jeff williams

Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain

CF 195: Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain Today we’re going to talk about spinal manipulative therapy vs. opioid therapy for Medicare-aged patients and we’ll talk about young elite pitchers, their hips, and pain. Stick around.  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s 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 #195 Now if you missed last week’s episode , we talked about Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

On the personal end of things, we just got back from Washington DC. It was a go go go whirlwind kind of thing that every single American needs to experience. It’s powerful. The buildings were meant to inspire and awe and intimidate foreign leaders. So what do you think they do to regular ol commoners like me and you? Pretty impressive. Even if you dislike most politicians like I dislike most politicians. Day 1 was getting there.

We got up at 4:00am to get to the 6 am flight. Got to DC by 1:30. Hopped onto the metro and boom, we’re at the hotel. If you’ve never experienced the DC Metro, hell that is reason enough to go all by itself. It’s a work of art and I’m constantly fascinated by it. You can go just about anywhere you want easily and in no time with no traffic. That doesn’t mean there no walking involved though. Bring a pair of walking shoes my friends. The first full day we logged over nine miles. The second full day was about 8 and a half miles. Same on the third. Bout 5-6 miles on the fourth day.  Unless you’re doing the bus tours and all, you’re in fir walking. Plain and simple. I’m always good for 5-6 miles. 9-10 in a day is a bit more than I want. I can do it, but it’s damn sure extra. But, we saw the Lincoln Memorial, WWII memorial, Vietnam Wall, Washington monument, White House, Capitol, air and space museum, natural history museum, American history museum, national art gallery with this hemisphere’s only Da Vinci painting, Mt Vernon, Arlington National Cemetery and the changing of the guard, Old Town Alexandria, and much much more.

It was a go-cation and I’m glad to be back home so I can sleep and get some rest. It’s bad when going to work is a vacation from your vacation.

Professionally, just getting into the swing of things with our Nurse Practitioner. He’s catching on slowly but surely. It’s happening. Never fast enough. But I see it happening. We’re also getting into the swing of things with our Parker Intern.  He’s a good guy. Seems to be a smart guy and seems to click right along with everything we do so all’s well there. It’s been fun teaching him. So, I’m still playing catch-up from being gone so let’s hop in.

Item #1

This first one is called “Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain among Older Medicare Beneficiaries”’ by Whedon et. al. (Whedon JM 2021) and published in Spine Journal on May 11 of 2021. Schiza!!! Es Caliente!  I just combined German and Spanish. Please make note. And recognize. 

Why They Did It

The objective of this study was to compare long-term outcomes for Spinal Manipulative Therapy (SMT) and Opioid Analgesic Therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP).

How They Did It

  • They combined elements of cohort and crossover-cohort design.
  • They examined Medicare claims data spanning a five-year period. 
  • They included older Medicare beneficiaries with an episode of cLBP beginning in 2013. 
  • They analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP.

What They Found

  • SMT was associated with lower rates of escalation of care as compared to opioid Analgesic Therapy. 
  • The adjusted rate of escalated care encounters was approximately 2.5 times higher fi the initial choice of care was opioid analgesic therapy vs. if the initial choice was SMT

Wrap It Up

Among older Medicare beneficiaries who initiated long-term care for cLBP with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher as compared to those who initiated care with spinal manipulative therapy

Item #2

I want to thank my friends at ChiroUp for finding this one. They’re always on top of it at ChiroUp. Don’t forget to use my code, Williams15 if you want to sign up with them for a discount! Number 2 this week is called, “Restriction in the hip internal rotation of the stride leg is associated with elbow and shoulder pain in elite young baseball players” by Sekiguchi et. al. (Sekiguchi T 2019) and published in the Journal of Shoulder and Elbow Surgery in September of 2019. Ahhhh the days of pre-pandemic. 

Why They Did It

Evidence is scarce concerning the relationship of physical dysfunction of the trunk and lower extremities with elbow and shoulder pain in young baseball players. This study aimed to examine the association of joint flexibility of the trunk and lower extremities and dynamic postural control with elbow and shoulder pain among elite young baseball players.

How They Did It

  • They analyzed baseball players (aged 9-12 years) who participated in the National Junior Sports Clubs Baseball Festival. 
  • Range of motion in external rotation and internal rotation (IR) of the hip, as well as the finger-to-floor distance and heel-to-buttock distance, was measured. 
  • The straight-leg-raise test was also conducted. 
  • Dynamic postural control was evaluated using the Star Excursion Balance Test. 
  • Multivariable logistic regression analyses were conducted to examine the association of physical function with the elbow or shoulder pain incidence.
  • Of 210 players surveyed, 177 without elbow or shoulder pain were included in the analysis.

What They Found

  • Of the participants, 16 (9.0%) reported having elbow or shoulder pain during the tournament. 
  • Participants with the incidence of elbow or shoulder pain had a significant restriction in hip IR of the stride leg compared with those without pain 
  • There were no significant associations of other joint flexibilities and the Star Excursion Balance Test with elbow or shoulder pain.

Wrap It Up

  • Decreased hip IR range of motion of the stride leg was significantly associated with the elbow or shoulder pain incidence. 
  • Players, coaches, and clinicians should consider the physical function of the trunk and lower extremities for the prevention of elbow and shoulder pain.
  • Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen.

Alright, that’s it for this week. Y’all go out and piss some excellence. Get involved in your state association and the ACA. Our profession needs evidence-based, patient-centered chiropractors driving the ship. So get in, get involved, and make the profession what you will.  Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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  The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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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

Sekiguchi T, H. Y., Yabe Y, Tsuchiya M, Itaya N, Yoshida S, Yano T, Sogi Y, Suzuki K, Itoi E (2019). “Restriction in the hip internal rotation of the stride leg is associated with elbow and shoulder pain in elite young baseball players.” J Shoulder Elbow Surg 29(1): 139-145.  

Whedon JM, K. A., Toler AW, Bezdjian S, Rossi D, Uptmor S, MacKenzie TA, Lurie JD, Hurwitz EL, Coulter I, Haldeman S, (2021). “Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain among Older Medicare Beneficiaries.” Spine (Phila Pa 1976).        

Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic

CF 194: Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic Today we’re going to talk about how lumbar fusion compares to no surgery, we’ll talk about a 30 year study on discs, and we’ll talk about PT vs. Chiro  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s 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 #194 Now if you missed last week’s episode , we talked about patellofemoral pain, sleep for pain, and physical disuse. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. OOOWEEEE…..If you’ve been listening, you know I’ve been goind through my second fellowship program. This second one is the Forensics fellowship. Several hours are taken on ChiroCredit. There’s a 20 hour course on the AMA Guides on Impairment. And there’s a 20 live course I’ll be doing to wrap this dude up. It’s in Chicago in October. Then I’m done.  Then, I can turn my full attention to making our new Nurse Practitioner famous locally, making sure our Parker intern is set up for success, and getting life back to some sense of normal.  I got the COVID booster shot last week and am headed to Washington DC for the Labor Day weekend. This will probably air just after I get back so updates on the scene in DC on the next episode. Hopefully the covid resurgence hasn’t made the experience a soup sandwich. We shall see.  I was 8 months out from when I got the vaccine. The booster came from a nurse practitioner friend of mine. The first shot I got back in December……I felt nothing at all. The second shot 23 days after that, my arm got sore. That’s it. Nothing else at all. This booster shot, my arm got sore as expected. I got it on a Thursday afternoon. She brought it over here to my clinic and gave it to us. Because she’s super sweet and more than awesome.  I went to work on Friday. I had almost 40 patients between 8 am and 1 pm and, while I didn’t necessarily struggle, I didn’t love life that day. I was tired. I really wanted to be in bed pretty much. I didn’t feel absolutely awful or anyhting like that. I just didn’t feel particularly good and didn’t really want to be here in the clinic, answering the same questions we always answer, and acting like I felt great and was a happy happy dude when all I really wanted was to just be in bed taking a nap.  Then I did go home and take a nap after work. I slept for a couple of hours and woke up feeling much better.  Then I woke up the next day and felt great again. No issues. All back to normal. People act like we are sheeple if we get it. Like we are the experiment. Maybe we are. I don’t give a damn. I have a thriving, successful practice with no partner or associate to fill the gap if I get sick and have to stay home.  First of all, I like feeling good. I don’t want to be sick. If I can do something that the data shows clearly prevents the virus and/or severe illness from the virus, I’m going to do it. When your clinic bills what mine bills each month, and you don’t care at all about losing that income for 2-4 weeks…..maybe a lot more than that…..then you can call me names. You can call me an experiment.  For me, I’m making smart business decisions. Not to mention the fact that after millions and millions of vaccinations globally with very few issues, I’m a hell of a lot more concerned about a proven killing and/or long-term debilitating virus like COVID than I am the vaccine.  So, my opinions and what’s right for me may not be right for you annd that’s OK. But I’ll be damned if anyone is going to act smarter, wiser, or more high and mighty than I because I got a freaking vaccine. Those that behave that way can straight up stick it in your ear or whatever other place you can think of.  On the other hand, if you got the vaccine, don’t be a jackhole if someone you know doesn’t want it. It’s new. People are scared of it. They’ve been misled in many situations. They’ve been misdirected on social media. It is what it is. You do you. Let’s all do us and realize we share this space. I’d a lot rather see disagreement with an undercurrent of love instead of disagreement with a smoggy fog of hate and disdain.  It’s 2021. Let’s all grow up and evolve.  Item #1 This first one this week is called, “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis” by Xu et. al. (Xu W 2021) and published in World Neurosurgery in February of 2021….hot mama, stand back.  Why They Did It They wanted to evaluate the efficacy and safety of lumbar fusion versus nonoperative care for the treatment of chronic low back pain associated with degenerative disk disease. How They Did It

