jeff williams

Chronic Pain Central Sensitization & Patient Barriers To Physical Therapy

CF 316: Chronic Pain Central Sensitization & Patient Barriers To Physical Therapy Today we’re going to talk about Chronic Pain Central Sensitization & Patient Barriers To PT and, I would argue….chiropractic care. 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #316 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Man, we’re going through some stuff at the office recently and it centers around collections. Remember when I said last week that practice is a big long game of whack-a-mole? Well, it’s a fact and what I’m currently dealing with is really a ‘death by a thousand cuts’ type of scenario with one glaringly large issue.  The bright neon sign issue right now is collections. We are billing appropriately but the checks aren’t showing up. We’ve had such a struggle with in-house billing in the past. We lost hundreds of thousands on that years ago so we’ve moved to off-site billers. We are now on our 4th, I believe.  I think we’re in the right spot with this one. However, in the transition, our collections have taken a nose dive and I mean a nose dive. As in, if we billed out $70k+, we had a collections of $28k. Right. Now, carry that out over 3 months with that kind of deficit, your resources that are meant to cover issues start to vanish fairly rapidly.  Remember, I have an overhead of $55k-$60k/month. I remember when I was younger and newer in practice. At the time, my overhead was about $25k. I was talking to an older chiro buddy of mine at a TX Chiro Assoc event and he told me his overhead was $45k/month. And he wasn’t integrated either. It blew me away. I couldn’t imagine having an overhead that high.  And…..well here we are. With 4 full time employees, a full-time NP, an acupuncturist, and 2 massage therapists…..it just sort of happens. All of the medical supplies….holy cow. That’s a pretty penny, folks. Massage supplies, acupuncture needles, 4,000 sq ft. Office, utilities…you get the point. It adds up fast and if you’re not cognizant of what’s up, it’ll get out of hand on you. That’s why I balance my own bank account each month. I know what’s coming in and what’s going out.  It’s why I know that we have a collections issue.  Remember we have death by a thousand cuts, right? Well, other issues of late are that we aren’t performing and charging for codes we could be. We’re letting cold laser patients walk out the door without doing laser. We’re letting exercise patients exit the building without doing their exerrcises. This is happening with patients that are covered under PI or on their insurance plan for rehab.  That’s just a training issue and we’re whacking that mole currently.  Another issue is that we’re still recovering from COVID on some level. In 2019, I had 220 more new patients over the course of that year than I had in 2023. What the hell? So, we’re whacking that mole by ramping up some marketing and website SEO efforts.  I have a call with the collection company today at lunch and I have addressed the other issues. Now, if we can get it happening on the collections, you’ll get to hear happy Jeff in future episodes. Yay!! Why do I share this stuff with you? I like to think this is not just a research article podcast. This is real life. If you know the struggles I’m dealing with and the successes I’m enjoying, you’re either going through the same and can learn, or you WILL be going through the same and can learn from my experiences.  Even when you’re riding the wave of success, things can short circuit and you have to always be paying attention so that you can catch it as quickly as possible so you can avoid disaster. After years of not having to give finances much consideration at all, it’s time to lean on some folks that owe the clinic money, lean on our biller a bit, get ourselves in order, and market.  Easy peasy right? I’ll keep you posted on our progress. Don’t cry for me, Argentina! You’ll be mad at me soon because I’ll be back to seeing 70+ new patients per month. Wait for it. When you’ve got my attention, you’ve got my attention and I have a tendency to really lean in and get focused. That’s where we are right now. While I don’t recommend it, it is a bit exhilerating. I’ll admit.  Item #1 Our first one today is called, “Nociplastic pain and central sensitization in patients with chronic pain conditions: a terminology update for clinicians” by Nijs et. Al. published in Brazillian Journal of Physical Therapy in May of 2023 and that’s hot enough! Remember, the citations can be found at chiropractscforward.com under this episode.  Nijs J, Malfliet A, Nishigami T. Nociplastic pain and central sensitization in patients with chronic pain conditions: a terminology update for clinicians. Braz J Phys Ther. 2023 May-Jun;27(3):100518. doi: 10.1016/j.bjpt.2023.100518. Epub 2023 Jun 14. PMID: 37348359; PMCID: PMC10314229. Why They Did It Acute pain has been tremendously beneficial throughout evolution as it enables us to identify potential harmful stimuli, and as it ensures we protect damaged tissue while it heals.  However, once evolved into a chronic state, its protective role diminishes with a wide range of negative and maladaptive sequelae that massively impact both the individual and society.  Neuroscientific research has significantly advanced our understanding about pain and chronic pain in particular, including the role of central (nervous system) sensitization in the generation and amplification of (persistent) pain experiences. This knowledge innovation created a massive implementation potential but also a challenge for clinicians to remain up-to-date in daily practice.  Particularly the variety of and rapid change in concepts and terminology used can be challenging for clinicians. For these reasons, this second part of the comprehensive pain management editorial series1 provides a terminology update regarding central sensitization and nociplastic pain in a clinically applicable way.  Essentially, central sensitization is the major underlying mechanism of nociplastic pain, which is a pain phenotype. To facilitate the understanding of the concept of central sensitization, it is crucial to understand that central sensitization is a homeostatic mechanism. This implies, similar to inflammation, that central sensitization is adaptive in the short term (e.g., in the days following surgery or following a motor vehicle accident). As such, it avoids further deterioration in acute pain situations.  However, central sensitization becomes maladaptive in the long term, with pain losing its protective value as commonly seen in patients with persistent pain (e.g., months after successful surgery or a motor vehicle accident).  In addition, central sensitization and inflammation – although physiologically very divert mechanisms – share many features, including the notion that multiple biomarkers together rather than a single gold standard are required for assuming its presence, the fact that they are both umbrella terms covering various clinical & biological presentations, that their clinical presentation varies substantially from patient to patient, and that they are both key mechanism in a wide variety of clinical conditions/diseases The presence of clinical features of central sensitization predicts poor treatment outcomes in patients with a variety of chronic pain conditions, at least when the treatment targets local tissues as the presumed source of nociception.  This applies to conservative interventions, but also to surgical interventions. These observations illustrate the need for early recognition of central sensitization in patients with chronic pain, in combination with tailored treatment. Item #2 Our last one today is called, “Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review”’ by Dickson et. Al. and published in Pain Medicine in February 2024 and that one’ll burn your damn eye brows off.  Cameron Dickson, Rutger M J de Zoete, Carolyn Berryman, Philip Weinstein, Kexun Kenneth Chen, Paul Rothmore, Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review, Pain Medicine, Volume 25, Issue 2, February 2024, Pages 104–115, https://doi.org/10.1093/pm/pnad134 Why They Did It To identify and synthesize patient-related barriers to… and enablers of ….the implementation of high-value physiotherapy (HVP) for chronic pain.  Furthermore, to review what patient-related interventions have been used to facilitate the implementation of high-value physiotherapy for chronic pain, as well as their efficacy. How They Did It The authors systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain.  They used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. What They Found
  • Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. 
  • Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient’s understanding of exercise benefits. 
  • Other barriers included fear of movement, fragmented care, and cost. 
  • Ten studies explored interventions, 9 of which aimed to improve exercise adherence. 
  • Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls.
Wrap It Up
  • Patients with chronic pain experience barriers to high value PT, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. 
  • Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. 
  • Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. 
  • Our findings suggest that interventions seeking to enhance implementation of high value PT, need to consider the multifactorial barriers experienced by patients with chronic pain.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.       

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

CF 315: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6).

If you’ve been following along, and I hope you have…The WHO updated their recommendations recently for pain. Spinal maniuplative therapy was include so we’re on the menu. But, they rated SMT at very low confidence, which is the same as what they rated ultrasound. So, in the eyes of the WHO, smt may be about as effective as ultrasound. Yeah, we’re call BS so we are going through each paper they used to make this determination and they all, except for a few, are old, outdated, and pretty much stink. We’ll talk about it…. 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. 

 

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #315 Now if you missed last week’s episode, we talked about Omnivorous vs Vegan and SMT For Chronic Neck Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Another day, another dollar by friends. Here we are at the end of January 2024 and if all works well and if you’re an insurance or hybrid clinic, then you know that you’ve been a little slower because the deductibles re-set in January for the most part and people don’t like to spend their own money.  But, about a month or so is as long as many of them ever want to go without going to the chiropractor and that’s OK.

The point being that hybrid clinics like mine should start seeing increased numbers in February. It may be mid to late February but we should see us start getting busier for sure.  In the meantime, I’ve started focusing more and more on marketing. I feel like I’m pretty dangerous when I have the time to be. Right now, I have the time to be. I used to sit around brainstorming ideas for marketing, memes, content, and all that entails. Then I’d create my own original stuff and post it.  I haven’t done that in forever it seems but here lately, and unfortunately, I’ve had some extra time to give those things attention again. I like a challenge and so I’m on it. I’ve targeted the demographics I want targeted.

