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Tylenol Fails For Back Pain, Cervical Disc Research, & CAM For Headache/Migraine

CF 128: Tylenol Fails For Back Pain, Cervical Disc Research, & CAM For Headache/Migraine Today we’re going to talk about Tylenol Fails For Back Pain, Cervical Disc Research, & complementary and alternative medicine For Headache/Migraine But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #128 Now if you missed last week’s episode, we were joined on the show by Dr. William Morgan. You wanna hear a truly impressive individual speak and share, this is one of those episodes, my friends. I wouldn’t steer you the wrong way. Go to last week’s episode and give it a listen. We talked about all kinds of good stuff, we talked about excellence, we talked about Parker, we talked about chiropractic in general and Dr. Morgan shared some experiences with us about treating the President of the United States of America. Wow. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

 

On the personal end of things….. I don’t know how long I’ve been back full force now but it’s been some time. As with anything, you start to adopt new procedures and then those new things become a habit and hardly even noticeable anymore.  I see chiros asking what others are wearing. Some don’t take COVID seriously so they don’t wear anything, to be honest. They just wash hands as if washing your hands takes it out of the air or prevents the coughing from putting it out there for you to breathe.  I wear a mask. I wear glasses so I just wear them for any eye cover. Who knows if that even matters? It probably doesn’t.  I wear gloves. Not because I’m afraid to touch anyone. I started out without gloves but the sanitizer and soap washing all of the time ate my hands up. Bad. So, gloves have solved that problem for me.

Maybe I just need some new soap and I can go back to no gloves.  Now after some unfortunate interactions on Facebook I’m stepping up onto my soapbox for a good old fashioned rant and, when I’m done, I hope we can still be friends.    The more interactions with people I have, even a select few supposedly educated chiropractors, the more I’m aware of how uneducated people can truly be. 

How can you confuse the mask issue? Yes, in the beginning, they said masks weren’t useful. Back when they were trying to prevent a run on N95 masks so the hospitals could have them available.  But for months now, they have recommended them for everyone when social distancing cannot be avoided. AKA; a chiropractor’s office.  Their latest update reiterates it. The best guess estimates are that 40% of COVID cases were due to a ‘healthy’ asymptomatic spreading it.  They also just said last week that up to 35% of positives were in completely asymptomatic cases. That’s excellent news!! That means that a little over 1/3 of people that get it do extremely well and never even know they have it. That’s amazing.  The problem is that that 1/3 is responsible for 40% of the cases because they don’t know they have it and are spreading it. 

How can we be so sure that masks are effective? There are three papers that were done. One in a bus, one in South Korea, and one in Washington State that suggest masks are EXTREMELY effective in stopping COVID in its tracks.  Let’s start with the choir practice(Hammer L 2020)  (https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm?fbclid=IwAR2iRGtCRNMPhYoxCtQnP1jGYobAhunSqWMH4DSpuga5oKaOHa4VbAH7pNc) 

Following a 2.5 hour choir practice attended by 61 persons, including a symptomatic, 32 confirmed and 20 probably secondary COVID cases occurred. If you’re counting, that’s 52 of the 61 members of the choir.  3 patients were hospitalized and 2 died. The transmission was likely facilitated by close proximity during practice and augmented by the act of singing.  Alright, now, let’s talk about the bus.  In short, scientists in China studied a guy in China who passed it on to 13 others.

On the bus, his germs jumped as far as 4.5 meters to other travelers and it lingered in the air for up to 30 minutes after the guy got off of the bus. 4.5 meters for us Americanos is almost 15 feet.  Now, let’s talk about a new paper that came out on May 13 so it’s recent news.

This paper was in the journal called Respiratory Medicine by Gao, et. al.(Gao M 2020) called ‘A study on infectivity of asymptomatic SARS-CoV-2 carriers’.  This paper follows a case of an asymptomatic spreader and 455 contact encounters to try to assess the infectivity of asymptomatic carriers.  The 455 contacts wore masks, the test subject wore masks. and nobody got sick. They didn’t give COVID to any of the 455. And all wore masks. This included family members.  Medical Express posted an article on May 17th about some research out of Hong Kong where they tested a masking mechanism with hamsters. https://medicalxpress.com/news/2020-05-hamster-masks-coronavirus-scientists.html

The research by the University of Hong Kong is some of the first to specifically investigate whether masks can stop symptomatic and asymptomatic COVID-19 carriers from infecting others. They placed hamsters that were artificially infected with the disease next to healthy animals. Surgical masks were placed between the two cages with airflow traveling from the infected animals to the healthy ones. The researchers found non-contact transmission of the virus could be reduced by more than 75 percent when the masks were used. Two-thirds of the healthy hamsters were infected within a week if no masks were applied. Not only that but, those that did become infected were also found to have less of the virus within their bodies than those infected without a mask. The most effective use of the masks was when the person wearing the mask was the infected one.  

The problem with that is that nobody knows who is infected because up to 35% of people infected don’t have any symptoms or feel sick.  So, you can pass it up to 15 feet away, you can be in close proximity to 61 others and give it to 52 of them, or we can all wear masks and mostly avoid giving it to anybody. Hmmm. Let me do the math, carry the three….and….yep, I’ll wear masks for a little while.

A mask is a small ask, people. That’s the new slogan. Just give me credit. That’s all I ask.  If you don’t require masks in your office as the CDC recommends right now, you’re putting yourself, your staff, and your immunocompromised patients at risk.  You can wash your hands until the skin falls off and think you’re protecting everyone and doing a good job but you’re not taking it out of the air.

The Czechoslovakian government got it right in their slogan, “My mask protects you and yours protects me.”

No, it’s not the damn flu. While the CDC’s latest updates have a lot of good news in it, it’s still clear it’s not the damn flu. If you claim it is, you are simply not very educated on it and you’re probably doing your patients a disservice by saying that it is.  COVID is estimated to have a .4 mortality rate. Flu is estimated at .1 so COVID is FOUR TIMES as deadly. We see that day to day because, in a BAD flu year, between 60k to 80k people die of it. IN A YEAR. 

COVID has killed over 100,000 Americans in just about 3 months or so. It’s not the same as the damn flu.  But, 0.4% is waaaayyy better than it was initially thought. Some other current news from Reuters out of Italy is that it is losing its potency. Meaning, it may have mutated to a less deadly version. That’s awesome news. 

In the beginning, I was worried and stressed and anxious. We all were. It was brand new and nobody knew anything about it. Not even the experts. Hell, when AIDS was brand new, the fear was that mosquitos could infect you. Then we learned more and then we were safer.  As more and more is known about this virus, I’m no longer as worried for myself or my family or even most of my patients. The newest CDC guesstimates show that 96.6% of COVID patients never even have to go to the hospital. That’s a pretty great stat right there. 

However, I AM afraid for my mother. I AM afraid for my Dad who is in a nursing home. I AM afraid for my other family member who is immunocompromised. I AM afraid for my patients that are immunocompromised. I AM going to continue to be safe and be smart for those people. Not out of fear but out of an abundance of education and because it’s not the flu. I hope you’re doing the same. 

While there’s a 96.6% chance none of us ever have to go to the hospital because of it, there’s a 100% chance I’d have to close my office for a bit. I don’t know about you but I can’t afford that. This podcasting gig doesn’t pay anything so I guess I need to mind my p’s and q’s and be smart about my day to day bidniz. 

I know several that say but, but, but….what about….but. All that crap is noise. Uneducated, noise tinged with a healthy dose of arrogance. It really is OK to follow science and evidence. We’ve been preaching it for 3 years now. Why would COVID change that?

Let science guide you. Not Bill Gates, Trump, or Pelosi. What does the science say? Stop listening to Fox and CNN. What does the science say? Stop listening to conservative or Liberal talk show hosts. What does the science say? Stop listening to Uncle Roy, the ranch manager or the warehouse worker. What does the science say? As far as that goes, stop listening to the physician on the hospital steps spouting politically biased crap and tying it into a COVID talk. Who the hell cares? What does the damn science say?

Keep it simple. Don’t let things confuse the topic. How severe, how easily spread, how can you avoid spreading or catching? Simple crap here.

The rest of those people are uneducated and arrogant noise. Noise I tuned out over a month ago. 

Alright, rant over. 

Item #1 Our first Item this week is called “Efficacy and safety of Paracetamol for Spinal Pain and Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Placebo Controlled Trials” by Machado, et. al(Machado G 2015). and published in British Medical Journal in March of 2015. 

Why They Did It They wanted to investigate the efficacy and safety of paracetamol (acetaminophen) aka Tylenol… in the management of spinal pain and osteoarthritis of the hip or knee.

How They Did It

  • Systematic review and meta-analysis
  • Medline, Embase, AMED, CINAHL, Web of Science, LILACS, International Pharmaceutical Abstracts, and Cochrane Central Register of Controlled Trials from inception to December 2014.
  • Paper considered for inclusion were all randomised controlled trials comparing the efficacy and safety of paracetamol with placebo for spinal pain (neck or low back pain) and osteoarthritis of the hip or knee.
  • 13 randomised trials were included

What They Found

  • There was “high quality” evidence that paracetamol is ineffective for reducing pain intensity and disability or improving quality of life in the short term in people with low back pain. 
  • For hip or knee osteoarthritis there was “high quality” evidence that paracetamol provides a significant, although not clinically important, effect on pain and disability in the short term.
  • “High quality” evidence showed that patients taking paracetamol are nearly four times more likely to have abnormal results on liver function tests

Wrap It Up “Paracetamol is ineffective in the treatment of low back pain and provides minimal short term benefit for people with osteoarthritis. These results support the reconsideration of recommendations to use paracetamol for patients with low back pain and osteoarthritis of the hip or knee in clinical practice guidelines.”

Item #2 This one is called “Relationship of Modic Changes, Disk Herniation Morphology, and Axial Location to Outcomes in Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation: A Prospective Study” by Kressig et. al(Kressig M 2016). and published in Journal of Manipulative Physiology and Therapeutics in October 2016. 

Why They Did It The authors here wanted to evaluate whether cervical disc herniation (CDH) location, morphology, or Modic changes (MCs) are related to treatment outcomes.

How They Did It

  • (MRI) and outcome data from 44 patients with CDH treated with spinal manipulative therapy were evaluated
  • MRI scans were assessed for cervical disc hernation location, morphology, and modic changes
  • Pain and Neck Disability Index data were collected at baseline; 2 weeks; 1, 3, and 6 months; and then again at 1 year

Wrap It Up Although patients who were Modic positive had higher baseline NDI scores, the proportion of these patients improved was higher for all time points up to 6 months. Patients with Modic I changes did worse than patients with Modic II changes at only 2 weeks.

Item #3 Our last one is called, “Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results From the 2012 National Health Interview Survey” by Zhang et. al(Zhang Y 2017). and was published in Headache journal in September of 2017. 

Why They Did It They did this to answer the following questions: (1) Which complementary and alternative (CAM) modalities are used most frequently among migraine/headache sufferers? and (2) What are the self-reported reasons for CAM use among migraine/headache sufferers?