  • A comprehensive search for papers was done in PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure  up to June 30, 2020. 
  • The main outcomes including clinical results, complications, and all-cause additional surgeries were presented in the form of short- and long-term follow-up results. 
  • Six prospective studies involving 159 patients for short-term follow-up and 675 for long-term follow-up were included

What They Found The 2 interventions exhibited little difference in regard to short- and long-term Oswestry Disability Index and visual analog scale scores for back and leg pain, except that lumbar fusion might bring about lower additional surgery rate, and higher complication rate in the long term. Wrap It Up The present meta-analysis determined that fusion surgery was no better than nonoperative treatment in terms of the pain and disability outcomes at either short- or long-term follow-up. It is necessary for clinicians to weigh the risk of complications associated with fusion surgery against additional surgeries after nonoperative treatment. Item #2 This second one is called, “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi (Sääksjärvi S 2020) and published in Spine Journal in 2020. It’s steamy….but not that hot anymore.  Why They Did It The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up. How They Did It

  • In an earlier study, 75 patients aged 20 years with LBP had their lumbar spine examined by MRI. 
  • At a follow-up of 30 years, the subjects were contacted; 35 of 69 filled a pain and disability questionnaire, and 26 of 35 were also reexamined clinically and by MRI. 
  • The images were evaluated for decreased signal intensity and other degenerative changes. 
  • Association between decreased signal intensity of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed 
  • Association between decreased baseline signal intensity and pain/disability scores from the questionnaire was analyzed

What They Found

  • The total number of lumbar discs with decreased signal intesity increased from 23 of 130 (18%) to 92 of 130 (71%)
  • Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs
  • Discs that had even slightly decreased signal intensity at baseline were more likely to have severely decreased signal intensity at follow-up, compared to healthy discs
  • The best of the best news, as you may have guessed if you’ve listened to this podcast for any amount of time, Severity of DD at baseline did not have a significant association with current pain or disability.

Wrap It Up In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms. Hallelujah.  Item #3 This last one is called, “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation” by Nima Khodarkarami ´(Khodakarami N 2020) and published in Healthcare journal in 2020.  Why They Did It Given that there are costs and benefits with either PT or Chiropractic for the treatment of low back pain, the remaining question is in a short period of time which of these treatments is optimal?  A decision tree analytic model was used for estimating the economic outcomes. The findings showed that the total average cost in the chiropractic group was $48.56 lower than the PT group.  The findings also showed that the daily adjusted life years (DALY) in the chiropractic group was 0.0043 higher than the PT group.  Chiropractic care was shown to be a cost-effective alternative compared with PT for adults with at least three weeks of LBP over six months. 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 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 Khodakarami N (2020). “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation.” Healthcare 8(1): 44.   Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347.   Xu W, R. B., Luo W, Li Z, Gu R, (2021). “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis.” World Neurosurg 146: 298-306.    

Patellofemoral Pain, Sleep For Pain, and Physical Disuse

CF 193: Patellofemoral Pain, Sleep For Pain, and Physical Disuse Today we’re going to talk about patellofemoral pain, sleep for pain, and physical disuse But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s 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 #193 Now if you missed last week’s episode , we talked about To Do lists, frailty, and we talked about pain and lost work days. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

This one will be a bit short today. My time will loosen up eventually and I’ll be able to dive deeper into some of the things going on around the office that you may relate to. But today ain’t that day. If you listened last week, you know that I believe in a To Do list and I believe in making it the priority if you’re going to be productive and if you ever hope to complete your epic saga of world domination. I’m stepping on the gas on the AMA Impairment Rating course because the national conference in Chicago is in October. That’s not too far off so it’s time to get down to bidniz. I’m elbows deep researching and generating a medical weight loss protocol for my clinic. Not only that, but I’m researching and creating a protocol for PRP Hair Restoration.

It’s pretty dang cool and the research has shown how effective it is. But, the main reason I need to be a bit brief this morning is that today is our first day and onboarding of our Parker University intern. He’ll be with us through the end of November so he gets plenty of time to find all of my screw-ups.  Admit it. You don’t do everything perfectly. Research tells us that we can’t adjust as precisely as we were taught. Yet, in our documentation, we’re supposed to notate the very specific levels of adjustment. We all must reconcile these things within our way of functioning. 

Academia is one thing. Real-life is quite another.  For example, the college dinged my records when I sent them a sample for auditing purposes. One of their reasons was that on a PI, I didn’t provide a full robust diagnosis on the first visit. Well, what they didn’t ask me was why. The reason being that most PIs have been nowhere prior to showing up at our clinics. They’ve not had x-rays. They had traumatic onset so, with regards to Choosing Wisely, we should be getting x-rays.  What if I did an exam right away without imaging just because academia says I need that dx on day one? I’ve had a fractured neck in my office before. We didn’t have a clue until the Xrays. What if I go pushing, pulling, and tugging on a fractured Cervical vertebra? Nope…..not here academia. Ding those notes all you want but I’m going to put a generalized place keeping dx like cervicalgia on the file until the x-rays come back clear. Then I’ll do the exam safely. Then I’ll assess a more appropriate diagnosis.  So there! Now, how to responsibly teach these things to an intern while still keeping within academic teachings and parameters?  We shall see. Let the adventure begin.

Item #1

This first one this week is called, “Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial” by Zago et. al. (Zago J 2020) and published in the Journal of Sports Rehabilitation on in December of 2020 and that’s hot because I said it’s hot…

Why They Did It

The authors say that the effects of an exercise program for the treatment of patellofemoral pain syndrome are well known. However, the effects of osteopathic manipulative treatment (OMT) are unclear.

Their objective was to evaluate the effects of OMT versus exercise on knee pain, functionality, plantar pressure in middle foot (PPMF), posterior thigh flexibility (PTF), and range of motion of hip extension in runners with patellofemoral pain syndrome.

How They Did It

  • It was a randomized controlled trial
  • It was performed in a human performance laboratory
  • There was a total of 82 runners with patellofemoral pain syndrome that participated
  • The participants were randomized into 3 groups: OMT, EP, and control group. 
  • The OMT group received joint manipulation and myofascial release in the lumbar spine, hip, sacroiliac joint, knee, and ankle regions. 
  • The EP group performed specific exercises for lower limbs. The control group received no intervention.
  • The main evaluations were pain through the VAS, functionality through the Lysholm Knee Scoring Scale, dynamic knee valgus through the step-down test, PPMF through static baropodometry, PTF through the sit and reach test, and range of motion through fleximetry. 
  • The evaluations were performed before the interventions, after the 6 interventions, and at 30-day follow-up.

What They Found

  • There was a significant pain decrease in the OMT and EP groups when compared with the control group. 
  • OMT group showed increased functionality, decreased plantar pressure in middle foot, and increased posterior thigh flexibility. The range of motion for hip extension increased only in the EP group.

Wrap It Up

Both OMT and EP are effective in treating runners with patellofemoral pain syndrome. 

