forward thinking chiropractic

How Car Wrecks Contribute To Future Neck and Back Pain

CF 196: How Car Wrecks Contribute To Future Neck and Back Pain

Today we’re going to talk about How Car Wrecks Contribute To Future Neck and Back Pain. I have two different papers with what I thought were surprising conclusions in one way or another. Not only did I find themm a bit surprising but I don’t think the defense attorneys in PI cases will like either paper much. Just an assumption on my part. All of that coming up in this episode. But first, here’s that sweet sweet bumper music      

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #196 Now if you missed last week’s episode , we talked about Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

We just ended our fourth week as an integrated practice and starting our fifth. It’s a struggle. I’m not going to lie. You see the money going out but you don’t see it coming in. That’s why, to pull this off, you need to be a busy Chiro and you need to have reserves in place.

Otherwise, it could be doomed. Unless you’re a hype machine. A marketing mastermind that fills the schedule before the integration even takes place. Let’s be honest, most of us just aren’t. I know the value of marketing. I know how to market on a fundamental level. But it’s hard. It’s hard to get your message out there and it’s hard to break through.

So, week one, maybe 4-5 appointments. Week two, maybe 18 appointments. Week 2 was about the same. Then last week was maybe only 8-9. So it’s up and down. We aren’t covering the salary but, we have reserves set back AND I’m fortunate enough to be busy.  The trick is just getting the message out and I feel like we’re doing that both externally as well as internally.

We have in-office brochures, flyers, and posters. Email marketing, social media, and all that good hoopla. It’s happening. We’re making it happen. 

In other news, I recovered from my five days in Washington DC. Geez. What a go-cation. It’s not the cost of taking a trip. It’s the cost of being gone. How much money you lose by not being in the office. That’s the real number and it just kills me!! So, I don’t think about it because I truly believe we need to be taking a trip once per quarter. You have to so you don’t lose your damn mind. It’s just a must.

Speaking of, I have a trip in just about three weeks to Chicago for business to finish off my Fellowship in Forensics. I’m looking forward to that and to networking with everyone involved with that whole side of the profession. Multiple streams of income folks. I do it inside the office as well as outside. Speaking, mentoring, authoring, medico-legal, Ortho fellowship, personal injury, family, triwest, acupuncture, massage, laser, esthetician, Texas Chiropractic Association, Texas Council of Chiropractic Orthopedists, Nurse Prac, and everything that falls under that.

That’s inside.

Outside is music, voice-over, art, real estate investing, and all kinds of other things I’m looking at.  What would it be like to just do a couple Of things?  Who knows? That’s just not me.  I make myself crazy but I honestly don’t know any other way. 

If you were thinking you could get into business for yourself and sit on the computer half the day fiddle assing on the computer, I got news. Your competition is out there getting Diplomates, certifications, and expertise to run circles around you.

Get busy.

Or wonder where all of those new patients are going since they don’t seem to be coming to see you.

Item #1

Alright, let’s hop in with our first one today called “Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis” by Nolet et. al. (Nolet PS 2019) and published in PM&R in November of 2019. In case you didn’t know, PM&R stands for physical medicine and rehabilitation. 

Why They Did It

They say in the abstract that neck injury resulting from a crash is associated with a high rate of chronicity. Prognosis studies indicate 50% of injured people continue to experience NP a year after the collision. This is difficult to interpret due to the high prevalence of NP in the general population. In other words, those that have not been in a car wreck still have neck pain, right? The stated goal of the authors here was to summarize the literature that has examined the association between a motor vehicle collision (MVC) related neck injury and future neck pain (NP) when compared to the population that has not been exposed to neck injury from a crash.

How They Did It

  • They performed a systematic review of the literature using five electronic databases, searching for risk studies on exposure to a car crash and future neck pain published from 1998 to 2018. 
  • The outcome of interest was future neck pain. 
  • Eligible risk studies were critically appraised using the modified Quality in Prognosis Studies (QUIPS) instrument. 
  • Eight articles were identified of which seven were of lower risk of bias. Six studies reported a positive association between a neck injury in an MVC and future NP compared to those without a neck injury in an MVC

What They Found

  • Pooled analysis of the six studies indicated an unadjusted relative risk of future neck pain in the car crash-exposed population with neck injury of 2.3, which equates to a 57% attributable risk to those having been in a car wreck. 
  • In two studies where exposed participants were either not injured or injury status was unknown, there was no increased risk of future neck pain

Wrap It Up

They wrap it up by saying, “There was a consistent positive association among studies that have examined the association between MVC-related neck injury and future neck pain. These findings are of potential interest to clinicians, insurers, patients, governmental agencies, and the courts.” I see personal injury patients. This is good info for their reports, their file, and their attorneys if they’re represented. 

 

Item #2 This one is called, “Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis” by Nolet, et. al.  (Paul S. Nolet 2020)and this one was published in Accident Analysis and Prevention in 2020.  It’s not that hot but I’m using it anyway just because I like it and cuz I say so….

Why They Did It The purpose of this study is to summarize the evidence for the association between exposure to a motor vehicle collision (MVC) and future low back pain (LBP).

How They Did It

  • A systematic search of five electronic databases from 1998 to 2019 was performed. 
  • Eligible studies describing exposure to a MVC and risk of future non-specific LBP were critically appraised using the Quality in Prognosis Studies (QUIPS) instrument. 
  • The search strategy yielded 1136 articles, three of which were found to be at low to medium risk of bias after critical appraisal. 

What They Found

  • All three studies reported a positive association between an acute injury in a MVC and future LBP. 
  • Pooled analysis of the results resulted in an unadjusted relative risk of future LBP in the MVC-exposed and injured population versus the non-exposed population of 2.7, which equates to a 63 % attributable risk under the exposed.

Wrap It Up

There was a consistent positive association in the critically reviewed literature that investigated the risk of future LBP following an acute MVC-related injury. For the patient with chronic low back pain who was initially injured in a MVC, more often than not (63 % of the time) the condition was caused by the MVC.  Thats a lot right, folks? Look, it’s obvious to say an injury was caused by a car wreck. It’s common as a chiropractor to hear patients tell you that their neck pain started with a car wreck they had 20 years before. We hear it all of the time.  But for reals, 57% for the neck and 63% of the back?

That’s solid and flies directly in the face of the other side of the courtroom when they try to tell jurors that the forces experienced in a low-speed impact are about the same as stepping off of a curb on the street. This is, by the way, one of the most ridiculous things I’ve ever heard in my entire life but an argument that they most certainly use periodically.  Fools!!!! The fools we must suffer in life!! I’m sure plenty of folks refer to me in the same manner. It is what it is. Let’s all just try to be the least of the fools…., if that makes any sense at all. 

Alright, that’s it.

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message

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

Key Point:

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

Contact

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

Connect

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

Website

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

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

Bibliography

Nolet PS, E. P., Kristman VL, Murnaghan K, Zeegers MP, Freeman MD (2019). “Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis.” PM R. 11(11): 1228-1239.  

Paul S. Nolet, P. C. E., Vicki L. Kristman, Kent Murnaghan, Maurice P. Zeegers, Michael D. Freeman (2020). “Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis.” Accid Anal and Prev 142.          

Factors Leading To Surgery For Some Discs & Disc Innervation

CF 183: Factors Leading To Surgery For Some Discs & Disc Innervation

Today we’re going to talk about the innervation of the disc and we’re going to talk about some factors that can lead to surgery for lumbar disc herniations.  But first, here’s that sweet sweet bumper music

 

 

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #183 Now if you missed last week’s episode , we talked about Adjustments as immune boosters and we talked about pain. Is it mind or is it matter? Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

It’s been a bit of a whirlwind these last few weeks.  I’ve talked a little more recently about launching my very first book. It’s out. It’s available on Amazon. It’s called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. And I’d love for you to go pick up a copy for yourself. You can get either ebook or a paperback sent to your front door. Your call.  Here’s why I think you need it. All of the research we talk about here and lots before I started the podcast, has been categorized for you into conditions and body regions. So, if you need some research on neck pain, flip to the section and there you go. Migraines? SI joint issues? Go to those sections and there you go.  This comes in handy when you have a talk to give and don’t have the time to go searching through pubmed all day.

Or when a patient asks you a question on something specific. Or a host of any other reasons. It’s a reference for your practice for your education, patient education, and community education.  So go grab that up while you’re thinking about it. 

As mentioned in a previous episode, we visited New Orleans, Then we were home for one weekend. Then the next weekend we were off to Dallas for the Texas Chiropractic Association’s ChiroTexpo event which is our state’s convention basically.  Two board of directors meetings for me plus some networking, classes, and problem-solving. Essentially. 

I have seen him speak before. I went to Forward 19 in St Louis before the Rona came along and saw Brett Winchester talk. We had him in Dallas at this event and he did not disappoint. I was able to better connect with Brett here in Texas. We will absolutely have him on a future podcast and in the meantime, if you want to learn more about Dr. Winchester, check out his podcast at Gestaldt Podcast.  The dude is sharper than a tack, has worked with the St. Louis Cardinals, and is one of those on the top and on the edge so check him out if you’re smart. 

Then, even though Dr. Kevin Christie was already a friend, we really got to hang out and shoot the proverbial shoo shoo in Dallas, along with Dr. Winchester. And it was just a good time had by all. 

I used to be lone wolf, folks. I used to not care about the profession. I just cared about my office, my numbers, my business. Me, me, me. I got a bit shamed into joining the TCA. Then, they had a vacancy on the Board of Directors due to the director in my district having cancer. Well, how can you say no? I was thrown into the fire with no context, no history, no experience, and little idea of what to say or how to act. But I was thrown in with a group of about 20 people that lead the profession and develop leaders from scratch. That’s what they did for me. We got there. We made it happen. 

Fast forward about a decade or so and I was on the Board of Directors for about 5 years, been the Chiropractic Development Initiative Chair, served as the Public Relations Chair, and am now going into the second year as the Department Coordinator for Scientific Affairs. I help steer the speakers we have at our events among other things. 

Associations need your membership dollars and you need to be members. But that’s just a mostly passive notion. The REAL benefit is realized when one becomes active and plugged into the association. Meaning, through being active and involved at just about every step, I have developed a network of close friends and colleagues from around the entire state of Texas that, even though some practice differently than I, would still go to bat for me, support me, and back me. And I them. 

We have developed brothers and sisters, camaraderie, and family with each other. I cannot begin to share with you how many times I’ve had questions or issues that I was able to just call up one of my TCA buddies and get a solid answer for it.  This medical integration I’m going through right now. Do you think I just up and decided to do it and jumped into the fire? Hell no.

I called all of my TCA buddies who have done it previously.  One is now my consultant on it. The attorney that wrote the law that allows for this integration is TCA’s lobby team. He’s the one that has created the paperwork and contracts for me.  Literally, none of what I am today is possible to the degree it’s been possible if not for being active, plugged in, and a solid member of the TCA leadership. 

I don’t say this to brag that I’m active or brag about my positions in the TCA or to boast in any way. I say this to let you know that there is a difference between being a member and being an active member. Between building something larger than yourself and your own practice and doing your own small thing. Between being an influential leader and being a bench warmer.  Get into the game. Raise your hand. You can thank me later.

Our profession needs evidence-based, patient-centered leaders like you. Don’t bitch about our profession if you’re not willing to step in and do something to change it. 

Item #1

This one is called “Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System” by Anderson et. al. [1] and published in Spine Journal on March 15, 2021 which means it’s got the hot spread all over it. 

Why They Did It

To determine surgery-free survival of patients receiving conservative management of lumbar disc herniation (LDH) in the military healthcare system (MHS) and risk factors for surgical intervention

How They Did It

  • The Military Data Repository was queried for all patients diagnosed with lumbar disc herniation from 2011-2018
  • Follow-up time to surgical intervention was defined as the time from diagnosis to first encounter for lumbar microdiscectomy or lumbar decompression in either a military treatment facility or in the civilian sector. 
  • The Military Data Repository was also queried for history of tobacco use at any time during military healthcare system care, age at the time of diagnosis, sex, military healthcare system beneficiary category, and diagnosing facility characteristics. 
  • Multivariable Cox proportional hazards models were used to evaluate the associations of patient and diagnosing facility characteristics with time to surgical intervention.
  • A total of 84,985 military healthcare system beneficiaries including 62,771 active duty service members were diagnosed with lumbar disc herniation in a military treatment facility during the 8-year study period. 
  • A total of 10,532 (12.4%) military healthcare system beneficiaries failed conservative management onto surgical intervention with lumbar microdiscectomy or lumbar decompression. 

