CF 269: Children, Activity, and Depression and Axially Loaded MRIs
Today we’re going to talk about Children, Activity, and Depression and Axially Loaded MRIs
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!
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 com
You have found yourself smack dab in the middle of Episode #269
Now if you missed last week’s episode, we talked about Postoperative Acupuncture & Activity And Depression. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things….. This week has started out gangbusters, folks. 47 on the schedule and that’s just me. We have the nurse practitioner kicking, the massage therapists doing their thing, we have the acupuncturist banging ‘em out, and a full, brand new team, as most of you know…..and they’re learning and getting up to speed quickly.
They’re much quicker with everything they do every day. The new front desk staffer is phenomenal and really catching on. She’s the real deal so, things are smelling pretty darn rosey around Creek Stone folks.
Isn’t that a lot better than me fussing about being slow. Let’s hope my upward swing maintains so I don’t have to go back into gripey mode.
Now, things I’m doing lately. I’m experimenting a lot with ChatGPT. If you’re not familiar, you might give it a look-see. It’s a game changer for those like me that are highly involved in their own content creation, blogs, articles, marketing, and things of that nature. It’s scary but for now, scary in a good way and is saving me literally 3-6 hours every single week and saving lots of money as well.
Need an article, have ChatGPT get the base coat of the painting laid down for you while you come in and do the touch-ups. Need a meeting outline? ChatGPT. How about ideas for social media postings? Yep, ChatGPT. It’s remarkable.
Think about it; I have several things happening in my daily. Chiropractic Forward is a small part of my life. This ChatGPT is helping me get a lot of stuff lined out and I’m pretty excited about it.
So check it out. Remember, you heard it from your ol’ Uncle Jeffro first.
Let’s dive in.
Item #1 The first on today is called, “Physical Activity Interventions to Alleviate Depressive Symptoms in Children and Adolescents” by Francesco Recchia and published in Jamapediatrics on January 3, 2023. Dayum. That’s hot. Why They Did It
To determine the association of physical activity interventions with depressive symptoms in children and adolescents.
How They Did It
A random-effects meta-analysis using Hedges g was performed. Heterogeneity, risk of bias, and publication bias were assessed independently by multiple reviewers. Meta-regressions and sensitivity analyses were conducted to substantiate the overall results. The study followed the PRISMA reporting guideline.
PubMed, CINAHL, PsycINFO, EMBASE, and SPORTDiscus were searched from inception to February 2022 for relevant studies written in English, Chinese, or Italian.
What They Found
Twenty-one studies involving 2441 participants (1148 [47.0%] boys; 1293 [53.0%] girls; mean [SD] age, 14 [3] years) were included.
Meta-analysis of the postintervention differences revealed that physical activity interventions were associated with a reduction in depressive symptoms compared with the control condition (g = −0.29; 95% CI, −0.47 to −0.10; P = .004).
Analysis of the follow-up outcomes in 4 studies revealed no differences between the physical activity and control groups (g = −0.39; 95% CI, −1.01 to 0.24; P = .14).
Moderate study heterogeneity was detected (Q = 53.92; df = 20; P < .001; I2 = 62.9% [95% CI, 40.7%-76.8%]). The primary moderator analysis accounting for total physical activity volume, study design, participant health status, and allocation and/or assessment concealment did not moderate the main treatment effect. Secondary analyses demonstrated that intervention (ie, <12 weeks in duration, 3 times per week, unsupervised) and participant characteristics (ie, aged ≥13 years, with a mental illness and/or depression diagnosis) may influence the overall treatment effect.
Wrap It Up Physical activity interventions may be used to reduce depressive symptoms in children and adolescents. Greater reductions in depressive symptoms were derived from participants older than 13 years and with a mental illness and/or depression diagnosis. The association with physical activity parameters such as frequency, duration, and supervision of the sessions remains unclear and needs further investigation. 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, “Magnetic Resonance Imaging Evaluation of Biomechanical Effects of Axial Loading on the Lumbar Spine” by Adnan Sehic and published in PubMed on 2022 30 Dec. Hot potato!
Why They Did It
The aim of this study is to determine the significance of alMRI in detecting the morphologic changes of the lumbar spine caused by axial loading and to compare it with conventional MRI images of the lumbar spine without loading.
How They Did It
The study was conducted as a prospective, descriptive clinical trial.
Imaging was performed with a MRI 1.5 T in the head-first supine position. Imaging was performed in two acts: without load and under load. Loading for alMRI was performed with the DynaWell L-Spine device.
The onset of loading was 10 minutes before the start of alMRI. The loading continued throughout the imaging procedure.
What They Found
After evaluating the changes in the height and size of the lumbar disks, the size of the DSCA, and the narrowing of the intervertebral foramina significant differences were found between the images before and after axial loading.
Wrap It Up
alMRI provides information on morphological changes of all segments of the lumbar spine. This data represents significant information that can lead to more accurate and effective treatment of LBP.
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!
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.
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
CF 259: Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff
Today we’re going to talk about Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff
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!
