pt

PT For Sciatica & Laser For Neck Pain

CF 320: PT For Sciatica & Laser For Neck Pain Today we’re going to talk about PT For Sciatica & Laser For Neck Pain But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #320 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. If you’ve been following along, you know I’m still digging my clinic out of the Winter doldrums but it’s coming along nicely. If you want to hear more about that and what we’ve been doing to change course and correct the path forward, listen to last week’s episode.  The plan laid down is starting to bring some fruit that I think we’ll be harvesting soon. I had 15 or 16 new patients last week. It’s not to the 20 or so I was used to before COVID but it’s better than the 9 or 10 I was seeing a month or so ago.  We’re back to doing the therapies on our patients that we should be legitimately doing. We’re not just failing to do them and watching that money simply walk out the door.  For example, we billed $106k in February as opposed to $82k in December. Quite a difference there. Now, that’s me and the nurse practitioner and while that may sound like a metric crap ton of money in a month, and it is for some, remember, my overhead monthly is approximately $65k or more. So, if you bill that much, guaranteed you’re not collecting that much. You might get $80 – $85 of that.  That leaves you with $15k….maybe $20k in profit for the month. So, it’s not where we want it but it’s moving in the right direction. We collected about $30k more in February than we did in each of the previous 3-4 months so collections is doing its deal and making me happy once again.  I’m such a fun guy when I’m making money instead of losing it!! Y’all!  This week is a short week for me. I’m flying out to Atlanta Thursday morning to the big VOAtlanta voice conference. Around 1,000 attendees. Last year, the dude that does all of the announcements for the TODAY show was sitting behind me. The guy that has voiced Goofy for the last 40 years was there. Nolan North who voiced the lead character in the video game Unchartered was there.  You just never know who’s going to be there but making the just right contact on these things could mean a lot financially. No doubt. So I go, I have some drinks at the bar, I attend classes and enjoy it and take it all in and just see what happens.   So that’s on tap this weekend and you know I’ll be talking about it on the podcast next week. But for now, let’s hop in on the research.  Item #1 The first one this week is called, “How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis” by Dove et. Al. and is published in European Spine Journal on December 29, 2022 and let’s do the hot thing just because! Remember, the citations can be found at chiropracticforward.com under this episode.  Dove, L., Jones, G., Kelsey, L. et al. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J 32, 517–533 (2023). https://doi.org/10.1007/s00586-022-07356-y Why They Did It Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial.  The purpose of this systematic review was to establish the short-, medium- and long-term effectiveness of physiotherapy interventions compared to control interventions for people with clinically diagnosed sciatica How They Did It This systematic review  Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed, Scopus and grey literature were searched from inception to January 2021 Inclusion criteria were randomised controlled trials evaluating PT interventions compared to a control intervention in people with clinical or imaging diagnosis of sciatica.  Primary outcome measures were pain and disability.  Study selection and data extraction were performed by two independent reviewers with consensus reached by discussion or third-party arbitration if required.  Risk of bias was assessed independently by two reviewers using the Cochrane Risk of Bias tool with third-party consensus if required.  Meta-analyses and sensitivity analyses were performed with random effects models  Subgroup analyses were undertaken to examine the effectiveness of physiotherapy interventions compared to minimal (e.g. advice only) or substantial control interventions (e.g. surgery). Three thousand nine hundred and fifty eight records were identified, of which 18 trials were included, with a total number of 2699 participants.  What They Found All trials had a high or unclear risk of bias. Meta-analysis of trials for the outcome of pain showed no difference in the short, medium or long term.  For disability there was no difference in the short, medium, or long term between physiotherapy and control interventions.  Subgroup analysis of studies comparing physiotherapy with minimal intervention favored physiotherapy for pain at the long-term time points.  Large confidence intervals and high heterogeneity indicate substantial uncertainty surrounding these estimates.  Many trials evaluating physiotherapy intervention compared to substantial intervention did not use contemporary physiotherapy interventions. Wrap It Up Based on currently available, mostly high risk of bias and highly heterogeneous data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica. Item #2 The second one today is called “Efficacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomised placebo or active-treatment controlled trials” by Chow et. Cl and published in The Lancet on December 5, 2009.  Chow R, Johnson, M, ‘Efficiacy of low-level laser therapy in the management of neck pain: a systematic review and meta-analysis of randomized placebo or active-treatment controlled trials’, 374, 9705, P1897-1908, Dec. 5, 2009. DOI:https://doi.org/10.1016/S0140-6736(09)61522-1 Why They Did It Neck pain is a common and costly condition for which pharmacological management has limited evidence of efficacy and side-effects.  Low-level laser therapy (LLLT) is a relatively uncommon, non-invasive treatment for neck pain, in which non-thermal laser irradiation is applied to sites of pain.  They did a systematic review and meta-analysis of randomised controlled trials to assess the efficacy of LLLT in neck pain. How They Did It We searched computerised databases comparing efficacy of LLLT using any wavelength with placebo or with active control in acute or chronic neck pain.  Effect size for the primary outcome, pain intensity, was defined as a pooled estimate of mean difference in change in mm on 100 mm visual analogue scale. What They Found We identified 16 randomised controlled trials including a total of 820 patients.  Side-effects from LLLT were mild and not different from those of placebo. Wrap It Up We show that LLLT reduces pain immediately after treatment in acute neck pain and up to 22 weeks after completion of treatment in patients with chronic neck pain. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Chronic Pain Central Sensitization & Patient Barriers To Physical Therapy