What They Found

Among all healthcare beneficiaries, several patient-level (younger age, male sex, and history of tobacco use) and facility-level characteristics (hospital vs. clinic and surgical care vs. primary care clinic) were independently associated with a higher risk of surgical intervention.

Wrap It Up

Lumbar disc herniation compromises military readiness and negatively impacts healthcare costs. military healthcare system beneficiaries with lumbar disc herniation have a good prognosis with approximately 88% of patients successfully completing conservative management. However, strategies to improve outcomes of conservative management in lumbar disc herniation should address risks associated with both patient and facility characteristics.

CHIROUP ADVERTISEMENT

Item #2 Our last one today is called “Innervation of the Human Intervertebral Disc: A Scoping Review” by Groh et. al. [2] and published in Pain Medicine in June of 2021 and that’s current hot. As in present-day, burning up the face of the Earth as we speak, hot. 

Why They Did It

Changes to the intervertebral disc (IVD) have been associated with back pain, leading many to postulate that the IVD may be a direct source of pain, typically referred to as discogenic back pain. Yet despite decades of research into the neuroanatomy of the IVD, there is a lack of consensus in the literature as to the distribution and function of neural elements within the tissue. The current scoping review provides a comprehensive systematic overview of studies that document the topography, morphology, and immunoreactivity of neural elements within the IVD in humans.

How They Did It

Articles were retrieved from six separate databases in a three-step systematic search and were independently evaluated by two reviewers.

What They Found

Three categories of neural elements were described within the IVD: perivascular nerves, sensory nerves independent of blood vessels, and mechanoreceptors. Nerves were consistently localized within the outer layers of the annulus fibrosus. Neural ingrowth into the inner annulus fibrosus and nucleus pulposus was found to occur only in degenerative and disease states.

Wrap It Up

While the pattern of innervation within the IVD is clear, the specific topographic arrangement and function of neural elements in the context of back pain remain unclear. I mostly included this because, in our Neuromusculoskeletal Diplomate program, they were clear about the innervation encroaching into a disc injury and how that makes re-injury somewhat easier and sometimes more painful. Because the nerves are further into the structure of the disc once the injury has occurred and then subsequently resolved.  Very interesting stuff.  That’s all I have the time for today folks. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

 

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

1. Anderson AB, B.M., Pisano AJ, Watson NI, Dickens JF, Helgeson MD, Brooks DI, Wagner SC,, Factors Associated With Progression to Surgical Intervention for Lumbar Disc Herniation in the Military Health System. Spine (Phila Pa 1976), 2021. 46(6): p. E392-E397.

2. Adam M R Groh, M., Dale E Fournier, MSc, Michele C Battié, PhD, Cheryle A Séguin, PhD,, Innervation of the Human Intervertebral Disc: A Scoping Review. Pain Med, 2021. 22(6): p. 1281-1304.

What Sitting On Your Butt Will Get You & Catastrophizing An MRI Result

CF 180: What Sitting On Your Butt Will Get You & Catastrophizing An MRI Result Today we’re going to talk about sitting on your butt and we’ll talk about catastrophizing from an image.  But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #180 Now if you missed last week’s episode, we talked about the alarming rising death rate among the working-age population and we discussed the role nutrition can play in chronic pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

It’s going to be a short one this week. I have to fit a full week if work responsibilities into three days because I’m taking off Thursday through Tuesday. My wife and kids and I are heading out to New Orleans to get fat and drink funny drinks.  I love Louisiana. I was in the football team at West Texas State for one semester before transferring to Northwestern Louisiana in Natchitoches. Same town Steel Magnolias was filmed in. Absolutely gorgeous. Going from the Texas Panhandle to Louisiana was a culture shock y’all. Whole different wonderful world. I tell people that you simply cannot spend any amount of real-time in Louisiana without absolutely falling in love with the people, the music, the culture, the food…..the VIBE. It’s special. We like to travel. I’ve told you here several times that you need a trip at least once per quarter. Something to look forward to. Something to work toward.  Once we see a place, it’s time to move on and see something else. There are too many places to see in the world to be going back to the same ol’ places all of the time.

Except for New Orleans. We go back just as often as we get the opportunity to.

It’s somewhat close and we love it So, we’re going this week. And I have to keep it short. The medical integration is going slowly. Business is steady but not Pre- Covid numbers. I’m frustrated with that if Imm. Ring honest and I’m always honest with you all. It’s really kind of pissing me off. But I’m a Christian. It’s not always in my hands. Good luck looks a whole lot like hard hard work. So do what’s right. Treat people right. Love folks. It’ll work out. Just be prepared and try to be a learn it all instead of a know it all. Here we go. But first, let’s hear from our amazing, practice-changing sponsors!

CHIROUP ADVERTISEMENT

Item #1

The first item up is called “The Association Between Leisure-time Physical Activity, Sedentary Behavior, and Low Back Pain: A Cross-sectional Analysis in Primary Care Settings” by Lemes, et. al. [1] and published in Spine Journal on May 1, 2021 Hot tamale, hot tamale….get ‘em while they’re good ’n’ hot!

Why They Did It To investigate the association between leisure-time physical activity (LTPA) and low back pain (LBP) in adults from primary care settings, and to explore how sedentary behavior influences this association.

How They Did It

  • Cross-sectional analysis of an ongoing longitudinal study with adults from Bauru, Brazil – that was 557 individuals.
  • Data on physical activity, sitting time, LBP, BMI, and chronic diseases were assessed by face-to-face interviews, physical evaluation, and medical records. 
  • Sociodemographic, behavioral, and health variables were used as covariables in the multivariable models.

What They Found

  • The fully adjusted model showed that active participants were 33% less likely to have LBP when compared with those insufficiently active
  • A significant association was found for active participants who spent less than 3 h/day sitting but not for those who spent 3 h/day or more in sedentary activities
  • An inverse association of LTPA with LBP was observed in obese participants, but not in those with normal BMI and overweight.

Wrap It Up

Leisure-time physical activity was inversely associated with the prevalence of LBP in adults from primary care. This association was influenced by sedentary behavior and BMI.

Item #2

Our last one this week is called, “The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials” by Rajasekaran, et. al. [2] and published in European Spine Journal in March of 2021.  Pork chops and hot sauce. 

Why They Did It Inappropriate use of MRI leads to increasing interventions and surgeries for low back pain (LBP). We probed the potential effects of a routine MRI report on the patient’s perception of his spine and functional outcome of treatment. An alternate ‘clinical reporting’ was developed and tested for benefits on LBP perception.

How They Did It In Phase-I, 44 LBP patients were randomized to Group A who had a factual explanation of their MRI report or Group B, who were reassured that the MRI findings showed normal changes. The outcome was compared at 6 weeks by VAS, PSEQ-2, and SF-12. In Phase-II, clinical reporting was developed, avoiding potential catastrophizing terminologies. In Phase-III, 20 MRIs were reported by both routine and clinical methods. The effects of the two methods were tested on four categories of health care professionals (HCP) who read them blinded on their assessment of the severity of disease, possible treatment required, and the probability of surgery.

What They Found

  • Both groups were comparable initial by demographics and pain. 
  • After 6 weeks of treatment, Group A had a more negative perception of their spinal condition, increased catastrophization, decreased pain improvement, and poorer functional status(p = significant for all). 
  • The alternate method of clinical reporting had significant benefits in the assessment of lesser severity of the disease, shift to lesser severity of intervention and surgery in three groups of HCPs.

Wrap It Up

Routine MRI reports produce a negative perception and poor functional outcomes in LBP. Focused clinical reporting had significant benefits, which calls for the need for ‘clinical reporting’ rather than ‘Image reporting’. Words matter, folks. Words matter. If you’re telling people that they have abnormal degeneration or an abnormally straightened cervical spine and telling them how concerned you are for their future if they don’t spend 70 visits and $5,000 this year to fix it……blah blah blah.  If you’re doing this, you either don’t understand stuff and you need to do a lot more sciencing……or…..or you’re predatory, unethical, and a sorry human being that needs to reconsider how you treat your fellow humans. 

Sorry, I realize that’s harsh. But it’s the truth. If you are taking images and using them to scare people into treatment to build your clinic and your numbers, you are in the wrong business. Go sell cars. This is healthcare and people’s very lives and the quality of their lives are involved.  Learn to communicate in a positive, optimistic manner. Learn to get people moving and functioning.

Learn to address the biopsychosocial aspect of pain. Learn to use it in the patient’s favor, not in your favor. Just learn if you don’t know these things. Raise the game. If you have the chance, and you do, why not just be a big deal then? Let’s all be big deal by being learn it alls. Being ethical, moral, honest, and loving. Oh, and by acting responsibly based on the model of evidence-based, patient-centered care.  We have companies out there teaching chiropractors how to ‘close’ patients. What clowns. That’s clown stuff folks. Don’t do it. Raise the game.  Way too many shenanigans have been going on in this profession for way too long.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

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

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

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

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

Bibliography

1. Lemes ÍR, P.R., Turi Lynch BC, Codogno JS, Oliveira CB, Ross LM, Araújo Fernandes R, Monteiro HL,, The Association Between Leisure-time Physical Activity, Sedentary Behavior, and Low Back Pain: A Cross-sectional Analysis in Primary Care Settings. Spine (Phila Pa 1976), 2021. 46(9): p. 596-602. 2.

2. Rajasekaran S, D.C.R.S., Pushpa BT, Ananda KB, Ajoy Prasad S, Rishi MK,, The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials. Eur Spine J, 2021.

