pain

Adjustments For Scoliosis & Importance Of Pain Perceptions

CF 231: Adjustments For Scoliosis & Importance Of Pain Perceptions Today we’re going to talk about Adjustments For Scoliosis & Importance Of Pain Perceptions 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 #231 Now if you missed last week’s episode , we talked about lumbar stenosis. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Weelllll, what a weekend I just wrapped up. You never know when life is going to throw darts with your nose as the bullseye but my pickup truck died a couple of weeks ago. Died died. I had to replace the entire engine. What a sheer joy.  I guess COVID has made engines hard to find as well. So, over $3,000 to do that. Now, while it’s in the shop getting a new engine, I bought a 2021 Chevy Silverado down in the Houston, TX area.

I worked from 8-12 last Friday then hopped on an airplane for a 2-hour ride down to Houston, then an Uber from the airport to the dealership in Tomball, TX. About a 45-minute Uber.  Then to the dealership, sign some papers, hop in this beautiful black beast of a truck, and headed back on the 10-hour drive to Amarillo, TX. Texas is a big place folk. It just is. 

I made it all of the ways to Wichita Falls at about 11:00 that night, slept in a hotel, got up at 7:00 am, and made it the rest of the way. I was back in Amarillo by noon on Saturday. With a new vehicle that I’m in love with.  I think side gigs are vital. We can kill it in our personal practices.

But, due to insurance reimbursements or the challenges of a cash practice, or whatever the reasons may be, it always seems the margins are a bit thin. When you have a catastrophe like a vehicle dying and you have to hop out and get a newer vehicle, especially one that runs North of $50 or $55k, it’s nice to have that extra side income.  My side gigs are voice-over…..holy cow voice-over. It’s changed my life. For real.

The term ‘game-changer’ is so overused, but voice-over has been a literal game-changer.  Real Estate – I’ve been doing some real estate work lately. We bought a short-term rental in Lubbock, TX, the home of Texas Tech. They are a D1 school and have all of the events that come with a D1 school. Without getting too deeply into numbers, my total overhead per month on the house is $1100.

Just last weekend it was graduation weekend. Just last weekend on a 3-night stay we made $1600. So you can see where you can go with short-term rentals.  There is a method will encounter if you listen to the Bigger Pockets podcast and that method is called the BRRRR method. It stands for Buy – Renovate – Rent – Refinance – and Repeat.

So you buy it below value and you renovate it and raise the value. Then you rent it to start making some money. After a seasoning period of 4-6 months, you refinance the property and get your down payment mostly back out of the property. Then you put that money down on another fixer-upper and repeat the process.  So, we refinanced our long-term rental home here locally and got a good chunk out of it. Now, with that chunk, we are buying another hosue in Lubbock for our kids to live in while they go through college saving us thousands and thousands over the years they’re down there. Then we’ll either convert it to a short-term rental or we’ll sell it all together and put the money on a beach house in Florida.  We also are looking at the Texas A&M market for a short-term rental.

Who knows? But for the rest of this year, I think we settle down and watch what the market does. It’s due for a slow down. Just want to see where and how before getting in too deep.  So, these two side gigs have been mostly non-time consuming and mostly hands-off. It only takes about 15 minutes per week to self-manage a short-term rental.  And…..this truck payment isn’t going to put me in the poor house as it may have in the past. 

So, what side gigs are you working on? What’s been successful for you? I’d love to hear about it and maybe share it with the rest of the think tank here at Chiropractic Forward. Shoot me an email at [email protected] Right before we get to it today…… are you tired of getting paid peanuts for your good work?  Insurance pays maybe half.  Medicare and Medicaid even less.  So how about full payment?  This comes with PI cases. How do you get these cases you ask? Learn the system.

Created by Paul Samakow, a 41-year veteran attorney – he explains in detail what to do, how to do it, and how to have attorneys not only send you their clients but how to assure they continue to do so. This system is delivered to you in both written and video form – Samakow is actually pretty funny when you watch – but his content and information are both spot on and serious, and will result in multiple referrals from attorneys if you follow his system. His 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 here is called, “Clinical observation of chiropractic manipulation in the treatment of degenerative scoliosis” by Lu-Guang et. al. (Li LG 2022) and published in Zhongguao Gu Shang in May of 2022 smooookin’! I want to thank my New Jersey friend, Dr. David Graber, for posting this on on Facebook. 

Why They Did It

To observe clinical efficacy of chiropractic manipulation in the treatment of degenerative scoliosis 

How They Did It

  • 120 patients with degenerative scoliosis were randomly divided into treatment group and control group
  • From 2017 to 2019 
  • The patients in the treatment group were treated with chiropractic manipulation once every other day for 4 weeks. 
  • The patients in control group were treated with eperisone hydrochloride tablets combined with a thoracolumbar orthopedic (TSLO) brace, oral eperisone hydrochloride tablets 50 mg three times a day, wearing TSLO brace for not less than 8 hours a day.
  • The course of treatment was 4 weeks. 
  • After the patients were selected into the group, visual analogue scale (VAS) and Oswestry Disability Index (ODI) were recorded before treatment, 1, 2, 3, 4 weeks after treatment and 1 month after treatment. 
  • The full length X-ray of the spine was taken before and 4 weeks after treatment, and the scoliosis Cobb angle, sagittal vertical axis (SVA) and lumbar lordosis (LL) were measured and compared. 

What They Found

  • There were significant differences in VAS and Oswestry Disability Index between the two groups at each time point after treatment There was significant difference in Cobb angle between treatment group and control group after treatment, but there was no significant difference in lumbar lordosis and sagittal vertical axis between treatment group and control group. 
  • There was no significant difference in Cobb angle, lumbar lordosis and sagittal vertical axis between two groups before and after treatment. 
  • During the treatment, there were 4 mild adverse reactions in the control group and no adverse reactions in the treatment group.

Wrap It Up

Chiropractic manipulation can effectively relieve pain and improve lumbar function in patients with degenerative scoliosis. The onset of action is faster than that oral eperisone hydrochloride tablets combined with TSLO brace, and it has better safety and can improve Cobb angle of patients with degenerative scoliosis.

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 last one today is called, “Pain cognitions and impact of low back pain after participation in a self-management program: a qualitative study”” by Joem et. al. (Joern 2022) and published in Chiropractic and Manual Therapies on the 21st of February 2022.  Schizahhhh….that one’s bringing the heat!

Why They Did It

Benefits from low back pain (LBP) treatments seem to be related to patients changing their pain cognitions and developing an increased sense of control. Still, little is known about how these changes occur. The objective of this study was to gain insights into possible shifts in the understanding of LBP and the sense of being able to manage pain among patients participating in a LBP self-management intervention.

What They Found

  • Four main themes, corresponding to the characterization of four patient groups, were identified: 
    • ‘Feeling miscast, 
    • ‘Maintaining reservations’, 
    • ‘Struggling with habits’ and 
    • ‘Handling it’. 
  • The participants within each group differed in how they understood, managed, and communicated about their LBP. 
  • Some retained the perception of LBP as a threatening disease, some expressed a changed understanding that did not translate into new behaviors, while others had changed their understanding of pain and their reaction to pain.

Wrap It Up

The same intervention was experienced very differently by different people depending on how messages and communication resonated with the individual patient’s experiences and prior understanding of LBP. Awareness of the ways that individuals’ understanding of LBP interacts with behavior and physical activities appears central to providing adaptive professional support and meeting the needs of individual patients. I have repeated this time and time again on this podcast and to my patients. How people think about their pain goes a long way in determining how they will do in the long run. 

Communicate through the optimistic and hopeful filter. Make sure you’re pulling your patients back from the cliff with your words instead of pushing them into the chronic pain pit.  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.

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

Joern, L., Kongsted, A., Thomassen, L, (2022). “Pain cognitions and impact of low back pain after participation in a self-management program: a qualitative study.” Chiropr Man Therap 30(8).  

Li LG, G. J., Gao CY, Sun W, Luo J, Yang KX, Yu J, Li JG, Wang BJ, Yang W, Zhuang MH (2022). “Clinical observation of chiropractic manipulation in the treatment of degenerative scoliosis.” Zhongguo Gu Shang 35(5): 442-447.  

