jeff williams

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
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Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

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

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 #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

Over Manipulation Syndrome

CF 305: Over Manipulation Syndrome

Today we’re going to talk about Over Manipulation Syndrome 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 #305 Now if you missed last week’s episode , we talked about  Interesting Thoughts On Low Back & Degenerative Cervical Myelopathy. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I skipped last week because I was at the MCM Mastermind. Dr. Kevin Chritstie’s group that I’m a part of. We met in Orlando. What a great trip. The kids went with us and I did the Mastermind meeting and then had a day and a half to hit Disney and hit it we did.  We killed ourselves trying to see everything. While that’s impossible, we did see a lot and had a great time. The Harry Potter stuff at Universal is legit folks. Crazy. The Star Wars stuff at Hollywood Studios is incredible. And the Avatar stuff at Animal Kingdom is cool as hell. I’m just saying.  I’ll add that we went about 10 years ago and I hated it. I hated all of it. This time, for whatever reason, was better. I didn’t absolutely hate it. I actually enjoyed most of it. Maybe because the kids are older and don’t have to be watched. Maybe I just knew more about what to expect. I’m not sure. But it was a good time had.  On the Mastermind…..I got some good tidbits and nuggets out of it and had a great time reconnecting with my tribe. These are my people and I can’t tell you how much we enjoy each other. We learn as much from each other at the bar or eating together than we learn from our speakers.  Our Mastermind is full but Dr. Christie started another Mastermind that has openings. If you are at all interested, I cna’t encouurage you enough to email Dr. Christie at drkchristie@gmail.com and see if you can sneak into his new group. Next year they’ll be meeting in San Diego, Denver, Phoenix, and Jackson Hole, Wyoming. All great places to hang out, learn, and network.  Alright, Happy Thanksgiving. Let’s hop into the research.  Item #1 This isn’t really a research paper we’re going to cover here. This is more a conglomeration to demonstrate something I’ve gotten a lot of push back on in private conversations with other chiropractors over the years. Let me start by saying that I Donn’t want to take money out of Chiros’ pockets. The evidence based folks should be mostly fine with what I’m going to talk about today because they’re not doing crazy stuff.  The more non-evidence based folks aren’t going to like this discussion at all. All I can say is that when someone making the right decision affects their financial status, well, you just never know what you’re going to get.  First thing….I’m not about to advocate not adjusting your patients. The adjustment is the cornerstone of my practice for more than 25 years. What we’re going to talk about, over manipulation syndrome or spinal instability, was never for any reason in any shape, form, or fashion on my radar screen before getting the Neuromusculoskeletal medicine diplomate and diving into ChiroUp.  Let’s start with a personal story. I went to the chiropractor first when I was hurt as a freshman in high school. I was hurt badly and nobody else helped me. After months of pain, my mom took me to the local chiro and in two weeks you’d never know I was hurt.  That’s why I ended up becoming a chiropractor in the first place. While that experience was life changing, it also led to my buddy and I being all cool and popping our own necks all of the time. It was hard to do at first. I really had to use both hands and really crank on it to get that pop noise we all covet so much.  But then, after some time of constantly self-adjusting my neck, it got easier. And easier, and easier. To the point that I could just turn my neck and it would pop incidentally for no reason at all. And if I didn’t pop it, it would get irritated and feel like it needed to pop all of the time.  I had created instability by self-adjusting all of the time.  Our spine wants to be stiff and solid without that extra movement. But I had created extra movement consistently enough that I had loosened all of those tiny muscles and connective tissues. As a compensation, because our spine wants stiffness and stability, the larger postural muscles stiffened up to try to make up for all of those tiny ones that went lax and lazy.  So, that sets up a neck that is stiff but hypermobile. You can share this with all of your self-adjustors if you like.  Anyway, that brings up two thoughts:
  1. When you have an older person, discs degenerate, connective tissue gets loosened through manual labor, people have had injuries, or something issues like Elhers Danlos have started to aggravate…..hypermobility starts to take hold
  2. When you have patients that have been going to chiropractors repeatedly over the years, you can create hypermobility where there was none. Like my time self-adjusting. I’m not talking about responsible and appropriate adjusting like you do with a limited, condition focused treatment plan. I’m talking about, “I need to see you once a week for the rest of your life to treat your immune system and help you avoid cancer.” Or, I need to see you 76 times and 10 sets of x-rays this year to make sure you have the right, perfect degree curvature in your neck. As common sense would dictate, this is probably going to be more common with more aggressive adjusters. 
I’ll tell you that I’m out on the cliff a bit on this topic if I’m being honest. When you go searching, you’ll find Over Manipulation Syndrome. But, it’s not a huge topic with 100’s of articles.  One of them is at hur911injurycenters.com, probably not a chiro friendly page if I’m just guessing. They say, “Over-manipulation syndrome can be caused through self-manipulation as well as through high-velocity adjustments from a chiropractor. If you or a chiropractor have over-manipulated a joint through high-velocity treatments, you might experience damage to the ligament structures. This damage can lead to joint instability and worsening of hypermobility.” One I found is by Dr. Mark Saracino, a Board Certified Chiropractic Neurologist from Pennsylvania. I will put the link to his thoughts in the show notes for you.  Dr. Saracino starts out with a funny/not so funny joke, ““How many Chiropractors does it take to change a light bulb?” Answer: “Just one, but it takes 56 visits!”  