neck pain

Thoracic Adjustments For Neck, Not Headache & Physical Activity In Children

CF 229: Thoracic Adjustments For Neck, Not Headache & Physical Activity In Children Today we’re going to talk about T-sp Adjustments For Neck, Not Headache & Physical Activity In Children 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 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 #229 Now if you missed last week’s episode , we talked about Exercise For Depression & Manipulation For Tendinopathy. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

I’ll be honest with you all…..I always am anyway…..I feel like I’m as busy as I’ve ever been but when I look at the numbers, they’re down a bit still. I’m not fully recovered to the numbers that we saw prior to the pandemic setting in in 2020. I know many of you are. I’m not yet. I’m not far off. But I’m not there dependably month after month yet.  As a result of my involvement in Dr. Kevin Christie’s Florida Mastermind that you’ve heard me mention, and at Kevin’s suggestion, I read a book called Who Not How by Dan Sullivan and Ben Hardy. I highly suggest it. This book is telling us to quit looking for how you do things and start looking for WHO can help you accomplish your goal.  This isn’t really a new concept but really sheds some light on the topic.

We need a team. We need helpers. We cannot ever hope to do it all ourselves and do it a high level. To start looking at bringing on team members as investments rather than costs.  It’s eye-opening for sure. Give it a try and see what you think. As a result, I’m looking for Whos. I have some Whos already. I make good use of virtual assisstants. I have one in Pakistan, one in Nigeria, and one in India.

They help me with marketing voice over, with my Chiropractic Forward website, with a website I’m trying to build for another business, and with stat keeping and monthly balancing and close outs in my chiro business.  But I’m still doing a lot of tasks weekly that can be farmed out to a Who. What daily and weekly worker bee tasks are you doing yourself that can be farmed out while investing in a new Who? My biggest one is an associate. I’m on the hunt. If you or someone you know is interested in interviewing with me for a potential position here in my clinic, I’d love to speak with you.

The Texas Panhandle has pros and cons like everywhere else but I will say that one of our biggest draws is our incredible people. We are kind, friendly, and helpful. That, and hey, we have the second largest canyon in the nation called Palo Duro Canyon. It’ll knock your socks and your shoes off.  Anyway, send me an email at [email protected] if you’re intersted and we’ll connect. 

Before we get to the research, I recently connected with a personal injury attorney and as a result, I have a gift for you!  I’m going to turn you on to a system that will result in your getting tons of PI cases from attorneys.   Yes, getting these referrals can be done. Paul Samakow, a veteran PI attorney, put this system together.  He knows what attorneys want to hear – inviting them to lunch doesn’t work, folks.   His system, delivered to you in both written and video form, is insightful and hits the mark. 

Over 25 concepts on how you can not only get attorneys to refer to you, but endear yourself to them. Samakow’s system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment. Go to gettingpicases.com/cs That’s gettingpicases.com/cs One more time so you get it right:   gettingpicases.com/cs

Item #1

The first one today is called, Thoracic spine thrust manipulation for individuals with cervicogenic headache: a crossover randomized clinical trial by McDevitt et. al. (Amy W. McDevitt 2022) and published in the Journal of Manual and Manipulative Therapy July of 2021. Shazam….it’s steamy. 

Why They Did It

To determine if thoracic spine manipulation (TSM) improves pain and disability in individuals with cervicogenic headache (CeH). Now, let’s take a step back just a bit and I’ll share some knowledge from the Neuromusculoskeletal Diplomate program about where Cervicogenic headaches lie in terms of prevalence.  Tension-type headaches are the overwhelming winners.

They make up about 40% or more of the headaches that present to just about any clinic.  Second place goes to migraines. True migraines make up only about 10%. Not nearly as much as you might expect. Since Tension type and migraine live on the same continuum of headaches, they can share some characteristics of each other so, many times, a tension type can behave like a migraine and vice versa.  True migraines, however, are only about 10% of cases.  Then comes cervicgenic headaches at only about 4% of the cases of headaches you see in clinic.  The good news is that tension type and cervicogenic are the ones we really have a lot of success with since they typically come from the suboccipital and/or neck region and that’s our bread and cinnamon butter, baby. That’s hero territory right there because we can turn someone’s life around muy pronto, mi amigo. 

How They Did It

  • It was a randomized controlled crossover trial 
  • It was conducted on 48 participants with cervicogenic symptoms. 
  • Participants were randomized to 6 sessions of thoracic spine manipulation or no treatment and after 4-weeks, groups crossed over. 
  • Outcomes were collected at 4, 8 and 12 weeks and included: headache disability inventory (HDI), neck disability index (NDI), and the global rating of change (GRC). 

What They Found

  • Comparing no-treatment group to the active treatment group, the Headache Disability Index outcomes were not significantly different between groups at any timepoint; 
  • The Neck Disability Index outcome, however, was significant at 4 weeks.

Wrap It Up

Thoracic spine manipulation had no effect on headache-related disability but resulted in significant improvements in neck-related disability and participant reported perceived improvement. Muy bueno, muy bueno. Don’t forget to adjust the T-spine for the neck pain.  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

This one is called, “Physical Activity In Children” by Michel et. al. (Michel J 2022) published on April 25, 2022….brand spankin new in the skillet. It’s burns! This is an article really rather than a research project so lets summarize this bad boy. 

They start by saying “The US received an overall grade of D− for physical activity in children, with only about 1 in 4 children meeting the daily recommendation of 60 minutes or more per day.

With the recent COVID-19 pandemic, this has worsened because children are even less active, missing out on daily activities and group sports, and increasing screen time.” “Being inactive has numerous harmful effects on health and well-being. It is linked to many chronic diseases and conditions, such as obesity, diabetes, high blood pressure, heart disease, cancers, and early death. In contrast, there are numerous benefits to physical activity for children, including decreased risk for developing all of these diseases and conditions.

Physical activity can also help to decrease stress and improve school performance, sleep, and mental health.” “US physical activity guidelines recommend that children aged 3 to 5 years be physically active throughout most of the day and that children aged 6 to 17 years have at least 60 minutes of moderate to vigorous physical activity daily. Moderate to vigorous activity means the heart rate is raised higher than the normal resting range and is associated with sweating and deeper breathing.” “How can you help your child meet these goals? First, be an example.

Children copy you, so if you make exercise a part of your routine, they are more likely to follow in your footsteps. You can also help by making physical activity a part of your whole family’s daily routine by setting a time every day, especially when your children are young. In addition, try to make activity fun. If your child enjoys physical activity from an early age, this will likely continue as they grow older.

It can also be helpful to make a list of physical activity options, both for outside and indoors for when the weather is not appropriate. “ These are recommendations for us as parents but also as providers that can guide and encourage out younger patients toward more activity.

Do you do anything outside of your office to encourage your patients to get active? What if one of your staff members wanted to host a walk in the park? A hike in nature? Or something similar?  Good for your patients and good for practice building.  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

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

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  

Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain

CF Ep. 213: Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain Today we’re going to talk about Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck 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!

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 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 #213 Now if you missed last week’s episode , we talked about Intermittent Fasting & Dementia And Your Level Of Activity. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, no…it’s not just you….I’m a little slower than normal right now. For most of us, that’s the nature of the beast. We just slow down in January because most of us take insurance and most of those plans re-set in January. People haven’t met their deductibles. They don’t like to spend their own money.  And that’s OK. Speaking from 24 years of experience, it’s normal and you’ll start seeing it pick back up around mid to late February. Definitely by March.  Like I sadi last week, this is the time that we start playing catch up and taking care of all of the stuff that’s been sitting on the back burner.  So start dusting off that stack on your desk and working through it while you have the time.    I want to be honest. Which I always am. I think I’m in a mid-life crisis. I’m tired of replacing employees. Re-hiring, etc. I’m tired of the same old questions we get from patients. I’m tired of dealing with the day-to-day stuff I’ve dealt with. Some of you will love what you’re doing so much that you’ll want to die in your office at 84 years old working on someone. 