Pain And COVID & Images Can Mislead

CF 225: Pain And COVID & Images Can Mislead Today we’re going to talk about Pain and COVID & how in the hands of the wrong practitioner, Imaging Can Mislead 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 #225 Now if you missed last week’s episode , we talked about The Complexity & Treatment of Chronic Pain. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. What a damn day folks. What a way to start a Monday. I get to work and have a message to remove the permissions on my page for one of the folks I have helping me with my ad campaign on Facebook.  Turns out he got hacked. Which means everyone he has permission with on social media got hacked as well! Including me. Unreal. So I showed up on a Monday going one direction with a ton of focuse. Next thing you know, I’m headed in teh complete opposite direction afraid I’m going to lose every bit of everything that makes up my professional online presence.  Including my Chiropractic Forward page and Insta. My Creek Stone Integrated Medical, my voice over page, my art page…..everything. I have a botu 22 pages for various things. Furniture building, bands I’ve been in, charity groups, etc.  So, that’s stressful as hell. For that very reason, I’m cutting it short and getting straight to the research. I’ll let you all know how it turns out next week.  Before the research though,  I have a gift for you!  I’m going to turn you on to a system I recently came acros that can result in your getting tons of PI cases from attorneys.  Getting these referrals can be done because it’s how I built my practice in the early days.  Paul Samakow, a veteran personal injury attorney, put this system together.  An attorney telling your how to talk to attorneys – he knows what attorneys want to hear – inviting them to lunch isn’t effective marketing these days.  His system, is delivered to you in both written and video form, and really 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. Which is always a big deal. That guarantee makes a difference for me. You should check it out. Even if you only get one case, you’ve made at least 4 or 5 times the investment. Trust me, I get, on average, about $2500-$3500 per settled case minimum. Lots of time much more than that.  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 this week is called, “Manifestations of Pain During the COVID-19 Pandemic Portrayed on Social Media: A Cross-Sectional Study” by D’Souza et. al. (Ryan S D’Souza 2022) and published in Pain Medicine in 2022 holy smokes it’s hot.  Why They Did It Pain is an often overlooked and underappreciated manifestation during the COVID-19 pandemic. Several permutations of pain should be considered, including: 1) acute pain related to viral infection, 2) exacerbation of preexisting chronic pain, and 3) new-onset pain from post-COVID syndrome. Preexisting chronic pain may worsen, potentially because of lack of health care access, worsening of psychological well-being, unavailability of medications, and other stressors A unique category includes patients without any history of chronic pain who developed persistent pain after recovery from COVID-19 infection [1]. This fits within a syndrome known as “post–acute COVID-19 syndrome” which describes patients who experience persistent symptoms beyond 4 weeks after the onset of COVID-19 symptoms  I have been seeing this A LOT!  Patients who suffer from pain may not be well informed and may turn to publicly available sources for their information needs, especially during the pandemic when in-person health care was less accessible [2]. With the omnipresence of social media and popular broadcast sites, these platforms should be considered vital in disseminating information on COVID-19 [3,4].  Thus, our objectives were 1) to view videos on the YouTube platform as a source of information on pain during the COVID-19 pandemic, 2) to report on their content on the location, type, and chronicity of pain symptoms, 3) to report the overall goal and target audience of the videos, and 4) to critically appraise video quality. Given the novelty of this topic, we hypothesized that the quality of videos would be low and there would be a paucity of videos published by professional societies.  Second, we compared video characteristics between low- and high-quality videos and hypothesized that lower-quality videos would more likely be produced by independent users. How They Did It
  • It was a cross-sectional study
  • They sampled videos on YouTube from March 2020 to March 2021 that had to do with COVID-related pain
  • The authors queried the YouTube platform (www.youtube.com) with the keywords “COVID-19 pain,” “chronic pain after COVID-19,” and “pain related to COVID-19” from March 11, 2020, to March 1, 2021, using the “relevance” filter. 
  • The authors restricted each search to the first 50 videos, yielding 150 videos screened.
Wrap It Up Our findings highlight that musculoskeletal/nociceptive pain in the back and extremities and visceral pain in the abdomen and chest are the most commonly reported pain types. Not surprisingly, the intended audience was patients, with an overall objective to educate on pain symptoms in most videos. This information is important, as it provides patients an explanation of the various pain generators in the body and the expected type of pain quality.  The general public may be unaware that COVID-19 infection, a disease primarily having pulmonary and cardiovascular manifestations, can actually cause painful symptoms, even in seemingly disparate areas such as the eyes or genitourinary system. However, only a minority of videos (15%) provided education on pain management. Thus, clinicians should consider focusing time on educating patients on treatment options, as publicly available sources are lacking in this component. Item #2 Thsi one is called “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations” by Brinjikji et. al.  (Brinjikji W 2015) and published in AJNR in 2015.  Why They Did It
  • They say in the abstract that degenerative changes are commonly found in spine imaging but often occur in pain-free individuals as well as those with back pain. 
  • They sought to estimate the prevalence, by age, of common degenerative spine conditions by performing a systematic review studying the prevalence of spine degeneration on imaging in asymptomatic individuals.
How They Did It
  • We performed a systematic review of articles reporting the prevalence of imaging findings (CT or MR imaging) in asymptomatic individuals from published English literature through April 2014. 
  • Two reviewers evaluated each manuscript. We selected age groupings by decade (20, 30, 40, 50, 60, 70, 80 years), determining age-specific prevalence estimates. 
What They Found
  • Thirty-three articles reporting imaging findings for 3,110 asymptomatic individuals met our study inclusion criteria. 
  • The prevalence of disk degeneration in asymptomatic individuals increased from 37% of 20-year-old individuals to 96% of 80-year-old individuals. 
  • Disk bulge prevalence increased from 30% of those 20 years of age to 84% of those 80 years of age. 
  • Disk protrusion prevalence increased from 29% of those 20 years of age to 43% of those 80 years of age. 
  • The prevalence of annular fissure increased from 19% of those 20 years of age to 29% of those 80 years of age.
Wrap It Up
  • Imaging findings of spine degeneration are present in high proportions of asymptomatic individuals, increasing with age. 
  • Many imaging-based degenerative features are likely part of normal aging and unassociated with pain. 
  • These imaging findings must be interpreted in the context of the patient’s clinical condition.
Don’t see it on an. Image and immediately assume that’s the issue. Phantom Limb pain exists in chronic pain conditions so why can’t low back pain be a phantom back pain? Take a long hard look at the biopsychosocial part of things. If you cannot line up the cliinical patient with the image, don’t make a big deal out of the findings because it’s likely meaningless.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Brinjikji W, L. P., Comstock B, Bresnahan BW, Chen LE, Deyo RA, Halabi S, Turner JA, Avins AL, James K, Wald JT, Kallmes DF, Jarvik JG (2015). “Systematic literature review of imaging features of spinal degeneration in asymptomatic populations.” AJNR Am J Neuroradiol 36(4): 811-816.   Ryan S D’Souza, M., Anthony E Kilgore, Shawn D’Souza (2022). “Manifestations of Pain During the COVID-19 Pandemic Portrayed on Social Media: A Cross-Sectional Study,.” Pain Medicine 23(2): 229-233.    

Sleep, Energy, and Pain & Depression and Rehab

Today we’re going to talk about Sleep, Energy, and Pain & Depression and Rehab

... continue reading.

Sitting On Your Butt And The Future Of American Pain

CF 214: Sitting On Your Butt And The Future Of American Pain Today we’re going to talk about Sitting On Your Butt And The Future Of American 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 #214 Now if you missed last week’s episode , we talked about the Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain. Make sure you don’t miss that info. Keep up with the class.    On the personal end of things….. Short ans sweet today folks becauuse I have just 3 days to fit in 5 days of work. Come Thursday, I’m off to Delray Beach, FL. Now that sounds amazing and all vacation-y right?/ Well it’s bidniz. I’m taking my wife and duaghter so it’s vacation-y for them but for me, I was invited to be part of a nationwide chiropractic mastermind. To help each other solve their problems, to network, and to conquer. And that’s the stuff I love being a part of. I can’t wait to put the things I learn into effect here in my cliniic and I can’t wait to help someone else that can maybe learn something from me. Who knows what they can learn from me? Guitar maybe. Lol So, the front desk girl I bragged on. She got a better job I guess. Working only 3 days a week and making the same money. Can’t blame her. I jsut got the back office staff filled and now to fill the front desk.  Time’s are tough folks. But that’s OK. I’ve been at it 24 years. No keeping this old dog down. I was here far before any staff and I don’t plan on going anywhere any time soon.  So, off to Indeed I go to find a new employee.  Let’s get on with the show so I can go hire someone.    Item #1 The first one this week is called ‘Association between sedentary behavior and low back pain; a systematic review and meta-analysis” by Mahdavi, et. al. (Mahdavi SB 2021) and published in Health Promotion Perspective in 2021 so that means it’s steamy hot.    Why They Did It Sedentariness is a substantial risk for many chronic diseases. We aimed to investigate the correlation of sedentary behavior and its indicators with low back pain (LBP) among adults and children   How They Did It
  • Original articles published up to April 28, 2020, using PubMed, Embase, Web of Science and Scopus were evaluated
  • We reviewed 49 English articles with analytical observational study design, of which, 27 studies with cross sectional/survey design were retained in the meta-analysis
  What They Found
  • Among adults, sedentary lifestyle was a considerable risk factor for LBP; prolonged sitting time and driving time were the significant risk factors. 
  • Sedentary behavior was associated with LBP in office workers. 
  • Moreover, excess weight and smoking were associated with LBP. 
  • Among children, sedentary lifestyle was a remarkable risk factor for LBP; prolonged TV watching and computer/mobile using and console playing time were significant risk factors for LBP. 
  Wrap It Up Sedentary behavior, whether in work or leisure time, associates with a moderate increase in the risk of LBP in adults, children and adolescents.   Item #2 The last one this week is called, “Decoding the mystery of American pain reveals a warning for the future” by Case et. al. (Case A 2020) and published in Proceedings of the National Academy of Sciences of the United States of America in September of 2020.    Why They Did It There is an expectation that, on average, pain will increase with age, through accumulated injury, physical wear and tear, and an increasing burden of disease. Consistent with that expectation, pain rises with age into old age in other wealthy countries. However, in America today, the elderly report less pain than those in midlife. This is the mystery of American pain.   How They Did It Using multiple datasets and definitions of pain, we show today’s midlife Americans have had more pain throughout adulthood than did today’s elderly.   What They Found Disaggregating the cross-section of ages by year of birth and completion of a bachelor’s degree, we find, for those with less education, that each successive birth cohort has a higher prevalence of pain at each age-a result not found for those with a bachelor’s degree.  Thus, the gap in pain between the more and less educated has widened in each successive birth cohort.  The increase seen across birth cohorts cannot be explained by changes in occupation or levels of obesity for the less educated, but fits a more general pattern seen in the ongoing erosion of working-class life for those born after 1950.  If these patterns continue, pain prevalence will continue to increase for all adults; importantly, tomorrow’s elderly will be sicker than today’s elderly, with potentially serious implications for healthcare. Dayum…..I know I need to get an associate in here because my back hurts all the damn time and I don’t have time to be running around town looking for a chiropractor that can fit me in.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.09-AM-150x55.jpg
The Message   I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!   Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!   Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.    Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.   Website
Home
  Social Media Links https://www.facebook.com/chiropracticforward/   Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/   Twitter   YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q   iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2   Player FM Link https://player.fm/series/2291021   Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through   TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/   About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Case A, D. A., Stone AA., (2020). “ecoding the mystery of American pain reveals a warning for the future.” Proc Natl Acad Sci U S A 117: 24785-24789.   Mahdavi SB, R. R., Vahadatpour B, Kelishadi R, (2021). “Association between sedentary behavior and low back pain; A systematic review and meta-analysis.” Health Promot Perspect 11(4): 393-410.    