CHIROUP ADVERTISEMENT

 

Item #2

This second item is called, “Machine learning suggests sleep as a core factor in chronic pain” by Miettinen et al. (Miettinen T 2021) and published in Pain in January of 2021 and it sizzles…

Why They Did It

The authors say that patients with chronic pain have complex pain profiles and associated problems.  Subgroup analysis can help identify key problems.

How They Did It

They used a data-based approach to define pain phenotypes and their most relevant associated problems There were 320 patients in the study undergoing tertiary pain management. They identified 3 patient phenotype clusters

Wrap It Up

If I try to get into the particulars of this paper, most of which I don’t understand and I’m relatively sure 90% of the rest don’t understand either if I get into it, our eyes will gloss over and we’ll question our life choices.  Instead, we’re going to skip to the important part of the conclusion. They say, “Machine learning suggested sleep problems as key factors in the most difficult pain presentations, therefore deserving priority in the treatment of chronic pain.” We have talked about it here before but, if you are not lining your chronic pain patient out with some very solid sleep recommendations, you’re not sign everything you can to help them. It’s clear that getting good sleep is key to getting on top of chronic pain. I commonly recommend a book to my chronic pain patients that says the same. It’s called ‘Back In Control’ by David Hanscum, MD. He’s a chronic pain sufferer but he’s also an orthopedic spinal surgeon so…..he’s no dummy walking around bumping into walls.  Sleep is part of the process. So make sure you’re recommending it to your chronic pain patients.

Item #3

This last one has the longest name ever given to a research paper in the known history of mankind. It is, “Physical disuse contributes to widespread chronic mechanical hyperalgesia, tactile allodynia, and cold allodynia through neurogenic inflammation and spino-parabrachio-amygdaloid pathway activation” by Ohmichi et. al.  (Ohmichi Y 2020)and published in Pain in August of 2020 and that’s just hot enough people! And can I just say that with a title this long, this Ohmichi had to of been trying to compensate? You know, like when a small person buys a huge truck. Something like that. I feel like these folks could work on their naming process a bit. That’s all I’m saying. 

Why They Did It

Physical disuse could lead to a state of chronic pain typified by complex regional pain syndrome type I due to fear of pain through movement (kinesiophobia) or inappropriate resting procedures.  However, the mechanisms by which physical disuse is associated with acute/chronic pain and other pathological signs remain unresolved. We have previously reported that inflammatory signs, contractures, disuse muscle atrophy, spontaneous pain-like behaviors, and chronic widespread mechanical hyperalgesia based on central plasticity occurred after 2 weeks of cast immobilization in chronic post-cast pain (CPCP) rat model.

Wrap It Up

As with the last paper we discussed, this one really gets into the weeds and my goal here is to make research more palatable so we’re going to go to the conclusion because that’s what really matters the most here.  They conclude that physical disuse contributes to dystrophy-like changes, spontaneous pain-like behavior, and chronic widespread pathological pain-like behaviors in chronic post-cast pain rats after 2 weeks of cast immobilization. Once upon a time, they’d tell pain sufferers to go home and get some rest. Take the pain killers and muscle relaxers and ‘ride it out’. Now, people will have laminectomies and they’ll be walking the hospital hallways the next day.  Movement is healing. As Liebenson says, ‘motion is the lotion for the joints’. Those not moving are those that are not healing. Be active if you want to stay active.  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 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

  • Miettinen T, M. P., Hagelberg N, Mustola S, Kalso E, Lötsch J, (2021). “Machine learning suggests sleep as a core factor in chronic pain.” Pain 162(1): 109-123.
  • Ohmichi Y, O. M., Tashima R, Osuka K, Fukushige K, Kanikowska D, Fukazawa Y, Yawo H, Tsuda M, Naito M, Nakano T (2020). “Physical disuse contributes to widespread chronic mechanical hyperalgesia, tactile allodynia, and cold allodynia through neurogenic inflammation and spino-parabrachio-amygdaloid pathway activation.” Pain 161(8): 1808-1823.
  • Zago J, A. F., Rondinel T, Matheus JP, (2020). “Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial.” J Spot Rehabil 30(4): 609-618.

 

To Do Lists, Frailty, and Pain & Lost Work Days

CF 192: To-Do Lists, Frailty, and Pain & Lost Work Days

Today we’re going to talk about To-Do Lists, Frailty, and Pain & Lost Workdays

But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s 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 practitioners 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 #192 Now if you missed last week’s episode, we talked about chiropractic preventing opioids and chiropractic adverse events. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I am starting week three of the medical integration. It’s stressful but it’s exciting too. Every day I’m convinced more and more that we picked the right nurse practitioner. Super smart and excellent with patients.  I’m lying if I act like there’s no anxiety in this deal though. Damn. The money flying out the doors in a direction is almost stunning. With little money coming in on the medical side. Everything has to start at ground zero. That’s a given. Everything has to grow from seed. That’s a given.  The trick is to get to maturity and profitability as quickly as humanly possible. That’s what we’re trying to do.  We’ve been doing social media and are about to do a direct Mail piece as well. We’re trying to get this thing on its feet muy pronto! Switching gears here, how do you stay productive? My means of staying productive is really pretty simple.

I keep a ToDo list and I follow it daily. I have it broken down into two sections. One is a grid. The days of the week are along the top of the grid. What HAS to be accomplished are listed below the day it has to be done. Then, I have a simple list outside of the grid. They’re things that need to be done when time allows. Outside of the must-do’s they’re the need to do’s if you will. So, for example, on Mondays, I have to write, record, edit, and upload the podcast. It’s a scramble from start to finish when I also have 40 or more patients to contend with as well. Sometimes I get it all done. Sometimes I just get it written and record it as time allows the rest of the week Don’t forget about email. I get at least 50-100 every day so that’s a job all by itself sometimes. I unsubscribe as often as I can.

I don’t like garbage and minutiae. Can’t have it. No time for that. Tuesdays, it’s my clinic’s blog that has to be written, the corresponding video is recorded, and it’s uploaded to YouTube and Facebook. Again, all accomplished between patients. I get off on Tuesdays around 2 pm. Sometimes that extra afternoon time is used to catch up. Sometimes I go home, work out, do voice-over, and then take classes toward the Forensics Diplomate. As you can see, Monday and Tuesday is go time. Wednesdays I  write and send a mass email to my emailing list with the blog and video I recorded the day before included. Usually, things start to loosen up a bit by the time Wednesday rolls around and I’m able to give attention to the Need To-Dos. Some marketing and all that good stuff. Thursdays I upload the new podcast episode, I post it on Facebook, I send out an email to my list, and lost it in our private Facebook group.

Then marketing, patients, voice-over, another website project I’m working on, and whatever else crosses the desk. Friday, I get off at 1 pm. The afternoon is spent catching up, taking classes, getting in phone calls with people that think they just have to get you on a phone call, or I hit happy hour if I’m lucky. So that’s my week. I don’t get on phone calls. If it can’t be texted or emailed, don’t bother. I don’t talk to salespeople. I don’t entertain anything that takes me off task if I can help it. I can’t. So that’s how I get it all done. The list is my priority and I make sure each item is accomplished. It keeps me on track, it keeps this podcast rolling, it keeps my clinic rolling, and it keeps my brain from exploding. Tel me how you stay on track. I’d love to hear about it. Email me at [email protected]

Item #1

The first one today is called “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study” by Tembo et. al. (Tembo 2021) and published in Calcified Tissue Interrnational……which is as niche-y as niche can be and it was published on May 20 of 2021. Good Lawd….the heat. 

Why They Did It

They wanted to investigate and quantify the predictability of frailty associated with musculoskeletal parameters. 

How They Did It

It was a longitudinal study Involved 287 men over 50 years old Baseline musculoskeletal measures included  femoral neck bone mineral density appendicular lean mass index whole-body fat mass index lower limb strength Frailty at the 15 year follow-up was defined as > or = to 3 of the following 1. Untintentional weight loss 2. Weakness 3. Low physical activity 4. Exhaustion 5. Slowness

What They Found

  • 48 men were frail. That’s 16.7%
  • Musculoskeletal models were better predictors of frailty
  • Musculoskeletal parameters improved the predictability model as measured by AUROC for frailty after 15 years

Wrap It Up In general, muscle models performed better compared to bone models. Musculoskeletal parameters improved the predictability of frailty of the referent model that included lifestyle factors. Muscle deficits accounted for a greater proportion of the risk for frailty than did bone deficits. For getting musculoskeletal health could be a possible avenue of intervention in regards to frailty.

