podcast

Car Crashes And Awesome Research To Go Along With It

CF 175: Car Crashes And Awesome Research To Go Along With It Today we’re going to talk about car wreck research and it’s pretty cool. Especially if you treat PI patients and you ever find yourself testifying. I’m going to give you a couple of caveman clubs that you can use to figuratively bash a rabid attorney with.  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 #175 Now if you missed last week’s episode , we talked about ow back disability and osteoarthritis research. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

We hired a nurse practitioner. I have to say that there are so many scary talented and scary smart people out there in the world, folks. We got to meet several of them while going through the interview process. If everyone comes out of school highly trained, it’s hard to use that as a measuring stick.  So, I fell back to my core need; which was to hire a good person. It wouldn’t be helpful to hire someone that would come in and feel superior to everyone else in the office. It wouldn’t be helpful to hire someone highly trained but they don’t treat my staff with respect and even love. That would kill office culture dead in its tracks and I like my office culture. 

I tease my staff. I tease my patients. They tease me back. I love the atmosphere. I don’t want to hire a stick in the mud. So I didn’t. When it comes down to it, you can train everything that needs to be trained. But you can’t make a miserable person a good person. You can’t make an introvert an extrovert. You can’t make someone that has a sense of entitlement into someone that is full of gratitude.  You just can’t do it. I think the one we hired is the closest of all that we interviewed to me and who I am and how I carry myself.

He’s new so there won’t be any bad habits. He’s eager to learn. I love that. I’m afraid I’m not the best teacher but we’re going to do it anyway! So, that’s my big news this week, the NP is on and this train is rolling down the tracks now.  Now, I’m going to tell you that here in Texas, masks are no longer mandated. Not even in the schools. So, as you might imagine, if COVID were still a huge concern here, there would be people piling up in the hospitals.

There aren’t. In fact, your hospital load just continues to dwindle. We are in an area of about 275,000 people or so. And the last number I saw last week was that we added 15 new cases that day.  That’s with kids going to school and interacting with each other. In BIG schools. When you go to a restaurant, the places are packed with people. I’m telling you, here in Texas, there is no ‘new normal’. There is the old normal.

You’d never even know that anything was ever different for a year, honestly.  Yet, numbers are continuing to go down. So, why are other states back on the rise? What does it all mean? Has Texas reached herd immunity through infections and vaccines? Maybe. Texas has been a problem state for COVID for months until more recently.  I don’t know all of the answers. But what I feel is that the states that are still on serious lockdown are doing their population an injustice when you compare them to Texas. If their kids aren’t in school, they should be. They’re doing more damage than good from what I can tell. At this point anyway. 

Trust me, I’ve been all about being safe and smart and taking care of each other. Especially those most at risk. But, at this point, everyone that wants to be vaccinated in my area is vaccinated. At this point, in my state, if you get sick, it’s because you chose to risk it. Plain and simple.  Alright, let’s dive in. But first, I want to drop in a word about our amazing sponsors and give you a way to save a little money. 

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This podcast episode was inspired by a recent episode of the Chiropractic Science podcast hosted by Dean Smith. His guest was Dr. Michael Freeman who I’ll talk about here in just a minute. These papers are papers they talked about on that episode so, if you want it from the horse’s mouth, go over to Chiropractic Science and find the recent episode with Dr. Michael Freeman and hit play. Then come back here and get my take on it. 

Item #1

This one is called “Is Acceleration a Valid Proxy for Injury Risk in Minimal Damage Traffic Crashes? A Comparative Review of Volunteer, ADL and Real-World Studies” by Nolet, et. al. (Nolet PS 2021) published in International Journal of Environmental Research and Public Health in March of 2021 and I can’t even….wouldn’t even try to touch it…..

Why They Did It

Let me preface this by saying that Dr. Michael Freeman is an author on this paper and he’s just a phenomenal asset to chiropractic, health in general, and personal injury research. If you aren’t familiar with Dr. Freeman, we’re talking about the fact that he’s a DC, an MD, and Ph.D. and a whole bunch of other stuff one single person has any business being.  Also on this paper is Dr. Art Croft. I have the advanced certification through Dr. Croft’s SPINE Institute in San Diego and I have to tell you that he’s one of the most impressive individuals I’ve ever personally met.  In the paper, they say, “Injury claims associated with minimal damage rear impact traffic crashes are often defended using a “biomechanical approach,” in which the occupant forces of the crash are compared to the forces of activities of daily living (ADLs), resulting in the conclusion that the risk of injury from the crash is the same as for ADLs.” 

To put that in me and you talk…..what they’re saying is that it’s common in court for attorneys to say that being in a 5mph low-speed rear impact is similar in force to just stepping off of a sidewalk curb. Or some other ridiculous analogy like that.  They go on to say, “The purpose of the present investigation is to evaluate the scientific validity of the central operating premise of the biomechanical approach to injury causation; that occupant acceleration is a scientifically valid proxy for injury risk.”

To put that in me and you talk…..they just want to see if common every day events are truly like a low-speed rear impact car wreck. 

How They Did It

  • Data were abstracted, pooled, and compared from three categories of published literature: 
      1. Volunteer rear-impact crash testing studies, 
      2. ADL studies, and 
      3. Observational studies of real-world rear impacts. 
    • We compared the occupant accelerations of minimal or no damage (i.e., 3 to 11 kph speed change or “delta-V”) (2 mph up to 7 mph. ) rear-impact crash tests to the accelerations described in 6 of the most commonly reported ADLs in the reviewed studies. 
    • As a final step, the injury risk observed in real-world crashes was compared to the results of the pooled crash test and ADL analyses, controlling for delta-V.
    • OK in me and you speak, Delta V just means the change in speed that was experienced. Anytime you are in a wreck, you essentially go from one speed to another in a millisecond. That’s not conceptually, that’s literally. Delta V helps to describe that change in speed. 

What They Found

  • The results of the analyses indicated that average peak acceleration forces observed at the head during rear impact crash tests were typically at least several times greater than average forces observed during activities of daily living.
  • In contrast, the injury risk of real-world minimal damage rear impact crashes was estimated to be at least 2000 times greater than for any activities of daily living. So defense attorneys can stick that in their hat and smoke it up twice.

Wrap It Up

The results of our analysis indicate that the principle underlying the biomechanical injury causation approach, that occupant acceleration is a proxy for injury risk, is scientifically invalid. The biomechanical approach to injury causation in minimal damage crashes invariably results in the vast underestimation of the actual risk of such crashes and should be discontinued as it is a scientifically invalid practice. That also seems like a mic drop if the attorney pulls it out and uses it in a case. And should be appropriately accompanied by superhero comic noises like

Slap! Pow! Snap! Kazaam! Fwaaaap!! I love it.

Item #2

Item #2 is called “Estimating the number of traffic crash-related cervical spine injuries in the United States; An analysis and comparison of national crash and hospital data” by Michael Freeman and Wendy Leith (Freeman MD 2020) and published in Accident Analysis And Prevention in July of 2020 and that’s still got some steam to it. 

Why They Did It

In the intro, they say, “Cervical spine injury is a common result of traffic crashes, and such injuries range in severity from minor (i.e. sprain/strain) to moderate (intervertebral disk derangement) to serious and greater (fractures, dislocations, and spinal cord injuries). There are currently no reliable estimates of the number of crash-related spine injuries occurring in the US annually, although several publications have used national crash injury samples as a basis for estimating the frequency of both cervical and lumbar spinal disk injuries occurring in lower speed rear impact crashes.”

In me and you speak, they’re saying that many defense attorneys want to use estimates on neck injury and severity prevalence from national databases but it doesn’t make sense to do it that way and you can’t use these databases as a proper defense in a court case.  They say the purpose is, “To develop a reliable estimate of the number of various types of cervical spine injuries occurring in the US by comparing data from national crash injury to national hospital emergency departments and inpatient samples.”

Well, that makes sense to me….let’s see how it came out. 

How They Did It

Comparative cross-sectional METHODS: Cervical spine injury data were accessed, analyzed, and compared from 3 national databases; the 

    1. National Automotive Sampling System-Crashworthiness Data System (NASS-CDS), 
    2. Nationwide Emergency Department Sample (NEDS), and the 
    3. Nationwide Inpatient Sample (NIS).

What They Found

  • It is estimated that there are approximately 869,000 traffic crash-related cervical spine injuries seen in hospitals in the US annually, including around 
      • 841,000 sprain/strain (whiplash) injuries, 
      • 2800 spinal disk injuries, 
      • 23,500 fractures, 
      • 2800 spinal cord injuries, and 
      • 1500 dislocations.
  • Because of highly restrictive inclusion criteria for both crash and injury types, as well as a very small sample size, the NASS-CDS underestimated all types of crash-related cervical spine injuries seen in US hospital emergency departments by 84 %
  • The injury type with the largest degree of underestimation in the NASS-CDS was cervical disk injuries, which were estimated at an 88 % lower frequency than in the Nationwide Emergency Department Sample
  • National insurance claim data, which include cases of cervical disk injury diagnosed both in and outside of the ED, indicate that the Nationwide Emergency Department Sample likely undercounts cervical disk injuries by 92 %, and thus the NASS-CDS correspondingly undercounts such injuries by 99 % or more.

Do you see why it’s so good to have people like Dr. Michael Freeman and Dr. Art Croft on our side? Holy smokes. Who else is out there putting attorneys in their place like these folks have done for years?

Wrap It Up

They end it by saying “Because of a limited sample size and restrictive criteria for both crash and injury inclusion, the NASS-CDS cannot be used to estimate the number of crash-related spinal injuries of any type or severity in the US. The most inappropriate use of the database is for estimating the number of spinal injuries resulting from low-speed rear impact collisions, as the NASS-CDS samples fewer than 1 in 100,000 of the cervical spine injuries of any type occurring in low-speed rear impact collisions.” Smack, Kowapow, Thunk! As I said, I love this kind of research. I remember Dr. Croft speaking about being an expert and attorneys starting to come at him and how he was able to just draw them out into deeper water before putting ‘em under!! I love it. 

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 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 http://www.chiropracticforward.com

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

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

Bibliography

Freeman MD, L. W. (2020). “Estimating the number of traffic crash-related cervical spine injuries in the United States; An analysis and comparison of national crash and hospital data.” Accid Anal Prev 142(105571).  

Nolet PS, N. L., Kristman VL, Croft AC, Zeegers MP, Freeman MD, (2021). “Is Acceleration a Valid Proxy for Injury Risk in Minimal Damage Traffic Crashes? A Comparative Review of Volunteer, ADL and Real-World Studies.” Int J Environ Res Public Health 18(6): 2901.      

Useless Research & Insulin or Inflammation

CF 172: Useless Research & Insulin or Inflammation Today we’re going to talk about how I treat my staff, we’ll talk about insulin vs. inflammation, and we’ll talk about some trash research that came out in JAMA recently that you may wind up being confronted with at some point so listen up.  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 #172 Now if you missed last week’s episode , we talked about going the way of the non-pharma world. If we could just get the the medical world to take a look at it. We also talked about insurance coverage trends and how they’re not very favorable to chiropractors. As you probably already feel. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

On the personal end of things, we’re still interviewing nurse practitioners and still getting our ducks in a row. We have the attorney that is setting up the medical entity meeting with our CPAs out in St. Louis to make sure it is set up in the most tax-advantageous as well as the most ideal legal way.  Any time you have your CPA and your attorney working together, you’re probably in a good place me thinks. I have a meeting with the medical director this week to go over what services he’s going to be OK with us offering. When appropriate, we’ll be looking at things like intra-joint injections, trigger point injections, low-level scripts but no narcotics.  Basically, anything we offer here will be very low risk. Not only because it inherently lowers our risk to adverse events, which makes me sleep better every night, but it also helps to keep a happy medical director. If it all works right, this is almost mailbox money for the medical director while providing an awesome gig for a nurse practitioner that is at least halfway motivated to build their practice. 