And wouldn’t that be an awful experience for the patient? Just as a side thought. Lol. 

Anyway, that’s not me. When I’m answering the question about why someone’s neck is hurting for the umpteenth time, the call for more freedom of time gets stronger.  And stronger and stronger.  That’s the reason that over the last few years I have started cultivating the side gigs. The exit strategy. Looky here; I write and perform music, I paint, I draw, I play the guitar, I build furniture, I sculpt, I throw the discus and want to compete in old man track meets, and I love spending time with my family and traveling.  So…how the hell do you do all of that while you’re in a clinic all day every day your entire life? The answer is….you don’t. You don’t do the things that feed your soul. You either don’t do them at all, or you don’t do them very often.

Until you’re 65 or so for most people. Well, I don’t plan on being most, folks. So, how do you own the practice instead of the practice owning you? Great question. I don’t know but here are some of the avenues I’m using to try to walk the path. 

  • Specialization and Board Certification
  • Nurse Practitioner
  • Associate chiropractor – If you’re interested in working for me, email me folks. [email protected] I’m looking. 
  • Real Estate Investing
  • Voice Over
  • Authorship
  • Speaking and Mentoring

In fact, I have a big presentation coming up at the Texas Chiropractic Association’s MidWinter Conference in Lubbock, TX on February 18th. It’s called Chronic Pain And The Upregulated Central Nervous System. I’m in the process of building that talk as we speak.  If that sounds like something your group or association could use, email me at [email protected] and let’s connect.

I’d love to come present for you and your peeps. 

So, anyway, I do all kinds of things. But those are the biggies.  Get your exit number in place. Even if you’re brand new. You gotta have your loans paid. You gotta have your retirement finances in the process. You gotta have investments working. Once that’s handled, what is the exit number that would make you secure to make your exit.  Or to make a Hybrid Exit. What’s that exactly? A Hybrid Exit would look different for different folks. For one person that might mean treating patients 2 days per week. For others, it might mean strictly being the owner but exiting patient treatment completely. It could mean a million things but, at the price point some of us make per year, it can be difficult to build enough side gig to replace that income.  For me, just looking at the numbers and potential, while keeping risk mitigation in mind, real estate seems the quickest way when you combine that with the clinic integration and hiring an associate chiro. Combining these three may get me there.  Then you throw in this voice-over blessing that I started last year…..wow. That was out of nowhere, was a complete surprise, and an amazing blessing. Voice over, by itself, has more than funded the down payment and the furnishing of our very first short-term rental house and investment I’ve been mentioning more and more recently. 

Let’s be honest though, you don’t have to be in voice-over to invest. You just have to keep the overhead down and save up enough for a downpayment. The rest will take care of itself. And the earlier you start, the faster you get there. I’m 49 and wish I’d had this mentality at 29. Damnit. 

But it’s never too late to start taking better care of your future, your physical health, and your mental health. That’s where I’m at.  I’ll keep updating you. 

Item #1

This first one is called “The Effects of Osteopathic Manipulative Treatment on Pain and Disability in Patients with Chronic Neck Pain: A Single-Blinded Randomized Controlled Trial” by Cholewicki et. al. (Cholewicki J 2021) and published in PM&R on October 31, 2021.

Aye chiwawa!

Why They Did It

Neck pain (NP) affects as much as 70% of individuals at some point in their lives. Systematic reviews indicate that manual treatments can be moderately effective in the management of chronic, nonspecific NP. However, there is a paucity of studies specifically evaluating the efficacy of osteopathic manipulative treatment (OMT). The authors wanted to evaluate the efficacy of OMT in reducing pain and disability in patients with chronic NP. And I’m glad they are because they’re right, there is a paucity of research on neck pain. Low back gets all the attention while neck pain…..treating neck pain is the main thing we chiros get beat up over. So why the hell not knock out a ton of high-level research on chiro, manipulation, and neck pain while continuing to highlight the low risk of adverse effects for its treatment? Can we finally get past this chiropractors cause strokes issue? Is there increased risk? Sure. But that doesn’t mean we go arounnd causing them. There are bad patients that shouldn’t be worked on and there are bad chiros that are far too rouugh. But for the most part, its not dangerous whatsoever.  Take the UFC for example

How They Did It

  • Single-blinded, cross-over, randomized controlled trial.
  • University-based, osteopathic manipulative medicine outpatient clinic.
  • 97 participants, 21-65 years old, with chronic, nonspecific NP
  • Participants were randomized to two trial arms: immediate OMT intervention or waiting period first. 
  • The intervention consisted of 3-4 OMT sessions over 4-6 weeks, after which the participants switched groups.
  • Primary outcome measures were pain intensity (average and current) on the numerical rating scale and Neck Disability Index.
  • 38 and 37 participants were available for the analysis in the OMT and waiting period groups, respectively

What They Found

  • The results showed significantly better primary outcomes in the immediate OMT group for reductions in average pain, current pain, disability, and improved secondary outcomes related to sleep, fatigue, and depression. 
  • No study-related serious adverse events were reported.

Wrap It Up

OMT is relatively safe and effective in reducing pain and disability along with improving sleep, fatigue, and depression in patients with chronic NP immediately following treatment delivered over approximately 4-6 weeks. One big thing here, this improvement was seen with 3-4 visits over 4-6 weeks. Shouldn’t that have been standardized and consistent from patient to patient? Like 4 visits over 6 weeks for example. Not a range. Next thing, this is about chronic pain. Is 3-4 visits over 4-6 weeks really enough to start addressing the issue of chronic pain? To introduce proprioception, movement, function, and all that good stuff?? No is the answer but, they still showed improvement. I’d love to see the outcomes in a design like this with a more robust and appropriate treatment schedule or frequency. 

Item #2 Thsi one is called “You don’t need expensive CBP BS protocols with biased research done by the stakeholders to entice the 9 out of 10 patients that naturally have a decreased cervical curvature into a 70 visit $5,000 treatment plan to fix a lack of cervical curve that a 20 year research project proved is no big deal anyway.  Oh wait….sorry….check that. The actual title is “Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain” by Lee et. al. (Lee 2020) and published in Annals of Rehabilitation Medicine on May 29 2020 and it’s hot enough! Sorry for the mistake. I’ll try to pay more attention to the research paper titles. I’m undiagnosed ADD like that. I take the eye off the ball every here and there. I’ll try to tighten that up a bit. 

Anyway

Why They Did It

  • This research was done by medical doctors so there is no chiropractic bias to this lack of curvature research information. 
  • The authors say they wanted to explore if the modified cervical and shoulder retraction exercise program restores cervical lordosis and reduces neck pain in patients with loss of cervical lordosis.

How They Did It

  • This study was a retrospective analysis of prospectively collected data. 
  • Eighty-three patients with loss of cervical lordosis were eligible. 
  • The eligible patients were trained to perform the modified cervical and shoulder retraction exercise program by a physiatrist, and were scheduled for a follow-up 6 to 8 weeks later to check the post-exercise pain intensity and lateral radiograph of the cervical spine in a comfortable position. 
  • The parameters of cervical alignment (4-line Cobb’s angle, posterior tangent method, and sagittal vertical axis) were measured from the lateral radiograph.
  • Forty-seven patients were included.
  • The mean age was 48.29±14.47 years

What They Found

  • Cervical alignment and neck pain significantly improved after undergoing the modified cervical and shoulder retraction exercise program. 
  • The upper cervical lordotic angle also significantly improved. 
  • In a subgroup analysis, which involved dividing the patients into two age groups (<50 years and ≥50 years), the change of the sagittal vertical axis was significantly greater in the <50 years group

Wrap It Up

The modified cervical and shoulder retraction exercise program tends to improve cervical lordosis and neck pain in patients with loss of cervical lordosis. So……if we’re evidence-based and patient-centered, we are not taking advantage of others. We don’t see patients as sales targets. We aren’t seeing them as targets to close on. We aren’t seeing them with dollar signs in our eyes.  Rather, we are seeing them as human beings that are in our clinic to place full faith, trust, body, mind, physical well-being, and their entire futures in our hands.