The ones I think that the economy and who happens to be the President will have no control over economically. We’ve re-newed our efforts in getting our message to these people.  In addition, we’ve re-newed our efforts in our public outreach. Face to face, person to person outreach. Dan Kennedy says, YCDBSOYA, You can’t do business sitting on your ass. You’re moving forward or falling behind. You’re the window or the bug. You either make things happen in your life or you sit around wonder what the hell just happened.  So that’s what’s up with Creek Stone on this Monday, January 29th.

I have 35 on the schedule when I typically have 45. You carry that out throughout the week, that’s 50 less per week which is 200 less appointments per month. That’s unacceptable.  I’ve had less new patients lately as well. I think my Google SEO has dimished since going with a very reputable company a few years ago so we switched it up and went with a new website company that I know gets results. That’s brand new.  I also got to looking at our new patients demographics and it looks like we’re seeing fewer VA patients recently. That’s worth investigating and diving into.  If you’re not doing these thing regularly, might get on it. It’s whack-a-mole folks. You can never hit the auto-pilot button and sit back and just do the work if you’re the owner. It’s a constant battle. Enjoy the great times and ride that wave. When things start popping up out of nowhere, dig in, have some grit, and wait for that next wave.  Alright, here we go with the research today. 

Item #1

The first one today is called, “Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial” by Krekoukias, et al., published in 2017 in the Journal of Manual Manipulative Therapy.  Remember, the citations can be found at chiropractscforward.com under this episode.  Krekoukias G, Gelalis ID, Xenakis T, Gioftsos G, Dimitriadis Z, Sakellari V. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther. 2017 May;25(2):66-73. doi: 10.1080/10669817.2016.1184435. Epub 2016 Jun 23. PMID: 28559665; PMCID: PMC5430451.

Why They Did It The authors wanted to examine the efficacy of spinal mobilization in subjects with low back pain (LBP) and associated spinal disk degeneration.

How They Did It Seventy-five subjects suffering from chronic LBP were randomly allocated into 3 groups of 25 subjects.  Each group received five treatment sessions with the first group receiving manual therapy (MT) (spinal mobilization), the second a sham treatment, and the third conventional physiotherapy (CP) (stretching exercises, transcutaneous electrical nerve stimulation, and massage).  Subjects were assessed for their pain intensity using the numerical pain rating scale and for their self-reported disability using the Oswestry and Roland-Morris Questionnaire at baseline and after the completion of the five treatment sessions.

What They Found Paired t-tests showed a significant improvement for all outcome measures in the manual therapy and conventional physiotherapy group.  Analysis of covariance revealed that the manual therapy group had significant improvement in all outcome measures in comparison with the sham and conventional physiotherapy group, whereas no significant difference was observed between the sham and conventional physiotherapy group

Wrap It Up Manual Therapy is preferable to conventional physiotherapy in order to reduce the pain intensity and disability in subjects with chronic LBP and associated disk degeneration.  The findings of this study may lead to the establishment of spinal mobilization as one of the most preferable approaches for the management of LBP due to disk degeneration.

Item #2 The last one is, “The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial” by Koes published in Spine journal in 1992 and they’re using 1992 to make this determination in 2024 because there’s no better and more current  Koes BW, Bouter LM, van Mameren H, Essers AH, Verstegen GM, Hofhuizen DM, Houben JP, Knipschild PG. The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial. Spine (Phila Pa 1976). 1992 Jan;17(1):28-35. doi: 10.1097/00007632-199201000-00005. PMID: 1531552.

Why They Did It As you see in the title of the paper, the plan was to test the effectgiveness of manual therapy, physiotherapy, and treatment by a general practitioner on back and neck pain

How They Did It It was a randomized controlled trial The effectiveness of manual therapy, physiotherapy, continued treatment by the general practitioner, and placebo therapy (detuned ultrasound and detuned short-wave diathermy) were compared for 256 patients with nonspecific back and neck complaints lasting for at least 6 weeks. The principle outcome measures were severity of the main complaint, global perceived effect, pain, and functional status. These are presented for 3, 6, and 12 weeks follow-up. 

What They Found Both physiotherapy and manual therapy decreased the severity of complaints more and had a higher global perceived effect compared to continued treatment by the general practitioner.  Differences in effectiveness between physiotherapy and manual therapy could not be shown. 

Wrap It Up A substantial part of the effect of manual therapy and physiotherapy appeared to be due to nonspecific (placebo) effects. From 1992 – Placebo seems to be why smt appears to be effective. We know that placebo can and should play a part in a patient’s recovery. And we can leverage placebo in our favor too. Placebo has a bad name for some reason. In the biopsychosocial construct we should be using to our advantage all of the time.  Encouraging and positive words, little pain free wins….these things play a part in neuroplasticity and moving it in our direction and moving the patient away from chronic pain. 

That doesn’t mean that smt is placebo only and there have been plenty of papers shwoing the effectiveness of SMT beyond placebo in teh last 10 years or more. This paper is liteerally 32 years old. What in the holy hell are they using this paper for in 2024? I can’t explain it.  To be fair, I suppose the Gate Theory from the 1960s is still relevant so why can’t this paper still be relevant, right?/

But I’d argue that the Gate Theory is gamechanging big stuff. This paper, in my opinion, isn’t in the same ball park with regard to impact and effectiveness. As knowledge base expands, more recent and more relevant knowledge replaces outdated knowledge. This paper should be replaced and not be relevant when recommending SMT for treatment.  My two cents.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)

CF 313: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

 

Integrating Chiropractors

 

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

 

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

 

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

 

OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable.

We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. 

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together. 

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #313

Now if you missed last week’s episode, we talked about Pet Ownership And Cognitive Decline & PT Effectiveness. 

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

On the personal end of things…..

Well, we got a mix of stuff this week in the clinic. Our new intern is getting comfortable and settled in and getting up to speed with the way the office works and flows. We are picking back up a little just in time for me to be gone for two work days to attend my quarterly Mastermind meeting. Yes, it gives me anxiety but I’m going. The Mastermind is important. 

For this Mastermind, we’ll be joined by Brett Winchester who, in case you are unaware, is probably a genius in the healthcare space but also is borderline crazy personally. He’s hilarious and a lot of fun to be around so I’m definitely looking forward to Brett being int he mix with the rest of our regular crew. 

Plus, the January meeting is when new members join the group so that should be fun. It’s always good to meet the newbies and get to know more about them and learn from them. Last year’s newbies said they were intimidated to come into the group. Pffft. They fully integrated quickly and are part of the family now. We have some super smart docs but the ones joining are super smart too and we are just as eager to learn from them as they are to learn from us. 

So it works well and we’re looking forward to getting to know them. 

So this Monday has gone much better so far than last Monday. If you listened to the podcast last week, we had land mines to avoid last Monday for some reason. Smoother today for sure. We thought it may have been Dontae’s first day jinx so we made him take a shower and wash it off and he’s not allowed to wear those same clothes anymore. I think we have it handled. 

We are really buckling down this week to try to determine the best way to get our medical services up to speed and working with 100% efficiency. I think I have an approach of, let’s implement and let’s see what happens. I think that makes sense in the beginning with any service but once you’re up and running, it is time to fine tune. 

How are your prices in 2024 vs 2017? The same? You know everything in the world has gone up in price so if your prices are the same, you are making less money overall. Less profit I should say. 

Are our medical service and chiropractic services in line with the market and other clinics in our area?? We don’t want to be the cheapest. We don’t want to be the most expensive either. We don’t want to offer an exam, a consultation, a treatment plan, an adjustment, x-rays, and therapy on the first visit for the low low price of $39. 

Racing to the bottom hurts you and everyone else. If you want to look like a street corner huckster, that’s how you make it happen. If you want to take x-rays on every single person, which isn’t in line with ACA’s Choosing Wisely guides by the way, that’s fine. I don’t fault people wanting to know exactly what they’re dealing with. However, why the hell would you give them away? 

If you say that it’s because you want to show them their degeneration and their listings……we aren’t friends. We are different people. If you do it to show them these things and then spook them into 70 visits over the course of the year, you gotta check that stuff. Look in the mirror. 

If you wouldn’t do it to your mom, don’t do it to your patients. 

Anyway, you don’t want to give your services away. Please don’t do that. But I don’t really want to be the most expensive either. If I’m toward the more expensive but still responsible and appropriately priced, then I feel that’s the sweet spot. But you have to be financially healthy if you’re going to do a good job taking care of your patients. 

When you’re all running through your day wondering focused on the number of visits because you can’t pay payroll that week, well, that’s a problem we gotta get fixed. 

So, this month is a good month to look through our services and see if we’re doing what we can price wise to stay competitive and but maximize our ROI. 

On a final note before we hop into our research this week, I love hate the Cowboys. They broke my heart yet again this year but it’s OK because I fully expected and anticipated it. I knew it was going to happen so it didn’t upset me. And honestly, why get upset over a bunch of spoiled brat millionaires playing a game anyway? I refuse to allow the pinche Cowboys do that to me so……I’m moving on. 