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 #259
Now if you missed last week’s episode , we were joined by Dr. Anthony Houssain and had an amazing discussion on how to choose a good practice location, on the clinic/gym hybrid model, and one why masterminds are so important for you growth. Make sure you don’t miss that info. Keep up with the class.On the personal end of things….. First thing, if you haven’t had enough of my podcast, or you just want to hear my thoughts in a different context and setting, Dr. Jay Greenstein and Brad Cost interviewed me for their podcast called TechTalk and we had a great chat about life, practice, and all things in between. Go check it out. It aired just a week or two ago so it’s one of their newest episodes. So, if you’ve been listening lately, you know I’ve been in a slump. I’m not a slump type of guy. I don’t know what ‘take a step back’ even looks like. It’s not in my vocabulary. All I know is progress, growth, win, win, win. I’m an old college football player and won state here in Texas in the discus. Competition, initiative, and growth are engrained in the very fabric of my being. It’s just how I’m built. So, being slower here in the clinic this year has been challenging for me. A bit financially but also big time mentally. I don’t have mental health issues. That’s now what we’re talking about. Mentally as far as trying to figure it out. Putting the puzzle together so that I can fix it and get back to growing. Part of that has been fixing my outlook day to day. Embracing the suck. Meaning, when I show up on a Monday morning and there’s 48 on the schedule and there are 5 in the lobby before we even open…..instead of being defeated before I even get into my office space, my personal area, instead of being defeated, I need to embrace the stress and anxiety, thank God for our blessings, and get to work making people feel better. So, I wanted to fix that first. Then, what else could be the issue. Well, I used to be #1 on the google search. For years I was the top one because nobody else had figured out the importance at that time so I had a step ahead. But, an internet company I was with screwed up my site, Google changed their algorithms, and boom, I started dropping. So I switched companies. They set up a great site but no real SEO. So I started blogging every single week. New, fresh, completely original content. Guess what, no help at all. Not even a little. I was falling like a rock. So I think website SEO is a big issue so I’m addressing that now too. You all know I’m in the Florida Mastermind with Dr. Kevin Christie. Well Kevin works with Darcy Sullivan of Propel. So, I contacted Darcy and she’s taking me on as a client and a big project I can only assume. Lol. I’m going to be talking every week or so about my experience so you’ll know how it’s going in real time and we’ll be able to see where I started and where I end up with Darcy’s help. It’ll be a learning project we’ll do together. Stick with me for the next 4-6 months on the website SEO thing because this should be interesting. If all works out well, you may be contacting Darcy and Propel as well. Time will tell. Alright, let’s get to the research shall we? Item #1 Our first on his called, “Lumbar spine MRI findings in asymptomatic elite male academy footballers: a case series: by Carmody et. Al. (Carmody S 2022) and published in BMC Sports Science Medical Rehabilitation on October 24th, 2022 and that’s brand new and it’s hot too! Why They Did It
Understanding common MRI findings may allow clinicians to appreciate the sport-specific effects on the lumbar spine, and to discern clinically significant pathology.
Prevalence data regarding radiological abnormalities seen during the surveillance of asymptomatic elite footballers is, therefore, important to help understand injury mechanisms and to prevent associated injuries.
The purpose of this study was to evaluate the magnetic resonance imaging (MRI) findings in the lumbar spines of asymptomatic elite male adolescent footballers.
How They Did It
A prospective case-series study was carried out.
MRI was performed in 18 asymptomatic male elite adolescent footballers recruited from a professional academy in England
The images were independently reported by two consultant musculoskeletal radiologists to achieve consensus opinion.
What They Found
Fifteen players (83%) showed one or more abnormalities, that included facet degeneration, synovial cysts, disc degeneration, disc herniation, and pars injury.
One player had mild (Grade 1) facet joint arthropathy at L4/L5
3/18 showed evidence of bilateral facet joint effusions.
Three synovial cysts were identified in 2 players,
4 presented asymptomatic pars injuries,
4 had a grade 2 subtotal stress fracture and
1 player had a grade 4 chronic stress fracture
Disc degeneration at one or more levels was demonstrated in 7 fo the 18.
Disc herniation was present in 5 or 27% of the players.
Wrap It Up A range of unsuspected findings on MRI of the lumbar spine are common in elite adolescent footballers.
Folks, all of those scary words used to send my patients straight to a surgeon for a second evaluation. Now I know better. These are all asymptomatic. No clinical issue whatsoever and these players ranged from 17 years old to almost 19 years old. No pain and almost 30% of them had disc herniations. We can manage these cases. If there is no progressive neurological deficit with regard to bowel and bladder function, DTRs, dermatomes, or motor function, why are you sending them anywhere?
Don’t do it. Pain is not a reason for surgery and we can manage them if you are educated and know what to do. If you do not know, get smart and get educated. Good starting points are:
Stu McGill’s book called Back Mechanic
Craig Liebensen
McKenzie Certifications
FMS/SFMA
DNS
Donal Murphy’s Spine Practitioner program and his CRISP Protocol books.
