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SMT and Geriatrics & Lower Costs – Back To Work Faster With Chiropractic

CF 233: SMT and Geriatrics & Lower Costs – Back To Work Faster With Chiropractic Today we’re going to talk about SMT and Geriatrics & Lower Costs – Back To Work Faster With Chiropractic But first, here’s that sweet sweet bumper music

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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 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 #233 Now if you missed last week’s episode , we were joined by Dr. Chris Chippendale and talked about communication and helping chiropractors become more effective in their interactions with patients. Make sure you don’t miss that info. Keep up with the class. 

 

On the personal end of things…..

Alright folks, it’s a short week for me because I’m headed out of town so I’m making this one lightening fast!  I am still currently hiring an associate for my practice in Amarillo, TX. If you’re smart, good with patients, looking for a medically integrated clinic, and are capable of building your patient base with or without my help, I want to get to know you better.  Send me an email at [email protected] and let’s talk bidness. 

I’ve got a couple of interesting research papers to go through with you in a moment but first. 

Are you tired of getting paid peanuts for your good work?  Insurance pays maybe half.  Medicare and Medicaid even less.  So how about full payment?  This comes with PI cases. How do you get these cases you ask? Learn the system. Created by Paul Samakow, a 41-year veteran attorney – he explains in detail what to do, how to do it, and how to have attorneys not only send you their clients, but how to assure they continue to do so. This system is delivered to you in both written and video form – Samakow is actually pretty funny when you watch – but his content and information are both spot on and serious, and will result in multiple referrals from attorneys if you follow his system. His system costs $997 and he guarantees satisfaction or your money back. You have to check this out.  Even if you only get one case, you’ve made at least 4 or 5 times the investment. Go to gettingpicases.com/cs That’s gettingpicases.com/cs One more time so you get it right:   gettingpicases.com/cs

Item #1

This first one today is called “Chiropractic Care For Workers With Low Back Pain” by Mueller et. al. (Dongchun Wang 2022)  and published in WCRI: Workers Compensation Research Institute on May 17, 2022. One word, two syllables… Day-um….that’s hot. 

They say, “This study describes the prevalence of chiropractic care and provider patterns of physical medicine treatment for workers with low back pain. It provides some evidence as to how different provider patterns of physical medicine treatment are associated with variations in overall medical and indemnity costs, and the duration of temporary disability.

The study also looks at the utilization of medical services, including magnetic imaging studies, opioid prescriptions, and pain management injections.” “The data used for this study are from the WCRI Detailed Benchmark/Evaluation database, which includes more than 2 million open and closed claims from 28 states, with injuries from October 1, 2015, through September 30, 2017, and detailed medical transactions up through March 31, 2019.” The article that led me to that page is called “Study links chiropractic care to lower costs, faster return to work.” By the writers with Claims Journal and published online on May 18, 2022. 

In the article they say, “A study by the Workers’ Compensation Research Institute found that medical care costs less and claimants return to work more quickly when low back pain treatment is provided solely by chiropractors.” Pow! Slap! Knee to the nads!!! They also say, “This study will be helpful for policymakers and stakeholders who are interested in re-evaluating the role of chiropractors, especially those who have been adopting evidence-based practices and contributing to cost-effective care,” stated WCRI President and Chief Executive Officer John Ruser in a press release. If you aren’t clear on what they’re saying there; vitalists need not apply. Evidence-based, patient-centered only.

Because that’s what makes sense anywhere on the face of the planet. 

Get this stat they threw out after studying 2 million cases, “The average medical cost per claim for low back pain patients who were treated exclusively by a chiropractor for both physical medicine and evaluation and management was $1,366, 61 percent less than the $3,522 treatment cost for low back pain cases that received no chiropractic treatment.” WOW! $3500 for medical treatment $1300 for chiropractic That’s approximately a $2,200 difference, folks. Holy smokes. If you multiply that $2,200 saving by the 2 million cases they studied, that’s a savings of up to $4.4 billion!!