If we are honoring this idea and honoring our patients, we are teaching them about this, we are teaching them about moving, we are teaching them how to self-manage at home, and we are doing what we can within a responsible and appropriate 2-4 treatment plan….give or take.  You know…..being a doctor and doing doctor stuff instead of doing street corner huckster stuff like I see so many fellow chiropractors doing.  It’s sad. We don’t have to put up with it in our profession. We just have to stop ignoring it and start calling it out and not putting up with it. We can run this behavior out of our profession. If we choose to. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus.

The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

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  

Bibliography

Cholewicki J, P. J., Reeves NP, DeStefano L, (2021). “The Effects of Osteopathic Manipulative Treatment on Pain and Disability in Patients with Chronic Neck Pain: A Single-Blinded Randomized Controlled Trial.”

PM R.   Lee, M., Jeon H, Choi J, Park Y, (2020). “Efficacy of Modified Cervical and Shoulder Retraction Exercise in Patients With Loss of Cervical Lordosis and Neck Pain.” ARM 44: 3.  

Manual & Passive Therapies For The Neck and Acupuncture For Post-Surgical Pain

CF 210: Manual & Passive Therapies For The Neck and Acupuncture For Post-Surgical Pain

Today we’re going to talk about Manual & Passive Therapies For The Neck and then we’ll talk about Acupuncture For Post-Surgical 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!

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 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 #210 Now if you missed last week’s episode, we talked about Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Just getting ready for Christmas. We talked a little last week about marketing and how we’re trying to set up our nurse practitioner for success.  I am currently going through a couple of different Fiverr sellers and creating a sales funnel. We are going to test it on our hormone pellets. Let’s keep our fingers crossed because if a sales funnel works on hormone pellets, then why wouldn’t it work for IV Therapy? PRP injections? Car Wreck patients? Spinal decompression patients? Just regular ol’ family practice patients? And on and on and on. 

You could conceivably and easily figure out your services that offer the highest ROI and then you could create a sales funnel for each.

Or….as in my case, have a Fiverr salesperson that knows more about it create it. Wouldn’t that be amazing if you could spend maybe $1000 per month on all of these ads funneling people into your different systems? Then they get the automated email trickles for whichever Funnell they happen to be in? And then they start calling and making appointments?

As we all know, this is a very real thing in lots of industries. Including healthcare. I’m certain I’m not the first to consider it but it’s kind of new thinking for me personally and I’m hoping that my hormone pellet funnel test bears fruit because if it does, it’s on like Donkey Kong.

I’ll be all over it and I’ll already have the people in place that can help me do it.  So, that’s exciting. 

No interns from Parker picked our office here in Amarillo, TX to come to visit for the Spring so looks like we’re on our own for the first 1/3 of 2022. But that’s OK, I’ve been on my own for like 24 years so I think we’ll be alright. 

On the side gig part of things, voice-over is still absolutely killing it. I never would have imagined what was possible for me in the voice-over industry. I’m still small potatoes when compared to what some of the guys make but for someone that’s only been in it for about a year, it’s been a game-changer when you consider keeping my life the same and still being able to fund other interests like real estate investing.

This year’s voice-over activities more than doubled the down payment we made on the investment property we just closed on in Lubbock, TX.  If you ever need a voice-over for your phone system, an online ad, podcast, TV/Radio ad, just holler. I got you. Send me an email at [email protected] or visit my voice-over website at www.jeffwilliamsvoice.com and we’ll connect. 

Speaking of investment property, if you’ve been listening, we bought a small house in Lubbock, TX, and closed on it last week. We are turning it into a short-term rental, we’ll call it an STR for short. That’s an Airbnb or Vrbo house. And they pay very well. 

Now, why live an hour and a half away from your STR? Won’t that be difficult?  The answer to the first question is because, while I love my hometown of Amarillo, TX, we don’t have a Division I college with a medical school and a law school.

Lubbock has Texas Tech there so they have the concerts and the graduations and the big football games and sports and traveling professors and all of that good stuff. Things that Amarillo just doesn’t have. And it’s only an hour and a half from here so we can still get there to handle any issues.  Besides that, most issues are not truly emergencies so as long as you have a dependable cleaner and a dependable handyman to be your eyes and ears on the ground and to take care of things when necessary, you don’t need to live in the same market.

People live in Ohio and self-manage their STRs in Florida or the Smokie Mountains.  Self-managing remotely should not be difficult at all. The ones doing it say that it takes about 15-20 minutes per week per house to self-manage. If there’s a plumbing issue, you’d call a plumber just like you would for your own house, give them the door code to get in and handle things, and voila! 

These days they have smart houses. Wireless thermostats, deadbolts, external property cameras, and water controls for the garden. You don’t have to have any contact with anyone. Just give them the code to the door. That goes for the guests as well.  You can buy STRs already furnished, which is my preference. This one was not so we’re having to purchase everything new for the house. They say count on $10,000 per bedroom if you’re furnishing it. So a 3 bedroom house, we would budget $30,000 in furnishings.

Truthfully, I think we’re coming in at about 1/3 lower than that benchmark. Because I have shopper of a wife and she knows how to find the deals. 

Anyway, we spent Saturday down in Lubbock setting it up and building furniture and all that good stuff. We didn’t even get close to getting it ready but we got further than we were. We’ll head back down this weekend and keep grinding until we can get it up and running and ready for our guests to have an excellent experience. 

Then, we have a long-term rental here in Amarillo that we used to live in ourselves. Once we moved out, we just held onto it and rented it out. We are refinancing it currently. We will take out the money that is there with the increased value of the home and we’ll put that down on an STR in the Florida area. We’re getting our system of self-management down with this closer Lubbock property. Then we’re taking the show on the road and going bigger.

People will always go to the beach and they’ll always go to Disney so that’s the plan.  Keep listening in for updates. I tend to share everything with y’all so you know I’ll be talking about it. 

Now on with it. 

Item #1

Let’s start off with this one called “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration” by Wong et. al. (Wong JJ 2016) and published in Spine Journal in December of 2016,  As a side note, this may be the longest of any title anywhere. They should work on their naming prowess. 

Why They Did It

In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD.

How They Did It

  • This was a systematic review and best evidence synthesis.
  • The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention.
  • They systematically searched five databases from 2000 to 2014
  • Studies with a low risk of bias were stratified by the intervention’s stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles. 
  • They screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias.

What They Found Evidence from seven exploratory studies suggests that 

  1. for recent but not persistent NAD grades I-II, thoracic manipulation offers short-term benefits; 
  2. for persistent NAD grades I-II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and 
  3. for NAD grades I-II, strain-counterstrain treatment is no better than placebo. 

Evidence from 15 evaluation studies suggests that  (1) for recent NAD grades I-II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice;  (2) for persistent NAD grades I-II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture;  (3) for WAD grades I-II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and  (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits.

Wrap It Up

Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counter strain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain I don’t know what to think about this one, to be honest.

