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The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7)

CF 317: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7) 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 #317 Now if you missed last week’s episode, we talked about Chronic Pain Central Sensitization & Patient Barriers To Physical Therapy.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Alright, we’re keeping it a little short this week because I’m going to the Bahamas Thursday through Monday. Now, if you’re a regular listener, you’re probably like…..last week you were talking about having a collections issue and stressing and now you’re going on a trip out of town. That seems like poor money management Ol’ Uncle Jeffro.  And that’s when I would say, you’re right. Lol. I’d say it’s nunya damn business but then I’d say…..yeah. I’m with you on that. I don’t really want to go because, for the first time in a month or so, it looks like my numbers are returning to where I want them and I’m building some steam so taking Thursday, Friday, and Monday off is tough. But…..a wise mentor once told me, you have to get out and go on a non-work-related vacation once per quarter or you’ll never survive.  Heres the deal, back in December, before the collections issue was realized, I told my wife, Hey honbun, you hate any jewelry I buy you, you won’t allow me to get you any clothes, you won’t allow me to get anything for the house because you didn’t get it and match your style, blah blah blah.  So, instead of more useless crap…..instead of buying things, we’re going to start buying experiences. Instead of gifts to each other, we bought a Valentine’s trip to The Bahamas. So it’s non-refundable and basically already paid for anyway so what do you do? You go to the damn Bahamas and try to get some rest.  2023 and the beginning of 2024 have literally been the hardest, most challenging times of my 26 year career in chiropractic. Personally and professionally. But mostly professionally. It’s been a grind, it’s been tough, and I wouldn’t recommend a year like we had on anyone.  We are currently hiring our 4th front desk girl and our third CA position has seen 4 or 5 turnovers in the last year. A couple of those kind of hurt personally, if I’m being honest. They were people I cared about.  Now that seems to reflect poorly on me but if we’re being honest here, I’ve never had an issuue with keepign folks for 3 years or so minimum. I had a manager for 11 years that still comes back to visit. I had another that was here 6 years or so.  The point being, I’m as fun and relaxes in real life as I hope I am here on theh podcast. We laugh and have fun and I don’t believed I’ve ever raised my voice to a staff member in 26 years. No matter how mad I get. Sometimes, we just have a run of bad luck. I’ve gone from about 65-70 new patients per month down to about 45-55. Not a huge hit for a month but carry that out over a year and……one word two-syllables…..Day-um.  Then throw in the fact that we’re on our 4th billing/collecting group in the last 5-6 years. That’s been a nightmare and cost me crazy money. Now we’re in a battle with a PI attorney in Houston that wormed his way into the Texas Chiropractic Association and, despite having signe Assignment Of Benefits and Letter of Protection on 7 different patients, is refusing to pay us around $27,000.  It’s a journey folks and 2023 was a bumpy road on that journey. Lots of potholes but I’m ever the optimist and, with our latest biller/collector, I think we’re in a good spot. Hopefully clinic numbers begin responding.  We’ve taken the necessary steps to remedy what’s been going on here. For those reasons, we are goign to the damn Bahamas and we are goign to eat, drink, and be merry and save it for when we get back. Trust me, the stress will still be here so we might as well just leave it here at the office when we leave.  So let’s continue our hunt for the reason behind the WHO recommending SMT but at ‘very low confidence’, which is at the same level as ultrasound. Not to diminish the effects of ultrasound but seriously, I’ve never seen ultrashound deliver the immediate results that spinal manipulative therapy can deliver.  We’ve learned so far that the WHO is using some garbage research to base this recommendation on. Old, out-dated studies, small sample sizes, and studies that just literally make no sense at all for the most part. Let’s see what Part 7 reveals.  Item #1 The first one today is called, “Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial” by Licciardone et. Al. and published in Spine in July of 2003. Which is 21 years old at this point. OK….duly noted…..so cold that it’s frozen solid….got it… Remember, the citations can be found at chiropractscforward.com under this episode.  Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J Jr. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine (Phila Pa 1976). 2003 Jul 1;28(13):1355-62. doi: 10.1097/01.BRS.0000067110.61471.7D. PMID: 12838090. Why They Did It The authors wanted to determine the efficacy of osteopathic manipulative treatment as a complementary treatment for chronic nonspecific low back pain. They say, “Osteopathic manipulative treatment may be useful for acute or subacute low back pain. However, its role in chronic low back pain is unclear.” How They Did It This trial was conducted in a university-based clinic from 2000 through 2001.  91 met the eligibility criteria.  They were randomized, with 82 patients completing the 1-month follow-up evaluation, 71 completing the 3-month evaluation, and 66 completing the 6-month evaluation.  The subjects were randomized to osteopathic manipulative treatment, sham manipulation, or a no-intervention control group, and they were allowed to continue their usual care for low back pain.  The main outcomes included the SF-36 Health Survey, a 10-cm visual analog scale for overall back pain, the Roland-Morris Disability Questionnaire, lost work or school days because of back pain, and satisfaction with back care. What They Found As compared with the no-intervention control subjects, the patients who received osteopathic manipulative treatment reported greater improvements in back pain, greater satisfaction with back care throughout the trial, better physical functioning and mental health at 1 month, and fewer cotreatments at 6 months.  The subjects who received sham manipulation also reported greater improvements in back pain and physical functioning and greater satisfaction than the no-intervention control subjects.  There were no significant benefits with osteopathic manipulative treatment, as compared with sham manipulation. Wrap It Up Osteopathic manipulative treatment and sham manipulation both appear to provide some benefits when used in addition to usual care for the treatment of chronic nonspecific low back pain. It remains unclear whether the benefits of osteopathic manipulative treatment can be attributed to the manipulative techniques themselves or whether they are related to other aspects of osteopathic manipulative treatment, such as range of motion activities or time spent interacting with patients, which may represent placebo effects. Alright John C Licciardone, DO, MS, MBA, FACPM. ….Go to his experts website and find the following.  https://experts.unthsc.edu/en/persons/john-licciardone Dr. Licciardone’s research focuses on prevention and treatment of chronic pain. He holds the Richards-Cohen Distinguished Chair in Clinical Research and directs the Osteopathic Research Center, including its PRECISION Pain Research Registry. The latter studies precision medicine and biopsychosocial approaches to pain management, including use of pharmacogenetics to optimize opioid prescribing and avoid unintended consequences of their use. He received a Midcareer Investigator Award from the National Institutes of Health (NIH) and served as an expert panelist for NIH in the area of chronic pain. He recently served on the Work Group that developed NIH’s Federal Pain Research Strategy. Dr. Licciardone is recognized by Expertscape as the leading international expert in osteopathic manipulation, and has served as a consultant to the World Health Organization on regulatory and safety issues relating to osteopathy in Europe and other nations. He directed the OSTEOPATHIC Trial, a five-year study funded by NIH that demonstrated substantial improvements and recovery from chronic low back pain with osteopathic manipulation. He is presently a Co-Investigator in the $14 million Prevention of Acute to Chronic Back Pain Trial (PACBAC Trial), a national study to assess the efficacy of patient self-management and spinal manipulation in preventing chronic low back pain. Item #2 Our second one today is by the same author and is called, “Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial” by Liccardone et al published in Annals Of Family Medicine in March of 2013 so…..it’s only 11 years old then.  Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med. 2013 Mar-Apr;11(2):122-9. doi: 10.1370/afm.1468. PMID: 23508598; PMCID: PMC3601389. Why They Did It We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain. How They Did It A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain.  The 455 patients were randomized to OMT or sham OMT, and to UST or sham UST main effects groups.  Six treatment sessions were provided over 8 weeks.  Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12.  Five secondary outcomes, safety, and treatment adherence were also assessed. What They Found There was no statistical interaction between OMT and UST.  Patients receiving OMT were more likely than patients receiving sham OMT to achieve moderate  and substantial improvements in low back pain at week 12.  These improvements met the Cochrane Back Review Group criterion for a medium effect size.  Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT.  Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study.  Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group Ultrasound therapy was not efficacious. Wrap It Up The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain.  It was safe, parsimonious, and well accepted by patients. Item #3 As a quick bonus, I was looking the dude up and found this paper: It’s called, “Osteopathic Medical Care With and Without Osteopathic Manipulative Treatment in Patients With Chronic Low Back Pain: A Pain Registry–Based Study” by….again…..Licciardone et al and pulished in Journal of Osteopathic Medicine in February of 2020 but they WHO didn’t use this one for whatever reason…..let’s see what it says.  Licciardone, John C. and Gatchel, Robert J.. “Osteopathic Medical Care With and Without Osteopathic Manipulative Treatment in Patients With Chronic Low Back Pain: A Pain Registry–Based Study” Journal of Osteopathic Medicine, vol. 120, no. 2, 2020, pp. 64-73. https://doi.org/10.7556/jaoa.2020.016   Why They Did It To assess osteopathic medical care and the effectiveness of OMT for chronic low back pain in a real-world setting without the constraints of a rigid research protocol.   How They Did It An observational study of 445 adults with chronic low back pain who had an established osteopathic physician (ie, DO) or allopathic physician (ie, MD)  It was conducted within the PRECISION Pain Research Registry from April 2016 through February 2019.  Primary outcome measures included a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related functioning, and use of nonsteroidal anti-inflammatory drugs or opioids for low back pain.   What They Found A total of 79, 48, and 318 patients, respectively, were treated by DOs who used OMT, DOs who did not use OMT, or MDs.  Patients treated by DOs who used OMT reported significantly lesser low back pain intensity and back-related disability than patients treated by MDs.  Patients treated by DOs who used OMT also reported less frequent use of nonsteroidal anti-inflammatory drugs or opioids   There were no significant differences in primary outcomes between DOs who did not use OMT and MDs   Wrap It Up This study of community-based patients in a pain research registry supports the effectiveness of OMT as an integral component of osteopathic medical care for chronic low back pain.  Patients treated by DOs who did not use OMT did not experience better results than patients treated by MDs in any primary outcome measure.  But…..the WHO didn’t include this. Maybe because it was an observational study rather than an RCT. Who knows? But this says SMT is an integral component of back pain whereas the others are less flattering.  It just feels dirty, WHO….it feels dirty! Don’t let those damn chiropractors get a head of steam or we’ll ALL be out of a job!! 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
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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    

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

CF 315: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6).