Think about it, nurses and nurse pracs are used to 12-hour shifts. They’ve missed important holidays and important events in their personal life due to having to work. Here, there are no weekends, there are not holidays spent working, vacation time, it’s all good in the hood at my place. Plus, they get to learn as much about orthopedics as they want to learn and a whole bunch they maybe don’t want to learn but is required to learn in order to work here.  That’s the deal though right?

Gotta pick the right NP because it all hinges on that one decision. Pick the wrong one and you’re out of business until you can get another hired. Doesn’t sound like a big deal until you factor in the 3 months it takes to get a new one credentialed. Speaking of, I have to get re-credentialed under the new medical entity. That’s because of Stark and anti-kickback laws.  This isn’t something to go into lightly. It’s like I said last week or two weeks ago here on the podcast, the wheels on this thing turn slowly and I’m OK with that. That way I don’t get out over my skis and lose control.  So, that’s where we’re at on that. 

Currently, I’m taking the opportunity to type this out on a Sunday afternoon. We are up at the office throwing a staff member her baby shower. No, I’m not a baby shower kind of dude as you may have guessed. I’m a Bud Light and guitars kind of guy. But, my wife decided we’re throwing our staff member a baby shower so here I am at the office recording this while the chicks and the hens are out there clucking and cackling. And I don’t mean that in a misogynist way. I mean it in a funny, playful kind of way so take it that way. 

It brought up a thought; do you treat your staff members like workers? Or do you treat them more like family? Right or wrong, as a result of my nature and my heart, we treat ours like family when appropriate. I’ve had staff ask me advice on deep dark stuff they were struggling with. I’ve had staff whose family was going to prison, the whole town knew, they were ashamed, and they just need some love, a little extra consideration, and a few big hugs. That one still gets me a little emotional when I think about it.  I’m going to give you a few more examples here but before I do, I don’t want you to misunderstand anything here. I’ve learned over the years that you cannot buy loyalty from your staff. They’re either with you every step of the way, or they are not. And that’s OK. Everyone is coming from different places, experiences, and motivations. Not a thing wrong with that.  But don’t do things for the wrong reasons. Don’t think you’re going to do a bunch of things for staff thinking it’ll ensure they stay with you forever. That’s just not reality and it’s a good way to allow yourself to get hurt on some level.  If you’re going to treat staff like family, you do it for all of the right reasons. Love, appreciation for them and their character, admiration for a job well done, team building, and things like that.  Getting back to it, I’ve sold a car to a staffer that was coming out of a bad relationship and had no transportation. I sold it to them for about $4,000 less than I could have gotten for it and let them pay it out $50 a paycheck and zero interest.  I’ve created a new, extra job for a staffer that was about to lose their house. It cost me an extra $1500/month for the following 2-3 years but that’s the way I am. 

I’ve sponsored kids sports for staffers more times than I can even start to recall.  In the end, money will come and go. It can be lost and it can be made. But it’s the relationships that stay with us.

Were we put on the planet just to make money and take care of our families? 

Or were we put on this planet to make ALL of our immediate relationships prosper and make the world, or at least our part of it, a better place?  You probably know where I come down on all that. It may sound a little hippy-dippy there, which I’m not at all, but I do see it that way. Money is nice and I see it as a challenge. A challenge to make it and see how much I can make ethically and morally. It’s fun to make money! But money really isn’t my main motivation any more.

I’m a huge stats person and track stuff like crazy. I balance my own bank statement every month. But I don’t count pennies anymore. I just don’t. I’m more into people, smiles, and all the good feels. Making people’s lives better when possible.  Alright, enough mushy stuff. 

Item #1 This first one today is called “Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation: A Systematic Review and Meta-analysis” by Wiebe et. al. [1] and was published in JAMA on March 12, 2021 and that so hot it’s got my glasses all steamy. I can’t see a thing. 

Why They Did It The authors wanted to answer the question of “What are the temporal associations among higher body mass index (BMI) and chronic inflammation and/or hyperinsulinemia?” They say that Obesity is associated with a number of noncommunicable chronic diseases and is supposedly a cause of premature death. They wanted to summarize evidence on the temporality of the association between higher body mass index (BMI) and chronic inflammation and hyperinsulinemia.

How They Did It

  • MEDLINE (1946 to August 20, 2019) and Embase (from 1974 to August 19, 2019) were searched
  • The data analysis was conducted between January 2020 and October 2020.
  • Longitudinal studies and randomized clinical trials that measured fasting insulin level and/or an inflammation marker and BMI with at least 3 commensurate time points were selected.
  • Of 1865 records, 60 eligible studies with 112 cohorts of 5603 participants were identified

Wrap It Up

The finding of temporal sequencing (in which changes in fasting insulin level precede changes in weight) is not consistent with the assertion that obesity causes non-communicable chronic diseases and premature death by increasing levels of fasting insulin. Meaning that that adverse consequences currently attributed to obesity could be attributed to hyperinsulinemia (or another proximate factor). Which is interesting in my book. I thought you all might like it. 

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Item #2 And our last item today is called “Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial” by Nguyen et. al.  [2] and published in JAMA Internal Medicine on March 15, 2021 which is indeed too hot to manipulate by one’s hand. 

Why They Did It They say that Osteopathic manipulative treatment (OMT) is frequently offered to people with nonspecific low back pain (LBP) but never compared with sham OMT for reducing LBP-specific activity limitations. Knowing this, they wanted to compare the efficacy of standard OMT vs sham OMT for reducing LBP-specific activity limitations at 3 months in persons with nonspecific subacute or chronic LBP.

How They Did It

  • This prospective, parallel-group, single-blind, single-center, sham-controlled randomized clinical trial recruited participants with nonspecific subacute or chronic LBP in France starting February 17, 2014, with follow-up completed on October 23, 2017. 
  • Participants were randomly allocated to interventions
  • Six sessions (1 every 2 weeks) of standard OMT or sham OMT delivered by nonphysician, nonphysiotherapist osteopathic practitioners.
  • The primary end point was reduction in LBP-specific activity limitations at 3 months as measured by the self-administered Quebec Back Pain Disability Index. 
  • Secondary outcomes were mean reduction in LBP-specific activity limitations; mean changes in pain and health-related quality of life; number and duration of sick leaves, as well as number of LBP episodes at 12 months; 
  • and consumption of analgesics and nonsteroidal anti-inflammatory drugs at 3 and 12 months. 
  • Adverse events were self-reported at 3, 6, and 12 months.

What They Found

Overall, 200 participants were randomly allocated to standard OMT and 200 to sham OMT, with 197 analyzed in each group

Wrap It Up In this randomized clinical trial of patients with nonspecific subacute or chronic LBP, standard OMT had a small effect on LBP-specific activity limitations vs sham OMT. However, the clinical relevance of this effect is questionable. So, look…..this paper and these researches absolutely wasted time, effort, and money in an attempt to make spinal manipulative therapy look bad. Who in the h e double hockey sticks sees new patients once every 2 weeks for only 6 visits?? Especially in a chronic pain sufferer. Trash, garbage.

Or since it was in France…..garbage.  It’s dumb, useless, and meaningless and I’m almost offended that this is even a paper. I’m starting ANY brand new case with 3 per week for a week or two minimum. Minimum. Combined with other appropriate ancillaries including exercise, soft tissue stuff, maybe acupuncture, maybe laser, maybe a referral to cognitive-behavioral therapist, maybe biomechanics coaching, and on and on and on. 

Papers like this and authors like this should give it up and get out of the game if they’re not going to be able to throw something together that’s better than this heap of trash.  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

1. Wiebe N, Y.F., Crumley ET, Bello A, Stenvinkel P, Tonelli M,, Temporal Associations Among Body Mass Index, Fasting Insulin, and Systemic Inflammation: A Systematic Review and Meta-analysis. JAMA Netw Open, 2021. 4.

2. Nguyen C, B.I., Zegarra-Parodi R,, Effect of Osteopathic Manipulative Treatment vs Sham Treatment on Activity Limitations in Patients With Nonspecific Subacute and Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Intern Med, 2021.

Breathing Through The Pain, Need For Rehab, & Forward Head Posture And Shoulder Pain

CF 164: Breathing Through The Pain, Need For Rehab, & Forward Head Posture And Shoulder Pain

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.  If this episode has a different type of sound quality when compared to previous episodes, my main computer died. It choked a little and held it’s belly and rolled around in agony for about a month and then…..sadly, it straight up and died. 

So, I have another ordered and in the meantime, I’m figuring out how to do this through my MacBook Pro. Where there’s a will, there’s a way. We’ll make it happen.  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 #164 Now if you missed last week’s episode, we talked about opioids and spinal pain and then we talked about vitalists’ scripts. That was about the point that I lost my mind momentarily. Because they make me crazy and all.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Wow, what a week I had last week, y’all. And I’m not talking in a good way. Oh hell no. This was one of those kick you in the face and in the backside. And when you’re falling to the ground, putting a boot in your ribs for good measure.  One word, two syllables. Day-um.  For patients that I’m comfortable with, it’s common for them to ask me how my day’s going and my go-to answer is usually something similar to, “Ah you know….pissing excellence. As usual. It becomes a habit after a while.” Yeah, not last week. I wasn’t the windshield. I was the bug. 

First thing’s first, on last Tuesday, my longest tenured employee and office manager turned in her resignation. Over 11 years, down the drain. She’s not just a staff member. She’s become my little buddy. She’s hilarious. She was also our marketing girl. Definitely a boot to the face. Pow.  But there are a lot of positives there as well. Being my longest employed staffer, she was also my highest paid so we will save a good chunk of money. We just need to make some adjustments on the marketing and things of that nature.  Then, on Wednesday, as mentioned previously, we joined the Wealthability program and we had a meeting with our new accountants they matched us with. They’re out in St. Louis. Well, they found that our previous CPA was wrong and now we have to pay a gob in taxes we weren’t expecting to pay. We can spread it out over an amount of time and it’s fixable but day-um…..

Come on man.

When you hire professionals, you expect a professional job that will prevent you from getting into trouble. Don’t you? That was a kick to the nether regions. Smack.  Then, later that afternoon, my main computer that has my entire life on it straight up died. Luckily, it had slowed a bit and I called my computer guy to come in and back it up so it can be replicated on another computer. Still, that computer won’t be here for 2 damn weeks.  Kick to the shin. Thunk. 

Then, two of my girls got the second vaccine shot and both got sicker than dogs. One missed work on Wednesday. Not that big of a deal. Just kind of sucked.  Then I got a visit from a connection that works in my Dad’s nursing home. She came to my house on Thursday night after work to tell me my Dad is being mistreated and is withering away.  Stomp to the noggin while I’m down. Snap.  There were some other little things here and there but you get the picture. Rough week. But we’re on the mend.

We’re heading the right direction this week I think. We have some good ideas and I think we are going to make some changes.  So, as a learning lesson, bad things can be used for an impetus to change course and go in a positive direction. For example, I’ve begun going down the path of fully integrating. I’m saving enough money with the departure of my manager that I can use that money toward integrating and hiring a nurse practitioner. 

This would fit my long term plan of being able to remove myself from my day to day practice. It’s a piece of the puzzle. The final piece of the puzzle would be hiring an associate. At that point, I believe my time begins to get freed up a bit.  Hopefully in five years, I’m mentoring my colleagues and teaching them how to accomplish what I’ve accomplished. I’m sharing wisdom with hungry evidence-based chiros and spreading the good news about evidence-based, patient-centered chiropractic care.  We’re going to get there.  In other news, last week wasn’t a total loss. You may have seen where the Texas Chiropractors, after a ten-year battle, put the smackdown on the Texas Medical Association. People’s elbow, Kabam!!

