low level laser

PT For Sciatica & Laser For Neck Pain

CF 320: PT For Sciatica & Laser For Neck Pain Today we’re going to talk about PT For Sciatica & Laser For Neck Pain 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 #320 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. If you’ve been following along, you know I’m still digging my clinic out of the Winter doldrums but it’s coming along nicely. If you want to hear more about that and what we’ve been doing to change course and correct the path forward, listen to last week’s episode.  The plan laid down is starting to bring some fruit that I think we’ll be harvesting soon. I had 15 or 16 new patients last week. It’s not to the 20 or so I was used to before COVID but it’s better than the 9 or 10 I was seeing a month or so ago.  We’re back to doing the therapies on our patients that we should be legitimately doing. We’re not just failing to do them and watching that money simply walk out the door.  For example, we billed $106k in February as opposed to $82k in December. Quite a difference there. Now, that’s me and the nurse practitioner and while that may sound like a metric crap ton of money in a month, and it is for some, remember, my overhead monthly is approximately $65k or more. So, if you bill that much, guaranteed you’re not collecting that much. You might get $80 – $85 of that.  That leaves you with $15k….maybe $20k in profit for the month. So, it’s not where we want it but it’s moving in the right direction. We collected about $30k more in February than we did in each of the previous 3-4 months so collections is doing its deal and making me happy once again.  I’m such a fun guy when I’m making money instead of losing it!! Y’all!  This week is a short week for me. I’m flying out to Atlanta Thursday morning to the big VOAtlanta voice conference. Around 1,000 attendees. Last year, the dude that does all of the announcements for the TODAY show was sitting behind me. The guy that has voiced Goofy for the last 40 years was there. Nolan North who voiced the lead character in the video game Unchartered was there.  You just never know who’s going to be there but making the just right contact on these things could mean a lot financially. No doubt. So I go, I have some drinks at the bar, I attend classes and enjoy it and take it all in and just see what happens.   So that’s on tap this weekend and you know I’ll be talking about it on the podcast next week. But for now, let’s hop in on the research.  Item #1 The first one this week is called, “How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis” by Dove et. Al. and is published in European Spine Journal on December 29, 2022 and let’s do the hot thing just because! Remember, the citations can be found at chiropracticforward.com under this episode.  Dove, L., Jones, G., Kelsey, L. et al. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J 32, 517–533 (2023). https://doi.org/10.1007/s00586-022-07356-y Why They Did It Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial.  The purpose of this systematic review was to establish the short-, medium- and long-term effectiveness of physiotherapy interventions compared to control interventions for people with clinically diagnosed sciatica How They Did It This systematic review  Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed, Scopus and grey literature were searched from inception to January 2021 Inclusion criteria were randomised controlled trials evaluating PT interventions compared to a control intervention in people with clinical or imaging diagnosis of sciatica.  Primary outcome measures were pain and disability.  Study selection and data extraction were performed by two independent reviewers with consensus reached by discussion or third-party arbitration if required.  Risk of bias was assessed independently by two reviewers using the Cochrane Risk of Bias tool with third-party consensus if required.  Meta-analyses and sensitivity analyses were performed with random effects models  Subgroup analyses were undertaken to examine the effectiveness of physiotherapy interventions compared to minimal (e.g. advice only) or substantial control interventions (e.g. surgery). Three thousand nine hundred and fifty eight records were identified, of which 18 trials were included, with a total number of 2699 participants.  What They Found All trials had a high or unclear risk of bias. Meta-analysis of trials for the outcome of pain showed no difference in the short, medium or long term.  For disability there was no difference in the short, medium, or long term between physiotherapy and control interventions.  Subgroup analysis of studies comparing physiotherapy with minimal intervention favored physiotherapy for pain at the long-term time points.  Large confidence intervals and high heterogeneity indicate substantial uncertainty surrounding these estimates.  Many trials evaluating physiotherapy intervention compared to substantial intervention did not use contemporary physiotherapy interventions. Wrap It Up Based on currently available, mostly high risk of bias and highly heterogeneous data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica. Item #2 The second one today is called “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials” by Chow et. Cl and published in The Lancet on December 5, 2009.  Chow R, Johnson, M, ‘Efficiacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials’, 374, 9705, P1897-1908, Dec. 5, 2009. DOI:https://doi.org/10.1016/S0140-6736(09)61522-1 Why They Did It Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects.  Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain.  They did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain. How They Did It We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain.  Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale. What They Found We identified 16 randomised controlled trials including a total of 820 patients.  Side-effects from LLLT were mild and not different from those of placebo. Wrap It Up We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Gluteal Tendinopathy – You Don’t Know What You Don’t Know