What They Found

The most frequently used CAM modality for headache/migraine was manipulative therapy at only 22%. Herbal supplementation was at 21.7% usage, and mind-body therapy was at 17.9%. The top 3 reasons given for using CAM for headaches were for general wellness, at about 28.7%, improving overall health at about 26.8%, and for reducing stress at about 16.7%. Although CAM is used by many sufferers of headaches and migraines, its use specifically for the headache or migraine is low in the US. 

Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

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About the Author & Host

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

  • Gao M, Y. L. (2020). “A study on infectivity of asymptomatic SARS-CoV-2 carriers.” Resp Med.
  • Hammer L, D. P., Capron I, Ross A, (2020). “High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020.” CDC Weekly 69(19): 606-610.
  • Kressig M, P. C., McChurch K, Schmid C, (2016). “Relationship of Modic Changes, Disk Herniation Morphology, and Axial Location to Outcomes in Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulation: A Prospective Study.” J Manipulative Physiol Ther 39(8): 565-575.
  • Machado G, M. C., Ferreira P, Pinheiro M, (2015). “Efficacy and safety of Paracetamol for Spinal Pain and Osteoarthritis: Systematic Review and Meta-Analysis of Randomized Placebo Controlled Trials.” BMJ 350(h1225).
  • Zhang Y (2017). “Complementary and Alternative Medicine Use Among US Adults With Headache or Migraine: Results From the 2012 National Health Interview Survey.” Headache 57(8): 1228-1242.

w/ Dr. William Morgan: A Conversation About Excellence, Research, Parker University, and Chiropractic

CF 127 w/ Dr. William Morgan: A Conversation About Excellence, Research, Parker University, and Chiropractic

Today we’re going to be joined by Dr. William Morgan, President of Parker University and over-all impressive human being.  But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Do it do it do it.  You have found yourself smack dab in the middle of Episode #127 Now if you missed last week’s episode, we talked about immunity-boosting, coconut oil failures, and screen time and its apparent association with autism. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  When we have a guest, we typically dispense with my personal thoughts and practice experiences over the course of the week. We will do that same this week outside of this; I was with many of you. I closed the shop for 2 weeks. Solid. Closed. Then, I gradually started back with urgent/emergent care just like our governing board in Texas recommended.  At this point, I’m in my 3rd week of being completely re-opened. Even to wellness and maintenance care. While I’m used to 180-220 patient visits per week, I’m now experiencing about 110-120. We’re low. Obviously. But, it’s growing every week. People are beginning to tire of the restrictions on their activities and, I’d assume to some extent, are becoming somewhat numb or less concerned…..or more comfortable I guess with the risk aspect of it all.  Regardless, they’re starting to return. I’m pretty sure those of you that closed and did a gradual re-opening like me are experiencing much the same. Now if we can get the massage therapists back to work safely. We’re still waiting to see what happens on that end of it.  OK, let’s get to our guest today. I tell you sincerely, we are hitting the high spots on this show. WI’m just sitting here thinking about all of the amazing guests we’ve had over the last three years and just in the last few months we’ve had Dr. Stu McGill, Dr. Mike Massey, and now Dr. Williams Morgan. It’s been fun to watch this thing of ours grow and continue to grow. You, the listener, is the main reason for that growth and I just want to continue to thank you and tell you how important you are to me and how much I appreciate you.  Usually, bios and intros can be a bit mundane. Not today, my friends.  When your guest has been the chiropractor to the US Congress, the US Supreme Court, and to the White Hosue, well, you know it’s going to be a good one don’t you? Not only that but Dr. William Morgan, as mentioned, is the President of Parker University, and an active member of the Texas Chiropractic Association and has been testifying on chiropractic issues in the last two Texas Legislative Sessions and is happy and proud to be a Texan. That’s my kind of guy right there!! Our Texan pride is indeed legendary and probably annoying to anyone outside of the state.  At age 17, he joined the Navy and served with an elite Marine Recon company as a hospital corpsman. During that time, he qualified in parachuting, military diving, submarine insertion, jungle warfare, combat swimming, explosives, mountaineering, winter warfare, and Arctic survival. Additionally, he attended anti-terrorist training at the FBI Academy. After leaving active military service and transferring to the Navy Reserves, Dr. Morgan began his educational journey to become a doctor of chiropractic. While at Palmer College of Chiropractic-West, he transferred to a Naval Special Warfare platoon as the unit’s primary hospital corpsman. He was sent to Special Operations Technician training to learn the principles of dive medicine. For the next eight years, he served as a dive medicine corpsman/combat swimmer for a platoon of Navy frogmen in Naval Special Warfare Unit One.   In 1985, Dr. Morgan received his Doctorate of Chiropractic from Palmer College of Chiropractic–West and soon after, married fellow Palmer graduate, Clare Pelkey. They practiced for thirteen years in California. In 1998, Dr. Morgan was chosen to establish the first chiropractic clinic at the National Naval Medical Center in Bethesda, Maryland, which later became Walter Reed National Military Medical Center. In 2015, Walter Reed recognized Dr. Morgan with its highest honor for clinical excellence, the Master Clinician’s Award. During the last 18 years at the military’s most prestigious medical centers, he practiced in an integrative setting, providing chiropractic care to the injured troops returning from the wars in Iraq and Afghanistan.  In the year 2000, Dr. Morgan was appointed as the Chiropractor to Congress at the U.S. Capitol. At the Office of the Attending Physician to Congress, doctors of many specialties care for members of Congress and the Supreme Court. In 2007, Dr. Morgan began serving as the White House Chiropractor. He was appointed chiropractor for the United States Naval Academy football team in 2009 (which never lost to Army while under his care).  In 2011, Dr. Morgan was appointed to the United States Navy Musculoskeletal Continuum of Care Advisory Board, an entity created to address the prevalent injuries sustained by U.S. Armed Forces Personnel during active-duty operations. Dr. Morgan also served on the Spine Subcommittee, which helps develop care algorithms for treating spinal conditions and determining the future of musculoskeletal management in the U.S. Armed Forces.  Dr. Morgan has completed a 2,000-hour residency in Integrated Medicine. He served on the Board of Trustees for Palmer College of Chiropractic for ten years. He is a Diplomate of the American Academy of Pain Management and has held adjunct faculty positions at F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, and New York Chiropractic College. Additionally, Dr. Morgan served as a consultant for the U.S. Department of Veterans Affairs (VA), helping to implement the VA’s chiropractic benefit and advocate for chiropractic research  Parker University inaugurated William E. Morgan as their seventh President in 2016. Upon arriving in Texas, he became an active member and supporter of the Texas Chiropractic Association (TCA). Almost immediately, he organized a leadership summit to establish a legislative agenda strategy for chiropractors in Texas. Texas Chiropractors had not won a significant legislative victory in two decades, but in 2017 four bills advantageous to the chiropractic profession passed. Additionally, Morgan has assisted in fundraising, membership recruitment, and awareness for the TCA. As a lifetime member of the American Chiropractic Association (ACA), he has also held several leadership positions in the organization.  Just last year, I was at the TCA President’s Gala when Dr. Morgan was awarded the Keeler Plaque which is awarded to the chiropractor of the year but is also a life time service award of sorts. It’s the most prestigious award the TCA gives so it’s quite an honor. And here in Texas, we are quite honored to have Dr. Morgan on our team. As a side note, I’m honored to know Dr. Morgan personally and really appreciate him agreeing to come on this podcast so let’s hop into it.  Welcome to the show Dr. Morgan, thank you so much for caving to my pestering and agreeing to shut me up by finally coming on the show.  Having the background you have, you’ve spent serious time on both coasts of our great nation. Now you find yourself dead center, right in the middle of the country. What was the allure of Texas for you, how has Texas treated you, and what has been your favorite thing about living here in Texas? Did you have any early perceptions of Texas or Texans when you moved here that proved to be false and did you have any that proved to be absolutely true? Everyone has a chiropractic story, what led you to want to be a chiropractor? Can you share a little about how you got to the point of climbing the ranks and becoming the chiropractor to Congress, the Supreme Court, and the White House? How did it all come about? Can you share some of the legally shareable and more unique stories or experiences of treating those types of patients? You moved to Dallas, TX to take the helm of Parker University as their 7th President. Just a little background on me personally, I was there when Jim Parker was still around. I was there when he passed away and his son Karl took over and I believe Fab Mancini was coming on board about the time I graduated. I’m well acquainted with Parker of yesteryear. When you got to Parker, what was one of the first things you wanted to change? What would you say has/have been the changes you’ve made since arriving that you are the proudest of? When I was in school there, exercise/rehab honestly was not a big aspect of the curricula. I know a bit about you and Parker Fit. Have exercises and rehabilitation taken on a larger role since 1998? Some areas of the country never experience something you all, unfortunately, went through last year. Tell us a bit about the tornado, the aftermath, and going forward from it.  Now, from one awful event to another. Our current global pandemic. How is Parker University handling this event? What can students expect going forward? During this crazy time, there have been a lot of divisions in the country from opening vs. closing to ‘I refuse to wear a mask’ vs. ‘can you please wear a mask’? Our profession, unfortunately, is no different. It’s been divided along clear lines for decades and this pandemic has brought some of the divisions into the spotlight. One of them is between those that promote spinal manipulative therapy as a way to boost immunity and those that do not support that. When this was really first unfolding and our Texas Board of Chiropractic Examiners, the WHO, the WFC, and the ACA were all telling chiropractors the support for immunity boosting is not present in the research literature, you and Dr. Katie Pohlman (I love Katie and need her on the show BTW)…you and Dr. Pohlman recorded a very smart and well-stated video saying that indeed, the research literature cannot support immunity-boosting at this time. Obviously, I was and am 100% on board with it and I said all of that to ask you this, was there any fallout to that? How did you handle it? And what went into the decision to record it in the first place.  Let’s move to legislative issues. What have you felt is our biggest issues in Texas and on the national level when it comes to chiropractic?  I have said repeatedly on this show that due to the opioid crisis and due to the emerging research over the last 5-10 years, I truly feel there’s not been a better time to be a chiropractor since the 1980s. As the President of a chiropractic college, what is the status of our profession right now? Not just in terms of the pandemic but over the course of the last year. Over the course of the next 5 years. Am I right about it being a great time? Am I wrong? Or a little bit of both? Thank you for joining us today! Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Chiropractic evidence-based products

Integrating Chiropractors

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

w/ Dr. Kris Anderson – FQHC, Chiropractic Research, and Professionalism

CF 079: w/ Dr. Kris Anderson – FQHC, Chiropractic Research, and Professionalism

Today we’re going to be joined by a special guest Dr. Kris Anderson from North Dakota. Yes, North Dakota’s finest is here to tell us about some of the stuff he’s got shaking and there’s a lot of stuff shaking thanks to this amazing guy. 

But first, here’s that silky satiny bumper music

Chiropractic evidence-based products

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

You have collapsed into Episode #79

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. I just got in my first box. I started with the non-surgical spinal decompression brochures. I wanted them for myself and ordered enough to send you some too!

