrals for chronic and acute low back pain.  We should be absolutely flooded with referrals. We should be emptying out lobbies of furniture so we have more room in the corner to put a new referral. But nope. Hell no. My opinion is because we have vitalist chiropractors trying to convince patients they have to see them every week for the rest of ever…..as long as ye shall live….forever and ever amen. Taking x-rays and convincing them they’re going to die if they don’t fix that decreased curvature. Telling patients they’re going to pop their back and fix their gall bladder issue.  THAT’S why we can’t have nice things. You have these evidence-based, patient-centered chiropractors over here going, “What they hell? We can help these people so much!” But we’ll never get the chance because vitalists don’t know how to stay in their lane. To be fair, they were taught their lane was much larger than research suggests it is. We do what we’re taught. The difference is, some of us are better at smelling BS than others.  Too many chiropractors have a stopped up nose and can’t seem to smell very well. Which is unfortunate.  Back to the article, they say, “The high burden and cost of preventable disease should push us to think differently about health at a foundational level.” And to that I say, “Indeed, Sir.” They also say that we should embrace the notion that no amoutn of preventable death or illness is acceptable and that about $730 billion could be repurposed. Like to pay our debt…..just a suggestion.  They conclude by saying, “high body-mass index, high systolic blood pressure, high fasting plasma glucose, dietary risks, and tobacco smoke exposure account for most of the spending on preventable illness.  Preventing these risk factors would require an engagement with subsidising the availability of nutritious foods, disincentivising the commercial production of harmful products, investing in early childhood education that leads to healthy exercise and dietary habits, and creating cities that encourage healthy behaviours.” For example, why does healthy food cost more than garbage food? That’s exactly reverse of what it should be. If we really care about lower socioeconomic folks and you want to fight for universal healthcare and things of that sort, wouldn’t it make sense to protest stuff like that? Why aren’t we seeing picket lines outside of Tyson food factories or in front of grocery stores. They could be carrying signs that say, “Stop keeping our poor fat” or “make healthy affordable” or stuff like that. I’ll keep watching the TV. I’m not holding my breath though. Making healthy food affordable isn’t quite as sexy as all of the other reasons people are finding to stay outraged these days.  Don’t get me wrong, I’m not making light of peaceful and respectful protest. That’s what Amercia is built on. I’m less understanding of the destruction, riots, and death that have come with so many of the more recent activities.  Anyway, it’s a great article and I’ve linked it in the show notes at chiropracticforward.com if you’d like to go a little further in depth in the thing. Chiropractors can help this issue though. The research is there. They just have to start giving it a try. I think they’d be surprised with the results. Unless they referred to a vitalist. Then, when the patient reported back to the MD, the MD would probably never make another referral to a chiropractor as long as they lived once they realize that their referral made them look like an idiot. Just a guess.  CHIROUP ADVERTISEMENT Item #2 This one is called “Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal Women With Osteoporosis: A Randomized Controlled Trial” by ElDeeb, et. al(ElDeeb A 2020). published in the Journal of Manipulative and Physiological Therapeutics in May of 2020…..eh….it’s not fresh from the fire but it’s still steaming out of the microwave.  https://www.jmptonline.org/article/S0161-4754(20)30044-0/fulltext Why They Did It To investigate the effect of whole-body vibration (WBV) on muscle work and bone mineral density (BMD) of the lumbar vertebrae and femur in postmenopausal women. How They Did It
  • 43 postmenopausal women with low bone mineral density
  • randomly assigned to WBV and control groups
  • Both groups got calcium and Vit D supplementation once per day
  • The WBV group additionally got WBV exercises 2x/week for 24 weeks
  • Hip power generation and absorption, knee power absorption and generation, ankle power generation adn absoprtion were all measured. 
  • Dual-energy X-ray absorptiometry was used to measure bone mineral density of the lumbar spine and femor before and after intervention
What They Found
  • There were significant increases in the hip muscle work, knee muscle work, ankle musle work during gait in the WBV group.
  • Bone mineral densityof the lumbar spine and femur were significantly increased in the WBV group. 
  • However, there were no significant changes in teh control group 
  • The posttreatment values of the hip, knee, and ankle muscle work and the bone mineral density of the WBV group were significantly higher htan the posttreatment values of the control group. 
Wrap It Up The conclusion states, “Whole-body vibration training improved the leg muscle work and lumbar and femoral bone mineral density in postmenopausal women with low bone mineral density.” Pretty interesting stuff, folks. Is this definitive proof? No. The sample size is small but it is randomized which is good. Would I advertise that I’m going to increase osteoporotic BMC? Nope. If my mom had osteoporosis, would I have her on the WBV? You bet your sweet bippy I would.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography
  • ElDeeb A, A.-A. A. (2020). “Effect of Whole-Body Vibration Exercise on Power Profile and Bone Mineral Density in Postmenopausal Women With Osteoporosis: A Randomized Controlled Trial.” J Manipulative Physiol Ther 43(4): P384-393.
  • Galea S, M. N. (2020). “The cost of preventable disease in the USA.” The Lancet 5(10): E513-E514.

Manipulation For Concussion, Sleep And Cognitive Decline, & Dementia Predictors And Prevention

CF 148: Manipulation For Concussion, Sleep And Cognitive Decline, & Dementia Predictors And Prevention

Today we’re going to talk about manipulation and concussion, sleep and cognitive decline, dementia predictors and prevention. 

But first, here’s that sweet sweet bumper music

Subscribe button 

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

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

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

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

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

Do it do it do it. 

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

 

You have found yourself smack dab in the middle of Episode #148

Now if you missed last week’s episode , we were joined by Dr. Katie Pohlman, head of research at Parker University and the ACA Researcher of the Year for 2020. That right there is enough for you to just go and listen I think. What a great person and professional to have on our team. Make sure you don’t miss that info. Keep up with the class. 

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

On the personal end of things…..

On the personal side of things, it’s still looking up. I’m back to about 140-145/week. We started this Monday off with 7 new patients and 4 re-exams. As of right now, I’m writing this on a Monday. We already have 143 scheduled this week and that without today’s patients being all set up for Wednesday and Wednesday’s patients be re-booked on Friday so I’m looking to definitely have an up-week this week. 