Just that group of stuff right there will put you heads and shoulders beyond what the majority of your colleagues and yes…competitors are able to do. You immediately differentiate yourself and then you lengthen the road between yourself and the others more and more with each cert you get. Then look at Diplomates to solidify a canyon between yourself and the rest. Stop sitting on your ass if you don’t know anything about this stuff. Get on it and make this profession what it should be. Bam. Pow. Smack. Kachunga, Slap! Wowza! Tough talk and tough love. But hopefully motivating works from you Ol’ Uncle Jeffro. You’re welcome. 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 next one is called, “Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial” by Moustafa et. al. (Moustafa IM 2022)published in Journal of Clinical Medicine on September 29, 2022 and that’s a hot tamale with jalapeños atop of it. And as a side note, I’m still trying to figure out how I got stuck with a boring name like Williams while you got guys walking the Earth with the last name Moustafa. It’s just not fair.Why They Did It
to investigate the effects of sagittal head posture correction on 3D spinal posture parameters, back and leg pain, disability, and S1 nerve root function in patients with chronic discogenic lumbosacral radiculopathy
How They Did It
A randomized controlled study with a six-month follow-up
80 (35 female) patients between 40 and 55 years experiencing chronic discogenic lumbosacral radiculopathy with a definite hypolordotic cervical spine and forward head posture (FHP) and were randomly assigned a comparative treatment control group and a study group
Both groups received TENS therapy and hot packs, additionally, the study group received the Denneroll cervical traction orthotic.
Interventions were applied at a frequency of 3 x per week for 10 weeks and groups were followed for an additional 6-months.
Radiographic measures included cervical lordosis (CL) from C2-C7 and FHP; postural measurements included: lumbar lordosis, thoracic kyphosis, trunk inclination, lateral deviation, trunk imbalance, surface rotation, and pelvic inclination.
Leg and back pain scores, Oswestry Disability Index (ODI), and H-reflex latency and amplitude were measured
What They Found
Statistically significant differences between the groups at 10 weeks were found: for all postural measures,
No significant difference for back pain, leg pain and ODI at 10 weeks were identified.
Only the study group’s improvements were maintained at the 6-month follow up while the control groups values regressed back to baseline.
At the 6-month follow-up, it was identified in the study group that improved cervical lordosis and reduction of FHP were found to have a positive impact on 3D posture parameters, leg and back pain scores, ODI, and H-reflex latency and amplitude.
OK….a dude who sells the Denneroll did this paper. It’s funny how other researchers find no big deal when it comes to the cervical curve. However, literally ALL of this guy’s ‘papers’ somehow make a big deal out of C-sp decreased curvature. Hinky, huh? It’s so odd. It’s like Firestone doing research and finding out how amazing their tires are. Hey everyone….McDonald’s did a research project and they found out how yummy their food is!! Yay McDonald’s you’re so amazing and thank you for doing your own research on your own company for the rest of us dumbasses. Thank you for being so awesome and kind. Blah. 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!
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
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube 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 Bibliography Carmody S, R. G., Mitchell A, Kryger KO, Ahmad I, Gill M, Rushton A, (2022). “Lumbar spine MRI findings in asymptomatic elite male academy footballers: a case series.” BMC Sports Sci Med Rehabil 14(1): 184.
Moustafa IM, D. A., Harrison DE (2022). “Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Lumbosacral Radiculopathy: A Randomized Controlled Trial.” J Clin Med 11(19): 5768.
CF 242: Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs Today we’re going to talk about Effectiveness Of Neck Exercise For Disc Herniation and Supine vs. Prone MRIs 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!
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
Then go Like our Facebook page,
Join our private Facebook group, and 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 #242 Now if you missed last week’s episode , we talked about Does Supplementation Work & Non-Surgical Treatment For Stenosis. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
Well, last week was insanity around my office. I personally saw about 196 appointments and our nurse practitioner had his best week since we integrated and brought medical services into our clinic. He saw 38 appointments not counting me. I say, “Not counting me,” because I got the hormone pellets. If you’re not familiar, go search up BioT or search up Evexipel. We use Evexipel and it’s a hormone balancing or optimization procedure. The provider does some blood work and finds out where you’re at with some key hormones.
I’m way low on testosterone which makes me insane because I could drop some weight but I’m not nearly as bad as a lot of folks I see. I’m 6’4” and about 272. Yes, I should ideally be about 220 or even less if you listen to the government. However, I was a college offensive lineman and I’ve been a pretty thick dude my whole life. I have a dad bod but I’m not waddling around and having a hard time getting through doors is what I’m saying. OK? Anyway, I’m not sedentary either. I get lots of activity from 190+ patients in a week to exercise and throw the discus.
I’m a go-getter so the low T thing makes me a little insane but it is what it be and that’s just me. So, time to do it. We use Evexipel and when I did BioT, it was in the butt cheek and it was pretty freaking sore for about 5-7 days. Evexipel does the pellets in the flank for men and 4 days later, I have had very little to basically zero pain. It’s been amazing.
The pellets take about 5 days to start being absorbed in the body so I’m looking forward to the benefits. I’ll keep you updated. For my practice specifically, you’ve heard me mention that we will patch one hole and another leak will spring and I’m always on the lookout for them. Well, I found one just this morning. We had 1 96 patients on my side last week. I show up for work this morning and look at the schedule and there are only 36 patients on my schedule today.