Working Class Rising Death Rates & Nutrition Affects Chronic Pain

CF 179: Working Class Rising Death Rates & Nutrition Affects Chronic Pain Today we’re going to talk about the fact that there are rising death rates among folks that are of working-class age. Not just the elderly. Why is that happening? Then we’ll talk about diet and chronic pain.  But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #179 Now if you missed last week’s episode , we talked about  whether chiropractors cause disc herniations or not and we talked about how family doctors still aren’t getting the message. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. This medical integration thing is about to take off. Wee ahve the contracts all drawn up, questions answered, and ready to get them all signed.  New EIN, new credentialing for me and the NP, and full steam ahead. Did you know that I have to re-credential under the new entity as well? What a pain in the backside, right? Hell yeah it is. I’m OK referring patients back and forth within the same group. You start to run into risk of getting in trouble with the Stark, anti-kickback laws when you are referring patients back and forth across different entities.  So, yeah….there’s that. I won’t bore you with the particulars but it’s definitely a ride we’re on and it’s go time.  Everything I’ve seen and experienced thus far tells me that we’re in a good spot and things are proceeding fairly smoothly. Slowly but smoothly. Next will be credentialing and that will slow everything down for a couple of months but that’s probably a good thing I’m guessing.  I’m fortunate to have a genius for a wife that understands a lot of the legal end of things that I’m just not talented at. Plus we have an attorney in Austin that literally wrote the integration law that has set it all up for us. And we have Dr. Tyce Hergert with Southlake Physical Medicine consulting us so we have a talented and very smart team.  Surrounding yourself with good people is the first step to success. We can’t be expected to be the smartest expert on everything that we encounter in our personal or professional lives. We need good people in our lives and our network. Good and talented people who have the right kind of heart for our style.  That’s exactly what I have right now so I’m very confident going forward. I don’t take big risks. I take measured, smart risks. That’s exactly where I’m at.  Alright, busy busy this week so let’s get scooting with this episode.  Item #1 This one called “High and Rising Working-Age Mortality in the US. A Report From the National Academy of Sciences, Engineering, and Medicine” by Mullan Harris, et. al. [1] published in JAMA on May 10, 2021. Servin em up steamy and saucy.  Why They Did It They say, “Life expectancy has increased in the US and in the world for the past century. In 2010, life expectancy plateaued in the US while continuing to increase in other high-income nations. In the US, life expectancy declined for 3 consecutive years (2015-2017) due primarily to an increase in mortality among working-age adults (those aged 25-64 years).1 Although the increase in mortality was first described among White middle-aged adults, mortality is now increasing among young and middle-aged adults and in all racial groups. This increase in premature death, claiming lives during the prime working ages, has important implications for individuals, families, communities, employers, and the nation.” They found that average working-age mortality rates decreased after 2010 in 16 high-income countries but increased in the US. Three causes of death were identified as chiefly responsible: (1) drug poisoning and alcohol-induced causes, (2) suicide, and (3) cardiometabolic diseases. The first category includes mortality from mental and behavioral disorders, which often involve drugs or alcohol. Cardiometabolic diseases include endocrine, nutritional, and metabolic diseases (eg, diabetes, obesity); hypertensive heart disease; and ischemic heart disease and other diseases of the circulatory system (eg, arrhythmia, cardiomyopathy, heart failure). Drug and alcohol use were the largest contributors to increasing mortality among working-age adults, accounting for 8% (an estimated 1.3 million) of deaths in this population between 1990 and 2017 (an average of 44 869 per year). The increase was largest among White male adults and older Black male adults. They go on. They say, “The drug crisis was the product of 2 influences: an increase in access to legal and illegal drugs and the vulnerability of certain populations. The licensing of OxyContin in 1996, subsequent flooding of the market with prescribed opioids, and waves of highly potent heroin and fentanyl that coincided with growing demand for these substances have been described as a perfect storm.3 The drug supply expanded with limited government oversight, substantial marketing by the pharmaceutical industry, and overprescribing by physicians.” With regards to Suicide, they say, “Suicide, which accounted for 569 099 deaths among working-age adults during 1990-2017 (an average of 20 325 per year), increased primarily among White adults, especially White men, and in less populated, rural areas. Few studies have established a cause for this trend. Economic stresses are a possibility; suicide is associated with economic downturns, wage stagnation, weak health care safety nets, and foreclosures.4 Another potential contributing factor is declining social support from churches, civic organizations, and families. Such social supports, which protect against self-harm, have declined in recent decades, especially among lower-educated White adults. Easier access to firearms is associated with increased suicide rates; however, the greater increase in nonfirearm suicides during this period suggests other causes. Other risk factors for suicide include mental illness, comorbid conditions, disability, and substance use.” With regard to cardiometabolic disease they say, “Cardiometabolic diseases caused more than an estimated 4.8 million deaths among working-age adults during 1990-2017 (an average of 173 062 per year). The largest relative increases in cardiometabolic mortality occurred among younger adults (aged 24-44 years) in all racial/ethnic groups, White men and women, Black men (in recent decades), and those living in rural areas. Cardiometabolic mortality rates increased after 2010 for 2 reasons: (1) mortality from endocrine, nutritional, and metabolic diseases and hypertensive heart disease generally increased during 1990-2017 and (2) after a period of substantial reductions in mortality from ischemic heart disease and other circulatory diseases from the 1970s onward, progress stalled after 2010.” “The report discusses 3 explanations for this trend. First, the most important was the increased prevalence of obesity and its cardiometabolic consequences. Obesity rates increased in the early 1980s as a period-based phenomenon that affected the entire population, but the related cardiometabolic consequences occurred in a cohort fashion; younger cohorts born in the 1970s-1990s experienced obesogenic environments their entire lives, whereas exposure in older cohorts was limited to older ages.5 As a result, many young adults are entering their work lives with a high prevalence of chronic diseases associated with obesity. “ “The recent increase in mortality among working-age adults shows no signs of receding. Obesity rates are unrelenting, drug- and alcohol-related deaths and suicide rates, already high among working-age adults, increased during the COVID-19 pandemic” So what does all of that mean? Well, it means we are providers and we need to know this stuff and be aware of it. We need to be able to refer to specialists when we see the signs of drug or alcohol abuse, suicidal tendencies, or nutritional concerns.  It’s not just a, “‘hey he should get his crap together while he still can.” It’s a little more immediate than that I think .  CHIROUP ADVERTISEMENT Item #2 Item 2 today is called “Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis”” by Field et. al. [2] published in Pain Medicine on November 17, 2020 and that’s a bit roasty.  Why They Did It The standard Western diet is high in processed hyperpalatable foods that displace nutrient-dense whole foods, leading to inflammation and oxidative stress. There is limited research on how these adverse metabolic drivers may be associated with maladaptive neuroplasticity seen in chronic pain and whether this could be attenuated by a targeted nutritional approach. The aim of this study was to review the evidence for whole-food dietary interventions in chronic pain management. How They Did It
  • A structured search of eight databases was performed up to December 2019.
  • A meta-analysis was performed in Review Manager.
  • Forty-three studies reporting on 48 chronic pain groups receiving a whole-food dietary intervention were identified
What They Found
  • A visual analog scale was the most commonly reported pain outcome measure, with 17 groups reporting a clinically objective improvement
  • Twenty-seven studies reported significant improvement on secondary metabolic measures.
  • Twenty-five groups were included in a meta-analysis that showed a significant finding for the effect of diet on pain reduction when grouped by diet type or chronic pain type.
Wrap It Up There is an overall positive effect of whole-food diets on pain, with no single diet standing out in effectiveness. This suggests that commonalities among approaches (e.g., diet quality, nutrient density, weight loss) may all be involved in modulating pain physiology   Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography 1. Harris KM, W.S., Gaskin DJ,, High and Rising Working-Age Mortality in the US: A Report From the National Academy of Sciences, Engineering, and Medicine. JAMA, 2021. 2. Rowena Field, M.P., Fereshteh Pourkazemi, PhD, Jessica Turton, Kieron Rooney PhD,, Dietary Interventions Are Beneficial for Patients with Chronic Pain: A Systematic Review with Meta-Analysis. Pain Med, 2020. 22(3): p. 694-714.

Car Crashes and Research To Go Along With It (Part Two)

CF 176: Car Crashes and Research To Go Along With It (Part Two) Today we’re going to continue to talk about car wreck research. It’s good stuff and useful for all clinics and docs that deal with personal injury patients.  But first, here’s that sweet sweet bumper music
Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 
You have found yourself smack dab in the middle of Episode #176 Now if you missed last week’s episode, we talked about Car crashes and awesome research around that topic. Part one I guess. Today’s episode is pretty much part two. So, make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. On the personal side of things, we are still going down the path towards having the medical entity completed. I made a hire that I feel confident in. The nurse practitioner was referred to me by another nurse practitioner here in town who was his preceptor or teacher for his clinical hours when he was going through school. She told me that he is super smart, excellent with patients, eager to learn, and his wife is an amazing cook. So I was sold. And just taking the time to get to know him, I’m even more confident that I have made a good decision going forward. The majority of the work on this is going to be in the first 3 to 6 months I think. We have to get systems in place, I have to teach the nurse practitioner the exam I do. How do you teach somebody how to do the exam that an ortho fellowship practitioner does? Well, we shall find out.  I’ve already loaned him one of my dr. Stuart McGill books to get started on. I’ve been sharing with him a lot of the information that I learned in the Neuromusculoskeletal program, I’ve talked to him about McKenzie protocols and migrating the disc, and started him on the path of different ways to think of chronic pain. Including the up-regulated and sensitized central nervous system as well as the biopsychosocial aspect of chronic pain. Yellow flags, words matter, limiting MRIs, and all of the associated Tom Foolery.   He was unfamiliar with quite a bit of what I have been teaching him and showing him. But very receptive and very interested in learning about that side of pain and newer ways of thinking about it and approaching it. I think we’re going to be a great team.  Outside of that part of my life, I’ve started with the book launch. Not really the launch itself as much as getting the book ready for launch and putting together a launch team. What does a launch tram do exactly? Well, let me tell you. Basically, I’m going to be uploading it to Amazon once it’s formatted for it and everything is in place. Then, it’ll be free for the first 3 days. That’s when everyone on my launch team will go download it. Then, leave a review for it…..because my launch team is cool and they know that’s part of the launch process.  The free downloads and the Amazon book reviews give the book a little Amazon juice which will propel it up the charts a bit. That way, when the initial 3 days are over, and I can start charging money for it, the Amazon Juice has it set up for success and sales.  So, that’s the plan and guess what?? I’d love it if you regular listeners would like to be on my launch team. If so, just send me an email to [email protected] and make sure you tell me you’re on the launch team. It’s that easy. Or, send me a message through our Facebook group or the Facebook page or through smoke signal.  Whatever means you can get me a message that you want to help us, that’ll work for me.  It would be rude of me to not thank a couple of folks. I need to thank Dr. Chris Howson and Dr. Steven Roffers for helping me with the editing process. Dr. Howson is the inventor of the Drop Release tool, he’s smarter than hell, and he’s a good person on top of all of that. Go check out the Drop Release tool and show Dr. Howson some love won’t you? Dr. Roffers is the group admin of the Facebook group called Chiropractic Research Alliance with over 8,000 members, he’s a certified medical editor and serves on the editorial boards of 14 journals. Dr. Roffers offered to help me edit the draft as well.  So, these two pros need to be thanked and properly recognized for their efforts and their generosity. I appreciate you two and just appreciate you.  I honestly thought I’d ask for launch team members and there’d be crickets. In the first post I made on my Facebook properties, I’ve now got about 25 super awesome people that want to help support and promote the project. And in the process, they’re supporting and promoting evidence-based, patient-centered healthcare.  It’s a win-win and I thank you all. More to come as I get further down the road.  Now, on with the research.  CHIROUP ADVERTISEMENT As I mentioned last week, this podcast episode was inspired by a recent episode of the Chiropractic Science podcast hosted by Dean Smith. It was episode number 55.  His guest was Dr. Michael Freeman who I talked about in last week’s episode. These papers are papers they talked about on that episode so, if you want it from the horse’s mouth, go over to Chiropractic Science and find the recent episode with Dr. Michael Freeman and hit play. Then come back here and get my take on it.  Now let me pause just a second and say that if you haven’t jumped into personal injury, don’t. Unless you plan on getting the education it takes to do a good job. Take courses. Make yourself the expert. Know your worth. It pays well but the stakes are high for your patients. You have to deal with attorneys. You might have to testify under oath in court. Do you REALLY want to do that if you’re education and experience are not up to snuff? When I jumped in back in 2007, I had a basic Chiro education but I was not specialized in car wrecks or whiplash. I could have been better. So I made myself better. I recognized my shortfalls and I filled the gaps. I got the Advanced Certification in whiplash biomechanics and Traumatology through the SPINE Institute out in San Diego, CA. I got the certification from the Personal Injury Institute through Matthew DeGaetano who was also a Croft Commando.  I have attended CE hours on PI specifically. I ended up compiling all of the experience and education into a macro for ChiroTouch. If you want to check that out, go to personalinjurymacro.com but you’re not going to want to buy it unless you’re using ChiroTouch. It’s like gold though if you have ChiroTouch.  It’s got all of the Croft stuff in there, the research citations, crash descriptions, risk assessments, the whole thing. Plus all of my customization after I went through the Fellowship for the Neuromusculoskeletal program. IT’s gold, folks.  Anyway, my point was that you do your reputation and you do your patients a disservice if you are in the PI arena but you don’t know what the hell you’re doing. Plain and simple. It’s lucrative but dammit, get educated or get out. And understand that you’re not going to get 100% on every case.  To demonstrate my point, as I said, I’m a specialist now with the Fellowship, I have the cert in whiplash biomechanics and Traumatology, and I’ve been recognized as an expert in whiplash at the District Court level. Because of my macros I created, I can make narrative reports that nobody I’ve met can beat.  And YET…..I still don’t get 100% of my bills. Don’t think you’re going to get 100% either.  Because that’s the way PI works. Not all cases are created equally. Some fall apart completely. Some attorneys are truly awful people so stay on your toes. Some are amazing people and those are the ones you want to work with. Sometimes, the patient disappears. Sometimes they get in trouble and go to jail. Sometimes the insurance company just won’t budge and the attorney doesn’t feel there’s a strong enough case to go to court on.  At those times, you better be willing to wheel and deal. Otherwise, you might get that one bill paid but that attorney won’t be sending you any more clients and guess what? Attorneys talk to each all of the time. They’re mostly all good friends.  Some of my best friends professionally are attorneys. Some of my biggest enemies professionally through the years have been attorneys. One still owes me $42,000 and I don’t expect I’ll ever get it out of him because he’s a worthless, useless, terrible human being. But, it’s part of the dangers of swimming in this particular lake. Some of the fish have no souls.  But again, some are amazing people that I have forged solid friendships with.  I went off the rails a bit there but the point again is this; either get educated and do it at a high level or leave it to others that did actually put the work in to get the extra education. Plain and simple.  Item #1 Our first paper is called, “A systematic approach to clinical determinations of causation in symptomatic spinal disk injury following motor vehicle crash trauma”’ by Dr. Michael Freeman, et. al. (Freeman MD 2009)  and published in Physical Medicine and Rehabilitation back in 2008.  Why They Did It This is a really long description of the objective here so follow along and we’ll discuss, “Clinical determinations of causation in cases of intervertebral disk (IVD) injury after a motor vehicle crash (MVC) are often disputed in court settings.  No published systematic guidelines exist for making such determinations. This has resulted in nonclinical people determine injury causation and performing the evaluations. This is traditionally a clinical activity.  The result is causal determinations that are potentially disconnected from clinical observations of injury. Meaning, when non-clinical people are doing the evaluation, they get it wrong a lot.  The purpose of this review was to evaluate the current literature on causation, causal determinations after trauma and intervertebral disk injury after a motor vehicle crash, and to develop a practicable, logical, and literature-based approach to causation determinations of symptomatic intervertebral disk injury after a motor vehicle crash. That was almost all quoted from the paper’s abstract but I tried to make it even more basic and less confusing.  What They Found
  • The results of the review indicate IVD injury can result from any MVC regardless of magnitude, thus meeting the first criteria of causation, biologic plausibility.
  • Individual determinations of causation depend entirely on the temporal association between the collision and the symptom onset (the second criterion) and a lack of a more probable explanation for the symptoms (the third).
  • When these causal elements are met, clinicians can assert causation on a “more probable than not” or “reasonable probability” basis.
  • You may have heard me mention I’m currently undergoing the Forensics Diplomate program right now. That is legal speak there. Probably meaning ‘greater than a 50% chance.”
Wrap It Up For the conclusion, they say, “Because of a lack of an established or reliable relationship between collision force and the probability of IVD injury the investigation of collision parameters is not a useful adjunct to causal determinations.” Item #2 Our last one today is called “Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma” by Freeman et. al. (Freeman MD 2020) and published in the International Journal Of Environmental Research and Public Health in 2020 and that’s still got some smoke! Now….if you don’t know, what is Videofluoroscopic examination? It’s basically x-rays (and video) that are dynamic. X-rays that are moving. So you can see the patient go into cervical flexion. It’s cool as hell. But you can accurately see when there is ligament injury or ligament laxity as well because in real time, you can observe the one vertebra slide forward on the one under. It’s crazy and a bit spooky.  When you see one vertebra slip forward on the one underneath as the patient goes into cervical flexion, it’ll make you anxious in your belly. It might make you pee a little. Anyway, look it up. See if you can find some videos through your Google machine.  Why They Did It Intervertebral instability is a relatively common finding among patients with chronic neck pain after whiplash trauma. Videofluoroscopy (VF) of the cervical spine is a potentially sensitive diagnostic tool for evaluating instability, as it offers the ability to examine relative intervertebral movement over time, and across the entire continuum of voluntary movement of the patient. At the present time, there are no studies of the diagnostic accuracy of Videofluoroscopy for discriminating between injured and uninjured populations. How They Did It
  • Symptomatic (injured) study subjects were recruited from consecutive patients with chronic (>6 weeks) post-whiplash pain presenting to medical and chiropractic offices equipped with Videofluoroscopy facilities.
  • Asymptomatic (uninjured) volunteers were recruited from family and friends of patients. 
  • Three statistical models were utilized to assess the sensitivity, specificity, positive and negative predictive values (PPV and NPV) of positive Videofluoroscopy findings to correctly discriminate between injured and uninjured subjects.
What They Found
  • A total of 196 subjects (119 injured, 77 uninjured) were included in the study.
  • Videofluoroscopic examination of the cervical spine provides a high degree of diagnostic accuracy for the identification of vertebral instability in patients with chronic pain stemming from whiplash trauma.
Wrap It Up “Videofluoroscopic examination of the cervical spine provides a high degree of diagnostic accuracy for the identification of vertebral instability in patients with chronic pain stemming from whiplash trauma.”     Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.    Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
Chiropractic evidence-based products