In one part it seems they don’t assign any effectiveness to manipulation but then in the conclusion, they say it’s an effective intervention. What gives? Who the hell knows. All I have access to is the abstract.  I can tell you that while anecdotal, you can’t convince me that manipulation doesn’t provide significant relief. Sometimes immediately. You’ve seen them come in with a locked up neck and one adjustment increases their range of motion immediately and pain levels are reduced fairly quickly.  Combined with some exercise and strain/counterstrain, they leave the office skipping down the street and singing along with Louie Armstrong on ‘What a wonderful world.” I know systemic reviews are high-level research. I’ve just seen so many other papers showing impressive effectiveness that this one doesn’t really move me one way or the other. 

Item #2

Last one today is called, “Effects of Acupuncture on Postoperative Pain After Total Knee Replacement: Systematic Literature Review and Meta-Analysis” by Ko et. al. (Hsing Fang Ko 2021) and published in Pain Medicine on June 21, 2021…damnit….so hot. 

Why They Did It They wanted to identify the analgesic effectiveness of acupuncture after total knee replacement by systematic review.

How They Did It

  • A search of randomized controlled trials was conducted in five English medical electronic databases and five Chinese databases. 
  • Two reviewers independently searched in five English medical electronic databases and five Chinese databases. 
  • Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form. 
  • Meta-analyses were performed with all-time-points meta-analysis.
  • A total of seven studies with 891 participants were included.

What They Found

  • The meta-analysis results indicated that acupuncture had a statistically significant influence on pain relief. 
  • The subgroup analysis results showed that acupuncture’s effects on analgesia had a statistically significant influence. 
  • Electroacupuncture frequency ranged between 2 and 100 Hz.

Wrap It Up

As an adjunct modality, the use of acupuncture is associated with reduced pain and the use of analgesic medications in postoperative patients. In particular, ear acupuncture 1 day before surgery could reduce analgesia. 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 the 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.

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About the Author & Host

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

Bibliography

  • Hsing Fang Ko, C.-H. C., PhD, Kai-Ren Dong, Hsien-Chang Wu (2021). “Effects of Acupuncture on Postoperative Pain After Total Knee Replacement: Systematic Literature Review and Meta-Analysis,.” Pain Med 22(9): 2117-2127.
  • Wong JJ, S. H., Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G, Carroll LJ, Ameis A, Ammendolia C, Brison R, Nordin M, Stupar M, Taylor-Vaisey A, (2016). “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration.” Spine J 16(12): 1598-1630.

How Car Wrecks Contribute To Future Neck and Back Pain

CF 196: How Car Wrecks Contribute To Future Neck and Back Pain

Today we’re going to talk about How Car Wrecks Contribute To Future Neck and Back Pain. I have two different papers with what I thought were surprising conclusions in one way or another. Not only did I find themm a bit surprising but I don’t think the defense attorneys in PI cases will like either paper much. Just an assumption on my part. All of that coming up in this episode. 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 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. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #196 Now if you missed last week’s episode , we talked about Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

We just ended our fourth week as an integrated practice and starting our fifth. It’s a struggle. I’m not going to lie. You see the money going out but you don’t see it coming in. That’s why, to pull this off, you need to be a busy Chiro and you need to have reserves in place.

Otherwise, it could be doomed. Unless you’re a hype machine. A marketing mastermind that fills the schedule before the integration even takes place. Let’s be honest, most of us just aren’t. I know the value of marketing. I know how to market on a fundamental level. But it’s hard. It’s hard to get your message out there and it’s hard to break through.

So, week one, maybe 4-5 appointments. Week two, maybe 18 appointments. Week 2 was about the same. Then last week was maybe only 8-9. So it’s up and down. We aren’t covering the salary but, we have reserves set back AND I’m fortunate enough to be busy.  The trick is just getting the message out and I feel like we’re doing that both externally as well as internally.

We have in-office brochures, flyers, and posters. Email marketing, social media, and all that good hoopla. It’s happening. We’re making it happen. 

In other news, I recovered from my five days in Washington DC. Geez. What a go-cation. It’s not the cost of taking a trip. It’s the cost of being gone. How much money you lose by not being in the office. That’s the real number and it just kills me!! So, I don’t think about it because I truly believe we need to be taking a trip once per quarter. You have to so you don’t lose your damn mind. It’s just a must.

Speaking of, I have a trip in just about three weeks to Chicago for business to finish off my Fellowship in Forensics. I’m looking forward to that and to networking with everyone involved with that whole side of the profession. Multiple streams of income folks. I do it inside the office as well as outside. Speaking, mentoring, authoring, medico-legal, Ortho fellowship, personal injury, family, triwest, acupuncture, massage, laser, esthetician, Texas Chiropractic Association, Texas Council of Chiropractic Orthopedists, Nurse Prac, and everything that falls under that.

That’s inside.

Outside is music, voice-over, art, real estate investing, and all kinds of other things I’m looking at.  What would it be like to just do a couple Of things?  Who knows? That’s just not me.  I make myself crazy but I honestly don’t know any other way. 

If you were thinking you could get into business for yourself and sit on the computer half the day fiddle assing on the computer, I got news. Your competition is out there getting Diplomates, certifications, and expertise to run circles around you.

Get busy.

Or wonder where all of those new patients are going since they don’t seem to be coming to see you.

Item #1

Alright, let’s hop in with our first one today called “Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis” by Nolet et. al. (Nolet PS 2019) and published in PM&R in November of 2019. In case you didn’t know, PM&R stands for physical medicine and rehabilitation. 

Why They Did It

They say in the abstract that neck injury resulting from a crash is associated with a high rate of chronicity. Prognosis studies indicate 50% of injured people continue to experience NP a year after the collision. This is difficult to interpret due to the high prevalence of NP in the general population. In other words, those that have not been in a car wreck still have neck pain, right? The stated goal of the authors here was to summarize the literature that has examined the association between a motor vehicle collision (MVC) related neck injury and future neck pain (NP) when compared to the population that has not been exposed to neck injury from a crash.

How They Did It

  • They performed a systematic review of the literature using five electronic databases, searching for risk studies on exposure to a car crash and future neck pain published from 1998 to 2018. 
  • The outcome of interest was future neck pain. 
  • Eligible risk studies were critically appraised using the modified Quality in Prognosis Studies (QUIPS) instrument. 
  • Eight articles were identified of which seven were of lower risk of bias. Six studies reported a positive association between a neck injury in an MVC and future NP compared to those without a neck injury in an MVC

What They Found

  • Pooled analysis of the six studies indicated an unadjusted relative risk of future neck pain in the car crash-exposed population with neck injury of 2.3, which equates to a 57% attributable risk to those having been in a car wreck. 
  • In two studies where exposed participants were either not injured or injury status was unknown, there was no increased risk of future neck pain

Wrap It Up

They wrap it up by saying, “There was a consistent positive association among studies that have examined the association between MVC-related neck injury and future neck pain. These findings are of potential interest to clinicians, insurers, patients, governmental agencies, and the courts.” I see personal injury patients. This is good info for their reports, their file, and their attorneys if they’re represented. 

 

Item #2 This one is called, “Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis” by Nolet, et. al.  (Paul S. Nolet 2020)and this one was published in Accident Analysis and Prevention in 2020.  It’s not that hot but I’m using it anyway just because I like it and cuz I say so….

Why They Did It The purpose of this study is to summarize the evidence for the association between exposure to a motor vehicle collision (MVC) and future low back pain (LBP).

How They Did It

  • A systematic search of five electronic databases from 1998 to 2019 was performed. 
  • Eligible studies describing exposure to a MVC and risk of future non-specific LBP were critically appraised using the Quality in Prognosis Studies (QUIPS) instrument. 
  • The search strategy yielded 1136 articles, three of which were found to be at low to medium risk of bias after critical appraisal. 

What They Found

  • All three studies reported a positive association between an acute injury in a MVC and future LBP. 
  • Pooled analysis of the results resulted in an unadjusted relative risk of future LBP in the MVC-exposed and injured population versus the non-exposed population of 2.7, which equates to a 63 % attributable risk under the exposed.