If you listen regularly, I was at about 185-220 per week prior to COVID so, maybe we can make some strides this week toward getting back to some of the big numbers again. Maybe maybe. Fingers crossed. 

How are your numbers? I asked in our private group and will try to remember to share with you in next week’s episode. With me still being at about 80% or so, I’m curious if my experience is normal or not. If you want to jump into the private Chiropractic Forward group and comment on the thread, that’d be great or send me an email at dr.williams@chiropracticforward.com Either works just fine. 

Here’s a preview of something I’m working on. Many don’t know this but there was a big blow up at the World Federation of Chiropractic starting with the conference last year in Berlin. Now, just a month or so ago, several of the biggest baddest researchers we have in our profession left the WFC research committee and from an outsider looking in, it appears to be due to pressure from the ICA and the WFC sponsors. Sponsors that we evidence-based chiropractors use and sponsors that our money and business has given some teeth to. On the surface, it seems we have given them teeth to embolden the ICA and bully our top researchers. 

So, my goal is to compile as much information as I can in order to present what happened and why. I want to present it in a fair and well-balanced way looking only for the truth on the matter. I want to know which makes me suspect that you want to know as well. 

Everyone in the know has remained very hush hush on the matter and, if this is the vitalist side organizing sponsors that we use as well to bully the research community, then I want to know who I need to be doing business with and which businesses I may choose to find an alternative to. 

Be looking for that coming down the pike. I’m not trying to shake up the chiro world. I just want to know what happened and I may reconsider doing business with the businesses that made it happen. Because, again, on the surface, it seems our points of view on how the profession should proceed into the future are not in alignment. No pun intended. 

Outside of that, still so far so good around here. Just being smart and trying to stay healthy. Hell, I’m healthier now than I think I’ve ever been. I went back on Weight Watchers. It’s a program I was on about 8 years ago. I lost about 45-50 pounds without really much effort. I swore to the almighty I’d never put that weight back on again. Well…..I did. Lol. 

So, I’m back on the struggle bus but honestly, it’s not that bad. The program always made so much sense to me. It just teaches you how to eat what you’re surrounded by every day. Including fast food even. If you’re not familiar, based on height and weight, you’re assigned a point value. You’re allowed a certain number of points per day and overage points per week should you exceed those points. 

At the same time, foods are assigned point values and, once you are familiar with how much foods count against your daily points, you are able to make educated choices as to what is OK to eat and what just isn’t really worth eating. 

It’s a simple concept and I have to say, it works like crazy. I’ve lost over 15 pounds in about 3 weeks or so. 

Here’s to the next 45!!! Dammit. 

Alright, let’s get on with it this week. 

Item #1

This first one is called “Effectiveness of Osteopathic Manipulative Medicine vs Concussion Education in Treating Student Athletes With Acute Concussion Symptoms” by Yao et. al(Yao S 2020)., published in Journal of the American Osteopathic Association on August 7, 2020. Hot hot hot, it’s a lot hot! 

Why They Did It

The authors say that “current treatment options are limited and difficult to individualize. Osteopathic manipulative medicine (OMM) can aid musculoskeletal restrictions that can potentially improve concussion symptoms. Get that, they didn’t even say that they want to determine if it helps. They just straight up say osteopaths can help. Dammit. Chiropractors have to be more diplomatic in their research abstracts. 

As far as their objectives, more specifically, they said, “To assess concussion symptom number and severity in participants with concussion who received either OMM or an educational intervention.”

How They Did It

  • It was a randomized controlled trial 
  • Conducted at the New York Institute of Technology
  • Patients had concussion-like symptoms due to recent head injury within the previous 7 days
  • They were split randomly into two groups
  • One got manipulative therapy
  • The other group got concussion education intervention
  • They were assessed before and after with the Symptom Concussion Assessment Tool fifth edition

What They Found

  • 30 paticipants
  • The manipulation  group had significant decrease in symptom number and symptom severity compared with the concussion group

Wrap It Up

When used in the acute setting, OMM significantly decreased concussion symptom number and severity  compared with concussion education. This study demonstrates that integration of OMM using a physical examination-guided, individualized approach is safe and effective in the management of new-onset symptoms of uncomplicated concussions.

So let me just say this. Why in the H E double Hockey sticks does Osteopathic manipulation somehow trump chiropractic manipulation? Here’s your answer. It doesn’t if you see research validating osteo manipulation, then you just saw research validating chiropractic manipulation. Just because they got their outliers in line in a way that chiropractic has never even tried to do itself, doesn’t make their manipulation superior. At all. 

Adjusting Disc Herniations and Bulges

 

Item #2

This one is called “Association Between Sleep Duration and Cognitive Decline” by Ma, et. al(Ma Y 2020). and published in JAMA on September 21, 2020. My glasses just steamed up when I read that….because it’s that hot. 

Why They Did It

They wanted to answer the question, “What is the association between sleep duration and cognitive decline in the general aging population?”

How They Did It

  • This was a pooled cohort study 
  • Participants were 2 randomly enrolled cohorts comprising 28,756 individuals living in England and China
  • 50 years or older for the English
  • 45 years or older for the Chinese
  • Self-reported sleep duration per night according tro face-to-face interviews
  • Global cognitive z scores were calculatied 

Wrap It Up

They concluded that “an inverted U-shaped association between sleep duration and global cognitive decline was found, indicating that cognitive function should be monitored in individuals with insufficient (≤4 hours per night) or excessive (≥10 hours per night) sleep duration.” 

Item #3

This one is short, it’s an article in JAMA called “Nearly Half of Dementia Cases Could Be Prevented or Delayed” by Bridget Kuehn, published in JAMA on September 15, 2020. Fresh, sizzlin suckatash. 

Why They Did It

Basically, on this article, they’re covering the fact that there was a report in The Lancet back in 2017 identifying 9 preventable risk factors for dementia. They were….and still are:

  • Having little or no education
  • Hypertension
  • Untreated hearing impairment
  • Smoking
  • Obesity
  • Depression
  • Physical inactivity
  • Diabetes
  • Low social contact

This article is basically an update saying the emerging evidence suggests there are 3 more preventable dementia risk factors. They are:

  1. Head injuries
  2. Excessive alcohol consumption in midlife
  3. Air pollution exposure later in life. 

Some of the recommended steps to prevent dementia are as follows:

  • countries should provide primary and elementary education for all children,
  • take steps to prevent obesity and diabetes,
  • reduce air pollution 
  • reduce secondhand smoke exposure. 
  • programs to prevent people starting smoking, 
  • Prevent or treat hearing loss, and 
  • prevent head injuries,
  • encourage hearing aid use and smoking cessation. 
  • maintaining systolic blood pressure of 130 mm Hg or lower in midlife, 
  • limiting alcohol to fewer than 21 servings per week, and 
  • maintaining an active lifestyle.