Integrating Chiropractors

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  The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!   Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!   Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.    Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.   Website
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  Social Media Links https://www.facebook.com/chiropracticforward/   Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/   Twitter     YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q   iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2   Player FM Link https://player.fm/series/2291021   Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through   TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/   About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Freeman MD, C. C., Kohles S, (2009). “A systematic approach to clinical determinations of causation in symptomatic spinal disk injury following motor vehicle crash trauma.” PM R. 1(10): 951-956.   Freeman MD, K. E., Rosa S, Gatterman B, Strommer E, Leith W, (2020). “Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma.” Int J Environ Res Public Health 17(5): 1693.  

The Shake-Up With WFC’s Research Committee

CF 154: The Shake-Up With WFC’s Research Committee Today we’re going to talk about the research committee shake-up at the WFC. I’ve wondered for months now what exactly happened with shake-up and it hasn’t been easy to figure it out either. Who is to blame and what companies are to blame as well? We’ll get knee deep into it in this episode.  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 #154 Now if you missed last week’s episode , we talked about how some chiropractors could be better and being careful which guru you’re going to place your faith in. Some are just absolute loons and only driven by profit, not results and not the patient.

The saying is, when you’re focused on the outcomes, you’ll never have to worry about the income. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function

On the personal end of things…..

Chugging along. Making friends and influencing people. That’s how we do it here. Actually, that’s not true. I’m sure I got the vitalists all fired up last week and probably will this week as well. I’ll probably get some companies fired up too.  We’ll see. It doesn’t have a thing to do with anything chiropractic but I’ve mentioned a time or two here that I’m branching out and, as a retirement plan, I’m working on a little side gig in the voice over / voice artist industry. This stuff is fascinating y’all. It really is. 

So I went through the steps you’re supposed to go through in getting yourself all set up and now, here I am, I got a commercial demo done. If you’re just feeling goofy and bored, go to jeffwilliamsvoice.com and there’s a demo there you can listen to. Turns out I have the John Deere, Ford truck, eat this burger type of voice and I’m totally OK with that.  Anyway, after you get a demo, you start submitting to talent agencies around the world. Well, hell….I don’t have all day to spend on doing this stuff so I can only get a few per day and there are tons of them.

But, in just the first round or so of submissions, I already got signed up with a talent agent out in San Francisco and Los Angeles as well as interest from a talent agency in Barcelona Spain and potentially a marketing firm down in Dallas/Ft. Worth. . So….how damn cool is that? Maybe, one of these days, my side gig takes over my day job. I’m not holding my breath though. But, seriously, my buddy has done it for about 7 years and he’s making six figures. Can you imagine making a good 6 figure salary but no employees, no overhead, you can make that money in your basement in your underwear (sorry for the visual there), and you can do it from anywhere in the world as long as you have an internet connection?

Well, it’s a cool idea and a lot of folks get to do it that way. Who knows? It’s a lot of luck and all that stuff but I’ve never been one that was afraid to take chances or afraid to fall on my face.  Either way, it’s exciting and isn’t that what it’s about? Keeping life interesting and exciting? That reminds me, if you need a voice over for a youtube video, your podcast intro, or any commercial you’re doing, remember ol Uncle Jeffro here. I got you covered!

Item #1

Now, let’s get to spilling the tea shall we? I have to start by saying, I don’t love talking about this stuff. I don’t at all. It makes me uncomfortable. Mostly because some of my friends won’t like it. I work with a lot of chiropractors around the nation in different capacities and to be honest, while we work FOR the chiropractic profession, we don’t see eye to eye with each other on WHAT chiropractic is.  Still, they’re my friends. So what do I do? Do I just say nothing about things I know they won’t agree with? Or do I talk about it and give my view point on them?

Well, I have a podcast so I guess I talk about it. I could stay out of the messiness of our profession and avoid tough subjects all together I guess. But who ever changed anything by taking that sort of stance? That’s not really any kind of stance at all is it? You change things by standing up, somewhere, and supporting your convictions. So that’s where i’m at. I don’t like. I’m uncomfortable with it, honestly. But the show must go on.  Let’s start with what happened. Dr. Greg Kawchuk was the head of the World Federation of Chiropractic. I’m a fan of Dr. Kawchuk. so when I saw on Facebook or Twitter or somewhere that he resigned his post as head of the WFC research committee, it had me a bit miffed. Not only that but a lot of HUGE chiropractors on the committee left with him. Researchers on the level of Jan Hartvigsen for example. 

To be specific, those that resigned are

  • Greg Kawchuk DC PhD Canada – Chair
  • Simon French, PhD, MPH, BAppSc(Chiro) Australia
  • Iben Axén DC PhD Sweden
  • Jan Hartvigsen DC PhD Denmark
  • Martin Descarreaux DC, PhD Canada
  • Carolina Kolberg DC PhD Brazil

Every single one of these researchers has been in the episodes we have released. They are big time for our profession. The vitalists, unfortunately, have labeled them subluxation deniers. I label them scientists but….whatever.  I say tomato, they say dumb stuff. Their statement of resignation went like this, “Effective immediately, we (Greg Kawchuk (Chair), Iben Axen’, Martin Descarreaux, Simon French, Jan Hartvigsen, and Caroline Kolberg) resign from the World Federation of Chiropractic (WFC) Research Committee.

We no longer feel it is possible to function as independent academics in our roles on the committee. We urge the WFC to continue to promote the EPIC principles (Evidence-based, People-centered, Interprofessional and Collaborative), and to protect its core values from potential conflicts and outside influence. We wish the best for the WFC and our colleagues who serve on its Research Committee.” Now, it wasn’t all bad because they put Dr. Christine Goertz into the post as the head of the WFC committee and if you’re a listener here at the Chiropractic Forward evidence-based chiropractic podcast…..well then you know what a fan of Dr. Goertz we are. She’s a chiropractic treasure. 

But, when I first heard the news, as you can imagine, and as you probably felt when you heard, it was a bit concerning for our profession to lose so many high profile, top-level researchers at once. What’s that going to mean for our profession and why did this happen in the first place? I started paying attention. I started looking for information. What the heck happened? But nothing. Not only nothing on the story but nobody was talking about it either. Like….it was just another event that happened on just another day. No big deal. When, in reality, at least to research consumers such as myself, it was a huge deal! Why did this happen and what the hell is the story?

Well, I’m going to give away the ending here before we really dive in, I’m not 100% sure but at least now I have an idea. A generaly idea.  When I decided I was going to do this episode, I put it in our private Facebook group. We only have around 450 members approximately. Again, in case you don’t know, we have a public Chiropractic Forward page. That’s just to get the word out about the podcast and market the podcast.  Then we also have a Chiropractic Forward private group where we can share research papers, we can discuss amongst ourselves, and all that good stuff and we can do it privately. I encourage you all to join the private group.

Not if you’re a vitalist. That’s not the group for you. But if you’re evidence-based and patient-centered, then you’re a good fit.  Anyway, I posted in there that I wanted to do this episode and if anyone had the back story, please send me a private message about it. That I wanted to get it figured out and tell our audience. 

There was a lot of interest in the episode but nobody knew the story about what happened. I asked elsewhere. Nobody knew but everyone wanted to know. I even asked Dr. Kawchuk himself and he was tied up in a research project. Dangit.  Unfortunately, the research community’s lack of open communication on this matter has left this up to others to define the narrative. For example, when Googling up this story, I got an article by Matthew McCoy. The ever-so-nutsy vitalist out in Georgia. The townhall crier and huckster of woo. Yes, he’s one of them setting the narrative. 

Also, one of the top hits was by our global hater for the ages, Edzard Ernst. What a toolbag. Yes, our global hater sets the narrative on what is happening in the chiropractic world. But nothing from the evidence-based, patient-centered side of the profession. What in the hell is going on here, people? Why in the hell are you all sitting on your hands? Why are you not talking about this, writing about this, yelling about this, or at least pushing back on this? Are we spineless? No pun intended by the way. 

It’s just astonishing to me that so little is written about it and that the only information you can find on it is created by flat-earthers or by the apex of chiropractic haters.  Finally, one of my colleagues here in the U.S. contacted me through text and we set up a phone call. They gave me the story as well as they understood it and that’s what I’m going to give you. Thank you to this colleague for shedding as much light on this story as you could. I really do appreciate it and I’m pretty sure the rest of our audience does as well. 

If we are being fair, a small part of it appears to be Dr. Kawchuk’s fault, a very large part of it seems to fall on the vitalist, subluxation or nothing, rah rah rah crowd, and an even bigger aspect of the whole enchilada I believe can be directly pointed at the WFC’s corporate sponsors that backed the vitalist, subluxation is the only way crowd. I personally blame the companies. Without them bullying the WFC with sponsorship dollars, this wouldn’t have happened regardless of the rest of the dominoes that fell. 

Let’s back up a bit.  It sounds like it all begin in Berlin in 2019. Those of us paying attention know that it goes back much further than that though don’t we? Oh yeah, with the evidence-based, patient-centered model becoming more and more prevalent and moving the vitalists more and more to the fringe of the world, the louder the minority has become.  Still, it appears, Berlin 2019 at the WFC conference was the final straw. Dr. Greg Kawchuk, who again, I’m a fan of, was one of the speakers at the event. His presentation was not vitalist/subluxation friendly.