CF 254: Gluteal Tendinopathy – You Don’t Know What You Don’t Know Today we’re going to talk about Gluteal Tendinopathy – You Don’t Know What You Don’t Know 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 #254. Now if you missed last week’s episode, we talked about Spinal Cord Stimulators vs. Placebo & we talked about Low Back pain, Chiropractic, And Opioids. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

You may have heard me talk about it a time or two but I’m really impreessed with a contraption that we have in our office. When I bought mine it was only the third purchased in Texas. Texas is a big place, folks!  One had been sold to a research lab, one had been sold to a Physical Therapy outfit, and then mine. Definitely we’ve been ahead of the curve. When I have a car crash patient or a chronic pain patient, we can run the BESS test and the mCTSIB tests to test for concussion and proprioception.  Not just test proprioception but train it as well. Balance training, rehab training, movement evaluation, and excellent shoulder rehab as well. It’s called the ISO Free by Tecnobody and it’s cool and it makes me different from the rest of my colleagues by giving us capabilities nobody else has.  Check out these products and see what you think.

Go to https://www.tecnobody.com/en/products. Once you decide you have to have more information, email me at creekstonecare@gmail.com and I’ll hook you up with the people that can get you a deal on it.  This week I’m really starting to look forward to a little trip we’ve been planning for a while. Remember, you should take a solid trip about once per quarter. It’s the only way to preserve your sanity. You have to get out of your office and spend time on your loves or risk losing your mind completely.  Our trip this go around is part of Dr. Kevin Christie’s Florida Mastermind. We are all meeting in the Florida Keys. Key Largo to be specific. Which is the first Key south of the mainland.

Kevin picked this resort because my wife and I went there in February 2020. Just one month before the pandemic set in on the world.  People were just starting to think seriously about masks and all of that stuff back then. It was a blast and this resort called Playa Largo was the bees knees. Massages every day, drinks poured in cored pineapples on the beach at sunset, ,dining on the beach and being served funny umbrella drinks as you lounge in the hammock reading Stu McGill’s Back Mechanic book was amazing.  Check it out.

Just Google up Playa Largo and see what you find. It’ll make you consider Key Largo instead of Key West.  So that’s coming up November 11-13 or somewhere around there. We’re taking my daughter with us and I believe all other Mastermind members are bringing wife and kiddos so it should be a really special time of bonding, swapping ideas, and growth.  Speaking of growth, you’ve been hearing me fuss about being slow. We’re still slower than I want but it looks to be picking up a bit. Just in time to go to Key largo, right?

I have anxiety about it but I’m going and I’m not letting business worry me or stress me out. I have to compartmentalize that stuff and step away from it. Which I am. 

What do you have coming up that you’re looking forward to? I talked about the Tecnobody products earlier. Are you using anything new and cool? I’d love to hear about it and check it out. I love new gadgets that get patients better! Email me at dr.williams@chiropracticforward.com and tell me all about it.  Let’s hop into the research

Item #1

Let’s talk about Gluteal Tendinopathy, shall we. My friends at ChiroUp recently put out an awesome rundown of GT through their email list. Check the show notes for the link to their rundown on it at this poin in the show notes. https://chiroup.com/blog/what-is-the-most-common-cause-of-hip-pain After going through the Ortho Diplomate, GT has been on my radar and it’s amazing. Once you know to look for it, you’re going to find it EVERYWHERE!

