forward chiropractic

Useless Research & Insulin or Inflammation

CF 172: Useless Research & Insulin or Inflammation Today we’re going to talk about how I treat my staff, we’ll talk about insulin vs. inflammation, and we’ll talk about some trash research that came out in JAMA recently that you may wind up being confronted with at some point so listen up.  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 #172 Now if you missed last week’s episode , we talked about going the way of the non-pharma world. If we could just get the the medical world to take a look at it. We also talked about insurance coverage trends and how they’re not very favorable to chiropractors. As you probably already feel. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

On the personal end of things, we’re still interviewing nurse practitioners and still getting our ducks in a row. We have the attorney that is setting up the medical entity meeting with our CPAs out in St. Louis to make sure it is set up in the most tax-advantageous as well as the most ideal legal way.  Any time you have your CPA and your attorney working together, you’re probably in a good place me thinks. I have a meeting with the medical director this week to go over what services he’s going to be OK with us offering. When appropriate, we’ll be looking at things like intra-joint injections, trigger point injections, low-level scripts but no narcotics.  Basically, anything we offer here will be very low risk. Not only because it inherently lowers our risk to adverse events, which makes me sleep better every night, but it also helps to keep a happy medical director. If it all works right, this is almost mailbox money for the medical director while providing an awesome gig for a nurse practitioner that is at least halfway motivated to build their practice. 

Think about it, nurses and nurse pracs are used to 12-hour shifts. They’ve missed important holidays and important events in their personal life due to having to work. Here, there are no weekends, there are not holidays spent working, vacation time, it’s all good in the hood at my place. Plus, they get to learn as much about orthopedics as they want to learn and a whole bunch they maybe don’t want to learn but is required to learn in order to work here.  That’s the deal though right?

Gotta pick the right NP because it all hinges on that one decision. Pick the wrong one and you’re out of business until you can get another hired. Doesn’t sound like a big deal until you factor in the 3 months it takes to get a new one credentialed. Speaking of, I have to get re-credentialed under the new medical entity. That’s because of Stark and anti-kickback laws.  This isn’t something to go into lightly. It’s like I said last week or two weeks ago here on the podcast, the wheels on this thing turn slowly and I’m OK with that. That way I don’t get out over my skis and lose control.  So, that’s where we’re at on that. 

Currently, I’m taking the opportunity to type this out on a Sunday afternoon. We are up at the office throwing a staff member her baby shower. No, I’m not a baby shower kind of dude as you may have guessed. I’m a Bud Light and guitars kind of guy. But, my wife decided we’re throwing our staff member a baby shower so here I am at the office recording this while the chicks and the hens are out there clucking and cackling. And I don’t mean that in a misogynist way. I mean it in a funny, playful kind of way so take it that way. 

It brought up a thought; do you treat your staff members like workers? Or do you treat them more like family? Right or wrong, as a result of my nature and my heart, we treat ours like family when appropriate. I’ve had staff ask me advice on deep dark stuff they were struggling with. I’ve had staff whose family was going to prison, the whole town knew, they were ashamed, and they just need some love, a little extra consideration, and a few big hugs. That one still gets me a little emotional when I think about it.  I’m going to give you a few more examples here but before I do, I don’t want you to misunderstand anything here. I’ve learned over the years that you cannot buy loyalty from your staff. They’re either with you every step of the way, or they are not. And that’s OK. Everyone is coming from different places, experiences, and motivations. Not a thing wrong with that.  But don’t do things for the wrong reasons. Don’t think you’re going to do a bunch of things for staff thinking it’ll ensure they stay with you forever. That’s just not reality and it’s a good way to allow yourself to get hurt on some level.  If you’re going to treat staff like family, you do it for all of the right reasons. Love, appreciation for them and their character, admiration for a job well done, team building, and things like that.  Getting back to it, I’ve sold a car to a staffer that was coming out of a bad relationship and had no transportation. I sold it to them for about $4,000 less than I could have gotten for it and let them pay it out $50 a paycheck and zero interest.  I’ve created a new, extra job for a staffer that was about to lose their house. It cost me an extra $1500/month for the following 2-3 years but that’s the way I am. 

I’ve sponsored kids sports for staffers more times than I can even start to recall.  In the end, money will come and go. It can be lost and it can be made. But it’s the relationships that stay with us.

Were we put on the planet just to make money and take care of our families? 

Or were we put on this planet to make ALL of our immediate relationships prosper and make the world, or at least our part of it, a better place?  You probably know where I come down on all that. It may sound a little hippy-dippy there, which I’m not at all, but I do see it that way. Money is nice and I see it as a challenge. A challenge to make it and see how much I can make ethically and morally. It’s fun to make money! But money really isn’t my main motivation any more.

I’m a huge stats person and track stuff like crazy. I balance my own bank statement every month. But I don’t count pennies anymore. I just don’t. I’m more into people, smiles, and all the good feels. Making people’s lives better when possible.  Alright, enough mushy stuff. 

Item #1 This first one today is called “Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation: A Systematic Review and Meta-analysis” by Wiebe et. al. [1] and was published in JAMA on March 12, 2021 and that so hot it’s got my glasses all steamy. I can’t see a thing. 

Why They Did It The authors wanted to answer the question of “What are the temporal associations among higher body mass index (BMI) and chronic inflammation and/or hyperinsulinemia?” They say that Obesity is associated with a number of noncommunicable chronic diseases and is supposedly a cause of premature death. They wanted to summarize evidence on the temporality of the association between higher body mass index (BMI) and chronic inflammation and hyperinsulinemia.

How They Did It

  • MEDLINE (1946 to August 20, 2019) and Embase (from 1974 to August 19, 2019) were searched
  • The data analysis was conducted between January 2020 and October 2020.
  • Longitudinal studies and randomized clinical trials that measured fasting insulin level and/or an inflammation marker and BMI with at least 3 commensurate time points were selected.
  • Of 1865 records, 60 eligible studies with 112 cohorts of 5603 participants were identified

Wrap It Up

The finding of temporal sequencing (in which changes in fasting insulin level precede changes in weight) is not consistent with the assertion that obesity causes non-communicable chronic diseases and premature death by increasing levels of fasting insulin. Meaning that that adverse consequences currently attributed to obesity could be attributed to hyperinsulinemia (or another proximate factor). Which is interesting in my book. I thought you all might like it. 

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Item #2 And our last item today is called “Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial” by Nguyen et. al.  [2] and published in JAMA Internal Medicine on March 15, 2021 which is indeed too hot to manipulate by one’s hand. 

Why They Did It They say that Osteopathic manipulative treatment (OMT) is frequently offered to people with nonspecific low back pain (LBP) but never compared with sham OMT for reducing LBP-specific activity limitations. Knowing this, they wanted to compare the efficacy of standard OMT vs sham OMT for reducing LBP-specific activity limitations at 3 months in persons with nonspecific subacute or chronic LBP.

How They Did It

  • This prospective, parallel-group, single-blind, single-center, sham-controlled randomized clinical trial recruited participants with nonspecific subacute or chronic LBP in France starting February 17, 2014, with follow-up completed on October 23, 2017. 
  • Participants were randomly allocated to interventions
  • Six sessions (1 every 2 weeks) of standard OMT or sham OMT delivered by nonphysician, nonphysiotherapist osteopathic practitioners.
  • The primary end point was reduction in LBP-specific activity limitations at 3 months as measured by the self-administered Quebec Back Pain Disability Index. 
  • Secondary outcomes were mean reduction in LBP-specific activity limitations; mean changes in pain and health-related quality of life; number and duration of sick leaves, as well as number of LBP episodes at 12 months; 
  • and consumption of analgesics and nonsteroidal anti-inflammatory drugs at 3 and 12 months. 
  • Adverse events were self-reported at 3, 6, and 12 months.

What They Found

Overall, 200 participants were randomly allocated to standard OMT and 200 to sham OMT, with 197 analyzed in each group

Wrap It Up In this randomized clinical trial of patients with nonspecific subacute or chronic LBP, standard OMT had a small effect on LBP-specific activity limitations vs sham OMT. However, the clinical relevance of this effect is questionable. So, look…..this paper and these researches absolutely wasted time, effort, and money in an attempt to make spinal manipulative therapy look bad. Who in the h e double hockey sticks sees new patients once every 2 weeks for only 6 visits?? Especially in a chronic pain sufferer. Trash, garbage.

