forward chiropractic

Steps Per Day And Dementia & Vets And Chiropractic

CF 248: Steps Per Day And Dementia & Vets And Chiropractic Today we’re going to talk about Steps Per Day And Dementia & Vets And Chiropractic But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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  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, look down your nose at people 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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #248 Now if you missed last week’s episode, we were joined by the one and only, my friend, Dr. Jay Greenstein and man…..what a great episode. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

First, hey, I’m hiring. I need an asscoiate. Seriously, if you go to work for a franchise people, honest talk here…..you have a cap in salary. You will adjust all day every day and on the weekends. You will work your butt straight off and you’ll never get paid more.  At a private practice, like mine for example, you’re not going to have a cap. Once your prove yourself and you’re helping build the clinic, you will get paid without a cap.

You get paid for the work and effort you put in. If you want to work your tail straight off and not get paid what you’re worth, I’m not the right call for you.  If you want to work but get mentored by an ortho and forensics diplomate, play a part in this podcast, and set yourself apart from the parts of the profession you don’t like….oh….and get paid for your efforts with a potential buyout down the road, then I am exactly the guy you want to speak with.  If you think Amarillo is a great place to live and raise a family, which it absolutely is, send me an email at creekstonecare@gmail.com I want to meet you. Doesn’t matter when you hear this episode.

I’m always looking for top talent and I know if you’re listening to this podcast then you are indeed top talent. Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office. 

When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. Second, we just got back from Vegas. I try take at least one short trip every quarter. Sometimes more. Sometimes less but we have to get out of the clinic.  Certainly after you’ve built and you’re on the way. It’s the only way you stay sane. I’m not telling you to close down the clinic and go to Europe for a month as a solo doc. Just a long weekend here and there. It’ll keep you likable. We saw Motley Crue, Def Leppard, Poison, and Joan Jett and it was a great. Just what we needed. I have to admit that I’m still on a bit of a buzz from having Jay Greenstein join me on the show last week. What a freaking gem that guy is. Don’t miss that episode. For any reason. I think that’ll be quite enough of rambling from me. Let’s get it started

Item #1

The first one is called “Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK” by del Pozo Cruz, et. al. (del Pozo Cruz B 2022) and published in JAMA on September 6, 2022. Pow! Hottern’ a firecracker!

Why They Did It

The authors wanted to find out if there is a dose-response association of daily step count and intensity with incidence of all-cause dementia among adults living in the UK?

How They Did It

  • UK Biobank prospective population-based cohort study with 6.9 years of follow-up. 
  • A total of 78,430 of 103,684 eligible adults aged 40 to 79 years with valid wrist accelerometer data were included. 
  • Registry-based dementia was ascertained through October 2021.

What They Found

  • This cohort study of adults assessed with wrist-worn accelerometers found that accruing more steps per day was associated with steady declines in dementia incidence risk, up to 9800 steps per day, beyond which the benefits upturned. 
  • The dose associated with 50% of maximal observed benefit was 3800 steps per day, and steps at higher intensity (cadence) were associated with lower incidence risk.

Wrap It Up

The findings in this study suggest that accumulating more steps per day just under the popular threshold of 10 000 steps per day and performing steps at higher intensity may be associated with lower risk of dementia onset. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2

Our last one this week is called “Health-Related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care Plus Chiropractic Care vs Usual Care Alone: Secondary Outcomes of a Pragmatic Clinical Trial” by Hays et. al. (Ron D Hays 2022) and published in Pain Medicine on January 21 of 2022. Shazzaaammm! It’s sizzlin’ hot.  And I want to make note of the authors on this paper. They are among some of my very favorite researchers in our profession. There are lots of them but in particular Rober Vining, Ian Coulter, Katherine Polhman (former guest) and Christine Goertz (also a former guest) Yay for these folks. They are working for you every day. 

Why They Did It

This study examines Patient-Reported Outcome Measurement Information System (PROMIS®)-29 v1.0 outcomes of chiropractic care in a multi-site, pragmatic clinical trial and compares the PROMIS measures to: 

  1. Worst pain intensity from a numerical pain rating 0–10 scale, 
  2. 24-item Roland-Morris Disability Questionnaire (RMDQ); and 
  3. Global improvement (modified visual analog scale).

How They Did It

  • It was a pragmatic, prospective, multisite, parallel-group comparative effectiveness clinical trial comparing usual medical care (UMC) with UMC plus chiropractic care (UMC+CC).
  • Three military treatment facilities
  • 750 active-duty military personnel with low back pain
  • Linear mixed effects regression models estimated the treatment group differences. 
  • Coefficient of repeatability to estimate significant individual change.

What They Found

The researchers found statistically significant mean group differences favoring UMC+CC for all PROMIS®-29 scales and the Roland-Morris Questionnaire score. 

Wrap It Up

Findings from this pre-planned secondary analysis demonstrate that chiropractic care impacts health-related quality of life beyond pain and pain-related disability.  Further, comparable findings were found between the 24-item Roland-Morris Questionnaire and the PROMIS®-29 v1.0 briefer scales. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

Key Point:

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

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

Connect

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

del Pozo Cruz B, A. M., Naismith SL, Stamatakis E, (2022). “Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK.” JAMA Neurology.

Ron D Hays, P., Zacariah K Shannon, DC, MS, Cynthia R Long, PhD, Karen L Spritzer, BA, Robert D Vining, DC, DHSc, Ian D Coulter, PhD, Katherine A Pohlman, DC, MS, PhD, Joan A Walter, PA, JD, Christine M Goertz, DC, PhD, (2022). “Health-Related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care Plus Chiropractic Care vs Usual Care Alone: Secondary Outcomes of a Pragmatic Clinical Trial.” Pain Med 23(9): 1550-1559.    

Upregulated Central Nervous System & Shared Decision Making With The Patient

CF 245: Upregulated Central Nervous System & Shared Decision Making With The Patient Today we’re going to talk about Upregulated Central Nervous System & Shared Decision Making With The Patient. But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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, look down your nose at people 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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #245 Now if you missed last week’s episode , we talked about Recognizing Cervical Artery Dissection. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Things are clicking along pretty normally for a chaotic clinic. Today, let’s talk a little about your relationships with your employees before we get to the research.  Everyone has different styles of owning or managing their clinics and staff. Mine has always been to treat them like family. Honestly, we spend more time with our staff than we do with our own families. So why not have friendly and almost family-like relationships with them? Why the hell not? I don’t want awkward forced relationships with the people I’m with every day all day. I want fun, happy, and friendly relationships. With people I look forward to seeing every day. 

My staff is hilarious and we have a lot of fun together. 

I’ll give you a little story as an example. My office manager is getting married in September. Probably about the time this episode goes live. She had her wedding shower on August 13th at her mother’s house. It wasn’t the regular boring old wedding shower. They had drinks, men and women, cornhole, and beer pong in the back yard…..you get the picture. Pretty much my entire staff of 12 or 13 was there. Which is nice. They feel like family to an extent. That’ll warm your heart, right? Well, I’m of the age that beer pong wasn’t ‘a thing’ in my college years. We played simple games like quarters or something like that. Anyway, I went to the wedding shower. My wife actually helped host it and run it all. She made a huge table full of charcuterie items and it was just all very well done. 

So that’s point #1; she felt close enough to us to not only want us at her wedding shower but to have my wife help host it.  Then, after gifts were opened and a few filtered out, everyone moved to the backyard and played cornhole and beer pong. My office manager made me be her teammate for a game of beer pong. Now, I told her I can’t play with drinks because I was driving so I just sipped on one beer while we played.  Turns out, I actually have a little talent for beer pong. We won the first game against her fiancee and Boom! Instant respectability amongst the kiddos. 

So, point #2; when your staff likes you and wants you to participate in aspects of their personal life, I say you just do it.  You build friendship, loyalty, camaraderie, and trust the more you just say, “Yes.” Play beer pong. Even when you don’t want to or don’t know how to play it. It’ll pay off in the long run.  If you feel differently, let me know. Send me an email at dr.williams@chiropracticforward.com I want your opinion so I can share with the collective. 

OK, on to the research. 

 

Item #1

Our first one is called “Does shared decision making results in better health related outcomes for individuals with painful musculoskeletal disorders? A systematic review” by Christopher et. al. (Yannick Tousignant-Laflamme 2017) published in the Journal of Manual and Manipulative Therapy in 2017. 

Why They Did It

Shared Decision-Making (SDM) is a dynamic process by which the health care professional and the patient influence each other in making health-related choices or decisions. SDM is strongly embedded in today’s health care approaches and is advocated as an ideal model since it renders individuals more control over the health care they choose to receive, and has been shown to improve patient outcomes. The goal of this systematic review was to investigate the added value of SDM on clinical health-related outcomes in patients with a variety of musculoskeletal conditions.

How They Did It

PubMed and CINAHL. To be considered for review, the study had to meet all the following criteria: (1) prospective studies that involved treatment decision-making;  (2) randomized controlled trial design;  (3) involving patients faced with having to make a treatment decision;  (4) comparing SDM with a control intervention and  (5) including one or more of the following outcome measures: well-being, costs, health-related pain or disability measures, or quality of life.