https://drsaracino.com/PDFs/INFO/TooManyChiropracticVisits.pdf He says, “To my knowledge, no studies have shown that manipulations, once a month or more, are harmful. Just as dependencies on unnecessary drugs and surgeries should be avoided, patients should not become dependent on frequent manipulations- no more than 6 per year to the same spinal bone. Spinal manipulation is an important, but small part of a chiropractic neurologist’s treatment capabilities. It should be employed as infrequently as possible.” I want to go on record here and disagree with him on that point. If he thinks that 6 adjustments with exercises are going to get some of the veterans I see from the VA out of pain after suffering for 40 years…..well, trust me…..6 adjustments Ain’t gettin it done. He’s got a bias. He’s being a proponent of all of the magic outside of an adjustment that a chiropractic neurologist can perform. So I just disagree on that one point.  But I do agree with the point of avoiding unnecessary consistent and frequent adjustments.  To further clarify, there are some suffering from high impact chronic pain, which is chronic pain with an associated disability. They will never be free of pain and seem to only do well seeing a chiropractor every other week or so on a pain management basis. Then, there is a group called Caring Medical in Florida. They also have a bias. They specialize in prolotherapy to tighten lax ligaments. So, it makes sense they’re going to highlight Over Manipulation Syndrome. That doesn’t make them wrong. But I’m being honest as I can be on this. They have a bias and it should be noted.  I’ll put the link in the show notes as well.  https://www.caringmedical.com/prolotherapy-news/manipulation-syndrome-oms/#:~:text=Over-manipulation syndrome is a,or manipulation by a practitioner. Ross Hauser, MD says from the top of the article, “Over-manipulation syndrome is a condition characterized by chronic pain of the joints or vertebrae from instability due to ligament laxity that is caused by excessive self-manipulation or manipulation by a practitioner.”  To keep from pissing everyone off, he says, “In our opinion, a good chiropractic or osteopathic physician is an invaluable asset to a person’s health and care. Many cases of chronic pain, headaches and health ailments can be resolved with manipulation. Yes, overly aggressive spinal manipulation can be the cause of spinal instability, but when done correctly it can cause immediate (or quick) relief of symptoms.” And more to the point I’m making, “We see a large number of hypermobility cases where the patients present with a history of excessive chiropractic manipulations. A short course of manipulation to relieve pain or tension is understandable. However, patients who sign up for long-term chiropractic packages that include thrusting manipulations often find themselves even more unstable after the treatment course. Good chiropractors treat each patient individually and conservatively.” I agree. Reminder – I’m not advocating not adjusting your patients. The adjustment is the cornerstone of my practice for more than 25 years. I’m not advocating only adjusting your patients 6 times per year.  What I am advocating AGAINST….is long, extended, ongoing, maybe never ending treatment protocols to try to treat pain. When what you may be actually doing is causing a greater problem called instability and hypermobility by over manipulating and loosening the structures that hold the spine tight.  How much is too much? Who the hell knows? Certainly not me. Everyone is different, different ages, different work loads, different injuries throughout the years, different chiropractors over the years, etc.  But if all you’re doing is identifying ‘subluxations’ and knocking down the high spots without also considering instability or hypermobility, then you’re at risk of doing your patients and injustice and potentially making them actually worse.  If they already have hypermobility, what good are more adjustments and mobility really going to do for that particular area of their spine? Not much in my opinion. Why not think outside of the box a little and try stabilizing and strengthening the spot instead of mobilizing it? For neck instability, try a contraption called The Iron Neck. It’s great at strengthening the neck in a 360 degree way. It’s outstanding and I’m not sure there is a better strategy out there for neck stability.  For low back instability, we use McGill’s Big Three and add Dead Bug which is also ChiroUp’s protocol for L-sp instability.  If you don’t know how to look for and test for spinal instability, one of the clues for the low back is that it hurts to roll over in bed. Also, sometimes these people bend over to grab something and get a ‘catch’ or a ‘locked up’ back when trying to stand up from that position. They kind of have to work out of it to finally stand up.  With the low back, you can have a patient prone on their stomach. If it hurts when you palpate the l-sp facets, have them do a ‘superman’ position with their legs straight and lifted backward off of the table. If you palpate again while they’re in that position and it feel better, then you are likely looking at a instability patient. When you stabilize that region and palpate it and it feels better, the back is telling you it has too much mobilization and needs stabilization instead.  Simple sudden movements can hurt as well. The Space Mountain ride fired up the instability in my neck last week. It jerked me around on the roller coaster when it was dark and I couldn’t brace or see what was in front of me.  So there you have it. I’ve had some of the smartest chiros in the evidence-based realm tell me I’m crazy. That chiropractors absolutely cannot create spinal instability. I know that for so many, it’s a completely new thought process but I ask that you seriously give it consideration.  How is it that self-adjustors, like I once was, can create instability from adjusting too much but a chiropractor somehow cannot? I’ll also share that I have no bias on this deal. In fact, advocating against constant, frequent, adjusting does me no good whatsoever considering the adjustment is the literal cornerstone of my clinic. I have zero bias. I just follow research, I read, I observe, I talk to others, and I have personal experience and I’m telling you flat out – some patients will do better with strengthening and stabilization because they’re already got too much mobilization and the wrong chiropractor can potentially be the cause of that hypermobilization.  Convince me I’m wrong at dr.williams@chiropracticforward.com. I’d love to hear your thoughts on this topic. I think it’s important.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as  it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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