CF 316: Chronic Pain Central Sensitization & Patient Barriers To Physical Therapy Today we’re going to talk about Chronic Pain Central Sensitization & Patient Barriers To PT and, I would argue….chiropractic care. But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #316 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Man, we’re going through some stuff at the office recently and it centers around collections. Remember when I said last week that practice is a big long game of whack-a-mole? Well, it’s a fact and what I’m currently dealing with is really a ‘death by a thousand cuts’ type of scenario with one glaringly large issue.  The bright neon sign issue right now is collections. We are billing appropriately but the checks aren’t showing up. We’ve had such a struggle with in-house billing in the past. We lost hundreds of thousands on that years ago so we’ve moved to off-site billers. We are now on our 4th, I believe.  I think we’re in the right spot with this one. However, in the transition, our collections have taken a nose dive and I mean a nose dive. As in, if we billed out $70k+, we had a collections of $28k. Right. Now, carry that out over 3 months with that kind of deficit, your resources that are meant to cover issues start to vanish fairly rapidly.  Remember, I have an overhead of $55k-$60k/month. I remember when I was younger and newer in practice. At the time, my overhead was about $25k. I was talking to an older chiro buddy of mine at a TX Chiro Assoc event and he told me his overhead was $45k/month. And he wasn’t integrated either. It blew me away. I couldn’t imagine having an overhead that high.  And…..well here we are. With 4 full time employees, a full-time NP, an acupuncturist, and 2 massage therapists…..it just sort of happens. All of the medical supplies….holy cow. That’s a pretty penny, folks. Massage supplies, acupuncture needles, 4,000 sq ft. Office, utilities…you get the point. It adds up fast and if you’re not cognizant of what’s up, it’ll get out of hand on you. That’s why I balance my own bank account each month. I know what’s coming in and what’s going out.  It’s why I know that we have a collections issue.  Remember we have death by a thousand cuts, right? Well, other issues of late are that we aren’t performing and charging for codes we could be. We’re letting cold laser patients walk out the door without doing laser. We’re letting exercise patients exit the building without doing their exerrcises. This is happening with patients that are covered under PI or on their insurance plan for rehab.  That’s just a training issue and we’re whacking that mole currently.  Another issue is that we’re still recovering from COVID on some level. In 2019, I had 220 more new patients over the course of that year than I had in 2023. What the hell? So, we’re whacking that mole by ramping up some marketing and website SEO efforts.  I have a call with the collection company today at lunch and I have addressed the other issues. Now, if we can get it happening on the collections, you’ll get to hear happy Jeff in future episodes. Yay!! Why do I share this stuff with you? I like to think this is not just a research article podcast. This is real life. If you know the struggles I’m dealing with and the successes I’m enjoying, you’re either going through the same and can learn, or you WILL be going through the same and can learn from my experiences.  Even when you’re riding the wave of success, things can short circuit and you have to always be paying attention so that you can catch it as quickly as possible so you can avoid disaster. After years of not having to give finances much consideration at all, it’s time to lean on some folks that owe the clinic money, lean on our biller a bit, get ourselves in order, and market.  Easy peasy right? I’ll keep you posted on our progress. Don’t cry for me, Argentina! You’ll be mad at me soon because I’ll be back to seeing 70+ new patients per month. Wait for it. When you’ve got my attention, you’ve got my attention and I have a tendency to really lean in and get focused. That’s where we are right now. While I don’t recommend it, it is a bit exhilerating. I’ll admit.  Item #1 Our first one today is called, “Nociplastic pain and central sensitization in patients with chronic pain conditions: a terminology update for clinicians” by Nijs et. Al. published in Brazillian Journal of Physical Therapy in May of 2023 and that’s hot enough! Remember, the citations can be found at chiropractscforward.com under this episode.  Nijs J, Malfliet A, Nishigami T. Nociplastic pain and central sensitization in patients with chronic pain conditions: a terminology update for clinicians. Braz J Phys Ther. 2023 May-Jun;27(3):100518. doi: 10.1016/j.bjpt.2023.100518. Epub 2023 Jun 14. PMID: 37348359; PMCID: PMC10314229. Why They Did It Acute pain has been tremendously beneficial throughout evolution as it enables us to identify potential harmful stimuli, and as it ensures we protect damaged tissue while it heals.  However, once evolved into a chronic state, its protective role diminishes with a wide range of negative and maladaptive sequelae that massively impact both the individual and society.  