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

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

 

 

Store

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

 

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Ma Y, L. L., Zheng F, (2020). “Association Between Sleep Duration and Cognitive Decline.” JAMA Open 3(9).

Yao S, Z. H., Angelo N, Leder A, Mancini J, (2020). “Effectiveness of Osteopathic Manipulative Medicine vs Concussion Education in Treating Student Athletes With Acute Concussion Symptoms.” J Am Osteopth Assoc

w/ Dr. Katie Pohlman – New Research, Upcoming Research, And the Need For It All

CF 147 w/ Dr. Katie Pohlman – New Research, Upcoming Research, And the Need For It All

Today we’re going to be joined by the one and only, research extraordinaire , Dr. Katie Pohlman. We’re going to talk about all kinds of research-related shenanigans so just you know that you are in the right place at the right time my friend.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #147.

Now if you missed last week’s episode , we talked about how chiropractic helped the VA cut opioid use among veterans and then we talked about diagnosing lumbar stenosis. Make sure you don’t miss that info. Keep up with the class. 

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

On the personal end of things…..

This week we have a guest you’ve heard me talk about plenty of times and I’m excited to have her with us so we won’t dwell on the my personal happenings too long here.   

First, we see numbers rising fairly significantly around my neck of the woods. Here in Texas, you can’t get anyone to take it seriously so we have folks walking around everywhere without a mask on. That tends to limit my interaction with people I don’t know. Of course, they’re required here in my clinic but going into a convenience store, that’s a different story. 

The last time I did that the clerk and myself were the only ones wearing them out of about 10 people. That’s a little distressing. To say the least. But, it is what it is. Darwinism is a real thing. Of course I don’t wish it on anyone and every loss is tragic. But there’s also the natural progression of Darwinism. Those that go by ‘heart’ and ‘opinion’ rather than science and self-preservation…..well, that’s a more dangerous course and I wish them all luck. In the end, regardless of how many get it, we’re looking at 98% of them coming through alright. No percentage guess on how many survive but suffer ongoing issues though. I haven’t heard numbers on that. 

Anyway, as far as the practice goes, we are clicking along and doing well. The new patient count is staying up there where it needs to be and the weekly visits will follow. Still around 145 last week though. I want to see that up around the 185 per week mark. Minimally. 

Then we can get back to paying down debt (aka school loans) and investing rather than paying the bills and surviving. Lol. lt’s good to pay the bills and survive but we should have bigger plans shouldn’t we? Investing and being debt free is key to the later part of life and it’s hard to do so when you’re down. 

Speaking of, I want to pass along some info to you guys and gals. I just finished up a book and decided I’d order 2 more off of Amazon to give out as gifts. The only other book I’ve ever done that with was one called The Easy Way To Quit Smoking by Alan Carr. I ordered several to loan out to my patients that are smokers. 

This book though was about investing. I have read financial books before but, if I’m being honest, getting into symbols and specifics and all…..it’s just not my forte. My wheelhouse exists elsewhere. Which sucks because being financially sound is key to all of our lives. 

Anyway, the book is called Quit Like A Millionaire by Kristy Shen and Bryce Leung. They’re a married couple with different last names. I don’t know. Young people these days do stuff different. Lol. Anyway, I am always skeptical about titles like that. Sure sure….quit like a millionaire. Riggghhhtttt. This book is different. When I said young people do things differently, these two really do. There are real, actionable steps here and I have to admit, even at 48 years old, I’m pretty jazzed about getting my numbers back up so I can jump in head first on some of these suggestions. 

They retired at 32 years old. She’s got the research and the numbers behind her and I’m impressed. If I can get started on it soon, I’ll talk about it and share my experiences with you as I go along. Until then, you might check her website at https://www.millennial-revolution.com/start-here/

Introduction

Enough of that, let’s get going with our guest today.  Welcome to the show, Dr. Pohlman. I appreciate you joining us today.

How are things at Parker University today?

Tell me why you became a chiropractor and then what it was that led you into the research side rather than the treatment side of the profession. 

Congratulations on being the ACA Researcher of the Year. Tell me, with all of the amazing researchers doing work in the profession right now, in your opinion, what made you the pick for the award this year. 

Let’s talk about your post at Parker University. Can you tell us about your day-to-day? For the research-minded listener out there in podcast land, what does the head of research at Parker do every day when you go into work?

I have a paper here that you were the lead author on called “Assessing Adverse Events After Chiropractic Care at a Chiropractic Teaching Clinic: An Active-Survellance Pilot Study” and published in the Journal of Manipulative and Physiological Therapeutics in August of 2020 so brand new stuff here(Pohlman K 2020). While unfamiliar with the other authors on the paper, I do recognize Dr. Greg Kawchuk. I got to see him speak last September in St. Louis at the Forward ’19 conference and wow….he’s an effective speaker to say the least. He’s a heavy hitter for sure. The stated objective here was to assess the feasibility of implementing an active-surveillance reporting system within a chiropractic teaching clinic and subsequently determining the frequency of adverse events after treatment is administered. Now pilot studies are basically the research before the research, right? So, what is down the road along these lines and why is this paper important to us?

Here is a quote from the conclusion of the paper that I think our listeners would find educational. You say, “Our preliminary findings identified that over 50% of patients had improved symptoms after a chiropractic encounter, whereas 8.9% of patients reported worsening symptoms and 5.0% reported new symptoms. Additionally, results from this study suggest that although most symptoms improve with care, there are symptoms that worsen or are new after care, which may not have been previously known to interns or practitioners.”

Another project you were an author on is called “Chiropractic Care of Adults With Postpartum-Related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review,” by yourself and Carol Ann Weiss et. al(Weiss C 2020). published again in the Journal of Manipulative and Physiological Therapeutics in again, August of 2020. It was a really busy August for you apparently! The objective of this one was to conduct a systematic review assessing the effectiveness of specific chiropractic care options commonly used for postpartum low back pain, pelvic girdle pain, or a combination of the two.  Can you lead us through the paper a little and talk about the abstract’s conclusion which says, “No treatment option was identified as having sufficient evidence to make a clear recommendation.”