I guess this issue didn’t register with any of my staff members because when I asked what happened to my schedule this week, they just acted like it’s normal and the week starts filling out on Mondays. Oh no no no. That’s not how we need to be looking at it. Let’s do a little high-level, global thinking here. I saw 25 new patients last week. If they’re all on schedule, that’s at least 25 appointments booked on the following Monday. Remember Monday has 36 currently.
Well, 6 of those are new patients. So, let’s throw out those 6 new patients and that leaves us with 30 today. If we remove the new ones from last week, the 25 that should have been guaranteed…..then that just leaves us with 5 established patients. 5. Cinco. Cinco freaking established patients for a Monday. So, when we’re looking at it in this manner, well, clearly there’s a problem. Patients aren’t on schedule and we’ve had significant fall-off.
This means I’m either not doing my job educating them on why they need to be consistent, or the staff isn’t encouraging the message and supporting the message, or the front desk isn’t getting them rescheduled. Or all three. Either way, we basically bled 25 new patients last week. So, that hole has to get plugged, yet again, this week. Another thing to consider is that it’s basically Back To School time and that’s traditionally a slow-down time for us. So that something else can go stupid next week. Because that’s the way it goes.
Item #1
This first one is called “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation” by Wu et. al. (Wu SK 2022)and published in BMC Musculoskeletal Disorders on July 30 of 2022. Bam!!! Into the frying pain! It’s hot.
Why They Did It
To better understand biomechanical factors that affect intervertebral alignment throughout active therapeutic exercise, it is necessary to determine spinal kinematics when subjects perform spinal exercises. This study aims to investigate the outcomes of active cervical therapeutic exercise on intervertebral foramen changes in neck pain patients with disc herniation.
They were followed up with videofluoroscopic images.
The dynamic changes in the foramen were computed at different timepoints, including the neutral position, end-range positions in cervical flexion-extension, protrusion-retraction, and lateral flexion movements.
What They Found
The results showed that the active cervical flexion, retraction, and lateral flexion away from the affected side movements increased the area of the patients’ intervertebral foramen; while the active extension, protrusion, and lateral flexion toward the affected side reduced the areas of intervertebral foramen before treatment.
After the treatment, the active cervical flexion significantly increased the C2/3, C3/4, and C6/7 foramen area by 5.02-8.67%, and the extension exercise significantly reduced the C2/3 and C4/5 area by 5.12-9.18% compared to the baseline.
Active retraction movement significantly increased the foramen area from C2/3 to C6/7 by 3.82-8.66%.
Active lateral flexion away from the affected side significantly increased the foramen by 3.71-6.78%
Wrap It Up
The 8-week therapeutic exercises including repeated cervical retraction, extension, and lateral flexion movements to the lesion led to significant changes and improvements in the intervertebral foramen areas of the patients with disc herniation.
Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. 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? My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.
Item #2
I saw this one in the Forward Thinking Chiropractic Alliance group on Facebook and it’s pretty darn interesting. It’s called, “Prone Position MRI of the Lumbar Spine in Patients With Low Back Pain and/or Radiculopathy Refractory to Treatment” by Avellanal et. al.and published in Pain Physician in August of 2022 damnit this Is the first day of August it just doesn’t get any more fire than that heat!
Why They Did It
There are patients with limiting low back pain (LBP) with or without radicular pain in whom conventional supine magnetic resonance imaging (MRI) show no causative pathology. Despite the limitations of dynamic axially loaded MRI examinations, these imaging studies have shown a striking ability to diagnose pathology unrecognized by conventional MRI. The difference in findings between supine and prone MRI with patient symptom correlation has not been studied.
How They Did It
Nineteen patients suffering from chronic moderate-to-severe LBP and/or radicular pain
Nonresponsive to conventional therapy or interventional treatment
Both supine and prone MRIs were performed and analyzed by a neuroradiologist.
Specific supine and prone measurements were registered, including spinal canal area, lateral recess diameter, foraminal area, and ligamentum flavum thickness.
Three-dimensional MRI reconstructions of varying pathology patterns were created.
What They Found
In 52.6% of cases, disc pathology or increased disc pathology was seen only on prone imaging.
They observed significant buckling and increased thickness of the ligamentum flavum in 52.6 % of cases in the prone position that was absent from the supine MRIs.
They also documented varying grades of spondylolisthesis and facet joint subluxation resulting in significant foraminal stenosis in 26.3% of prone cases not seen from supine MRIs.
Wrap It Up
Four patterns of pathological findings have been identified by MRI performed in the prone position.
These findings were not observed in the supine position.
Prone MRI can be a significant and useful tool in the diagnosis and treatment of patients with back pain refractory to treatment whose conventional supine MRIs appeared unremarkable.
Which I also take as yet another reason you cannot trust MRI’s for definitive diagnosis of the source of 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.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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.
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
Bibliography Wu SK, C. H., You JY, Bau JG, Lin YC, Kuo LC (2022). “Outcomes of active cervical therapeutic exercise on dynamic intervertebral foramen changes in neck pain patients with disc herniation.” BMC Musculoskelet Disord 23(1): 728.