Literally everywhere.

You just don’t know what you don’t know and I didn’t know before the Ortho Diplomate.  First, Why do people get it? They say it’s from excessive tension or compression of the area.  Secondly, what does it look like? GT is lateral hip pain and is tendinopathy of the glute medius or minimus. It hurts to walk but very tellingly, it hurts to lay on that side because of the compression but it also hurts to lay on the other side because we always stretch the leg over the other one so there is tension on the area. Pain on going up and down stairs for sure. One of our patients could barely get into and out of their RV and she was unhappy. 

Also, there is usually significant pain on palpation of the area. You can get their attention very quickly by poking around on it.  Current thinking is away from bursitis and more toward GT. If bursitis is present, it’s probably more a symptom of GT.  This thinking is fresh enough that I found myself in a pissing match with an ortho surgeon about whether it’s bursitis or it’s GT.

We’re always going to have less authority than the ortho in this case so, I told the patient what the research shows and said that ultimately, the terminology doesn’t matter because it will be treated the same. That worked out fine. Try to avoid pissing matches on GT because it’s just not widely known about right now.  Orthos are injecting corticosteroids into the hip joints of these GT patients and they’re stunned that it has no effectiveness. That’s because the problem isn’t in the joint. It’s in the connection on the posterior aspect of the greater trochanter.  How do we test for it and treat it?

  1. Hip Lag Sign
  2. FaberEx
  3. Palpation

What I do in my office is I use the Drop Release, which was invented by my friend, Dr. Chris Howson of the Great State of North Dakota, to beat it up just a little bit. I use regular SMT to make sure things are moving well. Then I recommend they do some cold laser on the insertion to work down some inflammation. We combine that with targeted rehab exercises from ChiroUp.  We have also combined my side with trigger point injections from our Nurse Practitioner.

It has been an awesome combination for us here at my clinic and we are helping these people get past GT a lot faster.  Recent research is showing, that PRP injections at the site show promise in helping chronic GT recover quickly as well. That’s exciting because we do PRP here at my clinic! I have the luxury of those not responding to the trigger points and my help to also try PRP now.  So, let’s cover that paper briefly before wrapping up for this week’s episode.  It’s called “The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection” by Fitzpatrick et. al. (Fitzpatrick J 2018) and published in the American Journal of Sports Medicine and was published on January 2, 2018. 

Why They Did It

There would be no difference in the modified Harris Hip Score (mHHS) between a single platelet-rich plasma (PRP) injection compared with a corticosteroid injection in the treatment of gluteal tendinopathy.

How They Did It

  • Randomized controlled trial;
  • There were 228 consecutive patients referred with gluteal tendinopathy who were screened to enroll 80 participants; 
  • Participants were randomized (1:1) to receive either a blinded glucocorticoid or PRP injection intratendinously under ultrasound guidance. 
  • A pain and functional assessment was performed using the mHHS questionnaire at 0, 2, 6, and 12 weeks and the patient acceptable symptom state (PASS) and minimal clinically important difference (MCID) at 12 weeks.
  • Participants had a mean age of 60 years, a ratio of female to male of 9:1, and mean duration of symptoms of >14 months.

What They Found

  • Pain and function showed no difference at 2 weeks or 6 weeks
  • The mean mHHS was significantly improved at 12 weeks in the PRP group compared with the corticosteroid group 

Wrap It Up

Patients with chronic gluteal tendinopathy for greater than 4 months, diagnosed with both clinical and radiological examinations, achieved greater clinical improvement at 12 weeks when treated with a single PRP injection than those treated with a single corticosteroid injection 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 https://traffic.libsyn.com/chiropracticforward/CF_-_Ep._254.mp3

Bibliography Fitzpatrick J, B. M., O’Donnell J, McCrory PR, Zheng MH, (2018). “The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection.” Am J Sports Med 46(4): 9336-9939.