Go Houston Texans. Go Texas Rangers. Go Houston Astros!

Cowboys….maybe next year. 

Now this week we’re continuing our series. If you don’t know or are unaware, the WHO recently recommended spinal manipulative therapy for back pain but at very low confidence. Which is equal to ultrasound. I dove in and found their citations with regard to SMT specifically and we’re going through them one by one to find out, with all of the research we’ve seen and covered combined with American College of Physicians recommendations, Parker Gallup polls, and on and on and on…..how can SMT be at very low confidence. 

So here we go. 

Item #1

Our first one is called, “Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain” by Gibson, et al and published in The Lancet in June of 1985. Not sure why they’re pulling papers from that far back but whatever. 

And I’m going to say that this paper is so old that even the abstract didn’t make a ton of sense. 

Gibson T, Grahame R, Harkness J, Woo P, Blagrave P, Hills R. Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain. Lancet. 1985 Jun 1;1(8440):1258-61. doi: 10.1016/s0140-6736(85)92323-2. PMID: 2860453.

Why They Did It

The effectiveness of spinal manipulation carried out by a non-medical qualified osteopath was compared with that of short-wave diathermy (SWD) and a placebo

How They Did It

109 patients with low back pain. 

That’s it. That’s all of the info on it. No idea if it was a randomized controlled trial or what. 

What They Found

More than half the subjects in each of the 3 treatment groups benefited immediately from therapy. 

Significant improvements were observed in the 3 groups at the end of 2 weeks’ treatment, and these were still apparent at 12 weeks. 

The outcome of treatment was unrelated to the initial severity or duration of pain or to the trend of pain towards deterioration or improvement. 

It is, therefore, unlikely that the results simply reflect the natural history of low back pain. 

Wrap It Up

Benefits obtained with osteopathy and short-wave diathermy in this study may have been achieved through a placebo effect.

So…..that’s a crap paper and why the WHO would have that paper as having any influence on our profession in 2024 is beyond me. 

Item #2

Our last one today is called, “Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial” by Grande-Alonso et. Al and published in Pain Medicine in December of 2019

Remember paper citations will be found in the show notes at chiropracticforward.com episode 313.

Grande-Alonso M, Suso-Martí L, Cuenca-Martínez F, Pardo-Montero J, Gil-Martínez A, La Touche R. Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial. Pain Med. 2019 Dec 1;20(12):2571-2587. doi: 10.1093/pm/pnz093. PMID: 31074484.

Why They Did It

To compare the effectiveness of a biobehavioral approach with and without orthopedic manual physical therapy on the intensity and frequency of pain in patients diagnosed with nonspecific chronic low back pain.

How They Did It

  • A single-blind randomized controlled trial. 
  • Fifty patients were randomly allocated into two groups: one group received biobehavioral therapy with orthopedic manual physical therapy, and the other group received only biobehavioral therapy. 
  • Both groups completed a total of eight sessions, with a frequency of two sessions per week. 
  • The somatosensory, physical, and psychological variables were recorded at baseline and during the first and third month after initiation of treatment.

What They Found

  • In both groups, the treatment was effective, presenting significant differences for all the variables in the time factor. 
  • There were no significant differences between groups in intensity or frequency of pain, with a large effect size (>0.80), but there were intragroup differences for both intervention groups at one- and three-month follow-up. 
  • There were also no significant differences between groups in the secondary variables during the same follow-up period.

Wrap It Up

The results of this study suggest that orthopedic manual physical therapy does not increase the effects of a treatment based on biobehavioral therapy in the short or medium term, but these results should be interpreted with caution.

I do not have the full paper, only the abstract. How was the orthopedic manual physical therapy defined? What was involved? Is that SMT? I don’t know. 50 patients isn’t much of a sample size either really. 

I’m not sure why the WHO felt this one was suitable to make their determination off of but that’s why we’re doing this, right?

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The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

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About the Author & Host

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

 

Pet Ownership And Cognitive Decline & PT Effectiveness

CF 312: Pet Ownership And Cognitive Decline & PT Effectiveness Today we’re going to talk about Pet Ownership And Cognitive Decline & PT Effectiveness But first, here’s that sweet sweet bumper music  

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

 

On the personal end of things….. Alright, this was a crazy day. Where do we start? First, we had our new intern from Parker College start today. Welcome to the practice Donte. I’ll say he either picked the craziest day of days to start or he’s just bad luck.  Frist thing, it’s freezing outside and there are ice pellets coming out of the sky. It’s been pretty nice here in the Texas Panhandle until Donte’s first day with us. Now we’re just hoping no blizzard moves in with these 60 mph winds. 

Then, we one staffer out sick and then another got a call that her mother was having some health issues and she had to leave in a hurry so prayer for our work family. We’d appreciate your best wishes as well for her and her family.  Then we had a patient come in that was just a difficult one. It was our first from a PT so hey…..that’s cool as hell but this patient was a difficult one for sure.  There was more to the day that was challenging but I’m not going into the whole thing.

The point is, if Dontae was hoping to see an old guy navigate a day full of hurdles and land mines, he definitely got it.  It was a damn day and here’s hoping that the rest of the week is smooth sailing full of perfect patients and lots of learning for our new intern. 

Pro Tip, check out the C-sign. I was talking with one of my chiro buddies recently and he mentioned something about a patient with a low back and hip issue he had years ago. I asked if the patient had a C sign. My colleague wasn’t aware of the C-sign and I’ll admit that I wasn’t either until about 4 years ago when I went through the Ortho Diplomate. 

This is a Dr. Tim Bertlesman special for you. If they give you the C-sign, it’s the hip until you rule the hip out. That is an excellent rule of thumb and so easy to remember and bring back up because once you see and recognize the C-sign, you’ll be reminded immediately.  The C-sign is when a patient says, “It hurts right here.” And the have their thumb and index finger in a C shape and running the C along their iliac crest back and forth. Sometimes down into the inguinal area.  If you see that, assume it’s the hip until you rule it out with either orthos or imaging.  There’s your pro tip today.

Let’s get on with the episode. Since we’re going to have so many of the WHO and SMT and very low confidence episodes coming up, I’m going to split those up and just do them every other week to keep you invested and from getting bored with it.  You can thank Dr. Steven Brown from Gilber AZ for that. Lol. He said I seem obsessed with the topic.

He was joking of course but, while I’m not obsessed per se, I am definitely wondering; if we have as much research in our favor as we’ve covered for over 6 years now, how on Earth can the WHO have us at ‘very low confidence?’ Which is the same as ultrasound by the way.  I want to know. I’m figure a lot of you do as well. From our previous episodes on it, I see they’re using papers with low sample size and some that are definitely older studies to make that determination. But we’ll keep exploring. Just not this week. 

Item #1 Our first on ethis week is called, “How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis” by Dove, et. Al. and published in European Spine Journal on 29th of December 2022 and while it’s not piping hot, I haven’t gotten to use it in a bit so here ya go!! Remember citations to the papers can be found on our website at chiropracticforward.com and episode 312.  Dove, L., Jones, G., Kelsey, L. et al. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J 32, 517–533 (2023). https://doi.org/10.1007/s00586-022-07356-y

Why They Did It Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial.  The purpose of this systematic review was to establish the short-, medium- and long-term effectiveness of physiotherapy interventions compared to control interventions for people with clinically diagnosed sciatica

How They Did It It was a systematic review  Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed, Scopus and grey literature were searched from inception to January 2021.  Inclusion criteria were randomised controlled trials evaluating physiotherapy interventions compared to a control intervention in people with clinical or imaging diagnosis of sciatica.  Primary outcome measures were pain and disability.  Study selection and data extraction were performed by two independent reviewers with consensus reached by discussion or third-party arbitration if required.  Risk of bias was assessed independently by two reviewers  Three thousand nine hundred and fifty eight records were identified, of which 18 trials were included, with a total number of 2699 participants.  All trials had a high or unclear risk of bias. 

What They Found Meta-analysis of trials for the outcome of pain showed no difference in the short, medium or long term.  For disability there was no difference in the short, medium, or long term between physiotherapy and control interventions.  Subgroup analysis of studies comparing physiotherapy with minimal intervention favoured physiotherapy for pain at the long-term time points.  Large confidence intervals and high heterogeneity indicate substantial uncertainly surrounding these estimates.  Many trials evaluating physiotherapy intervention compared to substantial intervention did not use contemporary physiotherapy interventions.

Wrap It Up Based on currently available, mostly high risk of bias and highly heterogeneous data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica.  Future studies should aim to reduce clinical heterogeneity and to use contemporary physiotherapy interventions.