CF 198: MRI’s and Clinic Presentation & Surgery vs. Conservative Care For Discs Today we’re going to talk about surgery vs. conservative treatment for discs and we’ll talk about MRI findings and clinical pain. 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!
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.
I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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You have found yourself smack dab in the middle of Episode #198
Now if you missed last week’s episode , we talked about Extruded Discs – Surgery or No Surgery? Make sure you don’t miss that info. Keep up with the class.On the personal end of things….. Well, we went with ReviewWave and I have to say it’s overall been a very positive experience. Except for this one thing. Today, we showed up for work and we have it set to where new patients can pick their schedule and make the appointment themselves. Within certain parameters, of course. Well. Something’s wonky because we showed up at work and, instead of the 6 or 7 new patients we expected today, we now have 10 new patients and 4 re-exams on top of our regular load of established patients. As you can imagine, this presents a certain set of difficulties. Especially when my exam takes 20 minutes minimum and more typically takes about 30-40 minutes per new patients. So, we’re forced to step on the gas a touch. We’ll get through it and we’ll do a good job but, being too busy is as bad as not being busy enough in some ways. Patients like to know they’re going to a provider that a lot of other folks go to and find value in. But, when it looks like you’re running them through like cattle and your one on one time is 30-45 seconds rather than a couple of minutes or more….they notice it and I don’t care what the vitalistic philosophy wonk gurus in the profession try to convince you, patients don’t like that. They feel it and sense it and they don’t like it. I don’t like it. I don’t like people waiting on me. I don’t like making a bad first impression. I don’t like to be rushed any more than I normally am. More than anything, I don’t want to fall into quantity over quality. I always want quality here. And never forsake it in the search for quantity. That’ll get us nowhere that we want to go. So, this part of the show will be short, we will survive and do a good job regardless of time constraints, and we have a call scheduled with ReviewWave to remedy the issue. When you get too busy to fit them in, create a waiting list, hire help, or raise your pricing to thin the herd. Just a little tip from your Ol’ Uncle Jeffro. Let’s dive in Item #1 The first one is called “Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study” by Gugliotta et. al.(Gugliotta M 2016)and published in BMJ Open, that is the British Medical Journal for the peasants in the crowd. It’s a joke! Anyway, it was published in December of 2016 and it goes a lil sumpin like dis…. Why They Did It We sought to compare short-term and long-term effectiveness of surgical and conservative treatment in sciatica symptom severity and quality of life in patients with lumbar disc herniation in a routine clinical setting. How They Did It
It was a prospective cohort study of a routine clinical practice registry consisting of 370 patients.
Outcome measures were the North American Spine Society questionnaire and the 36-Item Short-Form Health Survey to assess patient-reported back pain, physical function, neurogenic symptoms and quality of life.
Primary outcomes were back pain at 6 and 12 weeks.
Standard open discectomy was assessed versus conservative interventions at 6, 12, 52 and 104 weeks.
What They Found
Surgical treatment patients reported less back pain at 6 weeks than those receiving conservative therapy, were more likely to report ≥50% decrease in back pain symptoms from baseline to 6 weeks and reported less physical function disability at 52 weeks.
The other assessments showed minimal between-group differences with CIs, including the null effect.
Wrap It Up Compared with conservative therapy, surgical treatment provided faster relief from back pain symptoms in patients with lumbar disc herniation, but did not show a benefit over conservative treatment in midterm and long-term follow-up.
So, bad for conservative interventions in the short term. Good in the long term. When they spread it out and look long term, there’s minimal difference. So, why risk it in the first place. The rate that low back surgeries must be re-done is too high to risk it. They estimate that around 40% of back surgeries fail. Yeah, I’m good as long as I don’t have cauda equine or progressive neurological deficits. You keep your full dose of surgery. I’ll have none on this day! So, long-term, minimal difference,…..well then we’re going with no surgery any time it’s appropriate and makes sense. CHIROUP ADVERTISEMENT Item #2 Alright, the last paper we have today is called, “Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-Based Cohort Study” by Kasch et. al. (Kasch R 2021) and published in Spine Journal.Why They Did It The authors wanted to examine associations between common lumbar degenerative changes observed on MRI and present or future low back pain.How They Did It
Participants from a population-based cohort study were imaged at study entry,
LBP status measured at baseline and 6-year follow-up.
MRI scans were reported for the presence of a range of MRI findings.
LBP status was measured on a 0-10 scale.
What They Found
MRI findings were present in persons with and without back pain at baseline.
Higher proportions were found in older age groups.
76.4% of participants had a least one MRI finding and 8.3% had 5 or more different MRI findings.
Most MRI findings were slightly more common in those with LBP and pain severity was slightly higher in those with MRI findings
In the longitudinal analyses we found most MRI findings were not associated with future LBP-severity regardless of the presence or absence of baseline pain.