What They Found

We did not find a single study that looked at the true effect of SDM on patient-reported outcomes in a population with musculoskeletal pain.

Wrap It Up

For the management of painful musculoskeletal conditions, in the light of the current evidence (none), we estimate that it would be wise to explore the effectiveness of SDM before forcing its large-scale implementation in rehabilitation. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.

Item #2

The last one is called, “Mechanisms of chronic pain – key considerations for appropriate physical therapy management” by Courtney et. al. (Carol A. Courtney 2017) and published in the Journal of Manual and Manipulative Therapy in March of 2017.  Rather than a full-blown research project, this one is more of an informational article with some future direction. 

They say the following: “In the last decades, knowledge of nociceptive pain mechanisms has expanded rapidly. The use of quantitative sensory testing has provided evidence that peripheral and central sensitization mechanisms play a relevant role in localized and widespread chronic pain syndromes.  In fact, almost any patient suffering from a chronic pain condition will demonstrate impairments in the central nervous system. In addition, it is accepted that pain is associated with different types of trigger factors including social, physiological, and psychological.  This rationale has provoked a change in the understanding of potential mechanisms of manual therapies, changing from a biomechanical/medical viewpoint, to a neurophysiological/nociceptive viewpoint. 

Therefore, interventions for patients with chronic pain should be applied based on current knowledge of nociceptive mechanisms since determining potential drivers of the sensitization process is critical for effective management.  The current paper reviews mechanisms of chronic pain from a clinical and neurophysiological point of view and summarizes key messages for clinicians for proper management of individuals with chronic pain.”

Now, I don’t know exactly where you’ve been hearing this since 2019. Oh, wait, yes I do. Here!

 

You’ve been hearing it here and research is catching up.  I didn’t invent this stuff, of course. And I’m no smarter than everyone else. I just happened to take the course for the Diplomate of the International Academy of Neuromusculoskeletal Medicine and was taught by Drs. Anthony Nicholson and Matthew Long in that course and THEY are on the cutting edge.  They are the reason I’ve been preaching this stuff for so long now. They’re the reason my patients get better at the rate they do. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

Carol A. Courtney, C. F.-d.-l.-P. S. B. (2017). “Mechanisms of chronic pain – key considerations for appropriate physical therapy management.” Journal of Manual & Manipulative Therapy 25(3): 118-127.  

Yannick Tousignant-Laflamme, S. C., Derek Clewley, Leila Ledbetter, Christian Jaeger Cook & Chad E Cook, (2017). “Does shared decision making results in better health related outcomes for individuals with painful musculoskeletal disorders? A systematic review.” Journal of Manual & Manipulative Therapy 25(3): 144-150.  

Does Supplementation Work & Non-Surgical Treatment For Stenosis

CF 241: Does Supplementation Work & Non-Surgical Treatment For Stenosis Today we’re going to talk about if vitamin Supplementation Works for preventing cardiovascular issues or cancer and we’ll talk about  Non-Surgical Treatment For Stenosis But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

  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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #241 Now if you missed last week’s episode, we talked about Brain Activity From Spinal Manipulative Therapy & PT Is As Good As Arthoscopic Surgery For Meniscus Issues. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

What an amazing weekend in Tampa Florida, y’all. Seriously. When you think about a mastermind weekend, you think about learning stuff. And yes….absolutely, we’re learning. Friday from 8-5 we’re learning. Saturday from 8-1, we’re learning.  What doesn’t get counted or thought about is the discussion between the members during the classroom time.

We’re not talking about your chiropractor down the street. In some cases, we’re talking about the cream of the crop in the evidence-based chiropractic world.  We’re talking about doctors that have taught around the world. We’re talking about chiropractors that have 6+ associates under them. We’re having discussions with people on that level involved and contributing and sharing.  But what also doesn’t get counted or thought about is what happens outside of the classroom.

The bonds that have been forged over the past 7 months of being in this group. The friendships that have been formed. The networking and the sharing of tools, thoughts, and processes.  Little things like…..have you ever considered charging a small $2.00 admin fee on every checkout so that you can cover ordering a patient’s records, filing and dealing with insurance companies, denials, etc….credit card fees, writing mattress and freaking hot tub notes, and all of the other crap we have to do for free?

Well, that came up in the group, we brainstormed it, came up with a sign for the lobby to warn patients, and knock it out. A $2.00 fee per transaction will bring in an additional $25,000 or so per year and cover my credit card fees with a little left over for other admin costs. Not one word from the patients has been said according to those in the group already doing it. 

That’s just the beginning.

Did you know there are lots of government credits you probably qualify for that you’re not getting? I didn’t either until I joined this group. We estimate most of us have made 20x the return on investment so far. So that’s pretty amazing.  And then….the bonds. I have been fortunate enough to create a network and bonds with these folks that will be with me for the rest of my life. Not just professionally but personally as well. And they don’t just help me with my practice but referrals for speaking engagements and things that are professional but outside of the clinic.  It’s been great, folks. If you’re an earner and go-getter and you want to be a part of it, email Kevin Christie at drkchristie@gmail.com or email me at dr.williams@chiropracticforward.com and we’ll get you connected to see if you’re right for the group. 

Alright, let’s dive in. 

Item #1

Our first one today is called, “Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement” by the US Preventive Services Task Force (Force 2022) and published on June 21, 2022. And it’s hotter than Tampa in July!

Why They Did It

According to National Health and Nutrition Examination Survey data, 52% of surveyed US adults reported using at least 1 dietary supplement in the prior 30 days and 31% reported using a multivitamin-mineral supplement.  The most commonly cited reason for using supplements is for overall health and wellness and to fill nutrient gaps in the diet.  Cardiovascular disease and cancer are the 2 leading causes of death and combined account for approximately half of all deaths in the US annually.  Inflammation and oxidative stress have been shown to have a role in both cardiovascular disease and cancer, and dietary supplements may have anti-inflammatory and antioxidative effects.

Objective 

To update its 2014 recommendation on the evidence on the efficacy of supplementation with single nutrients, functionally related nutrient pairs, or multivitamins for reducing the risk of cardiovascular disease, cancer, and mortality in the general adult population, as well as the harms of supplementation.

How They Did It

Community-dwelling, nonpregnant adults.

What They Found

  • The USPSTF concludes with moderate certainty that the harms of beta carotene supplementation outweigh the benefits for the prevention of cardiovascular disease or cancer. 
  • The USPSTF also concludes with moderate certainty that there is no net benefit of supplementation with vitamin E for the prevention of cardiovascular disease or cancer. 
  • The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with multivitamins for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined. 
  • The USPSTF concludes that the evidence is insufficient to determine the balance of benefits and harms of supplementation with single or paired nutrients (other than beta carotene and vitamin E) for the prevention of cardiovascular disease or cancer. Evidence is lacking and the balance of benefits and harms cannot be determined.

Wrap It Up

So….nothing firm for beta carotene, Vitamin E, or multivitamins or a combo for preventing cardiovascular disease and cancer. 

 

Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds? My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2 Our last one this week is called, “Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review” by Ammendolia et. al. (Ammendolia C 2022) and published in BMJ Open on January 19, 2022. Sizzle baby. It’s hot. 

Why They Did It

Neurogenic claudication due to lumbar spinal stenosis (LSS) is a growing health problem in older adults. We updated our previous Cochrane review (2013) to determine the effectiveness of non-operative treatment of LSS with neurogenic claudication.

How They Did It

  • A systematic review.
  • We only included randomised controlled trials published in English where at least one arm provided data on non-operative treatment and included participants diagnosed with neurogenic claudication with imaging confirmed LSS.

What They Found

  • Of 15,200 citations screened, 156 were assessed and 23 new trials were identified. 
  • There is moderate-quality evidence from three trials that: 
  • Manual therapy and exercise provides superior and clinically important short-term improvement in symptoms and function compared with medical care or community-based group exercise; 
  • Manual therapy, education and exercise delivered using a cognitive-behavioral approach demonstrates superior and clinically important improvements in walking distance in the immediate to long term compared with self-directed home exercises and 
  • Glucocorticoid plus lidocaine injection is more effective than lidocaine alone in improving statistical, but not clinically important improvements in pain and function in the short term. 

Wrap It Up

  • There is moderate-quality evidence that a multimodal approach that includes manual therapy and exercise, with or without education, is an effective treatment and that epidural steroids are not effective for the management of LSS with neurogenic claudication. 
  • All other non-operative interventions provided insufficient quality evidence to make conclusions on their effectiveness.

We use Dr. Ammendolia’s program for stenosis patients in our office and it’s legit. It really helps. Our patients get outstanding results when they’re on the program, being good teammates and doing the things they’re supposed to be doing.  Stenosis is a lack of real estate. It’s frustrating for patients and practitioners but over the years, Dr. Ammendolia’s course has been the most impressive way of treating it I’ve ever experienced. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    

Bibliography

Ammendolia C, H. C., Plener J, Bussières A, Schneider MJ, Young JJ, Furlan AD, Stuber K, Ahmed A, Cancelliere C, Adeboyejo A, Ornelas J (2022). “Non-operative treatment for lumbar spinal stenosis with neurogenic claudication: an updated systematic review.” BMJ Open 12(1).  