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

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.

Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection

CF 187: Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection

Today we’re going to talk about Hypermobile Patients, Sports-Related Concussion, & Obesity’s Pain Connection 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. 

  • 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 #187 Now if you missed last week’s episode , we talked about the western diet and its effects and we talked about some pretty cool acupuncture research. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Our nurse practitioner starts on August 2nd but we are having a hard time getting our malpractice person to respond to us and get that in place. We can’t get credentialing until that happens. Credentialing takes at least 2 months typically.  So, you see the issue. That was an unplanned obstacle.  We are in the process of changing our signage on the front of the building as well. We have one big sign out on the main street so that’s two inserts…..one for each side. 

Then we have two suites here so we have two doors. Which means we have two signs on the front of the building. So, added up, we get to order 4 inserts. Signs aren’t cheap if you’ve had to put one in lately.  Those are just some of the things that we’re messing with lately.  Clinic numbers, we are in week 3 with some good solid numbers. Not pre-COVID numbers but getting there. I’ll be honest with you, I’m not sure I want pre-COVID numbers. There were weeks I was at 220 appointments for the week. 25 new patients, re-exams running out my ears.  Now, that’s not bragging. I’m not there anymore. What I’m saying is that sometimes, it’s too much. In healthcare, you really can be too busy. Things start falling through the cracks.  My mom had a bone density test misread because her primary is simply too busy. He took responsibility and, other than putting her back surgery off longer than it should have, no harm was done. But the point is, we can get too busy.  I am extremely conservative in my finances. I don’t like taking big chances. I don’t like huge what-ifs. I like small, measured, and reasonable risks. You cannot eliminate risks. But we can mitigate them. We can make them minute instead of big gaping holes.  I should have hired an associate. And to be fair, we started to do that. It just simply fell through. And it was a blessing in disguise when you consider what COVID did to our practice. Now we get a chance to potentially say, “‘If I could go back and do that all over again…..” 

At this time, I’m at a point in my caseload that it’s all fairly easily manageable. We’re at probably 165-170 per week. That’s manageable for evidence-based, patient-centered practice. We are rehab-heavy. Rehab takes time and I have an excellent staff and ChiroUp to help me make it all happen.  However, if we get to the 190-200 appointments per week range, it’s time to start shopping for an associate. It’s too much and too many other things I’m trying to accomplish both personally and professionally suffer from that caseload.  And my brain space is just destroyed if I’m being honest. It’s not fun to go to work when you’re overwhelmed every day. It’s unpleasant. Even when the majority of your patients are amazing people. Nobody wants to go to doctors that are overwhelmed like that and I don’t want to be one of those doctors either.  So, just a little brain dump there and some free-flow thought for you. I have an intern coming in from Parker College in September. That’ll be my first intern to have onboard so who knows….maybe that ends up being a long-term thing.

Maybe not.

Time will tell.  On the horizon for me, real estate investing!! Regular listeners may have heard me talk about exit strategies. If you’re a thinker, you’re not only thinking about today but what you want out of tomorrow. I’ve been in business for over 23 years at this point and have never taken more than 5-7 days of vacation at a time. I’ve never been to Europe or anywhere outside of the Caribbean.  So, smart moves is what get us there. We are in a business where our presence is mandatory for a business to continue. In essence, our business owns us. Not the other way around. So how do we flip it? Well, we need people in place that fill the gap when we are out. We need to be the CEO instead of the hands-on worker. That’s part of the reason we are bringing in a nurse practitioner. That’s part of the reason we’ll be looking for an associate when the numbers truly rebound.

That’s the reason I started a voice-over side gig, which is going amazingly by the way. What a blessing that has been, y’all. I can’t even begin to tell you how well that’s going. I’ve voiced over 200 spots just since January. That’s over 33 per month. It’s been insane. That’s also the reason that real estate investing is my next mountain.  Mailbox money, y’all. Now, real estate investing takes effort and work so it’s not technically mailbox money but, when done right, is the fastest path to financial freedom. That’s the reason for the book I wrote and the speaking opportunities I’m getting involved in.  These are all potential paths toward early, comfortable, happy, partial retirement. Retirement to me doesn’t mean any work. It means control of my time. So in that context, retirement cannot come quite soon enough.  So, what’s your exit strategy? Are you going to work until you’re 88 and die at your desk in your office?

Which some want…and there’s not a thing in the world wrong with that. Or, do you have other things in your life to accomplish and need to start planning for that? Some say you need to start with the ending in mind. If you want to sell your business someday, shouldn’t you plan for that from the start? How do you build a business that’s ready to sell when it’s your time? Something to think about. I’m not sure I have all of those answers because they continue to unfold as I progress but I’m getting closer to solid ideas and strategies on it.  Alright….on to the research. 

Item #1

Let’s get it started this week talking about hyper mobility, Ehlers-Danlos, and all that good stuff. If you don’t really consider hypermobility in your daily treatment…..please….for the love of everything holy, please listen up and pay attention. This is where so many chiropractors are getting it wrong.  It’s becoming more and more clear every year that a good chiropractor should know when to mobilize and when to stabilize. Some of you are no doubt asking yourselves, what the hell does that mean? Sometimes the spine doesn’t want to be adjusted. There is already a plethora of movement there. Adjusting only increases the motion in an area that the increased motion is what is actually causing the complaint. In these cases, when in the hands of a vitalistic, subluxation, philosophy, doctor-centered chiropractor, this patient is going to get adjustment after adjustment for weeks and weeks.  I’m sure you can predict the eventual outcome here. And it’s not corrections of a subluxation. It’s spinal instability that compounds the issue.  The condition and patient population that is at increased risk here would be self-adjusters but mostly, those suffering from Ehlers-Danlos, which if you are unfamiliar, is a connective tissue disorder that allows these folks to behave a bit like an elastic rubber band. 

A hint of whether someone is EDS is the Beighton Scale. If I stand a new patient up and have them touch their toes and they put their hands flat on the floor, they’re getting put through the Beighton Scale to test for hypermobility. We need to know if they have too much movement in their joints. Because instead of more adjustments and more movement in the segments of the spine, they typically respond better to weight training, supportive activities and strengthening. 

This paper is called “Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review” by Gregory Reychler and Maya-Mafalda De Backer et. al. (Reychler 2021) and published in the American Journal of Medical Genetics on June 19, 2021…. My glasses….they’re steamed up..it’s hot.  Why They Did It The objective of this systematic review was to investigate the effect of the different physiotherapy techniques related to the children and adult patients with hEDS How They Did It

  • PubMed, SPORTDiscus, Cochrane Library, PEDro, Scopus, and Embase databases were analyzed from inception to April 2020.
  • Characteristics of the studies (authors), patients (sample size, sex, age, Beighton score), and non-pharmacological treatment (length of the program, number of sessions, duration of the session, and type of intervention), and the results with the dropout rate were extracted. 
  • From the 1045 retrieved references, 6 randomized controlled trials with a sample size ranging from 20 to 57 patients were included in the systematic review
  • There was a huge heterogeneity in the interventions. The duration of the program were from 4 to 8 weeks

What They Found

  • Pain or proprioception demonstrated significant improvements in the intervention group regardless of the type of intervention. 
  • A benefit of the inspiratory muscle training was observed on functional exercise capacity.
  • The quality of life was systematically improved.