Or since it was in France…..garbage.  It’s dumb, useless, and meaningless and I’m almost offended that this is even a paper. I’m starting ANY brand new case with 3 per week for a week or two minimum. Minimum. Combined with other appropriate ancillaries including exercise, soft tissue stuff, maybe acupuncture, maybe laser, maybe a referral to cognitive-behavioral therapist, maybe biomechanics coaching, and on and on and on. 

Papers like this and authors like this should give it up and get out of the game if they’re not going to be able to throw something together that’s better than this heap of trash.  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.

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TuneIn

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About the Author & Host

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

Bibliography

1. Wiebe N, Y.F., Crumley ET, Bello A, Stenvinkel P, Tonelli M,, Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation: A Systematic Review and Meta-analysis. JAMA Netw Open, 2021. 4.

2. Nguyen C, B.I., Zegarra-Parodi R,, Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med, 2021.

Texas Chiropractors Beat TMA & Smack Goliath In The Nose – w/ Dr. Tyce Hergert & Dr. Tom Hollingsworth

CF 168: Texas Chiropractors Beat TMA & Smack Goliath In The Nose

Today we’re going to talk about the state of the chiropractic profession in Texas and we’ll do a walkthrough of the case and court battle the Texas chiropractors just won. We’re going to be joined by two chiropractors with intimate knowledge and front row seats to the show through the years. But first, here’s that sweet sweet bumper music

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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 #168 Now if you missed last week’s episode , we talked about overcoming challenges. We talked about hip and knee osteoarthritis, and we talked about the risks for pain going from acute to chronic. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

We talked about the challenges of my life last week. Well, then my pickup died on top of all of the rest of the list I laid out for you last week. So…..that’s fun.  Rolling with the punches. That’s what I’m doing here. Rolling with the punches. We have times in our lives when more is going on than really should be going on. Best we can do is just hold on tight, take the ride, and enjoy it when it all settles down a bit.  And it will most certainly settle down a little bit. For most people, life isn’t something we can just settle in the back row and watch from afar without involvement or participation. Which means, when your must partake, you will have times that are more hectic than others. This is that time. I don’t need a car payment right now with all of the other things I have going on.

But you know what; I’m not broke, business is coming back, and it’s all going to take care of itself. I just have to hold on and ride that ride. Maybe even try to smile here and there and find something to enjoy out of it. Who knows? But I’m damn sure on a ride currently. Better believe it. Speaking of a ride; my wife and I took a quick weekend out to Tampa Bay and Clearwater Florida last weekend. Nice trip. It wasn’t Key Largo which is where we went a year ago, just before the pandemic. But it was pretty. We stumbled right into Spring Break without knowing it so it was a bit too busy and tourist-y for our liking but it was gorgeous nonetheless.  So far, the retirement plan is taking us to Key Largo one of these days. On the flight back, they routed our plane through Las Vegas.

If you don’t know American geography, that is 4 time zones toward the west just to go back 2 time zoned back to the east just to get home. It was stupid. Well over 6 hours of flying on a trip that should have been around 3 hours of flying. Dumb.  Alright, let’s get on with it this week shall we?

First I need to recognize one of the best sponsors a podcast could ever have. 

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OK, before we bring our guests on, I want to introduce them to you. They have both been my close friends for years now. First I need to say that there are literally about 20 people that could or should be joining us on this podcast today. But then it would get disorganized and it would be a mess. I felt it was easier to keep it streamlined and simple so we could have a good, focused conversation. 

I’ll first tell you about Dr. Tom Hollingsworth.

Tom is the longest serving Board member for the Texas Chiropractic Association. Dr. Hollingsworth’s fingerprints are on all parts of what makes the TCA the TCA in 2021 not to mention, as you’ll hear momentarily, all over the defense the TCA helped the TBCE put up against the Texas Medical Association.

Dr. Hollingsworth practices in Corpus Christi, TX down on the Texas Gulf Coast at Beacon Chiropractic. Also, Tom was one of my first guests back when I first started this podcast over three years ago and I’m so happy to have him joining us again. http://www.beaconclinics.net

My second guest is Dr. Tyce Hergert. Tyce has been a guest two or three times on this podcast but it’s been a while. Dr. Hergert has been involved in the TCA for a lifetime it seems and it instrumental in getting yours truly active in the TCA as well. Tyce has served in lots of different capacities in the TCA culminating with his post as President where he was instrumental in guiding the TCA to 4 or 5 legislative wins during his term as well as steering the defense of this assault from the TMA. Tyce is the owner of Southlake Physical Medicine in Southlake, TX. http://southlakephysmed.com

Just to give you a brief history of my involvement, I was on the Board of Directors for the TCA when the case prior to this one was concluded. Which was about the time this latest assault was started. So, I was there for its beginnings. I was on the Board for about 4 or 5 years before moving through the ranks as the Chiropractic Development Initiative Chairman, the Pubic Relations Chairman, and now the Scientific Affairs Department Coordinator. So, while not knee deep in the trenches at all times, I’ve been there helping make promotional material, get the word out, and sweating and worrying with everyone else that really knew what was going on.  If you really knew what was going on, you would have been sweating as well. 

There are few folks on this planet that can speak on this case any better than our two guests today so let’s dive in shall we? Welcome, welcome, welcome, friends and colleagues…

First of all, how did everyone do with the Texas deep freeze that made the news world wide just a week or so ago?

Since our time is limited, let’s go ahead and jump right into the meat and taters here. I think we should start with the case we beat the TMA on just prior to this latest one. Who wants to describe that whole debacle?

Now, about the time that case wrapped up was about the time I very first heard the term VONT. I have to admit, I thought that was such a random little piddly thing that I did not give it much thought at all. I thought it would be a simple little whatever and would have little to zero impact on regular practicing chiropractors. What were your first thoughts on the VONT case in the very beginnings of it all?

A case that started with VONT had a way of morphing and transforming into all kinds of attacks, didn’t it? Tell us how that happened and what it meant?

Besides fighting the court case, what did chiropractors at the TCA do to fight this thing outside of the courtroom? Talk a little about the fundraising we all did. 

Can we stop just a second and let’s recognize some of the key players here from the TCA and the TBCE that really made the difference for Texas Chiropractors?

Talk about how the TCA was fighting this case in the Texas legislature. 

Now, we lost this case twice, right? Why do you think the two lower courts got it wrong? We know that it sure feels like Hurley just doesn’t like chiropractors. She’s been overruled on our cases at least twice that I know of. 

What could a loss have meant to not only Texas Chiropractors but also to chiropractors around the nation? Maybe globally?

Along with the crushing defeat the TMA suffered here, they had to pay all court costs and legal fees. Do we have a number on that yet? 

Tell me what you think this loss means to the TMA? Any idea of where their next attack might be?

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

My Insane Life, Hip & Knee Osteoarthritis, Risks For Acute to Chronic Pain

CF 167: My Insane Life, Hip & Knee Osteoarthritis, Risks For Acute to Chronic Pain Today we’re going to talk about hip and knee osteoarthritis and we’ll talk about the risks for back pain going from acute to chronic pain. Interesting couple of papers. Plus all my current ongoings.  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. The Bon Jovi and Def Leppard kind of research.  Not the stuffy, high-brow, high and mighty, better than you 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 #167  Now if you missed last week’s episode, we talked about dry needling, types of exercises that count, motor skills for chronic low back, and the relationship between high blood pressure and dementia. Keeping you folks smart! Check it out.  Keep up with the class.  

On the personal end of things…..

Alright, you wanna talk about juggling a bunch of balls in the air, I’m here to tell you about having balls in the air. Let’s go through it a bit, shall we? Then you can find yourself and your situation and maybe my path helps you on yours. 

    • I lost my office manager of over 11 years – here’s what I’m doing about that. 
    • Setting up a medical entity – what’s that about?
    • Looking at RHC’s – explanation to follow
    • I have finished my book – The Remarkable Truth About Chiropractic: A Unique Journey Into The Research.  – What’s that process like so far?
    • I have a virtual Assistant helping me build a website to help you all succeed – what’s the timeline? 
    • I started my second Fellowship/Diplomate program last week. Maybe I’ve lost my mind
    • Here in Texas, we went through SNOWVID 19
    • We are switching CPAs. Maybe this group gets it right. 
    • The Voice Over career has started going a little crazy here lately – I’ll explain
    • I’m about to head to Florida because…..well….because my life.
    • My main computer that holds my life has been dead for two weeks now. 