If you’ve been following along, and I hope you have…The WHO updated their recommendations recently for pain. Spinal maniuplative therapy was include so we’re on the menu. But, they rated SMT at very low confidence, which is the same as what they rated ultrasound. So, in the eyes of the WHO, smt may be about as effective as ultrasound. Yeah, we’re call BS so we are going through each paper they used to make this determination and they all, except for a few, are old, outdated, and pretty much stink. We’ll talk about it…. 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 #315 Now if you missed last week’s episode, we talked about Omnivorous vs Vegan and SMT For Chronic Neck Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Another day, another dollar by friends. Here we are at the end of January 2024 and if all works well and if you’re an insurance or hybrid clinic, then you know that you’ve been a little slower because the deductibles re-set in January for the most part and people don’t like to spend their own money.  But, about a month or so is as long as many of them ever want to go without going to the chiropractor and that’s OK.

The point being that hybrid clinics like mine should start seeing increased numbers in February. It may be mid to late February but we should see us start getting busier for sure.  In the meantime, I’ve started focusing more and more on marketing. I feel like I’m pretty dangerous when I have the time to be. Right now, I have the time to be. I used to sit around brainstorming ideas for marketing, memes, content, and all that entails. Then I’d create my own original stuff and post it.  I haven’t done that in forever it seems but here lately, and unfortunately, I’ve had some extra time to give those things attention again. I like a challenge and so I’m on it. I’ve targeted the demographics I want targeted.

The ones I think that the economy and who happens to be the President will have no control over economically. We’ve re-newed our efforts in getting our message to these people.  In addition, we’ve re-newed our efforts in our public outreach. Face to face, person to person outreach. Dan Kennedy says, YCDBSOYA, You can’t do business sitting on your ass. You’re moving forward or falling behind. You’re the window or the bug. You either make things happen in your life or you sit around wonder what the hell just happened.  So that’s what’s up with Creek Stone on this Monday, January 29th.

I have 35 on the schedule when I typically have 45. You carry that out throughout the week, that’s 50 less per week which is 200 less appointments per month. That’s unacceptable.  I’ve had less new patients lately as well. I think my Google SEO has dimished since going with a very reputable company a few years ago so we switched it up and went with a new website company that I know gets results. That’s brand new.  I also got to looking at our new patients demographics and it looks like we’re seeing fewer VA patients recently. That’s worth investigating and diving into.  If you’re not doing these thing regularly, might get on it. It’s whack-a-mole folks. You can never hit the auto-pilot button and sit back and just do the work if you’re the owner. It’s a constant battle. Enjoy the great times and ride that wave. When things start popping up out of nowhere, dig in, have some grit, and wait for that next wave.  Alright, here we go with the research today. 

Item #1

The first one today is called, “Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial” by Krekoukias, et al., published in 2017 in the Journal of Manual Manipulative Therapy.  Remember, the citations can be found at chiropractscforward.com under this episode.  Krekoukias G, Gelalis ID, Xenakis T, Gioftsos G, Dimitriadis Z, Sakellari V. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther. 2017 May;25(2):66-73. doi: 10.1080/10669817.2016.1184435. Epub 2016 Jun 23. PMID: 28559665; PMCID: PMC5430451.

Why They Did It The authors wanted to examine the efficacy of spinal mobilization in subjects with low back pain (LBP) and associated spinal disk degeneration.

How They Did It Seventy-five subjects suffering from chronic LBP were randomly allocated into 3 groups of 25 subjects.  Each group received five treatment sessions with the first group receiving manual therapy (MT) (spinal mobilization), the second a sham treatment, and the third conventional physiotherapy (CP) (stretching exercises, transcutaneous electrical nerve stimulation, and massage).  Subjects were assessed for their pain intensity using the numerical pain rating scale and for their self-reported disability using the Oswestry and Roland-Morris Questionnaire at baseline and after the completion of the five treatment sessions.

What They Found Paired t-tests showed a significant improvement for all outcome measures in the manual therapy and conventional physiotherapy group.  Analysis of covariance revealed that the manual therapy group had significant improvement in all outcome measures in comparison with the sham and conventional physiotherapy group, whereas no significant difference was observed between the sham and conventional physiotherapy group

Wrap It Up Manual Therapy is preferable to conventional physiotherapy in order to reduce the pain intensity and disability in subjects with chronic LBP and associated disk degeneration.  The findings of this study may lead to the establishment of spinal mobilization as one of the most preferable approaches for the management of LBP due to disk degeneration.

Item #2 The last one is, “The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial” by Koes published in Spine journal in 1992 and they’re using 1992 to make this determination in 2024 because there’s no better and more current  Koes BW, Bouter LM, van Mameren H, Essers AH, Verstegen GM, Hofhuizen DM, Houben JP, Knipschild PG. The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial. Spine (Phila Pa 1976). 1992 Jan;17(1):28-35. doi: 10.1097/00007632-199201000-00005. PMID: 1531552.

Why They Did It As you see in the title of the paper, the plan was to test the effectgiveness of manual therapy, physiotherapy, and treatment by a general practitioner on back and neck pain

How They Did It It was a randomized controlled trial The effectiveness of manual therapy, physiotherapy, continued treatment by the general practitioner, and placebo therapy (detuned ultrasound and detuned short-wave diathermy) were compared for 256 patients with nonspecific back and neck complaints lasting for at least 6 weeks. The principle outcome measures were severity of the main complaint, global perceived effect, pain, and functional status. These are presented for 3, 6, and 12 weeks follow-up. 

What They Found Both physiotherapy and manual therapy decreased the severity of complaints more and had a higher global perceived effect compared to continued treatment by the general practitioner.  Differences in effectiveness between physiotherapy and manual therapy could not be shown. 

Wrap It Up A substantial part of the effect of manual therapy and physiotherapy appeared to be due to nonspecific (placebo) effects. From 1992 – Placebo seems to be why smt appears to be effective. We know that placebo can and should play a part in a patient’s recovery. And we can leverage placebo in our favor too. Placebo has a bad name for some reason. In the biopsychosocial construct we should be using to our advantage all of the time.  Encouraging and positive words, little pain free wins….these things play a part in neuroplasticity and moving it in our direction and moving the patient away from chronic pain. 

That doesn’t mean that smt is placebo only and there have been plenty of papers shwoing the effectiveness of SMT beyond placebo in teh last 10 years or more. This paper is liteerally 32 years old. What in the holy hell are they using this paper for in 2024? I can’t explain it.  To be fair, I suppose the Gate Theory from the 1960s is still relevant so why can’t this paper still be relevant, right?/

But I’d argue that the Gate Theory is gamechanging big stuff. This paper, in my opinion, isn’t in the same ball park with regard to impact and effectiveness. As knowledge base expands, more recent and more relevant knowledge replaces outdated knowledge. This paper should be replaced and not be relevant when recommending SMT for treatment.  My two cents.  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.

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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    

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)

CF 313: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5)

But first, here’s that sweet sweet bumper music

Chiropractic evidence-based products

 

Integrating Chiropractors

 

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OK, we are back and you have found the Chiropractic Forward Podcast where we are 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 #313

Now if you missed last week’s episode, we talked about Pet Ownership And Cognitive Decline & PT Effectiveness. 

Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, we got a mix of stuff this week in the clinic. Our new intern is getting comfortable and settled in and getting up to speed with the way the office works and flows. We are picking back up a little just in time for me to be gone for two work days to attend my quarterly Mastermind meeting. Yes, it gives me anxiety but I’m going. The Mastermind is important. 

For this Mastermind, we’ll be joined by Brett Winchester who, in case you are unaware, is probably a genius in the healthcare space but also is borderline crazy personally. He’s hilarious and a lot of fun to be around so I’m definitely looking forward to Brett being int he mix with the rest of our regular crew. 

Plus, the January meeting is when new members join the group so that should be fun. It’s always good to meet the newbies and get to know more about them and learn from them. Last year’s newbies said they were intimidated to come into the group. Pffft. They fully integrated quickly and are part of the family now. We have some super smart docs but the ones joining are super smart too and we are just as eager to learn from them as they are to learn from us. 

So it works well and we’re looking forward to getting to know them. 

So this Monday has gone much better so far than last Monday. If you listened to the podcast last week, we had land mines to avoid last Monday for some reason. Smoother today for sure. We thought it may have been Dontae’s first day jinx so we made him take a shower and wash it off and he’s not allowed to wear those same clothes anymore. I think we have it handled. 

We are really buckling down this week to try to determine the best way to get our medical services up to speed and working with 100% efficiency. I think I have an approach of, let’s implement and let’s see what happens. I think that makes sense in the beginning with any service but once you’re up and running, it is time to fine tune. 

How are your prices in 2024 vs 2017? The same? You know everything in the world has gone up in price so if your prices are the same, you are making less money overall. Less profit I should say. 

Are our medical service and chiropractic services in line with the market and other clinics in our area?? We don’t want to be the cheapest. We don’t want to be the most expensive either. We don’t want to offer an exam, a consultation, a treatment plan, an adjustment, x-rays, and therapy on the first visit for the low low price of $39. 