Item #2 The last one today is called, “Pet Ownership, Living Alone, and Cognitive Decline Among Adults 50 Years and Older” by Li et al and published in JAMA Network Open on December 26, 2023 and POW! That’s a hot one folks! Pet lovers listen up! Li Y, Wang W, Zhu L, et al. Pet Ownership, Living Alone, and Cognitive Decline Among Adults 50 Years and Older. JAMA Netw Open. 2023;6(12):e2349241. doi:10.1001/jamanetworkopen.2023.49241

Why They Did It Is pet ownership associated with cognitive decline in older adults, and how does pet ownership mitigate the association between living alone and the rate of cognitive decline? They wanted to explore the association of pet ownership with cognitive decline, the interaction between pet ownership and living alone, and the extent to which pet ownership mitigates the association between living alone and cognitive decline in older adults.

How They Did It This cohort study used data from waves 5 (June 2010 to July 2011) to 9 (from June 2018 to July 2019) in the English Longitudinal Study of Ageing.  Participants included adults 50 years and older.  Pet ownership and living alone in wave 5. Verbal memory and verbal fluency were assessed, and composite verbal cognition was further calculated. Of the 7945 participants included, the mean (SD) age was 66.3 (8.8) years, and 56.0% of the subjects were women.

What They Found Pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency.  Three-way interaction tests showed that living alone was a significant modifier in all 3 associations.  Stratified analyses showed that pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency among individuals living alone, but not among those living with others.  Joint association analyses showed no significant difference in rates of decline in composite verbal cognition, verbal memory, or verbal fluency between pet owners living alone and pet owners living with others.

Wrap It Up In this cohort study, pet ownership was associated with slower rates of decline in verbal memory and verbal fluency among older adults living alone, but not among those living with others, and pet ownership offset the associations between living alone and declining rates in verbal memory and verbal fluency.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4)

CF 311: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4) But first, here’s th at 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #311 Now if you missed last week’s episode, we talked about the same thing only it was Part 3.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. It’s January 2 today as I’m typing. That means a new year….a new me. Right. Not really. I’m the exact same dude I was on 12/31 with the same personality, belt line, and problems . My daughter said, “”what’s your resolution, Dad?” I said I don’t make them. I don’t believe in them. I try to better myself every day. If I need to lose weight, we don’t wait until 12/31 to decide we’re going to do it. I think of stuff and I just do it.  So, I don’t do resolutions. However, I do like motive, ambition, decisions to move in a positive direction, and overall good positive feelings. So, while I don’t engage in resolutions myself, I do support them 100%.  I’ve said here that 2023 was a tough one for me personally and professionally. No big game changers or life changers. Just irritations that had to be dealth with. It wasn’t a fun one. So I’m hoping that 2024 will be finally movign in the right direction. The changes that need to be made happen and they have the effect they were intended to have and on and on.  My hope is the same for all of you.  We should all have a little extra time on our hands for a month or so. That’s if you take insurance. Deductibles re-set in January and for some reason, people don’t like using their own money so it’ll be a bit beffore they return. Usually, if experience serves me, it’ll be around mid February to the first of March before it really ramps back up.  That means we have time to plan, prepare, review our systems, train, and market.  So let’s get to it so we can all get after it.  Item #1 The first one this week is called “Chronic low back pain and vertebral manipulation” by Ghroubi et. Al. and published in Annals of Readaptive Physical Medicine and published in October of 2007. The WHO is using a paper from 2007. Duly noted.  Remember that the citations for these papers will be in teh show notes at chiropracticforward.com episode 311 Ghroubi S, Elleuch H, Baklouti S, Elleuch MH. Les lombalgiques chroniques et manipulations vertébrales. Etude prospective à propos de 64 cas [Chronic low back pain and vertebral manipulation]. Ann Readapt Med Phys. 2007 Oct;50(7):570-6. French. doi: 10.1016/j.annrmp.2007.02.012. Epub 2007 Mar 8. PMID: 17382426. Why They Did It This study examined the short-term effectiveness of vertebral manipulation for treating chronic low back pain and disability. How They Did It Sixty-four patients were randomly assigned into two groups.  One group received 4 true vertebral manipulations (VMG), and the other group received sham manipulations (sham-VMG) under the same conditions as for the first technique.  Patients formulated assessments after the manipulations and 1 month later. What They Found
  • Patients receiving the true manipulations showed significant improvement in pain (visual analogic scale score and function)
  • (Oswestry scale). Pain improvement persisted at the second month (P=0.01). 
  • The improvement was more evident in the group that received adjustments than the sham-group. 
  • No change in perceived disability was observed in the sham-VMG.
Wrap It Up Our study confirms the efficiency of short-term vertebral manipulation for treating chronic low back pain. The assessment of vertebral manipulation effectiveness is difficult. This manual therapy must be preceeded by a specific clinical exam performed by a trained physician. Item #2 The last one this week is called, “Lumbar spinal manipulation on trial. Part I–clinical assessment” by Evans et. Al. published in Rheumatological Rehabilitation in February 1978. Yes, the WHO is basing our effectiveness partly on a paper from 1978 that had a sample of 32. Whether the information is positive or negative in the paper……should we be looking at stuff from 1978, 46 years ago, with such a small sample when we’ve seen so many more current papers come through showing effectiveness? I’m not research so it’s just a question from and enthusiastic observer. That’s all.  Evans DP, Burke MS, Lloyd KN, Roberts EE, Roberts GM. Lumbar spinal manipulation on trial. Part I–clinical assessment. Rheumatol Rehabil. 1978 Feb;17(1):46-53. doi: 10.1093/rheumatology/17.1.46. PMID: 153574.
  • Thirty-two patients with chronic low back pain were treated three times at weekly intervals with rotational manipulation. 
  • Patients with femoral or sciatic root pain were included provided they did not exhibit root compression signs. 
  • Background therapy of codeine phosphate was administered throughout. 
  • There was a significant increase in spinal flexion measured clinically during the three-week period of manipulation followed by a significant decrease in the three-week period after manipulation. 
  • The first week of manipulative treatment was more painful than the corresponding week in the control group but in the second and third weeks there was less pain in the manipulated group. 
  • Pain scores were reduced to a significant degree within four weeks of starting treatment only in the group manipulated in the first treatment period. 
  • Patients benefitting subjectively from manipulation were more likely to be older and to have had symptoms for a shorter period than those not deriving benefit. 
  • The age of onset of symptoms was significantly later in the responders.
Well, there you have it for part 4 of why the WHO recommends spinal manipulative therapy but at very low confidence.  We have TEN more episodes on this to explore. Are we enjoying this? Is it useful to you? I know I’m learning and I’m definitely covering papers we haven’t covered on the podcast before so I’m locked in and rocking. I’d love to hear form you on 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. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 3)