The last paper I want to ask you about is one you were on that we covered way back in episode #68 and the paper was called “Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada.” It’s amazing how much wonderful research goes on in Canada, BTW. Anyway, it was published in Complementary Therapies in Clinical Practice in March of 2019(Manansala C 2019). This one was interesting to me because it highlighted the fact that spinal pain in young people has been established as a risk factor for pain later in their life. Basically, you all wanted to see how kids respond to chiropractic. I think most chiropractors find this to be obvious given our clinical observations but the conclusion of the paper was “the findings of th epresent study provide evidence that a pragmatic course of chiropractic care, including spinal manipulation, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice are a viable conservative pain management treatment option for young people.” What can you tell me about this paper? Did you learn anything new that you didn’t already know going into it?

Do you ever get tired of having a new paper come out? Is it exciting every time?

When I was at Forward ’19, I heard about a program for the first time. I had never heard of CARL before. It turns out that you are very involved. Can you tell us what it is and why it’s important?

What are you and your crew working on now? What’s coming down the line and what big questions are you hoping to get answers to?

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

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

Store

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

Chiropractic evidence-based products

Integrating Chiropractors

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.33-AM-150x55.jpg

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg

 

The Message

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

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

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

Website http://www.chiropracticforward.com

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

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

YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

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

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

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

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

Bibliography

  • Manansala C, P. S., Pohlman K, (2019). “Change in young people’s spine pain following chiropractic care at a publicly funded healthcare facility in Canada.” Complementary Therapies in Clinical Practice.
  • Pohlman K, F. M., Ndetan H, Hogg-Johnson S, Bodnar P, Kawchuk G, (2020). “Assessing Adverse Events After Chiropractic Care at a Chiropractic Teaching Clinic: An Active-Survellance Pilot Study.” J Man Physiol Ther.
  • Weiss C, P. K., Draper C, Silva-Oolup S, Stuber K, Hawk C, (2020). “Chiropractic Care of Adults With Postpartum-related Low Back, Pelvic Girdle, or Combination Pain: A Systematic Review.” J Man Physiol Ther.

 

Chiropractic Helps VA Cut Opioids & Diagnosing Lumbar Stenosis

CF 146: Chiropractic Helps VA Cut Opioids & Diagnosing Lumbar Stenosis

Today we’re going to talk about the success of the VA in reducing prescription opioid use – psst, guess who has helped them do that? And we’ll talk about diagnosing and testing for stenosis.

But first, here’s that sweet sweet bumper music

Subscribe button

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

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

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

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #146

Now if you missed last week’s episode , we talked about how even kids can hurt. We talked about manipulation for lumbar radiculopathy. And we talked about the lack of attention found on the chiropractic boards for biopsychosocial issues. 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. 

CF 145: Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters

 

On the personal end of things…..

To kick off on a cool note you’ll all appreciate, I have a patient that is a med school student that has had amazing results for a pretty significant and lingering disc injury. Your truly opened his eyes to the power of what an evidence-based chiropractor is capable of and it’s paid off for him and, the more of the younger docs that experience something like he has with chiropractic, the more accepted the evidence-based faction of our profession becomes. And the more accepted, the more referrals we get. 

That’s not the good news I wanted to share though. The good news is that he said in one of his classes last week, when they were talking about back pain, manipulation was recommended. In med school. Did you freaking A hear that? Med school is now teaching medical doctors that spinal manipulation isn’t only accepted…..but it’s reco-freaking-mended. 

Bam, Kapow, Zap, Snap, Whack!!

Super hero noises for cool stuff. Hell yeah. 

Moving on, now that school is up and rocking and people are in their normal routines once again, the growth I was talking about a week or two ago is showing to be sustainable at this time. 17 new patients last week tells me we may be slowly getting back to where we were before the Rona. Climbing out of the hole slowly but surely. 

I know all states are different. Here in Texas, as many of you may suspect, is challenging. We probably have A LOT more anti-maskers than many states out there have. We’ve been at work, live…in person since May 1st. Some chiros never took the 2 weeks to step back and see what was up. They just kept motoring through. And….I have to say it looks like they were the smart ones from what I’ve seen. 

I lost out on 2 weeks of work by shutting down completely. Not only that, but from April 1st or so, we were open but emergency only. Honestly…..how many emergencies do we have? We have some but they’re not going sustain my practice. So….I lost two weeks but only doing the emergency thing made me lose a lot of business as well. 

Then, we’re open to everyone and anyone basically on May 1st. Cool, but it took a good while before people started coming in. They knew we closed for a bit and didn’t always know we were back open. Plus, a ton of them were just scared. Understandably. 

So, as with everyone else that follows science, rules, and recommendations, we lost out. For sure. Since I’ve been back at it….again….May 1st, it seems that maybe we could have been safely going the whole time. I could look back and be upset that I followed the rules and that I’m a boy scout like that. But, I’m not going to be. Because how quickly we may forget; it was spooky. Nobody knew the mortality rate. Nobody knew what percentage end up in the hospital or what percentage gets put on a ventilator and how those percentages change from age group to age group. 

We didn’t know anything about it. When you get reports that the death rate is as high as 5% and then a separate paper says it lives on plastic as much as 3 days…..well hell. Please excuse me a sec while my anxiety goes through the roof. I mean, I want to be polite and excuse myself but yeah, the anxiety was going through the roof for myself as well as for the majority of us out there. Not the subluxation slaying spine whisperers of course but for us sciencers….yeah….we were concerned. 

Now we know so much more. We know when everyone in the clinic is masked, we lower our chances of transmission. Life is continuing. Anxiety is still somewhat up there. But life’s continuing as it all seems to work itself out.  The college kid cases are going up all the time. As expected because they’re kids and they’re knuckleheads. As long as they don’t take it home to vulnerable folks, then I don’t see it as harmful. It’s only helpful. 