Compared to zero MRI findings, having multiple MRI findings (≥5) was associated with mildly greater pain-severity at baseline and greater increase in pain-severity over 6 years in those pain free at baseline, but not in those with baseline pain
Wrap It Up Our study shows that the MRI degenerative findings we examined, individually or in combination, do not have clinically important associations with LBP, with almost all effects less than one unit on a 0-10 pain scale
Meaning, quit catastrophizing MRI findings. Quit telling 40 year olds they have the backs of 85 year olds. Quit pushing them into the chronic pain pit because you don’t know schiza from shinola and you’re too damn lazy to take the time and energy to get some smarts beyond what you learned in chiropractic college. Slap pow pop kazow!!
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen.
Let’s get to the message. Same as it is every week.Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ TwitterTweets by Chiro_ForwardYouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography Gugliotta M, d. C. B., Dabis E, Theiler R, Jüni P, Reichenbach S, Landolt H, Hasler P. (2016). “Surgical versus conservative treatment for lumbar disc herniation: a prospective cohort study.” BMJ Open 6(12).
Kasch R, T. J., Hancock MJ, Maher CG, Otto M, Nell C, Reichwein N, Bülow R, Chenot JF, Hofer A, Wassilew G, Schmidt CO (2021). “Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-Based Cohort Study.” Spine (Phila Pa 1976).
CF 150: The Fate Of An OxyContin Producer & The Outdated Use of MRI Diagnosing Cervical Dysfunction Today we’re going to talk about the outdated use of MRI to diagnose cervical dysfunction and then the fate of an oxycontin producer. But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
Like our Facebook page,
Join our private Facebook group and interact, and then
go review our podcast on iTunes and other podcast platforms.
While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
You have found yourself smack dab in the middle of Episode #150 Now if you missed last week’s episode, we talked about the costs of preventable disease, and then we’ll talk about whole-body vibration for function and bone mineral density in postmenopausal, osteoporotic women. Make sure you don’t miss that info. Keep up with the class. While we’re on the topic of being smart, did you know that you can use our website as a resource?
Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function
On the personal end of things…..
On the personal side of things, it’s an alright week. Nothing too crazy other than the rise in the Rona around the nation. We got my biggest week last week since Rona hit us. We had 170 visits last week. Still down from my average of 182 pre-Rona but way up from an average of 135-145 post-Rona.
So progress. Then this week, we’re having three days of snow, ice, and sleet. So….it’s a Texas Two-Step. Two steps forward and one step back. Patience is a virtue. Blah. Such is life.
I thought I’d share a recent experience with you all in an effort to let you know you’re not alone, we can’t make them all happy, and how I handled it.
So last weekend I got an email. It wasn’t positive. In fact, it was a bit combative. Let’s just say it wasn’t flattering. Now, I’d like to be fair to myself here. In 22+ years, I’ve had conflict or whatever you want to call it….let’s call it miscommunication. I’ve had a miscommunication with patients only 3-4 times. Five if I’m pushing it. But this goes to serve as an example, you’re never too old or in practice too long to be above being questioned. In fact, in today’s culture of disrespecting ‘experts’ for lack of a better word, questioning authority, and an overall culture of lacking mutual respect…..well, I think it makes sense that we’re all more likely to have some miscommunication issues here and there.
Then, online reviews throw a whole other kink into the plan, doesn’t it? So, due to respect for this person and HIPAA, I will be very vague here but in general, this person had significant cervical disc radiculopathy. Sometimes you make a diagnosis and you’re not 100% sure but you’re heading that direction. Not with this one. There was no doubt. They were very upset. Crying. Nauseous. Not feeling well and rating the pain at a 7 out of 10 on the VAS scale.
We tried some over-the-door traction but it really made the person nauseous so that was out. I tried some retraction/extension exercises and started them on nerve gliding exercises to try to make some headway. The second treatment comes and we are able to do a little more. Now they’re rating it at a 4 out of 10. Looks like we’re on easy street right? We got this!!
We did very light decompression and the patient said it felt good and they were doing better. OK. Whew. Another one on the road to avoiding surgery. Not so fast. For whatever reason, this patient never showed up again. I don’t always think about my patients but I did think about this one because they were so severe on day one. I wondered how they were doing and why I never saw them again.
Well, this weekend’s email answered that for me. There’s no need to read the whole email just because there’s no need but the sentiment of it was that I had a conversation with them that they characterized as saying that anxiety was causing the pain and that I told them I couldn’t help them. What they took from the conversation was that I should have ordered an MRI on day one basically, that I blamed mental and emotional issues on the part of the patient for their pain and they felt that was unprofessional and uneducated. And potentially ego-driven on top of all of that. They mentioned they sought out an MRI, went to a neurosurgeon, and had a two-level fusion, and are on the road to recovery with the help of PT.
Oh….you know I’m always honest with you folks because honestly, that’s not flattering stuff. Nobody wants to look into themselves and say, “Does this person have a point? Where did I go wrong and how can I prevent that from happening again with someone else? But here’s the truth, I literally don’t recall that conversation whatsoever. I have a thousand different conversations every week. But I know me. I’ve never in my life told a patient that they have mental or emotional problems and those are the source of their pain. Nor have I ever insinuated that anxiety is the pain source when it’s clear as a bell that it’s radiculopathy secondary to a disc issue. My staff has heard me repeat the same discussions, the same lines, and the same jokes day after day, month after month and they’ll be the first to tell you I’ve never said anything of the sort.