Word on the street is that his speech was met with cheers but was also met with water bottles being thrown up on the stage and antics like that. Because, you know….our profession is divided in two in case you’ve been hiding in a cave. So, cheers makes sense. I don’t know what makes the other side think it’s OK to throw stuff on the stage but who knows? Maybe that’s just a dumb little European quirk.  I had the opportunity to see almost the exact same speech at the Forward ’19 event in St. Louis a little over a year ago. I absolutely loved it. And, no….it was not subluxation friendly.  Here was the difference in the speech I saw in St. Louis and the one that was given in Berlin.

Dr. Kawchuk, it is suggested, made a quip during his speech that taking a child to a vitalistic chiropractor is similar to taking a child to a Catholic priest.  There are no recordings in existence of this version of the speech but I believe the basic gist of the comment was that if you’re willing to take your kid to a vitalist for 60+ visits, then you should leave your kids with a Catholic priest.  OK, let’s address this because this one comment is what the ICA hung their hat on so I think it’s a pivotal thing. I think it’s also why this part of the speech was dropped when I heard it in St. Louis.  It is my understanding, first of all, that Dr. Kawchuk wrote a letter of apology but it was perceived as having some “Yeah, but…” sentiment attached so maybe it didn’t come off as sincere as his detractors would want.

But here’s the thing, it wouldn’t have mattered how sincere the apology was, they found something to hang their hat on. They found an achilles heel and they weren’t going to let go of it. Regardless of what Greg said to them about it.  Can I just say that I’m a Christian and I’m used to getting made fun of by so many out there in the world. It almost doesn’t even affect me anymore. Notice I said ‘almost’.

Now, I’m not Catholic. But Catholics are Christians so, by association, I should be rather offended as well right? I suppose if I were of the easily offended mindset, I would be. But I’m not because I see it all for what it’s worth.  Number one: the Catholic church has had quite a well-chronicled issue in the past with priests and misconduct. I don’t know how you could argue with that and someone bringing it up has become VERY commonplace. That doesn’t make Greg’s comment any more out of place than the 100 other people I have seen mention or make fun of it on Facebook over the past 3-5 years. It’s become very common. Doesn’t make it right but it does make it common. 

Number Two: did that belong in this speech? Well, I wasn’t the speaker so how do I know. I know that I saw the same speech last year without the comment and it seemed very effective and very welcome to everyone that was in attendance. So, it appears it would have been just as good and ultimately less offensive to some.  Knowing what we now know, it doesn’t appear that it was a good choice to go with for that particular speech to that particular crowd. I would say that I enjoy a great and entertaining speech and the one I saw in St. Louis by Dr. Kawchuk was just that. It was actually pretty dang amazing.

I became an instant fan and hearing of the Catholic priest comment later on did nothing to dampen my fandom.  I suggest people lighten the hell up and quit being so damned dramatic. Water off a duck’s back. Oh my goodness, someone said something you didn’t like or agree with? Poor thing. Bless your heart.  So, Greg gave them something to hold onto and go on the attack with. OK. Do you think the ICA got irate over the priest comment? Or do you think they got irate because the speech was anti-vitalist, anti-subluxation?

Honestly….think about it. Let’s be smart. Which do you think it was? It should already be clear what I think it is.  So, the speech is made and the vitalists lose their damned minds and the ICA decides to deal with this travesty. Nobody but the higher ups over there know exactly how it all went down but, by all appearances, it looks like they started leaning on sponsors to pull support from the WFC until changes that the ICA deemed appropriate were made.  So, basically, the ICA decided to be a bully and start flexing on the playground.

They could read the tea leaves and with scientists like Kawchuk, Hartvigsen, and the others steering, the future wasn’t so bright for the ICA bullies so they started figuring out how to pull the purse strings. That’s what it looks like to me.  It looks like companies like ChiroHealth and Foot Levelers leaned on the WFC to remove Kawchuk. In advance of that, Greg just resigned. Then, the other top-level researchers resigned in solidarity and, I would imagine, in protest to what was happening. 

And I don’t blame them one bit.  Here’s the thing here; it is my opinion and the opinion of others that these vendors used our money that we paid them to bully the WFC at the urging of the ICA to oust Kawchuk. And it is my opinion that they used one sour comment to do it. When I feel pretty sure that they bullied the WFC simply because they didn’t like that the speech and the research committee seemed anti-subluxation. Here are the companies that pulled support simultaneously at this pivotal time for the WFC:

  • Standard Process
  • ChiroHealthUSA – USA
  • Chiro Diplomatic Corps
  • NCMIC – USA
  • National Chiropractic Council – USA
  • Koala Mattress – Australia
  • Life Chiropractic College West – USA
  • Life University – USA
  • Lloyd Table Inc – USA
  • Breakthrough Coaching – USA
  • Chiropractic Education Australia Ltd. – Australia
  • Da Vinci Labs – USA
  • Integrated Assessment Services Inc. – Canada
  • Japan Federation of Chiropractic Professionals – Japan
  • Mettler Electronics Corp. – USA
  • Tokyo College of Chiropractic (Formerly RMIT University) – Japan
  • Sidecar

It looks like vendors like ChiroHealth, Foot Levelers, and several others used the money we paid them, to then turn around and bully the WFC research committee because they gave a speech that was anti-subluxation. Used. Our. Money.  I repeated that for a reason. They use our money to get rid of the world’s biggest and best researchers because they didn’t like what they said.  On the other hand, these are the companies that continued to financially support and sponsor the WFC:

  • Palmer College of Chiropractic
  • Parker University
  • Logan Chiropractic College
  • New York Chiropractic College
  • Southern California University of Health Sciences
  • University of Bridgeport
  • University of Western States
  • National University of Health Sciences
  • Canadian Memorial Chiropractic College
  • Anglo European College of Chiropractic
  • Madrid College of Chiropractic
  • Nordisk Institute
  • Dynamic Chiropractic
  • The American Chiropractor
  • Chiropractic Economics

I would like to thank this group that chose to continue to support the WFC, thus continue to support research and science. Thank you for not being bullied by the ICA and the loud minority. Now, let’s be fair. Maybe it was just that times are tough. COVID has us all down. I know it’s got me down. Did they pull or reduce support for the WFC because of the ‘Rona? How are we to know? I don’t know. You don’t know either. But it seems pretty danged coordinated in conjunction with Dr. Kawchuk’s resignation doesn’t it? I mean….doesn’t it? It’s your choice to continue working with these companies but I’ll tell you this much, being evidence-based as I am….I will be second-guessing my commitment and participation with them going forward.

Honestly, how could you not? As my colleague so eloquently stated to me, “Their power is our power.” Again, nobody knows the exact motivation of these companies. I sure as hell don’t. I just know what it looks like.  What if enough of us contacted these companies and griped about this? We can collectively tell them we don’t approve of that sort of influence. We don’t approve of them using our money to bully our research community.

What if this were to serve as a rallying cry for activism over apathy? For a bunch of crappy stuff to take place, all it takes is for good people to just sit on their hands and do nothing.  This can be a rally cry for the WFC and Dr. Goertz, for the ACA, CARL, for the FTCA, and for this Chiropractic Forward Podcast. But, as my esteemed colleague said, there’s a cover charge to getting your voice heard and social media doesn’t quite cut it.  Now, how much of all of this was theater and how much was legitimate?

If Kawchuk was going to be let go because of the financial pressure by the ICA and these companies, was his resignation simply to keep the ICA from getting a win? It seems they reduce exposure by just going to their universities and doing their research there anyway. They’re not out front taking all of the heat and they’re still doing all of their research and all that anyway. Makes you wonder why anyone would want to be out front like that anyway, doesn’t it? I don’t think it was theater.

I think Greg got tired of dealing with the vitalist crap and said to hell with you people. I think the ICA bullied these companies and the WFC to push him out under the guise of a priest comment but really because they didn’t like the anti-subluxation sentiment of the research coming out of the WFC. And I think the companies did exactly what the ICA wanted them to do. So, I think the vitalists and subluxation people won at the end of the day.  It’s all looking like a bunch of stinky garbage on the part of the vitalists but, sometimes those unafraid to get down in the slop are the ones that win the battle. Doesn’t mean they win the war. Just the battle. 

Here’s what I believe. I believe right and truth win every single time. Eventually. So, let’s look at it from that perspective. There are mountains of papers supporting spinal manipulative therapy. There is a paucity as the researchers say….a paucity of solid, respectable research backing the vitalistic, subluxation theory that was generated in the late 1800’s. Here in 2020..it just hasn’t formulated into a solid, well-researched fact, folks. I’m sorry. Don’t punish the messenger.  Anecdotal evidence and charismatic gurus with guitars don’t make it true or make it right. 

Here’s something else I believe strongly, when you have people like McCoy and Edzard Ernst setting the narrative for our profession because we’re not willing to discuss something openly, well, then we’re just asking for it, folks. You either want a well-respected profession or you don’t.  Or, do you want a split all together? The Primary Spine Practitioner program through the University of Pittsburgh may be a good first step for some of you that are bent on the separation.  Can’t we all just get along? I don’t see it happening. I really don’t. I don’t see how our profession can be unified.

Vitalists refuse to follow or even notice solid research that doesn’t confirm their bias. Outright refuse. They insist it’s appropriate to see regular healthy people once per week for life.  Evidence says that’s not appropriate so, therefore, evidence-based chiropractors say it’s inappropriate and it gives us a bad name. So, what do you do about that? You can’t fix it. Evidence based folks can’t continue in a profession where part of the crowd makes them appear illegitimate.

Vitalists refuse to conform to any appearances of being evidence-based.  So, what’s the answer? You tell me. I don’t see a clear answer. I think it lies with the middle group that is neither evidence-based or vitalistic. They’re just out there making a living and getting through their days but are pretty much apathetic to either. When something happens that activates that group, I think that’s what will be the deciding factor on where this profession goes. 

I disagree with 99.9% of everything Edzard Ernst says but I agree with this comment wholeheartedly when he says, “In my view, the problem of the chiropractic profession is unsolvable. Giving up Palmer’s obsolete nonsense of vitalism, innate intelligence, subluxation, etc. is an essential precondition for joining the 21st century. Yet, doing so would abandon any identity chiropractors will ever have and render them physiotherapists in all but name, Neither solution bodes well for the future of the profession.”

I would say that he left out the fact that many PTs are now adding spinal manipulative therapy to their arsenal so maybe PTs are rendering themselves chiropractors rather than the other way around? I would also add to Ernst’s comment that a recent nationwide poll showed that people go to chiropractors to get rid of their pain. They do not go for wellness, vitalism, weekly visits, or innate intelligence talk.  In the comments of Ernst’s post a chiropractor chimed in and said that in his opinion, the profession has a better chance of providing a valuable healthcare service without the ICA members which make up only about 5% of the profession tagging along and raising a stink whenever someone challenges their model or views. 

Researchers should have the freedom to speak thei truth without fear of reprisal of companies that we essentially fund. It goes a hell of a lot deeper than a bad joke folks. It’s an attack on evidence-based chiropractic and an attack on the research community. And we’d better all start seeing it that way because now, the ICA has a win and you can believe they’ll be back for more. If these companies reduced or withheld funding to pressure the WFC based on the ICA’s pressure, we should let these companies know how we feel about it.  I see chiropractors going forward in the world treating pain, following current research, and current widely accepted guidelines. Guidelines that are based in the research literature. I see a profession that accepts a certain standard and a profession that hopefully begins to take policing its own seriously. 

Otherwise, we’ll continue to be the pimple on healthcare’s butt. And that’s the way I see it. And before anyone says it, I’ll say it first…no, I do not want to be a medical doctor. No desire at all. But being a chiropractor doesn’t mean that I have to blindly accept and promote a philosophy from the late 1800’s. They are not mutually exclusive. In any way. The adjustment is the cornerstone of my personal practice and the way I treat patients. It’s just not the end-all-be-all of what I do.  And all of this mess when we are at the precipice of actually breaking through in the healthcare industry. I’ve said it so many times on this podcast but there is no better time to be a chiropractor.

Y’all, it’s a perfect storm. The opioid crisis. The research backs every freaking thing we do OUTSIDE of the subluxation theory. Literallly everything we do.  Spinal manipulative therapy, exercise/rehab, low level laser, massage, acupuncture, balance and proprioceptive training, and things like that. Research backs it all up. It just can’t back up the subluxation stuff.  But we are at a point that we can actually get more patients in our doors if we are a respectable, evidence-based, patient-centered profession.  Again, you can disagree with me. You can cuss me. But you’ll always know where I stand and according to me, I stand for what’s right, I stand for the truth, ethics, morality, and I stand for patients and their right to be treated like respected individuals and not targets that have to be closed.