Interesting Thoughts On Low Back & Degenerative Cervical Myelopathy

CF 304: Interesting Thoughts On Low Back & Degenerative Cervical Myelopathy Today we’re going to talk about Interesting Thoughts On Low Back & Degenerative Cervical Myelopathy 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!

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Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow, 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 #304 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….. We’re going to go quickly today. I have only a three day week this week because the fam and I are headed to Orlando this week for my Mastermind meeting If you do not recall, I’m in Dr Kevin Christie’s group and there are about 25 of us. We meet once per quarter and this will be our last one of the year. It’s always good to get around people that are doing big things. I’d say I’m probably somewhere in the middle of the group. Some are doing bigger things that I am and some are not. Some are right where Imm at but in a different way.  The point is I can learn from each of them and they can learn from me. That’s the essence of a mastermind group I suppose. Dr Christie has started a second Mastermind group now and this one is more for those in the western parts of the USA. I highly recommend listening to him on his Modern Chiropractic Mastery podcast and connecting with him either through email or through his Facebook group if the same name Masterminds are valuable. I don’t take trips once per quarter taking time out if my clinic for small silly stuff. This is big and you should be a part of it if you can be.  Next, poaching employees from other chiropractors in your area. General business tip: I’ve had a local chiropractor go after and poach two of my providers (acupuncture & massage) in less than two months. The tip is, don’t be a douchebag. Hire and train your own damn people, folks. I had invested years into each of these two people and helped them build their clientele and they were VERY well treated and paid.  Which I feel is mostly on them. That doesn’t mean I don’t need to look into our own setup to try to understand how they could do what they did. However, not just one, but two in less than two months……that’s dirty and has me hoppin’ mad. We came out on top big time on the acupuncturist. Without a doubt. The same will happen with the LMT. He just doesn’t know it yet. I’m happy he got the acupuncturist. It solved a big problem for me. Our new one is better and easier to do business with. I’m actually OK with him getting that particular LMT. I still have two others.  All parties involved over there are going to learn some lessons from each other. It’s not really about the individuals. It’s about the principle. I’ve never gone after my colleagues’ staff and never would. In fact, I’ve had MULTIPLE opportunities to poach others’ staff and told them I could not hire them because of my relationship with their boss. So, if you like making enemies out of your colleagues, going after their staff is a perfect way to do it. Item #1 OK, this first one this week is called “The mediating effect of social functioning on the relationship between catastrophizing and pain among patients with chronic low back pain” by Papianou et. Al. and published in Pain Medicine in November 2023. Schiza!! It’s muy caliente, my friends. Three languages in six words. Pow.  Citation is in the show notes, folks Lauren N Papianou, Jenna M Wilson, Robert R Edwards, Christine B Sieberg, Samantha M Meints, The mediating effect of social functioning on the relationship between catastrophizing and pain among patients with chronic low back pain, Pain Medicine, Volume 24, Issue 11, November 2023, Pages 1244–1250, https://doi.org/10.1093/pm/pnad093 Why They Did It
  • Pain catastrophizing can be characterized as an interpersonal form of coping used to elicit support or empathy from others. Despite intentions of increasing support, catastrophizing can impair social functioning. 
  • While considerable work has addressed the relationship between catastrophizing and pain, limited empirical work has examined this relationship within a social context. 
  • First, we examined the role of catastrophizing as a potential contributor to group differences (chronic low back pain [cLBP] vs pain-free controls) in social functioning. 
  • Then they conducted a follow-up, exploratory analysis to examine the relationships between catastrophizing, social functioning, and pain within the subgroup of participants with cLBP.
What They Found
  • Participants with cLBP reported higher levels of pain, impaired social functioning, and higher catastrophizing compared to pain-free controls. 
  • Catastrophizing partially mediated the group difference in impaired social functioning. 
  • Additionally, social functioning mediated the association between higher catastrophizing and greater pain within the subgroup of cLBP participants.
Wrap It Up
  • We showed that impaired social functioning was driving the relationship between higher pain catastrophizing and worse pain among participants with cLBP. 
  • Interventions, such as cognitive behavioral therapy, should address catastrophizing in individuals with cLBP, while simultaneously improving social functioning.
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 Our last one this week is called, “The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy – A Systematic review and Meta-analysis” by Jiang et. Al. and published in Global Spine Journal in 2023 and that’s hot enough to be some hot stuff.  Jiang Z, Davies B, Zipser C, et al. The value of Clinical signs in the diagnosis of Degenerative Cervical Myelopathy – A Systematic review and Meta-analysis. Global Spine Journal. 2023;0(0). doi:10.1177/21925682231209869 Why They Did It
  • Delayed diagnosis of degenerative cervical myelopathy (DCM) is likely due to a combination of its subtle symptoms, incomplete neurological assessments by clinicians and a lack of public and professional awareness. Diagnostic criteria for degenerative cervical myelopathy will likely facilitate earlier referral for definitive management.
  • They wanted to determine (i) the diagnostic accuracy of various clinical signs and (ii) the association between clinical signs and disease severity in degenerative cervical myelopathy?
How They Did It
  • A search was performed to identify studies on adult patients that evaluated the diagnostic accuracy of a clinical sign used for diagnosing degenerative cervical myelopathy. 
  • Studies were also included if they assessed the association between the presence of a clinical sign and disease severity. 
  • The QUADAS-2 tool was used to evaluate the risk of bias of individual studies.
What They Found
  • This review identified eleven studies that used a control group to evaluate the diagnostic accuracy of various signs. 
  • An additional 61 articles reported on the frequency of clinical signs in a cohort of degenerative cervical myelopathy patients. 
  • The most sensitive clinical tests for diagnosing DCM were the Tromner and hyperreflexia, whereas the most specific tests were the Babinski, Tromner, clonus and inverted supinator sign. 
  • Five studies evaluated the association between the presence of various clinical signs and disease severity. 
  • There was no definite association between Hoffmann sign, Babinski sign or hyperreflexia and disease severity.
Wrap It Up The presence of clinical signs suggesting spinal cord compression should encourage health care professionals to pursue further investigation, such as neuroimaging to either confirm or refute a diagnosis of DCM. I’ll put some links to the tests at this point in the show notes at chiropracticforward.com Remember, it’s episode 304 Tromner Sign https://www.grepmed.com/images/7323/clinical-video-neurology-reflex-sign Inverted Supinator Sign   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  