Hell yeah, folks. Lol. It’s a wonderful life, right? Let’s start at the top. As I’ve mentioned a time or two, my main employee, my OG staffer, over 11 years, and basically almost family member actually quit me and went to work elsewhere making a little more money with the change of making even a bit more next year. 

So, my main right-hand wo-man is adios but Jiminy crickets people….do you have a clue how much money I’m saving on this? She got raises every year for 11 years in her normal capacity and we created an extra marketing position for her as well at a considerable amount monthly as well.  Now, that means I’m out a marketing position but it also means I can take that money and try some different marketing for a while. Because, if I’m being honest, I’m not sure how much what we were doing was actually helping.  Plus, with the money I’m saving here, I can transition.

With the closing of doors, we usually get to experience the opening of other doors. And that’s what we’re doing. As mentioned, we are using some of the funds we are now saving to move our practice into a medical entity, hire a nurse practitioner, and move toward being finally truly integrated.  This has been a goal for years but I’ve just never pulled the trigger. Now, with PPP in place to help us pay for our payroll, it makes sense to use our existing resources, in addition to what we are now saving, to go ahead and get it done.  I’ll update you on the process as I make my way.

So far, we’ve signed paperwork with the attorneys to create the entity, we have our attorney in communication with our new CPA, which I’ll talk about later, and I’ve started reaching out. I’ve also signed up with a consulting firm on it to try to make sure I have a head start and I’m not trying to re-invent the damn wheel. I don’t like making costly mistakes. My wife and I call them ‘dummy taxes.’

If you’ve been a regular listener here, you know I’ve paid some MONSTROUS, CATACLYSMIC dummy taxes.  First, I have some fairly close relationships in the medical community. So, not only to put them all on notice of what we have planned but also to test the waters of who may be interested in being a part of it….I started reaching out. Here’s how: Hey Friend! I’m in the process of transitioning to a medical entity and hiring a nurse practitioner eventually. I’ll need to have a medical director (MD/DO) to serve in that capacity.

As I go through the process of finding one, would you be willing or able to serve as a potential character witness on my behalf if the MD or DO wants to talk to people in healthcare that know me, have experience with me and my clinic, and can speak to how I approach healthcare? I just want to be sure and ask first before I get too much further into the process. Hope you’re doing well and having a good Monday. Now, my MD/DO friends may just step up and say, “Hey I’ll be your medical director!” They may not. We’ll see. I have one in mind but it’s always good to have more than one or two options, me thinks. Also, when I reach out to my NP friends, one may raise their hands to sign up. Either way, I’m being polite, I’m putting all my friends and network on notice of intentions, and who knows, maybe it serves as some sort of guerrilla marketing. I don’t see a downside.  So, that’s the process there so far.

We almost looked at a Rural Healthcare Clinic before we decided on going the NP route. And we may still eventually. We had a call with a consulting and management firm for the RHCs and it was alright but it was also clear that the ROI wasn’t where we had heard it was and it was clear that it’s quite an endeavor and even more regulated than the medical entity endeavor would be.  It made sense to go with what my colleagues and network is the most familiar with and potentially stray off into the RHC thing if the interest is still kicking around our brains in a couple of years. 

Next on my list, the book. Being an author has always been a big goal of mine.

I love books, I love reading, and I love the idea of facilitating learning. It’s a natural progression for me. As mentioned, it’s called ‘The Remarkable Truth About Chiropractic: A Unique Journey Through The Research’. It’s essentially all of these papers I go through every week organized into their relevant categories so that they’re all in one resource and are easy to find for quick reference. Some just have the Why They Did It, How They Did It, What They Found, and The Wrap It Up sections for each paper. Some topics go further into discussion and talking points.  I believe the way to do it these days is to self-publish. I’m still figuring it out right now while it is off being edited. You wanna know who’s editing it? It’s my good friend, literary scholar, and inventor of the Drop Release tool, and hospitalist chiropractor extraordinaire from the frozen tundra of North Dakota, Dr. Chris Howson! Thank you sir. This will give you all something to look forward to in the near future. I hope you’ll all need your very own copy! So…..that’s exciting. 

On top of that, I’ve had a virtual Assistant helping me build something I think some of you will be interested in. I don’t want to give to say too much until it’s built. First, I don’t want anyone beating me to the idea, and second, I don’t want to move in that direction and then figure out I can’t make it work and then it was for nothing. Nobody wants their failure in the shop’s front window….right there on Main Street! Lol. So I’ll just say that it is something that if you need it and haven’t used it before, will 100% help you be more successful and more cognizant of what’s going on with your business from day to day. So….that’s exciting as well. 

I started my second Fellowship/Diplomate program last week. Maybe I’ve lost my mind. I probably have. Or….I’m secretly a genius. Here’s what I’ve always said; I may get beat. I may not be the best ever. And that’s OK. But I can damn sure guarantee you that it will not be due to a lack of effort. It most certainly won’t be because someone else out-worked me. Maybe they were unethical. Maybe they were lucky. Maybe they inherited something I did not. But it won’t be because I got outworked or because I didn’t try hard enough. Maybe that’s just me. Maybe it’s totally Gen-X. I don’t know. But that’s the way it is in my life. 

Here in Texas, we went through SNOWVID 21. First, you have to know that my area of Texas is very used to snow and ice and blizzards and all of that good stuff. I grew up in it. What South Texas is not used to is the ice and blizzards and snow. That was rough on them but the real kicker was losing power for not only hours but for days. Losing electricity led to losing water. Then water pipes busting and homes and offices ruined. It’s a mess. Chiropractors and Texans, in general, are trying to recover but it wasn’t any little thing. It was the worst Winter Weather event since 1890 or something like that. People can figure out -30 degree wind chill. What they can’t figure out is no power, no water, and no food. It was that real for some folks. 

We are still going through the intro phases of the Wealthability program with the Tom Wheelright group, new CPAs, the whole thing. Part of that was figuring out that our previous CPAs have been wrong and we have to figure out how to get right and part of that answer is money so…..fun fun fun.

What a wonderful life.

I’ve been without my main computer for about two weeks due to Snowvid but it’s getting up and running today which means my life is going to be up and running just a bit smoother within a day or two. Yay!! The voice-over side gig is going a little crazy at the moment. I’ve found a way to get another full-time job I think. I’ll keep you updated as that goes along but, in short, I signed with a talent agency called Heyman Talent in Cincinnati Ohio and they cover Ohio, Indiana, and Kentucky. I signed with Crown North out of San Francisco some time back as well so it’s an interesting adventure. I’m 48 years old and signing with talent agents. What the hell is that about exactly? Who knows but I’m a do-er. Let’s see what happens. 

OK, let’s get to the papers.

Only two this week because the personal side of things took a little longer than usual. Before we get to the papers though, let’s recognize my friends and this show’s amazing sponsors. 

CHIROUP 

Item #1 This first one is called “Diagnosis and Treatment of Hip and Knee Osteoarthritis – A Review” by Katz et. al. (1) and published in JAMA on February 9 of 2021, Hot off the press, smokin’ stack of steam.  What we have here on our hands…..on our meaty little mitts….is a good ol fashioned learnin’ sesh on Osteoarthritis. This is truly some good stuff, folks. Where in here can you find an opportunity to help patients and, in turn, make a living and be the expert in your community?