My daughter has been going to in-person on-campus junior high with over 1,000 fellow knuckleheads. In the first six weeks there have been 2-3 teachers come down with it and about 4 kids. While that may seem a lot to some of you, I see it as a win so far. All of those people in one building together for 6 weeks and that’s all the spread we have? And let’s be fair, I know one of the teachers for sure got it from her husband who brought it home from work. 

To me, it means so far, they are not giving it back and forth to each other at the schools as long as they’re being careful and masking. So far. I really thought they’d all be closed down and go back to strictly online learning by now. I’m still pleasantly wrong. I’ll take it. 

Alright folks Enough Rona rambling. I don’t start talking about it becuase I love the topic. I’ll admit that I do find it all fascinating though. I really do. I’m a bit nerdy about stuff like that. 

Anyway, I talk about it every week because….damnit….that’s what’s going on. It’s the way it is. It’s in my personal happenings as it is in yours as well. So, I might as well talk about it and share with you my experiences, what I’m seeing in my practice, and how I’m muddling through this mess. It’ll either let you know you’re not alone or it’ll show you what you don’t want to do. I’m good either way. As long as you get some use out of it!

Item #1

This one comes from the Office of Public and Intergovernmental Affairs(2020) and is called “VA reduces prescription opioid use by 64% during past eight years.” It was published online on July 30, 2020…..yep…..pretty damn hot. 

This was an article that was basically announcing that t he VA has successfully reduced prescription opioid use in patients within the VA system by 64%. They went from more than 679.000 veterans in 2012 to 247,000 in 2020. 

Lancet Low Back Update & Movement Disorders Mean Pain

 

They say they achieve this dramatic reduction by safer amd more responsible use of opioids but also by treating chronic pain using alternative therapies and treatments. Guess who’s a big part of that? Chiropractors. Yep that’s right. And to be fair…acupuncturists as well. We are getting referrals from the VA for both chiropractic and acupuncture. 

They say, the “VA takes an interdisciplinary approach to care focused on a Veteran’s Whole Health by using non-pharmacological, complementary pain management treatments, self-care, skill building, and support to transition from a biomedical to a biopsychosocial model of pain care. “

How many times have you heard me screaming about the biopsychosocial aspect of chronic pain? A LOT….a lot…

If you follow the link in the article to their list of complementary pain management treatments, chiropractic and acupuncture are the first two listed. Good stuff people. Good stuff. 

They’re just not there yet but wouldn’t have been nice if the title was something like, “The VA system reduces opioids 64% by be smarter and by using chiropractic and acupuncture.” I’m not holding my breath for that day but it really should read just like that. Baby steps I suppose. Itty bitty, teensy weensy baby steps it seems. 

Next paper covers diagnostic tests for stenosis but…

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.

Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  

Picture a T bar with a built-in drop piece.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.

It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

This one is called “Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study” authored by Tomkins-Lane et. al(Tomkins-Lane C 2020). and published in European Spine Journal in June of 2020. Damn hot enough!

Why They Did It

The authors wanted to reach a consensus on which diagnostic tests are most important in confirming the clinical diagnosis of lumbar spinal stenosis

How They Did It

  • Phase 1: 22 members of the International Taskforce on the Diagnosis and Management of LSS confirmed 35 diagnostic items
  • An on-line survey was developed that allows experts to express the logical order in which they consider the diagnostic tests, and the level of certainty ascertained from each test.
  • Phase 2, Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine
  • Round 2: Meeting of 15 members of Taskforce defined final list of 10 items.
  • Round 3: Survey was distributed internationally, followed by Taskforce consensus.

What They Found

  • 432 clinicians from 28 different countries participated
  • Certainty of the diagnosis was 60% after selecting the first test and significant change in certainty ceasing after eight items at 90.8% certainty
  • The most frequently selected tests included MRI/CT scan, neurological examination and walking test with gait observation. 
  • The diagnostic test selected most frequently as the first test was neurological examination.

Wrap It Up

“This is the first study to reach an international consensus on which diagnostic tests should be used in the clinical diagnosis of LSS. The final recommendation includes three core diagnostic items: neurological examination, MRI/CT and walking test with gait observation. The Taskforce also recommends 3 ‘rule out’ tests: foot pulses/ABI, hip examination and test for cervical myelopathy.”

Related but on a separate note, the grocery cart sign hints you toward stenosis. If walking through a grocery store just kills the patient but they can lean over on the cart with their elbows and that alleviates the pain….or if sitting removes the complaint fairly quickly, you need to start sniffing up the stenosis tree. 

I am a big fan of Dr. Carmen Amendolia’s program which he was able to validate through research. It’s called the Boot Camp for Stenosis and it’s REALLY turned a very difficult condition to treat into a much more successful outcome for me personally. 

Basically, it’s just a lack of real estate in the canals and this program helps the patient understand the condition as well as self manage after a 2xweek for 6 week protocol. It’s well-thought out and very well done. And easy to do and understand. 

I highly recommend it. Your stenosis patients will thank you profusely.  

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

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

Key Takeaways

Store

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

Subscribe Button

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • (2020). “VA reduces prescription opioid use by 64% during past eight years.” VA US Dept Veterans Affairs.
  • Tomkins-Lane C, M. M., Wong A, (2020). “Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study.” European Spine Journal 29: 2188-2197.

 

Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

CF 142: Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

Today we’re going to talk about Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

But first, here’s that sweet sweet bumper music

Subscribe button

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 aro

und. 

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

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

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #142

Now if you missed last week’s episode , we talked about the update from the authors on The Lancet low back series and we talked about movement disorders and whether or not they translate into pain. 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…..

Kids still in school. I called it early. I’m giving most of the schools about 4-6 weeks before they decide the numbers are too high. I do not want to be a pessimist. I just don’t see how they’ll keep it under control. I drove by my daughter’s junior high at lunch and they had 100-200 kids out on the playground playing basketball. Right up on each other. Lol. 

I know they’re outside. I know. We’ll see. I know the University of Alabama just reported 1200 positives at the campus. Notre Dame, University of North Carolina. I just see it as a start. 

My son told me a kid in his math class turned up positive so that got him all up in a wrinkle. I told him he’s got a better chance of getting it riding in a car with someone to eat or gathering up in dorm rooms than getting it in a big huge classroom. It’ll hold 300 kids but there’s around 50 or 60 in there all wearing masks and distanced. Minimal risk. 