Hip Pain And Corticosteroids & Chronic Pain After Spinal Surgery

CF 303: Hip Pain And Corticosteroids & Chronic Pain After Spinal Surgery Today we’re going to talk about Hip Pain And Corticosteroids & Chronic Pain After Spinal Surgery 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 #303 Now if you missed last week’s episode , we talked about Spinal Manipulative Therapy And Bezodiazepines & Yanking Someone’s Head Off. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Back at it. You remember when I told you last week that I think we’re on a turnaround after having been out sick and then the next week having to spend half a week in Chicago for the Forensics conference? I think the trend is continuing.  I’m looking at 46 appointments today. That’s including 3 new patient exams, 2 PI intakes, and 3 re-exams. So it’s going to be a busy one today. I’ll be glad when the day wraps up at 6:00 pm this evening. Thursday is looking a little light but it’s 8:30 on a Monday morning right now. We have plenty of time to fill that day out in the next few days.  We had our first cold blast of the year and guess who’s not happy about it? This guy. This guy that love the Summer and green things and birds chirping and shiny happy people out running around and enjoying the warm weather. This guy.  In fact, cold weather and Winter basically piss me off a bit if I’m being honest. It’s terrible. Everything goes dormant, the clocks change so it’s dark before I even get off of work, the cold wind and wet rain and ice and snow…..I’m getting triggered just to talk about it honestly.  So, the point is, it’s a mental battle for me on some very low level. It’s in the background for sure but it’s a battle for me. I hate it and yet, I have to learn to live with it every year and just get through it. Maybe I’m dramatic about it. Sure. But don’t we have our challenges that work our mental state? We’re all different so I’m sure yours is likely different than mine in lots of cases.  Another thing that has been working my mental state is the lack of a good billing company. I tried to have in-house billing for years. I lost almost a million dollars over the course of 3 years because I trusted too much. She didn’t steal. She just didn’t re-submit when denied so once timely filing passes, you’re outta luck. Well, we were outta luck a bunch it seems and by the time I found it, it was pretty far gone.  A lot of beer will get you past something like that.  They don’t share these things with you when you’re going through school but there are some soul-sucking parts to being a clinic owner. What would it be like to just show up and go to work and go home without the worry and the fret of the HR part….the billing and collecting part? What would that all be like?? I don’t know but I’m moving down the path of finding that out. I’m working on a potential partial buyout in the next 6 months. And ya know what? I’m not even nervous about it. Because the business end of it isn’t my special skill. Not my special talent. It gives me loss of enjoyment.  So as I go down that path, I’ll be updating you. It may be something you’ll be interested in as well in the coming years. Especially if you’re 50-something and getting long in the tooth.  We shall see. To be continued.  Item #1 Our first one this week is called, “Rapidly Destructive Hip Disease Following Intra-Articular Corticosteroid Injection of the Hip” by Okie et. Al. and published in Journal of Bone Joint & Surgery on November 17, 2021.  Okike K, King RK, Merchant JC, Toney EA, Lee GY, Yoon HC. Rapidly Destructive Hip Disease Following Intra-Articular Corticosteroid Injection of the Hip. J Bone Joint Surg Am. 2021 Nov 17;103(22):2070-2079. doi: 10.2106/JBJS.20.02155. PMID: 34550909. Why They Did It While recent reports have suggested that hip corticosteroid injections can hasten joint degeneration, there are few published data on the topic. The purpose of the present study was to evaluate for an association between corticosteroid injection and rapidly destructive hip disease (RDHD) and to determine the rate of, and risk factors for, occurrence. How They Did It
  • This study was conducted in 2 parts. First, to assess for a potential association between hip corticosteroid injection and RDHD, a case-control analysis was performed. 
  • Patients who developed RDHD between 2013 and 2016 served as cases, whereas those who underwent total hip arthroplasty for diagnoses other than RDHD during the same period served as controls, and the exposure of interest was prior intra-articular hip corticosteroid injection. 
  • Second, in a retrospective cohort analysis, we analyzed all patients who received a fluoroscopically guided intra-articular hip corticosteroid injection at our institution from 2013 to 2016. 