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

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

DACO

Let’s talk a bit about the DACO program. I’m still studying. Nothing sexy there. I will say that the second time through the material is really really valuable. At least for me it is. I forget so much. Especially being 46. Not only am I older and I don’t remember things at the level I once did, but I also think I’m undiagnosed ADD. 

If I see anything shiny, man, I’m off in a completely different direction. When you have computers and phones dinging at you all the damn time, it’s tough. I have tried to minimize my notifications on the electronics. I’ve tried to keep my phone turned to do not disturb and all that good stuff. I can’t deal with all the racket when I’m trying to focus on something. 

So, yes, the second time through, for me, is of high value. 

Personal Happenings

If you hear something here that you really like and would like it in written form rather than spoken, just hop onto  chiropracticforward.com, find the episode, and just scroll down to copy and paste it. If you’re using it for content or on your website for some reason, just be cool and give us some credit please. I’d sure appreciate it and I’m sure the researchers we discuss would too. 

Now, let’s get ot our guest today. 

Sometimes, we have doctors on as guests that not everyone knows. I think that if you do not know our next guest, you either should or will know him in due time. He is a mover and shaker in our profession and is really just getting started. Some people cannot be ignored and I think our guest is one of those. Without a doubt. 

He is the current President of the North Dakota Chiropractic Association and was voted Chriopractor of the Year last year for the NDCA. That’s a pretty big deal. 

He has worked on behalf of the State of North Dakota with payers, legislatyors, government agencies, and other healthcare and community stakeholders. We’ll be finding out more about that in a bit. 

He has helped conduct research on safety as well on a smoking cessation pilot study.  

He was part of a study team whose systematic review of manual therapy for pediatric patients was published in BMC Complementary and Alternative Medicine. 

He treats part time as an employee of his local FQHC. Which stands for Federally Qualified Health Center. He’s their first chiropractor so I can’t wait to learn more about how that is progressing and what challenges he is encountering as he goes. 

If all of that were not enough, he is currently the AMA RUC HCPAC ACA Alternate Advisor. Don’t feel bad if you don’t know what that is because I had to ask too. We’ll tell you about it. Some of it is super double top secret but interesting for sure. 

He is also in the middle of a North Dakota Department of Health grant to help expand detection and management of hypertension within our profession. 

Now….now do you see why we have him here with us today? You may or may not know the name Kris Anderson but I feel confident the entire profession is going to know who he is by the time he’s done leaving his dent on our profession. 

We are happy to welcome Dr. Kris Anderson to the Chiropractic Forward Podcast today. Thank you for joining us today Dr. Anderson. 

My first question for you is, “When the hell do you ever sleep?” You have a ton of stuff going on.

I noticed on your CV that you worked as a barista at Starbuck’s during your time at Palmer. I’m not sure how anyone can hold a job while going through chiropractic college but, is this a skill that has paid off for you? Do you have an espresso machine in your office?

When I go through your information, you are involved in so many things. For example, I see your are District 4’s representative for Clinical Compass, Delphi Panelist, Grantee from ND Dept. of Health, Committee member for Notrh Dakota State Board of Chiropractic Examiners, ACA, and on and on. Where does all of this stem from? I’ve never even considered district representative for Clinical Compass was even a thing. Lol. 

We covered a paper you were part of back in Episode #68. In fact, that may be how we became familiar with each other. The paper was callled “Manual therapy for the pediatric population: a systematic review. It was in the BMC Complementary and Alternative Medicine(Prevost C 2019) just this year. I want to know all about it. How did you get involved with the team? Tell us a little about the process. 

This study came out at just about the same time as the Australians and certain spots in Canada started dealing with attacks on their rights to treat pediatric patients woith chiropractic care. What amazing timing. First, are pediatric patients a significant part of your practice and secondly, what has been the reception globally in regards to the paper’s findings?

As you probably well know, Texas has been in quite a battle with our state medical association. You are clearly as deeply involved in your state’s association. What challenges are the North Dakota chiropractors facing in 2019?

Do you have any specific goals to work on as President of the North Dakota Chiropractic Association?

Tell me about the gig with the FQHC? Dr. James Lehman was on our podcast in episode #55 and he was discussing the FQHC’s and integrating. He felt integration into them would be helped by completing a specialization like the DACO or something like that. What is your opinion on that? How did you get involved? 

What does your day at the FQHC look like?

Being the FQHC’s first chiropractor, what biases or other issues are you finding yourself having to address and navigate?

Tell us more about the grant you are in the middle of for the North Dakota Department of Health? How did it come about? What is the mission?

Let’s talk about alphabet soup….. AMA RUC HCPAC ACA Alternate Advisor. I promise, almost no person alive knows what all of that stands for so do us a favor and break it down for us and tell me what the purpose is. What’s the goal and how does it help chiropractors?

Those of us that have been active know the difference between being a member and being an active member. What has it meant to you both personally and professionally to not only be a member of your state association but to also be active in it? 

When we are sitting in our offices in Amarillo, TX or in Grand Forks, North Dakota, Washington DC and the ACA seems far away and somewhat out of reach. What have you seen is an effective way to become active with the ACA on a national level?

What’s coming down the pike for you in the next 5 years and in the next 10 years? Where do you see all of your efforts headed. Or where do you hope they’re headed?

Thanks for joining us

Chiropractic evidence-based products

Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Prevost C, G. B., Carleo B, (2019). “Manual therapy for the pediatric population: a systematic review.” BMC Comp Altern Med 19(60).

The Evidence For Some Surgeries, Searching for How We Help, and Opioid vs. Non-Opioid

CF 078: The Evidence For Low Back Surgery, Searching for How We Help, and Opioid vs. Non-Opioid

Today we’re going to talk about evidence for low back surgery, we’ll talk about if spinal manipulative therapy is partyly in the brain, opioid information for back, hip, or knee osteoarthritis….what does the research say?

But first, cool like a velvet Elvis, here’s that bumper music

Chiropractic evidence-based products

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

You have flip flopped into Episode #78

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

I should have in my first order of the decompression brochures in in just a few days. These dudes are going to look great. I’ll put some pics in the show notes and in the email we send out once a week to our email list. 

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

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

Personal Happenings

I’ve been asked to emcee the Texas Chiropractic Association’s President’s Gala which will be during the ChiroTexpo event in Dallas, TX on June 8th. 

I’m trying to figure out if I need to be making fun of everyone I introduce or not. Maybe I should trip them? You know we chiropractors….some of us can’t take a joke right? We’ll see how it goes. Most of the guys and gals in the TCA are pretty good with having fun. 

I always heard that people don’t join state associations because they think they’re made up of a bunch of old white dudes sitting around bitching. 

Well, not at the TCA, people. We have young people and certainly not all white. That doesn’t happen in Texas these days. We are a pretty mixed state in regard to ethnicity. We are also mixed in respect to gender. Several smart and highly capable women are either on the board or in a position of influence. Heck, we have a female going through the executive chairs starting in June. I’m excited to hear her ideas and see where we go under her direction. This girl is making it happen. She has young ones too. Nothing slows her down it seems. 

Let’s get to the topics today. 

Item #1

The first item we’re talking about is called “Randomised trial support for orthopaedic surgical procedures” authored by Hyeung Lim, Sam Adie, Justine Naylor, and Ian Harris(Lim HC 2014) and published in Plos One in June 13, 2014. 

This is an interesting one because we think that the surgical procedures we undergo have been fully validated. Fully vetted. Hell, you wouldn’t lay someone open unless it’s been researched and proven beyond a doubt to fix the issue would you? One would think so…..but…..let’s dive in a bit. 

Why They Did It

The authors wanted to investigate the proportion of orthopedic procedures supported by evidence from randomized controlled trials. Trials that compared surgical procedures to non-surgical alternatives. 

How They Did It

  • Orthopedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked
  • Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures
  • A risk of bias analysis was conducted for included studies using the Cochrane Collaboration’s Risk of Bias tool
  • 9,392 orthopedic procedures were performed across the index period

What They Found

Of the 83 RCTs, 23% were classified as supportive of operative intervention.23%. Twenty three percent were supportive of operative intervention. 

Only 37% of the total volume of procedures were supported by at least one RCT showing surgery to be superior to a non-operative alternative. ONLY 37% y’all. 

19.6% of the total volume of procedures were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative.

Sounds crazy right? 

Of the most common orthopedic surgical interventions….the most common…..of those surgeries, less than 20% of them had a low risk of bias randomized controlled trial backing them up. 

I have some problems with cussing in my personal life but I’m determined to keep this show mostly PG-13 but man. 

That’s just shocking. Cutting people open with no better evidence than that. 

One word – two syllables. Day-um. 

The Conclusion was “The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine.” 

Good Lord I hope the other areas of medicince have more scientific support. 

What procedures are we talking about? Let’s be fair, we’re mostly spine people and the majority of the procedures their taling about here have nothing to do with the back. They’re talking about things like:

  • Knees
  • Hips
  • Intrnal fixation of proximal or shaft fracture of the femur
  • Ankle fracture fixation
  • Shoulder arthroscopy
  • Arthroscopy of the ankle…….no studies at all. Lol

It’s just crazy to think about. If we’re talking about evidence-based practice, is this it? 20% of our profession is about half crazy I think. Well, that’s about the same number of procedures they do that only have one RCT with low bias risk. 

Is it evidence-informed? I don’t know. That still sound awfully low to even consider it evidence-informed. 

I don’t know all of the answers and I don’t pretend to. Do what you do, but…..why they hell do they question spinal manipulation and say we have weak evidence to perform it? What? Stupid. 

Makes me want to cuss in Spanish.

Item #2

This one is just building on what we understand about what a manipulation does. It doesn’t answer any questions definitively but it does lay more groundwork for the future. 

It’s called “Spinal manipulation therapy: is it all about the brain? A current reveiew of the nurophysiological effects of manipulation.” It is authored by Gile Gyer, Jimmy Michael (never trust a guy with two first names. Especially if he’s left handed), Jame INklebarger, and Jaya Tedla. Published in the Journal of Integrative Medicine in May of 2019(Gyer G 2019). 

Hot stuff coming up

Why They Did It

While spinal manipulation has become more and more accepted after being more and more validated by research, the fact remains that we still don’t know exactly HOW it works and according to my interview with Dr. Christine Goertz in Episode 67, we are far away from having that satisfaction. The authors say there are certainly biomechanical and neurophysiological reasons for it’s effectiveness, 

The paper says, “Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin.”

“The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more.” The nerual plastic changes part of that is really fascinating. It was once thought that the brain is the brain and we just start chipping away at brain cells as we age and go stupid stuff. Lol. 

They’re finding out that the brain changes. It can be trained. It can be built sort of like a muscle but in a neural sense. It’s fascinating. But that’s a different episode all together. 

I don’t have access to this full paper but, the point is, they’re trying to find out HOW we are effective through spinal manipulation and they recommend we plan for long-term follow up studies to help us determine the clinical significance of the neural responses that happen from spinal manipulation. 

Pretty interesting stuff there. 

Item #3

Last one for this week. It’s called “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial.” It was authored by Dr. Erin Krebs, MD et. al(Krebs E 2018). and published in JAMA on March 6 of 2018 so a little over a year ago. 