Force, U. P. S. T. (2022). “Vitamin, Mineral, and Multivitamin Supplementation to Prevent Cardiovascular Disease and Cancer: US Preventive Services Task Force Recommendation Statement.” JAMA 327(23): 2326-2333.    

Benzodiazepines and Mirror Therapy

CF 238: Benzodiazepines and Mirror Therapy  In today’s episode, we cover Benzopdiazapines and Mirror Therapy  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #238 Now if you missed last week’s episode , we talked about Chronic Pain and current thinking. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I usually type up the podcast ideas and outline on a Monday. Well, we were off this Monday for July 4th so I’m short a day this week which means that this personal happenings part of the podcast has to be short so I can make everything happen in this short week.  So here we go. I’m still on the hunt for an associate chiropractor. One who is a go-getter determined to be successful.

One that understands they can go to work for the Joint and get paid more currently. In the now and here. But there will be a cap and they will not be able to exceed that cap. One that understands that there is no cap with me. The more they bring in and grow the clinic and themselves, the more I want to take good care of them. Plain and simple. If that’s you, email me at creekstonecare@gmail.com.

I want to get to know you. 

I am getting ready and looking forward to being in Sarasota with the Florida MCM Mastermind for the weekend of July 22nd. It’s a good time of networking with my fellow mastermind people and helping each other build our businesses. Hell yeah. I thrive in masterminds. Even if I don’t necessarily have the time to implement everything I want to implement. I get inspiration, ideas, and actionable steps I can take almost immediately most of the time.  Lots of little tips and tricks and I learn as much or more from the Mastermind members outside of the classroom at the hotel bar as I learn in the classroom. If you’re interested in joining, send me a message, and let’s get you connected with Dr. Kevin Christie and hopefully get you plugged into the group ASAP. I mean really, we’re meeting in Sarasota on July 22nd and there’s still room for you but in November, we’re meeting a Playa Largo in Key Largo, FL. Everyone’s bringing their family too so you know you don’t want to miss that one. Reach out and let me help you get plugged in.  You have to be grossing $350,000 per year and growth-minded to play so holla.  Let’s get started today. 

Item #1

Our first one today is called “Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA” by Trager et. al. (Trager RJ 2022) and was published in BMJ Open on June 13, 2022. The sizzle…..it’s hot

Why They Did It

Although chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions.  We hypothesize that utilization of CSMT for newly diagnosed radicular LBP is associated with reduced odds of benzodiazepine prescription through 12 months’ follow-up.

How They Did It Retrospective cohort study. National, multicentre 73-million-patient electronic health records-based network (TriNetX) in the USA 2003 – 2021

What They Found

  • Odds of receiving a benzodiazepine prescription were significantly lower in the CSMT cohort over all follow-up windows prematching and postmatching (p<0.0001). 
  • Sensitivity analysis suggested a patient preference to avoid prescription medications did not explain the study findings.

Wrap It Up

  • These findings suggest that receiving CSMT for newly diagnosed rLBP is associated with reduced odds of receiving a benzodiazepine prescription during follow-up. 
  • These results provide real-world evidence of practice guideline-concordance among patients entering this care pathway. 
  • Benzodiazepine prescription for rLBP should be further examined in a randomized trial including patients receiving chiropractic or usual medical care, to reduce residual confounding.

Before getting to the next one, I have to tell you, that Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s life again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2

The last one today is called “3D augmented reality mirror visual feedback therapy applied to the treatment of persistent, unilateral upper extremity neuropathic pain: a preliminary study” by Mouraux et. Al. (Dominique Mouraux) and published in the Journal of Manual and Manipulative Therapy in 2017.

Why They Did It

The authors assessed whether or not pain relief could be achieved with a new system that combines 3D augmented reality system (3DARS) and the principles of mirror visual feedback.

How They Did It

Twenty-two patients between 18 and 75 years of age  All of whom suffered of chronic neuropathic pain.  Each patient performed five 3DARS sessions treatment of 20 mins spread over a period of one week.  The following pain parameters were assessed: 

  1. visual analogic scale after each treatment session 
  2. McGill pain scale and DN4 questionnaire were completed before the first session and 24 h after the last session.

What They Found

  • The mean improvement of VAS per session was 29%. 
  • There was an immediate session effect demonstrating a systematic improvement in pain between the beginning and the end of each session. 
  • They noted that this pain reduction was partially preserved until the next session. 
  • If we compare the pain level at baseline and 24 h after the last session, there was a significant decrease of pain of 37%. 
  • There was a significant decrease on the McGill Pain Questionnaire and DN4 questionnaire.

Wrap It Up

Our results indicate that 3DARS induced a significant pain decrease for patients who presented chronic neuropathic pain in a unilateral upper extremity.  While further research is necessary before definitive conclusions can be drawn, clinicians could implement the approach as a preparatory adjunct for providing temporary pain relief aimed at enhancing chronic pain patients’ tolerance of manual therapy and exercise intervention.

You can decide how well-related this is BUT, with phantom limb pain, in addition to cognitive behavioral therapy, they have treated using mirror therapy. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Key Point:

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

Contact

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

Connect

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

Website

Home

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

You Are What You Eat & Screen Time For Kids

CF 236: You Are What You Eat & Screen Time For Kids Today we’re going to talk about what you eat and mental health and we’ll talk about screen time for kids.  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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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. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #236 Now if you missed last week’s episode , we talked about about the inflammatory response’s protection from chronic pain, which is fascinating.. and we talked about where patients should be starting their journey for low back pain.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Struggles and challenges in my personal space. See if you recognize any of my struggles in your life and clinic.  Some are so busy they can’t see straight. I have to say that the last few weeks have been a bit slow for me compared to where I normally am, numberswise. I typically will see 180+ appointments per week, 23 or so NP per week included in that number, and around 650 or so total appointments per month by myself.  Lately, it’s more like 145 or so per week.  In my mind, it’s the economy. It’s gas prices. It’s uncertainty. I keep good stats and this is just not normal for me. I didn’t make anyone in town mad. I didn’t go out and kick the mayor’s dog or anything. My name and reputation hasn’t changed. We’re good.  So why the slow down? COVID isn’t really around to take the blame this time. And, in the past, any time there’s been a slow down, it’s either back to school in August or it’s the holidays. So, outside of those factors what else is working people’s brains these days? Uncertainty. The inability to afford extras because of the price of food and gas and real estate and vehicles and everything else y ou can think of.  I cannot wait until the post-COVID wreck finally settles and life starts to click normally once again. No more excuses about inflation, gas, supply chains, price gouging, or anything else. Just normal life. I can’t wait.  In the meantime, I’m still looking for an associate. I’m a go getter. I’m a do-er. If you are too and you need a great place to work, be mentored, and maybe even buy out one of these days, email me at creekstonecare@gmail.com, I want to start a conversation with you.  Before we get ot the research,  I’ve been telling you about a system that once obtained will help you get more  PI cases.  This system was created by an attorney who exclusively handles accident cases. He got tired of lame approaches by doctors wanting his referrals, so he created this system to teach you how to get the attention and then the love of PI attorneys.  You know these cases are the GOLD of our business.  Very few no-shows, full payment … not health insurance caps or Medicare or Medicaid. Go to: http://www.gettingpicases.com/cs Over 500 doctors nationwide are now using this system…. don’t be left out…  improve your practice, gain free time because of the added income you’ll realize, and appreciate that the attorney, Paul Samakow, is still offering a 100% Money Back Guarantee …  if you give his ideas a fair shake and it doesn’t work, he’ll refund your money…  you have nothing to lose here… Go to: http://www.gettingpicases.com/cs Item #1 This first one is an article that covers a paper. The article is called “Your mental health may depend on what’s in your diet” by the staff (Staff 2021) at Study Finds. It was published in September of 2021 and that’s just steamy enough! It’s an article so here is the summary of the info within:
  • “There is increasing evidence that diet plays a major role in improving mental health, but everyone is talking about a healthy diet,” says Lina Begdache, an assistant professor of health and wellness studies and co-author of the study
  • There is not one healthy diet that will work for everyone. There is not one fix
  • Results indicated that eating breakfast daily, getting moderate exercise frequently, and keeping fast food and caffeine consumption down improved the mental health of young women. In mature women, the same applied with the addition of high consumption of fruits daily.
  • In young men, daily exercise coupled with dairy and meat consumption increased mental health, along with a low intake of fast food and caffeine. The same applied to mature men with an additional intake of nuts daily.
  • “I have found it in my multiple studies so far, that men are less likely to be affected by diet than women are. As long as they eat a slightly healthy diet they will have good mental well-being. It’s only when they consume mostly fast food that we start seeing mental distress,”
  • “Women, on the other hand, really need to be consuming a whole spectrum of healthy food and doing exercise in order to have positive mental well-being. These two things are important for mental well-being in women across age groups.”
Interesting stuff there. Food for thought…..pun intended.  See what I did there? And….you’re welcome Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later. Item #2 The last one today is called “Association Between Screen Time Trajectory and Early Childhood Development in Children in China” by Zhao et. al. (Zhao J 2022) and published in JAMA Pediatrics on June 6, 2022. Aye yaye….muy caliente! Why They Did It Screen time has become an integral part of children’s daily lives. Nevertheless, the developmental consequences of screen exposure in young children remain unclear. The authors wanted to investigate the screen time trajectory from 6 months to 72 months of age and its association with children’s development at age 72 months in a prospective birth cohort. That’s 6 years old for those that don’t like brain math. Basically – Is early screen exposure associated with children’s cognitive, language, and social-emotional development? How They Did It
  • Women in Shanghai were recruited for this cohort study. 
  • Their children were followed up at 6, 9, 12, 18, 24, 36, 48, and 72 months of age. 
  • Children’s screen time was classified into 3 groups at age 6 months: 
  • continued low (ie, stable amount of screen time), 
  • late increasing (ie, sharp increase in screen time at age 36 months), and 
  • early increasing (ie, large amount of screen time in early stages that remained stable after age 36 months). 
  • Cognitive development was assessed by specially trained research staff in a research clinic. 
  • Of 262 eligible mother-offspring pairs, 152 dyads had complete data regarding all variables of interest and were included in the analyses. 
  • Data were analyzed from September 2019 to November 2021.
Wrap It Up The findings of this study suggest that both the duration and the onset of screen exposure matters in terms of children’s cognitive and social-emotional development. It found that excessive screen time in early years was associated with poor cognitive and social-emotional development. This finding may be helpful in encouraging awareness among parents of the importance of onset and duration of children’s screen time. Parents…..listen up. I wished I had this information when I was a young parent. I think some of the stuff we did would be 180 degrees different.    No doubt in my mind. And for those of you that don’t understand on Facebook how research like this is chiropractic, you don’t get it and probalby never will. We are a profession. Not a spinal manipulative therapy modality. We are a profession and kids mental health and development is as much a part of the health and well being of our patients as is low back pain.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Staff (2021). “Your mental health may depend on what’s in your diet.” StudyFinds.   Zhao J, Y. Z., Sun X, (2022). “Association Between Screen Time Trajectory and Early Childhood Development in Children in China.” JAMA Pediatr.    