The biggest bully of bullies got slapped the hell around by the Texas Chiropractic Association and the Texas Board of Chiropractic Examiners at the Texas Supreme Court level.  Just briefly, the TMA had sued the TCA and the TBCE approximately 10 years ago over our right to perform the VONT testing. Also known as vestibulo-ocular nystagmus test. Then that morphed into attacking our rights to diagnose and our rights to treat the Neuromusculoskeletal system rather than just the musculoskeletal system. Seemingly silly little things but, if they had won, technically, we couldn’t treat anything having to do with ‘nerve’ and we couldn’t have diagnosed our own patients so we’d depend on referrals from medical professionals……and how do you think that would have turned out in the long run?

Not good for an chiropractor on the planet because other medical associations would have precedence and would have repeated the process. Those of us in leadership positions for the TCA have been well-aware for the last decade that if we lost this case, we would be the first domino and it would effect every other chiropractor.  We lost, then we lost the appeal, then the Texas Supreme Court gave us the win. And the Texas Medical Association, the most predatory state medical association in the United States, has to cover the court costs. Oh, and on top of that, they can suck it.  We are going to have an entire episode where I’ll be joined by my fellow TCA members. Folks that have been the deepest in the trenches on this case and know every in and out of the entire process.  It’s going to be a good one so keep a lookout for that one.  Alright, let’s get to the good stuff shall we?

Item #1

This first one is called, “Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms” by Jafari, et. al. (1) and published in the Journal Of Pain in September/October of 2020. It’s not a lot hot but hot enough!

Why They Did It

This study sought to investigate effects of instructed breathing patterns on experimental heat pain and to explore possible mechanisms of action

How They Did It

  • In a within-subject experimental design, 48 healthy volunteers performed 4 breathing patterns: 
      1. Unpaced breathing, 
      2. Paced breathing (PB) at the participant’s spontaneous breathing frequency, 
      3. Slow deep breathing at 6 breaths per minute with a high inspiration/expiration ratio (SDB-H), and 
      4. Slow deep breathing at 6 breaths per minute with a low inspiration/expiration ratio (SDB-L)
  • During presentation of each breathing pattern, participants received painful heat stimuli of 3 different temperatures and rated each stimulus on pain intensity
  • Respiration, heart rate, and blood pressure were recorded.

What They Found

Compared to unpaced breathing, participants reported less intense pain during each of the 3 instructed breathing patterns.

Wrap It Up

Slow deep breathing is more efficacious to attenuate pain when breathing is paced at a slow rhythm with an expiration that is long relative to inspiration, but the underlying mechanisms remain to be elucidated. Oh…..elucidated. That’s a $5 word for the research crew there. Congrats on elucidated, folks. 

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Item #2

This one is called, “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019” by Cieza, et. al.  (2) and published in The Lancet on December 19, 2020. Smokin’, sizzlin’, steamy pot of chili pie.  I have learned, by the way, that Frito Pies are not an American thing.  It’s just mostly a Texan thing. I have eaten Frito pies my whole damn life and didn’t figure this factoid out until just a few years ago. I play Call Of Duty here and there on xbox.

I know….I’m a nerd but I’m a killing’ nerd on occasion! I can kill real people in a fake way right there with the best of them when I want to. And I have my glasses on. And I haven’t had any more than a few beers. Lol.  Anyway, I play with a dude from Louisville, KY and he’d never heard of Frito pies. Holy cow people. There are some things you need to get tuned into if you’re not from Texas. They are as follows:

    • Frito Pie
    • Fried Okra
    • Fried squash. 

Yes, all are terrible for you so…..as a priest told me at the bar back when I went to college in Louisiana and was asking him how this whole ‘priest being in a bar’ worked out….he said, “Everything in moderation, Brother.” We should probably get back to the paper, Y’all. 

Why They Did It

Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritized in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury.

How They Did It

To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability of 25 diseases, impairments, etc. 

What They Found

  • Globally, in 2019, 2.41 billion individuals had conditions that would benefit from rehabilitation, contributing to 310 million years of life lived with disability
  • This number had increased by 63% from 1990 to 2019
  • The disease area that contributed most to prevalence was musculoskeletal disorders with low back pain being the most prevalent condition in 134 of the 204 countries analyzed.

Wrap It Up

The authors wrap up their thoughts with this, “To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need.”

I will add that the vitalists that think they can only adjust their way out of every damn condition or complaint need to get in the back of the line and just keep quiet. If you are going to be current rather than look like a dumb dumb, then you need to understand that a good, learned chiropractor knows that we do not only mobilize with adjustments, stretching, and things of that nature. But we also much know when to stabilize through strengthening activities.  If you’re just hitting the high spots on all of your patients, you need to be better and raise you game. Mr. Vitalist…..I’m talking to you. 

Item #3

The last one today is called, “Does forward head posture change subacromial space in active or passive arm elevation?” By Dehqan, et. al. (3) and published in the Journal of Manual and Manipulative Therapy on November 30, of 2020 and that’s about the right amount of hot Why They Did It Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head and neck area and the shoulder girdle. The present study compared the acromiohumeral distance between individuals with normal head and neck alignment and those with moderate and severe FHP in active and passive arm elevation.

How They Did It

  • Based on the craniovertebral angle, 60 volunteers were selected and equally distributed among three groups, including group one with normal head and neck alignment, group two with moderate FHP and group three with severe FHP
  • The space between the humeral head and the acromion was measured in 10°, 45° and 60° of active and passive arm elevation as the acromiohumeral distance.

What They Found

  • The acromiohumeral distance was only different between the three groups at 45° arm elevation angle, and this difference was significant between groups one and three
  • In active and passive arm elevation, increased arm elevation angle reduced the subacromial space significantly
  • Also, in each arm elevation angle, the subacromial space differed significantly between the active and passive arm elevations.

Wrap It Up

They concluded, “The acromiohumeral distance was significantly lower in the severe FHP group than the group with normal head and neck alignment in the 45° active arm elevation angle, which could be due to the changed tension in tissues between active and passive arm elevation and also the maximum muscle activity in the 45° active arm elevation angle.”

Shoulder impingement folks.

I didn’t know anything about it until I went through he DACO program. Which is now the Neuromusculoskeletal Diplomate. It’s a real estate issue and when you have an upper cross type setup, forward head posture, you decrease the real estate.  Increase the real estate, decrease the issue in this sort of a setup.  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.

Website

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TuneIn

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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

  1. Hassan Jafari, Ali Gholamrezaei, Mathijs Franssen, Lukas Van Oudenhove, Qasim Aziz, Omer Van den Bergh, Johan W.S. Vlaeyen, Ilse Van Diest, Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms, The Journal of Pain, Volume 21, Issues 9–10, 2020, 1018-1030
  2. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vox T, Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. 396 (10267), P2006-2017, December 19, 2020.
  3. Behdokht Dehqan, Cyrus Taghizadeh Delkhoush, Majid Mirmohammadkhani & Fatemeh Ehsani (2020) Does forward head posture change subacromial space in active or passive arm elevation?, Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2020.1854010

 

Three Year Anniversary Top Ten Countdown

CF 156: Three Year Anniversary Top Ten Countdown

It’s our THREE YEAR ANNIVERSARY episode!!! We’re going to cover our All-time Top Ten episodes spanning over our first three years on the air.  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 #156 Now if you missed last week’s episode, we talked about the crazy and very suspicious shake-up with the research committee earlier this year at the World Federation of Chiropractic. Make sure you don’t miss that info. I believe it is vital for you as an evidence-based, patient-centered practitioner. Listen to it anyway because it’s important to keep up with the class. 

On the personal end of things…..

Well, no hate mail from last week’s episode or from the week before that when we highlighted a vitalist bragging about seeing 99 patients and 9 new patients in the span of 3 hours. Dammit, my eyes just about rolled out of my head yet again. It’s like every time I say that I gotta keep an eye on my eyes so I can keep them in my noggin. And, I have to step back a bit to keep from throwing up.  Not getting hate mail is a good thing.

Of course, there’s the very solid chance I’m simply speaking to an echo chamber here, and honestly, that’s OK too. I’d much rather be able to build this among my brethren without being molested by the ones that don’t agree with me.  The more like-minded folks we have listening, the better. The best thing I can say is to tell someone about us. I’m serious. I appreciate every single listen. But if all you do is listen and consume a free product, that’s not helpful in growing it and putting back into the thing you find value in. 

So, please. Tell someone about this podcast and the messages we convey every single week. Let’s build this message. Like I said in last week’s episode, this profession is in a battle. Not just between vitalists and evidence-based chiropractors but in a battle for integration, progress, and overall respect.  A battle for professional standardization. a battle over our research community. As I said last week, the ICA won the battle with the WFC research committee. They know there’s a battle. Now it’s time for evidence-based chiropractors to realize that fact and proceed accordingly. Yes, go read your research papers but then go and defend the evidence-based, patient-centered practice. Advocate for it.  Outside of that mess, things have been slower at the office. With this second spike, we’ve taken a step back. And it’s making my butt pucker a bit. I hate taking steps back. I like only progress. Only movement forward.

I’m seeing the number that I saw 5 or 6 years ago or more. Probably more. We are paying the bills but we’re not profiting right now. We’re just surviving. It can’t be over soon enough.  So that I don’t sound too spoiled; I understand I have it better than a lot of folks. Bar owners, full-time musicians, bartenders, servers, restaurant owners. That’s just for starters. I don’t know how these people survive without forgiveness plans and things like that. It’s insane where we are but I’d rather be sitting here in December than back in March, April, or May.  That’s for damn sure. As of the typing of this episode, the first vaccines are projected to be taken by Americans in about 5 days. Bring it on!! Let’s start getting life back to normal and then sit back and watch the comeback!

Before we get to our Top Ten list and before we get to our sponsor spot, I have to tell you, I’m about to give you a code for discounts on ChiroUp. People sometimes think ChiroUp is one thing or another but in all honestly, it’s a little too much to describe in one spot. It does A LOT!! It helps you implement rehab confidently. It writes reports to those in the medical community. It teaches you what exam protocols are appropriate for regions of the body. It teaches you how you should treat certain diagnoses. It does your report of findings for you. It gets you Google reviews. It tracks your patients’ progress after 30 days so you know how good you’re doing with your patients. It sends emails to your new patients full of recommendations, patient education, and videos of the exercises you recommended for them. It gives you marketing plans for different aspects of healthcare. And it does a hell of a lot more than that.  I could go into every single one of these topics and speak on each of them for half an hour but you’ll just have to trust me here. It is worth so much more than what ChiroUp charges. So, here’s the spot, take my code, use it, and then get better and love your life. You can thank Ol’ Uncle Jeffro later. 

CHIROUP ADVERTISEMENT

Just do it, folks. It’s worth every penny and much much more. It’s literally changed my practice from top to bottom for the better. There’s not another product out there I can say that about. 

Now, let’s get to our all-time 3rd anniversary top ten most listened to episodes, shall we? If you go to the show notes at chiropracticforward.com, find this episode….#156….and you scroll down through the transcription of the episode, you will find the links to each of these episodes so you don’t have to scroll through and find them on your own.