  • The rate of post-injection RDHD was determined, and logistic regression was used to identify risk factors for occurrence.
What They Found
  • In the case-control analysis, hip corticosteroid injection was associated with the development of RDHD. 
  • There was evidence of a dose-response curve, with the risk of RDHD increasing with injection dosage as well as with the number of injections received. 
  • In the retrospective cohort analysis, the rate of post-injection RDHD was 5.4%. 
  • Cases of post-injection RDHD were diagnosed at an average of 5.1 months following injection and were characterized by rapidly progressive joint-space narrowing, osteolysis, and collapse of the femoral head.
Wrap It Up
  • This study documents an association between hip corticosteroid injection and RDHD. 
  • While the risk of RDHD following a single low-dose (≤40 mg) is low, the risk is higher following high-dose (≥80 mg) injection and multiple injections. 
  • These findings provide information that can be used to counsel patients about the risks associated with this common procedure. 
  • In addition, caution should be taken with intra-articular hip injections utilizing ≥80 mg of corticosteroid and multiple injections.
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 Our last one this week is called, “Prevalence of Chronic Pain After Spinal Surgery: A Systematic Review and Meta-Analysis” by Alshammari et. Al. and published in Cureus on July 13, 2023 and Damnit that’s sizzlin’ hot! Why They Did It Degenerative disc disease and low back pain are common challenges that persist even after a discectomy. However, characterizations and quantifications of these illnesses from the patients’ perspective are insufficient. We aimed to perform a systematic review of the literature and meta-analysis to determine the frequency of chronic pain after spinal surgery.  How They Did It
  • They searched all of the common libraries of research to retrieve articles describing the frequency of persistent back pain, reoccurring disc herniation, and undergoing another operation following primary lumbar discectomy. 
  • They excluded articles that did not disclose the proportion of patients who experienced ongoing back or leg pain for over six months after the operation. 
  • They included 16 studies evaluating 85,643 patients. 
What They Found The pooled prevalence of persistent pain was 14.97%  Wrap It Up With all advancements in technology and operation techniques, many patients (14.97%) still have failed back surgery syndrome. Appropriate preoperative communication and multidisciplinary and coordinated treatment strategies yielded the best results. I would argue that it’s actually higher than that. In a book that I highly recommend called Back In Control by spinal surgeon Dr. David Hanscum, he cites research showing that when surgery is performed on a patient with chronic pain syndrome, that person is 60% more likely to develop chronic pain at the new site of injury….the site of surgery. That’s when everything goes perfectly.  I have a friend that is a neurosurgeon in our market and he regularly tells his patient that spinal surgery is about a 50/50 chance of success or failure. I haven’t asked him for research on that but I’m passing the info along as it was passed to me.  Take it or leave 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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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
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  

Spinal Manipulative Therapy And Benzodiazepines & Yanking Someone’s Head Off

CF 302: Spinal Manipulative Therapy And Benzodiazepines & Yanking Someone’s Head Off Today we’re going to talk about Spinal Manipulative Therapy And Benzodiazepines & Yanking Someone’s Head Off  

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 #302 Now if you missed last week’s episode , we talked about Excessive Generalization Of Fear Avoidance. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. The difference between an evidence based, patient centered practice and a vitalistic, philosophy-driven practice. In my view.  The vitalists believe that a patients or as they call them, a practice member…..should be seen in the clinic A LOT. Like some feel 1x/week or 1x every 2 weeks.

Even if nothing hurts. No pain. That’s just to stay healthy and all that stuff. So, their PVA is off the charts. Some are at 80 and above.  Even if no randomized controlled trials, the ACA, or any other respected guides back that up.  Then, there’s the evidence-based, patient-centered model.