  • Osteoarthritis (OA) is the most common joint disease, affecting an estimated more than 240 million people worldwide, including an estimated more than 32 million in the US. Osteoarthritis is the most frequent reason for activity limitation in adults. This Review focuses on hip and knee OA.
  • Patients with OA typically present with pain and stiffness in the affected joint(s). Stiffness is worse in the morning or on arising after prolonged sitting and improves within 30 minutes. Pain is use related early in the course but can become less predictable over time. Although OA is sometimes viewed as a disease of inexorable worsening, natural history studies show that most patients report little change in symptoms over 6 years of observation.
  • Nearly 30% of individuals older than 45 years have radiographic evidence of knee OA, about half of whom have knee symptoms.
  • Osteoarthritis leads to substantial cost and mortality. Forty-three percent of the 54 million individuals in the US living with arthritis (most of whom have OA) experience arthritis-related limitations in daily activities
  • Persons with knee OA spend an average of about $15 000 (discounted) over their lifetimes on the direct medical costs of OA.
  • Osteoarthritis can involve almost any joint but typically affects the hands, knees, hips, and feet. It is characterized by pathologic changes in cartilage, bone, synovium, ligament, muscle, and periarticular fat, leading to joint dysfunction, pain, stiffness, functional limitation, and loss of valued activities, such as walking for exercise and dancing
  • Risk factors include age (33% of individuals older than 75 years have symptomatic and radiographic knee OA), female sex, obesity, genetics, and major joint injury.
  • Persons with OA have more comorbidities and are more sedentary than those without OA. It has been estimated that 31% of persons with OA have at least 5 comorbid conditions.2 Persons with hip and knee OA have approximately 20% excess mortality compared with age-matched controls, in part because of lower levels of physical activity. They become sedentary
  • The reduced physical activity leads to a 20% higher age-adjusted mortality. 
  • Several physical examination findings are useful diagnostically, including bony enlargement in knee OA and pain elicited with internal hip rotation in hip OA. 
  • Radiographic indicators include marginal osteophytes and joint space narrowing. 
  • The cornerstones of OA management include exercises, weight loss if appropriate, and education—complemented by topical or oral nonsteroidal anti-inflammatory drugs (NSAIDs) in those without contraindications. 
  • Intra-articular steroid injections provide short-term pain relief and duloxetine has demonstrated efficacy. 
  • Opiates should be avoided. 
  • Clinical trials have shown promising results for compounds that arrest structural progression (eg, cathepsin K inhibitors, anabolic growth factors) or reduce OA pain (eg, nerve growth factor inhibitors). 
  • Persons with advanced symptoms and structural damage are candidates for total joint replacement. 

Conclusions and Relevance  

  • Education, exercise and weight loss are cornerstones of management, complemented by NSAIDs for the right patients, corticosteroid injections, and several adjunctive medications. 
  • For persons with advanced symptoms and structural damage, total joint replacement effectively relieves pain.

Item #2

Our second and last one today is called “Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care” by Stevans et. al. (2) and published in JAMA Network Open on February 16, 2021. Pop goes the weasel it’s fresh outta the oven!

Why They Did It To figure out the transition from acute to chronic low back pain using a tool to assess and predict the transition; demographic, clinical, and practice characteristics; and whether treatments that did not fit within common guidelines were partly to blame. 

They termed these treatments as nonconcordant. Treatments like opioids. Additionally, prescriptions that included benzodiazepines and/or systemic corticosteroids alone without the presence of nonsteroidal anti-inflammatory drugs or short-term skeletal muscle relaxants were considered nonconcordant. Nonconcordant diagnostic imaging consisted of an order for lumbar radiograph or computed tomography/magnetic resonance imaging (CT/MRI) scan. Nonconcordant medical subspecialty referral included referrals to nonsurgical or surgical specialties (eg, PTs, orthopedists, neurologists, neurosurgeons, or pain specialists). That was all considered nonconcordant care

How They Did It It was a cohort study with 5233 patients having acute low back pain Nearly half of the patients were exposed to at least one treatment recommendation that was not actually recommended within the first 21 days after the first visit   

What They Found

  • Patients were significantly more likely to transition to chronic low back pain as their risk on the prognostic tool increased and as they were exposed to more bad recommendations
  • Overall transition rate to chronic LBP at six months was 32%
  • Patient and clinical characteristics associated with the transition to chronic LBP included obesity, smoking, severe baseline disability, and depression/anxiety.
  • Patients exposed to 1, 2, or 3, bad recommendations in the first 21 days of pain were about 2 times more likely to develop chronic low back pain

Wrap It Up

This large inception cohort study found that the transition from acute to chronic LBP was substantial and the SBT was a robust prognostic tool. Early exposure to guideline nonconcordant care was significantly and independently associated with the transition to chronic LBP after accounting for patient demographic and clinical characteristics, such as obesity, smoking, baseline disability, and psychological comorbidities.

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message 

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

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

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

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

Website  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

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

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

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

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

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

Bibliography

  1. Katz JN, Arant KR, Loeser RF. Diagnosis and Treatment of Hip and Knee Osteoarthritis: A Review. JAMA. 2021;325(6):568–578. doi:10.1001/jama.2020.22171
  2. Stevans JM, Delitto A, Khoja SS, et al. Risk Factors Associated With Transition From Acute to Chronic Low Back Pain in US Patients Seeking Primary Care. JAMA Netw Open. 2021;4(2):e2037371. doi:10.1001/jamanetworkopen.2020.37371

 

Chiropractors Working On Kids

CF 165: Chiropractors Working On Kids

Today we’re going to talk about  chiropractors working on kids. Pediatric chiropractic. What’s the most current information and thinking. We’ll dive in a bit.  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 #165  Now if you missed last week’s episode, we talked about the use of breathing for pain, we talked about the need for rehab, and we talked about forward head posture and its impact on shoulder function and/or pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, the Chiefs lost the Super Bowl and Tom Brady and the Tampa Bay defense won it last night as of the time of me typing this episode out. It was all interesting.  One of my buddies said that I need to find out Brady’s regimen for staying active at that level so that I could sell it at my practice. I looked into it.

Yeah….that’s not happening because only a person making $25 million a year would go to that extent. Lol.

Nobody is buying anything close to what he does in the real world.  But kudos to him. There’s no denying what he’s accomplished and how special of a QB he is. I want to hate the guy but dangit…..he’s just so damn nice. How can you? As we watch the COVID numbers steadily declining, as a result, I see my appointment numbers beginning to steadily rise. It’s exactly what I saw back in August and September when the number fell from the July spike. Then October came around with the second spike and said, “Whoa wait a minute…..not so damn fast.”

But this time, I feel good about the positive numbers coming back to stay. Maybe we don’t reach pre-COVID numbers in the next month or two but I can see this Summer patients starting to lose some of their fears and starting to venture back out into the world.  That’s all good for us, my friends. It’s alright alright alright.  I don’t have a lot of personal stuff to share this week so let’s don’t talk just to fill up space, let’s get right to it. 

CHIROUP 

Item #1 This first one is called “Pediatric Osteopathic Manipulative Medicine: A Scoping Review” by DeMarsh, et. al. (1) and published in Pediatrics in February of 2021 and holy roasted marshmallows that’s sticky hot. 

Why They Did It

A common reproach precluding the use of osteopathic manipulative medicine (OMM) in pediatrics is a lack of evidence regarding its safety, feasibility, and effectiveness. They say, “We conducted a systematic, scoping review of pediatric osteopathic medicine to identify gaps in the literature and make recommendations for future research.”

How They Did It

  • 10 databases were searched using 6 key words and medical subject heading terms for any primary articles reporting osteopathic manipulation use in children published from database inception until initiation of the study.
  • Articles were selected if they reported primary data on osteopathic manipulation conducted in the United States on patient(s) 0 to 18 years old.
  • Baseline study characteristics were collected from each article and the Grading of Recommendations, Assessment, Development, and Evaluations system was used to critically appraise each study.
  • 315 unique articles with 30 studies fulfilling inclusion and exclusion criteria

What They Found

  • Of these, 13 reported the data required to demonstrate statistically significant results, and no significant adverse events were reported
  • The majority of studies were graded as providing weak clinical evidence because of significant methodologic flaws and biases.

Wrap It Up

The authors concluded, “There is little strong, scientific, evidence-based literature demonstrating the therapeutic benefit of osteopathic manipulative medicine for pediatric care. No strong clinical recommendations can be made, but it can be medically tolerated given its low risk profile. High-quality, scientifically rigorous osteopathic manipulative medicine research is required to evaluate safety, feasibility, and efficacy in pediatrics.

Here is what I think about this; we need more research and not just because this papers says we need it. All research paper say that because the researchers like to keep themselves in a job. And who the hell can blame them? The DOs are in the complex. They’re in. They’re not outside looking in like us. We’re like the cold kids on the cold street shivering and looking in the windows at the family all toasty and warm eating an elaborate dinner. 

We always get attacked for using SMT on kids. It’s normal. Especially when there’s no real indication for using it. But, when the osteopaths and the medical field are saying there’s no research. There’s not enough to go on for osteopathic manipulation…..that goes for us too. I know of some doing research on the pediatric end of things but, the point is, if chiropractors want to normalize and validate SMT in pediatric patients, we need to be hitting the research hard on it. 