The Complexity & Treatment of Chronic Pain

CF 224: The Complexity & Treatment of Chronic Pain Today we’re going to talk about manual therapy for chronic pain the complexities within.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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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 a  round.  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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #224 Now if you missed last week’s episode , we talked about Kids’ Mental Status & Zero Calorie Drinks. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Still no real results on trying out the lead generation marketing that I’ve spoken about recently. We’ve tweaked it and will continue seeing if we can make a go of it. Polls have shown it and I forget. Every now and then I recall; people aren’t nearly as interested in wellness and talk about maintenance or preventative. They want RELIEF from pain points. 

As chiropractors, we want them to care about wellness and maintenance, and prevention. But they don’t. Pain is a hell of a motivator. In fact, it’s unmatched as the main motivator. Does that mean there aren’t amazing wellness clinics? Of course not. There are but they’re more the unicorn than the run-of-the-mill horse trotting around. 

Also, more recently, I have a new competitor in town that is copying everything I am doing. Copying my providers and copying my services. But, severely discounting everything. To the point of embarrassment. The Joint is one thing. They serve a specific gap. ‘I feel great. No issues. Just wanna be popped.” They serve that demographic and I can make sense of their discounted rate. They aren’t solving problems there.  But this place that’s copying me now, they are solving problems. Or at least trying to. And charging $29 for that first visit with the exam and all of the rigamarole. That’s rubbish, garbage, clown stuff right there.

I hope the type of chiropractor that listens to this podcast knows better than that. Knows what that does to our industry.  Have you noticed that when a chiropractor owns the clinic, charges are pretty appropriate? When someone that is not a chiro owns it, services are devalued to an embarrassing point. Either that or the chiro is desperate.  All of it equals devaluing what we do. It’s poor form.

My least expensive adjustment is $45 US American Greenback Benjamins. It took me some years to start valuing my service. Now, thanks to research and guidelines and colleagues and mentors, I understand the value, the time, the education, the work, the responsibility, and the effort.  

Hell with anyone that wants to sell an exam, x-rays, report of findings, and adjustment for $29. That’s the way I see it. Pick up your game and be better.   as well.

You’ll be hearing more about it in upcoming episodes.  We all know that the number one type of case that we want is a personal injury case.

Remember, I just said pain is the motivator and if you don’t know why personal injury patients are so valuable, you haven’t been paying attention.  They are gold because the clients are more compliant, and we get paid at rates far above insurance or Medicare or Medicaid. The patient’s attorney tells them to go for treatment because it enhances their legal case and gets them more money.

But we know that if they aren’t moving from the start, recovery from pain and getting back to normal might not happen at all. We can help these patients so much and medical practices in most markets are turning them away now.  The problem is, how do we get PI cases?  Attorneys don’t generally respond to your invitation for lunch. And let’s face it, they’re a tough bunch. I have the answer.

An attorney I recently connected with has put together a system, that is both in written and video form, that shares how to approach attorneys and get them to send their PI clients to you. I checked it out personally and I like it. Attorney Paul Samakow is an attorney teaching how to speak to attorneys. His system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment. Just one of my PI cases averages $3000-$3500 for example. It’s a win-win. 

Go to gettingpicases.com/cs ‘C’ as in cat and ’S’ as in sweet. 

That’s gettingpicases.com/cs

One more time so you get it right:   gettingpicases.com/cs

Alright, let’s get on with the research, shall we?

Item #1

This one is called “Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts” by Coronado et. al.  (Rogelio A. Coronado & Joel E. Bialosky 2017)and published in the Journal of Manual and Manipulative Therapy in June 12 of 2017 and that is not hot. It’s not in the freezer. But it’s not hot. 

Why They Did It

They start by saying that chronic pain affects nearly one-third of the American population. That’s pretty stout, yeah? And sitting here 5 years later, we know that it’s only gotten worse.  Then they pop out with something fairly powerful. They say, “For manual physical therapists to play a key role in the management of individuals with chronic pain conditions, simply being a safer option is not good enough. Instead, we must practice in an effective manner as well. Manual physical therapists can effectively treat patients with chronic pain and other musculoskeletal disorders; however, the field is at a crossroads.

The traditional approach to manual therapy assumes that proper technique selection and precise implementation is the primary driver of a successful outcome [10,11]. In this view, the resultant outcomes are directly attributed to the applied intervention. A similar perspective on intervention may be witnessed in traditional medicine when, for example, a pharmaceutical agent is prescribed to manage cholesterol or blood pressure, or a surgical approach is elected based on abnormal imaging findings. We propose manual physical therapists will only be recognized as ideal providers for individuals with chronic pain if we accept an updated paradigm acknowledging the complexity of the manual physical therapy experience and accept the robustness of varying contextual elements inherent in our interactions.  For some clinicians, this will require a revolutionary shift in their perception of the development, maintenance, and modulation of pain [12].

Pain is an experience orchestrated by dynamic sensory, cognitive, and affective processes and is strongly influenced by patient’s expectations, mood, desires, and past experiences. Limiting pain perception to a peripheral impairment is outdated and a more comprehensive, albeit complex, approach to manual therapy accounts for a myriad of interacting factors impacting chronic pain outcomes.”

What did the five fingers say to the face? Slap!!

That was like Will Smith Rocking Chris Rock…..

“Maladaptive neuroplastic changes are evident in patients presenting with chronic pain conditions, suggesting intriguing targets for effective treatments. “Pain sensitivity can serve as a proxy measure for central sensitization – a phenomenon that may impact prognosis and treatment response – and perhaps provide a more effective therapeutic target for treating patients with chronic pain” How many times have you heard me talk about upregulation and pain sensitization?? This is it, right here.  Patients with chronic musculoskeletal pain often report co-existing psychosocial complaints known to worsen their prognosis and limit the effectiveness of interventions.

Manual therapists are in need of clinical strategies to minimize the influence of negative psychosocial factors and boost positive thinking and outlook. Just a diagnosis with zero treatment has been shown to be helpful. How many times have you heard that words matter?? With our words alone, we can push someone into chronic pain or bring them more toward the surface. 

“Manual therapy is often a component of a comprehensive treatment package and multiple interventions may interact to influence clinical response.” – exactly – a broad management approach and not one single intervention solve the puzzle.  “Patient education is an important component of a manual physical therapy interaction and the manner and content of education, specifically related to pain, can greatly influence treatment effectiveness. “ – If you’re not properly educating and explaining without the catastrophization and doctor dependency garbage we see in our profession, then you’re missing the boat and doing more damage than good.  “Manual physical therapists should recognize the multidimensional nature of chronic pain as well as the complex interactions of contributing factors accounting for manual therapy-related treatment effects.