Racing to the bottom hurts you and everyone else. If you want to look like a street corner huckster, that’s how you make it happen. If you want to take x-rays on every single person, which isn’t in line with ACA’s Choosing Wisely guides by the way, that’s fine. I don’t fault people wanting to know exactly what they’re dealing with. However, why the hell would you give them away? 

If you say that it’s because you want to show them their degeneration and their listings……we aren’t friends. We are different people. If you do it to show them these things and then spook them into 70 visits over the course of the year, you gotta check that stuff. Look in the mirror. 

If you wouldn’t do it to your mom, don’t do it to your patients. 

Anyway, you don’t want to give your services away. Please don’t do that. But I don’t really want to be the most expensive either. If I’m toward the more expensive but still responsible and appropriately priced, then I feel that’s the sweet spot. But you have to be financially healthy if you’re going to do a good job taking care of your patients. 

When you’re all running through your day wondering focused on the number of visits because you can’t pay payroll that week, well, that’s a problem we gotta get fixed. 

So, this month is a good month to look through our services and see if we’re doing what we can price wise to stay competitive and but maximize our ROI. 

On a final note before we hop into our research this week, I love hate the Cowboys. They broke my heart yet again this year but it’s OK because I fully expected and anticipated it. I knew it was going to happen so it didn’t upset me. And honestly, why get upset over a bunch of spoiled brat millionaires playing a game anyway? I refuse to allow the pinche Cowboys do that to me so……I’m moving on. 

Go Houston Texans. Go Texas Rangers. Go Houston Astros!

Cowboys….maybe next year. 

Now this week we’re continuing our series. If you don’t know or are unaware, the WHO recently recommended spinal manipulative therapy for back pain but at very low confidence. Which is equal to ultrasound. I dove in and found their citations with regard to SMT specifically and we’re going through them one by one to find out, with all of the research we’ve seen and covered combined with American College of Physicians recommendations, Parker Gallup polls, and on and on and on…..how can SMT be at very low confidence. 

So here we go. 

Item #1

Our first one is called, “Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain” by Gibson, et al and published in The Lancet in June of 1985. Not sure why they’re pulling papers from that far back but whatever. 

And I’m going to say that this paper is so old that even the abstract didn’t make a ton of sense. 

Gibson T, Grahame R, Harkness J, Woo P, Blagrave P, Hills R. Controlled comparison of short-wave diathermy treatment with osteopathic treatment in non-specific low back pain. Lancet. 1985 Jun 1;1(8440):1258-61. doi: 10.1016/s0140-6736(85)92323-2. PMID: 2860453.

Why They Did It

The effectiveness of spinal manipulation carried out by a non-medical qualified osteopath was compared with that of short-wave diathermy (SWD) and a placebo

How They Did It

109 patients with low back pain. 

That’s it. That’s all of the info on it. No idea if it was a randomized controlled trial or what. 

What They Found

More than half the subjects in each of the 3 treatment groups benefited immediately from therapy. 

Significant improvements were observed in the 3 groups at the end of 2 weeks’ treatment, and these were still apparent at 12 weeks. 

The outcome of treatment was unrelated to the initial severity or duration of pain or to the trend of pain towards deterioration or improvement. 

It is, therefore, unlikely that the results simply reflect the natural history of low back pain. 

Wrap It Up

Benefits obtained with osteopathy and short-wave diathermy in this study may have been achieved through a placebo effect.

So…..that’s a crap paper and why the WHO would have that paper as having any influence on our profession in 2024 is beyond me. 

Item #2

Our last one today is called, “Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial” by Grande-Alonso et. Al and published in Pain Medicine in December of 2019

Remember paper citations will be found in the show notes at chiropracticforward.com episode 313.

Grande-Alonso M, Suso-Martí L, Cuenca-Martínez F, Pardo-Montero J, Gil-Martínez A, La Touche R. Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial. Pain Med. 2019 Dec 1;20(12):2571-2587. doi: 10.1093/pm/pnz093. PMID: 31074484.

Why They Did It

To compare the effectiveness of a biobehavioral approach with and without orthopedic manual physical therapy on the intensity and frequency of pain in patients diagnosed with nonspecific chronic low back pain.

How They Did It

  • A single-blind randomized controlled trial. 
  • Fifty patients were randomly allocated into two groups: one group received biobehavioral therapy with orthopedic manual physical therapy, and the other group received only biobehavioral therapy. 
  • Both groups completed a total of eight sessions, with a frequency of two sessions per week. 
  • The somatosensory, physical, and psychological variables were recorded at baseline and during the first and third month after initiation of treatment.

What They Found

  • In both groups, the treatment was effective, presenting significant differences for all the variables in the time factor. 
  • There were no significant differences between groups in intensity or frequency of pain, with a large effect size (>0.80), but there were intragroup differences for both intervention groups at one- and three-month follow-up. 
  • There were also no significant differences between groups in the secondary variables during the same follow-up period.

Wrap It Up

The results of this study suggest that orthopedic manual physical therapy does not increase the effects of a treatment based on biobehavioral therapy in the short or medium term, but these results should be interpreted with caution.

I do not have the full paper, only the abstract. How was the orthopedic manual physical therapy defined? What was involved? Is that SMT? I don’t know. 50 patients isn’t much of a sample size either really. 

I’m not sure why the WHO felt this one was suitable to make their determination off of but that’s why we’re doing this, right?

Store

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

 

 

 

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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.

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TuneIn

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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

 

Omnivorous vs Vegan & SMT For Chronic Neck Pain

CF 314: Omnivorous vs Vegan & SMT For Chronic Neck Pain Today we’re going to talk about Omnivorous vs Vegan & 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 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 #314 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 5).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Let’s start by giving Dr. Steven Brown out in Gilbert, AZ a shoutout. If you listened last week, we had a paper that was just the abstract. It was a paper that the WHO is using in part to help them formulate their opinion that SMT is recommended but at very low confidence.  The paper used orthopedic manual physical therapy, whatever the hell that is.  “The protocol consisted of accessory mobilizations (posteroanterior), traction of the lumbar region, mobilization with movement in the coxofemoral joint, and global techniques of neural mobilization of the lumbar spine. The duration of the orthopedic manual physical therapy was 20–25 minutes per session.”  Dr. Brown says, “They did not get actual lumbar spine, SI joint, or hip manipulation at all. Just 20-25 minutes of mobilization.” So, there you have it from one of last week’s papers. I think as we go through them, it’s getting clearer and clearer that the WHO may have an agenda. Which chiropractors expect, honestly. When you have MDs running the show, they’re going to be super slow to promote SMT to the MainStage for anything. Using papers like we’ve been seeing to make their determination is just, quizzical. For lack of a better word. It’s perplexing when we know there is more current and more impactful research in favor of SMT.  Moving on this week, I just got back from Jupiter, FL and the MCM Mastermind with Dr. Kevin Christie, Dr. Brett Winchester, Dr. Lindsey Mumma, and many more. Florida wasn’t warm. It was in the 50s and 60s but we were in a classroom most of the time anyway. We had some fine dining at The Woods, which is Tiger Woods’ restaurant. No Tiger sightings but none were expected. Lots of Bentleys, Mercedes, Lambos, and the like. It’s always a little crazy in Florida when you consider the amount of money strolling around those towns.  Lots of great discussions, lots of thoughts and plans. Now to have the time to organize the thoughts and take action on them. One fun one came from my little friend, Dr. Tiffany Armstrong from Iowa. Her and her husband have a great practice out there and are adding a gym to the mix. Fun fun.  She was talking about Storybrand and what are your Big 3? She said patients and clients can’t really keep up with more than three things. It got me to thinking and here’s what I came up with:
  1. Pain Relief
  2. Function, Stability, Strength
  3. Performance Care
That’s why you join a mastermind. That was a little comment on a discussion that we had in class. Nothing game changing but enough to give me some clarity and direction with some things I’ve been wanting to tweak and change. Imagine how many of those little comments and conversations we have over the weekend.  Lots of direction this morning outside of the. Podcast so I’m hopping into it  Item #1 Our first one today is called, “Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial” by Landry et. Al and published in JAMA Network Open November 30, 2023. Kapow! It’s hottern’ a teapot! Remember, the citations can be found at chiropractscforward.com under this episode.  Landry MJ, Ward CP, Cunanan KM, et al. Cardiometabolic Effects of Omnivorous vs Vegan Diets in Identical Twins: A Randomized Clinical Trial. JAMA Netw Open. 2023;6(11):e2344457. doi:10.1001/jamanetworkopen.2023.44457 Why They Did It Increasing evidence suggests that, compared with an omnivorous diet, a vegan diet confers potential cardiovascular benefits from improved diet quality (ie, higher consumption of vegetables, legumes, fruits, whole grains, nuts, and seeds).  The researchers wanted to compare the effects of a healthy vegan vs healthy omnivorous diet on cardiometabolic measures during an 8-week intervention. How They Did It This single-center, population-based randomized clinical trial of 22 pairs of twins randomized participants to a vegan or omnivorous diet (1 twin per diet).  Participant enrollment began March 28, 2022, and continued through May 5, 2022.  The date of final follow-up data collection was July 20, 2022.  This 8-week, open-label, parallel, dietary randomized clinical trial compared the health impact of a vegan diet vs an omnivorous diet in identical twins.  Twin pairs were randomized to follow a healthy vegan diet or a healthy omnivorous diet for 8 weeks.  Diet-specific meals were provided via a meal delivery service from baseline through week 4, and from weeks 5 to 8 participants prepared their own diet-appropriate meals and snacks. The primary outcome was difference in low-density lipoprotein cholesterol concentration from baseline to end point (week 8).  Secondary outcome measures were changes in cardiometabolic factors, plasma vitamin B12 level, and body weight. Exploratory measures were adherence to study diets, ease or difficulty in following the diets, participant energy levels, and sense of well-being. A total of 22 pairs of twins What They Found After 8 weeks, compared with twins randomized to an omnivorous diet, the twins randomized to the vegan diet experienced significant mean (SD) decreases in low-density lipoprotein cholesterol concentration, fasting insulin level, and body weigh Wrap It Up In this randomized clinical trial of the cardiometabolic effects of omnivorous vs vegan diets in identical twins, the healthy vegan diet led to improved cardiometabolic outcomes compared with a healthy omnivorous diet.  Clinicians can consider this dietary approach as a healthy alternative for their patients. Item #2 OK, the last one this week is called, “A systematic review and meta-analysis of randomized controlled trials of manipulative therapy for patients with chronic neck pain” by Liu et. Al. published in Complementary Therapies in Clinical Practice in August of 2023 and it’s just hot enough! Zhen Liu, Jiao Shi, Yubo Huang, Xingchen Zhou, Huazhi Huang, Hongjiao Wu, Lijiang Lv, Zhizhen Lv, A systematic review and meta-analysis of randomized controlled trials of manipulative therapy for patients with chronic neck pain, Complementary Therapies in Clinical Practice, Volume 52, 2023, 101751, ISSN 1744-3881, https://doi.org/10.1016/j.ctcp.2023.101751. Why They Did It An increasing number of people suffer from chronic neck pain due to increased telecommuting. Manual therapy is considered a safe and less painful method and has been increasingly used to alleviate chronic neck pain.  However, there is controversy about the effectiveness of manipulation therapy on chronic neck pain.  Therefore, this systematic review and meta-analysis of randomized controlled trials (RCTs) aimed to determine the effectiveness of manipulative therapy for chronic neck pain. How They Did It A search of the literature was conducted on seven databases from the establishment of the databases to May 2022.  This study included RCTs on chronic neck pain managed with manipulative therapy compared with sham, exercise, and other physical therapies.  The retrieved records were independently reviewed by two researchers.  Further, the methodological quality was evaluated using the PEDro scale.  The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) assessment was used to evaluate the quality of the study results. Seventeen RCTs, including 1190 participants, were included in this meta-analysis. What They Found Manipulative therapy showed better results regarding pain intensity and neck disability than the control group.  Manipulative therapy was shown to relieve pain intensity and neck disability.  However, the studies had high heterogeneity, which could be explained by the type and control interventions.  In addition, there were no significant differences in adverse events between the intervention and the control groups. Wrap It Up Manipulative therapy reduces the degree of chronic neck pain and neck disabilities. Hurry, someone run and the the World Health Organization that we got a new paper to add to their crap recommendations…. More on the papers they’re using to recommend SMT at very low confidence in next week’s Part 6 of that series.  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    