CF 310: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 3) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 3) 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #310 Now if you missed last week’s episode, we talked about the same thing we’ll be covering this week but that was part 2 and we are about to get going with part 3 so hold your shorts.  Go back and listen to last week’s when you have time because you need to Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Well, Christmas was yesterday so I just have the holiday hangover today basically. Not from alcohol. I didn’t drink a drop yesterday. Just the activity, the family, the food, and the goign from here to there. Everything involved with a big holiday.  It’s been a tough year for me and my family. We are still recovering from a key passing in our family last year. The ripples were felt all year this year as well. An incredible amount of staff turnover, the like of I’ve never seen in 26 years of practice. And so much more. It was a tough one. While I know a new year makes no real difference, I’m hoping to put 2023 to bed and move to a positive, optimistic, properous 2024 full of more peace for me and my family.  After Chritmas……I’m tired. My normal bed time is around 1:00 am. Last night I was in bed and asleep by about 10:30. When I’m out that early, you know I had all I wanted. Maybe I’m just getting old.  This goes for young, mid, and old…..what are your practice plans?/ what’s the end game? Are you aiming to die in your office still working on patients? Which is fine. It’s just the question that needs to be answered. We get out of college and we start working. Day after day. Many times without thinking of the endgame which, when we’re younger, we don’t think will ever actually happen because we are, of course, indestructible.  Well, my friends, take it from your ol’ Uncle Jeffro, the day does indeed come for all of us. The chiropractor that made me want to be a chiropractor, Dr. Jerry Whitehead from Perryton, TX, just passed away. Sad but true. So what’s the end game? My advice…..build it to sell it. Maybe not in the next 5 years. Maybe not in the next 25 years. But if you build it to sell it, when you’re ready, you have a sell-able product with systems and staff in place to continue what you started.  Imagine an investor or another chiropractor that has it all laid out before them and all they have to do is sign on the line and it’s theirs.  So, my plan for example, is to get an associate in place. Then get another associate in place so there is redundancy. If one leaves us, the remaining one is there to train the next. I want to pay them in a way that the thought of leaving here and having to start their own thing just makes them want to puke. I got that idea from another very successful chiro.  Open up the books, show them your overhead and let them know how hard it is to run the show. Then pay them enough that the thought of giving up that money and having to be in control of all of that stress and management just makes them sick to their stomach.  Then, work into a management position. Also, if you haven’t named your practice yet, don’t do ‘Last Name Chiropractic’. What if I named mine Williams Chiropractic and someone named Bradburn bought it? Well now they have to completely re-brand or keep a name that’s not even theirs. We are Creek Stone for a reason. I like the imagery of the name but it’s also non-descript so anyone can buy it and comfortably continue building the brand.  I try to continuously strike a balance between building trust in me and my name with my community but also let the brand be the marketer instead of having my name and face on every bit of marketing. The less my name and face is in all of the branding, the easier it is for someone else to buy it and not have to overcome the transition of going from my name and face to theirs. If the brand is strong, it will stand on its own instead of depending on my name and image. Also, start thinking now, “What is your exit number?” Assuming you will exit at some point. I have a number in mind for me to have all bills covered, all debts paid, and have plenty fo retirement. With VoiceOver, that number has been significantly reduced by the way. Side gigs that can carry into and sustain retirement are pretty damn nice. We have airbnbs and VoiceOver helping us out on the deal.  I have a plan that I set into motion around 3 years ago and it’s really been paying off so, if all of the pieces fit together, I can ideally be in at least partial retirement by 55 or 56 I think. I hope.  My mom says thats too early. That I’m not old enough to retire. I responded to her, “Who the heck told you that?” Probably some corporation that needs their workers to stay in place into their late 60’s. I’ve workd hard since I was 14. I’m 51. I’m a musician, singer/songwriter, sculptor, painter, futrniture builder, voice actor, landlord, husband, and dad. I’m not wanting to retire. I just want to retire from every day, all day patient care. That’s all.  Anyway, if we were to make New Year’s resolutions, mine would be that my plan keeps taking shape and my financial future keeps going in the right direction to gain more and more freedom of my time. Time is not replaceable and we’re either wasting it or we are investing it. Time cannot be purchased so I’m doing everyhting I can to make the most of what time I have left.  Some thoughts for you with this new year coming up on us.  Item #1 Our first one this week is on the WHO’s list and it’s called, “Spinal Manipulative Therapy for Chronic Lower Back Pain in Older Veterans: A Prospective, Randomized, Placebo-Controlled Trial” by Dougherty et. Al. and was published in Geriatric Orthopedic Surgical Rehabiliation in December of 2014.  Citations are in the show notes.  Dougherty PE, Karuza J, Dunn AS, Savino D, Katz P. Spinal Manipulative Therapy for Chronic Lower Back Pain in Older Veterans: A Prospective, Randomized, Placebo-Controlled Trial. Geriatr Orthop Surg Rehabil. 2014 Dec;5(4):154-64. doi: 10.1177/2151458514544956. PMID: 26246937; PMCID: PMC4252156. Why They Did It Chronic lower back pain (CLBP) is problematic in older veterans. Spinal manipulative therapy (SMT) is commonly utilized for CLBP in older adults, yet there are few randomized placebo-controlled trials evaluating SMT. How They Did It The purpose of the study was to compare the effectiveness of SMT to a sham intervention on pain (VAS, SF-36), disability (Oswestry Disability Index), and physical function (SF-36 subscale, Timed Up and Go) by performing a randomized placebo-controlled trial at 2 Veteran Affairs Clinics. What They Found
  • Older veterans (≥ 65 years of age) who were naive to chiropractic were recruited. 
  • A total of 136 were included in the study with 69 being randomly assigned to SMT and 67 to sham intervention. 
  • Patients were treated 2 times per week for 4 weeks (which is roughly the Clinical Compass guides for chronic pain) assessing outcomes at baseline, 5, and 12 weeks postbaseline. 
  • Both groups demonstrated significant decrease in pain and disability at 5 and 12 weeks. 
  • At 12 weeks, there was no significant difference in pain and a statistically significant decline in disability scores in the SMT group when compared to the sham intervention group. 
Wrap It Up
  • The SMT did not result in greater improvement in pain when compared to our sham intervention; however, SMT did demonstrate a slightly greater improvement in disability at 12 weeks. 
  • The fact that patients in both groups showed improvements suggests the presence of a nonspecific therapeutic effect.
This was in 2014. I think we could makes some educated guesses here in almost 2024 that that could be do to SMT affecting and supporting functional movement, proprioceptive input, and encouragement as far as activity. This could go toward what you’ve heard me mention with regard to Reframe the conversation. Reprogramming basically.  As a side note, after being in this thing 26 years, It’s really hard for me to imagine no difference in the pain levels. Even if just short term. I find it odd but the sample size is honestly small here.  Who knows? But there it is and this is one of the papers the WHO used to recommend SMT but at very low level of confidence.  Item #2 Our last one today is called, “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial” by Didehdar et. Al. and published in Irish Journal of Medical Science in May of 2020.  Didehdar D, Kamali F, Yoosefinejad AK, Lotfi M. The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial. Ir J Med Sci. 2020 May;189(2):543-550. doi: 10.1007/s11845-019-02140-2. Epub 2019 Nov 26. PMID: 31773541. Why They Did It In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions. They aimed to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy How They Did It In the current study, 25 patients with chronic nonspecific low back pain aged 20-50 years were enrolled.  Patients were randomly assigned to lumbopelvic manipulation or sham.  Patients were evaluated before and 5 weeks after treatment by the Numerical Rating Scale (NRS), the Oswestry Disability Index (ODI), and proton magnetic resonance spectroscopy What They Found After treatment, severity of pain and functional disability were significantly reduced in the treatment group vs. sham group  After treatment, N-acetyl aspartate (NAA) in thalamus, insula, dorsolateral prefrontal cortex (DLPFC) regions, as well as choline (Cho) in the thalamus, insula, and somatosensory cortex (SSC) regions, had increased significantly in the treatment group compared with the sham group.  A significant increase was further observed in N-acetyl aspartate in thalamus, anterior cingulate cortex (ACC), and somatosensory cortex regions Also, a significant increase was observed in glutamate and glutamine levels of thalamus.  There was no significant difference in terms of brain metabolites at baseline and after treatment  in the sham group. Wrap It Up In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced. Nice. I’m not going to pretend to be a Neuro wonk but that’s nice.  There is a response when things are done to us. Of course. I see this come up with the insistence that adjustments improve the immune system. OK, but for how long? And is the improvement about the same is getting hit in the butt with a 2×4?  I don’t know the answers to those questions by the way. But, until we do, it’s probably not responsible to advertise that spinal manipulative therapy increases the immune system. If I see an ad that says, “Come in and get you adjustment to ward off COVID and flu,” my face is going to split and my eyes will roll out of my head. Because……just….no. Don’t do it please.  That was a slight tangent so let’s just stop here.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2)