Continuing to attribute an effective manual physical therapy intervention to the correction of a peripheral impairment is too simplistic and prevents conscious attempts to augment contributing factors known to enhance outcomes in patients with chronic pain. While perhaps a safer avenue than opioids, we believe the continuation of an outdated approach to manual physical therapy will result in suboptimal provision of care.” While this is geared to PTs it’s speaking to us chiros equally and we better pay attention because, in my learning and in my experience, it’s hitting every nail right on the head. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger    

Bibliography

Rogelio A. Coronado & Joel E. Bialosky (2017). “Manual physical therapy for chronic pain: the complex whole is greater than the sum of its parts.” J Man Manip Ther 25(3): 115-117.        

Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment

CF 205: Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment Today we’re going to talk about research backing the use of spinal manipulative therapy for neck pain. A systematic review and meta-analysis even! Big stuff. Then we’ll talk about treatment for lumbar radiculopathy. What extra tips can you pick up? But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #205 Now if you missed last week’s episode, we talked about The Case Of The Disappearing Disc & Vitamin D And Back Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, we got some stuff shaking folks. So, let’s talk about it. First thing, Drake leaving. Who the hell is Drake you might ask? Well, that’s our Parker university intern that’s been with us since last August. We’re spoiled as hell having Drake with us these days. We’re going to miss his help and honestly, he’s just a good guy. We’ll miss him personally as well.  Yes, I tried to hire him but not everyone wants to move to Amarillo so getting associates in this area can be a bit of a challenge. So I’m saying it, if you want to come to Amarillo, you’re always more than welcome to send me a resume at dr.williams@chiropracticforward.com and I’m happy to take a look. 

We have fun. We get people better. And life is good.  I mentioned a couple of weeks ago that we had a turnover and we’d be having a new front desk staffer coming on board. Well, this is the week and here we go. We may have gotten lucky on this one people. 

First, we hire off of Indeed. I’m sure they think I’m a bit of a prick but I use the assessment tools. They have to fill out a couple of assessments that test their knowledge. One is on EHR, another is general office procedure and stuff like that. Well, so many of them just go down the line clicking jobs and submitting without understanding that the assessments weed that out. If they don’t take the time to fill out the assessments, they didn’t care enough about the job to read about it. Which means I don’t care enough about them to waste my time learning more about them. So I move right past them. 

This girl has worked for an urgent care and only looked elsewhere because they didn’t have a full-time position like she needed. My friends actually work at the urgent care and vouched for her. We have the ones we’re interested in come in for a working interview. All of the staff agreed she was the clear choice both in experience as well as in personality.  Our office culture is one defined by fun. We jump scare each other. We laugh. We kid. We are always appropriate but there are times we could be more professional but….again…we have fun. And Our patients love it.

They commonly comment in our Google Reviews about how they love that everyone is so happy, having fun, and enjoying their work.  It’s easy when you have the crew I have. We do work. We work hard. Some days suck. Some days fly by. But think about it, we spend more time with our staff than we spend with our own families for the most part. Right? So why not having fun? Why not have a sense of family, of belonging, and a sense of being a team? Why not? So we’ll be making a new teammate this week. She’s going to be amazing. I just have a feeling. 

Also, I believe it was last week we discussed side gigs.  I mentioned my recent success in the voice over industry and that I’ve been schooling up on real estate investing and all that good stuff. I mentioned that I planned on parlaying that voice over success into real estate investments.  Well, I’ve been analyzing houses and I’ve been learning about remote management of short-term rentals and the pros and cons vs having a long-term rental and all of that good stuff.  Well, I identified 9 properties down in Lubbock TX. Lubbock is about an hour and a half to the south of Amarillo. It’s the home of Texas Tech and Buddy Holly. It’s also where one of my kids goes to college. It’s also the place where my other kid who is currently an 8th grader will likely go if I haven’t retired and moved to Florida when she goes to college. 

Lots of football games, basketball games, baseball games….lots of visits to the medical school there in town….lots of big-name concerts. It’s all good news for having a short-term rental.

Go back and listen to last week’s episode if you want to know why short-term rentals make more sense for tax reasons than other investments right now.  Anyway, I found 9 houses that my wife went to look at last week. She made an offer on one and, once we refi our rental house here in Amarillo, we’ll be able to pull out about $150,000 to put on 1-2 others. One of which is a flip we think we can profit $30k in about three months if there are no surprises or hiccups.  So…..I’m a fact finder. I’ve been finding facts for about a year now. Watching YouTubes. Taking little classes. Listening to podcasts. Reading books. Meeting people and building a small network. So, we’re on it. We’re excited. We’re pumped. We’re busy as hell. 

It’s kind of crazy the faith I have in my wife’s decisions. In lots of ways, she’s the smartest person I believe I’ve ever met. Our first house we bought together, I was on the road traveling with my band somewhere down in south Texas when she made an offer on it. I’d never even seen the house. 

The one I live in now, I actually saw and agreed on. 

The 2-3 down in Lubbock, I haven’t seen either. But I’m buying them. Lol. It’s crazy but she’s a hell of a teammate on this stuff and her vision of what she can do with a house has blown me away. She has some serious skills and I can’t wait to see what happens when she puts them to use on these investments. 

OK, on to the first paper.  Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials – PubMed

Item #1

The first one is called “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials” by Chaibi et. al. (Chaibi A 2021) and published in the Journal of Clinical Medicine in October 2021 and that’s got some smoke on it! Let me say that I’ve been yelling for some research on the effectiveness of SMT for neck pain for 4 years here on this podcast. I’ve talked to different researchers about it. They said they couldn’t get funding for it. Now, here we are with a small step for a chiropractor but a giant leap for chiropractor-kind…..or something like that. 

Why They Did It

Acute neck pain is common and usually managed by medication and/or manual therapy. General practitioners (GPs) hesitate to refer to manual therapy due to uncertainty about the effectiveness and adverse events (AEs); 

How They Did It

  • To review original randomized controlled trials (RCTs) assessing the effect of spinal manipulative therapy (SMT) for acute neck pain. 
  • Data extraction was done in duplicate and formulated in tables. 
  • Quality and evidence were assessed using the Cochrane Back and Neck (CBN) Risk of Bias tool and the (GRADE) criteria
  • Six studies were included. 

What They Found

  • The overall pooled effect size for neck pain was very large -1.37 (95% CI, -2.41, -0.34), favoring treatments with SMT compared with controls. 
  • They had a single study that showed that SMT was statistically significantly better than medicine (30 mg ketorolac im.) one day post-treatment. 
  • Minor transient adverse events reported included increased pain and headache, while no serious adverse events were reported

Wrap It Up

SMT alone or in combination with other modalities was effective for patients with acute neck pain. However, limited quantity and quality, pragmatic design, and high heterogeneity limit our findings. So, once again, researchers….please listen. We have enough information on the low back. We know we knock it out of the park on low back pain. Even our haters mostly know we kill it on low back pain. Those douches over at sciencebasedmedicine.whatever mostly admit we’re good on low back pain. And trust me, if you change their damn minds, you’re on to something.  So, let’s expand to the neck, please. Pretty please? Dr. Goertz, Dr. Pohlman, Drs influential with Chiropractic Compass, can we please continue down this path of exploring our effectiveness and low risk for adverse events in the neck because honestly, THIS clinically is what is holding us back. 

Professionally, it’s the vitalists in our profession. But clinically, it’s the perception that we do harm when treating the neck. Can we do harm? Well hell yes we can. Do we commonly do harm and are we likely or probable to do harm? Oh hell no. Why would you ask such a dumb question?

 

Item #2

https://pubmed.ncbi.nlm.nih.gov/30521781/

This one is called “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial” by Satpute et. al. (Satpute K 2019) and published in Archives of Physical Medicine and Rehabilitation on December 3rd of 2018. It’s mushy…not solidified but not as warm as we like. 

Why They Did It

To evaluate the effect of spinal mobilization with leg movement (SMWLM) on low back and leg pain intensity, disability, pain centralization, and patient satisfaction in participants with lumbar radiculopathy.

How They Did It

  • A double-blind randomized controlled trial.
  • The setting was in a General hospital.
  • 60 adults with the mean age of 44 years old were included
  • They were al diagnosed with subacute lumbar radiculopathy
  • They were randomly allocated to receive spinal mobilization with leg movement  exercise and electrotherapy or exercise and electrotherapy alone. 
  • All participants received 6 sessions over 2 weeks.
  • The primary outcomes were leg pain intensity and Oswestry Disability Index score. Secondary variables were low back pain intensity, global rating of change (GROC), straight leg raise (SLR), and lumbar range of motion (ROM)
  • Variables were evaluated blind at baseline, post-intervention, and at 3 and 6 months of follow-up

What They Found

  • Significant and clinically meaningful improvement occurred in all outcome variables. 
  • At 2 weeks the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability. 
  • Similarly, at 6 months, the spinal mobilization with leg movement group had significantly greater improvement than the control group in leg pain and disability. 
  • The spinal mobilization with leg movement group also reported greater improvement in the global rating of change and in SLR range of motion.