Wrap It Up

There was a consistent positive association in the critically reviewed literature that investigated the risk of future LBP following an acute MVC-related injury. For the patient with chronic low back pain who was initially injured in a MVC, more often than not (63 % of the time) the condition was caused by the MVC.  Thats a lot right, folks? Look, it’s obvious to say an injury was caused by a car wreck. It’s common as a chiropractor to hear patients tell you that their neck pain started with a car wreck they had 20 years before. We hear it all of the time.  But for reals, 57% for the neck and 63% of the back?

That’s solid and flies directly in the face of the other side of the courtroom when they try to tell jurors that the forces experienced in a low-speed impact are about the same as stepping off of a curb on the street. This is, by the way, one of the most ridiculous things I’ve ever heard in my entire life but an argument that they most certainly use periodically.  Fools!!!! The fools we must suffer in life!! I’m sure plenty of folks refer to me in the same manner. It is what it is. Let’s all just try to be the least of the fools…., if that makes any sense at all. 

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!

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 https://twitter.com/Chiro_Forward

YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

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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

Nolet PS, E. P., Kristman VL, Murnaghan K, Zeegers MP, Freeman MD (2019). “Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis.” PM R. 11(11): 1228-1239.  

Paul S. Nolet, P. C. E., Vicki L. Kristman, Kent Murnaghan, Maurice P. Zeegers, Michael D. Freeman (2020). “Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis.” Accid Anal and Prev 142.          

Updated Thinking On Chronic Pain and Exercise

CF 129: Updated Thinking On Chronic Pain and Exercise Today we’re going to talk about chronic pain and exercise.  But first, here’s that sweet sweet bumper music
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 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. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • 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!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #129 Now if you missed last week’s episode, we talked about Tylenol failures, cervical disc research, and we talked about complementary and alternative treatment for headaches and migraines. What’s the current research and thinking? 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 to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. Well, so far, no blowback from my rant on last week’s podcast so sometimes no news is good news. You either all agree with me or you’re not listening.  Rocking and rolling here at work, last week was finally the busiest I have been since late January or early February. It was quite a blessing. I have to admit, I’m not used to working that damned hard anymore but it’s OK. I just need to get back into fighting shape so I can see them all.  Last week we saw about 135 patients. Pre-COVID numbers were anywhere from 185-225 so I’m still significantly down but it’s trending upwards and it’s looking good right now. I cannot and will not fuss about it. Especially when I read that several are just now going back to work and have been closed completely this entire time. We’ve been fully, completely open for more than a month now. It’s hard to imagine being closed down any longer than we were honest. I don’t know how companies survive.  I see reports that the virus may have mutated to a lesser severity. Not only are some doctors claiming that people are getting less severe when they do get sick, but they are not getting sick as easily. That’s some exciting news if it is indeed a fact. Time will tell.  I don’t want to hear anything about ‘new normals’. Once this dude settles down, life will be normal. Not a new normal. It’ll be back to the way it was. I’m guessing August but who knows? It could be in the Fall. Maybe even the Spring. But it will be the old normal. You can count on that.  I hope your businesses are picking back up as well. I hope you’re seeing those old familiar happy faces coming back into the office to greet you. I hope you’re back on track to showing the world how effective and amazing chiropractic can be when practiced by an evidence-based, patient-centered professional. That’s you. That’s who listens to this show and I’m proud of you all. You make this profession better every day and I thank you.  I just hope you get something good from me every week. If you do, I won’t be shy about asking you to share this podcast with your colleagues. We are growing all of the time but it’s never quite fast enough to feel like I’m on a roll. So, with your help in sharing and talking about us, I think we can truly make a big difference and take this thing of ours to another level.  Item #1 This first one this week is called “Exercise Induced Hypoalgesia Is Impaired in Chronic Whiplash Associated Disorders (WAD) With Both Aerobic and Isometric Exercise” by Smith et. al(Smith A 2020). and published in Clinical Journal of Pain in May of 2020. Oy…..that’s smokin’ hot! Why They Did It First, let’s define Exercise Induced Hypolagesia. It is a generalized reduction in pain and pain sensitivity that occurs during exercise and for some time afterward. So, for normal, asymptomatic people, when they exercise, there’s less pain and they feel better and that lasts for a while when they finish exercising.  Exercise induced hypoalgesia can be impaired in patients with chronic pain and may be dependent on exercise type. Factors predictive of Exercise induced hypoalgesia are not known. This study aimed to: 
  1. compare Exercise induced hypoalgesia in participants with chronic whiplash associated disorders to asymptomatic controls, 
  2. determine if exercise induced hypoalgesia differs between aerobic and isometric exercise, 
  3. determine predictors of Exercise induced hypoalgesia.
How They Did It
  • A pre-post study investigated the effect of single sessions of submaximal aerobic treadmill walking and isometric knee extension on exercise induced hypoalgesia in 40 participants with chronic whiplash associated disorders and 30 controls
  • Pressure pain thresholds were measured at the hand, cervical spine and tibialis anterior
  • Appropriate baseline measurements were performed
What They Found Participants with whiplash-associated disorders demonstrated impaired exercise-induced hypoalgesia There was no difference in exercise-induced hypoalgesia between exercise types Wrap It Up “Individuals with chronic whiplash-associated disorders have impaired exercise-induced hypoalgesia with both aerobic and isometric exercise. Higher levels of physical activity and less efficient conditioned pain modulation may be associated with impaired exercise-induced hypoalgesia.” Item #2 This last one is by the great Dr. Craig Liebenson and is called “Pain with Exercise: Is it acceptable & if so how much & for how long?” and was published in First Principles Of Movement on May 20, 2020(Liebenson C 2020). Pow! Hot like a firecracker folks. https://firstprinciplesofmovement.com/pain-with-exercise-is-it-acceptable-if-so-how-much-for-how-long/ For articles, we dispense with our normal outline and we hit the high spots and interesting points.  Craig starts by quoting a paper by Smith, Littlewood where they say “Protocols using painful exercises offer a small but significant benefit over pain-free exercises in the short term, with moderate quality of evidence……Pain during therapeutic exercise for chronic musculoskeletal pain need not be a barrier to successful outcomes.” He also quotes Annie O’Conner’s, author of World of Hurt, where she says we must violate the patient’s expectation that hurt equals harm. Especially with light pain.  Craig also refers to a photograph from Silbernagel’s paper demonstrating a Pain-Monitoring Model where the safe zone on the VAS was 0-2, the Yellow or acceptable zone was 3-5 on the VAS, and the red high-risk zone was 6-10.  Silbernagel says, “Biological plausibility/explanation and reasoning ranks high and then you can individualize. Meaning waiting for the pain to subside does not work because you get weaker and the tissue decreases its tolerance to load. So loading with pain is beneficial to get the structures to improve. However, if it is a fracture it might be very different so know the injury and tissue.” I like this quote of Craig’s from the article: “Many people believe the medical adage – “if it hurts don’t do it”. We know that for some this promotes illness behavior by giving the idea that the body is fragile. Ben Smith & Chris Littlewood’s shoulder paper, Annie O’Conner’s WOH book, some of K Thorberg’s groin work, & you’re tendonopathy paper all show yellow pain is acceptable.  He says the idea of, if it hurts, don’t do it brings about clear yellow flags. Yellow flags such as
  • Hurt = harm
  • activity is harmful
  • if an activity hurts it should be stopped
On the topic of osteoarthritis, he says 
  • The patient decides what’s tolerable, 
  • Above 5 is the red area
  • If pain increases with exercise, that’s OK as long as by the next day it has calmed. 
He goes on to cite a new paper in JAMA by Ben Cormack asking about pain tolerance vs. using the traditional Numeric Rating Scale. They’re suggesting asking if the pain is tolerable is a better way to deal with it.  Cormack says:
  • “The exclusive focus of the numeric rating scale (NRS) on pain intensity reduces the experience of chronic pain to a single dimension.”
  • “This drawback minimizes the complex effects of chronic pain on patients’ lives and the trade-offs that are often involved in analgesic decision-making.”
  • “Furthermore, continually asking patients to rate their pain on a scale that is anchored by a pain-free state (ie, 0) implies that being pain-free is a readily attainable treatment goal, which may contribute to unrealistic expectations for complete relief.”
The modern approach to managing disabling musculoskeletal pain is to shift the focus from chasing symptomatic relief to addressing activity intolerances related to symptoms.
  • “ The overarching goal of chronic pain treatment is to make the pain tolerable for the patient rather than to attain a targeted numeric rating.”
  • “Our findings confirmed the intuitive assumption that most patients with low pain intensity (ie, NRS score, 1-3) find their pain tolerable.”
  • “In contrast, the tolerability of pain rated between 4 and 6 varies substantially among patients.
  • “In this middle range, if a patient describes the pain as tolerable, this might decrease the clinician’s inclination to initiate higher-risk treatments.”
  • “A substantial subgroup of patients with severe pain reported their symptoms as tolerable.”
Dr. Liebenson wraps up the article by saying, “This discussion highlights that hurt does not necessarily equal harm. Nearly all musculoskeletal pain guidelines over the last 30 years have emphasized that pain does not equal tissue damage or impending injury. This study goes a long way to show us better ways to educate people in reassuring ways that will get them back to activity and thus build a mindset that can make them feel less fragile.” Chronic pain is interesting stuff and is a HUGE market where there are lots of opportunities for educated, smart chiropractors to stick their flag in the dirt and stake a claim.  Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. 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.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   
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 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. 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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography
  • Liebenson C (2020). “Pain with Exercise: Is it acceptable & if so how much & for how long?” First Principles Of Movement.
  • Smith A, R. C., Warren J, Sterling M, (2020). “Exercise Induced Hypoalgesia Is Impaired in Chronic Whiplash Associated Disorders (WAD) With Both Aerobic and Isometric Exercise.” Clin J Pain.