Item #2

This one is called “Maternal Report of Outcomes of Chiropractic Care for Infants” by Miller et. al. (2) and published in the Journal of Manipulative and Physiological Therapeutics in March of 2019 not hot but still a bit steamy. 

Why They Did It

The authors say they wanted “to investigate the report by mothers of their infants’ condition before and after a trial of care provided by registered chiropractic clinicians in addition to ratings of satisfaction, cost of care, and reports of any adverse events or side effects. A second purpose was to report the demographic profile of infants who presented for care to 16 chiropractic clinics in the United Kingdom.”

How They Did It

  • Observational study
  • Collected reports by mothers of their infants’ demographic profiles and outcomes across several domains of infant behavior and their own mental state using the United Kingdom Infant Questionnaire.
  • Participating registered chiropractors were recruited through the Royal College of Chiropractors annual meeting in January 2016, and 15 clinics and the Anglo-European College of Chiropractic University College teaching clinic volunteered to participate.

What They Found

  • 2001 mothers completed intake questionnaires and 1092 completed follow-up forms
  • Statistically significant ( P < .05) improvements were reported across all aspects of infant behavior studied, including feeding problems, sleep issues, excessive crying, problems with supine sleep position, infant pain, restricted cervical range of motion, and time performing prone positioning
  • Maternal ratings of depression, anxiety, and satisfaction with motherhood also demonstrated statistically significant improvement 
  • In total, 82% reported definite improvement of their infants on a global impression of change scale.
  • 95% reported feeling that the care was cost-effective
  • 90.9% rated their satisfaction 8 or higher on an 11-point scale.
  • Minor self-limiting side effects were reported but no adverse events.

Wrap It Up

The authors concluded, “mothers reported that chiropractic care for their infants was effective, safe, and cost-effective. Although the observational design makes it impossible to determine efficacy, the study’s findings indicate that, on average, the changes observed by mothers were positive and may be clinically relevant.”

Item #3

Our last one today is called “Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7-14 years – a randomised clinical trial” by Lynge et. al. (3) and published in Chiropractic Manual Therapy in January of 2021….Oh, that’s a lot hot!!

Why They Did It

The authors stated objective here was to “investigate the effectiveness of chiropractic spinal manipulation versus sham manipulation in children aged 7-14 with recurrent headaches.”

How They Did It

  • It was a two-arm, single-blind, superiority randomized controlled trial.
  • It was performed at one chiropractic clinic with one pediatric specialty practice in Denmark, November 2015 to August 2020.
  • It included 199 children aged 7 to 14 years, with at least one episode of headache per week for the previous 6 months and at least one musculoskeletal dysfunction identified.
  • All participants received standard oral and written advice to reduce headaches
  • Children in the active treatment group received chiropractic spinal manipulation and children in the control group received sham manipulation for a period of 4 months
  • For outcome measures they used ‘Number of days with headache’, ‘pain intensity’ and ‘medication’ were reported weekly by text messages, and global perceived effect by text message after 4 months

What They Found

  • Chiropractic spinal manipulation resulted in significantly fewer days with headaches and better global perceived effect compared with a sham manipulation procedure.
  • There was no difference between groups for pain intensity during headache episodes.
  • Due to methodological shortcomings, no conclusions could be drawn about medication use.

Wrap It Up

The authors concluded “Chiropractic spinal manipulation resulted in fewer headaches and higher global perceived effect, with only minor side effects. It did not lower the intensity of the headaches. Since the treatment is easily applicable, of low cost and minor side effects, chiropractic spinal manipulation might be considered as a valuable treatment option for children with recurrent headaches.”

Alright, that’s it. Y’all be safe.

Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you.

Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store  Remember the evidence-informed brochures and posters at chiropracticforward.com. 

Chiropractic evidence-based products

Integrating Chiropractors

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The Message 

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

Key Point: 

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

Contact 

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

Connect 

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

Website 

Home

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TuneIn 

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About the Author & Host 

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

Bibliography

1. Pediatric Osteopathic Manipulative Medicine: A Scoping Review. Samantha DeMarsh, Anneliese Huntzinger, Alison Gehred, Joseph R. Stanek, Kathi J. Kemper, Jennifer A. Belsky

Pediatrics Feb 2021, 147 (2) e2020016162; DOI: 10.1542/peds.2020-016162

2. Joyce E. Miller, Heather A. Hanson, Mandy Hiew, Derek S. Lo Tiap Kwong, Zicheng Mok, Yun-Han Tee, “Maternal Report of Outcomes of Chiropractic Care for Infants”, J Man Physio Ther(42), 3, 2019, 167-176, https://doi.org/10.1016/j.jmpt.2018.10.005.

(https://www.sciencedirect.com/science/article/pii/S0161475418301453)

3. Lynge S, Dissing KB, Vach W, Christensen HW, Hestbaek L. Effectiveness of chiropractic manipulation versus sham manipulation for recurrent headaches in children aged 7-14 years – a randomised clinical trial. Chiropr Man Therap. 2021 Jan 7;29(1):1. doi: 10.1186/s12998-020-00360-3. PMID: 33413519; PMCID: PMC7792176.

CF 159: Set Yourself Apart In Your Chiropractic Care For Migraines

CF 159: Set Yourself Apart In Your Chiropractic Care For Migraines Today we’re going to talk about chiropractic care for migraines. What does new research tell us.  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 #159 Now if you missed last week’s episode , we talked about chiropractors within a primary spine care model, we talked about frozen shoulder treatments, and we talked about how evidence-based care is more cost-effective. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright alright alright. Christmas is over and as of the typing of this episode we are staring down New Year’s. No big deal for me. I’m not going anywhere so there’s nothing to get too excited or worked up about.  I guess the biggest news for me is that my wife and I got vaccinated last week. We got the Moderna version of the vaccine. Didn’t hurt a bit. I was one of the fortunate ones. I had absolutely zero reaction. No sore arm, no fever, no aches…..nothing. I guess if you poked on my arm fairly hard it would have been a bit sore but really, nothing at all.  If I had been in the research trial, I would think I got the placebo. That’s how uneventful it was for me.

My wife though, she felt a little crummy. No fever but maybe a little bit of overall achey-ness. Sore arm for a few days. But that’s about it. Nothing severe at all and she recovered quickly.  I’ve had several ask me online how we got ours so quickly. The first thing I’d say is that I have a network of providers here locally that I refer to, they refer to me, and on some level, we are friends. They know how closely we work with our patients. They don’t want us getting it and they don’t want us giving it to others.  So, when the vaccine came to town, they called and told us to come down and get ours. So we did. Here’s the cool part; they told me to reach out to fellow chiropractors and tell them to come to get vaccinated if they want one.

I thought to myself, “Can you imagine if this pandemic were just 10 years ago? Would the medical community have extended that offer to chiropractors then?” My guess is probably not.  Here’s the not-so-cool part. I reached out to about 40 in the area and only ONE of them accepted the offer. So, we gots some work to do in making chiropractors more evidence-science-based. Though I do want to be fair. I don’t think it’s unreasonable at all to wait 4-6 weeks just to make sure everyone does OK with this thing. even though the proper trials were done….it’s not unreasonable.  It’s just delaying the fact that people are going to do fine and everyone will end up getting it anyway but whatever. 

What I do think is unreasonable is continuing to refuse it beyond the 4-6 week mark. This thing is far beyond the flu both in transmissibility and in the risks of death and or disability. Sometimes that disability is short-term and sometimes it’s long-term. Don’t think of this as a death vs. living thing. Long-haulers is a real thing.  We don’t need to be out of work that long. We don’t need to have to figure out how to keep our employees paid while we are out sick for 2-4-6 weeks or however long we have to be out.  We don’t need to think we just have a sniffle or allergies and then spread this to our elderly or immunocompromised patients.  Being out of work for far too long or passing this onto risky patients….when all we had to do was just get the damn shot.

So….I got the damn shot and so far, so good. 

In other news, I have formed a collection of all of my research blogs from 2007 onward. I’ve organized them into categories so they can be easily found so now I have a book. I’m in the process of getting the book cover made. This dude is about 220 pages or so. It could be much longer but I’m trying to make it skinnier on purpose.  It is called “The Remarkable Truth About Chiropractic: A Unique Journey Into The Research”. We still have a lot of steps and hoops to jump through to get to the finished product but we are well on our way. Of course I’ll keep you updated on the progress.  Happy New Year folks. Let’s get on with the research today. 