The question to answer here was, “For patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, does opioid medication compared with nonopioid medication result in better pain-related function?”

How They Did It

They had 240 patients and found that the use of opioid vs. nonopioid medication did not result in significantly better pain-related function over 12 months. But they may have gotten some folks addicted in on the way to the conclusion. Lol. 

Basically, this study says stay away from opioids for moderate to severe chronic back pain or hip and knee osteoarthritis. the official conclusions was, “Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

Boom. Pop. Pow.

I feel like I’m preaching to the choir here but you never know who listens. 

Speaking of that, Dr. David Graber shared with me that after his episodes with us, he got an email all the way from Switzerland from a chiropractor that was pretty jazzed by his comments and thoughts and Dr. Graber wanted me to know that we are indeed reaching folks and influencing on some level. 

I can’t tell you how incredibly satisfying that is. Every now and then, I get a little bit of encouraging feedback but honestly, not enough. You never know what the reach is. Are you enjoying the show? Are you listening regularly? Send me an email at dr.williams@chiropracticforward.com and let me know. I love to hear from you guys. I really do. 

Not only is it inspirational like filling up your gas tank…..but feedback can help me direct the show in a direction that I know you guys are interested in or focused on. Feed back only helps me learn more and get better so send me an email won’t you?

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 instead of chemical treatments like pills and shots.

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Gyer G, M. J., Indlebarger J, Tedla JS, (2019). “Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation.” J Integrative Med.
  • Krebs E (2018). “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain The SPACE Randomized Clinical Trial.” JAMA 319(9): 872-882.
  • Lim HC, A. S., Naylor JM, Harris IA (2014). “Randomised Trial Support for Orthopaedic Surgical Procedures.” PLoS One 9(6).

w/ Dr. David Graber (Part One) – Chiropractic Technique, Chiropractic Gurus, Teaching

CF 076: w/ Dr. David Graber (Part One) – Chiropractic Technique, Chiropractic Gurus, Teaching

Today we’re going to be talking with Dr. David Graber from New Jersey. Parsippany, NJ to be specific. 

But first, here’s that bumper music


Chiropractic evidence-based products

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


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

You have collapsed into Episode #76

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

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

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

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

F4CP

We will be launching an athletes and opioids eBook toward the end of this month. It’s called A case for chiropractic disrupting the cycle of pain, prescriptions, and addiciton. I’m linking it in the show notes so go get and check it out. 

https://www.f4cp.org/package/home/viewfile/whiathletes-and-opioids-ebook

DACO

Let’s get to our guest today. As I mentioned at the top of the show, we have Dr. DavidCF ep. 76 Graber with us today. 

  • Dr. Graber graduated from New York Chiropractic College in 1985 and got his Sports Diplomate in 1996. 
  • He is a fromer NYCC assistant instructor of diagnosis and technique. 
  • He developed and taught over 20 different post-graduate courses in Chiropractic technique and theory, and rehabilitation. 
  • He was voted chiropractor of the year in 2012 by the Association of New Jersey Chiropractors
  • He is the charman of the ANJC council on technique and clinical excellence. 
  • And he’s here with us today. 
  • Welcome to the show
  • Tell me about your journey into chiropractic
  • Tell me about your journey into evidence-based chiropractic
  • When did you start getting into speaking and giving presentations? How did that come about?
  • I noticed a powerpoint where you taught cervical adjusting. After going through the powerpoint, how many ways are there to adjust a neck?  Minus the techniques Rambo and Chuck Norris use of course : )
  • You say you know how to suck at a technique. I don’t know anyone that wants to suck but, in order to avoiding sucking, you must explain. 
  • You mention the people that are publishing research and teaching courses on Chiropractic technique and how to approach them as if they were a financial planner. Can you explain that a little further for us?
  • I can’t think of anyone better than you to ask this question of. I see so many polar opinions concerning this: with the rising popularity of the YouTube folks like Cipriano and Gregory Johnson, AKA – Ring Dinger – what is you opinion of the Y-axis adjustment? Is it as dangerous as some think?

Chiropractic evidence-based products

Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

w/ Dr. Christine Goertz – Chiropractic Research, What Does The Science Say, And Where Are We Going?

Today, we have one of the giants of chiropractic research as our guest. I will go further into her background in a moment but we have Dr. Christine Goertz joining us today and, if you do not know who she is, it is time to listen up. Don’t you go anywhere because this is going to be an excellent episode full of great information. 

But first, here’s that “oh how sweet it is” bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have bounced your way into Episode #68 and we are so glad you did. 

Introduction

We’re here to advocate for chiropractic while we also make your life easier. 

Store

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

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

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

Guest Introduction

Christine Goertz, D.C., Ph.D., is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. Prior to joining Spine IQ, she was Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic for eleven years. 

Dr. Goertz received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1991 and her Ph.D. in Health Services Research, Policy and Administration from the School of Public Health at the University of Minnesota in 1999. Her 25-year research career has focused on working with multi-disciplinary teams to design and implement clinical and health services research studies designed to increase knowledge regarding the effectiveness and cost of complementary and integrative healthcare delivery.

She has extensive experience in the administration of Federal grants, both as a PI and as a program official at the National Institutes of Health (NIH). Dr. Goertz has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers. Her primary area of focus is the investigation of patient-centered, non-pharmacological treatments for spine-related disorders. Dr. Goertz is a former member of the NIH/NCCIH National Advisory Council and currently serves on the Board of Governors for the Patient Centered Outcomes Research Institute (PCORI), where she has assumed numerous leadership roles. In September 2018 Dr. Goertz was appointed to a 3-year term as Vice Chair of the PCORI Board by the Comptroller General of the United States. 

Welcome to the show Dr. Goertz. I can’t tell you how excited I am to have on our podcast. 

Can I first ask you what was the impetus for your wanting to get into the research end of the profession? How do you come to the decision to dive into research full-time vs. treating patients day-to-day like so many of us do?

I noticed on your CV that you are currently an adjunct professor with the Department of Orthopaedic Surgery at Duke University Medical Center in Durham, North Carolina and also an Adjunct Professor in the Department of Epidemiology, College of Public Health, University of Iowa. All the while, you are working with The Pine Institue for Quality (AKA Spine IQ). Can you tell us what a regular day looks like for you?

Whether you know it or not, you have been a game-changer for this profession. You have, likely unknowingly, played a big part in some of our podcast episodes. I want to start with a paper we covered. I called it The Veterans Paper and it was HUGE. Though I call it the Veterans Paper, you say it was done as part of the Department of Defense. I wonder….did you notice anything BIG after it was published in JAMA? Was it, in your opinion, any more impactful than your other papers?

Here’s what happened as soon as that paper came out from my perspective; almost immediately, we began getting interest from our local VA and, once we completed credentialing, we started seeing referrals. Before that paper…..nothing. No interest. I don’t know if you’re ready to take all of the credit for that but I’m going to give it to your regardless. On behalf of the entire evidence-informed chiropractic profession, thank you for that. 

In emails we have exchanged leading up to our time together today, you mentioned you have a large pragmatic trial funded by the NIH in the VA. Can you tell us anything about that?

In your work called “Insurer Coverage of Nonpharmacological Treatments for Low Back Pain – Time for a Change” published in JAMA October 2015, you say there are no policies emphasizing nonpharma treatment at the forefront of the patient experience, no meaningful levels of coverage for care professionals focussing on nonpharma therapy, and no policies providing financial incentives in favor of nonpharma. I have seen your work make huge differences but have to admit, I’m still seeing reimbursements for chiropractors being a challenge. We have folks out here struggling in practice in spite of everything in our favor. Have you experienced any changes after this came out in JAMA? Can we expect these sentiments you describe to gather steam in the next year or so?

In another piece of yours called “What does research reveal about chiropractic costs?” you say something I want to commend you on. You say, “without a doubt, the most common issues raised by those outside the profession relate to the quality and consistency of chiropractic care delivery.” I think we can all agree that standardization is likely the biggest hurdle our profession faces in regard to integration. Do you believe chiropractic residency training would better prepare chiropractic providers to offer high quality care within medical facilities?

I’m currently over 2/3 of the way through the Diplomate for the Academy of Chiropractic Orthopedists. I see the value every day but, in your opinion, should Board Certification become the norm for chiropractic providers rather than the exception?

In that same paper, when talking about costs for chiropractic care you point out that we are likely equal or less in cost. You say, “In particular, it appears that patients who visit a chiropractor are less likely to undergo hospitalization, resulting in lower global healthcare costs than those who receive medical care only.” Do you feel that the medical field is coming to the point they are seeing our potential in improvement as well as our cost-effectiveness on more of a widespread scale or are there just little pockets here and there? Is the medical field starting to catch on but the insurance companies are still not allowing the change? What are you seeing on your end of things?

You recently were part of a paper that was published just this year, 2019, called, “Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial.” I really have to talk to you researchers about trying to shorten the names of these papers. 

Anyway, you all concluded on that one that one session of chiropractic manipulative therapy had immediate effect of reducing the time required for asymptomatic special operations forces to complete a complex whole-body motor response task. Tell me….what are we looking at here? Where is this line of research leading future research?

I personally love it and think it has extremely high value so when I ask you this question, please don’t take it as a negative. Are you responsible for instigating the Palmer-Gallup Poll? What were the main goals for starting it and has it lived up to the original thought process behind its beginning? 

I thought this was an interesting question. A listener and member of our private group on Facebook, Dr. Trent Peng, suggested I ask you which chiropractic adjustment techniques are sufficiently evidence-based in the scientific literature?

In an article by Lisa Rappaport, called “Adding chiropractic to back pain care may reduce disability,” she interviewed you for the article. She had a quote in the article from you that said, “Spinal manipulation (often referred to as chiropractic adjustment) may help heal tissues in your body that form as a result of injury, decreasing pain and improving your body’s ability to move correctly.” 

The other was, “It is also possible that manipulation impacts the way that your body perceives pain through either the brain or the spinal cord and/or decreases pain from muscle strain, inflammation and/or spasm in the muscles next to your spine.” 

The first comment I have on this is that I love the second quote because there is more and more information coming out about what part the central nervous system plays in regard to pain. Pain sensitization, movement dysfunction, joint proprioception and thing of that nature. I thought that quote brought some of that into consideration without getting too complicated for a normal reader. So, kudos on that!

I remember thinking to myself that there are a lot of “may help” and “it is possible” kind of language. I understand that researchers shouldn’t formulate opinions or conclusions in definite terms or absolutes and I completely understand that, but my question to this point is do you ever see a time that all chiropractors can say with a high degree of confidence exactly what happens and exactly why it helps people heal or feel better?

I was sent a paper I believe you have in progress called “Assessment of chiropractic care on strength, balance, and endurance in active-duty US military personnel with low back pain: a protocol for a randomized controlled trial. In the Background section, you all say, Chiropractic care may facilitate the strengthening of trunk muscles, the alteration of sensory and motor signaling, and a reduction in pain sensitivity, which may contribute to improving strength, balance, and endurance for individuals with low back pain.”