CHIROUP ADVERTISEMENT

Item #2

This one is called “Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system” by Gaspar et. al. (Gaspar FW 2021) and published in PLoS ONE on June 17, of 2021 and that’s stuh, stuh, stuh, steamy people. 

Why They Did It

The authors wanted to quantify the influence of adherence to guideline-recommended interventions in the first week of treatment for an initial low back pain (LBP) injury on lost workdays.

How They Did It

  • It was a retrospective cohort of California’s workers’ compensation claims data from May 2009 to May 2018
  • 41 diagnostic and treatment interventions were abstracted from the medical claims for workers with acute LBP injuries and compared with guideline recommendations.
  • Lost workdays within 1-year post-injury were compared by guideline adherence using quantile regressions.
  • Of the 59,656 workers who met the study inclusion criteria, 66.1% were male and the average (SD) age was 41 (12) years

What They Found

  • The median number (IQR) of lost workdays was 27 (6–146) days. 
  • In the first week of treatment, 14.2% of workers received only recommended interventions, 14.6% received only non-recommended interventions, and 51.1% received both recommended and non-recommended interventions
  • Opioid prescriptions fell 86% from 2009 to 2018
  • Workers who received only guideline-recommended interventions experienced significantly fewer lost workdays (11.5 days; 95% CI: -13.9, -9.1), a 29.3% reduction, than workers who received only non-recommended interventions
  • The percentage of workers receiving only recommended interventions increased from 10.3% to 18.2% over the 9 years.

Wrap It Up

When workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers.

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 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 Gaspar FW, T. M., Wizner K, Hegmann K, (2021). “Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system.” PLoS One 16(6).   Tembo, M. C., Mohebbi, M., Holloway-Kew, K.L, (2021). “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study.” Calcified Tissue Int.  

 

Chiropractic Prevents Opioids & Chiropractic Adverse Events

CF 191: Chiropractic Prevents Opioids & Chiropractic Adverse Events Today we’re going to talk about chiropractic care preventing opioids and chiropractic adverse events.  But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s 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 #191 Now if you missed last week’s episode , we talked about Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

So, if you’re a regular listener, then you know that I’ve been slowly going through the Forensics Diplomate program. The initial 40 hours through ChiroCredit were not my favorites. Learning about court cases, procedures, and all that stuff…..let’s just say it’s not my skill set.  But, I did it. I sat through it all. Now I’m on to the course for impairment ratings through the AMA. It’s speaking my language a little more. OK….a lot more. It’s still very technical and all that good stuff but it makes a little more sense. However, it is written by medical doctors for medical doctors so there is a section that got me a bit hot. Did you know in the 6th edition of the Guides to Impairment, it says that chiropractors should stick with only assessing impairment of the spine….because….you know……we didn’t spend two full semesters dissecting an entire body or anything like that. Right?

The presenter said he realizes that statement may bring about some discussion but the evaluator must have knowledge, skills, and ability in that organ system or in that region to assess impairment. Otherwise, the impairment rating is likely to be faulty. So…..I guess chiropractors somehow have the inability to learn, know, or understand a shoulder, hip, ankle, etc? Let’s be fair, I get it if they think a chiropractor shouldn’t really be assessing impairment of the liver or GI system.

That’s not within our wheelhouse. But muscles, bones, ligaments, tendons, and joints of all sorts are damn well within our wheelhouse and it’s just dumb to act like a regular impairment doc doing impairment ratings are any more intimately familiar with them than we are.  That’s some elitist BS right there. And it stinks and smells like old outdated dogma. But let’s also be fair to them. Even though they’ve rarely given us the same respect in return. This was reprinted in 2009. I’m not sure when the original printing was. I’m sure the course I’m watching was done around the same time as well.  Think about it; how many changes have you seen in the MD/DC relationship arena in just the last 10 years alone? I’ve seen a lot.

Especially since the American College of Physicians came out in 2016 recommending spinal manipulative therapy for acute and chronic low back pain. On the heels of that The Lancet report on low back pain echoed the recommendation. Then Dr. Goertz’s paper was in JAMA showing how well veterans did when spinal manipulative therapy was added into the treatment protocol.  Plus, I see more and more chiropractors moving in the right direction. The direction of evidence-based, patient-centered care. Where decades ago, an MD wouldn’t bowl against a team that had a chiropractor on it and they wouldn’t even accept referrals from us, to now.

Now, I have a nurse practitioner working hand and hand with me every day. Some of the people I count as buddies are a vascular surgeon, and ER doc, and a neurosurgeon.  So….maybe the course just needs an update. Who knows? But it pissed me off a little and I paid $487 to get pissed off. Lol. This too shall pass. In fact, it may already have passed.  Alright, NP medical integration week #2. It’s getting there. Our NP did hormone pellet procedure last week. That whole process is pretty cool. Patients have to do the lab work first to make sure it’s necessary. But if it is, it can make a big difference for folks. We doing PRP shots, trigger point shots, B12 shots….it’s all pretty darn interesting and it’s multimodal. Which is evidence-based and, as always, I balance it in a patient-centered way. 

So, now in my office, we have me, exercise/rehab, medical services, acupuncture, 3 massage therapists, and all of the other stuff you’d expect in therapies. It’s grown into quite a deal.  I had a patient ask me the other day if I was a franchise. I asked why they’d think that? They just said that we offer so many things that he figured it was a franchise. I said no, we’re not. But I likened it to my step-dad’s shop. He’s got every tool, cord, clamp, and gadget you’d ever want in a shop. But when you ask him how he got it all, he’ll tell you that he got it one at a time. Kind of like Clint Eastwood in El Torino.  You just gather and grow as you need. As the risk makes sense. There was a time when getting a $13,000 decompression table was a big damn deal and came with a lot of financial risks. 

Now, understandably, the risk is different. To expand and grow, it costs more. You have to stick your neck out a little further and hope it doesn’t get chopped off.  There are sinkers and swimmers in this world. I like to think I’m a swimmer. It’s OK to venture out a little further each time you stretch. As long as you know how to swim. And I have the doggy paddle down, folks. Just keep swimming just keep swimming.  Alright, let’s dive into the research. 

Item #1

This one’s called “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain” by Whedon et. Al. (James M Whedon 2020) and published in Pain Medicine in December of 2020 and that’s just hot enough. 

Why They Did It They say “Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.”

How They Did It

  • We employed a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017.
  • They included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain
  • They identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.
  • The total number of subjects was 101,221

What They Found

  • Overall, between 1.55 and 2.03 times more nonrecipients filled an opioid prescription, as compared with recipients
  • Similar differences were observed for the acute groups.

Wrap It Up

Patients with spinal pain who saw a chiropractor had HALF the risk of filling an opioid prescription.   

CHIROUP ADVERTISEMENT

Item #2 Number two today is called “Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment” by Drew Oliphant (Oliphant D) and published in the Journal of Manipulative Physiological Therapeutics in 2004. Definitely not hot. 

Why They Did It The authors wanted to provide a qualitative systematic review of the risk of spinal manipulation in the treatment of lumbar disk herniations (LDH) and to estimate the risk of spinal manipulation causing a severe adverse reaction in a patient presenting with LDH.

How They Did It

  • They considered relevant case reports, review articles, surveys, and investigations regarding treatment of lumbar disk herniations with spinal manipulation and adverse effects and associated risks
  • Prospective/retrospective studies and review papers were graded according to quality, and results and conclusions were tabulated. 
  • From the data published, an estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or cauda equina syndrome (CES) in patients presenting with LDH was calculated. 
  • This was compared with estimates of the safety of nonsteroidal anti-inflammatory drugs (NSAIDs) and surgery in the treatment of LDH.

What They Found An estimate of the risk of spinal manipulation causing a clinically worsened disk herniation or CES in a patient presenting with LDH is calculated from published data to be less than 1 in 3.7 million.

Wrap It Up The apparent safety of spinal manipulation, especially when compared with other “medically accepted” treatments for LDH, should stimulate its use in the conservative treatment plan of LDH.

Item #3 The last one is called “Serious Adverse Events and Spinal Manipulative Therapy of the Low Back Region: A Systematic Review of Cases” by Herbert et. al.  and published in the Journal of Manipulative Physiological Therapeutics in 2015. Again….not hot but that’s OK. It’s a Systematic Review. 