Number Ten Coming in at Number 10: Our 10th most listened to episode was episode #137. We had a special guest for that episode. Dr. Aric Frisina-Deyo and we talked about chiropractors treating in an FQHC setting and we talked about setting the bar high. Higher than chiropractors typically set the bar for themselves or their profession. This guest….wow. Young, bright, driven, and very very impressive. There’s absolutely a good reason that one had so many listeners.  https://www.chiropracticforward.com/2761-2/

Number Nine It’s nice to see this one still in the Top Ten after so much time has gone by. It’s called What’s Good In A Chiropractor. It was way way back in Episode 101. Keep in mind here that we’re now on #156. This episode is more than a year old now so it’s good to see that the principles I covered in this episode are still resonating with our listeners. In this episode I discussed some key characteristics I feel make up a good chiropractor. We talked about things like honesty, being evidence-based, networking, listening, your office presentation, and things of that nature. It’s excellent to see this stuff staying relevant and meaningful.  https://www.chiropracticforward.com/what-makes-a-good-chiropractor-9-characteristics/

Number Eight Number eight is called Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack of Attention On The Boards for Biopsychosocial Matters. Our listeners gobbled this one up. I think because we need current thinking and information on things like adjusting in the region where we know there’s radiculopathy. We need to understand that just because a person is a kid doesn’t mean they don’t hurt. This episode covered that very well, in fact. And the biopsychosocial aspect of pain has been a big big topic over the last couple of years. I think people are struggling to learn more and more about it and how it can help their patients.  https://www.chiropracticforward.com/cf-145-kids-still-hurt-manipulation-for-lumbar-radiculopathy-lack-of-attention-on-the-boards-for-biopsychosocial-matters/

Number Seven Our 7th most listened to episode was a more recent one with one of my very favorites, Dr. Katie Pohlman who will be on again in the very near future. And will hopefully be on our podcast about a hundred times beyond that. Hell, maybe she’ll just be my co-host eventually. Lol. Anyway, this episode was number 147 and was called New Research, Upcoming Research, And the Need For It All. Dr. Pohlman is the head of research at Parker University and you’re starting to see her name anywhere and everywhere with regard to chiropractic research. She is a star and I’m happy that Parker has hitched their wagon to her shooting star. This episode was full of thoughts on chiropractic research, what she’s currently working on, and where it’s all going.  https://www.chiropracticforward.com/w-dr-katie-pohlman-new-research-upcoming-research-and-the-need-for-it-all/

Number Six Our sixth most listened to episode was episode number 113 with my friend, Dr. William Lawson. This one was called Brand New Guidelines On Neck Pain Treatment. Dr. Lawson had a hand in the new paper we discussed and it was basically an entire episode walking you through new guidelines on treating neck pain. It’s one of my favorite episodes because it laid out very clearly what we should be doing, what we should be thinking, and how we should be approaching case management for neck pain. Very informative and Dr. Lawson is always on the top of his game. https://www.chiropracticforward.com/w-dr-william-larson-brand-new-guidelines-on-neck-pain-treatment/

Number Five Our 5th most listened to episode of all time is number 140 with Dr. Chris Howson. It was called Chiropractors In Hospitals and Drop Release. Not only does Dr. Howson work in an outpatient hospital setting in North Dakota, but Dr. Howson is also the inventor of a newer chiropractic tool on the market called the Drop Release. Pretty cool stuff and Dr. Howson knows his stuff, folks. If you want to know how to integrate into a hospital setting and want to know what it’s like, this is the episode for you. Plus we talk a bit about the drop release, what it’s for, and all the goodies. Plus a discount code you can use if interested.  https://www.chiropracticforward.com/cf-140-w-dr-chris-howson-chiropractors-in-hospitals-drop-release/

Number Four Our 4th most listened to episode is number 144 and is called Common Surgeries Aren’t Well-Researched & Chiropractic Wins Again.  This one was a stroll through a current paper that really spotlighted the fact that the most common musculoskeletal surgeries that we see being performed today don’t have much research behind them. Especially research that tested having the surgery vs. not having it at all. You’d think that research would have been done but sadly it hasn’t in almost every case. In fact, they looked at 6,735 studies and only 64….less than 1% of them….only 64 compared a surgical intervention to not having surgery at all. And, get this, of that 64 that actually did compare the two, only 9 of them were actually favorable to having the surgery. Go to episode 144 for more on that. It’s astonishing to me.  https://www.chiropracticforward.com/common-surgeries-arent-well-researched-chiropractic-wins-again/

Number Three Alright, we’re in the top three now. Our 3rd most listened to episode of all time is number 143 and is called Spinal Manipulation Has No Effect On Chronic Pain – Our Experts’ Rebuttal. This one dealt with a paper that came out recently in JAMA and it was not favorable at all to chiropractors or spinal manipulative therapy. This episode went through our own experts thoughts on the paper and how you can rebut any mention you might get from this down the road as you navigate your relationships within the medical community. Very interesting and extremely useful episode right here. This one can actually help protect your bottom line in the right situation.  https://www.chiropracticforward.com/new-paper-spinal-manipulation-has-no-effect-on-chronic-pain-our-experts-rebuttal/

Number Two Number 2 on our top ten list is episode number 142 and is called Nonoperative Disc Treatment, D3 for Depression, and The Biopsychosocial Part Of Chronic Pain. This one really spoke to chiropractors because it was loaded with research. Of course, most of our episodes are loaded with research but this one had a paper about treating discs without operation. Well, who the heck doesn’t want to do that? It was very comprehensive and showed how 97% of 269,713 patients were treated without surgery. Good good stuff. Things look worse and worse for musculoskeletal surgery these days honestly. And, again, this paper covered the biopsychosocial aspect of pain and that’s a popular topic these days. Something for everyone in this episode! https://www.chiropracticforward.com/nonoperative-disc-treatment-d3-for-depression-the-biopsychosocial-part-of-chronic-pain/

Number One And our number one most listened to episode of all time for our 3rd Anniversary is one that actually surprised me. It’s episode number 141 and is called Lancet Low Back Update & Movement Disorders Mean Pain. Now why this one got all of the listens? I have no idea. The Lancet is well-respected and should absolutely be paid attention to. I’m glad it’s getting all of the listens, to be honest. It was basically an update on the original Lancet series on low back pain that we covered way back when. It’s top-level research having relevance to our chiropractic community and I’m glad to see so many of you appreciating it and paying close attention to it. It’s important. It’s not the sexiest topic we cover so that’s why I found it a bit surprising but it’s a great episode to catch the number one spot for sure. Very deserving.  https://www.chiropracticforward.com/lancet-low-back-update-movement-disorders-mean-pain/

An episode or series of episodes that fell off of the top ten list just this year is still important and one worth giving honorable mention to. Episodes 13, 14, and 15 are called Debunked, The Odd Myth That Chiropractors Cause Strokes.  If you don’t know the research on this topic, please, for the love of everything, go listen to those three episodes starting with 13. It’s knowledge fuel and it’ll give you more confidence if you happen to lack it.  https://www.chiropracticforward.com/debunked-the-odd-myth-that-chiropractors-cause-strokes/

Alright, that’s it. We made it through all ten of the most listened to episodes in the three-year history of The Chiropractic Forward podcast. I want to truly thank you all from the bottom of my heart for listening and being a part of this little part of the world. For being a part of this podcast. When I’m sitting down to type out an episode, you are who I have in mind. I try to identify things I’m interested in but I also try to identify tough conversations that are not being had that desperately need to be talked through. 

We aren’t as big and as widely listened to as I’d like to be but we are growing steadily. If I can get you all on my team and talking about it and sharing episodes with your buddies and interacting in the private group, this thing can begin turning into even more of what I envisioned when I first started it.  With your help, we can get the message out on evidence-based, patient-centered practice.  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 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 http://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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Chiropractic Helps VA Cut Opioids & Diagnosing Lumbar Stenosis

CF 146: Chiropractic Helps VA Cut Opioids & Diagnosing Lumbar Stenosis

Today we’re going to talk about the success of the VA in reducing prescription opioid use – psst, guess who has helped them do that? And we’ll talk about diagnosing and testing for stenosis.

But first, here’s that sweet sweet bumper music

Subscribe button

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 #146

Now if you missed last week’s episode , we talked about how even kids can hurt. We talked about manipulation for lumbar radiculopathy. And we talked about the lack of attention found on the chiropractic boards for biopsychosocial issues. 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. 

CF 145: Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters

 

On the personal end of things…..

To kick off on a cool note you’ll all appreciate, I have a patient that is a med school student that has had amazing results for a pretty significant and lingering disc injury. Your truly opened his eyes to the power of what an evidence-based chiropractor is capable of and it’s paid off for him and, the more of the younger docs that experience something like he has with chiropractic, the more accepted the evidence-based faction of our profession becomes. And the more accepted, the more referrals we get. 

That’s not the good news I wanted to share though. The good news is that he said in one of his classes last week, when they were talking about back pain, manipulation was recommended. In med school. Did you freaking A hear that? Med school is now teaching medical doctors that spinal manipulation isn’t only accepted…..but it’s reco-freaking-mended. 

Bam, Kapow, Zap, Snap, Whack!!

Super hero noises for cool stuff. Hell yeah. 

Moving on, now that school is up and rocking and people are in their normal routines once again, the growth I was talking about a week or two ago is showing to be sustainable at this time. 17 new patients last week tells me we may be slowly getting back to where we were before the Rona. Climbing out of the hole slowly but surely. 

I know all states are different. Here in Texas, as many of you may suspect, is challenging. We probably have A LOT more anti-maskers than many states out there have. We’ve been at work, live…in person since May 1st. Some chiros never took the 2 weeks to step back and see what was up. They just kept motoring through. And….I have to say it looks like they were the smart ones from what I’ve seen. 

I lost out on 2 weeks of work by shutting down completely. Not only that, but from April 1st or so, we were open but emergency only. Honestly…..how many emergencies do we have? We have some but they’re not going sustain my practice. So….I lost two weeks but only doing the emergency thing made me lose a lot of business as well. 

Then, we’re open to everyone and anyone basically on May 1st. Cool, but it took a good while before people started coming in. They knew we closed for a bit and didn’t always know we were back open. Plus, a ton of them were just scared. Understandably. 

So, as with everyone else that follows science, rules, and recommendations, we lost out. For sure. Since I’ve been back at it….again….May 1st, it seems that maybe we could have been safely going the whole time. I could look back and be upset that I followed the rules and that I’m a boy scout like that. But, I’m not going to be. Because how quickly we may forget; it was spooky. Nobody knew the mortality rate. Nobody knew what percentage end up in the hospital or what percentage gets put on a ventilator and how those percentages change from age group to age group. 

We didn’t know anything about it. When you get reports that the death rate is as high as 5% and then a separate paper says it lives on plastic as much as 3 days…..well hell. Please excuse me a sec while my anxiety goes through the roof. I mean, I want to be polite and excuse myself but yeah, the anxiety was going through the roof for myself as well as for the majority of us out there. Not the subluxation slaying spine whisperers of course but for us sciencers….yeah….we were concerned. 

Now we know so much more. We know when everyone in the clinic is masked, we lower our chances of transmission. Life is continuing. Anxiety is still somewhat up there. But life’s continuing as it all seems to work itself out.  The college kid cases are going up all the time. As expected because they’re kids and they’re knuckleheads. As long as they don’t take it home to vulnerable folks, then I don’t see it as harmful. It’s only helpful. 

My daughter has been going to in-person on-campus junior high with over 1,000 fellow knuckleheads. In the first six weeks there have been 2-3 teachers come down with it and about 4 kids. While that may seem a lot to some of you, I see it as a win so far. All of those people in one building together for 6 weeks and that’s all the spread we have? And let’s be fair, I know one of the teachers for sure got it from her husband who brought it home from work. 

To me, it means so far, they are not giving it back and forth to each other at the schools as long as they’re being careful and masking. So far. I really thought they’d all be closed down and go back to strictly online learning by now. I’m still pleasantly wrong. I’ll take it. 