Wrap It Up

Physiotherapy benefits on proprioception and pain in patients with hEDS even if robust randomized control studies are missing. Now, the full paper isn’t available for me to ingest so who the hell knows what all interventions these patients underwent. We don’t know. But, physiotherapy is Europe and Canada and Australia’s term for physical therapy. We know what PT is and in these patients, I’m assuming it is exercise and building strength and proprioception and balance.  All of that also helps clear up the joint and movement map in the brains of chronic pain patients. Which leads to more accurate sensorimotor function, less aberrant movement in the joints, more confidence in abilities and future capabilities, and less pain as an overall result.  And yes, I just tossed a bucket of Neuromusculoskeletal Medicine Diplomate on top of all of your heads. And didn’t it feel warm and fuzzy??

Of course it did and you’re welcome.  Let’s hear from our awesomely amazing sponsors. 

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Item #2 This second one is called “Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry” by Dong et. al. (Dong HJ 2021) and published in the Journal of Pain Research in February of 2021 and that’s holy mother of Hades hot. 

Why They Did It It is known that chronic pain makes it difficult to lose weight, but it is unknown whether obese patients (body mass index ≥ 30 kg/m2) who experience significant pain relief after interdisciplinary multimodal pain rehabilitation (IMMPR) lose weight. This study investigated whether obese patients with chronic pain lost weight after completing interdisciplinary multimodal pain rehabilitation in specialist pain units. The association of pain relief and weight change over time was also examined.

How They Did It

  • Data from obese patients included in the Swedish Quality Registry for Pain Rehabilitation for specialized pain units were used, including baseline and 12-month follow-up after IMMPR from 2016 to 2018
  • Patients reported body weight and height, pain aspects (eg, pain intensity), physical activity behaviors, psychological distress, and health-related quality of life
  • A reduction of at least 5% of initial weight indicates clinically significant weight loss. 

What They Found

  • A significant reduction of pain intensity was found after interdisciplinary multimodal pain rehabilitation 
  • A similar proportion of patients in the three groups with different pain relief levels had clinically significant weight loss 
  • Significant improvements were reported regarding physical activity behavior, psychological distress, and health-related quality of life, but weight change was not associated with changes of pain intensity.

Wrap It Up

“About one-fifth of obese patients achieved significant weight reduction after interdisciplinary multimodal pain rehabilitation. Obese patients need a tailored pain rehabilitation program incorporating a targeted approach for weight management.”

Item #3

The last on his called “Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review” by Eliott, et. al. (Elliott 2021) and published in Sports Medicine on June 18, 2021. It’s a big ol’ pot of hot. 

Why They Did It To systematically review the literature to investigate: (1) the relationship between neck strength and sport-related head and neck injuries (including sport-related concussion (SRC); and (2) whether neck exercise programs can reduce the incidence of (a) sport-related head and neck injuries; and (b) sport-related concussion.

How They Did It

  • Five databases and research lists of included studies were searched
  • From an initial search of 593 studies, six were included in this review

What They Found

  • The results of two observational studies reported that higher neck strength, but not deep neck flexor endurance, is associated with a lower risk of sustaining a sports-related concussion. 
  • Four intervention studies demonstrated that injury reduction programs that included neck exercises can reduce the incidence of sport-related head and neck injuries including sports-related concussion.

Wrap It Up

Consideration should be given towards incorporating neck exercises into injury reduction exercise programs to reduce the incidence of sport-related head and neck injuries, including sports-related concussion. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.       

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

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

Website https://www.chiropracticforward.com

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TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

  • Dong HJ, D. E., Rivano Fischer M, Gerdle B, (2021). “Lose Pain, Lose Weight, and Lose Both: A Cohort Study of Patients with Chronic Pain and Obesity Using a National Quality Registry.” J Pain Res 14(1863-1873).  
  • Elliott, J., Heron, N., Versteegh, T, (2021). “Injury Reduction Programs for Reducing the Incidence of Sport-Related Head and Neck Injuries Including Concussion: A Systematic Review.” Sports Med.  
  • Reychler, G., De Backer, M.-M., Piraux, E., Poncin, W., & Caty, G, (2021). “Physical therapy treatment of hypermobile Ehlers–Danlos syndrome: A systematic review.” American Journal of Medical Genetics: 1-9.          

Impact Of Chiropractic Care on Opioid Use & Garbage Marketing In The Chiropractic Profession

CF 163: Impact Of Chiropractic Care on Opioid Use & Garbage Marketing In The Chiropractic Profession

Today we’re going to talk about the impact of chiropractic care on opioid use and then we’ll talk about garbage marketing in the chiropractic profession. I go off a bit. I can’t help it. They make me nuts.  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. 

You have found yourself smack dab in the middle of Episode #163 Now if you missed last week’s episode , we had Dr. Bobby Maybee of the Forward Thinking Chiropractic Alliance and the Chiropractic Success Academy. It was Part Two of a two-part interview that I think you’ll all get plenty of excellent insight and inspiration from. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I had the second Moderna vaccine shot on January 20th and all’s well. My experience is that, if you remember, I had zero symptoms with the first shot. Not even a sore arm. Nothing at all.  With this second one, I had a pretty sore arm. It felt like when I got the flu shot. Just a sore arm. It was red for a couple of days too. It was honestly about two days and that was it. I may have been hyperfocused on whether I was having symptoms or not but was maybe a touch tired that day.

I got the shot at 2:30 in the afternoon and then went back to work until 6pm so….I may have been a touch draggy but like I said, that could have just been me being hyperfocused. It wasn’t anything very noticeable.  My wife felt a little crummy for one day. Then she was back at it.  Overall, not a bad deal. They say the full protection is approximately 2 weeks after shot #2 so we’re looking pretty good and, outside of the first two weeks we took off in late March of 2020, I haven’t had to take any days off due to illness and if it all works out, I won’t have to in the future. As a result of COVID anyway.  As I’ve said here, I don’t think it’s unreasonable at all to wait to get yours until you’ve seen how everyone else reacts to it.

I really don’t. I’m not a ‘get your shot instantly’ type of guy. Especially if you have associates that will pick up your slack should you get COVID and be out sick. But when you’re a solo doc like me, the business depends on your presence. I can’t get sick and be out for 2-4 weeks. Some folks are out much longer than that. For me, there’s nothing that makes more sense than getting the vaccine as quickly as possible.  In addition, I have a wife that is 100% over this mess and is ready to go traveling. So, happy wife – happy life in full effect.  Also, I have a local surgeon running advertisements all over TV and it makes me want to punt baby bunnies into the stratosphere.  He says in thw commercial that we all deserve to live without pain and then he goes into his campaign in support of back and neck surgery. Who am I to try to keep someone from marketing their business?

But day-um. One word, two syllables. Day-um. 

Years ago it was illegal to run an ad for hard liquor. You don’t see any cigarette commercials do you?  Now, I’m not saying surgery is equal to cigarette smoking and hard liquor but I know several that have done worse through one surgery they they would ever do from a life of smoking and drinking.  I see that commercial come on TV and I start talking to the TV. I have a strongly worded conversation with the TV every time. It’s because I know that there’s little to no support for spinal surgeries in the research and there’s not better outcomes from them either. The problem is that the common, every day patient does not know that. 

They see the damn white coat and lose their damn minds and just say, “OK.” A pharma commercial could say that you butt could fall out of you walking across a room if you take this medicine and people would still line up for it.  You tell them we’re going to get you moving and exercise and they think you’re dangerous or crazy. It’s a conundrum.  Alright, let’s get to the good stuff shall we?

Item #1

This first item is called “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain” by Whedon et. al(Whedon JM 2020)….there’s that Whedon name again. It was published in Pain Medicine in December of 2020 and that a lot hot

Why They Did It

Utilization of nonpharmacological pain management may prevent unnecessary use of opioids. Our objective was to evaluate the impact of chiropractic utilization upon use of prescription opioids among patients with spinal pain.

How They Did It

  • The total number of subjects was 101,221.
  • It was a retrospective cohort design for analysis of health claims data from three contiguous states for the years 2012–2017.
  • included adults aged 18–84 years enrolled in a health plan and with office visits to a primary care physician or chiropractor for spinal pain.
  • We identified two cohorts of subjects: Recipients received both primary care and chiropractic care, and nonrecipients received primary care but not chiropractic care.
  • We performed adjusted time-to-event analyses to compare recipients and nonrecipients with regard to the risk of filling an opioid prescription. We stratified the recipient populations as: acute (first chiropractic encounter within 30 days of diagnosis) and nonacute (all other patients).