Neuroscientific research has significantly advanced our understanding about pain and chronic pain in particular, including the role of central (nervous system) sensitization in the generation and amplification of (persistent) pain experiences. This knowledge innovation created a massive implementation potential but also a challenge for clinicians to remain up-to-date in daily practice.  Particularly the variety of and rapid change in concepts and terminology used can be challenging for clinicians. For these reasons, this second part of the comprehensive pain management editorial series1 provides a terminology update regarding central sensitization and nociplastic pain in a clinically applicable way.  Essentially, central sensitization is the major underlying mechanism of nociplastic pain, which is a pain phenotype. To facilitate the understanding of the concept of central sensitization, it is crucial to understand that central sensitization is a homeostatic mechanism. This implies, similar to inflammation, that central sensitization is adaptive in the short term (e.g., in the days following surgery or following a motor vehicle accident). As such, it avoids further deterioration in acute pain situations.  However, central sensitization becomes maladaptive in the long term, with pain losing its protective value as commonly seen in patients with persistent pain (e.g., months after successful surgery or a motor vehicle accident).  In addition, central sensitization and inflammation – although physiologically very divert mechanisms – share many features, including the notion that multiple biomarkers together rather than a single gold standard are required for assuming its presence, the fact that they are both umbrella terms covering various clinical & biological presentations, that their clinical presentation varies substantially from patient to patient, and that they are both key mechanism in a wide variety of clinical conditions/diseases The presence of clinical features of central sensitization predicts poor treatment outcomes in patients with a variety of chronic pain conditions, at least when the treatment targets local tissues as the presumed source of nociception.  This applies to conservative interventions, but also to surgical interventions. These observations illustrate the need for early recognition of central sensitization in patients with chronic pain, in combination with tailored treatment. Item #2 Our last one today is called, “Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review”’ by Dickson et. Al. and published in Pain Medicine in February 2024 and that one’ll burn your damn eye brows off.  Cameron Dickson, Rutger M J de Zoete, Carolyn Berryman, Philip Weinstein, Kexun Kenneth Chen, Paul Rothmore, Patient-related barriers and enablers to the implementation of high-value physiotherapy for chronic pain: a systematic review, Pain Medicine, Volume 25, Issue 2, February 2024, Pages 104–115, https://doi.org/10.1093/pm/pnad134 Why They Did It To identify and synthesize patient-related barriers to… and enablers of ….the implementation of high-value physiotherapy (HVP) for chronic pain.  Furthermore, to review what patient-related interventions have been used to facilitate the implementation of high-value physiotherapy for chronic pain, as well as their efficacy. How They Did It The authors systematically searched the APA PsycInfo, Embase, CINAHL, Medline, Scopus, and PEDro databases for peer-reviewed studies (published in English) of adults with chronic pain.  They used the Theoretical Domains Framework of behavior change to synthesize identified themes relating to barriers and enablers. Outcomes from studies reporting on interventions were also qualitatively synthesized. What They Found
  • Fourteen studies reported on barriers and enablers, 8 of which related to exercise adherence. 
  • Themes common to barriers and enablers included perceived efficacy of treatment, interrelationship with the physiotherapist, exercise burden, and the patient’s understanding of exercise benefits. 
  • Other barriers included fear of movement, fragmented care, and cost. 
  • Ten studies explored interventions, 9 of which aimed to improve exercise adherence. 
  • Of these, evidence from 4 randomized controlled trials of technology-based interventions demonstrated improved exercise adherence among intervention groups compared with controls.
Wrap It Up
  • Patients with chronic pain experience barriers to high value PT, including their beliefs, the nature of their interaction with their physiotherapist, perceived treatment efficacy, and cost. 
  • Enablers include rapport with their physiotherapist, achievable exercises, and seamless cost-effective care. 
  • Technology-based interventions have demonstrated effectiveness at increasing exercise adherence. 
  • Our findings suggest that interventions seeking to enhance implementation of high value PT, need to consider the multifactorial barriers experienced by patients with chronic pain.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.       