Alright folks Enough Rona rambling. I don’t start talking about it becuase I love the topic. I’ll admit that I do find it all fascinating though. I really do. I’m a bit nerdy about stuff like that. 

Anyway, I talk about it every week because….damnit….that’s what’s going on. It’s the way it is. It’s in my personal happenings as it is in yours as well. So, I might as well talk about it and share with you my experiences, what I’m seeing in my practice, and how I’m muddling through this mess. It’ll either let you know you’re not alone or it’ll show you what you don’t want to do. I’m good either way. As long as you get some use out of it!

Item #1

This one comes from the Office of Public and Intergovernmental Affairs(2020) and is called “VA reduces prescription opioid use by 64% during past eight years.” It was published online on July 30, 2020…..yep…..pretty damn hot. 

This was an article that was basically announcing that t he VA has successfully reduced prescription opioid use in patients within the VA system by 64%. They went from more than 679.000 veterans in 2012 to 247,000 in 2020. 

Lancet Low Back Update & Movement Disorders Mean Pain

 

They say they achieve this dramatic reduction by safer amd more responsible use of opioids but also by treating chronic pain using alternative therapies and treatments. Guess who’s a big part of that? Chiropractors. Yep that’s right. And to be fair…acupuncturists as well. We are getting referrals from the VA for both chiropractic and acupuncture. 

They say, the “VA takes an interdisciplinary approach to care focused on a Veteran’s Whole Health by using non-pharmacological, complementary pain management treatments, self-care, skill building, and support to transition from a biomedical to a biopsychosocial model of pain care. “

How many times have you heard me screaming about the biopsychosocial aspect of chronic pain? A LOT….a lot…

If you follow the link in the article to their list of complementary pain management treatments, chiropractic and acupuncture are the first two listed. Good stuff people. Good stuff. 

They’re just not there yet but wouldn’t have been nice if the title was something like, “The VA system reduces opioids 64% by be smarter and by using chiropractic and acupuncture.” I’m not holding my breath for that day but it really should read just like that. Baby steps I suppose. Itty bitty, teensy weensy baby steps it seems. 

Next paper covers diagnostic tests for stenosis but…

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 one is called “Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study” authored by Tomkins-Lane et. al(Tomkins-Lane C 2020). and published in European Spine Journal in June of 2020. Damn hot enough!

Why They Did It

The authors wanted to reach a consensus on which diagnostic tests are most important in confirming the clinical diagnosis of lumbar spinal stenosis

How They Did It

  • Phase 1: 22 members of the International Taskforce on the Diagnosis and Management of LSS confirmed 35 diagnostic items
  • An on-line survey was developed that allows experts to express the logical order in which they consider the diagnostic tests, and the level of certainty ascertained from each test.
  • Phase 2, Round 1: Survey distributed to members of the International Society for the Study of the Lumbar Spine
  • Round 2: Meeting of 15 members of Taskforce defined final list of 10 items.
  • Round 3: Survey was distributed internationally, followed by Taskforce consensus.

What They Found

  • 432 clinicians from 28 different countries participated
  • Certainty of the diagnosis was 60% after selecting the first test and significant change in certainty ceasing after eight items at 90.8% certainty
  • The most frequently selected tests included MRI/CT scan, neurological examination and walking test with gait observation. 
  • The diagnostic test selected most frequently as the first test was neurological examination.

Wrap It Up

“This is the first study to reach an international consensus on which diagnostic tests should be used in the clinical diagnosis of LSS. The final recommendation includes three core diagnostic items: neurological examination, MRI/CT and walking test with gait observation. The Taskforce also recommends 3 ‘rule out’ tests: foot pulses/ABI, hip examination and test for cervical myelopathy.”

Related but on a separate note, the grocery cart sign hints you toward stenosis. If walking through a grocery store just kills the patient but they can lean over on the cart with their elbows and that alleviates the pain….or if sitting removes the complaint fairly quickly, you need to start sniffing up the stenosis tree. 

I am a big fan of Dr. Carmen Amendolia’s program which he was able to validate through research. It’s called the Boot Camp for Stenosis and it’s REALLY turned a very difficult condition to treat into a much more successful outcome for me personally. 

Basically, it’s just a lack of real estate in the canals and this program helps the patient understand the condition as well as self manage after a 2xweek for 6 week protocol. It’s well-thought out and very well done. And easy to do and understand. 

I highly recommend it. Your stenosis patients will thank you profusely.  

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 & Vlogger

Bibliography

  • (2020). “VA reduces prescription opioid use by 64% during past eight years.” VA US Dept Veterans Affairs.
  • Tomkins-Lane C, M. M., Wong A, (2020). “Diagnostic tests in the clinical diagnosis of lumbar spinal stenosis: Consensus and Results of an International Delphi Study.” European Spine Journal 29: 2188-2197.

 

Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters

CF 145: Kids Still Hurt, Manipulation For Lumbar Radiculopathy, & Lack Of Attention On The Boards For Biopsychosocial Matters Today we’re going to talk about how kids can hurt, SMT for chronic lumbar radiculopathy, lack of testing on biopsychosocial matters.  But first, here’s that sweet sweet bumper music  

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. 

  • 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.    https://www.chiropracticforward.com/chiropractors-affected-by-covid-2019-opioid-overdoses-insurance-compensation-for-chiropractic/   You have found yourself smack dab in the middle of Episode #145 Now if you missed last week’s episode , we talked about some of the most common musculoskeletal surgeries and the incredible lack of research backing them up. We also talked about how chiropractic performs when lined up against multidisciplinary treatment. Check it out after this one. 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….. I think I’m getting busier. Feels like it anyway. 143 last week and the new patients are staying steady. Which is a good thing. I have the kind of practice that depends on new patients. When you’re evidence-based and you don’t make a ton of long-term recommendations…..you don’t make patients think they need to depend on you every week for the rest of their lives….well then, you have a constant turnover of patients.  My longest recommendation is for about a 3 month plan. Honestly, most people are feeling so good that they don’t wrap up a 3 month plan. Some of you agree with that and some of you will say I should be holding them to the program but, research is clear on this.  We should be teaching patients to self-manage at home. Not depending on us. And that’s part of it. Once they start self-managing and they’re feeling great, where’s the motivation to pay someone to mostly do what they’re doing at home already? I get it. And I don’t fuss with patients over their schedules when they’re doing amazing in the first damn place. There’s a point where that type of fussing and borderline bullying starts to look like greed. And I’m sure none of us want to look greedy. At least I don’t.  That’s the epitome of being patient-centered, right? But the point is, patient-centered, evidence-based chiropractors need a steady stream of new patients.  Now don’t get me wrong; I have wellness patients. They just aren’t the bulk of my practice. If I just depended on wellness/maintenance patients, we’d be in a world of hurt up in here, up in here.  Not long ago, evidence-based chiros threw monkey poo at maintenance. Then Andres Eklund came around and cleaned up the monkey mess. Then a systematic review recently came out saying maintenance care can now be considered evidence-based. It felt like slipping into a warm coat in the winter, ya know. Lol.  Now, that doesn’t mean once a week for life like the subluxation slayers lay on people. For the right population, once every month or two….or maybe every three months….that does indeed make difference and make some sense. If you’re unfamiliar with Andres Eklund, just go to our episodes link at chiropracticforward.com and use the search function there to search for maintenance care or Nordic papers and dive in. It’s wonderful stuff.  I love it when the hard work has already been done by people smarter than me. It’s good stuff.  Outside of all that boring stuff, still just trying to stay strong and healthy. I’m exercising much more regularly and really watching what I’m eating. It’s paying off too. I lost 7 pounds last week. Yeah, I know what you’re thinking…..how could Jeff get any sexier than he already is but I’m just going to say, hold my beer and watch. My michelob ultra beer that is…..because, you know….I’m on a diet and all. Lol.  I have one kid at Texas Tech where COVID is spreading like a bad STD and then I have another in person in junior high. So far in the first 5 weeks they’ve had 2 teachers and 2 kids out with the Rona. That may sound like a lot but, honestly, this junior high has about 1400 kids so……that’s not much.  The kid at Tech thinks he wants to come home every 2 weeks for the weekend. I love seeing the little knucklehead but another part of me is like…..you stay over there on that side of the house…..I’ll be on this side. He’s a big hugger. I’m normally good for a hug and all but…..Rona has me trying to stay healthy. You can’t turn down a hug from your kiddo though. Still……it’s a bit nerve wracking.  I tell people and you may have heard me say it but, most folks do fine if they get COVID and I expect I’ll do fine as well. Other than being out of shape and overweight, I’m not particularly unhealthy. Most folks, if they get it, they just stay home in bed, fluids, all that rigamarole but no big deal really.  Me….and most of you….we have to close down out businesses essentially. I have 14 employees, y’all. They have families. We bill out anywhere from $20k-$25k per week typically. At minimum, I’m probably out for 2 weeks. That means missing out on up to $50k in billing.  One word, two syllables….Day-um….Hell no. I’ll just do everything I can to stay healthy in the first place. Even if some knuckleheads don’t understand or get it.  Speaking of…..These anti-maskers….good Lord. I don’t know how they are where you live but here in Texas, did you know all kinds of degrees have morphed into now allowing the owner of the degree to now be an expert on epidemiology? Very powerful degrees. I’ve never heard of a degree that morphs into epidemiological expertise but evidently, it’s a fact these days.  I saw a great quote from a fellow chiro that went something like this, “I guess I just don’t understand the argument anti-maskers make in general. Regardless of anything, for me, as a healthcare professional, I need to be flexible and consider being wrong as part of my logic. Simply put, maybe masks work, maybe they don’t but it really doesn’t matter what you believe. The question sreally is, if you’re wrong can you live with the consequences? I wear a mask because I believe it reduces the risk of exposure for me and to those around me, but more importantly, if I’m wrong I won’t hurt anybody at all. Including myself. If you don’t wear a mask and you’re wrong, then the effects can be devastating during a really off day when things go they way they’re not supposed to go.  Or, how about the sneeze test? Have someone sneeze on you with a mask on and then have them sneeze on you without a mask on.  Which do you prefer? End of story.  Let’s get on with it. We have some pretty cool stuff to breeze through today.  Item #1 Let’s start with this one called “Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8–16 years” by Fuglkjaer et. al. it also has Jan Hartivigsen on it as well. It was published in Chiropractic and Manual Therapies in August of 2020(Fuglkjaer S 2020).  Hot tamale, hot tamale, that tamale….it’s hot… Why They Did It The objectives were to group children aged 8 to 16 according to their distribution of pain in the spine, lower- and upper extremity, determine the proportion of children in each subgroup, and describe these in relation to sex, age, number- and length of episodes with pain. How They Did It Data on musculoskeletal pain from about 1,000 Danish schoolchildren was collected over 3 school years (2011 to 2014) using weekly mobile phone text message responses from parents, indicating whether their child had pain in the spine, lower extremity and/or upper extremity. Result are presented for each school year individually. What They Found

  • Around 30% reporting no pain, around 40% reporting pain in one region, and around 30% reporting pain in two or three regions.
  • Most commonly children experienced pain from the lower extremities at about 60%, the the spine at about 30%, and then upper extremities at about 23%. 
  • Twice as many girls reported pain in all three sites

Wrap It Up Danish schoolchildren often experienced pain at more than one pain site during a schoolyear, and a significantly larger proportion of girls than boys reported pain in all three regions. This could indicate that, at least in some instances, the musculoskeletal system should be regarded as one entity, both for clinical and research purposes. Item #2 This one is excellent. It’s called “Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial” by Ghasabmahaleh, et. al. and published in The American Journal of Medicine on September of 2020(Ghasabmahaleh S 2020).  Sizzlin, smokin’. some stout stuff, y’all.  Why They Did It The authors wanted to evaluate the efficacy of spinal manipulation for the management of non-acute lumbar radiculopathy. How They Did It

  • It was performed in a university hospital
  • It was a randomized controlled trial with two parallel arms. 
  • 44 patients with unilateral radicular low back pain lasting more than 4 weeks were randomly allocated to manipulation and control groups.
  • The primary outcome was intensity of the low back pain on the VAS scale
  • Secondary outcome was the Oswestry Disability Questionnaire score
  • In addition they measure spinal ranges of motion. 
  • All patients had physiotherapy
  • The manipulation group got three sessions of manipulation therapy, one week apart. 
  • For manipulation, they used Robert Maigne’s technique. 