What They Found

Overall, between 1.55 and 2.03 times more non-recipients filled an opioid prescription, as compared with recipients.  Similar differences were observed for the acute groups.

Wrap It Up

Patients with spinal pain who saw a chiropractor had half the risk of filling an opioid prescription. Among those who saw a chiropractor within 30 days of diagnosis, the reduction in risk was greater as compared with those with their first visit after the acute phase. CHIROUP ADVERTISEMENT

Item #2

Alright, I’m going after vitalists a bit here today in item #1. I came across a script and I just can’t ignore this stuff anymore. If we’re not willing to call it out, then we are complicit. And I refuse to be that. In fact, if you have any of these scripts you’ve been given from vitalist gurus, please email them to me at [email protected] I would love to read them on future podcasts and discuss my disdain for the tom foolery within. 

This script is to be used when a patient hasn’t been in for a while. It’s basically used to scare the holy hell out them and force them back to your office because…..you know…..they depend on you to keep them healthy and there are no other means of keeping one healthy outside of the removal of the magical subluxation.  So, here is the script: Dear Patient I have been thinking about you! (with an exclamation mark because, you know….bilking and scaring people is super exciting and all). I realized I have not seen you in a while.

So, I reviewed your file and looked at your last x-ray.  I am concerned that based on your past history, you might be suffering the effects of spinal degeneration without being aware of it. The first effect of spinal degeneration is that the nerve that supplies the area stops performing its normal function.  This means that your nerve is unable to alert you to a problem that is potentially developing…. That’s not emotionally manipulative at all now, is it? It would be like cutting the wire to your fire alarm when your house is on fire!!! OMG!! Cutting….it sounds so awful!! 

The alarm can’t warn you of the fire in time to get out of the house, Holy s-word!!! That must mean I’m going to burn the hell up then. I better call this knucklehead’s office and be seen before I look like a crispy curly fry!! Gimme a damn break. I can’t believe professionals are sending out garbage like this.  It continues; Another sign of spinal degeneration is the loss of flexibility. You lose files without being aware of it. You begin to turn with your shoulders instead of using your neck.

You lift with your back instead of bending your knees. You should have enough flex to enjoy your life. This means you should be able to get out of bed in the morning without feeling stiff or sore. It means you can do the things you enjoy in life. You should be flexible enough to exercise and enjoy your hobbies and leisure time including sitting down to watch your favorite TV programs without being stiff when you get back up. 

The most serious effect of spinal degeneration is loss of vitality. Oh that sounds horrible. Not vitality!!  You should feel healthy!! Yes, you should but you can do that by making yourself move and exercise and eat better while getting a good amount of sleep. You don’t need a chiropractor to feel healthy.   You should have a sense of wellness and energy. You should be able to get out of bed ready to go. You don’t feel this way when your systems do not function properly. You feel that something is just not right but you can’t quite put your finger on it.

You feel stressed and tense. Yeah….like 100% of every other American on this planet.  Last paragraph of the garbage. 

I have set aside the next month for you as “Welcome back to Chiropractic month.” Damn, that’s so nice. They set aside a whole month for me. Sweet bastards. 

Do yourself a favor and call our office to schedule a visit. I will perform a ‘back to chiropractic adjustment and exam including x-rays if needed at no cost.’ Way to value you treatment, doc!! This visit has a normal valued of up to $175 and is yours absolutely FREE during the next month. It’s my way of encouraging you to get back on track and avoid the consequences of spinal degeneration. Please bring the enclosed ‘back to chiropractic’ coupon with you when you come to the office. I look forward to seeing you again soon! Now, if you can read through that without throwing up, congratulations. You have a stomach of iron.

Secondly, if you ever hear a vitalist claim they do not use scare tactics to take advantage of their patients, they’re simply not being honest. In essence, that’s exactly what the subluxation theory is in the first place. IT’s a scare tactic. The silent killer, right? You’ll get sick, you’ll be unhealthy. You’ll develop degeneration. Not because of the consequences of normal freaking aging but because you had all those subluxations all up in ya. 

Talking about the person and using the word ‘you’ is a sales tactic. They use the word ‘you’ or its variants 39 times in that mess of a sales letter.  Can I say that I’m not sure I’ve gotten a birthday card from my family MD much less a scare tactic-laden sales letter.  We can do better than this folks.

Crap like this make us all look like fools. Not to mention what it makes the ones sending their crap out look like. They look like bozo the clown in full makeup, y’all.  “I am concerned that based on your past history, you might be suffering the effects of spinal degeneration without being aware of it. The first effect of spinal degeneration is that the nerve that supplies the area stops performing its normal function.”

Come on man. Spinal degeneration is a normal part of aging. You quit building bone and then you start to regress over the years. This is natural. Stop making patients believe they have to depend on you. It’s not right and if the state boards have any teeth on this kind of garbage, they should start using it. That’s if chiropractic is ever going to step its game up.  We are better than this. When you and your heart and your business are built on things like, honestly, ethics, character, education, and love……you could never in your life send out something like that.  When you are built on selfishness, low-character, deceitfulness, and an anything to get ahead, then you’re more than happy to send it out and you won’t think twice when they come in because you scared them and then you scare them into treating every other week for the next year with upfront payment, blah blah blah. How do these types of practitioners live with themselves?  The absolute worst are the ones that claim it’s a God thing.

If they don’t come in and get their regular adjustment, they can’t allow God to express his true power in their body’s? Oh….is that right? The dude we Christians claim created the world and man in his own image……the dude controlling everything on Earth and beyond…..that dude needs a chiropractor to adjust their patients all of the time because he didn’t make quite perfect enough. The hell you say.

Remember, I’m a Christian. I can make fun. The hypocrisy in this type of practitioner is about as low as it gets for me.  All of these practitioners have big houses. No doubt. But at what cost personally and to our profession?  We’re better than that. Stop it dammit. Stop it now

Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

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

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.

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography Whedon JM, T. A., Kazal L, Bezdijian S, (2020). “Impact of Chiropractic Care on Use of Prescription Opioids in Patients with Spinal Pain.” Pain Med 21(12): 3567-3573.  

New Paper: Spinal Manipulation Has No Effect On Chronic Pain – Our Experts Rebuttal

CF 143: New Paper: Spinal Manipulation Has No Effect On Chronic Pain – Our Experts Rebuttal  

Today we’re going to talk about a new paper in JAMA saying that spinal manipulative therapy has not effect. Yeah…..BIG topic today so keep your seat, buckle up, I got some stuff to say. 

But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are 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 #143

Now if you missed last week’s episode , we talked about nonoperative disc treatment, Vitamin D3 for depression, and the biopsychosocial part of chronic pain. I used big words on this one folks. 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…..

First thing is, my website is jacking up in the last few weeks and it’s about to make me lose every marble I ever had in my noggin. So if you prefer reading the transcript on the website or listening via the website, I apologize if you’ve had issues doing so lately. Trust me, I am working diligently with people that know how to do this stuff to get it lined out and working properly and dependably

Next, my kid is coming home for the weekend from college. Pretty excited to see the knucklehead. 

My practice was busier this week. Not necessarily in the total numbers of visits. We ended up somewhere back around 140 last week. Which was about where we started when we came back from COVID full time. 

We were at about 140-145 or so per week and then fell off to about 125. That was mad Jeff time. Pouty Jeff time there. But, it was also back to school time and that’s traditionally the slower part of the year for me. 

Last week, we ended up with about 22 new patients in one week. Hell yeah I’ll take it. Bet you’re sweet bippy….pass me some more of that deep dish of deliciousness. 

That 22 should boost next week’s totals and that makes for content Jeff. Not happy…..no….I’m still down from Pre-Rona and still don’t have an associate so….not happy Jeff but definitely more content Jeff. Not only did I have the 22 new patients but a heaping spoonful of re-exams on patients that haven’t been in since the Rona began ruining crap. 

So, all in all, we’re moving the right direction. 

I was listening to an episode of mine from a couple of weeks ago. Kind of like game tape. Like the coaches go back and watch the game tape so they can learn about what they want and don’t want. My wife just says I like to hear myself talk and to her I say….you are fake news. 

But anyway, I predicted that by now, more schools would be closing down. At the moment, I stand corrected. More schools have not yet shut down. I also said that I hope I am wrong. And I’m saying right now that I’m glad I was wrong. I’m a big enough man to say it out loud and proclaim mine own idiocy!! 

Or am I an idiot. Today, which is 9/4, happy birthday to my wife Meg BTW, today I took note that Lubbock has reported 849 new cases in the last 3 days. Three days, y’all. 

They’re averaging 283 new cases every single day. And it’s because of that college. A little birdy in the Texas Tech healthcare system told me they got an internal email saying basically that things are getting out of control on the campus already because people living off-campus are being dumb and spreading it on campus. They say it’s expected to get a lot worse after this weekend. 

So, maybe I’m not an idiot after all. We know the incubation on this thing is about 2 weeks and they went to school right at 2 weeks ago. And now here we are. 