As you probably know, here in Texas, we are in a perpetual battle against the Texas Medical Association. Recently, they won a decision that was upheld on appeal to remove the ‘neuro’ snippet from our scope description of treatment the neuromusculoskeletal system. Essentially, they say we only treat the musculoskeletal system. With the research you have done and are currently involved in, what do you say to this?

What has been your favorite project or finding you have been a part of so far?

What has been your favorite paper, project, or finding that a colleague has written but you were not a part of?

What conclusion have you had to draw at the end of a paper that surprised you the most?

How do you see quality research translating into a greater level of inter-professional collaboration and how do you see the future of chiropractic unfolding in terms of integration into the healthcare system?

A tie-in question here, where do you see the profession in 10 years?

I know that low back is one of the biggest reasons for disability worldwide, if not the biggest. It deserves the attention it has received. We have research on low back pain now to the point that even traditional chiropractic detractors can’t really argue all that much with us on low back pain. But we still have a fight on our hands when it comes to cervical manipulation. My question is why do you think we don’t see more research for cervical manipulation and do you see the spotlight ever changing and the research beginning to focus on cervical manipulation and the benefits for neck pain and headache/migraine?

In the private Chiropractic Forward Facebook Group, we are curious….what are you up to right now? What are you working on? 

Apart from what you are working on right now, what are your goals in regard to research in the next 10 years?

Thank you so much for taking time out of your day to join us. I hope our listeners got as much use out of our talk as I did. I truly believe that our profession is where it is and going the direction it’s going in large part because of you an d your efforts. 

And I thank you so much. 

Chiropractic evidence-based products
Integrating Chiropractors
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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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


Inflammation and Cognitive Decline

Today we’re going to talk about brain inflammation, cognitive decline, your brain and your patients’ brains and we’ll talk about my brain. Scary stuff here. Plus we’ll talk about ALS and concussion. What’s the research saying?

But first, here’s that “hell yeah”  bumper music

Chiropractic evidence-based products
Integrating Chiropractors
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OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have stuttered into Episode #66

Introduction

We’re here to advocate for chiropractic while we also make your life easier.  

Store

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

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

Go check them out at chiropracticforward.com under the store link

DACO

Let’s talk a bit about the DACO program which is the Dipolomate of the Academy of Chiropractic Orthopedists. Still trucking along and hauling a big load of knowledge nuggets in my big 18-wheeter trailer. I don’t know where that came from. 

Recent classes for me have been Managing preganncy-related SI pain, diagnosing thoracic facet joint pain, managing Scheuermann’s disease, and diagnosing merlagia paraesthetica. 

I have told you before that I’m no guru. I learn all the time because I clearly don’t know it all. I have no problem admitting that I’m not, nor have never been, particularly knowledgable on meralgia paraesthetica. I am crapping you negative, folks, when I tell you that the very day after I had the drill on it, it shows up in my office. I swear, unbelievable. 

I’m not above admitting that I’ve been missing it for all these years. It hurts me a bit to admit but facts are facts and if I’m not honest with you, well then, what’s the point in all of this anyway?

If I can get you pointed in the right direction to get started with the DACO, shoot me an email at dr.williams@chiropracticforward.com. I’m happy to help. I get nothing out of it. No discounts on hours, no special considerations, nothing. I just think it’s that important. 

Personal Happenings

Front desk hunt….still a go. Still no rock star. Still not settling. There’s your update. 

Item #1

On with it. This one is called “Systemic inflammation during midlife and cognitive change over 20 years: The ARIC Study.” It was authored by KA Walker, RF Gottesman, DS Knopman, and a slew of rascally cohorts(Walker KA 2019). It was published in Nuerology in February of 2019. Hot stuff….comin’ through. Brand new people. 

Why They Did It

They wanted to examine the associaiton between systemic inflammation measured during midlife and 20-year cognitive decline. 

You know speaking of cognitive decline……..what the hell was I saying? Why did I even come into this room? : )

Anyway, here’s how they did it

This is REALLY dumbing it down a bit for the purpose of brevity but, within the atherosclerosis risk in communities cohort study, inflammatory biomarkers were measured during middle adulthood. they worked some math magic using the biomarkers, creactive protein, and cognition periodically over 20 years. 

12,336 participants

What They Found

Participants with a midlife inflammation composite score in the top quartile had a 7.8% steeper cognitive decline, compared to participants in the lowest quartile; CRP in the top quartile was associated with an 11.6% steeper cognitive decline. In cognitive domain-specific analyses, elevated midlife inflammatory markers were most consistently associated with declines in memory.

Wrapping It Up

The authors concluded, “Our findings highlight what may be an early pathogenic role for systemic inflammation as a driver of cognitive decline in the decades leading up to older adulthood.”

The weirdest thing. As soon as I went over this article, I went home that night and opened up the lates version of Chiropractic Economics magazine. It’s issue 3: February 22, 2019. 

Anyway, there’s an article in there on this exact very thing because my mind is creepy like that. Seriously, you might do this too but, I can think of a patient I haven’t seen in a little while and Bazinga….that week or the next they show up in my office staring me in the face in live real life and it freaks me out every time to know I have gravitational mind powers like that. Lol. 

Evidently my gravitational mind powers work in the information world as well because that’s the way it happened my friends. 

Now, there was all kinds of research citations present in this article but I did not look them up. I don’t know the quality of them. I just don’t have the time but, in short, if we want to decrease the kind of inflammation we see for cognitive decline, the kind in the paper we just talked about, then we need to look at making sure we have good levels of Curcumin/turmeric as well as good serum levels of vitamin D. 

They say the curcumin plays a role in regenerating neurons, creating new brain cells (lord knows I need that), and refreshing cells that may have once been considered irretrievable. So, all the damage I did in young adulthood….maybe there’s some hope after all. 

And are you realizing all of the information that has come out about Vitamin D in the last several years? There is also data refuting the use of ANY supplement but, knowing there’s no harm in a Vitamin D supplement, why WOULDN’T you consider taking it regularly? Worst case scenario, you lost a very minimal amount on a supplement that did nothing. 

Best case, you’re near superhero level. 

Item #2

Continuing with our brain stuff this week, here is item #2 titled, “Contact Sports as a Risk Factor for Amyotrophic Lateral Sclerosis: A Systematic Review” authored by R Blecher, MA Elliott, E Yilmaz and a plethora of associates(Blecher RA 2019). It waspublished in Global Spine Journal in February 2019 because the new stuff makes the folks tickle. And why not? I love information but there’s just something warm and fuzzy about  NEW informaiton isn’t there?

Why They Did It

They say that environmental factors for ALS have remained largely unknown and recent evidence suggests that participation in certain types of sporting activities are….not may be….but ARE associated with increased risk for ALS. They wanted to test the hypothesis that competitive sports at the highest level that involve repetitive concussive head and cervical spinal trauma result in an increased risk of ALS.

How They Did It

They searched electronic databases adn reference lists of key articles from inception to November 22, 2017.

They used 16 studies fitting the criteria for inclusion. 

The sports they looked at were of course, American football, basketball, cycling, triathlon, and skating. I’m wondering where hockey or rugby is in the mix. 

What They Found

I hate to say it but here’s what they found, “Our review suggests that increased susceptibility to ALS is significantly and independently associated with 2 factors: professional sports and sports prone to repetitive concussive head and cervical spinal trauma. Their combination resulted in an additive effect, further increasing this association to ALS.”

While we love our sports and we hate seeing the sissy-fication of the world in general, we also don’t want people to knowingly and purposefully put themselves in danger like this. 

Certainly not our children. We have to pay attention to this stuff. 

I played from 3rd grade up into college and only had my bell rung one time but I’m thinking I’m the exception, not the rule. I was always taller and bigger than most of the others on teh field so that may be why I escaped. Or at least I think I escaped. I’m 46. I still have time to lose my mind I suppose. 

Anyway, food for thought. 

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 instead of chemical treatments like pills and shots.

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

YouTube

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

iTunes

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

Player FM Link

https://player.fm/series/2291021

Stitcher:

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

TuneIn

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

About the Author & Host

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

Bibliography

  • Blecher RA, E. M., Yilmaz E, (2019). “Contact Sports as a Risk Factor for Amyotrophic Lateral Sclerosis: A Systematic Review.” Global Spine J 1: 104-118.
  • Walker KA, G. R., Knopman DS, (2019). “Systemic inflammation during midlife and cognitive change over 20 years: The ARIC Study.” Neurology.

CF 060: Medical Marketing & Integration Care Expectations



Chiropractic Wins Again, Push Ups Say A Lot, Low Iron & The Disc

CF 064: Chiropractic Wins Again, Push Ups Say A Lot, Low Iron & The Disc

Today we’re going to talk about how chiropractic and spinal manipulative therapy win again, we’ll talk about how push ups may tell us more than what you see on the surface, we’ll discuss some new information on low back discs and how they’re affected by low iron, and then we’ll gloss over a paper on physical therapy to toss you some thought nuggets. 

Chiropractic evidence-based products

But first, jsut for my friend and collegue, Dr. Michael Henry down in Austin, here’s that ‘you know you love it’ bumper music. He’s a big fan. 

Integrating Chiropractors

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

You have shimmied all 60’s like into Episode #64

Introduction

We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time in your week and give you confidence in your recommendations and treatments. And I feel confident in guaranteeing that to you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. I noticed an error on the shipping charge. That has been corrected now. 

Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at dr.williams@chiropracticforward.com if somehting is out of sorts or isn’t working correctly. 

DACO

Let’s talk a bit about the Diplomate of the Academy of Chiropractic Orthopedists probgram also known as the DACO. I finished up all 50 of the required live hours this weekend down in Austin, TX during the Texas Chiropractic Association’s legislative seminar. 

Not only did I get all of the hours wrapped up but I also got to see a lot of colleagues I have been doing battle along side with for the last 8 years or so. You may or may not know that the Texas Medical Association is particularly aggressive and attacks at will for anything and everything. Which means we have to constantly raise funds to defend the attacks. 

It’s this cute thing we do with each other from year to year. It’s really a special relationship chiropractors have with the TMA. I keep thinking one day they’ll start listening to their own profession and leave us the hell alone but nope. Not so far. Not until they have full and complete control of chiropractic care in Texas. Which is not going to happen. Just so you know.. 

They sued us because 2 docs in texas who were Neuro Diplomates were doing VONT testing. I’d never even heard of VONT until this last time we got sued by TMA. IF you can give me a good reason why a neuro diplomate cannot do VONT testing, I’ll send you a candy bar or some chicklets or something like that. 

It’s enough to make a guy crazy. I got to meet a lot of bright new people ready to help the TCA fight and overcome. Andrea Ohmann recently moved to Texas from Minnesota. She is in a hospital setting if I understood correctly. She’s a bright star to keep an eye on. I also need to thank Dr. Jamie Marshall for listening to us down in Conroe, TX. I really appreciate it!

I got to see Staff Sergeant Shilo Harris speak. I mentioned him a couple of episodes ago but I have to tell you, this man is a hell of a speaker and he’s in our corner specifically. He gives chiropractic care all of the credit for helping him get through all of his injuries and surgeries. He was blown up by an IED in Iraq and has been through absolute hell to get to where he is now and chiropractic was key to getting him there. 