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2)

CF 309: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2) 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 #309 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1).  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Hey crew, this week, we’re just kind of gearing up for Christmas because that’s a big deal. We have Christmas on a Monday this year so that’s nice and tidy, right. We don’t have to decide if we’re taking off Christmas Eve or not. It’s pretty simple this year.  I have a short story about something that we went through last week here in the clinic. It jusst takes one person to really throw a monkey wrench into your week.  I’ll start by saying, “Thank God I can’t prescribe medication.” Those folks have a whole extra layer of crap they have to deal with I’m sure. If you’re fresh faced and new in practice, here’s your warning, there are awful people out there in the world that just want to steal your joy for no damn reason at all. I’m better now but one of them stole mine last week. I had a patient that laid off of work. On their own. Not doctor-ordered. On the day before they decided to return to work, they came into the clinic. They told me they were only really in my clinic for their appointment to get a doctor’s note.  Fine, I’m happy to see patients and I’m happy to write a note that the patient came to see me that day. Not a big deal. Pretty much every day normal stuff.  The next day, the person starts harassing our front desk staffer about writing a note for them covering the days spent at home prior to their visit to our clinic.  The person expected us to falsify our records and create treatment dates for them pretending they were being seen in our office. Dates they were not seen in our office. THAT’S NUTS. And immoral. And unethical. And should be embarrassing for them to even ask, much less expect and DEMAND, an office to do for them.  They said I should be their advocate because I’m their doctor. If you  or your patients ever thought a provider was supposed to be the patients’ advocate, get that out of your head. As you likely know, we are taught specifically, especially in the medicolegal area of healthcare, that we are NOT our patients’ advocates.  We are objective care givers only. Besides that, advocating is one thing. Out and out lying and falsifying records is quite another.  When the patients was told that we cannot do that, the threats started. I received an email from this person telling me that online reviews are powerful tools and that they are going to let everyone know our clinic did them wrong and make sure anyone that reads it will never come to my clinic.  Really??  Using the threat of online reviews to extort a falsified doctor’s note so they don’t get into trouble at work because of their own actions?  This person, who works for a big government outfit, who has probably never took a chance and built anything on their own. Who has never laid awake at night worrying about their business. Who has never poured piles of money, blood, sweat, and tears into building their own brand and reputation. Who. Has never employeed 14 people and was responsible for feeding their families.  This type of person is going to try to tear us down because we wouldn’t lie for them.   You cannot make this stuff up. After not getting the note they demanded, they did go ahead and leave the revenge review. We got us a 1-star out of the deal.  We healthcare people cannot put people like this on blast due to HIPAA so…..we just sort of have to take it on the chin. It’s not the first time I’ve had a patient leave a completely false review but this one is the first one like this. No doubt.  I have the emails and the threats. I reported the review to Yelp as false, libelous, and disparaging with the review service. Of course, Yelp doing Yelp stuff and being absolutely worthless, decided to keep the review. So…..I responded. While the reviewer just used his first name and an initial for the last, I went ahead and addressed him by his full last name. If he’s putting me on blast for no reason, I’m putting him on blast for real. Let’s get the cockroach into the daylight.  After addressing him by his full name, my public response was as follows,  “The first thing I would like to clear up with you that has been taught to healthcare providers through the years, is that healthcare providers are absolutely NOT advocates for patients. We cannot be advocates for our patients. We are objective caregivers. Nothing more. So you can forget that talking point. Secondly, for you to ask a healthcare provider of any type to misrepresent your treatment dates, is quite honestly shocking. We offered, and were more than happy to write you a note for the day that you were seen in our clinic. That is very customary and very appropriate. We would have even been happy to include in the note that any issue experienced was supposedly ongoing. Furthermore, we would have even been happy to leave out any part about only being in the office to get a doctors note.  But we cannot, and will not pretend that we treated you on dates that we did not treat you. For you to demand that from us is quite honestly embarrassingly entitled of you. I understand that you being out of work for some amount of time might cause you issues with your supervisor. While we hate hearing that, we at Creek Stone shoulder zero responsibility in the matter and should have NEVER been expected to play a part in it in any way. You threatened to leave us a terrible review if we refused to lie for you. That will not be tolerated. In your threat to us, you claim that Yelp is a powerful tool. We absolutely understand that. While, we obviously could not prevent you from leaving us a libelous, disparaging, and legally actionable review in an attempt  to prevent others from seeking care with us, we want to be clear, direct, and factual in our response. This review is nothing more than a legally actionable revenge review and we suggest you remove it immediately.  Having a staff of 12 working at our clinic, and caring dearly about each one of them and their loved ones, I guess I’ll never quite understand why someone like you would try to affect our way of providing for our families. Especially when your discipline issue is your own fault.” So, I get an email that night saying that he was never asking me to falsify anything and that he would be fine with a note stating that I saw him on the date I saw him and mention that he stated that it started 3 days previous to the visit. Which would be an honest recounting of the visit I had with him. I have no problem with that.  He even said he’d be happy to leave me a great review. Lol.  OK, now we’re getting somewhere. I told him I have plenty of great reviews. There’s no need for that. I’m happy to provide a note recounting the encounter truthfully and honestly but I would apprecaite him removing the 1-star review. He was happy to do that and I was happy to provide an accurate note for his visit.  One more joy robber vanquished.  This person said they’ll never step foot in my clinic again. What a blessing. As you get busier, you get to choose who you will and who you will not do business with. I will not do business with people like this.  What’s the moral? JUST BE KIND TO OTHERS. You don’t know what others deal with. Be ethical. Be generous. If you did something wrong, take responsibility for your own actions. Thast goes for provider and patient Most importantly, don’t try to tear others down based on the faults in your own actions or behavior. I tell our staff that when we have a bad one…..just remember all of the amazing, loving, and kind patients that we have all day every day.  I had to take my own advice on this one.  I hope the grinch takes their presents from under the tree. Item #1 Our first one continuing from part one from last week is called, “Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation” by Bronfort, et al and published in Annals of Internal Medicine in September 16, 2014. Remember; citations are in the show notes at chiropracticforward.com Bronfort G, Hondras MA, Schulz CA, Evans RL, Long CR, Grimm R. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Ann Intern Med. 2014 Sep 16;161(6):381-91. doi: 10.7326/M14-0006. PMID: 25222385.  Why They Did It Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management. The researchers wanted to determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with home exercise and advice alone reduces leg pain in the short and long term in adults with Back-related leg pain. How They Did It
  • Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011. 
  • Research centers (Minnesota and Iowa).
  • Persons aged 21 years or older with Back-related leg pain for least 4 weeks.
  • 12 weeks of SMT plus home exercise and advice or home exercise and advice alone.
  • The primary outcome was patient-rated Back-related leg pain at 12 and 52 weeks. 
  • Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. .
  • Blinded objective tests were done at 12 weeks.
  • Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks. 
What They Found
  • For leg pain, SMT plus home exercise and advice had a clinically important advantage over home exercise and advice at 12 weeks but not at 52 weeks. 
  • Nearly all secondary outcomes improved more with SMT plus home exercise and advice at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks. 
  • No serious treatment-related adverse events or deaths occurred.
Wrap It Up For patients with Back-related leg pain, SMT plus home exercise and advice was more effective than home exercise and advice alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. Item #2 The last one this week is called, “Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial” by Bond et al and published in Journal of Manual Manipulative therapy in February of 2020. Right before the world took a dump on itself with the COVID pandemic.  Bond BM, Kinslow CD, Yoder AW, Liu W. Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial. J Man Manip Ther. 2020 Feb;28(1):15-27. doi: 10.1080/10669817.2019.1572986. Epub 2019 Mar 5. PMID: 30935324; PMCID: PMC7006726. Why They Did It The long-term goal of our study is to improve the understanding of the biological mechanisms associated with spinal manipulative therapy (SMT) in low back pain How They Did It
  • This project involved a pilot randomized, blinded clinical trial of 3-week SMT in chronic nonspecific low back pain (CNSLBP) patients. 
  • They recruited 29 participants and randomly assigned them into either a SMT or sham SMT group. 
  • Pre- and postintervention, they quantified the effect of SMT on clinical outcomes (Numeric Pain Rating Scale and Oswestry Disability Index) and pressure pain threshold at local (lumbar spine), regional (lower extremity), and remote (upper extremity) anatomical sites.
What They Found
  • The researchers observed a significant main effect for time signifying reduced hypersensitivity (increased pressure pain threshold) at local and regional locations at 3 weeks. 
  • Furthermore, they found significant main effects of time indicating improvements in pain and disability from baseline among all participants regardless of intervention. 
  • However, no between-group differences were observed in pressure pain threshold, clinical pain, or disability between the SMT and sham SMT groups over 3 weeks.
Wrap It Up After 3 weeks of SMT or sham SMT in chronic nonspecific low back pain patients, we found hypoalgesia at local and remote sites along with improved pain and low back-related disability 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      