Why They Did It The purpose of this study was to systematically search the literature for studies reporting serious adverse events following lumbopelvic spinal manipulative therapy (SMT) and to describe the case details.

How They Did It

  • A systematic search was conducted in PubMed including MEDLINE, EMBASE, CINAHL, and The Cochrane Library up to January 12, 2012, by an experienced reference librarian. 
  • Study selection was performed by 2 independent reviewers using predefined criteria. 
  • We included cases involving individuals 18 years or older who experienced a serious adverse event following SMT applied to the lumbar spine or pelvis by any type of provider (eg, chiropractic, medical, physical therapy, osteopathic, layperson). 
  • A serious adverse event was defined as an occurrence that results in death or is life threatening, requires hospital admission, or results in significant or permanent disability. 
  • A total of 2046 studies were screened, and 41 studies reporting on 77 cases were included.

What They Found

  • Important case details were frequently unreported, such as descriptions of SMT technique, the pre-SMT presentation of the patient, the specific details of the adverse event, time from SMT to the adverse event, factors contributing to the adverse event, and clinical outcome. 
  • Adverse events consisted of cauda equina syndrome (29 cases, 38% of total); lumbar disk herniation (23 cases, 30%); fracture (7 cases, 9%); hematoma or hemorrhagic cyst (6 cases, 8%); or other serious adverse events (12 cases, 16%) such as neurologic or vascular compromise, soft tissue trauma, muscle abscess formation, disrupted fracture healing, and esophageal rupture.

Wrap It Up

The anecdotal nature of these cases does not allow for causal inferences between SMT and the events identified in this review.  When chiropractic is done responsibly and appropriately, it’s safer than almost any medical intervention. It just is. Now, when you have people damn near yanking people’s heads off of their bodies, aggressively adjusting patients on YouTube that have had a significant history of stroke, and adjusting 80 year old women with the same gusto you’d use with a 25 year old male…..well….those folks are just asking for it.  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 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

  • James M Whedon, D., MS, Andrew W J Toler, MS, Louis A Kazal, MD, Serena Bezdjian, PhD, Justin M Goehl, DC, MS, Jay Greenstein, DC (2020). “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain Med 21(12): 3567-3573.  
  • Oliphant D “Safety of spinal manipulation in the treatment of lumbar disk herniations: a systematic review and risk assessment.” J Man Physiol Ther 27(3): 197-210.  

w/ Dr. Rob Pape – Quadrant Analysis & Practice Mechanics

CF 188: w/ Dr. Rob Pape – Quadrant Analysis & Practice Mechanics Today we’re going to be joined by Dr. Rob Pape.

I’ll get into his bio a bit deeper in the interview and introduction but Dr. Pape is the creator of Quadrant Analysis improving patient assessment by breaking down the evaluation process. He is also a co-creator of Practice Mechanics. Along with one of our previous podcast guests, Dr. Michael Massey, they have created Practice Mechanics to help their doctors hit that next level. We’ll get into it here shortly.  But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s 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 #188 Now if you missed last week’s episode, we talked about hypermobile patients, sports-related concussions, and obesity’s pain connection. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Still in the middle of medical integration. Our nurse practitioner starts on August 2nd so, we’re pretty close at this point. I just ordered the centrifuge for the PRP therapy. I have heard of PRP for a little while now but mostly for hair loss. I have a close family member that has a little hair loss going on so he and his mother were asking me about PRP for hair loss.  I didn’t know much about it. In case you aren’t familiar, PRP stands for plasma-rich platelets. They draw your blood, spin it down in the centrifuge, extract the platelets, and then inject it into the problem.  I literally spent 2 hours this weekend going through research on PRP therapy.

I filtered PubMed to only show me randomized controlled trials. I don’t need a lot of BS. Let’s just go further up the research pyramid for the good stuff, right? So what I found was actually surprising as hell. While I could find 2, 3, maybe 4 papers tops that showed equal effectiveness to cortisone or something like that…..the large majority of the papers were clear that PRP is showing impressive effectiveness for just about damn near anything they try it on including ACL surgery recovery, hair loss, plantar fasciitis, general osteoarthritis, shoulders, knees, hips, ankles, carpal tunnel, and the list goes on.  I have me a big ol’ file on my computer full of them all now. I can really get behind things like this that I can find a ton of positive research on. Just like everything else in my practice.

If I can find support in the literature, I have no problem encouraging it. Notice I didn’t say, “Sell it.” I’m a healthcare provider. Not a salesman. We should always be honest and tell our patients about the cool research behind something you think will truly help them but then we should shut up and be there for them however they want to use us. Plain and simple.  So, again, I have no problem encouraging and educating on something that has shown such effectiveness. It’s pretty amazing actually so I’ll keep you updated on that. If you’re integrating or considering doing it, it’ll come in handy for you. If you’re not, it might give you some direction on what to do with those patients that have some stubborn conditions. More to come on that.  OK, let’s get to today’s guest so we don’t go too long here. I want him to have plenty of time.  Before we do that though, let’s hear a word from our sponsors, shall we?

CHIROUP ADVERTISEMENT

Dr. Rob Pape is our guest today. He is a long-time innovator in clinical evaluation and treatment instruction. He created Quadrant Analysis, which combines a sub-classification system with practical biomechanics. Quadrant Analysis improves and simplifies patient assessment, breaking the body down into traceable patterns which chiropractors can utilize to get better and faster patient results. 

The Practice Mechanics resources include detailed information about Quadrant Analysis and specific techniques so you can help your patients get the results you want for them. Rob graduated from Life Chiropractic College West in 1996 and has been in successful practice ever since. His clinical approach is full body and generally combines joint and soft tissue work with movement therapy.

Welcome welcome Rob. Tell me where you are living these days, tell me about your family, and how long you’ve been in the trenches. What’s your story? Why are you a chiropractor today? What does your regular workday look like these days? You went to Life, a school that is notorious for being very philosophy-heavy, shall we say? With that as your initial base of knowledge and influence, what pointed you down the evidence-based/evidence-informed path? What’s your take on the profession today? What are we getting better at? Where are we losing ground? Where can we improve? If you could wave a wand and change one thing about the profession forever, what would you change? What would other chiropractors say is your best attribute? And what would the ones that know you really well say is your worst? What is the goal for Practice Mechanics? Outside of the obvious, which is building business, what do you hope to achieve by growing it?

How can doctors that are interested get in contact with you for more information? 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

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

Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection

CF 187: Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection

Today we’re going to talk about Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

  • 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 #187 Now if you missed last week’s episode , we talked about the western diet and its effects and we talked about some pretty cool acupuncture research. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Our nurse practitioner starts on August 2nd but we are having a hard time getting our malpractice person to respond to us and get that in place. We can’t get credentialing until that happens. Credentialing takes at least 2 months typically.  So, you see the issue. That was an unplanned obstacle.  We are in the process of changing our signage on the front of the building as well. We have one big sign out on the main street so that’s two inserts…..one for each side. 

Then we have two suites here so we have two doors. Which means we have two signs on the front of the building. So, added up, we get to order 4 inserts. Signs aren’t cheap if you’ve had to put one in lately.  Those are just some of the things that we’re messing with lately.  Clinic numbers, we are in week 3 with some good solid numbers. Not pre-COVID numbers but getting there. I’ll be honest with you, I’m not sure I want pre-COVID numbers. There were weeks I was at 220 appointments for the week. 25 new patients, re-exams running out my ears.  Now, that’s not bragging. I’m not there anymore. What I’m saying is that sometimes, it’s too much. In healthcare, you really can be too busy. Things start falling through the cracks.  My mom had a bone density test misread because her primary is simply too busy. He took responsibility and, other than putting her back surgery off longer than it should have, no harm was done. But the point is, we can get too busy.  I am extremely conservative in my finances. I don’t like taking big chances. I don’t like huge what-ifs. I like small, measured, and reasonable risks. You cannot eliminate risks. But we can mitigate them. We can make them minute instead of big gaping holes.  I should have hired an associate. And to be fair, we started to do that. It just simply fell through. And it was a blessing in disguise when you consider what COVID did to our practice. Now we get a chance to potentially say, “‘If I could go back and do that all over again…..” 

