CF 045: Harvard Health, Low Back Stenosis, Allergy Autism
As the title this week indicates, I’ve taken some files that have been gathering a little bit of dust in the dark corner and I’m bringing them out into the light.
Today we’ll talk about an article in Harvard Health, we’ll talk about low back stenosis research (something that doesn’t get a lot of attention), we’ll talk about a JAMA article on allergies and autism, and we’ll hit on a paper attempting to explain why some patients respond while others do not.
But first, you know what’s up, I wrote and recorded our jingle so you might as well just sit back and enjoy this candy for your ears. When you do create something, it’s going to be in EVERY show don’t ya know!! Here’s that bumper music
OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.
You have collapsed into Episode #45
OK, first thing, we should probably talk about the Texas vs. Oklahoma game that just happened this last weekend. By the time this posts, it’ll be two weeks ago but, still need to brag. What a game that was. I’m a Texas boy but either way would have been fine since most of OU’s players are from Texas anyway. I go for all of the Texas teams.
I want to thank Kyle Swanson for the shout out on the Forward Thinking Chiropractic Alliance group a couple weeks ago. He’s a Texas A&M Aggie. Look, like I said, I root for A&M too so we would probably be buddies in the real world if I’m guessing out loud.
Front Desk Staffing
Let’s get to the ongoing saga of hiring a new front desk staff. If you’ve been following along, you’ll remember that hiring a new front desk staff member has been nothing but a soup sandwich.
Messy. Gloppy, Unreal and confusing. Those are just some words I’m laying on you. I have more words for what we’ve been through on this deal but then my podcast would have an explicit designation and I try to keep it clean around here.
But, I believe progress has been made. We seem to have a new one that seems to be on top of her game. If she’s a “sticker,” then the search may very well be over. Of course, she’s not young which is probably why she’s a sticker so far. She’s closer to my age than any of the others have been. I’m not saying that young people have no work ethic…..I’m just saying that all of the young people that we interviewed for this job have no work ethic.
That sounds like I’m against young people, millennials, blah blah blah. I’m not. I have had some VERY intelligent and capable young people come through here as employees over the years. There are very smart, very talented young folks out there. We just didn’t encounter any of them for this round of hiring. That’s all I’m saying.
October has really taken off in terms of listens for the podcast. I can only guess you’re sharing episodes here and there with your network. To that, I say thank you. If I ever see you somewhere and you tell me you have been sharing my stuff, and hold your hands out like, “bring it in big boy,” well then…you’re getting a hug my friend.
I’m a hugger. Which can probably be scary if you don’t know me. I’m 6’4” and like 280 so….big guy coming through! But, those that know me know that I’m a teddy bear. Unless you try to steal my food. Then it’s pretty much on at that point.
On to the research
Let’s get on with trying to make your practice better. When your practice is better, your life is better.
Let’s start with the Harvard Article. It was published in November 2017. I have it linked at chiropracticforward.com for you all in the show notes for episode 45. The name of the article is “Where to turn for low back pain relief” and I couldn’t find the name of the author so there ya go.
The subtitle of this Harvard Medical journal….medical journal……is this: in most cases, a primary care doctor or chiropractor can help you resolve the problem. What the hell??? It seriously says that in a Harvard Medical article. I’m trying to catch my breath here. Sorry…..
It was published in November of 2017. The article says that there are many causes of low back pain and some of the most common is an injury to muscles or tendon which we know is called a strain and then injury to back ligaments which we call a sprain. And then there are herniated or bulging discs.
Going through the DACO program tells me that the prevalence between disc, facet, and SI joint pain stands at 40% for the disc, 30% for the facet, and 22.5% for the SI joint pain. BUT….over the age of 50 years old, it flips a little and the Facet joint gains prevalence over disc or SI pain. Just some nuggets to tuck away in your nugget pouch.
This article just blows me away when it gets to the “Where to Turn” subtitle. Beneath this subheader, it says, “Since you shouldn’t try to diagnose your own back pain, make your first call to a professional who can assess your problems, such as a primary care physician or a chiropractor.”
Both can serve as the entry point for back pain says Dr. Matthew Kowalski who serves as a chiropractor with the Other Clinical Center for Integrative Medicine at the Harvard-affiliated Brigham and Women’s Hospital.
What the hell is happening here? Am I in the Twilight Zone where everything is flipped and the medical world finally gets it?
The article goes on to say “A well-trained chiropractor will sort out whether you should be in their care or the care of a physical therapist or medical doctor.”
And here’s the difference between evidence-based/patient-centered chiropractors and those that are not.