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

Chiropractic evidence-based products

Integrating Chiropractors

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

Pet Ownership And Cognitive Decline & PT Effectiveness

CF 312: Pet Ownership And Cognitive Decline & PT Effectiveness Today we’re going to talk about Pet Ownership And Cognitive Decline & PT Effectiveness But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

 

On the personal end of things….. Alright, this was a crazy day. Where do we start? First, we had our new intern from Parker College start today. Welcome to the practice Donte. I’ll say he either picked the craziest day of days to start or he’s just bad luck.  Frist thing, it’s freezing outside and there are ice pellets coming out of the sky. It’s been pretty nice here in the Texas Panhandle until Donte’s first day with us. Now we’re just hoping no blizzard moves in with these 60 mph winds. 

Then, we one staffer out sick and then another got a call that her mother was having some health issues and she had to leave in a hurry so prayer for our work family. We’d appreciate your best wishes as well for her and her family.  Then we had a patient come in that was just a difficult one. It was our first from a PT so hey…..that’s cool as hell but this patient was a difficult one for sure.  There was more to the day that was challenging but I’m not going into the whole thing.

The point is, if Dontae was hoping to see an old guy navigate a day full of hurdles and land mines, he definitely got it.  It was a damn day and here’s hoping that the rest of the week is smooth sailing full of perfect patients and lots of learning for our new intern. 

Pro Tip, check out the C-sign. I was talking with one of my chiro buddies recently and he mentioned something about a patient with a low back and hip issue he had years ago. I asked if the patient had a C sign. My colleague wasn’t aware of the C-sign and I’ll admit that I wasn’t either until about 4 years ago when I went through the Ortho Diplomate. 

This is a Dr. Tim Bertlesman special for you. If they give you the C-sign, it’s the hip until you rule the hip out. That is an excellent rule of thumb and so easy to remember and bring back up because once you see and recognize the C-sign, you’ll be reminded immediately.  The C-sign is when a patient says, “It hurts right here.” And the have their thumb and index finger in a C shape and running the C along their iliac crest back and forth. Sometimes down into the inguinal area.  If you see that, assume it’s the hip until you rule it out with either orthos or imaging.  There’s your pro tip today.

Let’s get on with the episode. Since we’re going to have so many of the WHO and SMT and very low confidence episodes coming up, I’m going to split those up and just do them every other week to keep you invested and from getting bored with it.  You can thank Dr. Steven Brown from Gilber AZ for that. Lol. He said I seem obsessed with the topic.

He was joking of course but, while I’m not obsessed per se, I am definitely wondering; if we have as much research in our favor as we’ve covered for over 6 years now, how on Earth can the WHO have us at ‘very low confidence?’ Which is the same as ultrasound by the way.  I want to know. I’m figure a lot of you do as well. From our previous episodes on it, I see they’re using papers with low sample size and some that are definitely older studies to make that determination. But we’ll keep exploring. Just not this week. 