So, flummoxed as I have been, I slept on that email for the rest of the weekend thinking about it. The last thing you want to do is respond out of anger. You definitely don’t want to respond out of a defensive posture. Especially when you’re reasonably sure you did nothing uneducated or ego-driven. A response like that will only make us look more unprofessional than they already think we are and maybe even potentially provoke.
So, in short, I did not address the ego comment because I felt it was unnecessary. I’ll just take my lumps on that one. I mentioned how happy I was to hear from them and hear they are recovering. I genuinely was glad. Even if the email was less than flattering.At least they got some aspect of a resolution. Even if I wasn’t the end solution. I don’t feel there’s any ego on my part in that sentiment.
I explained that we typically do a trial treatment of a week or two before deciding on advanced imaging and that would have definitely been in the considerations had we treated beyond two appointments. That’s appropriate. Some can make an argument that there was radiculopathy so we could have gotten an MRI on day one. But, if we’re honest, how many patients do you have that have radiculopathies that you are able to clear fairly quickly without resorting to an MRI? My guess is quite a few because that’s my experience. We just don’t have to get very many. But again, we have to have the chance to find out, right?
I discussed briefly that I am very much on top of current research and thinking with regards to pain and neuromusculoskeletal issues and may have been assessing yellow flags. I discussed briefly what the biopsychosocial aspect of treatment entails these days but didn’t want to dwell on it much. Mostly because I never felt it was anxiety, mental, emotional driven thing to start with. It was clearly a disc. But I hope the mention somehow rebuts the idea that I need more education.
I offered that as a potential reason we may have had some miscommunication. I also mentioned that there have been very few patients over the years that I would just straight up tell them “I can’t help you.” I told them that I’m typically one of the most stubborn practitioners and will hold on until it’s crystal clear I’m not helping. That, for me, has never happened after only two visits. In a nutshell, I said that being patient-centered, evidence-based, and having high patient satisfaction was the most important thing to me and that I don’t recall the exact conversation or the wording but that I can learn from the email and can use it to make me better at my job and that I appreciated them taking the time to share their thoughts with me.
In the end, I was glad to hear about them feeling better and I apologized for any miscommunication on my end. While that sounds like a very long email, it wasn’t and I took the time to make sure it was hopefully as eloquent as a guy like myself can generate. Without arrogance, ego, combativeness, or being defensive. But WITH being caring, being professional, and being thoughtful.
Even though it may not be reciprocated, I respect this person and I DO hope they are feeling better. And, whether we feel like these things are our fault or whether we think we did anything wrong or not, we can ALWAYS always learn from stuff like this. We can always be better. I can promise you, I learned to not be lackadaisical when it comes to speaking to patients about central nervous system upregulation or sensitization. Or when discussing the biopsychosocial aspect of pain.
People don’t know what we know about that stuff and we shouldn’t assume that it’s an easy topic and everyone ‘gets it.’ Or will get it. I really cannot explain what happened there but, I do know it made me step back and think through it though. It made me check my communication.
Again, I don’t tell you all this stuff because I love it or love to talk about it. I don’t tell you all my patient numbers weekly because I love it. I share this stuff with you because what is happening with me is real. It’s real life. And if it’s happening to me, then it IS happening to many of you. And if it’s not currently happening to you, it CAN or WILL and you may learn from me. Not as a mentor per se but as that Ol’ Uncle Jeffro.
Alright, enough with the stress talk. Geez. Not very often at all. Maybe once every 5 years or so but when it happens……geesh. I take it personally, I take it home, I dwell on it, and I’m not too proud to admit that it affects me.
I care.
I truly do.
If you get anything from this podcast and all of these episodes, it should be that I care. I care about chiropractic patients, our profession, ethics, morals, professionalism, education, and doing it the right way.
I care.
Item #1 Let’s start out with this article that was in CNN Business last week. It’s an article by Chris Isidore called, “OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company”(Isidore 2020). It was published on October 21, 2020, it’s cold as hell in Texas but that….that’s hot. The highlights of the article are that Purdue Pharma, the maker of OxyContin, has agreed to plead guilty and to pay more than $8 billion. Not only pay $8 billion but to also close down the company. What? Yeah, they say the money will go to opioid treatment and abatement programs. “Purdue Pharma actively thwarted the United States’ efforts to ensure compliance and prevent diversion,” said Drug Enforcement Administration Assistant Administrator Tim McDermott. “The devastating ripple effect of Purdue’s actions left lives lost and others addicted.” They say, “The company doesn’t have $8 billion in cash available to pay the fines. So Purdue will be dissolved as part of the settlement, and its assets will be used to create a new “public benefit company” controlled by a trust or similar entity designed for the benefit of the American public.