IF we can’t agree on that, then maybe you can at least respect me and respect the fact that I’m willing to make a stand for what I believe in. Because honestly, I don’t see a lot of folks standing up on this deal.   Maybe it’s just me. I would assume these things would be common sense. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Chiropractic evidence-based products

Integrating Chiropractors

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

Lancet Low Back Update & Movement Disorders Mean Pain

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

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

But first, here’s that sweet sweet bumper music

Subscribe button

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

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

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

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

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

Do it do it do it. 

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

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

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

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

On the personal end of things…..

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

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

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

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

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

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

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

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

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

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

Item #1

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

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

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

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

In summary:

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

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

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

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

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

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

Item #2

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

Why They Did It

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

How They Did It

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

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

What They Found

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

Significant differences were found for coronal plane motions only

Wrap It Up

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

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

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

Store

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

Subscribe Button

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

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

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https://player.fm/series/2291021

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

TuneIn

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About the Author & Host

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

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

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

 

Adjusting Disc Herniations and Bulges

CF 135: Adjusting Disc Herniations and Bulges

Today we’re going to talk about Adjusting Disc Herniations and Bulges. Is this a good idea or a bad idea and what does the research have to say about it? 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 #135

Now if you missed last week’s episode , we talked about the impact sleep can have on cardiovascular issues and we talked about what the profession of chiropractic can learn from the podiatry profession. There was a great discussion there I believe and great lessons we can learn. Why did podiatrists start at about the same time as chirorpactic but they’re so much more recognized, respected, and integrated compared to the chirorpactic profession? We talked about it. Make sure you don’t miss that info. Keep up with the class. 

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…..

Keepin on keepin on folks. That’s it. Staying in business. One day at a time. So far so good. I hope you found some use out of our discussion a couple episodes back about tactics myself and others are using to get those patients returning back to your office. I think I was able to share some valuable info in that regard. 

Dr. Blake Bennett posted in our private Facebook group saying, “We mailed a thousand letters to patients who were in in the past couple years and a couple weeks later we mailed another 500 postcards to patients who haven’t been in longer than that. Email every 2-3 weeks to those on the list. He says the response was great and June was a good month.”

Providing value and giving back. Thank you Dr. Bennett. I know others in need appreciate your advice as do I. 

Let’s get on with the reason for the topic today. I saw a post not long ago in the Forward Thinking Chiropractic Alliance where a colleague was asking if it’s OK to adjust segments where there is a confirmed disc herniation or bulge. It was refreshing to see a resounding YES from all of my colleagues. 

My answer was “Yes” as well. I’ve been through this from the back end though and I’ll share some of that story with you. It’s a story I’m not happy about, I’m not proud of, and I’m not happy revisiting. It was a hard time in my life to be honest. But, it’s part of my story regardless so here goes.

Many moons ago I treated A LOT of personal injury cases. We all know some of those patients are better than others. This was not one of the great patients but she was fine. No big issues. She had a disc injury and I diagnosed it appropriately I’ll have you know. 

Now something to know about me; I’m all about gentle motion. I don’t like it when someone cranks my noggin around just looking for that crack sound. I’m not interested in that and I treat people the way I want to be treated. I’m very gentle, non-agressive, use little to zero rotation in the cervical area, and just won’t be rough with it. 

Same went for this lady. And, like so many other patients, she responded well. I tracked her from the beginning where she was having pain 75% of the time down to a much lower rating on the numeric rating scale and only about 25% of the time. She was happy, I was happy and all was gleeful in the land of daily practice. 

Until…..until her daughter attended an appointment with her one day. She came in with her just up in arms and actually screaming at me because I had the audacity to work on her mother when she had a disc herniation and clear mention of the disc herniation on her MRI report. 

I asked her if she’d ever been to a chiropractor before or knew anything about chiropractic. She had not. She knew nothing about what we do or why we do it. So, I tried to explain briefly and tell her how her mother was doing so much better and how she had improved, blah, blah, blah. Didn’t matter. She didn’t know anything but she knew enough to be straight up pissed the hell off that I’d ever work with her mother with that disc herniation. 

It made for an interesting day for sure. But not as interesting as the day I received notice from my state’s governing board that they had received a complaint on me from this patient. While it had this patient’s name on the complaint, it should have had the daughter’s name on it because the patient and I had a good relationship. 

So, no matter how good the notes were, no matter how well I tracked the improvement, guess what? I STILL had to hire an attorney to defend me to my own Board. Now, it’s important to understand that the Board isn’t here for us. They’re stated goal is to protect the interest of the public when it comes to chiropractors. Let’s be fair, they see the worst of the worst. Literally. They can, after some time, become a bit jaded and maybe even start to actually EXPECT the worst when they get a complaint. 

I literally could not believe I had to take two days off of work, fly to Austin, TX, get a hotel, and defend myself against something that was so black and white. But again, let’s be fair, the folks at the TBCE weren’t there. They didn’t witness what I saw. They didn’t see the happiness of the patient with her improvement. They weren’t there when we just did manual mobilization rather than agressive adjustments. I can’t blame them. It was the process and I had to go through it. Right or wrong. And trust me, if you’ve listened to this podcast long enough honesty is big with me. This was wrong. It should have never gotten beyond the initial complaint. But whatever. I went to Austin. 

Now, one of my colleagues and friends was on the enforcement committee and she asked me some straight forward questions with the attorney sitting there. I don’t know why the hell he was even there other than to collect a check because he didn’t say a damn thing or do a damn thing. 

This was before I went through a diplomate but after going through Croft’s Whiplash Biomechanics and Traumatology course. What I’m saying is I’m better today than I was back then but I was far from being a slacker back then. I answered all of the questions, walked out, and the attorney told me what a great job I did and then we waited. 

I ended up getting a warning but nothing on my record. No action taken against me. I was pissed then and am still pissed that I’d get a warning for anything at all. I didn’t deserve a warning. It wasn’t warranted because I didn’t do anything wrong. 

Now, the reason for that story for a couple of reasons. First, I want you to understand the value of documentation. Had I not had the documentation showing the improvement of this patient over her treatment, I would have been absolute toast based solely on the word of a patient’s daughter. A person that has never been to a chiropractor and knows nothing about the profession. That’s number one. So documentation people; don’t just document to remember what you did. Document to protect yourself and your staff. It sucks but you have to do it. 

The second reason I told that story is that this experience led me to start looking up research on discs and adjusting. Was I actually wrong and I just didn’t know it? I went searching for the answers because if I were to keep adjusting people, you damn well better believe that I’m going to be adjusting people with discs that many times are herniated or bulging. That’s either knowingly doing it and most times unknowingly doing it. 

Hell, we know that 60% of patients between the ages of 40 and 50 years old have disc findings that are completely asymptomatic. No pain at all. Still, when you’re adjusting a 40 – 50 year old, you have a 60% chance of adjusting someone with a bulge or herniation. So it made sense to me to protect myself from ever running into this crap again down the road. 

If I had those paper in front of me when I went in there to defend myself, maybe I don’t even get a warning. But, if someone is sitting on the enforcement and questioning concerning adjusting areas with disc issues, they need to be on top of that research as well. And they might have been. I don’t know. All of the folks at the TBCE have become well thought of friends and colleagues now that I’ve been active in the Texas Chiropractic Association for so many years. Not the case at the time though. I only knew one of them back then. Even though there’s been a turnover since this happened many moons ago, I’m still friends with even the new TBCE crew and they’re all highly respected and thought of by me. Good good people just trying to do a good job. 

Anyway, We’re going to go through some papers here for you so you can get a clear picture on this topic. 

Item #1

OK, Item #1 this week is called “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study” by McMorland, et. al. publshed in the Journal of Manipulative Physiological Therapeutics in October of 2010(McMorland G 2010). 

Why They Did It

The purpose of this study was to compare the clinical efficacy of spinal manipulation against microdiskectomy in patients with sciatica secondary to lumbar disk herniation (LDH).

How They Did It

  • 121 patients were in the study
  • Patients had to have failed at least 3 months of nonoperative management like analgesics, lifestyle modification, physiotherapy, massage, or acupuncture. 
  • They were randomized to either surgical microdiskectomy or standardized chiropractic spinal manipulation
  • Patients could opt to crossover to the other treatment after 3 months

What They Found

Significant improvement in both treatment groups compared to baseline scores over time was observed in all outcome measures. After 1 year, follow-up intent-to-treat analysis did not reveal a difference in outcome based on the original treatment received

Wrap It Up

“Sixty percent of patients with sciatica who had failed other medical management benefited from spinal manipulation to the same degree as if they underwent surgical intervention. Of 40% left unsatisfied, subsequent surgical intervention confers excellent outcome. Patients with symptomatic LDH failing medical management should consider spinal manipulation followed by surgery if warranted.”

Who does this not make perfect sense to? Well….besides my patient’s daughter that is? Oh, and just about any medical physician you can find. I just don’t know how they haven’t latched onto this research yet. Honestly. 

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

Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.

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

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

Item #2

This is a great one here called “Outcomes From Magnetic Resonance Imaging–Confirmed Symptomatic Cervical Disk Herniation Patients Treated With High-Velocity, Low-Amplitude Spinal Manipulative Therapy: A Prospective Cohort Study With 3-Month Follow-Up” by Peterson et. al. published in the Journal of Manipulative and Physiological Therapeutics in August of 2013(Peterson C 2013). 

Why They Did It

The purpose of this study was to investigate outcomes of patients with cervical radiculopathy from cervical disk herniation (CDH) who are treated with spinal manipulative therapy.

How They Did It

  • 50 Adult Swiss patients with neck pain and dermatomal arm pain; sensory, motor, or reflex changes corresponding to the involved nerve root; and at least 1 positive orthopaedic test for cervical radiculopathy were included.
  • Magnetic resonance imaging–confirmed CDH linked with symptoms was required.
  • Baseline data included 2 pain numeric rating scales (NRSs), for neck and arm, and the Neck Disability Index (NDI). At 2 weeks, 1 month, and 3 months after initial consultation, patients were contacted by telephone, and the NDI, NRSs, and patient’s global impression of change data were collected
  • High-velocity, low-amplitude spinal manipulations were administered by experienced doctors of chiropractic.
  • Acute vs subacute/chronic patients’ NRSs and NDIs were compared using the Mann-Whitney U test.

What They Found

  • At 2 weeks, 55.3% were “improved,” 68.9% at 1 month and 85.7% at 3 months.
  • Statistically significant decreases in neck pain, arm pain, and NDI scores were noted at 1 and 3 months compared with baseline scores
  • Of the subacute/chronic patients, 76.2% were improved at 3 months.

Wrap It Up

Most patients in this study, including subacute/chronic patients, with symptomatic magnetic resonance imaging–confirmed CDH treated with spinal manipulative therapy, reported significant improvement with no adverse events.

Item #3

This one is from Bergmann, et. al. and published in the Journal of Manipulative and Physiological Therapeutics in 1998 called “Manipulative therapy in lower back pain with leg pain and neurological deficit.(Bergmann TF 1998)”

Why They Did It

To discuss a case of sciatica associated with lower back pain that originates in a disc. We discuss the use of manipulative therapy as a conservative approach and compare it with other conservative methods and with surgery.

How They Did It

  • The patient suffered from lower back and left leg pain that had increased in severity over a 6-day period. There was decreased sensation in the dorsum of the left foot and toes. Computed tomography demonstrated the presence of a small, contained disc herniation.
  • The patient was initially treated with ice followed by flexion-distraction therapy. This was used over the course of her first three visits. Once she was in less pain, side posture manipulation was added to her care. Nine treatments were required before she was released from care.

Wrap It Up

“We need a nonsurgical, conservative approach to treat lower back pain with sciatica as an alternative to and before beginning the more aggressive, and potentially hazardous, surgical treatment. There is some support for the idea that lumbar disc herniation with neurological deficit and radicular pain does not contraindicate the judicious use of manipulation. there is ample evidence to suggest that a course of conservative care, including spinal manipulation, should be completed before surgical consult is considered.”

Item #4

The last one we’ll cover here is called “Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study” by Shokri et. al and published in Chiropractic and Manual Therapies in May of 2018(Shokri E 2018).

Why They Did It

To investigate the effect of lumbar and sacroiliac joint (SIJ) manipulation on pain and functional disability in patients with lumbar disc herniation (LDH) concomitant with SIJ hypomobility.