What They Found

  • Both groups experienced a significant decrease in back and leg pain
  • However, only the manipulation group showed significantly favorable results in the Oswestry scores, and the straight leg raise test. 
  • All ranges of motion increased significantly with manipulation but the control group showed favorable results only in right and left rotations and in extension
  • Between-group analyses showed significantly better outcomes for manipulation in all measurements with large effect sizes

Wrap It Up They wrap it up by saying, “Spinal manipulation improves the results of physiotherapy over a period of three months for patients with subacute or chronic lumbar radiculopathy.” I say hell with that conclusion. Lol. I say that PT ADDS TO spinal manipulation. I’ve told my patients for years now that there is great research for spinal manipulation and there is great research for exercise. It’s not about one or the other. They’re not mutually exclusive. The research is best for combining the two.  If you go to a PT and just get exercise, that’s not the full meal deal. You’re a taco or two short of a combo meal there.  If you go to a chiropractor and only get adjustments, yes, there should be some relief but, again, you a taco short. You could be better.  You don’t want evidence-based chiros out there in the world wishing you didn’t suck so much. Get on the exercise rehab. Learn. I didn’t used to know much about it. Hell, if I’m being honest, there’s A LOT more I still need to learn but I’m a hell of a lot better than I once was.  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 #3 Last one today is called “The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States” by Gliedt et. al. published in Chiropractic and Manual Therapies on 21st of August 2020(Gliedt J 2020).  On the hottest, freshest frijoles for the Forward fans.  Why They Did It Chiropractors treat spine complaints and therefore should be trained in the full spectrum of the biopsychosocial model. This study examines the use of psychosocial related terminology in United States doctor of chiropractic program (DCP) curricula, the Council on Chiropractic Education (CCE) standards, and the National Board of Chiropractic Examiners (NBCE) test plans. How They Did It Nineteen academic course catalogs, CCE curricular standards and meta-competencies, and NBCE test plans were studied Wrap It Up Despite evidence suggesting the influential role of psychosocial factors in determinants of health and healthcare delivery, these factors are poorly reflected in United States DCP curricula. This underappreciation is further evidenced by the lack of representation of psychosocial terminology in NBCE parts III and IV test plans. The reasons for this are theoretical; lack of clarity or enforcement of CCE meta-competencies may contribute. So when you hear people ask what we can do to make this profession better, stronger, and more respected…..this is just one more thing that can be done.  Our institutions can recognize the biopsychosocial aspect of chronic pain, they can teach it, they can teach yellow flags, and then they can test it.  Then we can look at making entrance into the schools a little more stringent and we can look at taking the subluxation slayers and spine whisperer courses out of our colleges. If someone wants to learn how to be doctor-centered and use x-rays to manipulate patients out of thousands of dollars a year, they need to be learning that garbage outside of an accredited chiropractic college. It has no place in our institutes beyond some historical perspective.  Over and out. Mic drop, bam, shazam, ala cazam.  https://www.chiropracticforward.com/common-surgeries-arent-well-researched-chiropractic-wins-again/   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.   

Chiropractic evidence-based products

Integrating Chiropractors

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The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website http://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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography

  • Fuglkjaer S, V. W., Hartvigsen J, Dissing KB, Junge T, Hestbaek L, (2020). “Musculoskeletal pain distribution in 1,000 Danish schoolchildren aged 8–16 years.” Chiropr Man Therap 28(45).
  • Ghasabmahaleh S, R. Z., Dadarkhah A, Hamidipanah S, Mofrad R, Najafi S, (2020). “Spinal manipulation for subacute and chronic lumbar radiculopathy: a randomized controlled trial.” The American Journal Of Medicine.
  • Gliedt J, B. P., Holmes B, (2020). “The prevalence of psychosocial related terminology in chiropractic program courses, chiropractic accreditation standards, and chiropractic examining board testing content in the United States.” Chiropr Man Therap 28(43).

Lancet Low Back Update & Movement Disorders Mean Pain

CF 141: Lancet Low Back Update & Movement Disorders Mean Pain

Today we’re going to talk about The Lancet Low Back Series Update and Movement Dysfunction and 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 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, 
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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #141

Now if you missed last week’s episode , we were joined by Dr. Chris Howson to talk about his job working in a hospital out-patient setting. Not an FQHC but the actual hospital. Pretty cool stuff. 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…..

The kids are back in school. I know some parts of the country are still doing video, off-site learning but here in Texas they’re back at it on-site, in-person and I’m concerned about it. How could you not be. Unless you’re one of the conspiracy, it’s the same as the flu, science-haters of course. Sorry, my eyes just rolled out of my head. Let me pick those up real quick and pop them back in. 

Alright….so, my son is at Texas Tech in Lubbock living in the dorm with a room mate and riding the elevators with groups of kids and hanging out in dorm rooms and all that college stuff. I’m telling you all that I support the idea of trying to get back to normal but this is a recipe for disaster and it’s only a matter of time. 

It’s like having some dead, dry brush sitting there on the ground and tossing a match on it. All schools, if I’m guessing are on borrowed time because the same thing that happened in North Carolina and Notre Dame and however many are added to the list by the time this airs…..that’s going to happen across the country and this second wave the CDC thinks we’re getting control of is about to get out of control again. 

Then we’ll close down the in-person classes again and we’ll all have to sit at home and idle again for another 2 months before it calms down again. I truly feel this is going to happen for grades k through college. How can it not?

I know I know….we need to get back to normal, kids need to socialize with peers, some kids are in awful situations, some kids don’t eat if they’re not in school, I get it. 

But at the same time, it’s a real danger. It won’t be gone after the election in November. You guys that think that are going to be so sad. I know you won’t admit you’re wrong but that’s OK. Science-y people have seen your social media posts and know who you are and we’ll pray for some peace of mind for you. 

Time will tell if I’m right. I don’t want to be right. But I don’t see how it can go any other way. 

As far as business, same same same. Hell, if anything, like I said last week, it’s gotten even slower for us. With back to school being our slowest time of the year traditionally, it makes sense that it’s gotten slower. But I damn sure don’t like it. In fact, it makes me hyper as hell. 

This in spite of advertising like crazy and creating an online presence that is twice of what it was before the Rona came and destroyed an amazing practice. 

But, that’s OK. We were never promised a life with no bumps in the road. A worry-free life. Yeah, that’s not real life. We take challenges and obstacles and we adapt and overcome. And that’s where we’re at. Adapting and overcoming. 

Item #1

Here’s a new one that is actually an update to a key paper a couple of years ago. It’s by Buchbinder et. al. and called, “The Lancet Series call to action to reduce low value care for low back pain: an update” published in Pain in September of 2020(Buchbinder R 2020). Well hell, lookie here. It’s only September 3 and here we are, smoking, sizzlin’ and steaming hot. 

This is a bit long but it’s important. While Jan Hartvigsen, a chiropractor, is in this group of authors, the rest are not and, I’d argue, bent a bit toward the medical field and PT. They’ll claim they’re not profession specific but it just seems a little more bent to PT. However, the information is still very relevant to chiropractors and, relevant to the medical field and insurance industry. Unfortunately, none of those seem to be paying any attention. 

Now, this is not necessarily a research paper but more of a commentary so let’s dive in with a good solid summary of the contents here. Pay attention. I promise you’ll learn some factoids to put into your social media posts. 

  • The 2018 Lancet Low Back Pain Series, comprising 3 papers written by 31 authors from disparate disciplines and 12 different countries, raised unprecedented awareness of the rising global burden of low back pain partly attributable to poor quality health care.
  • The series described current guideline recommended care of low back pain, and new strategies that show promise, but require further testing, to reduce low value care.
  • Low back pain is still the number one cause of disability in the world
  • In 2015, low back pain was responsible for 60·1 million disability-adjusted life-years; a 54% increase since 1990
  • A recent study estimated that US$134.5 billion was spent on health care for low back and neck pain in 2016 in the United States, the most out of 154 conditions studied, and this had increased by 6.7% annually between 1996 and 2016
  • For the vast majority of people with low back pain, it is currently not possible to accurately identify specific causes or nociceptive sources. Risk factors and triggers for episodes of nonspecific low back pain include previous episodes of back pain, the presence of other chronic conditions such as asthma, headache, and diabetes, poor mental health (including psychological distress and depression), genetic influences, as well as awkward postures, lifting, bending and heavy manual tasks, and being tired or being distracted during an activity.44 Smoking, obesity, and low levels of physical activity, all related to poorer general health, are also associated with occurrence of low back pain episodes.
  • Many patietns with low back pain are still receiving the wrong care. Even 2 years after the series came out. 
  • A 2018 systematic review that included 14 studies mostly from the United States (6 studies), United Kingdom (3 studies), and other high-income countries found that overall more than 50% of people with low back pain seek care annually and 30% have sought care within the past month.
  • A 2012 study in a US Veterans Affairs Health Care facility found that 59% of outpatient lumbar spine scans were inappropriate.3 This suggests that unnecessary lumbar spine magnetic resonance imaging scans for people not suspected of having a serious condition cost $US300 million per year in the United States. 
  • This is supported by a 2019 systematic review (14 studies) which found evidence that imaging is associated with higher medical costs, increased health care utilization and more work absence compared with nonimaged groups. Despite little evidence to support its use for most back conditions,43 and a 20% failure rate, another US study estimated that $US12.8billion was spent on spinal fusion surgery in 2011, the highest aggregate hospital costs of any surgical procedure.
  • Major international clinical guidelines have moved away from medicalized management of low back pain and prioritized nonpharmacological approaches as first line care.
  • A Los Angeles Times investigation has revealed that aggressive marketing appears to be leading to new epidemics of opioid prescribing in low-income and middle-income countries.
  • Although the high rates of opioid prescribing are now beginning to fall in some high-income countries such as the United States74 and the United Kingdom,22 worryingly, opioid medication is being substituted for or used with gabapentinoids.
  • In England, the number of prescriptions for gabapentin and pregabalin were 30% and 56% more, respectively, in the 12 months to December 2019 than the 12 months to December 2015.73 In one study of 251 patients referred to a pain service in the Northeast of England, 82.5% were taking an opioid, over half of whom (56.2%) were also on gabapentinoids, while 16% of those on dual therapy were on high doses of both drugs.
  • Not only does the evidence not support use of gabapentinoids for nonspecific low back pain (or sciatica),27 studies in both Canada and Australia have reported an increased number of overdose deaths associated with dual opioid and gab apentinoid use.
  • UK National Institute for Health and Social Care Excellence did not find any randomised controlled trials of cannabinoids to treat low back pain and advised against their use for chronic pain in adults.
  • A four-year prospective observational study found cannabis users had greater pain and lower self-efficacy in managing pain, and there was no evidence it reduced pain severity or interference or exerted an opioid-sparing effect.
  • There is therefore an urgent need to address politician and public misconceptions about cannabinoids and preventive action to limit the same aggressive marketing approaches for medicinal cannabinoids that enabled the opioid epidemic; a new prescribing epidemic may be imminent.
  • Regenerative medicines such as autologous platelet-rich plasma or stem cell injections into degenerated lumbar discs or facet joints aims to help discs and/or joints regenerate. However, there is only a weak relationship between radiological change and the presence/absence of low back pain (eg, disc degeneration is present in 54% of those symptomatic with low back pain and 34% of those who are symptom free11), which means that even if these products successfully produce regeneration they are unlikely to affect low back pain for most people.
  • Much of the money spent on low back pain is wasted and better solutions are needed.
  • The Lancet Series identified promising solutions that included focused implementation of best practice, the redesign of clinical pathways, integrated health and occupational care, changes to payment systems and legislation, and public health and prevention strategies.30 Yet, we also indicated that most were not yet ready for widespread implementation as the evidence underpinning them was inadequate.
  • Targeted efforts to reduce overuse of imaging for low back pain, a major source of healthcare waste and even iatrogenesis, have not met with much success
  • Global initiatives to decrease health care waste and iatrogenesis such as Choosing Wisely are therefore specifically targeting imaging for low back pain8; however, large-scale impact of these initiatives have not yet been well documented.
  • A controlled before-after study of a spine care pathway that incorporated conservative spine care recommendations introduced in one primary care practice (with 11 primary care physicians) but not another (with 74 primary care physicians) reported a reduction in health care expenditure, mostly attributable to reduced spine surgery costs.90 Opioid utilization was also reduced while manual care costs were increased.