Item #1 Our first on ethis week is called, “How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis” by Dove, et. Al. and published in European Spine Journal on 29th of December 2022 and while it’s not piping hot, I haven’t gotten to use it in a bit so here ya go!! Remember citations to the papers can be found on our website at chiropracticforward.com and episode 312.  Dove, L., Jones, G., Kelsey, L. et al. How effective are physiotherapy interventions in treating people with sciatica? A systematic review and meta-analysis. Eur Spine J 32, 517–533 (2023). https://doi.org/10.1007/s00586-022-07356-y

Why They Did It Physiotherapy interventions are prescribed as first-line treatment for people with sciatica; however, their effectiveness remains controversial.  The purpose of this systematic review was to establish the short-, medium- and long-term effectiveness of physiotherapy interventions compared to control interventions for people with clinically diagnosed sciatica

How They Did It It was a systematic review  Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed, Scopus and grey literature were searched from inception to January 2021.  Inclusion criteria were randomised controlled trials evaluating physiotherapy interventions compared to a control intervention in people with clinical or imaging diagnosis of sciatica.  Primary outcome measures were pain and disability.  Study selection and data extraction were performed by two independent reviewers with consensus reached by discussion or third-party arbitration if required.  Risk of bias was assessed independently by two reviewers  Three thousand nine hundred and fifty eight records were identified, of which 18 trials were included, with a total number of 2699 participants.  All trials had a high or unclear risk of bias. 

What They Found Meta-analysis of trials for the outcome of pain showed no difference in the short, medium or long term.  For disability there was no difference in the short, medium, or long term between physiotherapy and control interventions.  Subgroup analysis of studies comparing physiotherapy with minimal intervention favoured physiotherapy for pain at the long-term time points.  Large confidence intervals and high heterogeneity indicate substantial uncertainly surrounding these estimates.  Many trials evaluating physiotherapy intervention compared to substantial intervention did not use contemporary physiotherapy interventions.

Wrap It Up Based on currently available, mostly high risk of bias and highly heterogeneous data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy interventions for people with clinically diagnosed sciatica.  Future studies should aim to reduce clinical heterogeneity and to use contemporary physiotherapy interventions.

Item #2 The last one today is called, “Pet Ownership, Living Alone, and Cognitive Decline Among Adults 50 Years and Older” by Li et al and published in JAMA Network Open on December 26, 2023 and POW! That’s a hot one folks! Pet lovers listen up! Li Y, Wang W, Zhu L, et al. Pet Ownership, Living Alone, and Cognitive Decline Among Adults 50 Years and Older. JAMA Netw Open. 2023;6(12):e2349241. doi:10.1001/jamanetworkopen.2023.49241

Why They Did It Is pet ownership associated with cognitive decline in older adults, and how does pet ownership mitigate the association between living alone and the rate of cognitive decline? They wanted to explore the association of pet ownership with cognitive decline, the interaction between pet ownership and living alone, and the extent to which pet ownership mitigates the association between living alone and cognitive decline in older adults.

How They Did It This cohort study used data from waves 5 (June 2010 to July 2011) to 9 (from June 2018 to July 2019) in the English Longitudinal Study of Ageing.  Participants included adults 50 years and older.  Pet ownership and living alone in wave 5. Verbal memory and verbal fluency were assessed, and composite verbal cognition was further calculated. Of the 7945 participants included, the mean (SD) age was 66.3 (8.8) years, and 56.0% of the subjects were women.

What They Found Pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency.  Three-way interaction tests showed that living alone was a significant modifier in all 3 associations.  Stratified analyses showed that pet ownership was associated with slower rates of decline in composite verbal cognition, verbal memory, and verbal fluency among individuals living alone, but not among those living with others.  Joint association analyses showed no significant difference in rates of decline in composite verbal cognition, verbal memory, or verbal fluency between pet owners living alone and pet owners living with others.

Wrap It Up In this cohort study, pet ownership was associated with slower rates of decline in verbal memory and verbal fluency among older adults living alone, but not among those living with others, and pet ownership offset the associations between living alone and declining rates in verbal memory and verbal fluency.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

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Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

Brain Activity From Spinal Manipulative Therapy & PT Is As Good As Arthoscopic Surgery For Meniscus Issues

CF 240: Brain Activity From Spinal Manipulative Therapy & PT Is As Good As Arthoscopic Surgery For Meniscus Issues Today we’re going to talk about the Brain’s Activity as a result From Spinal Manipulative Therapy & we’ll talk about how PT Is As Good As Arthoscopic Surgery For Meniscus Issues 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. 