I do still believe it’s only a matter of time but for now, I was sort of wrong and I’m sort of OK with it. 

Let’s get on with it shall we?

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.

Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  

Picture a T bar with a built-in drop piece.  This greatly reduces the time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.

It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #1

Alright, let’s get to this POS paper. I say that because it doesn’t confirm my bias. Lol. It’s called “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial” by Thomas et. al(Thomas J 2020). published in JAMA on August 5, 2020. Hot steamy pile of dog crap here…big plate of shooey. 

Why They Did It

To evaluate the comparative effectiveness of spinal manipulation and spinal mobilization at reducing pain and disability compared with a placebo control group (sham cold laser) in a cohort of young adults with chronic LBP. As if this question has not already been answered a million jillion times. 

How They Did It

  • The study was single-blinded
  • placebo-controlled randomized clinical trial
  • 3 treatment groups
  • Conducted at the Ohio Musculoskeletal and Neurological Institute at Ohio University from June 2013 to August 2017
  • 4903 subjects eligible
  • 4741 did not meet inclusion criteria
  • 162 patients with Chronic Low Back Pain qualified for randomization 
  • Participants received 6 treatment sessions of 
  • spinal manipulation
  • spinal mobilization
  • sham cold laser therapy – placebo – during a 3-week period. 
  • Outcome measures were the change from baseline in Numerical Pain Rating Scale (NPRS) score over the last 7 days and the change in disability assessed with the Roland-Morris Disability Questionnaire 48 to 72 hours after completion of the 6 treatments.

What They Found

  • There were no significant group differences for sex, age, body mass index, duration of LBP symptoms, depression, fear-avoidance, current pain, average pain over the last 7 days, and self-reported disability.
  • At the primary endpoint, there was no significant difference in change in pain scores between spinal manipulation and spinal mobilization, spinal manipulation, and placebo, or spinal mobilization and placebo
  • There was no significant difference in change in self-reported disability scores between spinal manipulation and spinal mobilization, spinal manipulation, and placebo, or spinal mobilization and placebo

So it appears from this paper that spinal manipulation and spinal mobilization has absolutely NO utility NO use and makes NO sense for anything. Basically. This….when so many other papers have shown incredible utility, incredible effectiveness, and incredible cost-effectiveness. It makes very little to zero sense at all. 

Wrap It Up

Their conclusions was as follows, “In this randomized clinical trial, neither spinal manipulation nor spinal mobilization appeared to be effective treatments for mild to moderate chronic LBP.”

OK, I had to consult with those much smarter than I to really get a full picture of what’s going on here. Because I feel like someone’s picking on us a little here. You cannot have so many papers supporting spinal manipulative therapy and then this say there’s no use whatsoever. You simply can’t. Something smells awry in the land of Denmark, up in here, up in here. 

I’ll start with Dr. James Lehman. Dr. Lehman is an Associate Professor of Clinical Sciences at the University of Bridgeport/College of Chiropractic and Director of Health Sciences Postgraduate Education. Dr. James Lehman is a board-certified, chiropractic orthopedist. He teaches orthopedic and neurological examination and differential diagnosis of neuromusculoskeletal conditions. In addition, he provides clinical rotations for fourth-year chiropractic students and chiropractic residents in the community health center and a sports medicine rotation in the training facility of the local professional baseball team. He’s the driving force behind the Diplomate program for Neuromusculoskeletal Medicine. 

As Director, Dr. James Lehman developed the three-year, full-time resident training program in chiropractic orthopedics and neuromusculoskeletal medicine. The program offers training within primary care facilities of a Federally Qualified Health Center and Patient-Centered Medical Home. While practicing in New Mexico, he mentored fourth-year, UNM medical students. He has been generous with advice and mentorship for yours truly as well. We could go on and on. 

I sent this paper to Dr. Lehman and asked for his opinion on it. 

Dr. Lehman said, “I am not favorably impressed with the study for several reasons. It is my opinion that this study was simplistic and non-specific. When studies base the effort on determining the outcomes of a specific modality without a specific diagnosis, I question the outcomes.

 

As a chiropractic specialist, I use the definition promulgated by the National Pain Strategy. Chronic pain occurs more than 50% of the days for six months or longer. This study mentioned that pain occurred only greater than 3 months with no mention of the number of days that pain was experienced. In addition, this study used only mild and moderate chronic pain. It is my opinion that these patients may be experiencing mild symptoms for several reasons that are not relieved by manual medicine interventions. For example, poor posture and distress with resultant myofascial pain without joint dysfunction. Another example would be a patient with a true chronic pain condition that has centralized in the CNS.  These patients normally experience only a reduction in pain for a short period of time.

 

This study offers a simplistic diagnosis and not one that indicates the need for manual medicine interventions.

 

I always question studies that base the need of spinal manipulation on the finding of reduced joint motion. Although chiropractic programs teach motion palpation, the evidence demonstrates the examination procedure to be less than dependable.

 

“Regardless of the degree of standardization, interrater reliability of motion palpation of the thoracic spine for identifying pain and motion restriction performed by experienced examiners was poor and often not better than chance. These findings question the continued use of motion palpation as part of the clinical assessment as an isolated tool to detect loss of intersegmental joint play.” Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480941/

 

As we know, patients that present for chiropractic care for chronic low back pain demonstrate pain scale findings higher than 2/10 but more likely 5-10/10. Less than 5/10 indicates that the pain does not interfere with the patient’s activities of daily living. Hence, I believe the study was poorly designed. Why study the effectiveness of a manual medicine for an insignificant condition?

Thank you Dr. Lehman for such a thorough response and for laying out his thoughts so effectively on this. He really is a gem of this profession. 

I exchanged emails with Dr. Christine Goertz. Her resume is again, so long and impressive that we can’t do it right here but, in short, she is the Chief Operating Officer of the Spine Institute for Quality. She is also an Adjunct Associate at the Department of Orthopaedic Surgery, Duke University Medical Center, and Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. She has received nearly $32M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and has authored or co-authored more than 100 peer-reviewed papers. 

I almost hated to ask Dr. Goertz because I know how busy she is, but honestly, who better to ask, right? And, at the end of the day, I followed an old saying I’ve kept in mind my whole life. And that saying is, “No asky, no getty”

And, as expected, she did not have the chance to dive into it headfirst but did offer this, “Although I can’t comment on the details of the methods Without a deeper dive, one thing that strikes me is the decreased utility of studying spinal manipulation in isolation, as it is generally delivered in the larger context of chiropractic care.”

Which alludes to something I’ve said on this podcast so many times. Chiropractic according to every chiropractor outside of strictly subluxation slayers, is not a modality. It is a profession with A LOT of tools under its umbrella. Still, there’s something smelly about a paper claiming absolutely zero effectiveness of SMT. Really? None?

I emailed one of the smartest dynamic duos I have ever experienced in my entire chiropractic career, Dr. Anthony Nicholson and Dr. Matthew Long. They’re like the batman and robin of chiropractic geniuses. Honestly, good luck finding more intelligent and more thoughtful chiropractors anywhere. They are the creators of all online education curriculum through the CDI courses which are what is used by the Diplomate of Neuromusculoskeletal Medicine. Dr. Nicholson is a Diplomate of Orthopedics as well as a Diplomate in Neurology. 

Dr. Nicholson shared this with me. He said, “In relation to the article, firstly, I’d say that I don’t have researcher-level credentials in critiquing study design, validity, statistical methods etc.

I do obviously read a fair bit of research and integrate that with teaching and clinical experience.

This study seems pretty light to me in several respects and I’m not surprised by the conclusions.  The number of participants was pretty low (162), which lowers the power of the study to draw accurate conclusions.  Overwhelmingly though, here is the dilemma: there is obviously a strong desire to test certain clinical interventions and compare them.  

This means reducing the number of variables and attempting to isolate the specific effect of each intervention to the greatest degree possible.  The problem is that these interventions aren’t meant to be delivered in such a sterile way.  This omits the extremely important context effect and ritualistic aspect of a clinical encounter.  It doesn’t take into account the words, concepts, explanations, and empathy of the doctor that creates a certain context in which the specific intervention is delivered.  The same goes for any intervention, be it drugs or surgery.  Pain is all about meaning.  We are priming a patient’s brain to receive a certain sensory input in terms of what that means.  

The bottom line is that a clinical interaction is so much more than the sum of its parts, and each individual part is very tricky (I won’t say impossible, but you could say it’s pretty close) to evaluate in isolation.  Where does that leave us?  I don’t know!

But, what I do know (like all clinicians I suspect) is that I see meaningful changes to people’s lives every day with these interventions when they’re wrapped in the right clinical context (a successful therapeutic alliance with the patient that is built upon trust and rapport).  It’s difficult to study that!”

I don’t know how one could say it any better than Dr. Nicholson. He has such a way with words, I swear. Are all Australians as eloquent? I’m not sure. I’m a Texan, I’m pretty gruff and rough around the edges I’m afraid. I don’t speak his language but luckily I understand it. Lol. 