Very emotional and very impactful. I can’t imagine a legislator being confronted by him and his story and not being forced to see it our way. It’s powerful. Thanks to Shilo for eveything he’s doing for this profession. I hope you’ll go to http://shiloharris.com and see what he’s about. 

Beyond that our DACO hours were taught by Jeffrey Miller who is a chiropractor on staff at the University of Missouri medical school. He’s not as sharp as a tack. He’s actually sharper than a tack and told me he’d love to join us on the podcast so I’m going to do us all a favor and get that set up. We also have Dr. Christine Goertz’s episode coming up quickly so keep your eyes peeled for that one too. 

This get on with this deal here. 

Item #1

Our first item here is called “Manipulative Therapies: What Works” and is authored by Dr. Michael Smith, an MD, and his herd of collegues. It was published in American Family Physician on Febraury 15, 2019(Smith M 2019). I got this one from Dr. William Lawson in Austin, TX who is a DABCO and a swell dude on top of that. 

In case you missed it, this herd of authors are medical doctors. They start by saying that manipulative therapies include things like osteopathic manipulative treatment which is the same as chiropractic manipulative treatment. 

They say that, when you compare manipulative therapy to oral analgesics, cervcial manipulation and/or mobilization appears to provide better short-term pain relief and improved funciton in patietns with neck pain. 

They go on to say that manipulative therapy may be as effective as amitriptyline for treating migraine headaches and can reduce the frequency and intesity of pain. 

While there is some evidence showing that manipulative therapy can reduce length of hospital stays for preterm infants, there is ZERO research for some of the other reasons we see chiropractors treating infants. Things like otitis media, colic, allergies, and respiratory conditions. 

That was all in the abstract. That’s the medical world starting to take note. Can you hear it? When do the insurance companies start to take note as well?

THAT’S REALLY when our lives start changing. Oh happy day….I have a dream. A dream where we are no longer pursecuted for being right all the damn time. A dream that chiropractors don’t go around saying crazy crap and making the rest of us look bad. I have a dream people. I’m not going to pretend to be as good of an orator as Martin Luther King Jr. but you get the point. 

You know that the more of these articles that come out, the more they have to start gathering steam. Turn on a light bulb at night in South Texas and see what happens. The bugs start swarming. Turn on this kind of light and you’ll see these articles begin catching more and more attention until we finally have a consensus in the medical field. A consensus that says, “Hell, looks like they’ve been onto something this whole time. We better take another look at it.”

This is an excellent paper. And we need to keep seeing this more and more. Even if they’re talking specifically about osteopathic manipulative therapy, we know that chiropractors do it too and, in fact, chiropractors do almost all of it these days. DO’s have moved almost completely to medicine. We are the ones moving joints. Make no mistake about it. 

Item #2

Pushups…what can they tell us? Well, it appears they can tell us quite a lot from an article in StudyFinds called “Men Who Can Do More Than 40 Push-ups Far Less Likely To Develop Heart Disease.(Finds 2019)”

This article covers a new study that showed that men posessing the ability to perform 40 push-ups in one attempt are much less likely to suffer from heart disease wihtin the next 10 years. 

They showed where middle-aged men who can put in more than 40 in a single try have a 96% less chance of having heart disease when compared to those who could complete no more than 10 push-ups. 

So, it appears, to me…..that it’s time to start doing some push-ups muy pronto. 

Item #3

This one comes to us from the American Journal of Translational Research and is called “Iron defficiency accelerates intervertebral disc degeneration through affectring the stability of DNA polymerase epsilon complex(Zhang C 2015).” 

It was published in November of 2015 and appears to be mostly Chinese researchers. Could be Japanese, Korean, or Vietnamese but the name of the lead author is Chungiang Zhang and whole host of names that appear to be just as difficult to pronounce. 

We will not get deep into the details here because I’m not too proud to admit that the information here goes far above my head in many ways. I’ve said it before, I’m no guru. I’m like Alex Trebec on Jeopardy. He delivers the info but I promise he’s no expert on every question coming across his lips. Lol. 

But, when we stick with the basics, we see that iron serves as an important cofactor of iron-containging proteins that play critical roles in the maintenance of DNA stability and cell cycle progression. They say that disturbed iron homeostasis gives rise to things like cancer and anemia. 

In addition, they say that they found clear correlation between iron deficiency and intervertebral disc degeneration. 

They wrapped up their paper by saying, “In summary, our study suggests that iron deficiency is an important factor in the aggravation of IDD. Proper iron supplementation may be an effective strategy to alleviate the symptoms of patients with intervertebral disc degeneration.”

Item #4

Our last on the list, it has to do with PTs and is called “Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review,” authored by Heidi Ojha and a gaggle of others and published in Physiotherapy Theory and Practice in February 2019(Ojha H 2019).

This was a systematic review to compare the effects of minimal physical therapy utilization (two visits or less) vs. typical physical therapy utilization consisting of 3 or more visits on patient-important outcomes for patients with low back pain. 

They say this research is needed because there is such variation in physical therapy use for those with low back pain. 

Interestingly, they found that, when compared with minimal utilization, higher utilization demonstrated no significant differences on pain, disability, or quality of life at the 1-year follow-up.

Even more interesting was that the conclusion of the paper said the following, “While higher utilization may not result in significant improvements in patient-important outcomes, it may be more cost-effective for patients with chronic or complex LBP conditions when compared to minimal utilization.”

So, what the hell is that? It’s not going to make you any difference to see us a lot but the price point is agreeable so, by all means, we’d like to see you a crap load. Which isn’t as much as a crap ton. By the way. But I think you see what I mean. 

I have noticed so many papers that basically cast a lot of doubt on PT in general while all we seem to find in regards to manipulative therapy are positive reaffirmation of the chiropractic profession. 

It just makes me wonder where the tipping point is to be honest. When does the medical industry start to look at chiropractic as being more effective for these conditions that PT and making those referrals accordingly? I had some insight on a PT private group on Facebook a couple of weeks ago. 

The PTs were piling on a chiropractor’s advertisement techniques. Let’s be fair, the DC was a knucklehead and wasn’t being honest and identifying himself as a chiropractor in his marketing but, for discussion purposes here, that’s beside the point. 

They were bashing not only on that chiropractor but our profession as a whole. I bash on aspects of my profession as well but, where the rubber hits the road, we average better patient outcomes, we are safe, we are effective, and we average higher patient satisfaction. Even if some in our profession would win a county craziness competition. 

Don’t believe me? Go listen to Episode #49 of this podcast where we go over the Parker-Gallup poll. Very interesting episode and there are some valuable marketing nuggets in that one for you as well. Definitely worth the listen. 

Also Episode #26 talks about PTs and DCs. The age old grudge match. Go check them out and see what you think. 

Some in our profession are simply imbeciles. That sounds harsh but for a time after graduating, I held no interest in furthering my education. I wanted to coast. I’d done the hard work, right? I was so smart already after all those years of college. Well, you don’t know what you don’t know. And, I can admit that for a few years there, I was an imbecile. 

They learned enough to pass but that doesn’t make them smart or ethical and that’s sad. But again, when said and done, our profession consistently proves itself and is proven by insurance companies, governments, polls, surveys, and universities. 

From what I’ve seen recently, I can’t say the same for them and I just can’t see where they feel they have some moral high ground or platform to stand on and spout a bunch of denigrating thoughts at us. 

I thought it’d be a good idea once to refer to a PT. I had a car wreck patient and thought they could use PT and at that time, I wasn’t equipped to do much rehab. So onto the PT they went. In two damn weeks, the PT ran up a bill that would have literally taken me 4 months to run up. I was astounded. And, in that two week period, there was little to no improvement for the patient. 

On a separate occasion, I had a disc patient finally settled down and doing great. She was very active and very much into working out. I had her disc settled down to a point that she thought she’d go get PT on top of what I was doing. She did not talk to me about it. She just did it. Her thought process was that it would just be that much better to combine the two. Chiropractic and PT. Honestly, that’s not bad thinking in theory. 

She came back after one visit almost unable to walk or function. We tried and tried to get it to settle back down but she ended up taking herself to a surgeon to get our of pain. Sorry PTs. Quit talking smack and work with us instead of against us.

Ideally, PTs and chiropractors work hand in hand and complement each other. Many offices can and should operate in this manner. In reality though, I see PTs as great for post-operative rehab and rehab after certain types of injury. When it comes to joints and spines in general though, they can’t touch us. They talk bad about us, they steal services from us, they think they have the moral ground on us, but they can’t touch us.

Those of us practicing in an evidence-informed manner anyway. Those not practicing evidence-informed actually continue to provide them with whatever moral ground they believe they have. 

I for one would like to move on from the beginnings and progress our profession much like the MDs have done over the last 150 years. They went from blood-letting, leeches, and labotomies to what they can do now. Yet, there’s still a part of our profession wanting to hold on dearly to our originations of 100+ years ago. 

Chiropractors, let go. Progress. Practice current, in the current day and age. Practice evidence-informed. It’ll help you and it’ll help the profession in general. 

That’s my opinion anyway. Take it or leave it. 

This week, I want you to go forward with

  1. Chiropractic wins and wins and wins again. We made the right decision. We just need to only use our powers for the good. 
  2. Push-ups….let’s get to doing them!
  3. Iron deficiency for disc degeneration is something worth looking at. 
  4. When we are practicing evidence-informed chiropractic care, PTs only wish they could get the results we can get.

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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

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

Twitter

About the Author & Host

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

Bibliography

Finds, S. (2019) “Men Who Can Do More Than 40 Push-Ups Far Less Likely To Develop Heart Disease.” StudyFinds.

Ojha H, M. M., Johnston M, (2019). “Minimal physical therapy utilization compared with higher physical therapy utilization for patients with low back pain: a systematic review.” Physio Theory Practice.

Smith M (2019). “Manipulative Therapies: What Works.” AMerican Family Physician 99(4): 248-252.

Zhang C (2015). “Iron deficiency accelerates intervertebral disc degeneration through affecting the stability of DNA polymerase epsilon complex.” Am J Transl Res 10(11): 3430-3442.

Government-Regulated Rehab, Do Rotator Cuffs Need Repair, Carpal Tunnel

Government-Regulated Rehab, Do Rotator Cuffs Need Repair, Carpal Tunnel

Today we’re going to reach into my bag of papers that have been sitting and gathering a little dust waiting for their time in the sun. We’re talking about government-regulated rehab. Is it any more effective than doctor-regulated? Do you send rotator cuff issues straight to a surgeon and is that the smartest thing? We’ll also skim over some new info on carpal tunnel syndrome. 

But first, here’s that “goes down so smooth” bumper music.

Chiropractic evidence-based productsIntegrating Chiropractors

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

You have Frankenstein-shuffled into Episode #63 all creepy like

Introduction

Why does this podcast even exist? We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time through your week by giving you confidence in your recommendations and in your treatments. 

This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  I’m no guru but I do believe I was blessed with some amount of common sense that somehow continues to keep me in the game. You are ABSOLUTELY going to pick up some nuggets that you can use in your own practice. 