w/ Dr. William Lawson – Brand New Guidelines On Neck Pain Treatment

CF 113: w/ Dr. William Lawson –  Brand New Guidelines On Neck Pain Treatment

Today we’re going to be joined by Dr. William Lawson to talk about some brand new guidelines that came out in December regarding neck pain and the treatment of neck pain for chiropractors. Be sure and listen so you’re up on the latest and you’re not doing it wrong!

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. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • 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!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #113

Now if you missed last week’s episode, we talked about what effect lifestyle might have on dementia and we talked about whether or not the feeling of having a stiff back actually means that you have a stiff back. 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 to find whatever you want quickly and easily. 

I swear to you, I see chiropractors always asking about research papers and what research is there on this or that. I want to yell at the top of my lungs to go and check my damn website. But, you don’t want to look like you’re self-serving and pumping your own tires so…..I say nothing. It IS called social media for a reason. It’s not called to get online and sell your stuff to everyone all the time. So I don’t. 

With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

It just makes sense to be but hell, I used it all of the time because I can’t remember everything off the top of my head. I’m old now. My brain doesn’t brain like that anymore. 

On the personal end of things…..

Guys and girls…..you wouldn’t believe me if I told you. That’s if you’ve been listening regularly over the last 3 months. Now, remember, there’s a two-week delay on these podcasts so keep that in mind but, yesterday afternoon my step-dad went to the ER with heart issues. He’s 80 and he’s the one that had the appendectomy on Christmas day. 

Keep in mind that my biological dad is still in a nursing home at 76 years old after he suffered a stroke back on November 9th. 

Lots of other stuff is going on with other members of my family as well but those are the biggies for now. 

Anyway, it looks like he’ll be getting a heart cath today. I’ll keep you updated. 

On the bright side, I got my certificate to get in a big fancy frame. It’s the one that says I’m a Diplomate of the International Academy of Neuromusculoskeletal Medicine and I have to be honest, I remember being brand new in practice and really admiring the fact that some would go to the lengths of getting a Diplomate. 

I never considered that I would ever be one to do it though. When I got out of college, I didn’t want to see another book or class. I would say I was a bit of a lazy student back in the college days. I learned better from studying notes than I learned from listening to some boring teacher drones on and on day after day. 

Other than the lab classes, it was torture for me. I learn better by having words in front of me and studying them over and over. That’s why the school was so damn difficult for me. Especially histology. Lordy lordy. We had a 98-year-old with a monotone voice teaching us histology at Parker in Dallas. Can you imagine a more dry subject and it was taught by the driest person with the dry-est delivery. Hell no, folks. Hell no. If I had them, I would have given up the nuclear codes just to get him to shut up. It was awful. 

Anyway, the thought of my undergoing another 2-year course of study to get a Diplomate just wasn’t on the radar. And it stayed that way for about 20 years. Until one day. One day I was walking through the exhibit hall at ChiroTexpo ’18 in Dallas, TX and I met one Dr. Tim Bertelsman. He was pumping the tires on ChiroUp. BTW, if you want to go to chiroup.com and sign up with the code Williams99, you can get the first six months for only $99/month. You won’t regret it. 

Anyway, once he went through all of the amazing stuff that ChiroUp can do for me and my patients, he looked up at me…..I’m a pretty tall dude….and he said I should come to his lecture on back pain later that day. He said that it counts as 10 hours toward the 50 live hours needed toward the Orthopedic Diplomate. He said very confidently, “Come check it out. You’ll like it. You’ll stay.”

He got a chuckle out of me on that. I had other things I wanted to do for the weekend. Ten hours in a classroom wasn’t in the plans. Hell, being in TCA leadership, I already get about 40 or more hours a year anyway. 

Plus, The Diplomate was not on my radar so that didn’t mean anything to me but I was intrigued by the idea of focusing my knowledge and thoughts on the low back so I made sure I sat in on his class. At least for a bit just to check it out. 

Well, it’s obvious at this point, but I sat through the whole weekend. Dr. Bertelsman just nailed it. He’s engaging and interesting and extremely knowledgeable. He’s a star on the speaking circuit. 

So, I finished that class and thought, if that information was so good, what could I learn from the next one and on and on? Plus, I’d already knocked out 10 of the 50 live hours. Makes sense to at least look at it as a possibility. 

The more I looked at it, the more I realized that the Academy, Dr. James Lehman with the University of Bridgeport, and the Australian group with Dr. Anthony Nicholson and Dr. Matthew Long called Chiropractic Development International have all really really gone to great lengths to make getting that Diplomate easily accessible. They are working together to create a new culture of chiropractors. Chiropractic practitioners that are on a different level – a different plane from your regular run of the mill general chiropractor. 

I would have to say they have done just that. With only 5 live hour weekends required over the course of a year and half to 2 years, and the ability to take all of the other 250 hours in the comfort of you home…..well, it made sense. I get a ton of hours every year anyway so….why not?

I put the pedal to the metal and got the hours knocked out in about 6 months and spent the rest of my time just studying and reviewing the material. It worked out. Here we are, about the frame a certificate. 

The point is, it’s more convenient than it’s ever been and you can and should do it. If for now other reason than to be the best in your community at assessing, diagnosing, and treating. I mean really, who the hell doesn’t want that?

We are joined on the podcast today by the doctor that made it more convenient for folks in Texas to take on the Diplomate program.  Dr. William Lawson is our guest today. 

Dr. Lawson is located down in Austin, TX

He has a diplomate in Chiropractic Orthopedics as well as a Diplomate in Integrative Medicine college of pain management. 