How They Did It

  • Twenty patients aged between 20 and 50 years with MRI-confirmed LDH who also had SIJ hypomobility participated in the trial in 2010.
  • Patients who had sequestrated disc herniation were excluded
  • All patients received five sessions of spinal manipulative therapy (SMT) for the SIJ and lumbar spine during a 2-week period. 
  • back and leg pain intensity and functional disability level were measured with a numerical rating scale (NRS) and the Oswestry Disability Index (ODI) at baseline, immediately after the 5th session, and 1 month after baseline.

What They Found

A significantly greater mean improvement in back and leg pain was observed in the 5th sessions and 1 month after SMT

Wrap It Up

Five sessions of lumbar and SIJ manipulation can potentially improve pain and functional disability in patients with MRI-confirmed LDH and concomitant SIJ hypomobility.

There are more but I don’t want this episode to be an hour long. If I have a patient with a hot disc, I don’t typically adjust on day one. We focus on getting the patient moving. We sit them on a theraball and have them move their hips in circles, front to back, side to side, figure eights, and whatever other way we can think of. Most have a direction of preference that is in trunk extenstion. If this is right for the patient, we will do extension bias exercises. 

We make sure they are keeping their low back nice and stiff, neutral, and strong in every movement they make. We make sure they know what position to sleep in. We stress the importance of not laying down and hoping it goes away. Rather than that, they really need to be walking and doing the exercises. If they have people that just underwent surgery walking the next day, then doesn’t that same concept make sense for discs? Well of course it does. They typically come back the next day with the pain reduced enough to be able to do some light mobilization on the low back. I am careful to not be agressive and to not put an extreme amount of rotation into the spine. We want movement but we also want the spine as straight, strong, and neurtal as possible. 

Make sure you have schooled them on this concept. Tell them to make sure they behave like they have a long flourescent light bulb taped to their back and their job is to not break it. If you can remove the triggers that caused the pain, it’ll go a long way toward their recovery. 

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

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

Key Takeaways

Store

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

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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. 

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

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About the Author & Host

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

 

Bibliography

  • Bergmann TF, J. B. (1998). “Manipulative therapy in lower back pain with leg pain and neurological deficit.” J Manipulative Physiol Ther 21(4): 288-294.
  • McMorland G (2010). “Manipulation or microdiskectomy for sciatica? A prospective randomized clinical study.” J Manipulative Physiol Ther 33(8): 576-584.
  • Peterson C, e. a. (2013). “Outcomes from magnetic resonance imaging — confirmed symptomatic cervical disk protrusion patients treated with high-velocity, low-amplitude spinal manipulative therapy: a prospective cohort study with 3-month follow-up.” J Manipulative Physiol Ther 36(8): 461-467.
  • Shokri E, K. F., Sinaei E, Ghafarinejad F, (2018). “Spinal manipulation in the treatment of patients with MRI-confirmed lumbar disc herniation and sacroiliac joint hypomobility: a quasi-experimental study.” Chiropr Man Therap 26(16).

 

 

Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry?

CF 134: Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry?

Today we’re going to talk about  Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry?  But first, here’s that sweet sweet bumper music
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  OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our Facebook page, 
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  • 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 #134 Now if you missed last week’s episode, we talked about getting patients back to your office during COVID, shoulder impingement, cervical manipulation, and x-rays and neurodegenerative disease. That one was FULL of great information. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I’ve been holding pretty steady at 80-85% of where I’d like to be in my practice. While that’s frustrating, it’s also 100% understandable and patience has to kick in and we must simply wait it out. I am an eternal optimist. Or at least I try to be. I think it’s important.  For example, we are making less money BUT we are also spending less money. Not only in my office in overhead but also at home. We’re not taking trips or going and doing. We’re not eating out like we did this time last year. So, not as much money is required. We are more than meeting our monthly bills.  If I really take a step back and look at it from a macro view, life is good. I have a bit of extra time to do the things I need to do outside of patient treatment and, due to less spending, a decrease in income isn’t as significant as it would have been.  It’s not fun. Don’t get me wrong. Nobody that is an achiever wants to take a step back at any time. For me, it’s pedal to the metal man. Constant and sustained growth. So, even though there are legitimate reasons, it doesn’t matter. It’s still a hit to the heart to see your business shrink.  But, again, being an optimist is helpful. It’s going to be alright. I asked for some recommendations in our private Facebook group about how to get your patients to return to your offices during the COVID freakout. Dr. Jerome Fryer with Dynamic Disc Designs had a great suggestion. He said, “Do a walk through video…showing the safety measures exacted. Personalized and live. Share it to your email list and social followers.” That’s a great suggestion. While I was going through all of the things I am doing on last week’s episode, I mentioned how in marketing, our job is to remove all barriers to saying, ‘Yes.’ Well, COVID is the biggest barrier we face at this time so we have to remove that barrier. We aren’t epidemiologists so we won’t be coming up with any treatments or vaccines of course.  So, the way we can remove that barrier as much as possible is to show the safety measure we are taking. Talk about it, video it, demonstrate it. And let your patients see you cleaning while they’re in the office. Those coming to see you already will feel even that much more comfortable with your office when they see you taking steps to keep them and others safe.  Remove the barriers to saying yes.  Alright, let’s dive in Item #1 Let’s start though with this one here called “Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality” It was authored by Wang et. al.(Wang Y 2020) and appeared in JAMA on May 22 of 2020 and dammit that’s a blazing barrel of biscuits my friends.  Why They Did It The authors wanted to know if there were any longitudinal patterns of habitual sleep duration associated with the subsequent risk of cardiovascular events and all-cause mortality. How They Did It
  • This was a cohort study that included 52 599 participants 
  • 4 distinct sleep duration trajectories reported during a 4-year interval were identified.
  • Compared with a stable sleep duration of 7.0 to 8.0 hours per night, normal-decreasing and low-increasing patterns were associated with increased risk of first cardiovascular events and all-cause mortality
  • individuals reporting consistently sleeping less than 5.0 hours per night had the highest risk
Wrap It Up In this study, sleep duration trajectories with lower or unstable patterns were significantly associated with increased risk of subsequent first CVEs and all-cause mortality. Longitudinal sleep duration patterns may assist in more precise identification of different at-risk groups for possible intervention. People reporting consistently sleeping less than 5 hours per night should be regarded as a population at higher risk for CVE and mortality. Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument-assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.  Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively.  This greatly reduces the time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Its inventor, Dr. Chris Howson, from the great state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.  Go check out Drop Release at droprelease.com and tell Dr. Howson I sent you.  Item #2 Item #2 is one I got from Dr. David Wedemeyer who resides out in Costa Mesa, California. I have no idea how I didn’t know about this one already.  It’s called “How can chiropractic become a respected mainstream profession? The example of podiatry” by Donald Murphy, et. al.(Murphy D 2008) and published in Chiropractic Osteopathy in 2008.  Why They Did It The chiropractic profession has succeeded to remain in existence for over 110 years despite the fact that many other professions that had their start at around the same time as chiropractic has disappeared. Despite chiropractic’s longevity, the profession has not succeeded in establishing cultural authority and respect within mainstream society, and its market share is dwindling. In the meantime, the podiatric medical profession, during approximately the same time period, has been far more successful in developing itself into a respected profession that is well integrated into mainstream health care and society. The objective here was to present a perspective on the current state of the chiropractic profession and to make recommendations as to how the profession can look to the podiatric medical profession as a model for how a non-allopathic healthcare profession can establish mainstream integration and cultural authority. We suggest the chiropractic profession consider several questions that speak to the different histories of the chiropractic and podiatric profession. Why are podiatrists better integrated into hospitals and other multidisciplinary facilities than chiropractors? Why are most schools of podiatry integrated into the university system, while chiropractic schools (with very few exceptions) are not?  Why did the AMA not try to “contain and eliminate” the podiatric medical profession (despite the several turf battles podiatry has had with the orthopedic specialty)? Why were podiatrists not thrown in jail in the early days for practicing medicine without a license? How did podiatrists gain the level of cultural authority that they currently enjoy, despite having the same duration of existence and a smaller number of practitioners than chiropractic? Discussion One important reason podiatry succeeded in establishing itself in mainstream health care was its traditional dedication to public health. Podiatrists became active members of the American Public Health Association (APHA) as far back as the 1950s, embracing and contributing to the advancement of accepted public health initiatives, in cooperation with others involved in public health. Podiatrists slowly gained an image as proponents of public health, at a time when many chiropractors aggressively (and dogmatically, without evidence opposed many public health measures such as vaccination and water fluoridation.  One immediate action step that individual chiropractic physicians can make is to join and become active in the APHA. This would be one of the best ways for chiropractors to have an influence on public health policy. Spinal pain is an enormous public health issue, as the vast majority of Americans will develop a painful back or neck that will require treatment sometime in their lives It is also vital that those chiropractors who dogmatically oppose common public health practices, such as immunization and public water fluoridation, cease such unfounded activity. Authors say they are concerned that the common perception (which is well supported, in our experience) that chiropractors are only interested in “selling” a lifetime of chiropractic visits may be one of the primary factors behind our low standing in the minds of members of the public. This is supported by a Canadian study which found that when the public was educated about “subluxation”, the cornerstone of many chiropractors’ “lifetime treatment plans”, members of the public actually developed a negative view, and were more likely to want to consult a medical doctor to see if they had a subluxation prior to seeing a chiropractor  They say that we chiropractors must take a critical look at our educational institutions, find what is substandard, and correct those deficiencies. One of the problems that we encounter frequently in our interaction with chiropractic educational institutions is the perpetuation of dogma and unfounded claims. Examples include the concept of spinal subluxation as the cause of a variety of internal diseases and the metaphysical, pseudo-religious idea of “innate intelligence” flowing through spinal nerves, with spinal subluxations impeding this flow.  These concepts are lacking in a scientific foundation and should not be permitted to be taught at our chiropractic institutions as part of the standard curriculum. Much of what is passed off as “chiropractic philosophy” is simply dogma, or untested (and, in some cases, untestable) theories which have no place in an institution of higher learning, except perhaps in a historical context.  Faculty members who hold to and teach these belief systems should be replaced by instructors who are knowledgeable in the evidence-based approach to spine care and have adequate critical thinking skills that they can pass on to students directly, as well as through teaching by example in the clinic. They say consideration should also be given to upgrading admission requirements to chiropractic schools. In podiatric medicine, such upgrading, which included the requirement of the Medical College Admission Test (MCAT), a requirement of medical school admission, is considered one of the significant events in the profession’s history, giving the profession legitimacy in its calls for parity with medicine Continuing with education, they say it is essential that the chiropractic profession establish hospital-based residencies. There is a tremendous void in how chiropractic graduates develop any meaningful hands-on clinical experience with real patients in real-life situations. Perhaps the most important factor that helped the podiatric medical profession to flourish was the fact that podiatrists had a clear identity and purpose; the podiatric medical profession was founded on the purpose of filling a need in society – the care of problems of the foot. They did not invent a “lesion” and a “philosophy” and try to force it on the public. They certainly did not claim that all disease arose from the foot, without any evidence to support this notion The podiatric medical profession focused on a particular set of problems for which allopathic medicine had little interest and a limited ability to deal with effectively, i.e., common foot disorders The chiropractic profession must establish a clear identity and present this to society. In the beginning, DD Palmer invented a lesion, and theory behind this lesion, and developed a profession of individuals who would become champions of that lesion. This is not what credible professions do. Based on all the evidence regarding chiropractic practice and education, there is only one societal need (but it is a huge one) that chiropractic medicine has the potential to meet: non-surgical spine care. Our education and training is focused on the spine, and clearly, if there is a common bond among all chiropractors, it is spine care No matter how one looks at it, or what one would like reality to be, chiropractic medicine is about back pain, neck pain, and headache. Instead of fighting that fact (or denying it), we should embrace it fully and focus on becoming society’s go-to profession for disorders in this area. The World Federation of Chiropractic (WFC) has taken an important step in establishing a clear identity for chiropractors as “The spinal health care experts in the health care system”. It is critical that other state, provincial and national associations follow the lead of the WFC. Fidelity to the social contract. They say when an individual consults a member of any of the medical professions, it is reasonably expected that the advice and treatment that he or she receives is based in science, not metaphysics or pseudoscience. In addition, it is reasonably expected that the services he or she receives are being provided for the primary purpose of benefiting the patient, and not for any other reason.  The financial benefit to the professional is secondary and results from the degree of the clinical benefit received by the patient. Patients place their faith in the professional, and trust that they will not be subject to fraud, abuse, or quackery. This is the social contract as it applies to chiropractic physicians. Oh, how many times has my audience heard me railing against doctor-centered, clinic-centered practices? Just in the last month or so actually. Lol.  We feel it is important here to briefly contrast and compare podiatry and foot reflexology. While the two professions have always been distinct, there is a commonality in that each focuses its treatment efforts on the foot; however, this is where any resemblance between the two professions ends. Podiatric medicine is a science-based profession dedicated to the diagnosis and treatment of foot disorders. Foot reflexology is a metaphysically-based group consisting of non-physicians who believe that many physical disorders arise from the foot. Podiatrists have rejected foot reflexology as an unproven and unscientific practice, and do not consider it part of mainstream podiatric practice. Thus, it would be quite unreasonable to think that podiatry and foot reflexology could ever exist under one professional roof. Yet, this is the very untenable situation in which we find ourselves in the chiropractic profession. Chiropractic has frequently been described as being two professions masquerading as one, and those two professions have attempted to live under one roof.  One profession, the “subluxation-based” profession, occupies the same metaphysical and pseudoscientific space as foot reflexology. The other chiropractic profession – call it “chiropractic medicine” as we do in this commentary – has attempted to occupy the same scientific space as the podiatric profession.  Alas, the marriage of convenience between these two chiropractic professions living under one roof has not worked. We find science-based practitioners and organizations alongside quasi-metaphysical, pseudoreligious, pseudoscientific practitioners, and organizations.  The result is continually battling with a huge waste of energy and resources, while professional growth stagnates. We must finally come to the painful realization that the chiropractic concept of spinal subluxation as the cause of “dis-ease” within the human body is an untested hypothesis. It is an albatross around our collective necks that impedes progress. Wrap It Up “The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected, and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise.” I could add my own thoughts here but listeners of the show know what I think about it. I agree with every word and I bitch and fuss and get in a huff about this stuff all of the time.  I don’t know that getting in a huff all of the time is useful or helpful. I think it lessens my outrage if I’m outraged all of the time. So, I’m settling down here lately. I want to make points but not in a truly negative sense.  I want to disagree without being disagreeable. That’s not to say I’m not going to lose my marbles here and there. I will. This profession provides so many opportunities for lost marbles, It’s something you can count on. But, I’d like for the lost marbles to be fewer and farther between with more building rather than breaking. If that makes sense.  Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com. 
Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography
  • Murphy D, S. M., Seaman D, Perle S, Nelson C, (2008). “How can chiropractic become a respected mainstream profession? The example of podiatry.” Chiropr Osteopat 16(10).
  • Wang Y, W. J., Chen S, (2020). “Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality.” JAMA Open 3(5).