At this time, I’m at a point in my caseload that it’s all fairly easily manageable. We’re at probably 165-170 per week. That’s manageable for evidence-based, patient-centered practice. We are rehab-heavy. Rehab takes time and I have an excellent staff and ChiroUp to help me make it all happen.  However, if we get to the 190-200 appointments per week range, it’s time to start shopping for an associate. It’s too much and too many other things I’m trying to accomplish both personally and professionally suffer from that caseload.  And my brain space is just destroyed if I’m being honest. It’s not fun to go to work when you’re overwhelmed every day. It’s unpleasant. Even when the majority of your patients are amazing people. Nobody wants to go to doctors that are overwhelmed like that and I don’t want to be one of those doctors either.  So, just a little brain dump there and some free-flow thought for you. I have an intern coming in from Parker College in September. That’ll be my first intern to have onboard so who knows….maybe that ends up being a long-term thing.

Maybe not.

Time will tell.  On the horizon for me, real estate investing!! Regular listeners may have heard me talk about exit strategies. If you’re a thinker, you’re not only thinking about today but what you want out of tomorrow. I’ve been in business for over 23 years at this point and have never taken more than 5-7 days of vacation at a time. I’ve never been to Europe or anywhere outside of the Caribbean.  So, smart moves is what get us there. We are in a business where our presence is mandatory for a business to continue. In essence, our business owns us. Not the other way around. So how do we flip it? Well, we need people in place that fill the gap when we are out. We need to be the CEO instead of the hands-on worker. That’s part of the reason we are bringing in a nurse practitioner. That’s part of the reason we’ll be looking for an associate when the numbers truly rebound.

That’s the reason I started a voice-over side gig, which is going amazingly by the way. What a blessing that has been, y’all. I can’t even begin to tell you how well that’s going. I’ve voiced over 200 spots just since January. That’s over 33 per month. It’s been insane. That’s also the reason that real estate investing is my next mountain.  Mailbox money, y’all. Now, real estate investing takes effort and work so it’s not technically mailbox money but, when done right, is the fastest path to financial freedom. That’s the reason for the book I wrote and the speaking opportunities I’m getting involved in.  These are all potential paths toward early, comfortable, happy, partial retirement. Retirement to me doesn’t mean any work. It means control of my time. So in that context, retirement cannot come quite soon enough.  So, what’s your exit strategy? Are you going to work until you’re 88 and die at your desk in your office?

Which some want…and there’s not a thing in the world wrong with that. Or, do you have other things in your life to accomplish and need to start planning for that? Some say you need to start with the ending in mind. If you want to sell your business someday, shouldn’t you plan for that from the start? How do you build a business that’s ready to sell when it’s your time? Something to think about. I’m not sure I have all of those answers because they continue to unfold as I progress but I’m getting closer to solid ideas and strategies on it.  Alright….on to the research. 

Item #1

Let’s get it started this week talking about hyper mobility, Ehlers-Danlos, and all that good stuff. If you don’t really consider hypermobility in your daily treatment…..please….for the love of everything holy, please listen up and pay attention. This is where so many chiropractors are getting it wrong.  It’s becoming more and more clear every year that a good chiropractor should know when to mobilize and when to stabilize. Some of you are no doubt asking yourselves, what the hell does that mean? Sometimes the spine doesn’t want to be adjusted. There is already a plethora of movement there. Adjusting only increases the motion in an area that the increased motion is what is actually causing the complaint. In these cases, when in the hands of a vitalistic, subluxation, philosophy, doctor-centered chiropractor, this patient is going to get adjustment after adjustment for weeks and weeks.  I’m sure you can predict the eventual outcome here. And it’s not corrections of a subluxation. It’s spinal instability that compounds the issue.  The condition and patient population that is at increased risk here would be self-adjusters but mostly, those suffering from Ehlers-Danlos, which if you are unfamiliar, is a connective tissue disorder that allows these folks to behave a bit like an elastic rubber band. 

A hint of whether someone is EDS is the Beighton Scale. If I stand a new patient up and have them touch their toes and they put their hands flat on the floor, they’re getting put through the Beighton Scale to test for hypermobility. We need to know if they have too much movement in their joints. Because instead of more adjustments and more movement in the segments of the spine, they typically respond better to weight training, supportive activities and strengthening. 

This paper is called “Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review” by Gregory Reychler and Maya-Mafalda De Backer et. al. (Reychler 2021) and published in the American Journal of Medical Genetics on June 19, 2021…. My glasses….they’re steamed up..it’s hot.  Why They Did It The objective of this systematic review was to investigate the effect of the different physiotherapy techniques related to the children and adult patients with hEDS How They Did It

  • PubMed, SPORTDiscus, Cochrane Library, PEDro, Scopus, and Embase databases were analyzed from inception to April 2020.
  • Characteristics of the studies (authors), patients (sample size, sex, age, Beighton score), and non-pharmacological treatment (length of the program, number of sessions, duration of the session, and type of intervention), and the results with the dropout rate were extracted. 
  • From the 1045 retrieved references, 6 randomized controlled trials with a sample size ranging from 20 to 57 patients were included in the systematic review
  • There was a huge heterogeneity in the interventions. The duration of the program were from 4 to 8 weeks

What They Found

  • Pain or proprioception demonstrated significant improvements in the intervention group regardless of the type of intervention. 
  • A benefit of the inspiratory muscle training was observed on functional exercise capacity.
  • The quality of life was systematically improved.

Wrap It Up

Physiotherapy benefits on proprioception and pain in patients with hEDS even if robust randomized control studies are missing. Now, the full paper isn’t available for me to ingest so who the hell knows what all interventions these patients underwent. We don’t know. But, physiotherapy is Europe and Canada and Australia’s term for physical therapy. We know what PT is and in these patients, I’m assuming it is exercise and building strength and proprioception and balance.  All of that also helps clear up the joint and movement map in the brains of chronic pain patients. Which leads to more accurate sensorimotor function, less aberrant movement in the joints, more confidence in abilities and future capabilities, and less pain as an overall result.  And yes, I just tossed a bucket of Neuromusculoskeletal Medicine Diplomate on top of all of your heads. And didn’t it feel warm and fuzzy??

Of course it did and you’re welcome.  Let’s hear from our awesomely amazing sponsors. 

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Item #2 This second one is called “Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry” by Dong et. al. (Dong HJ 2021) and published in the Journal of Pain Research in February of 2021 and that’s holy mother of Hades hot. 

Why They Did It It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥ 30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight. This study investigated whether obese patients with chronic pain lost weight after completing interdisciplinary multimodal pain rehabilitation in specialist pain units. The association of pain relief and weight change over time was also examined.

How They Did It

  • Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used, including baseline and 12-month follow-up after IMMPR from 2016 to 2018
  • Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviors, psychological distress, and health-related quality of life
  • A reduction of at least 5% of initial weight indicates clinically significant weight loss. 

What They Found

  • A significant reduction of pain intensity was found after interdisciplinary multimodal pain rehabilitation 
  • A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss 
  • Significant improvements were reported regarding physical activity behavior, psychological distress, and health-related quality of life, but weight change was not associated with changes of pain intensity.

Wrap It Up

“About one-fifth of obese patients achieved significant weight reduction after interdisciplinary multimodal pain rehabilitation. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.”

Item #3

The last on his called “Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review” by Eliott, et. al. (Elliott 2021) and published in Sports Medicine on June 18, 2021. It’s a big ol’ pot of hot. 

Why They Did It To systematically review the literature to investigate: (1) the relationship between neck strength and sport-related head and neck injuries (including sport-related concussion (SRC); and (2) whether neck exercise programs can reduce the incidence of (a) sport-related head and neck injuries; and (b) sport-related concussion.

How They Did It

  • Five databases and research lists of included studies were searched
  • From an initial search of 593 studies, six were included in this review

What They Found

  • The results of two observational studies reported that higher neck strength, but not deep neck flexor endurance, is associated with a lower risk of sustaining a sports-related concussion. 
  • Four intervention studies demonstrated that injury reduction programs that included neck exercises can reduce the incidence of sport-related head and neck injuries including sports-related concussion.

Wrap It Up

Consideration should be given towards incorporating neck exercises into injury reduction exercise programs to reduce the incidence of sport-related head and neck injuries, including sports-related concussion. 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.       

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

  • Dong HJ, D. E., Rivano Fischer M, Gerdle B, (2021). “Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry.” J Pain Res 14(1863-1873).  
  • Elliott, J., Heron, N., Versteegh, T, (2021). “Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review.” Sports Med.  
  • Reychler, G., De Backer, M.-M., Piraux, E., Poncin, W., & Caty, G, (2021). “Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review.” American Journal of Medical Genetics: 1-9.          