He has a masters degree in Health Care Administration

He is certified in acupuncture

He is heavily involved in the Texas Chiropractic Association

He is an Air Force veteran

He does Designated Doctor work as well as medicolegal work

Let’s welcome Dr. William Lawson to the show. Thanks for taking some time out to come on the show today, Bill. Welcome!

This is actually your second time on The Chiropractic Forward show. The last time was September 27, of 2018 and it was episode #41. Here we are in episode 113 so it’s been a bit. Tell me what all has been going on in the life of Dr. Lawson since then

A quick review at chiropracticforward.com tells me that the last time you were on, we spent the episode discussing research targetting the cervical region. I remember fussing because we have so much research-based around the lumbar region and low back pain but nothing near as robust for the cervical region. Then, you got involved in research paper having to do with neck pain and treatment. Tell us how that came about and tell us what part you played in it. What was your contribution to it? 

So it turns out, all I have to do is raise a fuss to get neck pain some attention and voila…..here we are. : )

I noticed in the Acknowledgements section, some of our other friends were also involved in contributing. Drs Kris Anderson up in North Dakota, Dr. Craig Benton in Lampasas, TX, your name of course, and Dr. Dean Smith who is active with the Evidence-Based Chiropractor group. It looks like an excellent group. 

Let’s go ahead and give it this paper the Chiropractic Forward treatment if that’s OK

This paper you were involved in is called “Best-Practice Recommendations for Chiropractic Management of Patients With Neck Pain” authored by Wayne Whalen, Ronald Farabaugh, Cheryl Hawk and a slew of others. It was published in the Journal of Manipulative and Physiological Therapeutics on December 20, 2019 – Hot potato…

Why They Did It

Dr. Lawson, since you were involved in it, walk us through their reasoning for doing the paper if you will. 

How They Did It

I must admit to only reading the abstract so far so lead us a little deeper into how they go about formulating these guidelines and recommendations?

For those that don’t know or don’t really get deep into research, can you give us a layman’s explanation of what exactly a Delphi Panel is?

What They Found/Wrap Up

Tell us what they came up with. At the end of the day and after all of the effort, what do we have going forward?

(This is a good point to go beyond the abstract and cover the 16 points made in the Best-Practice Recommendations For Chiropractic Management of Neck Pain section of the paper)

  1. Begin care management with a thorough history.
  2. Follow the history with a condition-specific examination. It is the duty of the provider to perform an examination consistent with the complexity of the case, based initially on history, which includes the mechanism of injury.
  3. Evaluate patients with complaints of neck pain for potentially serious red flags.
  4. Consider referral for diagnostic imaging or other studies based on established clinical practice guidelines (see “Diagnostic Imaging” later).
  5. Develop a care plan based on history and examination. The care plan includes appropriate diagnostic tests. Sometimes referred to as a report of findings, the history, examination findings, plan of care, and prognosis should be reviewed with the patient through a process of shared decision-making and with their consent to proceed obtained.17
  6. Document factors that may delay recovery. (Yellow Flags?)
  7. Develop a working diagnosis and, when clinically indicated, consider differential diagnoses.
  8. Reassure the patient regarding the generally benign nature of minor neck pain and encourage activity and movement. With moderate to severe neck pain, emphasize the importance of treatment plan compliance.
  9. Determine whether to (a) manage the patient exclusively, (b) co-manage, or (c) refer to another provider.
  10. Begin treatment with a brief trial of care, 6 to 12 visits, followed by evaluation for treatment effectiveness. The initial trial is not the same as a limit or cap on care.
  11. Evaluate the patient briefly during each encounter, pre- and post-treatment. Conduct a more focused condition-specific evaluation after each benchmark in the treatment plan. Examples: Every 6 to 12 visits, or in 30-60-90-day intervals.
  12. Some patients’ responses to treatment may not follow a predictable pattern, or they may not respond. In this case, consider a modification to the treatment plan that may include, but may not be limited to (a) change in technique and/or modality, (b) referral to another provider within the same discipline for a second opinion, (c) referral to another provider outside the discipline for a second opinion and consideration of other treatment approaches, or (d) referral for diagnostic tests (eg, X-ray, magnetic resonance imaging [MRI], computed tomography scan, neurodiagnostic or blood studies)
  13. Refer patients with new or worsening symptoms or evidence of psychological issues to providers with expertise in those areas (eg, behavioral health).
  14. Determine at each visit and/or evaluation if the patient is improving, is worsening, or has plateaued, and discharge if appropriate.
  15. Encourage and provide home and self-care approaches.
  16. Document the history, clinical examination, treatments performed, the rationale for and response to care, and any referrals.

In the paper, just after the section we just covered, they recognize that not all patients recover fully. Unfortunately, we’re all well-aware. Tell me a bit about what they have to say about that. 

For patients who have reached MTB, the question then becomes: What is the best course of care to help control the ongoing pain? In general, patients unable to reach full recovery fall into one of these categories:

  • 1. No physician/provider intervention is necessary. The patient has residual minor neck pain but can manage it with self-care strategies: ice, nonsteroidal anti-inflammatory drugs, home-based exercise.
    2.
    Physician/provider intervention is necessary in periodic episodes of care. The patient experiences pain that exceeds his or her ability to self-manage and must return for care in an episodic fashion.
    3.
    Physician/provider intervention is necessary on an ongoing basis. The patient experiences pain that exceeds his or her ability to self-manage, and in the absence of care the condition deteriorates. These patients often benefit from 1 to 2 visits per month to providers of nonpharmacologic conservative care who use spinal manipulation, to be reevaluated every 6 to 12 visits.

Now, I have been seeing this paper being shared and discussed all over the Forward Thinking Chiropractic Alliance Facebook page as well as the Evidence-based Chiropractor Facebook group. Those are all very like-minded docs in there and we all love practice guidelines, the idea of professional standardization, a certain level of standards within that construct, and those sorts of things. 

So it’s no surprise that a paper putting guidelines into the profession is well-accepted by those groups. I wonder if you’ve seen or noticed any thoughts or opinions elsewhere? Basically, what is the paper’s reception as far as the rest of the profession is concerned? Or do you know? A lot of chiropractors don’t know a thing about research or new research and may not even know it exists. 

Let’s start wrapping it up a bit, do we have any more research papers you’re contributing to? What is next on your horizon? 

Thanks for coming on the show this week


The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

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About the Author & Host

Dr. Jeff Williams, DC, FIANM – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

CF 051: Necks, Integrity of the Cervical Spine, and the CDC on Opioids

Today we’re going to talk about the reliability of clinical tests assessing the cervical spine, what is happening when adjusting a neck as far as the integrity of the cervical spine, and what the CDC says about opioids. It’s all fascinating all the time here at the Chiropractic Forward Podcast 

But first, here’s that bumper music

Integrating Chiropractors

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 drifted all slow and gently into Episode #51

DACO

As has become the tradition, let’s talk a bit about the DACO program. DACO stands for Diplomate of American Chiropractic Orthopedist. Trudging along. I’m up to I believe 84 of the required 300. Classes this last week were on frozen shoulder, piriformis syndrome, Important aspects of lumbar MRI, and inguinal pain. 

This stuff is just invaluable, folks. I’m an organizational freak but at the end of each course, I’ll make myself a quick sheet that I can reference when something like that comes through the door. I think making these little quick sheets will really help to get some of the more rare or difficult cases figured out quickly. 

I’ve already put the lumbar differential diagnosis sheet to use a few times as well as the dizziness quick sheet I created. I have shared several times here that I don’t sit around a lot either at work or at home. I’m a busy bee. 

Vacation & Hobbies

Going on vacation, don’t even try to take me to a beach. If my wife wants to go to the beach, that’s all her. I’ll tag along and I’ll check in on her out there reading a book from time to time but, for the most part, I’ll be off doing, seeing, and experiencing. The ability to sit still and just relax…..that’s an ability I did not receive in this lifetime. 