CF 309: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2) 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #309 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Hey crew, this week, we’re just kind of gearing up for Christmas because that’s a big deal. We have Christmas on a Monday this year so that’s nice and tidy, right. We don’t have to decide if we’re taking off Christmas Eve or not. It’s pretty simple this year.  I have a short story about something that we went through last week here in the clinic. It jusst takes one person to really throw a monkey wrench into your week.  I’ll start by saying, “Thank God I can’t prescribe medication.” Those folks have a whole extra layer of crap they have to deal with I’m sure. If you’re fresh faced and new in practice, here’s your warning, there are awful people out there in the world that just want to steal your joy for no damn reason at all. I’m better now but one of them stole mine last week. I had a patient that laid off of work. On their own. Not doctor-ordered. On the day before they decided to return to work, they came into the clinic. They told me they were only really in my clinic for their appointment to get a doctor’s note.  Fine, I’m happy to see patients and I’m happy to write a note that the patient came to see me that day. Not a big deal. Pretty much every day normal stuff.  The next day, the person starts harassing our front desk staffer about writing a note for them covering the days spent at home prior to their visit to our clinic.  The person expected us to falsify our records and create treatment dates for them pretending they were being seen in our office. Dates they were not seen in our office. THAT’S NUTS. And immoral. And unethical. And should be embarrassing for them to even ask, much less expect and DEMAND, an office to do for them.  They said I should be their advocate because I’m their doctor. If you  or your patients ever thought a provider was supposed to be the patients’ advocate, get that out of your head. As you likely know, we are taught specifically, especially in the medicolegal area of healthcare, that we are NOT our patients’ advocates.  We are objective care givers only. Besides that, advocating is one thing. Out and out lying and falsifying records is quite another.  When the patients was told that we cannot do that, the threats started. I received an email from this person telling me that online reviews are powerful tools and that they are going to let everyone know our clinic did them wrong and make sure anyone that reads it will never come to my clinic.  Really??  Using the threat of online reviews to extort a falsified doctor’s note so they don’t get into trouble at work because of their own actions?  This person, who works for a big government outfit, who has probably never took a chance and built anything on their own. Who has never laid awake at night worrying about their business. Who has never poured piles of money, blood, sweat, and tears into building their own brand and reputation. Who. Has never employeed 14 people and was responsible for feeding their families.  This type of person is going to try to tear us down because we wouldn’t lie for them.   You cannot make this stuff up. After not getting the note they demanded, they did go ahead and leave the revenge review. We got us a 1-star out of the deal.  We healthcare people cannot put people like this on blast due to HIPAA so…..we just sort of have to take it on the chin. It’s not the first time I’ve had a patient leave a completely false review but this one is the first one like this. No doubt.  I have the emails and the threats. I reported the review to Yelp as false, libelous, and disparaging with the review service. Of course, Yelp doing Yelp stuff and being absolutely worthless, decided to keep the review. So…..I responded. While the reviewer just used his first name and an initial for the last, I went ahead and addressed him by his full last name. If he’s putting me on blast for no reason, I’m putting him on blast for real. Let’s get the cockroach into the daylight.  After addressing him by his full name, my public response was as follows,  “The first thing I would like to clear up with you that has been taught to healthcare providers through the years, is that healthcare providers are absolutely NOT advocates for patients. We cannot be advocates for our patients. We are objective caregivers. Nothing more. So you can forget that talking point. Secondly, for you to ask a healthcare provider of any type to misrepresent your treatment dates, is quite honestly shocking. We offered, and were more than happy to write you a note for the day that you were seen in our clinic. That is very customary and very appropriate. We would have even been happy to include in the note that any issue experienced was supposedly ongoing. Furthermore, we would have even been happy to leave out any part about only being in the office to get a doctors note.  But we cannot, and will not pretend that we treated you on dates that we did not treat you. For you to demand that from us is quite honestly embarrassingly entitled of you. I understand that you being out of work for some amount of time might cause you issues with your supervisor. While we hate hearing that, we at Creek Stone shoulder zero responsibility in the matter and should have NEVER been expected to play a part in it in any way. You threatened to leave us a terrible review if we refused to lie for you. That will not be tolerated. In your threat to us, you claim that Yelp is a powerful tool. We absolutely understand that. While, we obviously could not prevent you from leaving us a libelous, disparaging, and legally actionable review in an attempt  to prevent others from seeking care with us, we want to be clear, direct, and factual in our response. This review is nothing more than a legally actionable revenge review and we suggest you remove it immediately.  Having a staff of 12 working at our clinic, and caring dearly about each one of them and their loved ones, I guess I’ll never quite understand why someone like you would try to affect our way of providing for our families. Especially when your discipline issue is your own fault.” So, I get an email that night saying that he was never asking me to falsify anything and that he would be fine with a note stating that I saw him on the date I saw him and mention that he stated that it started 3 days previous to the visit. Which would be an honest recounting of the visit I had with him. I have no problem with that.  He even said he’d be happy to leave me a great review. Lol.  OK, now we’re getting somewhere. I told him I have plenty of great reviews. There’s no need for that. I’m happy to provide a note recounting the encounter truthfully and honestly but I would apprecaite him removing the 1-star review. He was happy to do that and I was happy to provide an accurate note for his visit.  One more joy robber vanquished.  This person said they’ll never step foot in my clinic again. What a blessing. As you get busier, you get to choose who you will and who you will not do business with. I will not do business with people like this.  What’s the moral? JUST BE KIND TO OTHERS. You don’t know what others deal with. Be ethical. Be generous. If you did something wrong, take responsibility for your own actions. Thast goes for provider and patient Most importantly, don’t try to tear others down based on the faults in your own actions or behavior. I tell our staff that when we have a bad one…..just remember all of the amazing, loving, and kind patients that we have all day every day.  I had to take my own advice on this one.  I hope the grinch takes their presents from under the tree. Item #1 Our first one continuing from part one from last week is called, “Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation” by Bronfort, et al and published in Annals of Internal Medicine in September 16, 2014. Remember; citations are in the show notes at chiropracticforward.com Bronfort G, Hondras MA, Schulz CA, Evans RL, Long CR, Grimm R. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Ann Intern Med. 2014 Sep 16;161(6):381-91. doi: 10.7326/M14-0006. PMID: 25222385.  Why They Did It Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management. The researchers wanted to determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with home exercise and advice alone reduces leg pain in the short and long term in adults with Back-related leg pain. How They Did It
  • Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011. 
  • Research centers (Minnesota and Iowa).
  • Persons aged 21 years or older with Back-related leg pain for least 4 weeks.
  • 12 weeks of SMT plus home exercise and advice or home exercise and advice alone.
  • The primary outcome was patient-rated Back-related leg pain at 12 and 52 weeks. 
  • Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. .
  • Blinded objective tests were done at 12 weeks.
  • Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. 
What They Found
  • For leg pain, SMT plus home exercise and advice had a clinically important advantage over home exercise and advice at 12 weeks but not at 52 weeks. 
  • Nearly all secondary outcomes improved more with SMT plus home exercise and advice at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. 
  • No serious treatment-related adverse events or deaths occurred.
Wrap It Up For patients with Back-related leg pain, SMT plus home exercise and advice was more effective than home exercise and advice alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. Item #2 The last one this week is called, “Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial” by Bond et al and published in Journal of Manual Manipulative therapy in February of 2020. Right before the world took a dump on itself with the COVID pandemic.  Bond BM, Kinslow CD, Yoder AW, Liu W. Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial. J Man Manip Ther. 2020 Feb;28(1):15-27. doi: 10.1080/10669817.2019.1572986. Epub 2019 Mar 5. PMID: 30935324; PMCID: PMC7006726. Why They Did It The long-term goal of our study is to improve the understanding of the biological mechanisms associated with spinal manipulative therapy (SMT) in low back pain How They Did It
  • This project involved a pilot randomized, blinded clinical trial of 3-week SMT in chronic nonspecific low back pain (CNSLBP) patients. 
  • They recruited 29 participants and randomly assigned them into either a SMT or sham SMT group. 
  • Pre- and postintervention, they quantified the effect of SMT on clinical outcomes (Numeric Pain Rating Scale and Oswestry Disability Index) and pressure pain threshold at local (lumbar spine), regional (lower extremity), and remote (upper extremity) anatomical sites.
What They Found
  • The researchers observed a significant main effect for time signifying reduced hypersensitivity (increased pressure pain threshold) at local and regional locations at 3 weeks. 
  • Furthermore, they found significant main effects of time indicating improvements in pain and disability from baseline among all participants regardless of intervention. 
  • However, no between-group differences were observed in pressure pain threshold, clinical pain, or disability between the SMT and sham SMT groups over 3 weeks.
Wrap It Up After 3 weeks of SMT or sham SMT in chronic nonspecific low back pain patients, we found hypoalgesia at local and remote sites along with improved pain and low back-related disability Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1)

CF 308: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1) But first, here’s that sweet sweet bumper music  