Evidence-based Chiropractic Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. My goal is to get enough pre-orders to pay for all of the initial order before the end of March. If you guys will go to chiropracticforward.com…..Just click the STORE link at the top right of the home page and you’ll be off and running. 

https://www.chiropracticforward.com/shop/

We can order any of the posters whenever but, I want to get pre-orders in place for the brochures since they have to be ordered in bulk. With pre-orders helping me do that, I can get them ordered at the end of March, get them to me in about a week and then get them to you in a week so, they’d be in your hands roughly mid-April. So, if you’re team Chiropractic Forward, go check them out and order up. I’ll make it happen for us all. 

I’m getting them for my office as well ya see. I can’t wait to get them. And, I have a ton more I’m working on. But, I’ll be using funds from the first batch, to fund the next batch of these brochures. Rome wasn’t built in a day, folks, cut me some damn slack. Help me out with the first batch and we’ll be up and running. Who knows what we can get done around here together?

DACO

DACO talk, hell yeah. I’m back to rocking and rolling thanks to the guys down under in Australia. They are very intuitive and really do go out of their way to make sure you’re enjoying the courses and getting what you can out of them. 

Recent courses for me have been Acute Torticollis in the Adult and Osteoporotic Compression fractures – Recognizing the Clues. 

I dreaded stepping into the whole idea of 300 hours added to an already full load of work, family, and hobbies. Honestly, I’ve said before, I see 60-70 new patients a month, wife and two kids, I build live edge furniture, I’m a musician many weekends, and a sculptor who’s trying to teach himself to paint and…well…I like to get ornery and have a beer here and there on the weekends too. (you need to grow up)

I don’t say that to brag and say Oh look at me look at me. I’m trying to make the point that, if I can do it, you can do it.

Here’s the deal, I was always learning and adding and reading research papers and all of that stuff anyway. I thought I’d take one live class and get some continuing education hours. Hell, I figured I’d sit in the class for a couple of hours and then go have lunch with my wife. 

Yeah, that didn’t happen. In fact, I’m blaming it all on Dr. Tim Bertlesmen for getting me into it. He and Dr. Brandon Steele are the partners in ChiroUp and he was teaching a class here for the Texas Chiropractic Association’s state convention last summer. I saw him in the expo hall and he told me to come check the class out.

I said I’ll check it out for a bit. He said, “You’ll like it. You’ll stay for the whole thing.” Dammit if he wasn’t right. Lol. Just amazing information that could be used immediately and I literally feel that way about every class I’ve had since then.

So, you see, it hasn’t been stressful. It hasn’t really been any work. It’s just been enjoyable learning that I would have been doing anyway. I might as well get something out of what I was already doing anyway, right?

When the hell do I have time to add 300 hours to my plate? Well, I take off about 2:30 on Tuesday afternoon to do a class. I usually take one on Saturday morning when I’m up before the rest of the family. Sometimes I’ll take another on Sunday. That puts me at about 9 hours a week.

Easy peesy. 

If I can get you started, email me at dr. williams @chiropractic forward.com

Personal Happenings

In personal happenings, it’s been a little crazy around here as you all might can gather if you follow along. If you remember we had a front desk issue back in August and just couldn’t get the position filled. Well, my amazing wife stepped in, got trained on insurance, billing, and all of that lovely mess of crap. She is literally the smartest person I’ve ever met in my life. Some may question her decision to marry me and her intelligence in making that decision but, I think she’s freaking Einstein basically. 

Anyway, that has turned into us getting to work at 8 am and now, because she’s a perfectionist and still maintains her work responsibilities from her other job….which she does from home….we’re literally here until about 8 pm every night and I’m just about done with that people. Being busy is a good problem to have but there is a point where it’s just too much. 

I think a nurse practitioner can take some of the load off and I think maybe bringing in a new young hungry associate would be really nice. But, while I can talk about evidence and research, I’m afraid I’m not particularly skilled at hiring associates or setting up a medical entity but, that’s the direction I’m moving in because this workload is not sustainable for me to have a happy life. It’s just not. Example: on Wednesday of last week, in one day, as a solo practitioner, we had 12 new patients. Now, 6 were just intakes from one car wreck and it went efficiently but, you get the point. 

While it is do-able, for me, it’s not necessarily desirable to have the stress of being piled up on. I’m more like 3 or 4 new patients per day spread evenly throughout the week with some periodic re-exams and a bunch of happy patients just getting better and better every time I see them. THAT’S my idea of a happy workday. That’s not what we have right now. Lol. Good problem to have, admittedly but, still stressful. 

We’re hiring right now to help take some load off of the wife and, before long, I’ll be turning my attention to integrating. You know I’ll be sharing my experience as we go through it all. 

Item #1: Government-regulated Rehab

This first item we’re going to talk about is titled “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial(Cote P 2019)” written by Pierre Cote, Eleanor Boyle, Heather Shearer, and a plethora of others. It was published in the British Medical Journal Open in 2019 and is cited in our show notes for episode 63. 

Why They Did It

They wanted to evaluate the effectiveness of a government-regulated guidelines line when comparing it to education and activation by general practitioners and to a preferred-provider insurance-based rehab program on self-reported global recovery from acute whiplash-associated disorders Grades 1-2. 

As mentioned in the title of the paper, it was a pragmatic randomized controlled trial. 

What They Found

Here’s what they decided, “Time-to-recovery did not significantly differ across intervention groups. We found no differences between groups with regard to neck-specific outcomes, depression and health-related quality of life.”

Item #2: Rotator Cuffs & Need For Repair

This one is called “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears(Boorman RS 2018).” Twas written by RS Boorman, KD More, RM Hollinshead, and a gaggle of others. Published in Journal of Shoulder and Elbow Surgery in March of 2018. 

Why They Did It

They wanted to look at the 5-year outcomes in patients enrolled in a nonoperative rotator cuff tear treatment program. What happened with them?

How They Did It

They took patients with chronic, defined as greater than three months, full-thickness rotator cuff tears on MRI that were enrolled in the nonoperative study from 2008-2010. 

They started a nonoperative, home-based treatment program and they were followed up with after different time intervals. 

What They Found

Check this out, at 5 or more years follow-up, approximately 75% of patients remained successfully treated with nonoperative treatment and had a quality of life score of 83 out of 100. 

Between years 2 and 5, only 3 patients thought to have a successful outcome regressed and had surgery

The operative and the nonoperative groups at the 5-year follow-up were not significantly different. 

Wrap It Up

The authors concluded, “Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. While some clinicians may argue that nonoperative treatment delays inevitable surgical repair, our study shows that patients can do very well over time.”

Pow. Snap. Bam. Smash. Kapow!

I don’t know why I take such joy in seeing that surgeons have less reason to do surgery but it give me a tickle in my belly and a warm fuzzy feeling. Who wants a hug, people? I’m feeling the spirit here. 

Item #3: Carpal Tunnel Syndrome

Our last item here is called “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial(Wolny T 2018)” and is written by T Wolney, et. al., published in Journal of Manipulative and Physiological Therapeutics in October of 2018. 

Why They Did It

They wanted to check the influence of manual therapy, including neurodynamic techniques, when compared to no treatment on overall health status in those with mild to moderate carpal tunnel syndrome. 

Again, as the title says, it was a randomized controlled trial with 189 subjects. 

They underwent treatment twice weekly. 

What exactly is meant by the term ‘Neurodynamic Technique’? Well, have you ever heard of nerve flossing? That is a type of neurodynamic technique. Gliding or sliding the median nerve in the case of carpal tunnel. Tensioning, relaxing basically. Pull out your Google machine. You’ll find some great YouTube examples of Neurodynamic Techniques to help you with your carpal tunnel patients. 

Now, what did they find?

The authors were able to conclude the following, “Manual therapy, including neurodynamic techniques, had a positive effect on overall health status in this group of individuals with carpal tunnel syndrome.”

Key Takeaways

  • The government doesn’t do a particularly better job than you can do on your own if you’re educated and stay evidence-informed
  • Even full-thickness tears of the rotator cuff do not mean surgical intervention in most patients
  • Carpal Tunnel Surgery doesn’t require surgical intervention in most mild-moderate patients if you learn some take-home exercises and implement neurodynamic techniques
  • Surgeons are going to need to start down-sizing those houses and maybe forego buying that private plane as they will be less and less busy in the years to come. 

Again, before you disappear this week, consider going to chiropracticforward.com and clicking on Store and pre-ordering our spanking brand new evidence-informed brochures. We are looking to gather up pre-orders and ordering all of them in bulk around March 29th. We would appreciate your help in making this happen. Team Chiropractic Forward!

https://www.chiropracticforward.com/shop/

 

Chiropractic evidence-based productsIntegrating Chiropractors

The Evidence-based Chiropractic Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

Website

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

 

Bibliography

  • Boorman RS, M. K., Lollinshead RM, (2018). “What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears.” J Shoulder Elbow Surg 27(3): 444-448.
  • Cote P, S. B., Shearer HM, (2019). “Is a government-regulated rehabilitation guideline more effective than general practitioner education or preferred-provider rehabilitation in promoting recovery from acute whiplash-associated disorders? A pragmatic randomised controlled trial.” BMJ Open 9(e021283).
  • Wolny T (2018). “The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial.” J Manipulative Physiol Ther 41(8): 641-649.

CF 033: Did You Need Proof That Chiropractors Help Headaches?

CF 041: w/ Dr. William Lawson – Research For Neck Pain

 

 

 

CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

CF 062: Chiropractic Prevalence, JAMA’s Awful Info on Opioids, & New Info on Screen Time

Today we’re going to talk about chiropractic prevalence, a new article in JAMA with some pretty terrible projections for opioid use and deaths, and new information on kiddos and the time they spend on screens. 

But first, here’s that bumper music

Chiropractic evidence-based productsIntegrating Chiropractors

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

You have collapsed into Episode #62

Introduction

We’re here to advocate for chiropractic and to give you some awesome information to make your life easier from day-to-day. We’re going to keep you from wasting time through your week by giving you confidence in your recommendations and in your treatments. This is something I feel confident in guaranteeing you if you listen and stick to it here at the Chiropractic Forward Podcast.  

Evidence-Based Chiropractic Store

Part of saving you time and effort is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. 

DACO

Let’s talk a bit about the DACO program. Man, this is how it goes with the DACO: just yesterday morning, I had a patient come in, mid-’60s and literally everything hurt. Restless leg syndrome was her main complaint but her GP just yesterday already started her on Vitamin D and iron supplements so she’s going in the right direction there. I have heard of acupuncture being good for it as well but have not seen any research on that so can’t make that claim. 

Anyhooo…literally everything hurt, couldn’t sit down and basically, a general overall look of being unwell for a lack of a better word. She just didn’t look healthy. I started asking her about bone scans and she’d never had one. Well, this guy just gets feelings and when I get a feeling, they get sent out. I sent her out for a bone scan. 

No kidding, that afternoon I sit down for a class. The next one up? Yep, diagnosing osteoporosis. Lol. Wouldn’t you know it? Anyway, had I had this class before the encounter with the new patient, I might not have sent her. I’m not sure.