Wrap It Up In patients with lumbar radiculopathy, the addition of spinal mobilization with leg movement provided significantly improved benefits in leg and back pain, disability, SLR ROM, and patient satisfaction in the short and long term. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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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 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

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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 (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

  • Chaibi A, S. K., Russell MB (2021). “Spinal Manipulative Therapy for Acute Neck Pain: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.” J Clin Med 10(21): 5011.
  • Satpute K, H. T., Bisen R, Lokhande P, (2019). “The Effect of Spinal Mobilization With Leg Movement in Patients With Lumbar Radiculopathy-A Double-Blind Randomized Controlled Trial.” Arch Phys Med Rehabil 100(5): 828-836.  

Reduced Access To Chiropractic & The Ideal Diet

CF 203: Reduced Access To Chiropractic & The Ideal Diet Today we’re going to talk about reduced access to chiropractic and we’ll talk about the ideal diet.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #203 Now if you missed last week’s episode, we talked about Pain And Clumsiness & Treatment Escalation. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

The resurgence continues in my clinic’s numbers. I believe we had 26 new patients this last week and about 183 or so patients. Our Nurse Prac is still building slowly. Honestly, a little slower than I expected. He is averaging around 15-20 appointments per week. Some are as simple as trigger points. Some are as extensive as hormone pellets and PRP injections. I’m telling you I’ve railed against cortisone injections for years and I still do. But lidocaine trigger points …..now that’s a different deal. I’ve been floored at how much they can make a difference for some of my patients that have been on the more pesky side with regard to some nagging pain.

Good stuff and it’s a $50 cash service so it’s not out of reach for most patients and it seems, so far, to be very effective for most. 

As with everything in life, nothing can stay good for too long, can it?

It seems the answer is no. It can’t. I left work on Friday after a great, busy, fairly stress-free week. As I was walking out the back door, my front desk employee for the last year and a half or so gives me her 2-week notice. Yep, we just got everything up and running and kicking some butt, and boom.

There are lots of reasons behind the scenes as to why she made the decision but the end story is that there was a bit of internal conflict, we’ve had some difficulties in the past with how this person handled some patients or situations, and….though we’ll miss this person’s incredible attention to detail, it’s probably a good move for all involved. We wish her the very best.

She’s a great person and a hard and dependable worker. Just a bad fit I suppose 

Now, you all know how valuable a front desk employee is. They are simply hard to replace but, it is what it is. Fortunately, and you all might listen up here, my wife took classes and became a front desk billing guru. So, she can train new front deskers, She can get them up to speed quicker than anyone I know because she’s smarter than anyone I know.  I mention this because my wife being trained so well takes a lot of burden off of us when it comes to replacing the front desk staff. It’s going to happen sooner or later and why be held hostage by employees because the owners don’t know what’s going on?

Now let’s be honest, I don’t know the front desk. That’s why at one time in my career, I absolutely WAS held hostage by the front desk. That’s why, several years ago, I found out that I lost an incredible amount of money over a 3-year time span. And when I say ‘incredible’, I’m talking around $750,000 over three years. I don’t like saying it but I’m always honest with you all. That’s the best way to be a coach or mentor or adviser.

It’s with honesty.

It wasn’t stolen or embezzled. It just wasn’t collected on and then the time passed to where it could no longer be billed and collected on. So…all of that work was just gone.  It’s not every day you find out you’ve lost around $750,000. Time and Bud Light helped me through and I’m doing OK today. You have to move beyond the things that will bring you down and keep you down if you allow them to.

But yeah, that’s why you can’t be held hostage by employees.  That’s also exactly WHY my wife got trained. So that we’d never be in that position again. And….we aren’t this time either.  We have the luxury of being able to pick and choose by personality type rather than strictly experience because we can train the skills ourselves.

So, to Indeed we go. Wading through hundreds of resumes that won’t show up when we schedule interviews. It’s insane. But, it’s a necessary evil and, I’m a Christian, so we pray for the perfect person to be led our way.  What do you need in a front desker? Personality! They are the first impression a person gets when they call on the phone. They are the first person a patient encounters when they get there and the last person they encounter on the way out. That’s as important and vital as anything.

Pain is weird and responds differently in everyone. so I don’t care if someone leaves feeling better immediately. Obviously that’s the goal but not the most important thing. What I really care about is how they feel about their experience being in our clinic and how they felt about the people they came into contact with while they were there. THAT’s what matters the most. Especially in the first visit or two. 

They can be practice builders and they can be practice killers.

This one, very key person. So…..let’s make it count shall we?? Let’s dive into the research this week. 

Item #1

This first one is called Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review” by English et. al. (English LK 2021) and published in JAMA Open Network on August 31, 2021, and that’s hotter than that the Texican sun in the Summer. 

Why They Did It

They wanted to answer the question, “What is the association between dietary patterns consumed and all-cause mortality?”

How They Did It

  • It was a systematic Review but of only one randomized clinical trial but 152 observational studies 
  • Participants were from 17-84 and from 28 different countries
  • They were all on the topic of dietary patterns and all=cause mortality

What They Found

  • They found a lot of what you’d probably expect they’d find. 
  • Evidence demonstrated that dietary patterns characterized by increased consumption of vegetables, fruits, legumes, nuts, whole grains, unsaturated vegetable oils, fish, and lean meat or poultry (when meat was included) among adults and older adults were associated with decreased risk of all-cause mortality. 
  • These healthy patterns consisted of relatively LOW intake of red and processed meat, high-fat dairy, and refined carbohydrates or sweets.

Wrap It Up

Despite the different approaches, study designs, dietary assessment methods, geographical regions, and dietary pattern labels, the evidence demonstrated that dietary patterns associated with lower all-cause mortality risk were consistently characterized by higher intake of vegetables; legumes; fruits; nuts; either whole grains, cereals, or non-refined grains; fish; and unsaturated vegetable oils.  These patterns were also characterized by lower or no consumption of animal products (red and processed meat, meat and meat products, and high-fat dairy products), refined grains, and sweets (ie, higher in added sugars).  Labels that were assigned to the dietary patterns varied widely (eg, Mediterranean, prudent, Healthy Eating Index, DASH, and plant-based), highlighting that high-quality diets with nutrient-dense foods are associated with better health, regardless of diet type or dietary pattern name.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783625?guestAccessKey=cea01652-195e-4ee2-ac19-d204e60b224f&utm_content=weekly_highlights&utm_term=091221&utm_source=silverchair&utm_campaign=jama_network&cmp=1&utm_medium=email

Item #2

This second one is called “The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults” by Davis et. al. (Davis M 2021) and published in the Journal of Manipulative and Physiological Therapeutics in June of 2021 and toastier than a hot toddy!

Why They Did It

The purpose of this study was to examine the extent to which access to chiropractic care affects medical service use among older adults with spine conditions.

How They Did It

  • They used Medicare claims data to identify a cohort of 39,278 older adult chiropractic care users who relocated during 2010-2014 and thus experienced a change in geographic access to chiropractic care. 
  • National Plan and Provider Enumeration System data were used to determine chiropractor per population ratios across the United States. 
  • A reduction in access to chiropractic care was defined as decreasing 1 quintile or more in chiropractor per population ratio after relocation.
  • Using a difference-in-difference analysis (before versus after relocation), they compared the use of medical services among those who experienced a reduction in access to chiropractic care versus those who did not.

What They Found

  • Among those who experienced a reduction in access to chiropractic care (versus those who did not), they observed an increase in the rate of visits to primary care physicians for spine conditions 
  • An annual increase of 32.3 visits per 1,000 
  • And the rate of spine surgeries (an annual increase of 5.5 surgeries per 1,000). 
  • Considering the mean cost of a visit to a primary care physician and spine surgery, a reduction in access to chiropractic care was associated with an additional cost of $114,967 per 1,000 patients
  • That’s to the tune of $391 million nationally

Two syllables – one word…..Day-um. 

That’s a metric crap-ton of green cheese. A gob of Benjamins. A Gaggle of American greenbacks. 

https://pubmed.ncbi.nlm.nih.gov/34376317/

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

 

Bibliography

  • Davis M, Y. O., Liu H, Anderson B, Bynum J, (2021). “The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults.” J Manipulative Physiol Ther 44(5): 353-362.
  • English LK, A. J., Bailey RL, (2021). “Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review.” JAMA Netw Open 4(8).

 

Pain And Clumsiness & Treatment Escalation

CF 202: Pain And Clumsiness & Treatment Escalation Today we’re going to talk about pain that causes clumsiness and we’ll talk about treatment escalation.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

 

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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #202 Now if you missed last week’s episode , we talked about breast plan illness and treating chronic pain centrally. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Things may have leveled out last week. We shall see. Still busy as can be but instead of 215 in a week, I believe last week was more around 185. This is exactly what we averaged weekly before COVID so I can live with that. I didn’t feel 100% overwhelmed. Tired, yeah. But not overwhelmed.  Let’s talk about the staff.  Have you ever hired a staff member that started out as a kid and just blossomed into something pretty darn special? Wouldn’t it be nice if we could predict these things? Unfortunately, hiring can be a bit of a crapshoot. The ones that look the best turn into clowns. Then you have the ones that are meh and stay meh. Then you have the ones you kind of aren’t sure about and they either sink or swim.  I found a swimmer.