Then I had a patient in here just last week, I treated her on a Tuesday. No temp, no symptoms at all….she goes home. The next day she feels a little funky. Her husband had the Rona a couple of weeks ago if I remember right. Anyway, she’s on high alert because of her husband so she goes and gets tested and she’s positive. The day after we had her in the clinic. 

Now, she was masked the whole time and my time with her was less than 3-5 minutes, she had no symptoms at the time so the risk, to my knowledge, while certainly not ideal, in the long run is probably minimal. 

Had that happened 3-4 weeks ago, I’d probably have been down at the place getting the tests and all that good stuff. Had Jake had a positive kid in his big ol math class a month ago, they’d probably be doing something more than just saying, hey this happened. Y’all wear a mask. 

Things ahve changed slightly in the past month I believe. I think more and more, we’re seeing we can live with this and it’s not the end of the world like some thought it’d be back in March and April. We still see cases going down but they’re still higher than they were in the first wave. Yet deaths aren’t. They’ve leveled and dropped as well. Which is all great news. 

I’m a nerd so I watch interviews with experts on vaccines and epidemilology and all that stuff done through the Journal of the American Medical Association. One of the experts said that’s it’s just not in the virus’s best interest to kill us off. It’s in its best interest to become more transmissible but less deadly so it can spread easier but not kill us…..so it can survive. Basically. 

That’s an interesting way to look at it. Then, yesterday, the CDC comes out and says that only 6% of deaths are due strictly to COVID. Well now hell. Doesn’t that give fuel to the fire for the science hating conspiracy nut cases? More ammo to confuse other dummies into their way of thinking but the truth is, it changed nothing. It just meant that 94% of COVID deaths have an average of 2.6 co-morbidities. 

Well, no durr Sherlock. That’s one of the few things we’ve all actually known this whole time. The CDC just was finally able to quantify it. That’s all. I’m still overweight. I’m still more at risk than John Workout over there drinking his fruit smoothie after his 6 mile run. No change whatsoever but day-um if the nut cases didn’t jump all over that one. 

Watching science haters just explode and reveal themselves on Facebook over the last 6 months has been such a disappointment. Especially the ones that you respected as doctorate level caregivers. 

Now look, I’ll admit something, in the very beginning, when nobody knew what the hell, how many would die and this and that, I got caught up in some of it. A whole bunch of us did. As more information comes to light, as we learn more about it, as we experience life with it, the danger is still there but, education has lessened any fear that might have been there in the beginning. 

Now, it’s just life and we have to keep living. We have to try to send kids to school. Let’s see what happens. We have to go to work. I’ve been working full time for basically 6 months following guidelines and so far so good. Can you imagine what business would look like if I just took off for months? Nope. Can’t do it. 

And isn’t there something to be said about government over reach on some of this stuff? How can they shut down bars yet allow people to gather up in a church? How can some bars stay open with music and bands but they’re able to stay open because you can buy a hamburger. Yet other bars are closed because they don’t sell a hamburger? How does any of it make sense? It’s a stack of hooey balls. 

I’m a Christian, I want people to want to go to church. So don’t get the wrong idea there. It’s a valid comparison. You can group up in church but not in a bar. It’s silly. 

We’ll know more about the back to school thing in jsut a few weeks. 

Alright, I’m rambling, let’s get to it. 

Item #1

The first article here is called “Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores. A Randomized Clinical Trial” by Okereke et. al(Okereke O 2020). and published in JAMA on August 4, 2020. Hot tamale, hot tamale….

Why They Did It

The authors wanted to know if long-term supplementation with vitamin D3 prevent depression in the general adult population? What’s your guess? D3 is a bit of a wonder kid, right?

How They Did It

  • 18353 men and women aged 50 years or older 
  • Randomized clinical trial 
  • Randomized testing happened from November 2011 through March 2014
  • Randomized treatment ended on December 31, 2017
  • Randomization was D3 or placebo

Wrap It Up

“Among adults aged 50 years or older without clinically relevant depressive symptoms at baseline, treatment with vitamin D3 compared with placebo did not result in a statistically significant difference in the incidence and recurrence of depression or clinically relevant depressive symptoms or for change in mood scores over a median follow-up of 5.3 years. These findings do not support the use of vitamin D3 in adults to prevent depression.”

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.

Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  

Picture a T bar with a built-in drop piece.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.

It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

This second one here is called “An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures” by Lilly et. al(Lilly D 2020). published in Global Spine Journal in July of 2020. Is it hot in here? I need some air!

Why They Did It

To compare the utilization of conservative treatments in patients with lumbar intervertebral disc herniations who were successfully managed nonoperatively versus patients who failed conservative therapies and elected to undergo surgery (microdiscectomy).

How They Did It

  • Clinical records from adult patients with an initial herniated lumbar disc between 2007 and 2017 were selected from a large insurance database.
  • Patients were divided into 2 cohorts: patients treated successfully with nonoperative therapies and patients that failed conservative management and opted for microdiscectomy surgery.
  • Nonoperative treatments utilized by the 2 groups were collected over a 2-year surveillance window.
  • “Utilization” was defined by cost billed to patients, prescriptions written, and number of units disbursed.

What They Found

  • 277 941 patients with lumbar intervertebral disc herniations were included.
  • Of these, 269 713 (97.0%) were successfully managed with nonoperative treatments,
  • 8228 (3.0%) failed maximal nonoperative therapy (MNT) and underwent a lumbar microdiscectomy.
  • failures occurred more frequently in males (3.7%), and patients with a history of lumbar epidural steroid injections (4.5%) or preoperative opioid use (3.6%).
  • A cost analysis indicated that patients who failed nonoperative treatments billed for nearly double ($1718/patient) compared to patients who were successfully treated ($906/patient).

Wrap It Up

“Our results suggest that the majority of patients are successfully managed nonoperatively. However, in the subset of patients that fail conservative management, male sex and prior opioid use appear to be independent predictors of treatment failure.”

Item #3

The last one is called “Biopsychosocial baseline values of 15 000 patients suffering from chronic pain: Dutch DataPain study” by Brouwer et. al (Brouwer B 2020) . and published in Regional Anesthesia and Pain Medicine in August of 2020….only the freshest for you fresh people. 

Why They Did It

They did this one in an effort to understand multidisciplinary approaches to solving chronic pain. 