We depend on new patients. And a lot of them. I have to see a lot of new patients to keep the machine turning. And when I’m out for any length of time, the ripples are felt for a while. So, I was out sick for a couple of days two weeks ago. Then, the very next week, I went to Chicago and was out for 2.5 days. So, guess what that did to my practice? Yep, you guessed it. Slower than COVID. Everything for me is now compared to COVID numbers, by the way. 

Anyway, it took me a week to start turning this Titanic back around and moving the other way but it’s turning. I’m back up to 44 today, which is a Monday. We’ll see how the rest of the week unfolds but it’s looking pretty good right now.  I would assume a vitalist that gets sick and has to miss is still loaded up when they return because these people have been led to believe that they have to make their appointments or their lack of neck curvature will cause degeneration or their immune system will quit working or something of that nature.  More power to them. It’s a good business model if all you care about is money but that’s just not a model I was ever on board with. 

So, yes, it took me a week or so but we are plugged in and back on track and kicking some derierre. 

Item #1

Our first one this week is called, “Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA” by Trager et. Al. and published in BMJ Open on June 12, 2022…..and it’s only lukewarm… Trager RJ, Cupler ZA, DeLano KJ, Perez JA, Dusek JA. Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA. BMJ Open. 2022 Jun 13;12(6):e058769. doi: 10.1136/bmjopen-2021-058769. PMID: 35697464; PMCID: PMC9196200.

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

How They Did It

  • Retrospective cohort study.
  • National, multicentre 73-million-patient electronic health records-based network (TriNetX) in the USA, queried on 30 July 2021, yielding data from 2003 to the date of query.
  • Adults aged 18–49 with an index diagnosis of rLBP were included. 
  • Serious etiologies of low back pain, structural deformities, alternative neurological lesions and absolute benzodiazepine contraindications were excluded. 
  • Patients were assigned to cohorts according to CSMT receipt or absence. 
  • Propensity score matching was used to control for covariates that could influence the likelihood of benzodiazepine utilisation.
  • The number, percentage and OR of patients receiving a benzodiazepine prescription over 3, 6 and 12 months’ follow-up prematching and postmatching.
  • 9206 patients age, 37.6 years, 54% male per cohort. 

What They Found

  • Odds of receiving a benzodiazepine prescription were significantly lower in the spinal manipulation cohort over all follow-up windows prematching and postmatching. 
  • After matching, benzodiazepine prescription at 3 months was 0.56, at 6 months 0.61 and 12 months 0.67. 
  • Sensitivity analysis suggested a patient preference to avoid prescription medications did not explain the study findings.

Wrap It Up

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

For our last one, we have “Spinal Cord Injury, Vertebral Artery Dissection, and Cerebellar Strokes After Chiropractic Manipulation” by Ramos etl al. and published in American Academy of Neurology in November of 2022 and I’m using my soundclip anyway because this is a hot topic!

Why They Did It Let’s just say it appears this provider stops at nothing. This injury to this woman happened after a visit with a chiropractor where she had cervical manipulative therapy. That’s putting it simply but it is both mine and Dr. Brown’s opinion that this was likely an axial traction move that gets all of the views on YouTube or a Y-strap type of adjustment that caused this issue. We have no way of knowing that nor are we stating that as a fact in any way.

We are simply surmising this because a simple diversified cervical break type of adjustment, to my knowledge, would be difficult to duplicate results like this. Seriously, if you saw the pictures on this, you’d know what I’m saying and would be nodding in agreement. 

This isn’t fun stuff to think about or talk about but I think it’s important. It came to me through Dr. Steven Brown out in Gilbert, AZ, one of my new connections and friends through the Forensics conference I attended in Chicago a couple of weeks ago.  This is from Brazil and they’re just not good at putting this sort of thing together so there’s really only a paragraph or so that I’ll just go ahead and quote here.  “A 48-year-old woman with chronic neck pain presented with a history of sudden neck pain and generalized weakness during a chiropraxis session. Neurological examination showed tetraplegia with C5 sensory level. Cervical spine CT revealed a fracture affecting C5 and C6 vertebra. Cervical spine MRI confirmed spinal cord injury. Also, bilateral vertebral artery occlusion and acute cerebellar infarction were found. Bony ankylosis was found in cervical CT spine suggesting undiagnosed ankylosing spondylitis was a risk factor for spine fracture.

Other neurological lesions related to chiropraxis include vertebral artery dissection, epidural hematoma and acute disk hernition. “ Y’all the pictuures on this patient’s imaging is just awful. I’ll try to include it in the show notes if the software allows an old man to figure it out.  When Dr. Brown sent over the information, he sent me his impression and review of the information as well and I’ll just share that with you now.  The greatest weakness of this report is the lack of details about the CSM procedure. It is difficult to see how a properly performed CSM could cause such catastrophic injuries.