I hired the daughter of one of my long-time friends. I didn’t want to hire her because I didn’t want to treat her differently because of my friendship with her mother and I also didn’t want to risk losing a friend because a problem popped up and I had to fire her daughter. Or something of that nature. You never know what’s going to happen but that was my thought process.  Anyway, she was the best applicant so I hired her. I had an office manager that had been there for roughly 11 years. She trained her up well. Her only job had been with Kohl’s so she’d been in retail and was only about 19 I think. Maybe 20. She was a kid. It took her a bit to settle in I think but once she did, she blossomed.  Fast forward a year or two and my long-time office manager got an offer for more money and she took it. This could have been catastrophic. But then this girl the had started as a kid stepped up and said, “I got it.” 

And no kidding…..she had it. She started marketing. She started setting up meetings with the staff where the weekly meetings and training had kind of fallen off. She started going to networking events. Now, a year after taking over as office manager, she’s the ‘go to’ for the entire office, she’s worked every position including billing and the front desk, and at 23 years old, I have every bit of confidence in that girl.  I told that story for no real reason but to just say ‘isn’t it a bit hinky?’ Wouldn’t it be nice to be able to bottle that up and figure out how to tell who’s going to crash and who’s going to soar? I know everyone has a different opinion on relationships in the office but my opinion, and my personality, is for my staff to be funny, professional, a little bit ornery, and a bit like family.

I care about my staff.  I root for them and they root for me. We tease each other non-stop but we are a family. I spend more time with those girls than I spend with my own family. That’s a big deal. Why would I want a boss-employee relationship with people I basically spend my entire life with? I’d rather them be bought in. Be like family. And when they’re no longer on my team, they’re still on the team to an extent because they became part of the family.  I could be wrong but of all of the people that have worked for me over the years, I can only think of maybe 3 that left on bad terms. Out of maybe 30 or more people.

That sounds like a high turnover rate but honestly, I’ve been in the job for 24 years almost and right now alone I have 13 employees. So, there have been plenty come and go over the years for different reasons. Going back to school, leaving to have babies, moving out of town. It is what it is. 

Most just don’t leave on bad terms and that’s the way I’d like to keep it. I hear horror stories about other chiropractors throwing fits, kicking furniture, yelling down at their staff, and basically acting like children in a grown-up’s body. That’s embarrassing for them.  Leaders come in all shapes and sizes but for me, funny, professional, friendly, respectful, and family sum it up. And love. I love most of the staff that has worked for me. Yes, I paid them.

But they also dedicated themselves to my clinic. That means something and I value it.  Alright, let’s hop in

Item 1    

https://www.frontiersin.org/articles/10.3389/fpain.2021.756771/full?fbclid=IwAR1LIiNtb03NVWKifKRNNnefXg2CYDjWcUynCfIFU3WcnoqzIX58m_Rzw3Y

This one is called “Does my neck make me clumsy? A systematic review of clinical and neurophysiological studies in humans” by Harman et. al. (Harman S 2021) and published in Frontiers in Pain Research on October 11, 2021 and that’s spectacularly steamy. 

 

Why They Did It

Clumsiness has been described as a symptom associated with neck pain and injury. However, the actuality of this symptom in clinical practice is unclear. The aim of this investigation was to collect definitions and frequency of reports of clumsiness in clinical studies of neck pain/injury, identify objective measures of clumsiness and investigate the association between the neck and objective measures of clumsiness.

How They Did It

Six electronic databases were systematically searched,  records identified and assessed including a risk of bias.  Heterogeneity in designs of studies prevented pooling of data, so qualitative analysis was undertaken. Eighteen studies were retrieved and assessed;  the overall quality of evidence was moderate to high.  Eight were prospective cross-sectional studies comparing upper limb sensorimotor task performance and ten were case series involving a healthy cohort only. 

What They Found

Clumsiness was defined as a deficit in coordination or impairment of upper limb kinesthesia.  All but one of 18 studies found a deterioration in performing upper limb kinesthetic tasks including a healthy cohort where participants were exposed to a natural neck intervention that required the neck to function toward extreme limits.

Wrap It Up

Alterations in neck sensory input occurring as a result of requiring the neck to operate near the end of its functional range in healthy people and in patients with neck pain/injury are associated with reductions in acuity of upper limb kinesthetic sense and deterioration in sensorimotor performance. Understanding the association between the neck and decreased accuracy of upper limb kinesthetic tasks provide pathways for treatment and rehabilitation strategies in managing clumsiness. In the Fellowship program for Neuromusculoskeletal Medicine, we actually learned a great deal about this.

Which is why I’ve included it this week. We know that when sensory information comes in if there is an alteration in the signal or in it’s processing, there will be alterations in the motor portion of the sensorimotor capability leading to aberrant movements and motion.  What if incidental pops and clicks were due to faulty sensorimotor and aberrant movement? It can be due to instability, sure. But it can also be to a smudged brain map. We know that when patients have chronic low back pain, the brain map can be smudged. Our brains have a map of our bodies.

Every joint, its capabilities, and it’s limitations. Chronic pain smudges that map. We also know that a large portion of our proprioception and sensory information also comes from our deep upper cervical muscles. In combination with the inner ear and eyes.  It doesn’t take a stretch of imagination to see chronic pain, either in low back or neck, or neck dysfunction being the source of issues for balance, proprioception, and accurate motor function.  It’s all fascinating, folks! Good stuff. 

Item #2

https://www.jmptonline.org/article/S0161-4754(21)00035-X/fulltext?dgcid=raven_jbs_etoc_email

This one is called “Risk of treatment escalation in recipients vs. non recipients of spinal manipulation for musculoskeletal cervical spine disorders; an analysis of insurance claims.” by Anderson et. al (anderson BR 2021) and published in June of 2021 so hot! 

Why They Did It

The purpose of this study was to evaluate the relationship between treatment escalation and spinal manipulation in a retrospective cohort of people diagnosed with musculoskeletal disorders of the cervical spine.

How They Did It

  • They used retrospective analysis of insurance claims from 2012-2018 from a single Fortune 500 company.
  • They categorized 58,147 claims into 7,951 unique patient episodes.
  • Treatment escalation included claims where imaging, injection, emergency room, or surgery was present.

What They Found

  • Treatment escalation was present in 42% of episodes overall: 2,448 (46%) associated with other care and 876 (26%) associated with spinal manipulation. 
  • The estimated risk of any treatment escalation was 2.38 times higher in those who received other care than in those who received spinal manipulation

Wrap It Up

Among episodes of care associated with neck pain diagnoses, those associated with other care had twice the risk of any treatment escalation compared with those associated with spinal manipulation.  In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic; therefore, these findings are relevant and should be considered in addressing solutions for neck pain. Additional research investigating the factors influencing treatment escalation is necessary to moderate the use of high-cost and guideline-incongruent procedures in people with neck pain. So, how many times have you seen patients that had fusions that they should have never had?

Many or most times based on MRI images from MRI’s they probably should have never had. Conservative care first, folks.  Failure to respond to conservative care. Conservative care being spinal manipulative therapy, exercise, laser, massage, acupuncture, yoga, tai chi, cognitive behavioral therapy, and I will add one from the anecdotal observation that is backed by non enough research….and that’s spinal decompression. I’ve never seen anything like it for discs and radiculopathy. Plain and simple.  Once those have been tried and failed, then you look at meds. Then you look at injections. Then you look at surgery. 

Understanding that cauda equina and progressive neurological deficits are really the main reasons for surgery. Pain, by the way, is not a reason for surgery.  No cauda equina? No altered sensory, motor, or reflexes? No surgery. 

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations.  So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

  The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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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

Anderson BR, M. W., Long CR, (2021). “Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims.” J Manipulative Physiol Ther 44(5): 372-377.

Harman S, Z. Z., Kendall J, Vindigni D, Polus B, (2021). “Does My Neck Make Me Clumsy? A Systematic Review of Clinical and Neurophysiological Studies in Humans.” Front Pain Res 2: 756771.      

Extruded Discs – Surgery or No Surgery?

CF 197: Extruded Discs – Surgery or No Surgery? Today we’re going to talk about extruded discs – surgery or no surgery? This one may surprise some of you.  But first, here’s that sweet sweet bumper music

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
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You have found yourself smack dab in the middle of Episode #197 Now if you missed last week’s episode , we talked about How Car Wrecks Contribute To Future Neck and Back Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, I’m feeling pretty good today. Last week was the very first time since February of 2020 that we hit the average weekly visit number that we were doing. I don’t know if that came out right. Before Rona, we were averaging 185 visits per week in 2019.  Rona came along and the best we’ve been able to eke out was about 160. Maybe 165. With the rollercoaster ups and downs of the Rona outbreaks, that number has been down but since February of 2020, it’s never been any higher than that.  Until last week. Last week, by myself, I hit 187. 23 of them were new patients. When you are evidence-based and patient-centered, you don’t hold on to patient unnecessarily for extended visits and treatment schedules so, unfortunately, you live and die by your new patient count. 