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #308 Now if you missed last week’s episode, we talked about Sciatica & Mental Stimulation And Dementia.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Man…..just getting ready for Christmas and all that good stuff. Actually, we are ramping up marketing. We’re doing it the wrong damn way though. Here’s what I mean; we are doing reactive marketing rather than proactive marketing.  I market every week with social media posts, emails, and internal stuff. But REALLY maketing and spending some money to do so, yeah, I haven’t done much of that for one big reason. Because I still have somewhat newer staff. And yes….I’m one of those that doesn’t have a professional marketer or rep. I send our staff out to market.  Here’s the best reason why. We are off on Tuesday afternoons because I’m either doing continuing ed or I’m doing VoiceOver. Instead of warming up a chair in teh clinic doing absoluttey nothing, let’s go spread the word of this amazign clinic in Amarillo, TX called Creek Stone.  I’d rather pay an hourly wage for half-assed marketing than an hourly wage for professional time-killing and trying to look busy.  So yes, we’ve been painfully slow compared to my normal so we are kicking the marketing into high gear and with the help of a coupld of my Mastermind besties, we have some really great ideas that we think can be very effective in getting this clinic back at the top of the game.  The staff overturn in the last year has just been brutal, folks. I’ve never in 26 years experienced anything like it. It has kept us mostly stagnate but beyond valleys are the peaks and I feel pretty good about the peak we’re about to come up on.  We have some great direction with the marketing but also great direction on website SEO and we finally feel that we have solved our billing and collections equation and finally have one that we feel really really good about.  While we have a slow down, it has given us the time to plug some holes and get our house back in order and get ready for the growth that is about to happen.  I want to go on a little trip here with the next several episodes of the podcast so let me lay the base coat for you. At the TCA, one of my buddies and our legislative homey, Dr. Craig Benton from Lampassas, TX, is trying to get movement on the Medicare Equality Bill and we are doing what we can to get more congressmen signed onto the bill.  As part of that initiative, Craig sent an email that had a paper attached showing benefits of spinal manipulative therapy. It was from the World Health Organization. Well, one of our executives from the TCA emailed back wondering why, in 2023 with all of the info on the benefits of smt, there is still a designation of very low confidence for SMT. In fact, if I recall correctly, ultrasound was poor and smt was very poor or something of that nature.  So, this executive asked where the WHO got its information, so I started diving into the paper and found a list of their research for SMT. I thought it would be interesting to go through them to answer our questions and maybe we all learn something.  So…..why the hell not? And remember this. At the end of each and every episode of this podcast I say, “he profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.”  I want you to know that I don’t just say that, I walk that walk and have for around 15 years. If you’re not active, get your ass moving.  Item #1 In that spirit, the first one today iis called “Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial” by Balthazard et. Al. and published in BMC Musculoskeletal Disorders in August 2012.  Remember, the paper citations are in the show notes. Also, this is a pilot study. I don’t include pilot studies in this podcast usually but, the WHO is using it to determine the effectiveness of SMT so we might as well cover what the WHO is using.  Balthazard P, de Goumoens P, Rivier G, Demeulenaere P, Ballabeni P, Dériaz O. Manual therapy followed by specific active exercises versus a placebo followed by specific active exercises on the improvement of functional disability in patients with chronic non specific low back pain: a randomized controlled trial. BMC Musculoskelet Disord. 2012 Aug 28;13:162. doi: 10.1186/1471-2474-13-162. PMID: 22925609; PMCID: PMC3518179. Why They Did It Recent clinical recommendations still propose active exercises (AE) for CNSLBP. However, acceptance of exercises by patients may be limited by pain-related manifestations.  Current evidence suggests that manual therapy (MT) induces an immediate analgesic effect through neurophysiologic mechanisms at peripheral, spinal and cortical levels.  The aim of this pilot study was first, to assess whether MT has an immediate analgesic effect, and second, to compare the lasting effect on functional disability of MT plus AE to sham therapy (ST) plus AE. How They Did It
  • Forty-two low back patients without co-morbidities, randomly distributed into 2 treatment groups, received either spinal manipulation/mobilization (first intervention) plus exercise, or detuned ultrasound (first intervention) plus exercise. 
  • Eight therapeutic sessions were delivered over 4 to 8 weeks. 
  • Immediate analgesic effect was obtained by measuring pain intensity (Visual Analogue Scale) before and immediately after the first intervention of each therapeutic session. 
  • Pain intensity, disability (Oswestry Disability Index), fear-avoidance beliefs (Fear-Avoidance Beliefs Questionnaire), erector spinae and abdominal muscles endurance (Sorensen and Shirado tests) were assessed before treatment, after the 8th therapeutic session, and at 3- and 6-month follow-ups.
What They Found
  • Thirty-seven subjects completed the study. 
  • MT intervention induced a better immediate analgesic effect that was independent from the therapeutic session 
  • Independently from time after treatment, manual therapy with exercise induced lower disability and a trend to lower pain. 
  • Six months after treatment, Shirado test was better for the sham treatment group. 
Wrap It Up
  • This study confirmed the immediate analgesic effect of MT over ST. 
  • Followed by specific active exercises, it reduces significantly functional disability and tends to induce a larger decrease in pain intensity, compared to a control group. 
  • These results confirm the clinical relevance of MT as an appropriate treatment for CNSLBP.
Item #2 Our last one today is called, “Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain” by Bialosky et. Al. and published in Journal Of Pain in February 2014.  Bialosky JE, George SZ, Horn ME, Price DD, Staud R, Robinson ME. Spinal manipulative therapy-specific changes in pain sensitivity in individuals with low back pain (NCT01168999). J Pain. 2014 Feb;15(2):136-48. doi: 10.1016/j.jpain.2013.10.005. Epub 2013 Oct 27. PMID: 24361109; PMCID: PMC3946602. Why They Did It Spinal manipulative therapy (SMT) is effective for some individuals experiencing low back pain; however, the mechanisms are not established regarding the role of placebo. SMT is associated with changes in pain sensitivity, suggesting related altered central nervous system response or processing of afferent nociceptive input. Placebo is also associated with changes in pain sensitivity, and the efficacy of SMT for changes in pain sensitivity beyond placebo has not been adequately considered. How They Did It
  • We randomly assigned 110 participants with low back pain to receive SMT, placebo SMT, placebo SMT with the instructional set “The manual therapy technique you will receive has been shown to significantly reduce low back pain in some people,” or no intervention. 
  • Participants receiving the SMT and placebo SMT received their assigned intervention 6 times over 2 weeks. 
  • Pain sensitivity was assessed prior to and immediately following the assigned intervention during the first session. 
  • Clinical outcomes were assessed at baseline and following 2 weeks of participation in the study.
What They Found
  • Immediate attenuation of suprathreshold heat response was greatest following SMT. 
  • Group-dependent differences were not observed for changes in pain intensity and disability at 2 weeks. 
  • Participant satisfaction was greatest following the enhanced placebo SMT.
Wrap It Up The results of this study indicate attenuation of pain sensitivity is greater in response to SMT than the expectation of receiving an SMT. These findings suggest a potential mechanism of SMT related to lessening of central sensitization and may indicate a preclinical effect beyond the expectations of receiving SMT. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Sciatica & Mental Stimulation And Dementia

CF 307: Sciatica & Mental Stimulation And Dementia Today we’re going to talk about Sciatica & Mental Stimulation And Dementia But first, here’s that sweet sweet bumper music

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Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #307 Now if you missed last week’s episode , we talked about Pain Neuroscience Education & Cannabis And Bipolar Disorder. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I just got back from Colorado Springs yesterday. Many of you know that I do voice over projects in my spare time. Whatever that is. I don’t really have spare time these days. But, I flew from Amarillo, TX, to Las Vegas, then to Colorado Springs…..how dumb is that? I hae to do that same path on the way home too.  I was doing live announcing for a Redline Cheer and Dance competition. The season is here and I’ll be hopping all over to these competitions and meeting all kinds of new people. It’s always interesting and mostly fun. It can be a bit of a grind but it’s mostly fun. The traveling, hotels, and meals…..I always enjoy them. New experiences keep you jazzed. And you can’t hardly beat the view from anywhere in CS.  The week after Thanksgiving was slow. I just didn’t have a good week last week and that can get in your brain if you allow it to. I don’t like being slow and I don’t like what it does to morale. I like a good low grade excited buzz in the office. Not a subdued and draggy feeling. Which is what last week was.  Today is Monday and I have 45 on my schedule so that’s an improvement and I’ll take it. I’m a motivated dude. I need to move forward at all times. Any set back kind of pisses me off and gives me the grumps.  But, as a leader, you can be honest with your manager. But you have to put on the front for the rest of your staff. You can tell you manager, hey, I’m struggling with finances this week and this provider or that provider in the clinic isn’t quite covering their overhead. That gives me anxiety and we need to pay attention to that. Or whatever. Hey manager, I don’t have the extra funds to replace this equipment, let’s figure out a work around until we do. Something like that. You can have those conversations with your manager because that’s why they’re there. Or, it’s supposed to be why anyway.  But when it comes to the rest of the office, you need to have that front on that everything is great, we’re working through a couple of challenges but nothing you’ve never seen, and it’s time to rock n roll. Don’t let them see you sweat. It’s not good for them or for you.  Fake it till you make it. It’s never on autopilot folks. It’s always changing and you have to keep dodging punches and swinging every single day.  So, let’s get to it so I can go back to swinging some punches around here. Metaphorically, of course.  Item #1 Our first one today is called, “I Am Worried I Have Sciatica—What Do I Need to Know?” By Zhang et. Al. and published in JAMA Internal Medicine on November 12, 2023 and Aye crumb! Es muy caliente, mi amigos! Zhang GY, Incze MA. I Am Worried I Have Sciatica—What Do I Need to Know? JAMA Intern Med. Published online November 13, 2023. doi:10.1001/jamainternmed.2023.5990. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2811335 This is more of an article instead of a research project so let’s hit the highlights. 
  • They say, “Sciatica is a type of pain that is caused by irritation of the sciatic nerve. This nerve travels from the low back down the legs. Sciatica most commonly happens when a disk in your spine gets damaged or worn out and presses on the sciatic nerve.”
  • The pain can be sharp and aching. It is often accompanied by numbness, tingling, or shooting pain down the back of one leg. Rarely, sciatica can cause muscle weakness, like having difficulty lifting your foot.
  • A medical professional can usually diagnose sciatica by asking about your symptoms and doing a physical examination. For most people, blood tests and imaging such as x-ray or magnetic resonance imaging are not necessary. If you have had cancer, spine infections, or injection drug use; have a new fever; cannot feel your groin area; cannot control going to the bathroom; have trouble urinating; or your leg feels weak, you should see a medical professional right away.
  • Most people with sciatica fully recover without any treatment. About one-third of people with sciatica recover within 2 weeks, and three-fourths of people feel better within 3 months. It is hard to predict who will get better and who will still feel pain. Sciatica can come and go. If your sciatica lasts more than 12 weeks, it is a good idea to get reevaluated by a health care professional.
  • There are many ways to treat pain related to sciatica. Anti-inflammatory drugs like ibuprofen or naproxen may provide modest, short-term relief. Acetaminophen (Tylenol) can also be helpful for pain. Other prescribed medications such as muscle relaxers, steroids, opioids (eg, tramadol, oxycodone), and gabapentin are not proven to help, and some may have dangerous side effects. Talk with your doctor about what medications are best for you. Maintaining gentle physical activity (eg, walking, light housework) as tolerated is important for recovery. A physical therapist can help to coach you on specific exercises to speed up the recovery process. There is no strong evidence that treatments like back adjustments (eg, from chiropractors), gentle spine stretching (called lumbar traction), or acupuncture work. Doctors sometimes give injections of steroid or numbing medications near the spine to help with pain. These might help relieve pain for a short time, but they do not help to heal sciatica.
  • If treatments like physical therapy and pain medications do not help after 4 months, surgery may improve symptoms for some people. But there is a chance that the pain may return even after surgery. Most surgeries for sciatica use small cuts and special tools to remove the damaged part of the spinal disk. This can relieve pressure on the sciatic nerve. Recovery time from sciatica surgery varies among people but generally takes 6 to 12 weeks. While surgery can help, it has risks, including nerve damage and infection.
Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Item #2 Last one today is called, “Lifestyle Enrichment in Later Life and Its Association With Dementia Risk” by Wu et al. and published in JAMA Network Open on July 14, 2023 and that’s a steamy stack something good! Wu Z, Pandigama DH, Wrigglesworth J, et al. Lifestyle Enrichment in Later Life and Its Association With Dementia Risk. JAMA Netw Open. 2023;6(7):e2323690. doi:10.1001/jamanetworkopen.2023.23690 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807256?guestAccessKey=eaeccd11-7338-417d-a1b5-70481ff42466&utm_content=weekly_highlights&utm_term=072323&utm_source=silverchair&utm_campaign=jama_network&cmp=1&utm_medium=email Why They Did It Lifestyles enriched with socially and mentally stimulating activities in older age may help build cognitive reserve and reduce dementia risk. Objective  To investigate the association of leisure activities and social networks with dementia risk among older individuals. How They Did It
  • It was a longitudinal prospective cohort study 
  • Used population-based data from the ASPREE Longitudinal Study of Older Persons (ALSOP) for March 1, 2010, to November 30, 2020. 
  • Community-dwelling individuals in Australia aged 70 years or older who were generally healthy and without major cognitive impairment at enrollment were recruited study 
  • A total of 19 measures of leisure activities and social networks assessed at baseline were classified using exploratory factor analysis.
  • Dementia was adjudicated by an international expert panel according to Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. 
  • Cox proportional hazards regression examined dementia risk over 10 years, adjusting for education, socioeconomic status, and a range of health-related factors.
  • This study included 10,318 participants. Their median age was 73.8 years at baseline, more than half (52.6%) were women, and most self-identified as White
What They Found
  • In adjusted analyses, more frequent engagement in adult literacy activities (eg, writing letters or journaling, using a computer, and taking education classes) and in active mental activities (eg, playing games, cards, or chess and doing crosswords or puzzles) was associated with an 11.0% and a 9.0% lower risk of dementia, respectively. 
  • To a lesser extent, engagement in creative artistic activities (craftwork, woodwork, or metalwork and painting or drawing) and in passive mental activities (reading books, newspapers, or magazines; watching television; and listening to music or the radio) was also associated with reduced dementia risk. 
  • In contrast, interpersonal networks, social activities, and external outings were not associated with dementia risk in this sample.
Wrap It Up These results suggest that engagement in adult literacy, creative art, and active and passive mental activities may help reduce dementia risk in late life.  In addition, these findings may guide policies for geriatric care and interventions targeting dementia prevention for older adults. So, it appears that working the brain keeps the brain working. Basically.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Pain Neuroscience Education & Cannabis And Bipolar Disorder