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group, and then 
  • Review our podcast on whatever platform you’re listening to 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #240 Now if you missed last week’s episode , we talked about Changing One’s Mind About Pain and how the cognitive aspect of pain has to be addressed. Fascinating stuff, folks. Truly. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I’m headed to Sarasota this weekend for the MCM Florida Mastermind with Kevin Christie and others. And when I say ‘others’, I mean big-timers. It’s a privilege to be invited and to be a member of this private group of masterminds.  I’m talking about Kevin, of course, but Brett Winchester, Jay Greenstein, Mark King, Ben Fergus, Scott Schreiber, and more! Power-hitters. If you are interested in being a part of this mastermind, email Dr. Christie at drkchristie@gmail.com We’re keeping it around 20 members and I believe we have about 15 at the moment. So, there are a few more seats. But don’t waste time because those spots might fill up PDQ. For you Yanks……that means pretty damn quick.  Going to Sarasota on Thursday means that all patients are getting packed into a 3 day work week. We have 52 on the schedule today as a result so this one is short and sweet my dear friends.  But I will say, the numbers are back to looking encouraging. At least until the back-to-school slow down comes along. We see it every year and I’m sure this one will be no different. Although, we are going to be doing some ‘Back to school doesn’t mean forget the chiropractor’ style marketing to try to combat it.  If you see back-to-school slowdowns every year, what are you doing to offset it? Let me know and I can share it with our audience. Email me at creekstonecare@gmail.com Let’s get going with the research. 

Item #1

The first one today is called, “Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears. Five-Year Follow-up of the ESCAPE Randomized Clinical Trial” by Noordyn et. al. (Noorduyn JCA 2022) and published in JAMA Network Open on July 8, 2022. Aye aye aye, that’s a hot plate of hot pie!

Why They Did It

There is a paucity of high-quality evidence about the long-term effects (ie, 3-5 years and beyond) of arthroscopic partial meniscectomy vs exercise-based physical therapy for patients with degenerative meniscal tears. The authors wanted to know….is exercise-based physical therapy just as good or equal to arthroscopic partial meniscectomy during a 5-year follow-up period in patients aged 45 to 70 years with a degenerative meniscal tear?

How They Did It

  • 278 patients completed the 5-year follow-up
  • A noninferiority, multicenter randomized clinical trial was conducted in the orthopedic departments of 9 hospitals in the Netherlands. A total of 321 patients aged 45 to 70 years with a degenerative meniscal tear participated. Data collection took place between July 12, 2013, and December 4, 2020.
  • Patients were randomly allocated to arthroscopic partial meniscectomy or 16 sessions of exercise-based physical therapy.
  • The secondary outcome was progression in knee osteoarthritis shown on radiographic images in both treatment groups.

What They Found

  • From baseline to 5-year follow-up, the mean (SD) improvement was 29.6 (18.7) points in the surgery group and 25.1 (17.8) points in the physical therapy group. 
  • The crude between-group difference was 3.5 points. 
  • Comparable rates of progression of knee osteoarthritis were noted between both treatments.

Wrap It Up

  • In this noninferiority randomized clinical trial after 5 years, exercise-based physical therapy remained noninferior to arthroscopic partial meniscectomy for patient-reported knee function. 
  • For us English speakers, that means that exercise was just as good as arthoscopic surgical intervention and didn’t lead to any increase in knee osteoarthritis
  • Physical therapy should therefore be the preferred treatment over surgery for degenerative meniscal tears. 
  • These results can assist in the development and updating of current guideline recommendations about treatment for patients with a degenerative meniscal tear.

Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later.

Item #2 The last one this week is called “Spinal Manipulative Therapy Alters Brain Activity in Patients With Chronic Low Back Pain: A Longitudinal Brain fMRI Study” by Tan et. al. (Tan W 2020) and published in Frontiers In Neuroscience on November 19th of 2020. Not as hot as it once was I suppose. 

Why They Did It They say that we know Spinal manipulative therapy (SMT) helps to reduce chronic low back pain (cLBP). However, the underlying mechanism of pain relief and the neurological response to SMT remains unclear. The authors were trying to get some clarity on the mechanism. Why does it help?