Item #1

This one is called “Association of drinking water and migraine headache severity” by Khorsha, et. al. (Khorsha F 2020) and was published in the Journal of Clinical Neuroscience in July of 2020 and that’s still a steaming pile of sizzle! Before we get into chiropractic care for migraines, let’s cover a little headache primer here for you. First thing, the history of the headache is key. In general, a headache is considered dangerous if there is any recent change in a headache’s character. Some have a long history with headaches but if that history changes, further exploration is needed. Recent onset of less than 6 months is more worrisome. Focal neurological signs. And lastly, cognitive changes. Changes in behavior for example. 

Getting back to headache types, 38% of headaches seen in a clinical setting are tension-type headaches right off the bat. Only about 10% are actual migraines. Only 4% of headaches are actually classified as true cervicogenic headaches. Then cluster headaches, and on and on….those are very rare. Here’s the fine print though. Tension-type and migraine headaches exist on the same continuum. Meaning, they share characteristics. I suppose you could even say that tension-type is a very very mild form of migraine while migraine is a very very extreme tension-type.

That may be overstating it a bit but there is a relationship between the two and they can share characteristics with each other.  According to Dr. Anthony Nicholson and Dr. Matthew Long with the CDI learning from the Diplomate in Neuromusculoskeletal Medicine, “It is a pervasive neurological condition with genetic underpinnings. Indeed, when you look more closely you will soon realize that migraineurs do not function normally in between headache episodes either (the interictal period). In other words, the headache symptoms are simply a feature of what might be described as a chronic neurological ‘disorder’ or ‘illness’. As we shall explore in this Drill, migraine is the manifestation of an abnormally excitable brain that is capable of over-activating the trigeminal system in genetically susceptible individuals.

The result is not only nasty headaches but also a host of other autonomic, cognitive, emotional and musculoskeletal disturbances. Furthermore, these can occur both during the headache or outside of the acute pain episode. It is therefore important that we immediately recognize a patient as a migraineur because it should influence the way we interpret their entire case. Not only that, but we certainly need to approach a migraine sufferer a little differently when it comes to dispensing manual treatment. “

If you think that makes a ton of sense, Dr. Anthony Nicholson just signed on to be a presenter for the Texas Chiropractic Association’s Winter Conference, which will be online for ALL OF YOU to enjoy. It’ll be march 5-6 and will also include myself, Annie O’Connor, Jay Greenstein, Brandon Steele, and Carlo Ammendolia as presenters. Don’t miss it folks! That’s huge. So, getting back to Dr. Nicholson’s description, we wouldn’t describe a tension-type headaches that way, would we? As you have probably experienced or at least guessed, migraines are much more difficult to address or treat than are the other types of headaches. 

I don’t have the time or space to go into the full treatment of migraines here but I do want to highlight some studies that we might leverage to our advantage and we can go that extra mile to help our patients with the issues of headaches and migraines.  Many times, they’re at the bottom of their rope when we get them. If we succeed where everyone else failed, well then, don’t we always enjoy being that practitioner? Hell yeah, we do.  Just remember 3 important questions:

  • Do you have recurrent headaches that interfere with work, family, or social functions?
  • Do your headaches last at least 4 hours?
  • Have you had a new or different headache in the last 6 months?

These should give you some guidance considering migraines typically last 4-72 hours and interfere with work, family, and social functions. Patients cannot simply muscle through migraines. It’s a nope. 

Why They Did It

“Based on evidence dehydration is closely related to promoting migraine headache frequency and severity. The Water intake is the best intervention to reduce or prevent headache pain. water intake in migraine patients has rarely been studied. the present study aimed to evaluate the relation between water intake and headache properties in migraine.”

How They Did It

  • It was a cross-sectional design with 256 women
  • They were aged 18–45 years old
  • They had all been referred to neurology clinics for the first time
  • The diagnosis of migraine by a neurologist according to ICHD3 criteria
  • To assess migraine severity the Migraine disability assessment questionnaire (MIDAS), visual analog scale (VAS), and a 30-day headache diary were used.
  • Pearson correlation analysis was used to evaluate the relationship between the number of days and duration of headache with daily water intake.

What They Found

The results showed that the severity of migraine disability, pain severity, headaches frequency, and duration of headaches were significantly lower in those who consumed more water or total water. Wrap It Up “The present study found a significant negative correlation between daily water intake and migraine headache characteristics but further clinical trials are needed to interpret the causal relationship.”

CHIROUP ADVERTISEMENT

Item #2 This second one is called “Endogenous Melatonin Levels and Therapeutic Use of Exogenous Melatonin in Migraine: Systematic Review and Meta‐Analysis” by Liampas L, et. al. (Liampas L 2020) and published in the Journal of Head and Face Pain on April 30 2020 schizza it’s hot.  Why They Did It The aim of this study was to review the existing evidence for the deployment of melatonin in migraine prophylaxis.  How They Did It

  • MEDLINE EMBASE, CENTRAL, PsycINFO, trial registries, Google Scholar, and OpenGrey were comprehensively searched
  • The quality of studies was assessed according to the Newcastle‐Ottawa Scale (case‐control studies) and the Risk‐of‐Bias Cochrane tool (RCTs)
  • Random‐effects (RE) or fixed‐effects (FE) model was used based on heterogeneity among studies 
  • Publication bias was assessed by funnel plots.
  • Literature search provided 11 case‐control studies
  • Regarding the treatment‐prevention of migraine, 7 RCTs and 9 non‐randomized studies were retrieved
  • Overall, melatonin was more efficacious and equally safe with placebo in the prevention of migraine in adults (3 of 4 RCTs provided superior efficacy results for melatonin

Wrap It Up

“Melatonin may be of potential benefit in the treatment‐prevention of migraine in adults, but complementary evidence from high‐quality RCTs is required.”

Item #3

Next up is “Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series” by Bernstein et. al. (Bernstein C 2019) and published in Global Advances in Health And Medicine” in 2019. Not hot but definitely not cold. 

Why They Did It

They ran a case series to illustrate an integrated model of care for migraine that combines standard neurological care with chiropractic treatment.

How They Did It

  • For each patient, we describe the rationale for referral, diagnosis by both the neurologist and chiropractor, the coordinated care plan, communication between the neurologist and chiropractor based on direct face-to-face “hallway” interaction, medical notes, team meetings, and clinical outcomes.
  • Findings are evaluated within the broader context of the multicause nature of migraine and the impact of integrative chiropractic. 

They highlighted 3 cases that we’ll touch on briefly.  Case 1

  • She was 40 when she first went to the neurologist for daily migraines. 
  • She started integrative care at 42 years old. 
  • She had had migraines since she was 29 years old. 
  • After seeing the neuro, the frequency went down to 3-4 times per week
  • She also had some TMJ issues and neck pain and stiffness. with some radicular symptoms that were only a few months in duration
  • Upon going to the chiro, they found trigger points that would stimulate the headache on compression, abnormal tracking of the TMJ, and tenderness over the right C2/3 facet joint. 
  • After spinal manipulative therapy, the patient experienced almost immediate reduction in headache and neck pain and a reduced headache frequency of 1 per month. 

Shazam! Pop! Smack. KaPow! Case 2

  • She was 31 at the start, 34 when integrating treatment. 
  • She had been having them since 12 years old that she managed with Excedrin for years. But they got more out of hand after her 2 pregnancies
  • 2 of the headaches even sent her to the ER
  • Associated symptoms included unilateral neck pain, nausea, and vomiting
  • She tried multiple trials of different medications with limited relief
  • Once making her way to the chiropractor, they found trigger points in the suboccipitals, temporalis, and masseters. Weakness in the deep neck flexor muscles, and substantial postural faults, forward head carriage, and rounded shoulders. 
  • Where her headaches had been rated from 7-8, after 9 months of treatment with admittedly poor adherence to the at-home exercises, she rated them at a 3 out of 10 and after 10 months experienced her first headache-free month. 