How They Did It

  • 11,214 patients suffering from chronic pain
  • The pain was analyzed using relevant Initiative on Methods, Measurement, and Pain assessment in Clinical Trials Instruments. 
  • Most patients were female

What They Found

  • The mean age was 55.6 years old
  • Severe pain was reported by 71.9%
  • Psychological and quality of life values deteriorated when pain severity increased
  • About 36% of them showed severe signs of depression or anxiety
  • 39% had high pain catastrophizing
  • Of all patients, 17.8% reported high values for pain severity, catastrophizing and anxiety or depression 

Wrap It Up

“Based on baseline biopsychosocial values, this study shows the complexity of patients referred to pain centers. Pain management with a biopsychosocial approach in an integrated multidisciplinary setting is indispensable. Above all, adjusted education on chronic pain and attention to its biopsychosocial aspects are deemed necessary.”

It becomes more and more clear that if all you’re doing is adjusting and sending them on their way, you’re wrong. 

If you’re adjusting and doing some exericises and sending chronic pain on its way, you’re partly wrong. 

If you’re adjusting when appropriate, if you’re prescribing patients exercises and teaching them how to self manage at home, addressing yellow flags and building confidence while you encourage addressing the cognitive aspect of chronic pain…..well….now you’re starting to get it. You’re becoming someone that can make a realy difference in your patients’ lives. 

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

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

Key Takeaways

Store

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

Subscribe Button

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Brouwer B, W. S., Jacobs C, Overdijk M, (2020). “Biopsychosocial baseline values of 15 000 patients suffering from chronic pain: Dutch DataPain study.” Reg Anesth Pain Med.

Lilly D, D. M., Eldridge C, (2020). “An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures.” Global Spine J.

Okereke O, R. C., Mschoulon D, (2020). “Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores A Randomized Clinical Trial.” JAMA 324(5): 471-480.

Lancet Low Back Update & Movement Disorders Mean Pain

CF 141: Lancet Low Back Update & Movement Disorders Mean Pain

Today we’re going to talk about The Lancet Low Back Series Update and Movement Dysfunction and Pain

But first, here’s that sweet sweet bumper music

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

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

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

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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #141

Now if you missed last week’s episode , we were joined by Dr. Chris Howson to talk about his job working in a hospital out-patient setting. Not an FQHC but the actual hospital. Pretty cool stuff. Make sure you don’t miss that info. Keep up with the class. 

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

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

On the personal end of things…..

The kids are back in school. I know some parts of the country are still doing video, off-site learning but here in Texas they’re back at it on-site, in-person and I’m concerned about it. How could you not be. Unless you’re one of the conspiracy, it’s the same as the flu, science-haters of course. Sorry, my eyes just rolled out of my head. Let me pick those up real quick and pop them back in. 

Alright….so, my son is at Texas Tech in Lubbock living in the dorm with a room mate and riding the elevators with groups of kids and hanging out in dorm rooms and all that college stuff. I’m telling you all that I support the idea of trying to get back to normal but this is a recipe for disaster and it’s only a matter of time. 

It’s like having some dead, dry brush sitting there on the ground and tossing a match on it. All schools, if I’m guessing are on borrowed time because the same thing that happened in North Carolina and Notre Dame and however many are added to the list by the time this airs…..that’s going to happen across the country and this second wave the CDC thinks we’re getting control of is about to get out of control again. 

Then we’ll close down the in-person classes again and we’ll all have to sit at home and idle again for another 2 months before it calms down again. I truly feel this is going to happen for grades k through college. How can it not?

I know I know….we need to get back to normal, kids need to socialize with peers, some kids are in awful situations, some kids don’t eat if they’re not in school, I get it. 

But at the same time, it’s a real danger. It won’t be gone after the election in November. You guys that think that are going to be so sad. I know you won’t admit you’re wrong but that’s OK. Science-y people have seen your social media posts and know who you are and we’ll pray for some peace of mind for you. 

Time will tell if I’m right. I don’t want to be right. But I don’t see how it can go any other way. 

As far as business, same same same. Hell, if anything, like I said last week, it’s gotten even slower for us. With back to school being our slowest time of the year traditionally, it makes sense that it’s gotten slower. But I damn sure don’t like it. In fact, it makes me hyper as hell. 

This in spite of advertising like crazy and creating an online presence that is twice of what it was before the Rona came and destroyed an amazing practice. 

But, that’s OK. We were never promised a life with no bumps in the road. A worry-free life. Yeah, that’s not real life. We take challenges and obstacles and we adapt and overcome. And that’s where we’re at. Adapting and overcoming. 

Item #1

Here’s a new one that is actually an update to a key paper a couple of years ago. It’s by Buchbinder et. al. and called, “The Lancet Series call to action to reduce low value care for low back pain: an update” published in Pain in September of 2020(Buchbinder R 2020). Well hell, lookie here. It’s only September 3 and here we are, smoking, sizzlin’ and steaming hot. 

This is a bit long but it’s important. While Jan Hartvigsen, a chiropractor, is in this group of authors, the rest are not and, I’d argue, bent a bit toward the medical field and PT. They’ll claim they’re not profession specific but it just seems a little more bent to PT. However, the information is still very relevant to chiropractors and, relevant to the medical field and insurance industry. Unfortunately, none of those seem to be paying any attention. 

Now, this is not necessarily a research paper but more of a commentary so let’s dive in with a good solid summary of the contents here. Pay attention. I promise you’ll learn some factoids to put into your social media posts. 