In summary:

The Lancet Low Back Pain Series outlined a way forward to address the increasing and costly effects of disabling low back pain. As a starting point, it garnered enormous media attention and continues to do so, but attention should now be directed towards engaging with consumers and patients, policy makers, clinicians, and researchers to identify and implement effective solutions. While effecting solutions will take time, measuring and benchmarking our progress in different countries will be crucial to these efforts.

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

The last one we’re going to cover this week is called “Passive intervertebral motion characteristics in chronic mid to low back pain: a multivariate analysis” by Brownhill et. al(Brownhill K 2020). published in Medical Engineering and Physics on 18th of August in 2020. Boiling and smoking and simmerin’!

Why They Did It

Studies comparing back pain patients and controls on how the vertebrae interact with each other and if dysfunction causes pain…..those studies have shown differences. A multivariate re-analysis was carried out to estimate main modes of variation, and explore group differences.

How They Did It

40 participants w/ mechanical back pain and 40 matched controls underwent passive recumbent quantiative videofluoroscopy

Intervertebral angles of L2/3 to L4/5 were obtained for right and left side-bending, extension, and flexion

What They Found

There were three main modes of variation and all of them were related to range of motion and its distribution between joints. 

Significant differences were found for coronal plane motions only

Wrap It Up

“The results confirm altered motion sharing between intervertebral joints in back pain, and provides more details about this. Further work is required to establish how these findings lead to pain, and so strengthen the theoretical basis for treatment and management of this condition.”

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. 

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.

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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 & VloggerBibliography

Brownhill K, M. F., Breen A, Breen A, (2020). “Passive Intervertebral Motion Characteristics in Chronic Mid to Low Back Pain: a Multivariate Analysis.” Medical Engineering & Physics.

Buchbinder R, U. M., Harvigsen J, Maher C, (2020). “The Lancet Series call to action to reduce low value care for low back pain: an update.” Pain 161: p 557-564.

 

w/ Dr. Chris Howson: Chiropractors In Hospitals & Drop Release

CF 140: w/ Dr. Chris Howson:  Chiropractors In Hospitals & Drop Release

Today we’re going to be joined by Dr. Chris Howson of the great state of North Dakota where we’ll be talking about chiropractic integration in a hospital setting as well as his new invention called Drop Release. 

But first, here’s that sweet sweet bumper music

Subscribe button

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 #140

Now if you missed last week’s episode , we talked about chiropractors affected by COVID, 2019 opioid overdoses, and insurnace compensation for chiropractic. 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…..

I am writing this on 8/17/20 which means I’m taking my son to college this afternoon for his freshman year. It’s my first kid to fly the coop and we’ll see how it goes. Many of you did this same thing years ago. Many of you don’t even have kids so I won’t dwell on it long. 

I’ll just say, especially to the young ones, there’s no time to waste. Whether it’s starting your own retirement account, starting your kids a college fund, or asking that girl on a date. There’s no time to waste because landmarks like I’m going through this week…..they arrive before you know it. Almost by surprise even. 

Before you know it, you’ll look up and you’ve been in business 20 years, your kids are graduating, you looking at retirement in the next 10-15 years and you don’t know exactly how it all happened. But it did and if you’re not a forethinker, it’ll punch you square in the nose and make your eyes cross. 

Just a word from your wise ol’ Uncle Jeffro. 

I don’t want to talk too much because we have a guest today. Before we welcome him, I want to do a proper introduction. 

  • 2004 graduate of Northwestern. 
  • Practicing in Grand Forks ND, 
  • has spent the last 9 years in an integrated practice setting. 
  • Has a strong background in sports and applies that “get em back on the field” mentality to all his patients.  
  • Member of FTCA, NDCA, and ACA.   
  • Currently pursuing the orthopedic diplomate.  
  • Inventor of the Drop Release.

Tell me a little bit about yourself and your family.

I always say that chiropractic isn’t something that immediately comes to mind when one is deciding what they want to be when they grow up. So how did you come to be a chiropractor?

Where did you go to school?

What in your background or your schooling best prepared you for your current practice setting? Did you have any mentors that were particularly impactful along the way?

We have talked at length on this podcast about integrating into the Federally Qualified Health Centers or FQHCs but your situation is a little bit different. Can you explain what you’re doing and how you got there? And how it’s different from an FQHC.

What kind of patient is your typical patient in the hospital setting? Are you just confined to acute low back or what? 

Have you had any issues or had to stand your ground when it came to those in the medical field that don’t necessarily love the chiropractic profession? 

Numbers

Do you see your model as something that can be repeated in TX, NC, CA, to Florida? And how? How could those interested start on the path you’re blazing up in ND?

Do you see your current way of practicing as your life long way or do you have plans to be in the private sector down the line?

So, we get along very well because we are both go getters and entrepreneurs. If people have been listening, lately, I’ve been giving them a code for a discount on a new little invention called Drop Release. You happen to be the inventor of Drop Release. I actually first met you in person at the Forward ’19 event in St. Louis when you were working your Drop Release exhibit booth. Tell us all how you came up with the idea. How did you take it from concept to reality? That’s the biggest hurdle most folks don’t get over. 

We might as well give them the code to save some money on Drop Release if they want one, don’t you think?

Thanks for joining us, Chris. I appreciate it. 

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 & Vlogger

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

CF 138: That Episode Where Vitalists Tune Out & NSAIDS vs. Cognitive Behavioral Therapy Today we’re going to talk about some research papers that the vitalists in our profession don’t pay attention to and don’t want to hear about because it doesn’t confirm the bias and then we’ll also cover a paper that pits NSAIDS against Cognitive Behavioral Therapy. Cognitive behavioral therapy is a key aspect to treating chronic pain. Very interesting stuff.  But first, here’s that sweet sweet bumper music.  

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. 

  • 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 #138 Now if you missed last week’s episode , we were joined by Dr. Aric Frisina-Deyo and discussed his research endeavors and even more importantly, his integration into the FQHC setting, what it’s like and how he did it. 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. 

w/ Dr. Stuart McGill – Clinical Jazz, Treating Kids Like Pros, Thoughts On Posture, and Being A Low Back Pain Ninja

 

On the personal end of things…..

So far so good. Looking at getting these kids back to school. What a great national debate. Of course, as with anything and everything else, everyone wants to make it a political issue rather than a public health issue. Which is always incredibly disappointing.  Listening to a podcast from JAMA, it sure seems it’s not a one size fits all decision. It looks like the answer lies within each different community.

Here’s what I do know for sure regardless of how well kids carry it or how poorly kids spread it, there WILL be some kids get sick and have an extremely hard time with it. Teachers WILL get sick and some WILL die. That’s if they keep the schools open beyond the first week or two. I think it’ll depend on how quickly people start getting sick again.  Now, I’m not advocating for or against kids going back to school but I sure don’t want anyone being surprised when it happens. Because it will.

For example, I have a friend that is a teacher. Late 50’s early 60’s. Chronic asthma and just had a heart cath. He does NOT want to go back and I don’t blame him one bit.  Some of the larger schools….you simply cannot socially distance. Do you remember what a school hallway looks like during class change? Anyway, these types of teachers, my prayers go out to them. My prayers go out to families like mine that have kids still in school and are worried about their kids and their kids bringing it home to them. 

I’ve said it here before; I think that if I get it, I probably do just fine. Yeah, I’m overweight but not so much that I can’t be active and all that. I’m type O+ blood type. I exercise and I don’t have any underlying issues like high blood pressure. I feel like I may get sick as hell but I do well.  But the BIG issue is that if I get it, I STILL have to shut my clinic doors for an undetermined number of weeks and that’s just simply not something I’m in a hurry to do. I’m sure you are not either. So, if for no other reason than to keep your doors from closing, it makes sense to continue to protect yourselves and your patients to the highest level possible. 

I’m just a few days away right now from taking my son to his first semester of college at Texas Tech in Lubbock, TX. How the hell is college and living in a dorm going to work out for these kiddos? I feel like I can read the future and my crystal ball tells me these kids are going to pass it back and forth like a beer pong ball. Is that good or bad?

Well, on the one hand, it’s good because most all of them will do extremely well with it and that will work toward herd immunity.  On the other hand, some will not do so well and some will get sick…..the parents will come to pick them up and take them home to care for them and….well…..you know how it goes from there. 

So, I’m concerned. I feel we are going to see what this bug can really do once school starts back up. That’s just my personal opinion. But, we’ve also heard some of the punch this dude packed back in the Spring has gone away and, while people are still dying from it, they are not dying in the numbers they were back in the Spring.  Don’t get me wrong here, I’m not cowering in fear in the corner afraid to touch people in my practice.

Outside of the first two weeks, we’ve been open 100%. I’m seeing about 140 per week right now. Shaking hands…..maybe even a little hug here and there. I just wear a mask and wash my hands a lot. We have the UV air scrubbers. We check temp and symptoms when they come in the door. We clean like crazy. But nothing I would consider overboard and…..So far so good. 

So….what do we do? We sit, wait, and watch. Just like we have been doing since February. In a way, I almost envy the deniers, the non-sciencers. They are just going through this oblivious with little to no sense of danger and non-ending mockery of the sciencers of the world. They say ignorance is bliss and you can see it on display on social media every day all day.

Unless you’re like me of course. I have the non-sciencers snoozed for 30 days so I don’t have to see the foolishness and can still enjoy myself.  I’m no expert in virology. I’m no epidemiologist. The difference between me and the non-sciencers is that I’ll freely admit that and will go actively looking for the answers in the research, from the experts, and through JAMA rather than ignoring science, ignoring experts, and listening to foolishness and propagating idiocy. 

But…..that’s just me. 