Pow! Zap! Slap! Case 3

  • 27 years old when first going to the neuro and 29 when she made it to the chiro
  • Migraines started when she was 13
  • Pounding and throbbing with aura. The whole nine yards. 
  • Migraines were nearly daily, disabling and interfering with life to the point she could only take 1-2 college classes each semester. 
  • Multiple medication trials
  • She underwent botox treatments that helped her have as many as 8 pain free days in a month. Which means she still had about 22 days of headaches in a month. How miserable. 
  • Fortunately the botox helped the severity dampen by about 50% but she still complained of the disabling neck pain. 
  • The chiropractor found trigger points in the sub occipital area and the traps and could reproduce the pain on compression. The chiro also noted substantial segmental mobility restriction in the upper cervical spine. 
  • After seeing the chiropractor, there was a nearly immediate positive response to initial care in headache and neck pain intensity and frequency. with a reported 50% reduction in the intensity. The average headache dropped to 3.5 out of 10. 

Zowey, Kapowey, Thunk! 

Wrap It Up

“Our case series highlights the promise of and the need to further evaluate integrated models of chiropractic and neurologic care. Although we observed improvement in patient outcomes in this small case series, rigorously designed studies with adequate control groups are needed to determine the efficacy and safety of chiropractic care for migraine patients.”

Item #4

Yep, it’s a longer podcast today but I can’t leave you without doing this paper real quick! It’s called “The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta‐Analysis” by Rist et. al. and published in the Journal of Head and Face Pain on March 14, of 2019. Again, not hot but damn sure not cold.  Why They Did It They wanted to perform a systematic review and meta‐analysis of published randomized clinical trials (RCTs) to evaluate the evidence regarding spinal manipulation as an alternative or integrative therapy in reducing migraine pain and disability.

How They Did It

  • PubMed and the Cochrane Library databases were searched for clinical trials that evaluated spinal manipulation and migraine‐related outcomes through April 2017
  • The methodological quality of retrieved studies was examined following the Cochrane Risk of Bias Tool.

What They Found

  • The search identified 6 randomized controlled trials eligible for meta‐analysis.
  • Intervention duration ranged from 2 to 6 months
  • Outcomes included measures of migraine days (primary outcome), migraine pain/intensity, and migraine disability
  • They observed that spinal manipulation reduced migraine days with an overall small effect size as well as migraine pain/intensity.

Wrap It Up

The authors concluded, “Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity. However, given the limitations to studies included in this meta‐analysis, we consider these results to be preliminary. Methodologically rigorous, large‐scale RCTs are warranted to better inform the evidence base for spinal manipulation as a treatment for migraine.” It’s like a computer. It only spits out information that is based on the information that was put into it. Same with a meta-analysis. If the studies going into it are few, your output won’t be too robust.

Of course, we know that the effect we have on migraines is much more than small. In the 3rd study we covered today, do you think any of those 3 case study patients thought that the relief they got from the chiropractor was small? Nope, they thought the results were worthy of superhero sound effects. At least if they had a brain like mine that’s what they’d think.  So, for our research community, there are your marching orders. We have research on the low back in spades. Let’s prove neck pain and headache/migraine now please? I’ve been asking for 3 years now. Please?

Besides the claims of the vitalists in our profession, those are the things that keep us from really stepping up. Lack of proof for neck pain effectiveness, headache/migraine effectiveness, and the lack of risk for spinal manipulation in the cervical region.  I feel the stroke risk has been debunked and handled. Now if we can get the other two firmly under our belts, we’ll be good to go.  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

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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

  • Bernstein C, W. P., Rist P, Osypiuk K, Hernandez A, Kowalski M, (2019). “Integrating Chiropractic Care Into the Treatment of Migraine Headaches in a Tertiary Care Hospital: A Case Series.” Glob Adv Health Med 8.
  • Khorsha F, M. A., Togha M, Mirzaei K, (2020). “Association of drinking water and migraine headache severity.” J Clin Neuroscience 77: 81-84.
  • Liampas L, S. V., Brotis A, Vikelis M, Dardiotis E, (2020). “Endogenous Melatonin Levels and Therapeutic Use of Exogenous Melatonin in Migraine: Systematic Review and Meta‐Analysis.” J Head Face Pain 60(7): 1273-1299.

 

Primary Spine Care, Frozen Shoulder, & Evidence-Based Chiropractic & Cost

CF 158: Primary Spine Care, Frozen Shoulder, & Evidence-Based Chiropractic & Cost

Today we’re going to talk about Evidence-Based Chiropractic, We talk about the primary spine care model integrated into a primary care setting. What happens when that’s the mode of treatment? Then we’re going to talk about some Frozen Shoulder (adhesive capsulitis) research in JAMA recently.   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 #158 Now if you missed last week’s episode, we talked about chiropractors that spread misinformation, we talked about patients needing movement, and we talked about love. I’m a softy at heart believe it or not. Make sure you don’t miss that info. Keep up with the class. Evidence-Based Chiropractic is catching on!

On the personal end of things….. We are sitting here on a Monday 12/21 as of the typing up of this episode. Christmas is upon us. Nothing crazy special going on beyond that.  There are a couple of things I’ll mention. The first is that I got the Mirror gym you hang on a wall. It’s basically like having a trainer in your living room. Lots of you are already used to this sort of a deal with products like Peloton but it’s new to me and it’s pretty awesome. I’m doing stuff like Tai Chi, yoga, boxing, kickboxing, and stuff like that.

Stuff I’d never do otherwise and it’s pretty darn cool.  We turned what used to basically be a dog room into a small gym and it’s been pretty cool so far. I’m enjoying it. I’ve always been a skinny dude stuck in a big dude’s body. So, now that I’m down 33 lbs on weight watchers, and I’ve added the home gym to the mix, I feel like I’m on the way to realizing the skinny dude. Eventually. Lots of work left to do first though. 

Secondly, I’m getting the vaccine in a day or two if everything works out. I have mentioned several times on the podcast that I have very positive relationships with a lot of folks in my local medical community. Through that network, my wife and I will be getting ours this week. I’m ready to get that dude and start moving on with life. 

No, I’m not worried about it. Understanding I have some level of influence and some level of leadership with my friends, family, and patients, I feel it’s important to get out front and set an example on this deal.  Especially being a chiropractor. When you see so many of us disenfranchised because of the vitalists in our profession out there preaching the harms of vaccines when they wouldn’t know how to make it through a research paper on the vaccine to save their lives…..well, wouldn’t it be refreshing to see evidence-based chiropractors stepping up and leading the way on this vaccine? Here’s my stance on it. Maybe it helps you if you’re on the fence. Maybe it doesn’t but here it is anyway.  I’m not an epidemiologist or a maker of vaccines. I have researched masks, COVID, the transmission of Covid, and things like that. Not as much on the vaccine on the vaccine itself though. 

Scientists understand so much more about that sort of research than I’ll ever know. A Fox Poll says 61% of Americans will get the shots while only 23% are strictly against taking it. There were 16% unsure. Probably the ones waiting to see if everyone does OK with it before they step up. And I don’t think that’s unreasonable.  The point is, those getting it like me…..I’m not the minority on it. For me, it’s not only about life or death. I have a 20-something-year-old patient that can’t go back to work because she’s still positive 6 weeks later. I know a nurse that was positive for over nine weeks. I know Patients that had to go to physical therapy for weeks. Long haulers is a real deal. In the end, it’s an easy decision for me. I’m not worried at all really.

There’s risk crossing the road. If I get sick, I have to close my office for at least 2 weeks if not more. That means I lose a lot of money, there will be patients drop off of the schedule, we’ll miss new patients, and I’ll be sick AND anxious the entire time. If COVID doesn’t make me nauseous, the destruction of my business while I’m out sick will.  Besides myself, I have 13 or so other employees and their families depending on my presence. My business depends on my presence and does not run when I’m not there. That’s a little different than a lot of other folks. I’m not doing that if I can prevent it. If a vaccine allows me to prevent it, well then, a vaccine it is.

We chiropractors work within inches of people’s faces and in close contact with them. That puts us at more risk than the average Joe and, if we have it, puts our patients at serious risk of getting it from us.  If you’re like me, we work with a lot of elderly and immunocompromised patients. I’m not willing to put them at risk like that when all I had to do was trust in science and just get the damn vaccine. They ran human trials on 35000-45000 or so people with no unacceptable issues. That’s a huge sample size. I’ve seen this thought on the FTCA group before. It’s probably a Bobby Maybee special quote but, back before Facebook, people would have just taken the vaccine.