This report is brief, lacking in detail about the CSM procedure, and has only two references. Another weakness of this report was that the actual time lapse from CSM to the onset of ischemic stroke symptoms was poorly documented. The term “during” needs to be clarified in terms of seconds or minutes.   The symptoms that prompted the patient to seek CSM are unknown. The catastrophic nature of the injures makes it appear the bilateral VAD was a direct result of an improperly performed CSM. However, a weakness of this report was the failure to consider that the practitioner may have failed to diagnose and refer a pre-existing cervical artery dissection.   The report does not review the patient’s past medical history of risk factors for dissection or stroke. The patient’s BMI (body mass index) was not recorded.

A low BMI is a risk factor for dissection, a high BMI is a risk factor for ischemic stroke.   The report does state that “bony ankylosis” was found on cervical spine CT examination, suggesting undiagnosed ankylosing spondylitis, which was a risk factor for spine fracture. However, Ramos did not verify if the patient had AS or not.   A weakness of this report was the failure to verify the type of practitioner that performed the CSM.

The report states “chiropractic”, but no effort was made to verify that the practitioner was an actual Doctor of Chiropractic. Numerous cases reports have attributed CSM to a DC when another type of practitioner performed the procedure.   A further weakness of this report was a failure to review the records from the practitioner performing the CSM. It is unknown if Informed Consent to the risk of stroke from CSM was obtained. The history and examination done by the practitioner of CSM are unknown. It was unknown if any neck injury occurred prior to CSM.  

Ramos concluded that CSM caused the cervical artery dissection was “related to” CSM. Studies showing no evidence of a causal relationship between CSM and dissection were not referenced. However, these studies assume the CSM was properly performed. In this case, the CSM was likely not properly performed if it caused such catastrophic injuries. 

So, I agree with everything Dr. Brown has to say here and will add that bias against chiros is present here. However, if this is a chiropractor that nearly yanked this woman’s head from her torso, I would be biased against he or she as well. Even as a chiropractor myself. Just because something gets a ton of views on social media or YouTube does not mean it’s amazing and without risk.  You’re all smart enough to know that you see the wins on videos. You don’t see the fails. I’ve seen a YouTube chiro almost yank a 70+-year-old tiny woman off of the table.

She had to lay there and recover for a good 3-5 mintues. Is that really what we enjoy or want to be known for? Of course it isn’t.  I want to be known for the woman that came to see me with lumbar radciulopathy that was developing mild foot drop and we were able to get her by. And fully recovered.

Or the veteran that couldn’t sleep or function and who’s neck made all kinds of crunchy sounds and since seeing me, it no longer makes noise and he’s feeling much better. Or the patients that was 35 and came in on a walker. He’d been to the ER twice before with bowel and bladder symptoms consistent with cauda equina but they never even did an MRI on him. I had a talk with him, told him exactly what he need to go to the ER and tell them and the next thing you know, he went through emergency surgery and now he’s back to leading a full and functional life. 

It’s not just me. You men and women have those stories too if you’ve been in practice long enough. These things don’t get views on YouTube and these patients aren’t typically dressed in yoga pants. You know what I’m saying here. But, they are the patients that we need to be known for. 

Keep plugging away. It’s a hell of a lot better time to be a chiropractor in 2023 than it was in 2000. I can guarantee it. Cooperation between evidence-based chiropractors and medical professionals is at an all time high and I only see it getting better from 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 https://www.chiropracticforward.com

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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      

Excessive Generalization Of Fear Avoidance

CF 301:

Excessive Generalization Of Fear Avoidance

Today we’re going to talk about Excessive Generalization Of Fear Avoidance 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!