SMT and The Low Back & How Much Exercise Is Actually Needed

CF 278: SMT and The Low Back & How Much Exercise Is Actually Needed

 

Today we’re going to talk about SMT and The Low Back & How Much Exercise Is Actually Needed

 

But first, heres 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, look down your nose at people 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.  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, drive, smart, 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 educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s 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.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward 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 com

  You have found yourself smack dab in the middle of Episode 278   Now if you missed last week’s episode, we talked about the safety of SMT in the cervical spine and we talked about Chiropractors’ beliefs around the need for x-rays. That one was surprising given the fact that it’s now 2023. Make sure you don’t miss that info. Keep up with the class.  

 

On the personal end of things…..

First thing’s first, yours truly voiced the Elvis character in a video game that just came out on Xbox and Playstation. It’s called God of Rock and the company that released it is called Modus.   If you’re a gamer and you like fighting games, go google up god of rock by Modus and see what you think. The Elvis character is named King and yep, that’s my voice. Even the grunts and groans, the punches and the taking damage. All of it. Crazy. Life. I lead, folks. Just insane but blessed too.   It’s warming up outside for most of us. At least here in the South it is. You Yankees feel free to correct me if you like. I can handle your ridicule.   It got me to thinking, with it getting warmer outside now, how does that affect your marketing efforts? Here’s what I’m thinking; what do we do more of when it warms up/

  • We do more yard work
  • Runners run more
  • Bikers bike more
  • Hikers hike
  • You’ve got Summer baseball, basketball, and whatnot.
  • Some of you will have rowing, waterskiing, and watersports. Note – that wouldn’t be Amarillo, TX just in case you’re wondering.

  The point being that your marketing might shift a bit to make sure you’re talking to the people that are out there putting their bodies under more stress than they have in the last 6 or so months.   So, go do all of the stuff. Build it this Summer  

Item #1   The first on today is called “Benefits and harms of spinal manipulative therapy for the treatment of chronic low back pain: systematic review and meta-analysis of randomized controlled trials” by Sidney M Rubinstein, Annemarie de Zoete, Marienke van Middelkoop, Willem J J Assendelft, Michiel R de Boer, Maurits W van Tulder and published in PubMed on March 13 2019.    

Why They Did It  

To assess the benefits and harms of spinal manipulative therapy (SMT) for the treatment of chronic low back pain.    

 

How They Did It  

  • Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence.
  • The effect of SMT was compared with recommended therapies, non-recommended therapies, sham (placebo) SMT, and SMT as an adjuvant therapy.
  • Main outcomes were pain and back specific functional status, examined as mean differences and standardized mean differences (SMD), respectively. Outcomes were examined at 1, 6, and 12 months. Quality of evidence was assessed using GRADE. A random effects model was used and statistical heterogeneity explored.

  What They Found  

  • 47 randomised controlled trials including a total of 9211 participants were identified, who were on average middle aged (35-60 years).

 

  • Most trials compared SMT with recommended therapies. Moderate quality evidence suggested that SMT has similar effects to other recommended therapies for short term pain relief (mean difference -3.17, 95% confidence interval -7.85 to 1.51) and a small, clinically better improvement in function (SMD -0.25, 95% confidence interval -0.41 to -0.09).

 

  • High quality evidence suggested that compared with non-recommended therapies SMT results in small, not clinically better effects for short term pain relief (mean difference -7.48, -11.50 to -3.47) and small to moderate clinically better improvement in function (SMD -0.41, -0.67 to -0.15). In general, these results were similar for the intermediate and long term outcomes as were the effects of SMT as an adjuvant therapy.

 

  • Evidence for sham SMT was low to very low quality; therefore these effects should be considered uncertain. Statistical heterogeneity could not be explained.

 

  • About half of the studies examined adverse and serious adverse events, but in most of these it was unclear how and whether these events were registered systematically. Most of the observed adverse events were musculoskeletal related, transient in nature, and of mild to moderate severity.

 

  • One study with a low risk of selection bias and powered to examine risk (n=183) found no increased risk of an adverse event (relative risk 1.24, 95% confidence interval 0.85 to 1.81) or duration of the event (1.13, 0.59 to 2.18) compared with sham SMT. In one study, the Data Safety Monitoring Board judged one serious adverse event to be possibly related to SMT.

 

Wrap It Up  

SMT produces similar effects to recommended therapies for chronic low back pain, whereas SMT seems to be better than non-recommended interventions for improvement in function in the short term. Clinicians should inform their patients of the potential risks of adverse events associated with SMT.    Before getting to the next one,   Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.   I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. 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. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.  

Item #2   Our last one this week is called, “How much exercise is needed to live longer” by Sara Berg, MS and published in American Medical Association on March 16, 2018.  

Why They Did It   To know many minutes of moderate or vigorous physical activity are needed to lower the risk of premature mortality.  

How They Did It   From two large prospective U.S. cohorts, 116,221 adults self-reported leisure-time physical activity—defined as exercise that is not done at work—through a validated questionnaire. The questionnaire was repeated up to 15 times over the course of 30 years.    

What They Found  

  • The study found that those who worked out two to four times beyond the minimum physical activity recommendations had a lower risk of death from cardiovascular disease.

 

  • Those who worked out two to four times above the moderate physical activity recommendations—about 300 to 599 minutes each week—saw the most benefit.

 

  • Participants had a 26% to 31% lower all-cause mortality while 28% to 38% had lower cardiovascular mortality. On top of that, 25% to 27% experienced lower non-cardiovascular mortality.

 

Wrap It Up   Adults who worked out two to four times more than the vigorous physical activity recommendations—about 150 to 299 minutes per week—were found to have 21% to 23% lower all-cause mortality, according to the study. They were also reported to have 27% to 33% lower cardiovascular mortality and 19% lower non-cardiovascular mortality.     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 cant 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….

 

Thats 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 cant 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

 

Social Media Links

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

 

Chiropractic Forward Podcast Facebook GROUP

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

 

Twitter

 

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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

 

Safety of SMT in the Cervical Spine & Chiropractors’ Beliefs Around the Need for X-rays

CF 277: Safety of SMT in the Cervical Spine & Chiropractors’ Beliefs Around the Need for X-rays

Today we’re going to talk about the safety of SMT in the cervical spine & Chiropractors’ beliefs around the need for x-rays.

But first, heres 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, look down your nose at people 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.  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, drive, smart, 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 educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s 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.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward 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 com

  You have found yourself smack dab in the middle of Episode 277   Now if you missed last week’s episode, we talked about Subacromial Dry Needling & Lumbar Discs With Stenosis Present. Make sure you don’t miss that info. Keep up with the class.  

 

On the personal end of things…..

I have just returned from the Tampa mastermind meeting so this likely will be shorter than normal. Mostly because after I’ve been gone a few days, the stuff has piled up and I’m usually tied up trying to get my desk cleared off and back to business as usually. The youz as the kids would say.   Tampa was good stuff, we had a talk from the Scheduling Institute and I was really impressed.

Wow.

I think this is a path I need to be going down and I think that path should start yesterday. Eye opening is just the most minimal way to put it.   We have hot seat sessions where one of us sits in the middle and tells the group their issues then the entire group asks questions and tries to offer help and advice to solve and move past those problems.  

We have Each One Teach One sessions to help learn what’s working for others in their practices. Kevin Christie and myself presented a 30 minute spot on ChatGPT.

Lindsey Mumma did one on niching your practice. And Ben Fergus did one on automating his front desk and check-in procedures. He’s done a lot of interesting things with his practice.   Again, get yourself into a Mastermind or create one. It’s outstanding.   Kevin is looking to maybe start another, separate group for the West Coast and Mountain area so keep your eyes and ears out. We’ll probably have Kevin on the podcast in the near future talking about that as well.   Let’s get at it.  

Item #1

The first one today is called “Safety of chiropractic manipulation of the cervical spine: a prospective national survey” by Haymo W Thiel, Jennifer E Bolton, Sharon Docherty, Jane C Portlock and published in PUBMED on October 1, 2007.  