High Impact Chronic Pain & Cannabinoids – What’s The Latest?

CF 185: High Impact Chronic Pain & Cannabinoids – What’s The Latest? Today we’re going to talk about…. 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!

https://www.amazon.com/dp/B096RST3WW

 

 

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 #185 Now if you missed last week’s episode , we talked about predicting frailty and we talked about a 30-year study on disc degeneration. Fascinating stuff as always. Make sure you don’t miss that info.  Keep up with the class. 

On the personal end of things…..

This is the season of big. Big stuff happening these days.  I have some cool stuff on the horizon in 2022 I’m looking forward to. It looks like I’ll be joining a high-level group of doctors that’ll be meeting virtually throughout the year and in-person 4 times a year to get the best, most current evidence-based guidelines and to solve each others’ biggest practice issues. More information to follow but I can’t emphasize how pumped I am to get that rolling. The worst part is that I have to wait until 2022.

But honestly, that’ll be here before we know it. If you’ve been following along lately, we are going through this Nurse Practitioner medical integration and our NP starts here in our clinic on August second.

That’s more than HUGE!

I released my first book on June 8th called ‘The Remarkable Truth About Chiropractic: A Unique Journey Into The Research’ which is live and for sale on Amazon and from my website at www.chiropracticforward.com as we speak  It’s a hell of a good reference for practitioners and content creators. It has mostly current research divided into sections for quick reference and it’s some of the most impactful and significant research you’ll find for our profession. Go get a copy. Then we have an intern coming from Parker University to hang out with us through the Fall semester. That’s a first for me. We’ll see how it goes. He seems like a great dude with a cool little family. It should be a good deal.

We also have a trip coming up to Washington DC at the end of August, the TCA. Reds me to put together an hour-long presentation on research for their Leadership Conference, and some friends just asked me to officiate their wedding vow renewal.  So, how’s your Summer going? In terms of numbers, I’m frustrated. I hear Chiros telling me how they’re right back where they were and all that good stuff. Not me. I’m still at about 140 a week right now. I averaged 185 a week before the Rona jacked everything up.  If you had any big breakthroughs as far as getting people to return, email us at [email protected]  and I’ll share in the next podcast. Maybe we can help all of our listeners get back to where they were. 

It sure can’t hurt. I know that. Takers eat well but givers sleep well. Be a giver and I’ll help spread the word.

Item #1

The first one today was spurred because of a question that popped up in our private Facebook group last week. I posted an article I wrote that I give to all of my chronic pain patients in my clinic. It’s basically a dive into chronic pain and the current thinking.  In the article, there is a mention of how pain pathways that are laid down become permanent. One of the questions by a group member was that, if it’s true that the pathways are permanent, then doesn’t that go contrary to the idea of neuroplasticity.

If you don’t know what that is, that’s the ability of our central nervous system to adapt to new normals or adapt to training and to change and function in ways that overcome certain challenges.  So if we have neuroplasticity, how can pathways be permanent, basically. 

What a great question. I hadn’t considered this before. After thinking on it a bit, my response was, “Can’t we have neuroplasticity yet still permanent pathways that give us a tendency toward chronic pain? You can have all kinds of neuroplasticity (thank God) but won’t the CNS still store the information/memory/etc? I went on to add that, “I believe that’s the thinking behind the original teaching.

Dr. James Lehman also describes ‘high impact chronic pain’. These are essentially people who tend to have chronic pain forever and can only control it through periodic treatment/therapy. That would also imply that neuroplasticity is complicated and may have its limitations. Something that we can definite leverage in our favor, but not a cure all?” So, following my comments, Dr. Lehman shared this research article focusing in on High Impact Chronic Pain.

Thank you to Dr. Lehman for the research citation and thank you to Nathan for an excellent question.  If you’re not in our Chiropractic Forward Facebook group, go do that.  IT’s called, “Prevalence and Profile of High-Impact Chronic Pain in the United States” by Pitcher et. al. (Pitcher MH 2019) and published in the Journal of Pain in February of 2019…..it’s a little steamy but not quite hot enough for my beloved sound bite. Damnit. 

Why They Did It

They say, “The multidimensional nature of chronic pain is not reflected by definitions based solely on pain duration, resulting in high prevalence estimates limiting effective policy development.  The newly proposed concept of high-impact chronic pain incorporates both disability and pain duration to identify a more severely impacted portion of the chronic pain population yet remains uncharacterized at the population level.” So it’s basically chronic pain AND disability rather than just chronic pain. 

How They Did It

As such, we used the 2011 National Health Interview Survey (N = 15,670) to 

  1. assess the likelihood of disability in the overall chronic pain population, 
  2. estimate the prevalence of High-Impact Chronic Pain, and 
  3. characterize the disability, health status, and health care use profile of this population in the United States.

What They Found

  • Overall, chronic pain, defined as pain experienced on most days or every day in the previous 3 months, was strongly associated with an increased risk of disability after controlling for other chronic health conditions
  • disability was more likely in those with chronic pain than in those with stroke or kidney failure, among others.
  • High-Impact Chronic Pain affected 4.8% of the U.S. adult population, or approximately 10.6 million individuals, in 2011.
  • The High-Impact Chronic Pain population reported more severe pain and more mental health and cognitive impairments than persons with chronic pain without disability, and was also more likely to report worsening health, more difficulty with self-care, and greater health care use.

Wrap It Up

High-Impact Chronic Pain clearly represents a more severely impacted portion of the chronic pain population. Understanding this heterogeneity will contribute to developing more effective legislation promoting safe and cost-effective approaches to the prevention and treatment of chronic pain.  PERSPECTIVE: High-Impact Chronic Pain is a powerful new classification that differentiates those with debilitating chronic pain from those with less impactful chronic pain. By addressing the multidimensionality of chronic pain, this classification will improve clinical practice, research, and the development of effective health policy.

 

CHIROUP ADVERTISEMENT

 

Item #2

OK, I’m about to be uncool…..I get it. Unless you happen to be in pain and benefit from it, I’m about to take a recently unpopular stance here. Old buy coming through. But I’m Gen X so don’t pull that, ‘OK, Boomer,’ BS on me. It’s powerless against the forces of research so don’t even try it.  Look, admit that you can’t follow only the research you like that confirms your biases and ignore and discount only the ones you don’t like that fly in the face of your beliefs or preferences. 

Let’s be clear, if opioids are the only thing that can possibly help with pain, why wouldn’t we use that. It’s a tool, albeit a dangerous one, but a tool we have at our disposal. The same goes for cannabinoids. I support it being used for medical purposes 100%.

So don’t misunderstand. What I cannot get behind is its recreational use. I never understood why folks need to have a completely altered reality by partaking in drug use, really of any kind, all day every day. Now, I get it….some folks have had awful experiences. It calms them. Helps them deal with it. Some have sleeping or anxiety disorders. I get it. And let’s be clear, I like to drink beer on the weekends here and there and I partake in some shots as well too. That’s definitely some altered reality but it’s few and far between. 

I’m talking about the wake and bakes that just have a normal life but they like it so they do it every day? I’m a no on this. You’ll never convince me that inhaling smoke of any kind daily is healthy, good for you, productive, or conducive to a better life long-term. You can’t do it. Because it’s not possible.  Not only that, but you are influencing your children when they go to copying your behavior.  So…..here I go being uncool.  This one is called “Association of Cannabis Use During Adolescence With Neurodevelopment” by Albaugh et. al. (Albaugh MD 2021) and published in JAMA Psychiatry on June 16, of 2021 a smoking steamy plate of Shazam. 

Why They Did It

The authors wanted to answer the question, “To what extent is cannabis use associated with magnetic resonance imaging–measured cerebral cortical thickness development during adolescence?”

What They Found

  • In this cohort study, linear mixed-effects model analysis using 1598 magnetic resonance images from 799 participants revealed that cannabis use was associated with accelerated age-related cortical thinning from 14 to 19 years of age in predominantly prefrontal regions.
  • The spatial pattern of cannabis-related cortical thinning was significantly associated with a positron emission tomography–assessed map of cannabinoid 1 receptor availability.

Wrap It Up

Results suggest that cannabis use during middle to late adolescence may be associated with altered cerebral cortical development, particularly in regions rich in cannabinoid 1 receptors.

 

Item #3

I’m just going to drive the depths of my uncool-ness to new depths here, folks. Don’t mind me.  This one is called, “Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status” by Han et. al. (Han B 2021) and published in JAMA Psychiatry on June 22, 2021. Ouchy wa wa. 