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Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow, 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.
  • 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 #301 Now if you missed last week’s episode , we talked about disc resorptions and pickleball injuries. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I just got back from Chicago. Long long long conference. It’s serious on the CEUs folks. 27 hours of classroom sitting. That’s rough. But, I will say, it’s one of the smartest groups of docs you’ll be in the same room with.  This conference was put on by the ACCC which is the American College of Chiropractic Consultant in conjunction with the America Board Of Forensic Professionals. Or somethiing like that. It’s the consultants with the forensics   So basically you have the coding and compliance specialists with the medicolegal expert witness folks and you have a nice mix of really detail-oriented, research knowledgeable, and super smart people.  The presenters at this conference gotta be tough and on their games because these folks are smart and, for the most part, know what the heck they’re talking about. I wouldn’t present to them. Lol.  Anyway, one of my buddies, David Graber, presented and did a great job. He was from 8-10 on a Saturday afterr we all stayed out a little too late but he was full of energy and did a great job keeping eveyrone engaged.  On Friday a new connection made out there presented. I did not know Dr. Steven Brown from Gilbert, AZ before this conference but we got to spend some quality time getting to know each other this weekend. It was funny how we met. I was in the elevator speaking to someone, I don’t remember who….and this voice from behind be goes….”Hey, aren’t you that chiropractor with the podcast?”  Not thinking anyone ever listens to my podcast, I was surprised and just said, “Yeah….I have a podcast!” He said, “I recognized your voice!” So, that was Dr. Steven Brown. Lol. Turns our Steven was a presenter at the conference and was talking about when it is actually possible for chiros to cause strokes from SMT and how we can potentially avoid the pitfall. Great talk, plenty of discussion and interaction and he knows his stuff. No doubt.  I got the opportunity to hang out with a friend and quasi-mentor of mine, Dr. James Lehman of the University of Bridgeport. I can’t say enough about Jim. He’s just a special guy and a great friend to me that I very much value.  My buddy, Ben Fergus, who lives in Chicago, came down to visit me and meet Dr. Graber and Dr. Lehman.  So, basically, a trip that I was not looking forward to at all turned into a great trip with lots of new connections made along the way. I don’t like classrooms filling up any of my weekends but this thing turned out A-OK.  If you’ve ever throught about a Diplomate in Forensics, I have some advice. Get the Neuromusculoskeletal Medicine Diplomate at 300 hours through the University of Bridgeport like I did. Then, for only 100 extra hours, you can get the Forensics Diplomate. Then with both of those in your pocket, you’ll be well-positioned to be a medicolegal expert witness.  If you had told me 5 years ago that I would have a Diplomate, I would have told you that you need to quick smoking the Devil’s lettuce. Now, sitting here in 2023, I am double board certified with two Diplomates. It’s weird how things change and interests change.  I was in a hurry and I loved the Neuromusculoskeletal information so much that I burned through the course in 6 months and you can too. For the most part, none of you are any busier with business and life than I am. I promise. That forensics diplomate probably only took me roughly 3 months to complete.  If you’d like any information on them, I’ll put the links in the show notes here. Just go to episode #301 at chiropracticforward.com and check it out.  https://www.bridgeport.edu/academics/programs/hs-postgrad-programs/orthopedics-neuromusculoskeletal-medicine https://www.acatoday.org/aca-membership/aca-specialty-councils/council-on-forensic-sciences/ Since it’s a little long, we’re just going with one paper this week. It’s called, “Excessive generalization of pain-related avoidance behavior: mechanisms, targets for intervention, and future directions” by Vandael et. Al. and was published in Pain Journal for November 2023 and that’s so hot not a man can hold it! Vandael, Kristofa,b; Vervliet, Bramb; Peters, Madelona; Meulders, Anna,c,*. Excessive generalization of pain-related avoidance behavior: mechanisms, targets for intervention, and future directions. PAIN 164(11):p 2405-2410, November 2023. | DOI: 10.1097/j.pain.0000000000002990 When you have chronic pain, it is natural to want to avoid activities that you think will cause pain. However, if you avoid too many activities, it can make your pain worse and lead to disability. One reason why people with chronic pain avoid activities is because they fear that those activities will cause pain. This fear is often based on past experiences of pain. However, the fear can sometimes spread to activities that are unlikely to cause pain. This is known as overgeneralization of pain-related fear. Overgeneralization of pain-related fear is a key feature of chronic pain disability. There are a number of things that can be done to reduce overgeneralization of pain-related fear, including:
  • Learning about pain and how it works
  • Gradually exposing yourself to activities that you fear will cause pain
  • Identifying and changing the negative thoughts and beliefs that contribute to your avoidance behavior
  • Learning to accept your pain and focus on living a meaningful life despite your pain
There are a few potential intervention targets to reduce overgeneralization of pain-related avoidance:
  • Competing goals: Encouraging people to pursue valued goals, even if it means experiencing some pain, can help to weaken the fear-avoidance relation.
  • Perceptual accuracy: Training people to more accurately perceive their movements can help to reduce generalization, as people are less likely to avoid activities that they know are safe.
  • Positive affect: Inducing positive affect can help to inhibit fear from spreading to novel safe stimuli and may also increase willingness to approach fear-evoking stimuli.
Other potential intervention targets include executive functions such as working memory and attentional control, and anxious traits such as anxiety, sensitivity, and intolerance of uncertainty. Future research on overgeneralization of pain-related avoidance should focus on:
  • Establishing the diagnostic and predictive validity of paradigms developed to study generalization of avoidance behavior in pain research.
  • Testing experimental interventions to reduce overgeneralization in both healthy subclinical and clinical samples.
  • Investigating the role of social factors in generalization.
  • Examining observational and instructed learning as mechanisms of generalization.
  • Conducting preventive trials in the acute pain stage.
  • Translating experimental interventions into practice to test for clinically relevant improvements.
This research is important to inform and strengthen evidence-based treatment for chronic pain. All of this is just building on what we’ve been learning in the last 5-10 years with regard to pain.  Fear avoidance is huge. We must address it before de-conditioning sets in.  Hurt doesn’t equal harm Movement at the joint and at the global level is healing, it improves proprioceptive input, it clears up a muddied and blurry neural map of our joints and our movements, it has an effect on neuroplasticity, and it increases our confidence in movement while lowering our overall pain levels.  So let’s get our patients moving as quickly as we can responsibly and appropriately.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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