 

Why They Did It  

To estimate the risk of serious and relatively minor adverse events following chiropractic manipulation of the cervical spine by a sample of U.K. chiropractors.  

 

How They Did It  

  • They studied treatment outcomes obtained from 19,722 patients.

 

  • Manipulation was defined as the application of a high-velocity/low-amplitude or mechanically assisted thrust to the cervical spine.

 

  • Serious adverse events, defined as “referred to hospital A&E and/or severe onset/worsening of symptoms immediately after treatment and/or resulted in persistent or significant disability/incapacity,” and minor adverse events reported by patients as a worsening of presenting symptoms or onset of new symptoms, were recorded immediately, and up to 7 days, after treatment.

 

What They Found  

  • Data were obtained from 28,807 treatment consultations and 50,276 cervical spine manipulations. There were no reports of serious adverse events.

 

  • This translates to an estimated risk of a serious adverse event of, at worse approximately 1 per 10,000 treatment consultations immediately after cervical spine manipulation, approximately 2 per 10,000 treatment consultations up to 7 days after treatment and approximately 6 per 100,000 cervical spine manipulations.

 

  • Minor side effects with a possible neurologic involvement were more common. The highest risk immediately after treatment was fainting/dizziness/light-headedness in, at worse approximately 16 per 1000 treatment consultations.

 

  • Up to 7 days after treatment, these risks were headache in, at worse approximately 4 per 100, numbness/tingling in upper limbs in, at worse approximately 15 per 1000 and fainting/dizziness/light-headedness in, at worse approximately 13 per 1000 treatment consultations.

 

Wrap It Up  

Although minor side effects following cervical spine manipulation were relatively common, the risk of a serious adverse event, immediately or up to 7 days after treatment, was low to very low.     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! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. 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. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.  

Item #2

Our last one this week is called, “Examining Clinical Opinion and Experience Regarding Utilization of Plain Radiography of the Spine: Evidence from Surveying the Chiropractic Profession” by Philip A. Arnone, Steven J. Kraus, Derek Farmen, Douglas F. Lightstone, Jason Jaeger 4 and Christine Theodossis  and published in Journal of Clinical Medicine on 10 March 2023. Hot potato!  

Why They Did It  

  • Plain Radiography of the spine (PROTS) is utilized in many forms of healthcare including the chiropractic profession; however, the literature reflects conflicting opinions regarding utilization and value.
  • Despite being an essential part of Evidence-Based Practice (EBP), few studies assess Doctors of Chiropractic (DCs) clinical opinions and experience regarding the utilization of Plain Radiography of the spine in practice.

  How They Did It

  • In creating the survey for this study, the authors intended to be consistent with Evidence-Based Practice and developed a series of 11 questions to adequately reflect the clinical opinion and experience of the US DCs on the utilization of Plain Radiography of the spine in a chiropractic clinical setting.

 

  • The survey included a variety of both Likert and binary response options that could accurately reflect each DCs’ clinical opinions and experience rather than solely binary response options.

 

  • Many aspects of the clinicians’ decision process were considered during the process, including why practitioners would or would not order Plain Radiography of the spine, what value DCs attribute to Plain Radiography of the spine, how to adequately reflect DCs’ clinical opinion and experience of Plain Radiography of the spine as it relates to patient care, and issues related to plain radiography utilization safety and research.

 

What They Found  

  • There is an inverse relationship in the responses between DCs that do and do not utilize Plain Radiography of the spine in their practice; however, the clinical opinion of US DCs who utilized Plain Radiography of the spine in their practice assigns a high value to the utilization of Plain Radiography of the spine.

 

  • These doctors believe it to be safe and that the DCs’ clinical experience is adequate for recommending Plain Radiography of the spine.

 

  • In summary, 77.6% of these DCs indicated that Plain Radiography of the spine has value beyond the identification of pathology, 79.1% indicate that x-rays important regarding biomechanical analysis of the spine, 83.0% noted they are vital to chiropractic practice and 84.7% believe they aid in measuring outcomes.

 

Wrap It Up  

  • This survey provides the most extensive insight into the clinical opinion of the US chiropractic profession regarding Plain Radiography of the spine and suggests that the majority of the DCs consider utilization of x-rays to have value beyond the identification of pathology, to be vital to chiropractic practice and essential to biomechanical analysis.

 

  • The DCs who utilized Plain Radiography of the spine only to rule out pathology in the presence of red flags are, in fact, statistical outliers in this study and may represent a minority of US DCs.

 

  • A majority of the DCs also consider the doctors’ clinical experience and expertise, coupled with patient preferences, to be appropriate for recommending Plain Radiography of the spine.

 

  • Most DCs in this survey found that sharing spinal radiographic findings with the patient is beneficial for patient outcomes. All participants in the survey believed that patient outcomes would benefit from continued research regarding appropriate utilization of Plain Radiography of the spine.

 

  • The results of this survey clearly indicate the value of Plain Radiography of the spine reflected by DCs and demonstrate the need for continued research to help understand how this value can affect the quality of care, conservative correction of spinal alignment and patient health.

 

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 cant 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….

 

Thats 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 cant 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

 

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

 

Remote Myofascial Release & Manual Versus Instrumental Spinal Manipulation

CF 275: Remote Myofascial Release & Manual Versus Instrumental Spinal Manipulation

 

Today we’re going to talk about Remote Myofascial Release & Manual Versus Instrumental Spinal Manipulation

 

But first, heres 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, look down your nose at people 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.  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, drive, smart, 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 educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s 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.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward 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 com

  You have found yourself smack dab in the middle of Episode #275   Now if you missed last week’s episode, we talked about spinal stabilization for chronic pain and we talked about dry needling. Make sure you don’t miss that info. Keep up with the class.  

On the personal end of things…..

Damnit….OK…..I’m pulling out the soapbox. You ready? Here we go.   I love certain aspects of this profession. I absolutely ABHOR others. One popped its ugly head up this morning. I have a brand new patient, 23 yrs old, a little knee pain I think is Pes Anserine, a little low back pain that seems facet-related, and some neck soreness. Most likely due to him self-adjusting it all of the time.   He came to me from another local chiropractor. This local chiro took x-rays on him. Which is not evidence-based by the way. No trauma, no steroid use, no systemic illness, no IV drug use….he’s good. Shouldn’t have had x-rays to begin with.   Regardless, because chiropractors are chiropractors, he gets x-rays and then the mind screwing begins. Guess what, he’s got a ‘tweak’ and his neck is straight and if he doesn’t handle that and get it fixed, it could be the end for him up to and including….get this…..cognitive decline. Are you with me? Freaking cognitive decline.

He’s 23 people.  

Not only does he think he’ll forget his wife’s name some day if he doesn’t fix his neck, he is recommended to be treated for 4x/week for a YEAR! Who the hell needs 4x/week for a year? WHO???   In case you were curious, the answer to that question is absolutely nobody on the face of the planet. Unless they’re looking to have their spine become unstable from too much mobilization. I mean, those people maybe but that would just be out of pure ignorance.   So I did some math and bam….that’s 208 visits this year. Let’s say that’s a conservative $45 per visit. I know this clinic and it’s likely more but let’s go with a safe bet. At $45 per visit that’s a grand total of $9,360.   Out-freaking-standing.

This 23 yr old that needs to quit popping his own neck needs to spend almost $10k in a clinic?   Insanity and if you are a predatory, ignorant chiropractor of this caliber, I want you to stop it now. Get some damn education. Because this is garbage, rubbish, and utter stupidity. Chiropractors like this should be ashamed of themselves and should surrender their license if they refuse to be moral, ethical, read research, and do smart things.   If you don’t do smart things, you’re and idiot and I got zero use for you as a supposed professional.  

OK, putting the soapbox away now…..  

Business is weird man. Ups and downs so we keep an eye on it but don’t let us go crazy unless we notice a sustained downturn. I was in a sustained down turn from September through February. We’ve been on the upswing once we had the 75% staff turnover.   I like our team and, while I think we’re coming out of the downturn, it’s not without its bumps and potholes. Last week was awful. But we had Easter and coming off of Spring Break. It’s whatever.  

This week, as I type this out on a Monday, I’m looking at 127 for me for the week. Which means, if I’m right, we’ll wind up somewhere around 155 or 165 before the week is through. And I’m totally good with that.   I have been playing around a lot lately with content creation, figuring out how to delegate more, and reclaim my time to the extent that I can. I’ve even been toying with the new AI stuff coming out. It’s scary but for where it is right now, it’s pretty incredible for business owners that don’t have the time they’d like to have to market.   I remember when we used to just join the rotary or Kiwanis Club, run an ad in the newspaper and yellow pages, and if you were fancy, you’d run a radio ad…..maybe. That was pretty uptown. Life was pretty simple for us back then. Just get into the community and let them know you’re open for business.  

There are so many more things to try to keep track of these days. It’s tough on business owners. Especially chiropractors because we are paid less and less but the price of everything has gone up and up while the price of treatment and its value in the eyes of the consumer has remained consistent with 10 years ago.   Our margins are thinner and thinner. We can’t just go out and grab up a marketing rep to grow our clinic for us like the medical boys. Well, most of us can’t anyway. So, when you find tools that can lighten your burden, you figure it out. That’s what I’m doing. I suggest, if you’re behind on it, you better catch up muy pronto, mi amigo. Or you might never catch up.   Early adopters are either roasted or champagne toasted. I think when it comes to AI, it’s not going anywhere so you might as well jump on and hold on tight because it’s going to get crazy in the years to come.    

Item #1  

The first on today is called, “Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients With Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial” by Hassan Tamartash PhD and published in Journal of Chiropractic Medicine on 14 February 2023. Dayum. That’s hot.    