The more not evidence-based amongst us, the ones that drive a billion people through their doors for everything from allergies to whatever…..they will not typically be turning those patients over to the medical doctor or the PT.
Moving to the next paper, it’s called “Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial” authored by Carlo Ammendolia, et. al. It’s all about low back stenosis. This paper is co-authored by DCs, AND MDs. It was published in the Archives of Physical Medicine and Rehabilitation on October 27, 2017.
Why They Did It
They wanted to the effectiveness of a comprehensive nonsurgical training program to a self-directed approach in improving walking ability in low back stenosis.
How They Did It
- It was a randomized controlled trial
- It was done in an Academic hospital outpatient clinic
- Participants suffered neurogenic claudication
- MRI confirmed lumbar spinal stenosis
- Subjects were suffering low back stenosis and randomized
What They Found
The conclusion stated, “A comprehensive conservative program demonstrated superior, large, and sustained improvements in walking ability and can be a safe nonsurgical treatment option for patients with neurogenic claudication due to LSS”
Low back stenosis can be helped
Dr. Ammendola has an amazing lumbar spinal stenosis program and training course. I have not personally taken it just yet but, it’s on my list after I finish up the DACO program. It comes HIGHLY recommended and this paper shows us why.
Trucking on, this one is called “Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls?” It was published in Spine Journal in September of 2015 and authored by Wong, et. al. 
Why They Did It
To determine whether patients with low back pain (LBP) who respond to spinal manipulative therapy (SMT) differ biomechanically from nonresponders, untreated. Some, but not all patients with low back pain report improvement after a visit to the chiropractor. Why does that happen?
What They Found
After the first SMT, SMT responders displayed statistically significant decreases in spinal stiffness and increases in multifidus thickness ratio sustained for more than 7 days; these findings were not observed in other groups.
Wrap It Up
Quote, “Those reporting post-SMT improvement in disability demonstrated simultaneous changes between self-reported and objective measures of spinal function. This coherence did not exist for asymptomatic controls or no-treatment controls. These data imply that SMT impacts biomechanical characteristics within SMT responders not present in all patients with LBP.”
And our last one this week comes to us from JAMA, also known as the Journal of the American Medical Association. This one is called, “Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children.” It was authored by Guifeng, et. al. and published in 2018. Again, these papers are cited in the show notes at chiropracticforward.com under episode 45 so check them out yourself please.
The question they attempt to answer here is, “What are the associations of food allergy and other allergic conditions with autism spectrum disorder (ASD) in children?”
They say in the paper that Common allergic conditions, in particular, food allergy, are associated with autism among US children, but the underlying mechanism for this association needs further study.
The study was a population-based, cross-sectional study used data from the National Health Interview Survey collected between 1997 and 2016
The conclusion was quote, “In a nationally representative sample of US children, a significant and positive association of common allergic conditions, in particular, food allergy, with ASD was found.”
They now need to find out the cause and underlying mechanisms so they can attempt to reverse the upswing of autism here in America.
So….it appears maybe it’s not all due to vaccines after all.
That wraps it up for us this week. I hope you enjoyed it. Research can be boring but, it can be fascinating too when you allow it to help guide your thought process when you are approaching your daily tasks and deciding on treatment options for your patients.
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 a mechanical pain and responds better to mechanical treatment instead of chemical treatments.
The literature is clear: research and experience show that, in 80%-90% of headaches, neck, and back pain, patients get good to excellent results when compared to usual medical care and it’s safe, less expensive, and decreases chances of surgery and disability.
It’s done conservatively and non-surgically with little time requirement or hassle for the patient. If done preventatively going forward, we can likely keep it that way while raising overall health! At the end of the day, patients have the right to the best treatment that does the least harm and THAT’S Chiropractic, folks.
Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.
Being the #1 Chiropractic podcast in the world would be pretty darn cool.
We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the author:
Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
1. School, H.M., Where to turn for low back pain relief. Harvard Health Publishing, 2017.
2. Ammendolia C, Comprehensive Nonsurgical Treatment Versus Self-directed Care to Improve Walking Ability in Lumbar Spinal Stenosis: A Randomized Trial, in North American Spine Society Meeting. 2017, Archives of Physical Medicine and Rehabiliation: Orlando, FL.
3. Wong AY, Do participants with low back pain who respond to spinal manipulative therapy differ biomechanically from nonresponders, untreated controls or asymptomatic controls? Spine, 2015. 40(17): p. 1329-37.
4. Guifeng X, Association of Food Allergy and Other Allergic Conditions With Autism Spectrum Disorder in Children. JAMA, 2018. 1(2).
CF 016: Review of The Lancet Article on Low Back Pain (Pt. 1)