Why They Did It

During the past decade, cannabis use among US adults has increased markedly, with a parallel increase in suicidality (ideation, plan, attempt, and death). However, associations between cannabis use and suicidality among young adults are poorly understood. The authors wanted to answer the question, “Are there associations between cannabis use and suicidality trends in young adults, and do they vary as a function of sex and depression?”

How They Did It

They examined 281 650 adult participants in the 2008-2019 National Surveys of Drug Use and Health data

What They Found

Past-year suicidal ideation and plan along with daily cannabis use increased among all examined sociodemographic subgroups (except daily cannabis use among current high-school students), and past-year suicide attempt increased among most subgroups. 

Wrap It Up

From 2008 to 2019, suicidal ideation, plan, and attempt increased 40% to 60% over increases ascribed to cannabis use and major depressive episode. Future research is needed to examine this increase in suicidality and to determine whether it is due to cannabis use or overlapping risk factors. Alright, that’s it. I’ll try to be cooler next week. In fact, I KNOW I’ll be cooler next week because we have the amazing Dr. Brett Winchester coming up as a guest so don’t miss him. He’s on the top of the mountain. Let’s find out how he got there, shall we? 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. 

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

https://www.amazon.com/dp/B096RST3WW

Chiropractic evidence-based products

Integrating Chiropractors

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

Bibliography

  • Albaugh MD, O.-G. J., Sidwell A, (2021). “Association of Cannabis Use During Adolescence With Neurodevelopment.” JAMA Psychiatry.
  • Han B, C. W., Einstein EB, Volkow ND, (2021). “Associations of Suicidality Trends With Cannabis Use as a Function of Sex and Depression Status.” JAMA Netw Open 4(6): e2113025.
  • Pitcher MH, V. K. M., Bushnell MC, Porter L., (2019). “Prevalence and Profile of High-Impact Chronic Pain in the United States.” J Pain 20(2): 146-160.

 

Predicting Frailty & A 30-Year Study On Disc Degeneration

CF 184: Predicting Frailty & A 30-Year Study On Disc Degeneration Today we’re going to talk about using bone or musculoskeletal parameters to predict frailty and then we’ll cover a 30-year study on disc degeneration. Sit tight and chew on the morsels of knowledge we’re about to dish up for you.  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. We’re the Metallica of chiropractic research……if there is such a thing. 

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 #1844

Now if you missed last week’s episode , we talked about the factors leading to surgery for some discs and then we talked about recent information concerning disc innervation and what happens when a disc is injured. 

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

On the personal end of things…..

So for personal happening this week, we are getting the training set up for a nurse practitioner down in Dallas. Our medical Director is good enough that he would like to be trained on what the nurse practitioner is doing as well. That means good things for us. 

When the medical Director is on board with the nurse practitioner, nothing but good happens. 

I’m still promoting and pushing my book. The one I’d love for you to purchase called “‘The Remarkable Truth About Chiropractic: A Unique Journey Into The Research’. It’s on Amazon and you can find the link on my homepage at chiropractscforward.com so go give it a look-see and a purchase. You can get it in paperback and as an ebook. 

This is an amazing resource for you practitioners in the field. Definitely for you content creators. Whether you’re looking for info to post on your social media, whether you’re teaching your patients and need material, or it you’re putting together a speech you need to give to a group……THIS is your resource to make your life easier and to save time. Seriously. Just flip to the topic and pick out the papers you like. BOOM….done. 

I noticed that the forward thinking chiropractic alliance had their fire event this past weekend. With all of the things I’m involved in, I was unable to attend either live or online. 

But, I purchased the online package so will be reviewing it when it is available online. It was all about implementing rehab into your practice and making money doing it. I love rehab and exercise being a part of my every day practice so I’m looking forward to waiting through all of the information. I am still trudging through the forensics fellowship and I have to say, it is not material that I enjoy. In fact, it’s pretty awful. 

But, with the forensics fellowship being a subsidiary of the orthopedics fellowship that I already went through, I only have to do 100 hours rather than 300 so there’s no reason to not do it. So, I am begrudgingly going through it. It feels like I would assume running through quicksand feels. I hate the material but I plan on enjoying The final results. 

Also, as part of the Parker CBI program, I have an intern coming on board. He’s going to move out to Amarillo for a semester and follow us around and work in the office starting in September. 

Throw that in on top of a nurse practitioner starting full-time with us on August 2, and I should have my hands full. This podcast is getting more and more challenging to write produce and record every week. Depending on how all of this goes in the fall, I may be forced to begin releasing an episode every two weeks rather than every week. Stay tuned. That decision is on the horizon. 

Other than all of that, I am involved in all of my extracurricular activities as well.

I am still going to the track and throw in the shot put and discus on the weekends and planning on competing in some masters events next spring and summer. Still trying to lose weight and stay involved in working out and being in the healthy lifestyle. And I’m still busy doing all of my artwork that I’ve been doing all along. 

If you’re interested in any of that you can find it on Facebook at Jeff Williams art. If I was that weren’t enough, I’m busy putting together a new band and music projectWell my voiceover career is also expanding and growing and growing a little bit crazy at the moment. You could say my cup runneth over exponentially. 

For that reason, let’s get on with the research.

Item #1

The first one is called “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi et al. (Sääksjärvi S 2020) and published in Spine Journal in October of 2020 which is cooling off but still pretty damn steamy. Hot enough to eat. 

Why They Did It

The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up

How They Did It

  • A prospective follow-up study.
  • In an earlier study, 75 conscripts aged 20 years with LBP had their lumbar spine examined by MRI. 
  • At a follow-up of 30 years, the subjects were contacted; 
  • 35 of 69 filled a pain and disability questionnaire, 
  • and 26 of 35 were also reexamined clinically and by MRI. 
  • The images were evaluated for decreased signal intensity and other degenerative changes. 
  • Association between decreased signal intensity of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed using Fisher exact test. 
  • Association between decreased baseline signal intensity and pain/disability scores from the questionnaire was analyzed with Kruskal-Wallis H test.

What They Found

  • The total number of lumbar discs with decreased signal intensity increased from 23 of 130 to 92 of 130 
  • Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs. Discs that had even slightly decreased signal intensity at baseline were more likely to have severely decreased signal intensity at follow-up, compared to healthy discs. 
  • Other degenerative changes were also more common in these discs. 
  • Severity of DD at baseline did not have a significant association with current pain or disability.

Wrap It Up

In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms.

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Item #2

Our last one today is called “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study” by Tembo et. al. (Tembo 2021)       and published in Calcified Tissue International in 2021….ouch….don’t touch it…..it sizzles. 

And honestly….who the hell knew there was an entire damn journal called calcified tissue international?? How damn niche can you get?? For reals. And don’t tell me it’s pronounced nish because I’m just going to kick you in the shin if we meet in person. I’m going with niche because there are riches in niches. Not in nishes so don’t do it. 

Why They Did It

How They Did It

  • This longitudinal study included 287 men aged ≥ 50 yr at baseline (2001–2006) from the Geelong Osteoporosis Study
  • Baseline musculoskeletal measures included femoral neck bone mineral density (BMD), appendicular lean mass index (ALMI, kg/m2) and whole-body fat mass index (FMI, kg/m2) and lower-limb strength
  • Frailty at the 15 yr-follow-up (2016–2019) was defined as ≥ 3 and non-frail as < 3, of the following: unintentional weight loss, weakness, low physical activity, exhaustion, and slowness
  • Potential confounders included anthropometry, smoking, alcohol, FMI, socioeconomic status and comorbidities

What They Found

  • Forty-eight (16.7%) men were frail at 15 yr-follow-up.
  • Musculoskeletal models were better predictors of frailty
  • Musculoskeletal parameters improved the predictability model for frailty after 15 years

Wrap It Up

In general, muscle models performed better compared to bone models. Musculoskeletal parameters improved the predictability of frailty of the referent model that included lifestyle factors. Muscle deficits accounted for a greater proportion of the risk for frailty than did bone deficits. Targeting musculoskeletal health could be a possible avenue of intervention in regards to frailty.

And now you know…..the rest of the story….

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. 

 

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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  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

Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347.  

Tembo, M. C., Mohebbi, M., Holloway-Kew, K.L, (2021). “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study.” Calcified Tissue Int.    

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!

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Integrating Chiropractors

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

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

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

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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.