How They Did It

  • We utilized brain functional magnetic resonance imaging (fMRI) upon the application of a real-time spot pressure mechanical stimulus to assess the effects of SMT on patients with cLBP.
  • Brain fMRI was performed for Group 1 at three time points: before an adjustment, after the first adjustment session, and after the sixth adjustment. 
  • The healthy controls (Group 2) did not receive an adjustment and underwent only one fMRI scan. 
  • During fMRI scanning, a real-time spot pressure mechanical stimulus was applied to the low back area of all participants. 
  • Participants in Group 1 completed clinical questionnaires assessing pain and quality of life

What They Found

Before SMT, there were no significant differences in brain activity between Group 1 and Group 2.  After the first adjustment, Group 1 showed significantly greater brain activity in the right parahippocampal gyrus, right dorsolateral prefrontal cortex, and left precuneus compared to Group 2.  After the sixth adjustment, Group 1 showed significantly greater brain activity in the posterior cingulate gyrus and right inferior frontal gyrus compared to Group 2.  After both the first and sixth adjustments, Group 1 had significantly improved outcomes scores than the control group

Wrap It Up

The authors say, “We observed alterations in brain activity in regions of the default mode network in patients with cLBP after SMT. These findings suggest the potential utility of the default mode network as a neuroimaging biomarker for pain management in patients with cLBP. In a sense, we can re-map faulty wiring through motion, function, and proprioception which are all things provided in a good adjustment and targeted exercise. If all you’re doing is adjustments though, reconsider. A broad management protocol is the key.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

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

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

Bibliography

Noorduyn JCA, v. d. G. V., Willigenburg NW, (2022). “Effect of Physical Therapy vs Arthroscopic Partial Meniscectomy in People With Degenerative Meniscal Tears: Five-Year Follow-up of the ESCAPE Randomized Clinical Trial.” JAMA Netw Open 5(7).  

Tan W, W. W., Yang Y, Chen Y, Kang Y, Huang Y, Gong Z, Zhan S, Ke Z, Wang J, Yuan W, Huang W, Zee C, Chen Z, Chen BT (2020). “Spinal Manipulative Therapy Alters Brain Activity in Patients With Chronic Low Back Pain: A Longitudinal Brain fMRI Study.” Front Integr Neurosci.    

Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic

CF 194: Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic Today we’re going to talk about how lumbar fusion compares to no surgery, we’ll talk about a 30 year study on discs, and we’ll talk about PT vs. Chiro  But first, here’s that sweet sweet bumper music

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

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Integrating Chiropractors

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Then go Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #194 Now if you missed last week’s episode , we talked about patellofemoral pain, sleep for pain, and physical disuse. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. OOOWEEEE…..If you’ve been listening, you know I’ve been goind through my second fellowship program. This second one is the Forensics fellowship. Several hours are taken on ChiroCredit. There’s a 20 hour course on the AMA Guides on Impairment. And there’s a 20 live course I’ll be doing to wrap this dude up. It’s in Chicago in October. Then I’m done.  Then, I can turn my full attention to making our new Nurse Practitioner famous locally, making sure our Parker intern is set up for success, and getting life back to some sense of normal.  I got the COVID booster shot last week and am headed to Washington DC for the Labor Day weekend. This will probably air just after I get back so updates on the scene in DC on the next episode. Hopefully the covid resurgence hasn’t made the experience a soup sandwich. We shall see.  I was 8 months out from when I got the vaccine. The booster came from a nurse practitioner friend of mine. The first shot I got back in December……I felt nothing at all. The second shot 23 days after that, my arm got sore. That’s it. Nothing else at all. This booster shot, my arm got sore as expected. I got it on a Thursday afternoon. She brought it over here to my clinic and gave it to us. Because she’s super sweet and more than awesome.  I went to work on Friday. I had almost 40 patients between 8 am and 1 pm and, while I didn’t necessarily struggle, I didn’t love life that day. I was tired. I really wanted to be in bed pretty much. I didn’t feel absolutely awful or anyhting like that. I just didn’t feel particularly good and didn’t really want to be here in the clinic, answering the same questions we always answer, and acting like I felt great and was a happy happy dude when all I really wanted was to just be in bed taking a nap.  Then I did go home and take a nap after work. I slept for a couple of hours and woke up feeling much better.  Then I woke up the next day and felt great again. No issues. All back to normal. People act like we are sheeple if we get it. Like we are the experiment. Maybe we are. I don’t give a damn. I have a thriving, successful practice with no partner or associate to fill the gap if I get sick and have to stay home.  First of all, I like feeling good. I don’t want to be sick. If I can do something that the data shows clearly prevents the virus and/or severe illness from the virus, I’m going to do it. When your clinic bills what mine bills each month, and you don’t care at all about losing that income for 2-4 weeks…..maybe a lot more than that…..then you can call me names. You can call me an experiment.  For me, I’m making smart business decisions. Not to mention the fact that after millions and millions of vaccinations globally with very few issues, I’m a hell of a lot more concerned about a proven killing and/or long-term debilitating virus like COVID than I am the vaccine.  So, my opinions and what’s right for me may not be right for you annd that’s OK. But I’ll be damned if anyone is going to act smarter, wiser, or more high and mighty than I because I got a freaking vaccine. Those that behave that way can straight up stick it in your ear or whatever other place you can think of.  On the other hand, if you got the vaccine, don’t be a jackhole if someone you know doesn’t want it. It’s new. People are scared of it. They’ve been misled in many situations. They’ve been misdirected on social media. It is what it is. You do you. Let’s all do us and realize we share this space. I’d a lot rather see disagreement with an undercurrent of love instead of disagreement with a smoggy fog of hate and disdain.  It’s 2021. Let’s all grow up and evolve.  Item #1 This first one this week is called, “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis” by Xu et. al. (Xu W 2021) and published in World Neurosurgery in February of 2021….hot mama, stand back.  Why They Did It They wanted to evaluate the efficacy and safety of lumbar fusion versus nonoperative care for the treatment of chronic low back pain associated with degenerative disk disease. How They Did It