  • The 2018 Lancet Low Back Pain Series, comprising 3 papers written by 31 authors from disparate disciplines and 12 different countries, raised unprecedented awareness of the rising global burden of low back pain partly attributable to poor quality health care.
  • The series described current guideline recommended care of low back pain, and new strategies that show promise, but require further testing, to reduce low value care.
  • Low back pain is still the number one cause of disability in the world
  • In 2015, low back pain was responsible for 60·1 million disability-adjusted life-years; a 54% increase since 1990
  • A recent study estimated that US$134.5 billion was spent on health care for low back and neck pain in 2016 in the United States, the most out of 154 conditions studied, and this had increased by 6.7% annually between 1996 and 2016
  • For the vast majority of people with low back pain, it is currently not possible to accurately identify specific causes or nociceptive sources. Risk factors and triggers for episodes of nonspecific low back pain include previous episodes of back pain, the presence of other chronic conditions such as asthma, headache, and diabetes, poor mental health (including psychological distress and depression), genetic influences, as well as awkward postures, lifting, bending and heavy manual tasks, and being tired or being distracted during an activity.44 Smoking, obesity, and low levels of physical activity, all related to poorer general health, are also associated with occurrence of low back pain episodes.
  • Many patietns with low back pain are still receiving the wrong care. Even 2 years after the series came out. 
  • A 2018 systematic review that included 14 studies mostly from the United States (6 studies), United Kingdom (3 studies), and other high-income countries found that overall more than 50% of people with low back pain seek care annually and 30% have sought care within the past month.
  • A 2012 study in a US Veterans Affairs Health Care facility found that 59% of outpatient lumbar spine scans were inappropriate.3 This suggests that unnecessary lumbar spine magnetic resonance imaging scans for people not suspected of having a serious condition cost $US300 million per year in the United States. 
  • This is supported by a 2019 systematic review (14 studies) which found evidence that imaging is associated with higher medical costs, increased health care utilization and more work absence compared with nonimaged groups. Despite little evidence to support its use for most back conditions,43 and a 20% failure rate, another US study estimated that $US12.8billion was spent on spinal fusion surgery in 2011, the highest aggregate hospital costs of any surgical procedure.
  • Major international clinical guidelines have moved away from medicalized management of low back pain and prioritized nonpharmacological approaches as first line care.
  • A Los Angeles Times investigation has revealed that aggressive marketing appears to be leading to new epidemics of opioid prescribing in low-income and middle-income countries.
  • Although the high rates of opioid prescribing are now beginning to fall in some high-income countries such as the United States74 and the United Kingdom,22 worryingly, opioid medication is being substituted for or used with gabapentinoids.
  • In England, the number of prescriptions for gabapentin and pregabalin were 30% and 56% more, respectively, in the 12 months to December 2019 than the 12 months to December 2015.73 In one study of 251 patients referred to a pain service in the Northeast of England, 82.5% were taking an opioid, over half of whom (56.2%) were also on gabapentinoids, while 16% of those on dual therapy were on high doses of both drugs.
  • Not only does the evidence not support use of gabapentinoids for nonspecific low back pain (or sciatica),27 studies in both Canada and Australia have reported an increased number of overdose deaths associated with dual opioid and gab apentinoid use.
  • UK National Institute for Health and Social Care Excellence did not find any randomised controlled trials of cannabinoids to treat low back pain and advised against their use for chronic pain in adults.
  • A four-year prospective observational study found cannabis users had greater pain and lower self-efficacy in managing pain, and there was no evidence it reduced pain severity or interference or exerted an opioid-sparing effect.
  • There is therefore an urgent need to address politician and public misconceptions about cannabinoids and preventive action to limit the same aggressive marketing approaches for medicinal cannabinoids that enabled the opioid epidemic; a new prescribing epidemic may be imminent.
  • Regenerative medicines such as autologous platelet-rich plasma or stem cell injections into degenerated lumbar discs or facet joints aims to help discs and/or joints regenerate. However, there is only a weak relationship between radiological change and the presence/absence of low back pain (eg, disc degeneration is present in 54% of those symptomatic with low back pain and 34% of those who are symptom free11), which means that even if these products successfully produce regeneration they are unlikely to affect low back pain for most people.
  • Much of the money spent on low back pain is wasted and better solutions are needed.
  • The Lancet Series identified promising solutions that included focused implementation of best practice, the redesign of clinical pathways, integrated health and occupational care, changes to payment systems and legislation, and public health and prevention strategies.30 Yet, we also indicated that most were not yet ready for widespread implementation as the evidence underpinning them was inadequate.
  • Targeted efforts to reduce overuse of imaging for low back pain, a major source of healthcare waste and even iatrogenesis, have not met with much success
  • Global initiatives to decrease health care waste and iatrogenesis such as Choosing Wisely are therefore specifically targeting imaging for low back pain8; however, large-scale impact of these initiatives have not yet been well documented.
  • A controlled before-after study of a spine care pathway that incorporated conservative spine care recommendations introduced in one primary care practice (with 11 primary care physicians) but not another (with 74 primary care physicians) reported a reduction in health care expenditure, mostly attributable to reduced spine surgery costs.90 Opioid utilization was also reduced while manual care costs were increased.

In summary:

The Lancet Low Back Pain Series outlined a way forward to address the increasing and costly effects of disabling low back pain. As a starting point, it garnered enormous media attention and continues to do so, but attention should now be directed towards engaging with consumers and patients, policy makers, clinicians, and researchers to identify and implement effective solutions. While effecting solutions will take time, measuring and benchmarking our progress in different countries will be crucial to these efforts.

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.

Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  

Picture a T bar with a built-in drop piece.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.

It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

The last one we’re going to cover this week is called “Passive intervertebral motion characteristics in chronic mid to low back pain: a multivariate analysis” by Brownhill et. al(Brownhill K 2020). published in Medical Engineering and Physics on 18th of August in 2020. Boiling and smoking and simmerin’!

Why They Did It

Studies comparing back pain patients and controls on how the vertebrae interact with each other and if dysfunction causes pain…..those studies have shown differences. A multivariate re-analysis was carried out to estimate main modes of variation, and explore group differences.

How They Did It

40 participants w/ mechanical back pain and 40 matched controls underwent passive recumbent quantiative videofluoroscopy

Intervertebral angles of L2/3 to L4/5 were obtained for right and left side-bending, extension, and flexion

What They Found

There were three main modes of variation and all of them were related to range of motion and its distribution between joints. 

Significant differences were found for coronal plane motions only

Wrap It Up

“The results confirm altered motion sharing between intervertebral joints in back pain, and provides more details about this. Further work is required to establish how these findings lead to pain, and so strengthen the theoretical basis for treatment and management of this condition.”

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

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

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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

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About the Author & Host

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

Brownhill K, M. F., Breen A, Breen A, (2020). “Passive Intervertebral Motion Characteristics in Chronic Mid to Low Back Pain: a Multivariate Analysis.” Medical Engineering & Physics.

Buchbinder R, U. M., Harvigsen J, Maher C, (2020). “The Lancet Series call to action to reduce low value care for low back pain: an update.” Pain 161: p 557-564.