Fortunately for me, I’m to a point that new patients aren’t a huge concern. I always have my eye on the count, but it doesn’t give me anxiety these days. We are pretty established here in my community and it tends to mostly take care of itself. Thank my good Lord.  I don’t know if you’ve listened this long but back in February of 2020, the 14th to be exact, my wife and I took a trip to Key Largo. It was amazing.

I left a bustling, busy as hell practice to go on vacation. There was some concern about this COVID stuff but nothing crazy.  In fact, I remember asking my wife on the way to Florida if we should take a mask just in case they told us we needed one. She told me if I brought a mask, that she’d punch me in the nose. Lol. Yes, I have that kind of a wifey. She’s a feisty Texas woman, ya know.  After a week in The Keys, I came back to a ghost town. And then it got worse. I swore I’d never go on vacation again if it was going to tank my practice like that. Well, obviously, it was COVID. And it’s taken a year and a half to start to reclaim our lost business.

But, at 45 patients today as I type this and 5 of them being new patients, this week is looking good too.  Here’s the best news about it all; this is in the midst of a BIG resurgence of COVID here in Amarillo locally. They are adding numbers at the rate they were adding them back in the worst of times. But people are done with it. They just are.  I was one of the first group of providers to be vaccinated here locally. My friends and connections in the medical world here called me when it first came available. They recognized that we work in very close proximity with patients and reached out. Most of my staff and I accepted. I’ve been vaccinated since January 2021. 

I just got the booster on August 26th. It’s a personal thing for each of us but, when you have had a hit on your business like I have, and you’ve had all of the ups and downs, and you’re just now getting back to where you left off after basically losing a year and a half…….well, I’m not about to take a chance on getting sick and being out for 2-4 weeks and watching my business go to crap again.  Including me, I have 12 employees.

That includes 4 CA’s, 3 LMT’s, an NP, an acupuncturist, an esthetician, a billing pro, and I have an intern from Parker College here. These people have families, mortgages, bills, car payments, and gambling debts just to name a few things.  The point is, when you’re the main provider and breadwinner, for me, it’s up to us to be as responsible as we can to make sure we are able to do our jobs.  For example,  here in Amarillo, TX, we are fairly close to the Colorado and New Mexico mountains. About 3 and a half hours to NM and about 5 or so to Colorado. Pretty close. We grew up going skiing in the mountains.

But it dawned on my during my last trip a few years ago; they call them accidents for a reason.  If I fall and break a wrist or twist a knee up, I could be out of a job for up to 6 weeks or more. Well hell, in most cases, that’s more time out than COVID would take you out. I’m the major provider at this time for this clinic. I can’t allow that. So, I gave up snow skiing. It’s not worth it to me.  Why should the pandemic be looked at any differently? For me, it shouldn’t be.  Anyway, I got a little sidetracked there.

Things are going well. I’m hoping business is back to normal and stays normal. For me and for you. We have all fought hard and deserve it.  Now, let’s get some folks to feeling better shall we? Let’s hop into research having to do with large extruded discs.  Once upon a time, I would send them straight to a Neurosurgeon. Not so quickly these days. Knowledge and clinical experience tell me to think twice. Especially in the absence of progressive neurological deficits. 

Item #1

Item one is called “Spontaneous Regression of a Large Lumbar Disc Extrusion” by Ryu et. Al (Ryu Sung-Joo 2010) and published in the Journal of Korean Neurosurgical Society back in 2010. It’s got a little dust on it but not a ton.  

Why They Did It

They say that Although the spontaneous disappearance or decrease in size of a herniated disc is well known, that of a large extruded disc has rarely been reported. This paper reports a case of spontaneous regression of large lumbar disc extrusion. The disc regressed spontaneously with clinical improvement and was documented on a follow-up MRI study 6 months later. 

How They Did It

  • It’s a case report so it’s not incredibly impactful but still helpful for something like this. You can see it on one MRI and then 6 months later, it’s gone. 2+2=4 so I’m OK with a case report on something like this here. 
  • A 53-year-old woman was referred to our clinic with a 6-month history of low-back and left lateral leg pain with numbness. Six months earlier, her symptoms had developed suddenly as severe left lateral leg pain. 
  • A neurological examination showed no neurological deficits. The straight leg raise test was negative bilaterally. The lumbar spine MRI performed 6 months earlier revealed a left posterolateral herniated nucleus pulposus which was migrated caudally and compressed the left L5 root
  • She received conservative treatment including pain-relieving medication, physical therapy and spinal anesthetic block therapy due to her poor medical conditions

What They Found

  • After conservative treatment, her clinical symptoms subsided gradually but the numbness of her left lateral leg still remained. A second MRI study performed approximately 6 months after the prior examination reveal almost complete disappearance of the extruded fragment that had been located posterolateral to the L5 vertebral body, and no evidence of compression or displacement of the dural sac or nerve root
  • The height of the L4/5 disc space remained decreased compared to the other levels and was unchanged from the previous MRI examination.

Wrap It Up

  • The precise mechanisms of disc regression are unclear. Three hypotheses have been proposed to explain the process of disc regression. 
  •  
  • The first hypothesis, “retraction of a herniated disc”, proposes that the herniated disc retracts back into the intervertebral space17). Theoretically, this can occur if there is a disc bulge or if the disc material protrudes through the anulus fibrosus but is not separated from it6). However, it would be unlikely in cases of completely extruded or migrated fragments. 
  •  
  • The second explanation, “dehydration of herniated disc”, states that the herniated fragment would disappear due to gradual dehydration and shrinkage16). 
  •  
  • The third hypothesis, “inflammatory reaction and neovascularization”, which is the most compelling and studied hypothesis, states that extruded disc material into the epidural vascular space of spine is recognized as a “foreign body” and induces an inflammatory reaction by the autoimmune system. This would cause neovascularization of the cartilaginous tissue along with infiltration by inflammatory cells, such as macrophages, granulocytes, and lymphocytes7,8,10,11,15). Several histopathology studies from surgical specimens and experimental animal research support this theory
  • Nevertheless, it is possible that all 3 mechanisms play a role in the regression and disappearance of herniated disc tissue.
  • Motor and sensory deficits are present in 50-90% of patients with a herniated lumbar disc18). Surgery can be carried out as an emergency when bladder symptoms or progressive motor weakness are present. In the absence of these symptoms, 75-90% of patients with acute sciatica due to a protruded lumbar disc experience a resolution of symptoms without surgery 
  • Conservative treatment should be considered when cauda equina syndrome or progressive motor weakness are absent in the acute stage of the lumbar herniated disc. Surgical intervention should be considered in cases with neurological deficits or intractable low back and leg pain despite the initial conservative treatment

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Item #2

Our last one is called “Spontaneously disappearing large herniated lumbar disc fragment”’ by Reddy et. al. (Reddy UV 2014) and published in the Journal of Orthopaedics and Allied Sciences in 2014. As impactful as this information is, why do you think there aren’t more studies on it that are recent? Could it because it suggests they shouldn’t be doing surgery on these large extruded discs?

Why They Did It There are reports of spontaneous regression of large extruded disc; however, the exact underlying mechanism and management of such cases remains controversial. We report a 40-year-old female who opted for conservative management for a large extruded lumbar disc. Follow-up magnetic resonance imaging (MRI) showed complete disappearance of the disc fragment; however, there were degenerative changes in the upper and lower adjacent margins of the vertebral body.  Herniated lumbar disc is one of the common causes of low back pain and smaller disc herniations tend to regress over a period of time; and thus, the pain is known to improve with conservative management. 

How They Did It

A 40-year-old female presented with low back pain of 2 year duration. The pain was radiating to lower limbs more to the left side. There was no history of motor or sensory deficits. There was no history of bowel or bladder dysfunction. She was investigated for the similar problem with an MRI 6 months back and it showed a large disc protrusion [Figure 1]. However, she opted for conservative management. On examination, there were no focal motor or sensory deficits. Deep tendon reflexes were normal except bilateral sluggish ankle jerks. Planters were flexor. As the patient was complaining in the severity of the pain with numbness and a repeat magnetic resonance imaging (MRI) was performed. Follow-up MRI showed complete disappearance of the disc fragment;

What They Found

The exact timing for spontaneous regression of the protruded disc material is not known; however, it ranges from few weeks to months. The fastest regression of the fragmented disc material was reported in 2 months.

Wrap It Up

Present case illustrates that a conservative approach can be adopted for a large extruded lumbar disc as it can resolve in a selective group of patients. [24],[38],[39] Spine surgeons should be aware of spontaneous regression of the disc phenomenon as a patient with a large extruded disc who opted for the conservative management initially can have persistence pain, but there may not be an underlying protruded disc. It is important to perform a repeat imaging of the spine to assess the degree and severity of the disc protrusion before making a plan for surgery or any further conservative management.

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

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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.

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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

  • Reddy UV, A. A., Hegde KV, Suneetha P, Rao MG, (2014). “Spontaneously disappearing large herniated lumbar disc fragment.” J Orthop Allied Sci 2: 26-28.  
  • Ryu Sung-Joo (2010). “Spontaneous Regression of a Large Lumbar Disc Extrusion.” J Korean Neurosurg Soc. 48(3): 285-287.