CF 306: Pain Neuroscience Education & Cannabis And Bipolar Disorder Today we’re going to talk about Pain Neuroscience Education & Cannabis And Bipolar Disorder But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #306 Now if you missed last week’s episode , we talked about Hip Pain And Corticosteroids & Chronic Pain After Spinal Surgery. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. First day back from our 4-day Thanksgiving holiday break. Now, let’s just say this; I was going to work the morning of the Friday after Thanksgiving. But, I had a bit of a mutiny with the employees. And, to be honest, I’m not sure how it sits with me.  I didn’t want to work on Friday to start with but, being honest here, we’ve been a little slower than I’m used to lately and I felt like I needed to. Plus I was in Orlando a week or so ago for our Mastermind meeting so that was slow on my return as well.  Anyway, I was approached and the crew feels they’ve been putting in a lot of energy with being shorthanded, etc and they wanted that day off. And wanted it paid I’m assuming. So my conundrum was, stand my ground and risk losing employees and fostering a low-simmering dislike of me and thee job we are here to do? Or submit to a request I already wanted for myself anyway? Right or wrong, I chose to give them the day and I have to say that I thoroughly enjoyed it. And today, the staff seems to be in a better overall mood and, I hope, ready to rock n roll and make it happen this week and get things back to normal. Which means busy busy.  How would you handle that? I didn’t dig it. I can tell you that.  Alright, enough clinic stuff, let’s hop into the research! Item #1 The first on today is called, “Pain neuroscience education for reducing pain and kinesiophobia in patients with chronic neck pain: A systematic review and meta-analysis of randomized controlled trials” by Lin et. Al. published in European Journal of Pain on September 11, 2023 and BAM! It’s smokin! https://doi.org/10.1002/ejp.2182 Why They Did It Chronic neck pain (CNP) is a common musculoskeletal disorder. Pain neuroscience education (PNE) is a promising nonpharmacological intervention for CNP, however, its effectiveness remains unclear. This systematic review and meta-analysis aimed to evaluate the effectiveness of PNE in treating CNP. How They Did It Electronic databases from inception to February 2023 were searched for randomized controlled trials  The primary outcome was the change in pain intensity, and the secondary outcome was improvement in kinesiophobia,  Two authors independently scrutinized eligible articles, extracted data and assessed quality; a random-effects model was employed for data pooling. What They Found In total, seven RCTs comprising 479 participants were included and demonstrated that PNE significantly reduced pain intensity  Subgroup analysis revealed that the adult group experienced significant pain reduction after PNE, whereas the adolescent group did not.  PNE also reduced kinesiophobia which was evaluated in four of seven RCTs  There was indication that increased intervention duration contributed to greater pain reduction.  No adverse events were reported following PNE or the control treatment. Wrap It Up Pain neuroscience education effectively reduced pain intensity and kinesiophobia in patients with chronic neck pain.  A longer PNE time leads to greater pain reduction and is more effective in adults than in adolescents. According to Physiopedia – Pain Neuroscience Education (PNE) is a strategy that aims to teach patients to reshape their mindset and perception of pain despite these factors. It provides patients a better understanding of their condition and motivates them to become active participants in their treatment programs. Based on a large number of high-quality studies, it has been shown that teaching people with chronic pain more about the neuroscience of their pain produces immediate and long-term changes.  Item #2 Our last one this week is one of these that always makes me uncool and all and yes, alcohol is worse but we already tried outlawing it so here we go, it’s called, “Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder” by Jensen et. Al. and published in JAMA Psychiatry on May 24, 2023 so it’s still nice and steamy and cozy.  Remember that you can find these citations in our show notes on our website at chiropractscforward.com Jefsen OH, Erlangsen A, Nordentoft M, Hjorthøj C. Cannabis Use Disorder and Subsequent Risk of Psychotic and Nonpsychotic Unipolar Depression and Bipolar Disorder. JAMA Psychiatry. 2023;80(8):803–810. doi:10.1001/jamapsychiatry.2023.1256 Why They Did It They say that Cannabis use is increasing worldwide and is suspected to be associated with increased risk of psychiatric disorders; however, the association with affective disorders has been insufficiently studied. The question they tried to get clarity on is, “Is cannabis use disorder associated with an increased risk of psychotic and nonpsychotic unipolar depression and bipolar disorder?” How They Did It This was a prospective, population-based cohort study using Danish nationwide registers included all individuals born in Denmark before December 31, 2005, who were alive, aged at least 16 years, and living in Denmark between January 1, 1995, and December 31, 2021. Which means 6,651,765 individuals in Denmark that were followed up for 119,526,786 person-years The main outcome was register-based diagnosis of psychotic or nonpsychotic unipolar depression or bipolar disorder.  What They Found Cannabis use disorder was associated with an increased risk of unipolar depression, psychotic unipolar depression, and nonpsychotic unipolar depression.  Cannabis use was associated with an increased risk of bipolar disorder in men and women, psychotic bipolar disorder, and nonpsychotic bipolar disorder in men and women.  Cannabis use disorder was associated with higher risk for psychotic than nonpsychotic subtypes of bipolar disorder but not unipolar depression. Wrap It Up This population-based cohort study found that Cannabis use disorder was associated with an increased risk of psychotic and nonpsychotic bipolar disorder and unipolar depression.  They say that These findings may inform policies regarding the legal status and control of cannabis use. So, do what you will with the info. Don’t punish the messenger.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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