They weren’t worried about this stuff back before Facebook told them to worry about it.  No matter what’s out there these days, you have people casting doubt on it for zero reasons. Maybe it’s a call for attention at all costs. Who knows? But it’s to the point now where science and experts are constantly doubted and discounted. And that’s about as dumb and dangerous as can be.  It was OK to cure smallpox and polio but COVID……nah bruh.

If there were real questions, would basically the entire medical complex be in line taking it? My guess is that they wouldn’t.  What if someone can afford to be out of work or out of their office for 2-4-6 weeks and they want to wait to get it? I think it’s reasonable if someone wants to wait to see if anyone has adverse effects before they take it. I don’t think that’s unreasonable at all. But I think that it’s just delaying the fact that almost everyone is going to do fine with it and most people are going to end up getting it.

They started it in England two weeks ago. Nothing has happened. Because they already did the test trials to make sure nothing would happen. Considering the success of the testing, I think the people not getting it are at far more risk than the people that are getting it. Besides all that, I’m ready to get back in my life. Traveling, doing fun stuff, having a life…..important stuff. Like seeing my mom and step pops and being able to visit my dad in the nursing home for the first time since March.

More power to those that have been doing those things all along but for the above-mentioned reasons, we have not.

So that’s where I’m at. We are all on our own walk and we all need to do what we think is best. Staying healthy, staying open and available, and continuing to provide for my family, my staff, and my patients are what I think is best.  So, I’m out front on this. It’ll be good for my patients and family to see a picture of me getting my vaccine on social media. It’ll be good for my patients to see it.

And it’ll be good for those in the medical community that is friends with me to see it. It’ll reaffirm that no….I’m not one of THOSE chiropractors.  I encourage you to be out front with it if you get one. Be a leader and blaze the trail.  And Merry Christmas, Dammit. 

Item #1 The first one today is called “Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study” by Whedon, et. al. (Whedon JM 2020) and published in the Journal of Manipulative and Physiological Therapeutics on September 1, of 2020. And that’s a blistering blast of hotness.  If you don’t recognize the Whedon name, he is very prolific in chiropractic research. 

Why They Did It

The objective of this investigation was to compare the value of primary spine care with usual care for the management of patients with spine-related disorders within a primary care setting.

How They Did It

  • They retrospectively examined existing patient encounter data at 3 primary care sites within a multi-clinic health system
  • Designated clinicians serve in the role as primary spinal care as the initial point of contact for spine patients, they coordinated the care, and they followed up for the duration of the episode of care
  • A primary spinal care doctor may be a chiropractor, PT, or medical or osteopathic physician trained in primary spinal care for spine-related disorders
  • They had sites where the primary spinal care was implemented as well as control sites where they just stuck with the usual care model
  • They examined clinical encounters occurring over a 2 year period from February 2016 to March 2018. 

What They Found

  • Primary spine care was associated with reduced total expenditures compared with usual care for spine-related disorders
  • At site one, the average per-patient cost was $162 in a year and $186 in year two. 
  • That is compared to site II, a control site, where the cost in year one was $332 and $306 in year two. And in site three, also a control site offering only usual care, where the cost in year one was $467 and year two was $323

Wrap It Up

Among patients with SRDs included in this study, implementation of the PSC model within a conventional primary care setting was associated with a trend toward reduced total expenditures for spine care compared with usual primary care. Implementation of PSC may lead to reduced costs and resource utilization but may be no more effective than usual care regarding clinical outcomes.

CHIROUP ADVERTISEMENT

Item #2

Our second item today is called “Comparison of Treatments for Frozen Shoulder: A Systematic Review and Meta-analysis” by Challoumas, et. al. (Challoumas D 2020) and published in JAMA Open on December 16, of 2020 and it does not get one degree hotter than that people!

Why They Did It

The authors here wanted to know the answer to the question, “Are any treatment modalities for frozen shoulder associated with better outcomes than other treatments?”

How They Did It

  • It was a meta-analysis of 65 studies with 4097 participants
  • They searched Medline, EMBASE, Scopus, and CINHAL in February 2020.
  • Studies with a randomized design of any type that compared treatment modalities for frozen shoulder with other modalities, placebo, or no treatment were included.
  • Data were independently extracted by 2 individuals
  • Pain and function were the primary outcomes, and external rotation range of movement (ER ROM) was the secondary outcome
  • Length of follow-up was divided into short-term (≤12 weeks), mid-term (>12 weeks to ≤12 months), and long-term (>12 months) follow-up.

What They Found

  • Despite several statistically significant results, only the administration of intra-articular (IA) corticosteroid was associated with statistical and clinical superiority compared with other interventions in the short-term for pain
  • Subgroup analyses and the network meta-analysis demonstrated that the addition of a home exercise program with simple exercises and stretches and physiotherapy (electrotherapy and/or mobilizations) to the intra-articular corticosteroid may be associated with added benefits in the mid-term

Wrap It Up

The findings of this study suggest that the early use of intra-articular corticosteroid in patients with frozen shoulder of less than 1-year duration is associated with better outcomes. This treatment should be accompanied by a home exercise program to maximize the chance of recovery.

Item #3

Now, on to Evidence-Based Chiropractic. Our third and final one this week is called “Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study” by Whedon et. al. (Whedon JM 2020) and published in the Chiropractic and Manual Therapies on December 14, 2020. Get your red hots right here, get ‘em hot right here.  I told you Whedon was prolific. That’s two papers in this one episode that he’s the lead author on and I did not do that on purpose. I didn’t realize who the authors of the papers were until I started typing. He’s on his A-game. 

Why They Did It

The abstract for our Evidence-Based Chiropractic talk leads off by saying, “Low back pain (LBP) imposes a costly burden upon patients, healthcare insurers, and society overall. Spinal manipulation as practiced by chiropractors has been found to be cost-effective for the treatment of LBP, but there is wide variation among chiropractors in their approach to clinical care, and the most cost-effective approach to chiropractic care is uncertain. To date, little has been published regarding the cost-effectiveness of different approaches to chiropractic care. Thus, the current study presents a cost comparison between chiropractic approaches for patients with acute or subacute care episodes for low back pain.” How They Did It

  • It was a retrospective cohort design to examine the costs of chiropractic care among patients diagnosed with acute or subacute low back pain.
  • The study time period ranged between 07/01/2016 and 12/22/2017
  • They compared cost outcomes for patients of two cohorts of chiropractors within the health care system: Cohort 1) a general network of providers, and Cohort 2) a network providing conservative evidence-based care for rapid resolution of pain.
  • They used generalized linear regression modeling to estimate the comparative influence of demographic and clinical factors on expenditures.
  • A total of 25,621 unique patients were included in the analyses

What They Found

  • The average cost per patient for Cohort 2 (mean allowed amount $252) was lower compared to Cohort 1 (mean allowed amount $326
  • Patient and clinician related factors such as health plan, provider region, and sex also significantly influenced costs.

Wrap It Up In general, providers in Cohort 2 were found to be significantly associated with lower costs for patient care as compared to Cohort 1. Utilization of a clinical model characterized by a patient-centered clinic approach and standardized, best-practice clinical protocols may offer lower cost when compared to non-standardized clinical approaches to chiropractic care.

So….just who the hell do you all know that’s been preaching this until his face is about to explode? That’s right, listeners of this podcast. One word, two syllables…..Day-um.  Evidence-based and patient-centered care is the future of chiropractic. It is first and foremost, treating our patients with respect and the best care and that’s what they deserve.  Secondly, it’s speaking the language of the medical community. Which is the language of research. When you’re using their language, you’re starting to communicate more effectively.  I think it’s time for superhero sound effects….boom, pow, snap, kawachow!

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Key Point:

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

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

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

  • Challoumas D, B. M., McLean M, (2020). “Comparison Of Treatments For Frozen Shoulder: A Systematic Review and Meta-Analysis.” JAMA Open 3(12): e2029581.
  • Whedon JM, B. S., Dennis P, Fischer VA, Russel R, (2020). “Cost comparison of two approaches to chiropractic care for patients with acute and sub-acute low Back pain care episodes: a cohort study.” Chiropr Man Therap 28(68).
  • Whedon JM, T. A., Bezdijan S, (2020). “Implementation of the Primary Spine Care Model in a Multi-Clinician Primary Care Setting: An Observational Cohort Study.” J Man Physiol Ther 43(7): P667-674.

 

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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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

  • 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.

 

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.

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

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

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

TuneIn

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About the Author & Host

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

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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 & 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.