The Justice Department said it will function entirely in the public interest rather than to maximize profits. Its future earnings will go to paying the fines and penalties, which in turn will be used to combat the opioid crisis.” Maybe it’s just me but that sounds Big Brother as hell to me. Don’t get me wrong, pharma companies, in many instances, are of the devil but to dissolve them, then recreate them and they be basically government run? I don’t know about all that but to me, that’s what this sounds a bit like.
They go on to say, “That new company will continue to produce painkillers such as OxyContin, as well as drugs to deal with opioid overdose. “The company, which filed for bankruptcy in 2019, pleaded guilty to violating federal anti-kickback laws, as it paid doctors ostensibly to write more opioid prescriptions.” What a-holes. Paid doctors to write more opioid prescriptions. And what a-hole of a doctor do you have to be to take payment to write addicting prescriptions in the first damn place? Honestly. Meanwhile, we recently crossed the 450,000 dead mark.
Dead from opioid-related overdoses. All the while we evidence-based chiropractors sit and watch stuff we could help treat just spiral out of control. We’re sitting on the bench waiting for the coach to put us in the game but we just rarely get our number called. If they want to make surgeons the quarterback of the football team, at least we could be the running back or tight end or something. Geez.
We could be a key part of the pain team and research has told the stakeholders several times. But nope. We’re stuck riding the pine. A little further down in the article, my worries are actually hit on when they say, “So some states are objecting to the settlement. Twenty-five state attorneys general wrote to US Attorney General William Barr last week arguing against the plan to create a government-controlled company out of the assets of Purdue Pharma, arguing that the government should not be in the business of selling OxyContin.”
And I agree with the 25 state attorneys general. That, to me, is not what American was built on. Again, don’t get me wrong, I’m all about punishing the hell out of a corrupt and evil company like Purdue Pharma. I’m even all about putting them out of business. Hell, the Statler family that runs this business pulled $10 billion out of the company and placed into family trusts before filing bankruptcy. It’s a bad group of people. Lop they’re damn heads off if you think they deserve it…..OK, maybe not to that extent but you get my point.
But, putting a company out of business and then stepping in as the government to take it over and run it…..no. I don’t like it. But that’s just me.
CHIROUP ADVERTISEMENT
Item #2
Alright, my last one today is called “Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI” by Anton Bowden(Bowden 2018) and published in the Journal of Spine Surgery in September of 2018 and it goes a little sumpin’ like dis.
Why They Did It
Bowden starts by saying “Studies dating back several decades have failed to show a strong correlation between abnormal MRI scans of the intervertebral discs and clinical symptoms. Which you know if you’ve been following along. This is part of why the patient I mentioned earlier was mad at me for not immediately ordering an MRI.
He continues, “The recently published 20-year prospective longitudinal study of cervical spine disc degeneration” by Daimon et al.(Daimon K 2019), is perhaps the strongest confirmation to date affirming that intervertebral discs naturally degenerate with age, and that evidence of degeneration alone is insufficient information with which to make a conclusion regarding the root cause of a patient’s symptoms.” We have covered that paper here on the Chiropractic Forward Podcast before. They discuss the study at length saying, “Daimon et al. found that while MRI signal intensity longitudinally decreases across all cervical disc levels, there is a peak in structural degeneration that occurs at the C5–C6 level, with C4–C5 and C3–C4 having progressively lower degeneration rates. Since the C5–C6 level also corresponds with the highest flexion-extension range of motion of the cervical spine, a mechanical component of the degeneration process appears to be highlighted by the study.
Once the C5–C6 level has been destabilized due to degeneration, sequential acceleration of degeneration at adjacent levels was observed. This insight has relevance to current discussions regarding adjacent-segment disease subsequent to arthrodesis and arthroplasty. The authors also observed that 95% of subjects experienced degenerative progression over the 20-year study period, while only 67% developed clinical symptoms. This observation lends strength to the argument that trying to fight all forms of disc degeneration is an insolvable fight against nature, at least for the foreseeable future.” I was happy to see him mention this, “As a biomechanist, I would be remiss to point out that imaging alone is missing fundamental information regarding the dynamic function of the spine. Spines that look very similar while lying down in the MRI may move very differently while going about activities of daily living—and the consequences can be dramatic for mechanical loading and pain in the discs and adjacent spinal structures “ Here on the show in some of the earlier episodes, we covered the fact that discs that show little to no issues in the supine position can look very different when seated or standing.
Significantly different as a matter of fact. The research has been done on this yet I’ve had discussions with two separate radiologists and both of them guessed there would be little to no change in the disc with position change. That’s just not the case, is it? I’m happy to see this author recognize the fact. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world.
Keep taking care of yourself and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
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 preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!
Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!
Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.
Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
Bibliography
Bowden, A. (2018). “Twenty years of ‘insanity’ in diagnosing underlying clinically relevant cervical dysfunction using traditional MRI.” J Spine Surg 4(3).
Daimon K, F. H., Nishiwaki Y, (2019). “A 20-year prospective longitudinal MRI study on cervical spine after whiplash injury: Follow-up of a cross-sectional study.” J Ortho Science 24(4): 579-583.
Isidore, C. (2020) “OxyContin maker to plead guilty to federal criminal charges, pay $8 billion, and will close the company.” CNN Business.