Getting Patients Returning, Shoulder Impingement, Cervical Manipulation, & X-rays and Neurodegenerative Disease

CF 133: Getting Patients Returning, Shoulder Impingement, Cervical Manipulation, & X-rays and Neurodegenerative Disease Today we’re going to talk about getting your patients back in your office, we’ll talk about shoulder impingement, cervical manipulation research, and we’ll talk about low dose x-rays being the cause of neurodegenerative disease.  But first, here’s that sweet sweet bumper music  

Chiropractic evidence-based products

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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 #133 Now if you missed last week’s episode, we talked about giving, we talked about maintenance care, dry needling, and we also talked about vitalism.

Make sure you don’t miss that info. Keep up with the class. 

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

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

 

On the personal end of things….. The last two episodes have had a talk about vitalism and all of that. I got red in the face and gripey and some would even say…..disagreeable.  None of that this week. Fun and positivity. I made the mistake of going back to recording the personal part of the podcast….this part of the podcast….two weeks in advance. Well, it bit me in the butt an episode or two back. I should know by now that that damn COVID’s going to change the program. Lol. I said it was looking good and numbers were great and by the time we get to air time, 2 weeks down the road, the roadmap was different and crap was firing up everywhere again.

It sounded silly for it to be firing up everywhere and there I am on a fresh episode talking about how good it’s looking. Lol. So…..I’m not going to mention anything like that again.  Besides, you guys are probably not in the mood to hear more about it anyway. Instead, I’ll tell you that I’m at about 81% of where I want to be. The least I want to see per week is about 180 appointments. Each week. 13 – 15 new patients per week. That’s the LEAST I want to see.  As of this recording, last week I saw 146 and 15 patients.

So, I’m not at 180 yet but I’m more comfortable with my new patient count. Let’s keep that rocking and the other numbers should take care of itself sooner than later. It’s a Monday afternoon and I have 120 on the books. That’s before Wednesday gets booked up, Thursday, and Friday. So, starting a Monday with 120 already booked for the week, that tells me we have a good chance at a continued recovery.  What are your numbers looking like? Is your practice starting to get back to normal and stabilize?

What are you doing to make sure your business survives this mess? I want to hear about it so I can share it with our audience. If you’ll share with us on the Facebook page, in the Facebook group, or by sending me an email at [email protected]…..I’ll make sure and share with the rest of our listeners. This can be an excellent way to help others that are struggling right now.  Last week I talked about giving. Well, this is a great way to give back to your profession and colleagues that may not be doing as well as we are.  I’ll start.  I doubled down on Social Media Instead of one post a day, we went to 3 per day and 4 per day on the weekends.  We went from just talking about chiropractic to fun posts with a little bit of chiropractic here and there.

About every 4th or 5th post.

We want to entertain. I don’t know that anyone wants to be sold anything right now but, I don’t personally mind commercials or being interrupted if I’m simultaneously being entertained. So that’s what we did. We started entertaining our crowd We asked for people to help us by inviting their friends to our page. And they did! We hit numbers that would have taken us 3 years to build. We hit them in only about 4 days. I was amazed. Just because we asked and, it seems that at this time, more people are willing to help others.  Of course, that’s if they’re not bitching at each other about masks.  I got back to my weekly emails to my patients.

I had fallen off to emailing only once every 3-4 weeks. Now I’m back on a weekly schedule.  I revamped my To-Do list to include everything thing that I need to accomplish every day so I don’t forget or let things lapse. I want to stay on point with getting our message out every day, every week, every month.  I decided to try a professional company for Facebook ads. We still have a lot of really mixed results on that sucker right now so I haven’t talked much about it but I’ll let you know how we do down the road. 

In the meantime, as if I needed something else to occupy my time, I started a voice-over career on the side. Lol. To go along with my sculpting, drawing, and art career. To go along with my furniture building career. Which will go along nicely with my singer/songwriter/guitar-playing career?  Geez….is that the very definition of A.D.D. or what? But yeah, if you need any commercials voiced for you, holler at me. I’m happy to help. 

Back to the office, I got back to doing weekly YouTube videos. Every week like clockwork. That made me get back to writing my own weekly blog. That’s work I used to hire out to a guy in South Africa but I took it back over for a bit and it’s been fun actually.  So, as you can see, I’ve made A LOT of changes to get back on track and get this sucker not just where it was this time last year, but 10% or bigger. Why the hell not? Overall, I have made it a point to highlight what we are doing to help keep them as safe as we can. If COVID is the barrier, then we need to do everything we can to remove that barrier. 

Alright, as I said, you guys and gals send me your suggestions of things you are doing to get your patients back in your clinic. 

Item #1 This first one this week is called ‘Relationship between shoulder impingement syndrome and thoracic posture’ by Hunter et. al.(Hunter D 2020) and published in Physical Therapy journal in April of 2020 and that means that that is one hot son of a mother!!

Why They Did It They say that shoulder impingement is the most common form of shoulder pain and a persistent musculoskeletal problem and that we have had limited success in treating it. They wanted to test whether or not thoracic posture has anything to do with it. 

How They Did It

  • This was a case-control study. 
  • Thoracic posture of 39 participants with shoulder impingement was measure using the modified Cobb angle from a lateral x-ray. 
  • They accounted for age, gender, and dominant arm
  • T-sp range of motion was measured with an inclinometer

What They Found

  • Individuals with shoulder impingement had greater thoracic kyphosis and less active thoracic extension
  • Greater thoracic kyphosis was associated with less extension ROM

Wrap It Up “Individuals with shoulder impingement had a greater thoracic kyphosis and less extension ROM than age- and gender-matched healthy controls. These results suggest that clinicians could consider addressing the thoracic spine in patients with shoulder impingement.”

Item #2 Item #2 this week is called “The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review” by Giacalone et. al.(Giacalone 2020) published in Cureus in April of 2020 which makes it too hot to handle for me!

Why They Did It They say that cervical manipulative techniques are mostly used for the treatment of biomechanical joint dysfunction, but little is known about possibly using them in order to achieve better performance on a healthy subject

How They Did It

  • A systematic search was carried out on the Pubmed electronic database from the beginning of January to March 2020.
  • Two independent reviewers conducted the screening process through the PRISMA diagram to determine the eligibility of the articles.
  • The inclusion criteria covered randomized controlled trial (RCT) manuscripts published in peer-reviewed journals with individuals of all ages from 2005 to 2020.
  • The included intervention was thrust manipulation or HVLA directed towards the cervical spine region. 
  • After reviewing the literature, 21 of 74 articles were considered useful and relevant to the research question.

What They Found

  • HVLA techniques, on subjects with musculoskeletal disorders, are able to influence pain modulation, mobility, and strength both in the treated area and at a distance.
  • Cervical manipulations are effective in the management of cervicalgia, epicondylalgia, temporomandibular joint disorders, and shoulder pain.
  • With regard to results on strength in healthy subjects, given the divergent opinions of the authors, we cannot yet state that manipulation can significantly influence this parameter.

Item #3 Our last one is called ‘Low-dose x-ray imaging may increase the risk of neurodegenerative diseases’ by Caroline Rodgers(Rodgers C 2020) and published in Medical Hypotheses in April of 2020…..look at April…..not just bringing us COVID…but also bringing us a bunch of plates of steamy hot stuff. 

As the journal says, this is a hypothesis. The hypothesis presented in this paper explores the possibility that X-ray imaging commonly used in dental practices may be a shared risk factor for sporadic dementias and motor-neuron diseases. As the evidence will suggest, the brain is ill-equipped to manage the intrusion of low-dose ionizing radiation (IR) beyond that which is naturally occurring.

When the brain’s antioxidant defenses are overwhelmed by IR, it produces an abundance of reactive oxygen species (ROS) that can lead to oxidative stress, mitochondrial dysfunction, loss of synaptic plasticity, altered neuronal structure and microvascular impairment that have been identified as early signs of neurodegeneration in Alzheimer’s disease, Parkinson’s, amyotrophic lateral sclerosis, vascular dementia and other diseases that progressively damage the brain and central nervous system.

Common assumptions regarding the risks of low-dose IR will be addressed, such as 1) comparing rapid, repeated bursts of man-made IR sent exclusively into the head to equivalent amounts of head-to-toe background IR over longer periods of time; 2) whether epidemiological studies that dismiss concerns regarding low-dose IR due to lack of evidence it causes cancer, heritable mutations or shortened life spans also apply to neurodegeneration; and 3) why even radiation-resistant neurons can be severely impacted by IR exposure, due to IR-induced injury to the processes they need to function. 

If X-ray imaging is found to be associated with neurodegeneration, the risk-versus-benefit must be reevaluated, every means of reducing exposure implemented and imaging protocols revised. So…..we here at Chiropractic Forward will be following along here. Because if this turns out to confirm that radiation causes neurodegenerative disease, you know what that means for the chiropractors shooting x-rays on each and every patient and then doing several follow up x-rays on them?  They won’t be happy campers. But, maybe they’ll start following more guidelines that say no x-rays outside of red flags. I’ve said several times that I’m not against chiropractors that shoot initial x-rays. I’m really not.

Some are just more comfortable working on people when they’ve seen what they can see.  My issue is using the initial x-rays as a scare tactic and communicating in a catastrophic way to achieve a long treatment schedule out the patient. One they likely don’t need at all.  My other issue would be repeating x-rays several times through treatment.

That’s not evidence-based and the patient doesn’t need them. 

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. 

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

Bibliography Giacalone A, F. M., Magnifica F, Ruberti E, (2020). “The Effect of High Velocity Low Amplitude Cervical Manipulations on the Musculoskeletal System: Literature Review.” Cureus 12(4): e7682. Hunter D, R. D., McKeirnan S, (2020). “Relationship Between Shoulder Impingement Syndrome and Thoracic Posture.” Phys Ther 100(4): 677-686. Rodgers C (2020). “Low-dose X-ray Imaging May Increase the Risk of Neurodegenerative Diseases.” Med Hypotheses 142(109726).