  • A comprehensive search for papers was done in PubMed, Embase, Cochrane Library, and China National Knowledge Infrastructure  up to June 30, 2020. 
  • The main outcomes including clinical results, complications, and all-cause additional surgeries were presented in the form of short- and long-term follow-up results. 
  • Six prospective studies involving 159 patients for short-term follow-up and 675 for long-term follow-up were included

What They Found The 2 interventions exhibited little difference in regard to short- and long-term Oswestry Disability Index and visual analog scale scores for back and leg pain, except that lumbar fusion might bring about lower additional surgery rate, and higher complication rate in the long term. Wrap It Up The present meta-analysis determined that fusion surgery was no better than nonoperative treatment in terms of the pain and disability outcomes at either short- or long-term follow-up. It is necessary for clinicians to weigh the risk of complications associated with fusion surgery against additional surgeries after nonoperative treatment. Item #2 This second one is called, “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi (Sääksjärvi S 2020) and published in Spine Journal in 2020. It’s steamy….but not that hot anymore.  Why They Did It The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up. How They Did It

  • In an earlier study, 75 patients aged 20 years with LBP had their lumbar spine examined by MRI. 
  • At a follow-up of 30 years, the subjects were contacted; 35 of 69 filled a pain and disability questionnaire, and 26 of 35 were also reexamined clinically and by MRI. 
  • The images were evaluated for decreased signal intensity and other degenerative changes. 
  • Association between decreased signal intensity of a disc at baseline and the presence of more severe degenerative changes in the same disc space at follow-up was analyzed 
  • Association between decreased baseline signal intensity and pain/disability scores from the questionnaire was analyzed

What They Found

  • The total number of lumbar discs with decreased signal intesity increased from 23 of 130 (18%) to 92 of 130 (71%)
  • Distribution of DD changed from being mostly in L4-L5 and L5-S1 discs to being almost even between the four lowermost discs
  • Discs that had even slightly decreased signal intensity at baseline were more likely to have severely decreased signal intensity at follow-up, compared to healthy discs
  • The best of the best news, as you may have guessed if you’ve listened to this podcast for any amount of time, Severity of DD at baseline did not have a significant association with current pain or disability.

Wrap It Up In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms. Hallelujah.  Item #3 This last one is called, “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation” by Nima Khodarkarami ´(Khodakarami N 2020) and published in Healthcare journal in 2020.  Why They Did It Given that there are costs and benefits with either PT or Chiropractic for the treatment of low back pain, the remaining question is in a short period of time which of these treatments is optimal?  A decision tree analytic model was used for estimating the economic outcomes. The findings showed that the total average cost in the chiropractic group was $48.56 lower than the PT group.  The findings also showed that the daily adjusted life years (DALY) in the chiropractic group was 0.0043 higher than the PT group.  Chiropractic care was shown to be a cost-effective alternative compared with PT for adults with at least three weeks of LBP over six months. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     

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  The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website https://www.chiropracticforward.com Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter https://twitter.com/Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Khodakarami N (2020). “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation.” Healthcare 8(1): 44.   Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347.   Xu W, R. B., Luo W, Li Z, Gu R, (2021). “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis.” World Neurosurg 146: 298-306.