 

Item #1 Let’s get to this first one called “Nonsteroidal Anti-inflammatory Drugs vs Cognitive Behavioral Therapy for Arthritis Pain; A Randomized Withdrawal Trial” by Fraenkel, et. al. (Fraenkel L 2020) and published in JAMA on July 20, 2020. Hot tater, pitch it around, hot tater… Why They Did It Is replacing meloxicam with placebo about the same as continued meloxicam, and is engaging in a telephone-based cognitive behavioral therapy program about the same as continuing meloxicam for patients with knee osteoarthritis? How They Did It

  • 364 patients that took NSAIDs for knee osteoarthritis most days of the week for at least 3 months
  • The subjects stopped taking the NSAID and took 15 mg per day of meloxicam 
  • Those who remained eligible were randomized in a 1:1 ratio to receive meloxicam or placebo for 4 weeks
  • Participants receiving meloxicam then continued this medication for 10 weeks, while those receiving placebo participated in a 10-week cognitive behavioral therapy program

What They Found

  • A total of 180 were randomized to get the placebo followed by CBT
  • 184 were getting the meloxicam
  • The estimated difference in the WOMAC pain score between the two groups after 4 weeks was 1.4
  • After 14 weeks, the difference was .8
  • There was no statistically significant difference in the pain or in disability

 

10 Back Facts & How Does Chiropractic Perform When Integrated?

Wrap It Up Among patients with knee osteoarthritis, placebo and cognitive behavioral therapy (after placebo) are inferior to meloxicam. However, the WOMAC pain score differences between the 2 groups were small, and there were no statistically significant differences in participants’ global impression of change or function after 14 weeks.

I have been searching for a cognitive behavioral therapist locally for some time now and have yet to identify one in my market. The only cognitive behavioral therapist I have found is at the VA so the public doesn’t have access to them. I’m still searching. It’ll happen eventually because chronic pain isn’t going anywhere and cognitive behavioral is going to get more and more important as they continue to learn more and more about the ability of cognitive behavioral therapy to help these folks. 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 one is called “The accreditation role of Councils on Chiropractic Education as part of the profession’s journey from craft to allied health profession: a commentary” by Innes et. al. (Innes S 2020) published in Biomed Central on July 22, 2020. Whew….whew the hotness. Cool it down here. 

This is an article so we’ll hit the high spots here:

  • Chiropractors see themselves as well positioned to provide safe, effective and economical care for the on-going financial burden that spinal pain imposes. However, in many places of the world, the chiropractic profession continues to find itself struggling to gain acceptance as a mainstream allied health care provider.
  • They say there is a need for scrutiny of international chiropractic educational accreditation standards, which are the responsibility of Councils on Chiropractic Education (CCEs)
  • They found that there is sufficient evidence to identify areas of concern that could be addressed, at least in part, by improvements to CCEs’ educational standards and processes.
  • Areas included a lack of definitions for key terms such as, ‘chiropractic’, ‘diagnosis’, and ‘competency’, without which there can be no common understanding at a detailed level to inform graduate competencies and standards for a matching scope of practice.
  • They go on to say there is some evidence to suggest that in some cases this level of detail is avoided in order to enable a “big tent” approach that allows for a diversity of approaches to clinical care to co-exist. This combined with the held view that chiropractic is “unique”, highly valued, and best understood by other chiropractors, explains how students and practitioners can cling to ‘traditional’ thinking. This has implications for public safety and patient quality of care.
  • They say that despite the global implications of low back pain, the low utilization of chiropractic has remained unchanged over the past 35 years or so. Mostly because we are not gaining mainstream acceptance to the point of being on equal footing with others. Why the hell could that be ya think?

They wrap up the conclusion as follows, “If chiropractic care is to gain mainstream acceptance worldwide then it needs to adopt, through revitalized CCE accreditation standards and processes, those of other allied healthcare professions and wholeheartedly embrace science, evidence-based practice and patient-centered care.”

Ya can’t say it any clearer than this folks. This is the core of the issue. If you are a regular listener, then you know a couple of weeks ago, we covered a bit older paper about what chiropractic can learn from podiatry. This…..this is it just in different words. Non-sciencers act like WE’RE the ones destroying the profession of chiropractic. 

Where I stand, and the way I see it, the evidence-based, patient-centered practitioners…..the sciencers….are the ones desperately trying to save the profession, its reputation, and bring it into the year 2020 instead of the early 1900s.  This is a loooonnnggg article. I didn’t read all of it. I didn’t have the time but, my conclusion for you is this; we have to learn, adapt, upgrade, and advance. You just have to people. Dammit. 

w/ Dr. James Lehman (Pt. 1) – National Scope, Chronic vs. High Impact Chronic, Coordinated Care/Medicaid, DACO to DIANM

Item #3

In yet one more effort to make the vitalists hate me, this new one is called “The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature” by Corso, et. al. (Corso M 2020) and published in Biomed Central Chiropractic and Manual Therapies on July 9, 2020, sizzlin’ sausage and saurkraut surprise…. Why They Did It To determine the diagnostic and therapeutic utility of routine or repeat radiographs (in the absence of red flags) of the cervical, thoracic or lumbar spine for the functional or structural evaluation of the spine and to investigate whether functional or structural findings on repeat radiographs are valid markers of clinically meaningful outcomes. How They Did It

  • They searched MEDLINE, CINAHL, and Index to Chiropractic Literature from the days of Adam and Eve to November 25, 2019.
  • They used rapid review methodology recommended by the World Health Organization
  • 959 citations, 176 screened, and 23 critically appraised. 

What They Found

Nine low risk of bias studies investigated the validity and reliability of routine or repeat radiographs. These studies provide no evidence of clinical utility.

Wrap It Up

“We found no evidence that the use of routine or repeat radiographs to assess the function or structure of the spine, in the absence of red flags, improves clinical outcomes and benefits patients. Given the inherent risks of ionizing radiation, we recommend that chiropractors do not use radiographs for the routine and repeat evaluation of the structure and function of the spine.” If you’re just now hearing this, welcome to the show. We’ve been saying this for a while now. ACA has been saying this through Choosing Wisely since about 2016 or so.

I cannot fault you for wanting x-rays on the first visit. Some are just uncomfortable otherwise. Who am I to tell you to not shoot those? However, the repeated and updated x-rays…..nope. No sir. No ma’am. Cut it out.

If you’ve been listening, there is even some idea or evidence that repeated x-rays like this may potentially be an impetus for neurodegenerative disease. So…..if you bought that x-ray machine thinking it was going to be a cash register ringing up the dollars for you, you’re going to have to stop, take a step back, re-evaluate your practices, and use it like most other healthcare practitioners use imaging. Sparingly and only when necessary.  Alright, that’s it. Y’all be safe. I hope y’all enjoyed the cognitive behavioral discussion.

Good stuff. 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. 

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 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 http://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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography Corso M, C. C., Mior S, TKumar V, Smith A, Cote P, (2020). “The clinical utility of routine spinal radiographs by chiropractors: a rapid review of the literature.” BMC Chiro Man Ther 28(33).

Fraenkel L, B. E., Suter L, (2020). “Nonsteroidal Anti-inflammatory Drugs vs Cognitive Behavioral Therapy for Arthritis Pain A Randomized Withdrawal Trial.” JAMA.

Innes S, L.-Y. C., Walker B, (2020). “The accreditation role of Councils on Chiropractic Education as part of the profession’s journey from craft to allied health profession: a commentary.” BMC Chiro Man Ther 28(40).    

w/ Dr. Aric Frisina-Deyo – Chiropractors In An FQHC Setting & Setting The Bar High Early On

CF 137: w/ Dr. Aric Frisina-Deyo – Chiropractors In An FQHC Setting & Setting The Bar High Early On

 Today we’re going to be joined by Aric Frisina-Deyo. We’re going to discuss the ins and outs of working in an FQHC. You’ve heard us talk about it before with Dr. James Lehman. How do you do it, what can you expect out of it, and what does it look like? But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!

Do it do it do it. 

You have found yourself smack dab in the middle of Episode #137

Now if you missed last week’s episode, we talked about adjustments making a person stronger, providing more endurance, and providing improved balance. We talked about new evidence on muscle relaxers, and we talked about the best recovery posture after some intense training. Find out if it’s better to recover having your hands on your knees or standing up with your hands behind your head like we’ve been taught over the years. 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….. So far, so good. Staying steady, healthy, and strong. No big drop-offs in business but no big growth beyond our 80% mark either. Like I said last week, 80% is my new normal for now and, if that’s my new cap, then it’s time to simply start comparing my weekly numbers to the 80% mark and just continue growing and comparing to that.  Basically, my 80% is what I’m now accepting as my new 100% if that makes sense. That’s my roof or my ceiling. I have stopped comparing my numbers currently to the numbers of last year or the numbers of pre-COVID.

It’s not fair to me or my employees. Like it or hate it, there is a new normal for now and for the foreseeable future and I’m living and operating in that world for now.  That just makes more sense to me. Otherwise, I’m trying to reach a bar that is very difficult to reach and I think I’ll be perpetually frustrated and nobody’s got time for that.

So, I’m comparing my numbers to last week’s numbers and last month’s numbers. It just makes more sense.  I have a new assistant taking care of the Chiropractic Forward website. You’ll have to go check it out here and there. She’s in the process of updating the Store link where we have evidence-based patient education brochures and brand new posters for your offices.  Just go to chiropracticforward.com and click on the Store link while you’re there. Maybe sign up for our weekly email newsletter while you’re at it. No spam, just a weekly reminder on Thursdays when the new episodes go live. That’s it. 

Introduction Alright, let’s get on with the show and introduce our guest today. Today we’re joined by Dr. Aric Frisina-Deyo. Being in only his second year of practice, Aric was wondering why I’d be interested in his story. Well, it’s simple, he is integrated into and working for an FQHC. Meaning, he’s already functioning at the top of the game and I want to know about it. 

I’m guessing if I want to know about it, many of you would like to know about it.  First, you may think your area doesn’t have an FQHC and for the most part, you’re probably wrong. Just pull out your Google machine and type in ‘FQHC and the area you live in’. See what it pulls up. Dr. James Lehman pulled that one on me when I told him I didn’t think my area had any.

Well, turns out we had two of them and I had no idea. One more in the win column for Dr. Lehman.  What is an FQHC, you might ask? It stands for Federally Qualified Health Center. If you have listened to either of the episodes we have had with Dr. James Lehman from the Neuromusculoskeletal Medicine Diplomate of the University of Bridgeport.    to start the second year of the three year Neuromusculoskeletal Medicine Residency through the University of Bridgeport. Very active while a student holding numerous positions in clubs and student government, Aric was able to take MDT and MPI which, along with this schooling, has helped to shape his practice style.

He is currently providing care to underserved populations in New Britain, Danbury and Clinton, CT in Federally Qualified Health Centers in a multidisciplinary setting alongside MDs, DOs, APRNs, PAs, Podiatrists, Dentists, Dieticians, other Allied Health Professionals. Aric is also working toward his diplomate in Neuromusculoskeletal Medicine and has had the privilege to assist in instruction for the orthopedic and neurological examination labs at UBSC. When not treating patients, studying or moderating FTCA, Aric can be found spending time with his wife and two children. He has already co-authored 6 research publications. 

So let’s welcome Aric to the show thank you for joining us today. 

Tell us where you are located and a little about the area if you don’t mind. 

Before we get to the FQHC’s, tell me a bit about your journey to becoming a chiropractor. I always say that it’s not the first thing that comes to mind when most kids are deciding what they want to be when they grow up. 

Tell me about where you attended college and your unique experience there that has led to your position and the current practice environment.   

Is there an advantage to being a resident in an FQHC? Explain the pros and cons of your experience. 

Do you evaluate or see many chronic pain patients?

Do your patients tend to present with many co-morbidities or are they usually just spinal pain.

If so, how do you manage the co-morbidities?

Do you care for many high-impact chronic patients with disabilities? And…..for our audience, can you explain the difference between high-impact chronic pain and run-of-the-mill chronic pain?

Tell us about your experience working with and interacting with your medical field counterparts there at the FQHC. 

Do you see the FQHC being your preferred practice setting going forward or is a private practice in your future?

Before we wrap up here, I met you through Dr. Kris Anderson up in North Dakota. He’s been a previous guest on our podcast. He has suggested you have something working with dry needling research. Can you share some of that information with us?

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