His partner in CDI and in fighting chiro crime….remember the batman and robin reference….anyway, Dr. Matthew Long wrote an outstanding article on this type of study that I’ll link in the show notes. Please go check it out. 

He says, “For many chiropractors the realities of clinical practice and the supposed truths of scientific research often seem irreconcilable. This is particularly apparent when reviewing research that investigates the effects of spinal manipulation upon a specific condition. 

Adjusting Disc Herniations and Bulges

 

Often there is little, if any, the difference in outcome between the placebo (sham) intervention and the ‘real’ procedure. In both cases, the patient is seen to improve, often quite substantially. However, the study is unable to show conclusively that active treatment is better than the sham. This phenomenon is especially prevalent when the intervention is being tested for its capacity to reduce pain, which carries a large emotional connotation into the experimental setting. We can see this in a recent migraine study by Chaibi and colleagues (1), who concluded that the significant beneficial effect obtained by sufferers was “probably a placebo response”.

To most clinicians this is deeply unsatisfying. While it is true that the science of placebo has undergone a reappraisal and a softening of opinion in recent years, the average hard working chiropractor probably feels that there is more to their daily practice than simply putting on a good show. 

While many experiments are based upon our ability to modulate pain, others seek to determine how manipulation might influence the biomechanics of a patient’s spine. After all, the dominant model by which spinal manipulation has been justified for over 100 years is largely mechanical in nature (whilst acknowledging the desire to reduce some sort of neural distress that resulted). 

Unfortunately, these biomechanical experiments are sometimes even less impressive in their outcomes, and there is little difference between the active treatment and the control. However, before we become too jaded I think that we should pause for a moment and ask ourselves two important questions:

  1. Are we posing research questions based upon a legacy model of spinal manipulation?
  2. Can the design of these studies preclude us from finding any meaningful answers?

It is my contention that the science of neuromusculoskeletal health has evolved considerably, and yet we are perhaps still looking at the world through an outdated lens.

This dynamic duo is the future of this profession. I’m including the link to the article in the show notes at this point in the show so go there to episode 143, scroll down and click on it. Stop arguing like a damn teenager and just do it or you go to bed with no supper. Don’t you roll your eyes at me, Give me your phone, you’re grounded.”

Another very relevant though from Dr. Long in the article is this:

“Some of the things we know about spinal manipulation include:

1. It is not a mechanical realignment.

2. It does not help relieve pain by increasing range of motion.

3. It can produce changes in smoothness and quality of movement, which are critical for stability and control.

4. It influences the brain’s perception of the spine, and how it can (and should) move.”

It goes on and, as with anything from Dr. Nicholson and Dr. Long, it is eloquent, easy to understand, and basically amazing. This is why you always hear the Neuromusculoskeletal Medicine Diplomates talk about the outstanding education you get in the program. It’s largely due to these two amazing doctors and educators. 

Go read the rest of that article, please.  

https://cdi.edu.au/clarity/its_the_whole_package.php

Now, last but absolutely not least is one of my new favorite research superstars in our profession. We are going to have her on a future episode so keep watching for that. Dr. Katie Pohlman from Parker University was kind enough to send me her thoughts on the paper. 

Dr. Pohlman is Director of Research at Parker University and an inaugural fellow of the Chiropractic Academy of Research and Leadership (CARL) program. She received Researcher of the Year in 2020 from the American Chiropractic Association (ACA), is the current Vice President of the ACA’s Council on Women’s Health, and has served as Vice President of the ACA’s Council on Chiropractic Pediatrics. Dr. Pohlman received her Doctor of Chiropractic (D.C.) degree and M.S. in Clinical Research from Palmer College of Chiropractic and her Ph.D. in Pediatrics from the University of Alberta. We could keep going but I think you get the point. 

She’s one of the most impressive ‘newer’ researchers in our profession. I say newer in quotes because I only found out about Dr. Pohlman in the last few years. But trust me here, you’re going to be hearing and seeing A LOT more out of her in the future. 

Dr. Pohlman said this, “This was a well-designed study of manipulation and mobilization with a strong placebo arm. The population was young, non-obese individuals with chronic back pain. 

As stated in the discussion, the sample population baseline pain level on a 0-11 scale was ~4.3, which I feel left little room the clinical meaningful 2 points decrease. The study also used characteristics from a clinical prediction rule for the inclusion of patients. 

That Episode Where Vitalists Tune Out & NSAIDS vs. Cognitive Behavioral Therapy

The characteristic list that they use included patients having pain for less than 16 days. Since this study was looking at chronic pain this characteristic was not included. 

I support the idea of pre-identifying responders versus non-responders; however, the characteristics used in this study may not have been most useful for chronic pain patients. 

A more useful model at this time is the Andres Eklund ‘s psychological subgroups (which also have not be validated… watch for more studies in the near future). 

(NOTE: this study was published after the start of the RCT being discussed.) 

Another consideration for this study was the 3 weeks of care and the manipulation/mobilization techniques that were used. I will leave these concerns for clinicians to discuss.”

Katie is wonderful for taking time out of her day to offer us some insight on this. 

Now, I want to address the F4CP. The Foundation For Chiropractic Progress. They came out shortly after this paper with a press release in support of this paper. Saying it’s correct, they support it, and it is further proof that a D.O. or any other practitioner outside of a Doctor of Chiropractic is clearly ineffective. 

The insinuation is that no other practitioner can deliver an adjustment as well and as effectively as a chiropractor and that had the study included spinal manipulative therapy delivered by chiropractors, it would have shown clear effectiveness. 

Because you know….chiropractors are evidently the ONLY practitioners that can adjust I guess. 

Let me get this straight upfront; I love the F4CP. I support them. I love what they’ve done for our profession and are doing for our profession. I would say that I believe there are some TICs and some TORs in there and that’s not necessarily helpful for the evidence-based side of the profession but overall, it’s a great group and does a good job of being well-rounded and representing the profession as a whole.

With that being said, in this paper, I think the F4CP is just wrong to support the paper like this. For me, it’s lazy and almost comes off like the way a politician would slide around something. You know what I mean? Avoid the elephant in the room and say, “See there, had they used chiropractors, it’d been a different dealio all together because we’re the superstars’ nobody else can be. I don’t know…..I guess if the other spinal manipulative therapy people would maybe….I don’t ….try not to suck so much….that’d be great and all”

It’s BS and I don’t like their handling of it. I like their handling of just about everything else but whoever pulled the trigger on this, I just can’t agree with. There are holes to be poked in it. There are too many papers showing the effectiveness to sit around and let 3 PhDs set the tone for spinal manipulative therapy going forward. 

You think insurance companies, chiro haters, and trolls aren’t going to grab this and run like they stole something with this thing? Of course, they will. And are. Hell, I’ve seen where chiropractors themselves are now saying the manipulation isn’t all that effective. Chiropractors y’all. Then you have the Airrosti folks who don’t adjust. We all have to do what we do and what we feel but come on man. I always say chiropractic isn’t an adjustment, it’s a profession. But let’s have some real talk here. The adjustment is still damn well the cornerstone of the profession. Don’t any of you kid yourselves on this? It is and it is for a reason. 

So for me, on this deal, the F4CP is wrong. Sorry to any of you that may be in the F4CP. I’m aware you didn’t ask my opinion first but I’m giving it second. Lol. 

I do support you overall. Just not here. 

The study isn’t an indictment of chiropractic in general but I’d say that this paper doesn’t take any of the other things a chiropractor does into account at all. When the pain is centralized and the CNS is upregulated, simple manipulation is a start but is only a tiny piece of the puzzle. 

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. 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. 

Subscribe Button

The Message

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

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

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

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

Key Point:

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

That’s Chiropractic!

Contact

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

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

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

Connect

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

Website

Home

Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

YouTube

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

iTunes

https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

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https://player.fm/series/2291021

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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

  • Thomas J, C. B., Russ D, (2020). “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain
  • A Randomized Clinical Trial.” JAMA Open 3(8).

 

Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

CF 142: Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

Today we’re going to talk about Nonoperative Disc Treatment, D3 for Depression, & The Biopsychosocial Part Of Chronic Pain

But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way aro

und. 

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. 

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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #142

Now if you missed last week’s episode , we talked about the update from the authors on The Lancet low back series and we talked about movement disorders and whether or not they translate into pain. 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…..

Kids still in school. I called it early. I’m giving most of the schools about 4-6 weeks before they decide the numbers are too high. I do not want to be a pessimist. I just don’t see how they’ll keep it under control. I drove by my daughter’s junior high at lunch and they had 100-200 kids out on the playground playing basketball. Right up on each other. Lol. 

I know they’re outside. I know. We’ll see. I know the University of Alabama just reported 1200 positives at the campus. Notre Dame, University of North Carolina. I just see it as a start. 

My son told me a kid in his math class turned up positive so that got him all up in a wrinkle. I told him he’s got a better chance of getting it riding in a car with someone to eat or gathering up in dorm rooms than getting it in a big huge classroom. It’ll hold 300 kids but there’s around 50 or 60 in there all wearing masks and distanced. Minimal risk. 