But, it’s just funny how in tune with clinical practice the classes really are. Also, as a consequence of the class, I have a quick sheet made up that changes the way I deal with potential osteoporosis patients from here on out. Forever and ever amen. 

Personal Happenings

So far, not a lot of blowback on my recent episode covering my thoughts on faith-based practices. Sometimes I’m mouthy, right? I get it. Who the hell cares what I have to say? I don’t know who cares honestly. Lol. But, we’re growing and growing so at least some of you identify with my way of thinking.

I’m religious and I think that’s what makes me feel that I can be credible in critiquing certain things in regard to religion. I just have a hard time with management companies coaching their impressionable doctors how to use the bible to manipulate scared patients looking for answers. When I think about it, it makes my pee hot. 

Anyway, it turns out that you guys agree with me and that makes me like you even more. Before you know it, we’re all going to be besties and share milkshakes with two straws and all of that mumbo jumbo. 

I’m glad you’re here with me today as we dive into the information I have for you this week. Here we go. 

Item #1

I want to start with one that had some conclusions I found surprising and somewhat encouraging……sort of. This new paper from The Journal of Alternative and Complementary Medicine published January 18, 2019, and authored by Stephanie Taylor, Patricia Herman, Nell Marshall, and colleagues called “Use of Complementary and Integrated Health: A Retrospective Analysis of US Veterans with Chronic Musculoskeletal Pain Nationally[1].”

Due to time constraints on me, I didn’t go beyond the abstract here so….freaking sue me. I’ll have it cited in the show notes at chiropracticforward.com so you can go get it and dive in you over-over-achiever you with all that time sitting around. Must be nice pal. 

Why They Did It

The authors say that little is known regarding the use of complementary and integrative health therapies for chronic pain in the VA system which is the nation’s largest integrated healthcare system. We will get into chiropractic prevalence briefly.

In my experience, I can echo this paper’s sentiment that the VA is at the forefront of the movement away from opioids and toward alternative healthcare. 

They researched this paper over 2 years for the use of 9 types of alternative therapies that included meditation, yoga, acupuncture, chiropractic, guided imagery, biofeedback, tai chi, massage, and hypnosis. 

What they found

27% of younger veterans with chronic musculoskeletal pain use alternative healthcare

The most used for was meditation at 15%. I found that surprising. Meditation means slowing down, sitting still, relaxing, and all that good stuff. In this day and age, I just have a hard time seeing that as the most prevalent form of alternative healthcare. 

We all think we’re so busy and, for us chiropractors, a lot of us really ARE too busy to stop and meditate. I may just be taking my own personal experience here and assuming everyone else on the planet is like me and, of course, that’s not true. Still, meditation was the most prevalent in this study. 

Yoga was next at 7%. Again, I guess I haven’t realized how popular yoga is getting these days but, I know the VA is pushing it so that may be playing a part in it. 

Coming in in 3rd place we have acupuncture. Once again, it’s surprising to me but, the VA is directing the recommendations and, in the real world, outside of the VA, acupuncture does not out-pace chiropractic. I do believe the VA is seeing it’s use for PTSD and chronic pain though and is responding appropriately. 

Finally, here comes Chiropractic care coasting in in 4th place for chiropractic prevalence.

Ugh. We know outside the enclosed ecosystem of the VA, chiropractic care is not less prevalent than yoga, meditation, and acupuncture. But, being within the VA, we know that medical doctors, PA’s, and nurse practitioners are making these recommendations and referrals so we still clearly have a lot of work to do. We are still a world away from where we need to be in regard to chiropractic prevalence,

You know what else that means though right? There are incredible potential and opportunity. If the VA is an example of the rest of the allopathic world, we could say that even fewer than 5% of chronics get referred to us from the GPs and orthopedic surgeons. I think that’s fair because most of them are unaware of Dr. Christine Goertz’s work that was published in JAMA not long ago.

If you’re unfamiliar with that, go listen to Episode 25 of this podcast. In short, she showed how veterans with chiropractic care mixed in with their traditional care had better outcomes. That’s when we started seeing the referrals from the VA

Also, you’ll notice that all of the nine therapies tracked here were on the list of first-line therapies that came from the updated recommendations by the American College of Physicians in February of 2016[2]. 

I guess my point on the paper here is that the medical world, or at least the VA part of it, is paying attention to research regardless of whether it goes against their previously held biases. They are absolutely trying to reverse the opioid epidemic. And we have a lot of work to do to gain that trust and get those referrals. When they’re recommending meditation before chiropractic care for chronic pain, then there is a ton of room for us to shine. So go shine it up all you shiny happy people out there. 

Item #2

On to item numero dos, number 2 for our non-Spanish speaking population out there. This one is discouraging and…..well….awful if I’m being honest.

This one is from JAMA called “Prevention of Prescription Opioids Misuse and Projected Overdose Deaths in the United States” published on February 1, 2019, and authored by Quiushi Chen, Marc Larochelle, David Weaver, and colleagues[3].

Why They Did It

In JAMA, they always start with the question being answered here. The authors wanted to answer this one: “what is the projected effect of lowering incident non-medical prescription opioid use on the future trajectory of the opioid overdose crisis in the USA?

I’m just going to cut to the chase on it and leave a bunch of details out. Here’s why. I don’t want us getting bogged down in the details and methods and all that stuff.

I want you to be able to retain just a few numbers and not be distracted by the rest of the minutiae. You like that word? I know you do. Minutiae, You say that to the right fellow nerd and you may just get you a date, people.

It’s a powerful word so take it, use it, enjoy it. I swear I’m undiagnosed ADHD. I swear it. 

Anyway, here’s the deal, although we as a nation, as a world, now see the issues with opioids and are now trying to address the issue, It’s not getting better and it won’t get any better according to this paper. 

Check it out, according to this paper, the annual number of opioid overdose deaths is projected to increase from 33,100 in 2015…..then we know that 72,000 died in 2017….all the way up to 81,700 deaths projected 2025. 

They are projecting from 2016-2025 to lose a total of approximately 700,400 people to opioid deaths. They say about 80% of that will be due to illicit opioids. I don’t know how the hell they can tell that but that may be a little bit of, “yeah it’s happening but it’s not our fault,” BS going on there but who knows? In this paper, they’re assuming that the illegal use of opioids will increase from 61% in 2015 to 80% by 2025. I don’t know. Sounds like fuzzy math to me but I’m not a researcher. 

I think their numbers are fuzzy because we know 2015 saw about 36,000 die, but then 2016 saw around 63,000 die if I remember correctly. Then, 2017 saw 72,000 die. Are you seeing the graph there in your mind? It’s not only up and to the right on this deal, but its up and to the right like it’s climbing Mt. Everest. The numbers have harnesses fastened tightly and ropes and expert climbing guides and they’re going straight up the face like pros! 

These guys are guessing that by 2025, in 9 years, the deaths will only have increased a total of 9,000 per year, so….they’ll only increase an average of 1,000 deaths per year. Do you see why I think they’re crazy? The deaths increased by 9,000 just last year. Do you see what I’m saying? I’m not saying they’re wrong but….they’re wrong. Lol. 

They then say that across all interventions tested, further lowering the incidence of prescription opioid misuse from 2015 levels is projected to decrease overdose deaths by only 3%-5.3%. 

Their quoted conclusion is, “This study’s findings suggest that interventions targeting prescription opioid misuse such as prescription monitoring programs may have a modest effect, at best, on the number of opioid overdose deaths in the near future. Additional policy interventions are urgently needed to change the course of the epidemic.”

So what do we take from this exactly? Here’s my deal. On the surface at least it smells like a steaming pot of shoo shoo caca doody, 

Instead of recognizing the fact that unnecessary surgeries were many times the reason people got addicted in the first place, and that there are amazing opportunities outside the allopathic world to prevent those unnecessary and financially motivated surgeries, they say, “Hey look, a lot of this is done illegally and that’s just going to get worse and our part of this is really very small.

In fact, we can lower the prescriptions of opioids but it’s really not going to do a lot of good and, in fact, we think we should still be able to prescribe them as much as we are right now….blah blah blah poop coming out of the mouth and falling onto the floor with a splat. 

They are making guesses 9 years in the future what addict behaviors will be. I think that’s presumptuous and ultimately impossible. I just thought it was entertaining and that you all might enjoy this group trying to minimize responsibility or what role they can really play on decreasing opioid use.

I could totally be mischaracterizing this and they may have the best intentions in mind. While I trust my GP and I trust the friends of mine that are surgeons personally….I just don’t trust stuff like this. 

Obviously, I don’t agree with them but I’m a bumpkin chiro on the Texas Plains. I wouldn’t listen to me if I were them either. Lol. 

Item #3

OK, last item for this week and it’s something I’m admittedly fascinated with and I think that’s because I have a high schooler and a 5th grader and this stuff hits home any time I see it or read about it. 

This one was in JAMA too and called, “Association Between Screen Time and Children’s Performance on a Developmental Screening Test” written by Sheri Madigan, Dillon Browne, Nicole Racine and colleagues[4] published January 28, 2019. 

Why They Did It

The main question they were trying to answer was this, “Is increased screen time associated with poor performance on children’s developmental screening tests?” Basically, does screen time have a direct effect on child development?

They had 2,441 kiddos in it. A random-intercepts, cross-lagged panel model revealed that higher levels of screen time at 24 and 36 months were significantly associated with poorer performance on developmental screening tests at 36 months and 60 months. 

What They Found

Their conclusion was, “The results of this study support the directional association between screen time and child development. Recommendations include encouraging family media plans, as well as managing screen time, to offset the potential consequences of excess use.”

Yes, it’s easy to just hand them a device and hope they’re quiet long enough to get a nap in. Guilty as charged. Guilty as charged. 

But, turns out as we may have guessed if we really thought about it 8-9 years ago when all of this really started….this isn’t in their best interest in the long run. 

Chiropractic evidence-based productsIntegrating Chiropractors

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

Connect

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

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Stitcher:

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TuneIn

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

About the Author & Host

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

 

Bibliography

1. Taylor S, H.P., Marshal N,, Use of Complementary and Integrated Health: A Retrospective Analysis of U.S. Veterans with Chronic Musculoskeletal Pain Nationally. J Altern Complement Med, 2019. 25(1).

2. Qaseem A, Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med, 2017. 4(166): p. 514-530.

3. Chen Q, L.M., Weaver D,, Prevention of Prescription Opioid Misuse and Projected Overdose Deaths in the United States. JAMA Network Open, 2019. 2(2): p. e187621-e187621.

4. Madigan S, Association Between Screen Time and Children’s Performance on a Developmental Screening TestAssociation Between Screen Time and Child DevelopmentAssociation Between Screen Time and Child Development. JAMA Pediatrics, 2019.

CF 025: Vets With Low Back Pain. Usual Care + Chiropractic vs. Usual Care Alone

CF 027: WANTED – Safe, Nonpharmacological Means Of Treating Spinal Pain

CF 052: Chiropractic Forward Podcast Year One Review