Why They Did It   The purpose of this study was to evaluate the effects of myofascial release technique of a remote area on lumbar elasticity and low back pain (LBP) in patients with chronic nonspecific LBP.    

How They Did It  

  • For this clinical trial, 32 participants with nonspecific LBP were assigned to a myofascial release group (n = 16) or a remote release group (n = 16).
  • Participants in the myofascial release group received 4 sessions of myofascial release to the lumbar region. The remote release group received 4 myofascial release sessions to the crural and hamstring fascia of the lower limbs.
  • Low back pain severity and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment by the Numeric Pain Scale and ultrasonography examinations.

 

What They Found   The mean pain and elastic coefficient in each group before and after myofascial release interventions were significantly different (P ≤ .0005). The results showed that the changes in mean pain and elastic coefficient of the 2 groups after myofascial release interventions were not significantly different from each other.    

Wrap It Up   The improvements in the outcome measures for both groups suggest that remote myofascial release was effective in patients with chronic nonspecific LBP. The remote myofascial release of the lower limbs reduced the elastic modulus of the lumbar fascia and LBP.     Before getting to the next one,

  Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.     I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. 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. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.  

Item #2  

Our last one this week is called, “Effects of Manual Versus Instrumental Spinal Manipulation on Blood Flow of the Vertebral and Internal Carotid Arteries in Participants With Chronic Nonspecific Neck Pain: A Single-Blind, Randomized Study” by Burcu Kocabey and published in Journal of Chiropractic Medicine on 14 February 2023. Hot potato!  

Why They Did It   The aim of this study was to compare the hemodynamic effects of manual spinal manipulation (MSM) and instrumental spinal manipulation (ISM) on the vertebral artery (VA) and internal carotid artery (ICA) in participants with chronic nonspecific neck pain (NNP).  

How They Did It  

  • Thirty volunteers aged 20 to 40 years old with nonspecific neck pain over 3 months duration were included.
  • Participants were randomly divided into the following 2 groups: (1) spinal manipulation group (n = 15) and (2) instrumental spinal manipulation group (n = 15). Ipsilateral (intervention side) and contralateral (opposite side of intervention) VAs and internal carotid arteries were evaluated using spectral color Doppler ultrasound before and immediately after manipulation.
  • Measurements were recorded by visualizing the internal carotid artery carotid sinus (C4 level) and the VA at the V3 segment (C1-C2 level).
  • The blood flow parameters of peak systolic velocity, end-diastolic velocity, resistive index, and volume flow (only for VA) were evaluated. The spinal segment, in which biomechanical aberrant movement was detected by palpation in the upper cervical spine, was manually manipulated in the spinal manipulation The same methodology was performed for the instrumental spinal manipulation group using an Activator V instrument (Activator Methods).

  What They Found  

  • Intragroup analysis exhibited no statistically significant difference between the spinal manipulation and instrumental spinal manipulation groups in terms of peak systolic velocity, end-diastolic velocity, resistive index of ipsilateral and contralateral internal carotid artery and VA, in addition to volume flow of both VAs preintervention and postintervention.
  • Within the intergroup analysis, there was a significant difference in ipsilateral internal carotid artery peak systolic velocity in the spinal manipulation
  • Other parameters did not show any significant difference

 

Wrap It Up  

Manual and instrumental spinal manipulations applied to the upper cervical spine in participants with chronic nonspecific neck pain did not appear to alter blood flow parameters of the VAs and internal carotid arteries.   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

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

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 cant 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….

 

Thats 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 cant 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

 

Social Media Links

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

 

Chiropractic Forward Podcast Facebook GROUP

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

 

Twitter

 

YouTube

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

 

iTunes

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

 

Player FM Link

https://player.fm/series/2291021

 

Stitcher:

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

 

TuneIn

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

 

About the Author & Host

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

 

 

Bibliography

Hassan Tamartash, Farid Bahrpeyma, Manijhe Mokhtari Dizaji,
Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients With Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial,
Journal of Chiropractic Medicine,
Volume 22, Issue 1,
2023,
Pages 52-59,
ISSN 1556-3707,
https://doi.org/10.1016/j.jcm.2022.04.002.
(https://www.sciencedirect.com/science/article/pii/S1556370722000645)

 

Burcu Kocabey, Dilber Karagözoğlu Coşkunsu, Koray Güven, Mustafa H. Ağaoğlu, Selvi Yüce,
Effects of Manual Versus Instrumental Spinal Manipulation on Blood Flow of the Vertebral and Internal Carotid Arteries in Participants With Chronic Nonspecific Neck Pain: A Single-Blind, Randomized Study,
Journal of Chiropractic Medicine,
Volume 22, Issue 1,
2023,
Pages 1-10,
ISSN 1556-3707,
https://doi.org/10.1016/j.jcm.2022.05.006.
(https://www.sciencedirect.com/science/article/pii/S1556370722000876)       

Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation

CF 270: Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation

 

Today we’re going to talk about Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation

 

But first, heres 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

This image has an empty alt attribute; its file name is Screen-Shot-2018-07-12-at-10.23.22-AM-150x55.jpg

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

  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, look down your nose at people 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.  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, drive, smart, 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 educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s 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.
  • Then go Like our Chiropractic Forward Facebook page,
  • Join our private Chiropractic Forward 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 com

  You have found yourself smack dab in the middle of Episode 270   Now if you missed last week’s episode , we talked about Children, Activity, and Depression and Axially Loaded MRIs. Make sure you don’t miss that info. Keep up with the class.  

On the personal end of things…..

Isn’t it weird?  You have one group of staff for an amount of time, they all leave, then you are forced to replace them all at once basically…..then you get so busy that your cup runneth over?   For the last 6 months I’ve been running on maybe 30-35 appointments on a Friday and 130 for the whole week. Which is abysmal for me. I have a large machine to keep running and those numbers are just barely enough.   Now, we have 52 on my schedule today, which is a Monday as I type. I’ve got 153 for the week but I’m typing at 10am on Monday morning so none of Monday’s patients have been set up for Wednesday or Friday appointments. We ended up last week at 175 appointments.  

The point is not to brag but to demonstrate. You can do everything you can think of up to and including banging your head against the wall…and get nowhere if you have a staff that is not fully supporting the mission of not only getting patients better but ALSO growing your clinic.   You can meet with them, you can encourage them, you can show them the way to bonuses and extra pay, you can treat them like family, and all of the other stuff we do for our teams.   But if they’re not growth minded hustlers, they work against you. And I use hustlers in a complimentary context. A go-getter. Someone with drive. Someone that gets it and has some hustle.  

That’s a hustler to me.  

Don’t get me wrong here. Except for one of them, I absolutely love those girls. I would still do anything for them. No sweeter and no more caring people ever existed. You can have the most loving and caring people on the planet in place and still not be growth minded. The best people on the planet can still fall into ruts and get stuck in the daily grind.   My old team fell into bad habits that did not support growth. They were all besties. They all quit at the same time and we were forced to start completely over almost from scratch. And what seemed like a complete and utter disaster has become one of the greatest comeback stories of my career.  

We’ve done some other things as well. We started with a social media company. I’ve never done that before. We hired Darcy Sullivan with Propel for our website SEO to get that back up to snuff. We know Google is the biggest driver of new patients so it makes sense to spend the money to make sure it’s on par.  

But the biggest game changer has been our new staff. Hands down.   I tell you this for one reason only. If you’re down, here’s what you do and probably the order you should do it in:

  1. Take a long, hard, and very honest look at yourself and your habits. Are you doing the things you need to be doing to grow and to be successful? Are you paying attention to customer service and putting that #1? Are you properly training your staff and properly motivating them? It starts at the top so make sure you have a tight ship before you go looking anywhere else.
  2. Look at your marketing. Have you slacked on your internal and external marketing? If so, get those gaps filled.
  3. Website SEO – make sure it’s where it should be
  4. Pay very close attention to your staff. Their habits between patients. Their interactions with patients. The conversations they have with your patients on the way to therapy or rehab. Start phasing out the ones that do not fully support your mission and your clinic’s growth.

  That’s the advice you’re getting this week from your Ol’ Uncle Jeffro. Hopefully I dropped some good solid knowledge nuggets on some of you.   Take it or leave it but that’s the way I see it at the moment and it’s based on the school of hard knocks over the last 6 months. And, by the way and as a side note, isn’t it interesting that at 50 years old and in practice 25 years, we still learn lessons like this? Damnit.   Alright, here we go with this week’s research.      

Item #1  

The first one today is called, “A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy” by Eric Chun-Pu Chu and published in Scientific Reports on 23 January 2023. Dayum. That’s hot.     Why They Did It   This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 spinal manipulative therapy sessions results in a severe AE.  

How They Did It  

  • This study adhered to the Open Science Framework. The Ethics Committee of the Chiropractic Doctors Association of Hong Kong approved the study which included a waiver of patient consent.

 

  • All methods were performed in accordance with the relevant guidelines and regulations.

 

  • The current study was a retrospective database analysis of a complaints log including adverse events from January 1, 2017, through August 31, 2022.

    Wrap It Up  

  • This current study, which retrospectively studied a large dataset from integrated chiropractic clinics in Hong Kong, found that severe AEs potentially occurring in relation to SMT were rare, yielding an incidence of 0.21 per 100,000 SMT sessions.

 

  • No AEs were identified that were life-threatening or resulted in death.

 

  • The sample size of 39 AEs across 960,140 SMT sessions in 54,846 patients was insufficient to identify independent predictors of severe AEs.

    Before getting to the next one,   Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you cant live without those products, send me an email and Ill give you the hookup. They will 100% differentiate your clinic from your competitors.     I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. 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. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.  