Then I had a patient in here just last week, I treated her on a Tuesday. No temp, no symptoms at all….she goes home. The next day she feels a little funky. Her husband had the Rona a couple of weeks ago if I remember right. Anyway, she’s on high alert because of her husband so she goes and gets tested and she’s positive. The day after we had her in the clinic. 

Now, she was masked the whole time and my time with her was less than 3-5 minutes, she had no symptoms at the time so the risk, to my knowledge, while certainly not ideal, in the long run is probably minimal. 

Had that happened 3-4 weeks ago, I’d probably have been down at the place getting the tests and all that good stuff. Had Jake had a positive kid in his big ol math class a month ago, they’d probably be doing something more than just saying, hey this happened. Y’all wear a mask. 

Things ahve changed slightly in the past month I believe. I think more and more, we’re seeing we can live with this and it’s not the end of the world like some thought it’d be back in March and April. We still see cases going down but they’re still higher than they were in the first wave. Yet deaths aren’t. They’ve leveled and dropped as well. Which is all great news. 

I’m a nerd so I watch interviews with experts on vaccines and epidemilology and all that stuff done through the Journal of the American Medical Association. One of the experts said that’s it’s just not in the virus’s best interest to kill us off. It’s in its best interest to become more transmissible but less deadly so it can spread easier but not kill us…..so it can survive. Basically. 

That’s an interesting way to look at it. Then, yesterday, the CDC comes out and says that only 6% of deaths are due strictly to COVID. Well now hell. Doesn’t that give fuel to the fire for the science hating conspiracy nut cases? More ammo to confuse other dummies into their way of thinking but the truth is, it changed nothing. It just meant that 94% of COVID deaths have an average of 2.6 co-morbidities. 

Well, no durr Sherlock. That’s one of the few things we’ve all actually known this whole time. The CDC just was finally able to quantify it. That’s all. I’m still overweight. I’m still more at risk than John Workout over there drinking his fruit smoothie after his 6 mile run. No change whatsoever but day-um if the nut cases didn’t jump all over that one. 

Watching science haters just explode and reveal themselves on Facebook over the last 6 months has been such a disappointment. Especially the ones that you respected as doctorate level caregivers. 

Now look, I’ll admit something, in the very beginning, when nobody knew what the hell, how many would die and this and that, I got caught up in some of it. A whole bunch of us did. As more information comes to light, as we learn more about it, as we experience life with it, the danger is still there but, education has lessened any fear that might have been there in the beginning. 

Now, it’s just life and we have to keep living. We have to try to send kids to school. Let’s see what happens. We have to go to work. I’ve been working full time for basically 6 months following guidelines and so far so good. Can you imagine what business would look like if I just took off for months? Nope. Can’t do it. 

And isn’t there something to be said about government over reach on some of this stuff? How can they shut down bars yet allow people to gather up in a church? How can some bars stay open with music and bands but they’re able to stay open because you can buy a hamburger. Yet other bars are closed because they don’t sell a hamburger? How does any of it make sense? It’s a stack of hooey balls. 

I’m a Christian, I want people to want to go to church. So don’t get the wrong idea there. It’s a valid comparison. You can group up in church but not in a bar. It’s silly. 

We’ll know more about the back to school thing in jsut a few weeks. 

Alright, I’m rambling, let’s get to it. 

Item #1

The first article here is called “Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores. A Randomized Clinical Trial” by Okereke et. al(Okereke O 2020). and published in JAMA on August 4, 2020. Hot tamale, hot tamale….

Why They Did It

The authors wanted to know if long-term supplementation with vitamin D3 prevent depression in the general adult population? What’s your guess? D3 is a bit of a wonder kid, right?

How They Did It

  • 18353 men and women aged 50 years or older 
  • Randomized clinical trial 
  • Randomized testing happened from November 2011 through March 2014
  • Randomized treatment ended on December 31, 2017
  • Randomization was D3 or placebo

Wrap It Up

“Among adults aged 50 years or older without clinically relevant depressive symptoms at baseline, treatment with vitamin D3 compared with placebo did not result in a statistically significant difference in the incidence and recurrence of depression or clinically relevant depressive symptoms or for change in mood scores over a median follow-up of 5.3 years. These findings do not support the use of vitamin D3 in adults to prevent depression.”

Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. I love new toys! If you’re into soft tissue work, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend.

Drop Release uses fast stretch to stimulate the Golgi Tendon Organ reflex.  Which causes instant and dramatic muscle relaxation and can restore full ROM to restricted joints like shoulders and hips in seconds.  

Picture a T bar with a built-in drop piece.  This greatly reduces time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day.  Drop Release is like nothing else out there, and you almost gotta see it to understand, so check out the videos on the website.

It’s inventor, Dr. Chris Howson, from the great state of North Dakota, is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase.

Go check Drop Release at droprelease.com and tell Dr. Howson I sent you.

Item #2

This second one here is called “An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures” by Lilly et. al(Lilly D 2020). published in Global Spine Journal in July of 2020. Is it hot in here? I need some air!

Why They Did It

To compare the utilization of conservative treatments in patients with lumbar intervertebral disc herniations who were successfully managed nonoperatively versus patients who failed conservative therapies and elected to undergo surgery (microdiscectomy).

How They Did It

  • Clinical records from adult patients with an initial herniated lumbar disc between 2007 and 2017 were selected from a large insurance database.
  • Patients were divided into 2 cohorts: patients treated successfully with nonoperative therapies and patients that failed conservative management and opted for microdiscectomy surgery.
  • Nonoperative treatments utilized by the 2 groups were collected over a 2-year surveillance window.
  • “Utilization” was defined by cost billed to patients, prescriptions written, and number of units disbursed.

What They Found

  • 277 941 patients with lumbar intervertebral disc herniations were included.
  • Of these, 269 713 (97.0%) were successfully managed with nonoperative treatments,
  • 8228 (3.0%) failed maximal nonoperative therapy (MNT) and underwent a lumbar microdiscectomy.
  • failures occurred more frequently in males (3.7%), and patients with a history of lumbar epidural steroid injections (4.5%) or preoperative opioid use (3.6%).
  • A cost analysis indicated that patients who failed nonoperative treatments billed for nearly double ($1718/patient) compared to patients who were successfully treated ($906/patient).

Wrap It Up

“Our results suggest that the majority of patients are successfully managed nonoperatively. However, in the subset of patients that fail conservative management, male sex and prior opioid use appear to be independent predictors of treatment failure.”

Item #3

The last one is called “Biopsychosocial baseline values of 15 000 patients suffering from chronic pain: Dutch DataPain study” by Brouwer et. al (Brouwer B 2020) . and published in Regional Anesthesia and Pain Medicine in August of 2020….only the freshest for you fresh people. 

Why They Did It

They did this one in an effort to understand multidisciplinary approaches to solving chronic pain. 

How They Did It

  • 11,214 patients suffering from chronic pain
  • The pain was analyzed using relevant Initiative on Methods, Measurement, and Pain assessment in Clinical Trials Instruments. 
  • Most patients were female

What They Found

  • The mean age was 55.6 years old
  • Severe pain was reported by 71.9%
  • Psychological and quality of life values deteriorated when pain severity increased
  • About 36% of them showed severe signs of depression or anxiety
  • 39% had high pain catastrophizing
  • Of all patients, 17.8% reported high values for pain severity, catastrophizing and anxiety or depression 

Wrap It Up

“Based on baseline biopsychosocial values, this study shows the complexity of patients referred to pain centers. Pain management with a biopsychosocial approach in an integrated multidisciplinary setting is indispensable. Above all, adjusted education on chronic pain and attention to its biopsychosocial aspects are deemed necessary.”

It becomes more and more clear that if all you’re doing is adjusting and sending them on their way, you’re wrong. 

If you’re adjusting and doing some exericises and sending chronic pain on its way, you’re partly wrong. 

If you’re adjusting when appropriate, if you’re prescribing patients exercises and teaching them how to self manage at home, addressing yellow flags and building confidence while you encourage addressing the cognitive aspect of chronic pain…..well….now you’re starting to get it. You’re becoming someone that can make a realy difference in your patients’ lives. 

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. 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. 

Subscribe Button

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 – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography

Brouwer B, W. S., Jacobs C, Overdijk M, (2020). “Biopsychosocial baseline values of 15 000 patients suffering from chronic pain: Dutch DataPain study.” Reg Anesth Pain Med.

Lilly D, D. M., Eldridge C, (2020). “An Assessment of Nonoperative Management Strategies in a Herniated Lumbar Disc Population: Successes Versus Failures.” Global Spine J.

Okereke O, R. C., Mschoulon D, (2020). “Effect of Long-term Vitamin D3 Supplementation vs Placebo on Risk of Depression or Clinically Relevant Depressive Symptoms and on Change in Mood Scores A Randomized Clinical Trial.” JAMA 324(5): 471-480.