As a result, I make live edge furniture. Go to Facebook and look up Amarillo live edge and custom furniture. I am a sculpture and charcoal artist. Go back to Facebook now and look up River Horse Art Gallery. I’m in the process of teaching myself to paint right now too. I also am a singer/songwriter. Go back to Facebook once again. Yes, once again and look up Flying Elbows Perspective.

Crazy name indeed. 

So, here’s the point. It’s not to brag or pump my tires. The point is that this is how important I’ve found the DACO program to be. While I haven’t completely put everything else on hold, the DACO has taken priority of my time. One reason is that I want to motor through it quickly and efficiently. The next reason would be that I’ll be the only DACO in all of Texas West of the Dallas/Ft. Worth metroplex. 

What does that get me? Maybe a pat on the back. Maybe a part time or full-time gig on staff at an FQHC. As we have mentioned in previous episodes, there are reports of DCs on FQHC staffs making as little as $120/visit up to $300/visit on even Medicaid visits. Unbelievable. But you have a better shot at getting into the system when you are specialized AKA – a Diplomate. 

Just a part of making us all better. You guys and gals need to be looking at this stuff. 

Before we hop into the papers for the week, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. I think I have some pretty cool stuff coming down the pike you’ll be interested in. That’s in you enjoy evidence-based education.

Now, here we go with some vital information that we think can build confidence and improve your practice which will improve your life overall.

Paper #1

The first paper here is called “Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration” It was done my Madege Lemurnier et. al. and published in the European Spine Journal in September 2017[1]. 

Why They Did It

With a title as long as that one, what the heck are they doing here? They say they were hoping to determine the reliability of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. 

How They Did It

They updated the systematic review of the 2000-2010 Bone and Joint Decade Task Forst on Neck Pain and Associated Disorders. 

They searched the literature for studies on the reliability and validity of Doppler velocimetry to evaluate the cervical arteries. 

They had two independent evaluators look through it all

What They Found

  • Preliminary evidence showed that the extension-rotation test may be reliable and has adequate validity to rule out pain arising from facet joint. Or rule in I suppose. Just in case you are unaware of the cervical extension-rotation test, it’s exactly as it sounds. Have the patient extend and then rotate toward the side you’re testing. When you combine this maneuver with palpation you can typically get a good idea of whether the patient is suffering from a facet issue. You need to know that this test is also effective in sniffing out a low back facet issue as well. Lumbar extension and then rotation can give you some good clues sometimes.
  • The evidence suggests variable reliability and preliminary validity for the evaluation of cervical radiculopathy including neurological examination (manual motor testing, dermatomal sensory testing, deep tendon reflexes, and pathological reflex testing), Spurling’s and the upper limb neurodynamic tests.
  • No evidence found for doppler velocimetry. 

Wrap It Up

Little evidence exists to support the use of clinical tests to evaluate the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders. We found preliminary evidence to support the use of the extension–rotation test, neurological examination, Spurling’s and the upper limb neurodynamic tests.

Paper#2

On to our second paper. This one is called “Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation” and appeared in Spine Journal in August of 2018 and was authored by Dr. William J. Anderst, et. al[2].

Why They Did It

Since cervical manipulation is such a common intervention for neck pain, the authors wanted to characterize the forces involved and the facet gapping that takes place during manipulation. 

How They Did It

It was a laboratory-based prospective observational study

It included 12 patients 

Each patient had acute mechanical neck pain

One of the outcome measurements was the neck pain rating scale (NPRS)

Other measurements were taken for amount and rate of cervical facet joint gapping 

What They Found

The authors concluded, “This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral ROM is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.”

Pretty cool stuff. 

Paper #3

Our last paper for this episode is called, “CDC: Drug overdoses hit new record.” It’s an article on thehill.com written by Nathaniel Weixel and was published on August 15th of this year, 2018[3]. 

The article leads off saying that 72,000 Americans died from drug overdoses in 2017 and that’s based on information provided by the Centers for Disease Control and Prevention. That is a new record folks and we have our friends in the medical realm to thank for it. 

Who’s To Blame?

Now, that, of course, doesn’t mean pharmacists and medical doctors are bad and there was a mass conspiracy to cause this deal. But it does mean that SOME of them are bad. SOME doctors are doing time in an orange outfit right now because they knew better but the dollar was mightier than common sense and common decency. 

There were pharmacies dispensing 100x more than their population could ever consume but they want to not refer to us and talk about the integrity of the cervical spine. That kind of crap is what got us here.

But, it’s also what has brought chiropractors from the shadows into the light. When you have the mess the medical field has created, then you have to start looking for the non-pharma solutions and we are it. 

Comparison

72,000 deaths. You ever heard of the Vietnam War? Of course, you have. We all have. Some either remember or have seen what a big deal it was. The deaths, the protests, the loss. I’ve been to the Vietnam Wall in Washington DC several times. It’s profound. It’s stunning to see all of those names. 

Just to compare, the total number of those lost in Vietnam stands at 58,220. Now keep in mind, that takes into account deaths from as early as 1956 all the way up to as late as 2006 and comes from Defense Casualty Analysis System Extract Files from The Vietnam Conflict Extract Data File. 

I did my homework. I’m not giving you fake numbers here. 

Essentially, 13,780 more deaths happened because of opioids, In just one year. In just 2017. That doesn’t even begin to scratch the surface when you start totaling up 2016, 2015, and further back. Unbelievable isn’t it? 

If we look at it, 2014 had 28,647 deaths, 2015 had 33,100 deaths, 2016 saw 63,632 deaths…..and then 72,000 in 2017. 

I’m guessing you can see the trend. Hell yes, it’s an epidemic.

The Math

I’ll do the math for you because I love you and I’m glad you’re here and I don’t want you to have to think too hard while you’re giving me your time. Over the last 4 years, that’s approximately 200,000 opioid-related deaths. 197,379 to be more specific. 

The genie seems to be out of the bottle.

While we can’t put the genie back in, we can offer solutions for the future. Many of those addicted to opioids became addicted due to spinal surgery. Many of those surgeries were unnecessary. One paper I reviewed showed that approximately 5% of lumbar fusions are necessary making about 95% of the unnecessary. Yeah….95%. 

The Answer

We have the answer people. The American College of Physicians, The White House, The Lancet, 2 papers in JAMA, Consumer Report surveys, The Joint Commission, The FDA…..seriously, there is not one reason that we aren’t inundated by spinal pain referrals at this very moment. No reason at all. It actually makes me mad as hell that we are not. 

Exactly what the hell does it take to make general practitioners, neurosurgeons, orthopedic surgeons, nurse practitioners, and physician assistants understand that an evidence-based chiropractor is best situated to help these people as a first-line therapy?

Integrating Chiropractors

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 instead of chemical treatments like pills and shots.

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

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 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.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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 and Host:

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

CF 012: Proven Means To Treat Neck Pain

CF 041: w/ Dr. William Lawson – Research For Neck Pain

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

 

 

 

Bibliography

1. Lemeunier N, Reliability and validity of clinical tests to assess the anatomical integrity of the cervical spine in adults with neck pain and its associated disorders: Part 1—A systematic review from the Cervical Assessment and Diagnosis Research Evaluation (CADRE) Collaboration. Euro Spine J, 2017. 26(9): p. 2225-2241.

2. Anderst W, Intervertebral kinematics of the cervical spine before, during, and after high-velocity low-amplitude manipulation. Spine (Phila Pa 1976), 2018. 0(0).

3. Weixel N. CDC: Drug overdoses hit new record. The Hill 2018  5 August 2018]; Available from: https://thehill.com/policy/healthcare/401961-cdc-drug-overdoses-hit-new-high-in-2017.