Item #2   Our last one this week is called, “Effects of Lumbar Manipulation Spinal in Patients with Pain Caused by a Lumbar Disc Herniation: A Systematic Review” by Guillermo Cano-Escalera and published in Indian Journal of Physiotherapy and Occupational Therapy on 2023-01-16. Hot potato!   Why They Did It   Herniated discs usually present with pain accompanied with paresthesia and loss of muscle strength, causing limitations in the activities of daily life. Among the therapeutic strategies aimed at obtaining an improvement in the symptomatology, highlights the Osteopathic manipulation.  

How They Did It  

  • 11 computerized databases were consulted.
  • Only randomized controlled clinical trials were included.
  • The tool for assessing the risk of bias was the one proposed by Cochrane.

  What They Found  

  • A total of 3 randomized controlled clinical trials were selected and considered low risk of bias.
  • The results showed an improvement in all the variables measured in the experimental group of osteopathic manipulation.
  • However, the improvement was greater in the study group that underwent surgery.

  Wrap It Up  

  • Lumbar manipulation spinal is an effective technique to improve the symptomatology of pain originating from a herniated lumbar disc.
  • None of the participants had adverse reactions and their outcome improved significantly in the short and long term.

      Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen.   Let’s get to the message. Same as it is every week.  

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website https://www.chiropracticforward.com  

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

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

Twitter https://twitter.com/Chiro_Forward  

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

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

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

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

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

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

Bibliography

  • Cano-Escalera, G. “Effects of Lumbar Manipulation Spinal in Patients with Pain Caused by a Lumbar Disc Herniation: A Systematic Review.” Indian Journal of Physiotherapy & Occupational Therapy Print- (ISSN 0973-5666) and Electronic –(ISSN 0973-5674) 17(1).  
  • Chu, E. C., Trager, R.J., Lee, L.YK (2023). “A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy.” Sci Rep 13: 1254.        

5 Year Chiropractic Forward Roundup and All Time Top Ten Episodes

CF 260: 5 Year Chiropractic Forward Roundup and All Time Top Ten Episodes

Today we’re going to talk about our 5 Year Roundup and we highlight the All Time Top Ten Episodes 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, look down your nose at people 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.  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, drive, smart, 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 educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s 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. 
  • Then go Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward 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 #260 Now if you missed last week’s episode , we talked about Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff. Make sure you don’t miss that info. Keep up with the class.  Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors.

On the personal end of things….. We’re not going to do a lot of personal stuff on this show. I want to first just thank those of you that have been listeners of this show. I probably over share sometimes about what’s going on with me or with my clinic.  Because of that, those of you that are long-time listeners know a lot about me. Thanks for putting up with me and coming along on this ride with me. You’ve been with me through key staff changes and huge practice changes.  You’ve been with me through adding a nurse practitioner and integrating my entire practice medically. You’ve been with me through the ‘I’m so busy I can’t keep up’ stages to the ‘I can’t figure out why I’m so slow’ stages. That’s one I’m climbing out of right now as we speak.  The reason I share so much about what I’m doing or going through is

  1. It’s cathartic. It makes me feel better to talk about it. It’s like a weekly journal and if you’re familiar with journaling, it’s helpful mentally and effective. 
  2. I know that if I’m going through it and I figure it out, then somebody else is going through it and my experience will help guide them. If you are not going through it currently, there’s a damn good chance you eventually will go through it and my experience will set you up to be able to handle it better. 

So, thank you. I continue to be blessed by all of you. I’m glad you find value in what I share. I hope somewhere along the way, I have helped you to be better than you were before. That’s the daily goal for me as well as for you. We’re in it together. 

Now, onto the All Time Top Ten most listened to episodes of the Chiropractic Forward podcast. 

There were some surprises for me on this one. As I cover these, I’ll also leave the links to them in the show notes so you can easily go listen should you have interest. 

10. Our tenth place episode is episode #114 which was titled

Ten Keys to Practice Success

This one has been piling up the listens since February 11, 2020. Yep, right before the RONA came to town to wreak havoc. https://www.chiropracticforward.com/ten-keys-to-chiropractic-success/ I covered a wide range of the ten keys to my success and broke them down for you. Evidently, you and your buddies found value in it. And that makes me feel warm and fuzzy inside my belly. 

9. Our ninth place goes to episode #189 where we were joined by the one and only Dr. Brett Winchester. One of the smartest and funniest human beings I think I’ve ever met in my life. Humble and amazing, Brett makes you proud to be a chiropractor and through Dr. Kevin Christie’s Florida Mastermind group, has become a friend of mine. One I greatly value.  On the episode, Brett talked about Chiropractic Excellence, Inspiration, & Being The Best Evidence-informed Chiropractor You Can Be. It is definitely worth your time. 

https://www.chiropracticforward.com/w-dr-brett-winchester-chiropractic-excellence-inspiration-being-the-best-evidence-informed-chiropractor-you-can-be/

8. Our 8th most popular episode goes to episode #139 and was called Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic. It went live on August 20, 2020 so, still in the pandemic but after a Spring and Summer of the COVID mess and we talked about some research on how it affected us as a profession, we went over fresh at the time opioid overdose info, and then we talked about how insurance companies reimburse us. You probably already know that part. You’re living it! Lol.  https://www.chiropracticforward.com/chiropractors-affected-by-covid-2019-opioid-overdoses-insurance-compensation-for-chiropractic/ 7.

Coming in at #7 is episode #113 where we were joined by the current Texas Chiropractic Association President himself, the head hombre, The Illustrious Potentate from Austin, TX, Dr. William Lawson where we covered a paper he played a part in that covered new and updated guidelines on treating cervical pain.  https://www.chiropracticforward.com/w-dr-william-larson-brand-new-guidelines-on-neck-pain-treatment/

6. At #6 we have episode #142. In this one, we covered treatment for nonoperative discs, we talked about supplementing Vitamin D3 for depression and what the research says, and we covered the bio psychosocial part of chronic pain. This one is my kind of episode. The bioqsychosocial aspect is something I just find to be fascinating and intriguing. I’m glad you all seemed to find it interesting as well.  https://www.chiropracticforward.com/nonoperative-disc-treatment-d3-for-depression-the-biopsychosocial-part-of-chronic-pain/

5. Number 5 this year is episode #136 and it was called ‘Chiropractic’s Effect On Strength and More, Status Of Muscle Relaxers, And The Best Recovery Posture.’ This episode is a pretty standard run of the mill episode. It doesn’t have any of my real estate golden nuggets hidden within….nothing special but everyone likes it so hell yeah. I’ll take it. This one showed how to best recover your breath after exercise, how opioids are still bad, and how active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control. https://www.chiropracticforward.com/cf-136-chiropractics-effect-on-strength-and-more-status-of-muscle-relaxers-and-the-best-recovery-posture/

4. Still in the top Five since August of 2020, it’s episode #141 called “Lancet Low Back Update & movement Disorders Mean Pain” This one has been one of the top episodes since it was first released and has stayed there. This one covers an update The Lancet released. An update on the huge low back series they came out with originally around 2016/2017 if I recall correctly. We covered the original series here on the podcast toward the very beginning of Chiropractic Forward existence.  https://www.chiropracticforward.com/lancet-low-back-update-movement-disorders-mean-pain/

3. Our 3rd most listened to episode is #143 called ‘New Paper: Spinal Manipulation Has No Effect On Chronic Pain – Our Experts Rebuttal’. Basically, some no so flattering research came out trying to prove that spinal manipulative therapy was basically useless. For this episode, I contacted several of our profession’s experts and we gave our own rebuttal to this paper right here on the podcast. The exact conclusion of the paper we talked about said, ““In this randomized clinical trial, neither spinal manipulation nor spinal mobilization appeared to be effective treatments for mild to moderate chronic LBP.” Well, who the hell can say that? Seriously. After all of the papers in support of SMT for chronic low back, someone’s going to pop out with that? Nope.  So we talked about it and met it head on.  https://www.chiropracticforward.com/new-paper-spinal-manipulation-has-no-effect-on-chronic-pain-our-experts-rebuttal/

2. Hitting number two all time is episode #140 with my buddy, Dr. Chris Howson of the Great State of North Dakota. We talked about Chiropractors In Hospitals & Drop Release. He should know because he is in a hospital-run outpatient clinic and is well-integrated in the medical community. He also invented the Drop Release so of course we talked about that and how he uses it. I use the hell out of mine now too! https://www.chiropracticforward.com/cf-140-w-dr-chris-howson-chiropractors-in-hospitals-drop-release/

  1. Coming in this year at the Number One spot for the most listened to podcast episode in the history of this show is episode #137. In this episode I was joined by Dr. Aric Frisina-Deyo and we talked about Chiropractors In An FQHC Setting & Setting The Bar High Early On. This episode, of course, was excellent and Aric is one of the more impressive individuals you’ll ever meet in our profession. Congratulations to Dr. Frisina-Deyo on being #1. 

Alright. That was fun. It’s always cool to go back and re-visit some of these episodes once a year and see what is resonating with our listeners. It’s interesting. Out of the top ten, only four of them included a guest. Also, you’d think the one with did where we were joined by Dr. Stu McGill would be in the top ten somewhere…..but not at all. Dr. McGill came in around #14 all time. We have been fortunate enough to be joined by not only Stu but Dr. William Morgan, Dr. Katie Pohlman, Dr. Christine Goertz, Dr. Tyce Hergert, Dr. Kris Anderson, Dr. Jay Greenstein, Dr. Kevin Christie and the list goes on and on and on.  If you are still new to the podcast, I hope you’ll spend some time going back through some of the episodes that peak your interest.

We’ve had a good run so far and, for now, I plan to continue it as long as it’s fun and as long as you listen.  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