Shazamm

But the reason we have a healthcare cost issue is that the information is there but it still won’t change. Just watch. Which make my pee hot but it is what it is.  “Indemnity costs were also lower for workers whose low back pain was treated exclusively by a chiropractor: $492 compared to $3,604 for workers who received no chiropractic treatment.” “Injured workers treated exclusively by chiropractors also used fewer drugs and diagnostic imaging scans, the report says.

Comparing a subset of claims with similar characteristics, the researchers found only 1% of claimants treated by chiropractors were prescribed opioids, compared to 10.3% of claimants who were not treated by chiropractors. In the chiropractic group, 4.3% of claimants received a magnetic-resonance imaging scan, compared to 18.9% for the non-chiropractic claimants.”

Come on folks, you know this information is amazing. It was done by practitioners on both sides of the aisle of healthcare and published in a respectable journal.  Share, yell this stuff out. It’s one of the coolest papers to emerge in the last few years so make sure all of your patients know about it!

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

Item #2

This last one is called “Spinal manipulative therapy in older adults with chronic low back pain: an individual participant data meta-analysis” by Jenks, et. al. and published in European Spine Journal on May 28, 2022. Schiza! (Jenks A. 2022) Es muy caliente!

Why They Did It

Many systematic reviews have reported on the effectiveness of spinal manipulative therapy (SMT) for low back pain (LBP) in adults. Much less is known about the older population regarding the effects of SMT. The authors wanted To assess the effects of SMT on pain and function in older adults with chronic LBP in an individual participant data (IPD) meta-analysis.

How They Did It

  • They used Electronic databases from 2000 until June 2020, 
  • They also referenced lists of eligible trials and related reviews.
  • They used Randomized controlled trials (RCTs) which examined the effects of SMT in adults with chronic LBP compared to interventions recommended in international LBP guidelines.
  • Pain and functional status were examined at 4, 13, 26, and 52 weeks.
  • 10 studies were retrieved, including 786 individuals, of which 261 were between 65 and 91 years of age. 

What They Found

  • There is moderate-quality evidence that SMT results in similar outcomes at 4 weeks
  • Second-stage and sensitivity analysis confirmed these findings.

Wrap It Up

SMT provides similar outcomes to recommended interventions for pain and functional status in the older adult with chronic LBP. SMT should be considered a treatment for this patient population. Alright ladies and gents, if I didn’t get your juices flowing on some excellent quotes and material for you social media purposes so you can share all of the good news…..well then….you just can’t be helped. Lol.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

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

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

Bibliography

Dongchun Wang, K. L. M., Donald R. Murphy, and Randall D. Lea, (2022). “Chiropractic Care for Workers with Low Back Pain.” WCRI WC-22-17.  

Jenks A., d. Z. A., van Tulder M, (2022). “Spinal manipulative therapy in older adults with chronic low back pain: an individual participant data meta-analysis.” Euro Spine J.      

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

CF Ep. 213: Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain Today we’re going to talk about Easy, Cheap Way To Fix Cervical Curvature & SMT For Chronic Neck Pain But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

You have found yourself smack dab in the middle of Episode #213 Now if you missed last week’s episode , we talked about Intermittent Fasting & Dementia And Your Level Of Activity. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

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

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

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

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

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

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

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

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

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

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

Item #1

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

Aye chiwawa!

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

Anyway

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

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

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

Bibliography

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

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

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

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

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

But first, here’s that sweet sweet bumper music

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

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #143

Now if you missed last week’s episode , we talked about nonoperative disc treatment, Vitamin D3 for depression, and the biopsychosocial part of chronic pain. I used big words on this one folks. Make sure you don’t miss that info. Keep up with the class. 

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper. 

On the personal end of things…..

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

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

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

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

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

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

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

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

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

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

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

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

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

Let’s get on with it shall we?

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

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

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

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

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

Item #1

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

Why They Did It

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

How They Did It

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

What They Found

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

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

Wrap It Up

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

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

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

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

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

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

 

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

 

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

 

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

 

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

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Adjusting Disc Herniations and Bulges

 

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

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

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

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

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

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

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

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

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

1. It is not a mechanical realignment.

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

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

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

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

Go read the rest of that article, please.  

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I do support you overall. Just not here. 

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

Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it.

Let’s get to the message. Same as it is every week. 

Key Takeaways

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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!

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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. 

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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

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