spinal manipulation

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

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

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 kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

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

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

 

On the personal end of things…..

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

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

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

Item #1

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

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

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

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

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

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

Shazamm

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

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

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

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

Item #2

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

Bibliography

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

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

No Immunity Boosting Benefit, Coconut Oil Fails, and Screen Time & Autism

CF 126: No Immunity Boosting Benefit, Coconut Oil Fails, and Screen Time & Autism Today we’re going to talk about Immune boosting via spinal manipulative therapy, we’ll talk about coconut oil and it’s a mirage, and we’ll talk about autism and screen time. It’s a good one today folks! But first, here’s that sweet sweet bumper music 
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 kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 
  • Like our facebook page, 
  • Join our private facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. No spam, just a reminder when the newest episodes go live. Nothing special so don’t worry about signing up. Just one a week friends. Check your JUNK folder!!
Do it do it do it.  You have found yourself smack dab in the middle of Episode #126 Now if you missed last week’s episode, we talked about current knowledge on making a robust low back pain diagnosis. Make sure you don’t miss that info. Keep up with the class.  While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points.  Just so you know, all of the research we talk about in each episode is cited in the show notes for each episode if you’re looking to dive in a little deeper.  On the personal end of things….. We’re still hanging in there. For me personally, I shut down in the beginning for two weeks. Completely shut down. Some stayed open the whole time and never made a lot of changes. So at this point, understandably, they’re ahead as far as getting their patient base back to 100%.  For me, I’m more around 65%-70% of my normal load. While the entrepreneur in me is not real happy with that, the business owner that was needing to take a breath and breathe a little bit is happy about it. At this point, it is what it is. Literally. There’s only so much we have control over. I am a saver by nature. I started a multi-account system years ago that socks money away for different purposes. I have about 7 or 8 different accounts that I move money to at the end of each week. So, fortunately, I don’t take loans. Other than student loans and house loans, I don’t get into much debt at all.  That only goes so far and I’m not willing to drain it all just to keep employees when I don’t have enough business but, if things continue to go well and we see the numbers coming back to a more normal state and then hopefully stabilize, I don’t believe I’ll have to do anything like drain accounts or let employees go. I love my staff and I’ll fight for them. But I won’t go broke for anyone. Except maybe my kids or my mom.  So far so good. This crap has a time limit. We won’t be stuck with it like this forever. Maybe longer than we want but not forever. One foot in front of the other, one day at a time. We’ll get there.   Item #1 Let’s start out easy today. This one is called “Association of Early-life social and digital media experiences with the development of autism spectrum disorder-like symptoms” by Karen Heffler, et. al. (Heffler K 2020) and published in JAMA on April 20, 2020 and that’s a hot one folks.  Why They Did It They wanted to answer the question, “Are screen media exposure and social and demographic factors associated with the risk for autism spectrum disorder on a modified checklist for autism in toddlers at 2 years of age? How They Did It
  • Data for this cohort study were derived from the National Children’s Study, 
  • A total of 2152 children were enrolled at birth from October 1, 2010, to October 31, 2012. 
  • Data were analyzed from December 1, 2017, to December 3, 2019.
  • Caregivers reported whether the child viewed television and/or videos (yes or no) at 12 months of age, hours of viewing at 18 months of age, time spent by the caregiver reading to the child (number of days per week compared with daily) at 12 months of age, and frequency of playing with the child (daily or less than daily) at 12 months of age
  • Prematurity, maternal age at birth, child sex, household income, race/ethnicity, and caregiver English-language status were included in analysis.
Wrap It Up “This cohort study found greater screen exposure and less caregiver-child play early in life to be associated with later ASD-like symptoms. Further research is needed to evaluate experiential factors for potential risk or protective effects in ASD.” Basically, “Less screen exposure and more parent-child play at 12 months of age were associated with fewer ASD–like symptoms at 2 years of age” Before we get to the next item this week, I did a thing Being an evidence-informed practitioner can present a set of problems at times. Mostly problems with regard to patient volume because we don’t typically treat patients with long-term recommendations. So we see them come and go depending on if they hurt or not. It can lead to lulls, disappointment, and boredom if there’s not a steady stream of new patients coming through your pearly gates each and every month. I have taken various courses over the years at Udemy so when I decided to create a course, I immediately thought Udemy would be a good place to start.  While I’m still building the course and adding content every week, it’s live and ready to go for those interested in getting started. I’m putting the link to the course at this point in the show notes. You can go to chiropracticforward.com, go to Episodes and find this episode and just scroll till you find it.  https://www.udemy.com/course/marketing-evidence-based-chiropractic/?referralCode=36A4D91C66B48300360B Over the last two years or so, I’ve averaged almost 80 new patients every month as a solo practitioner. If you’re interested, I created, basically, my playbook for marketing and my thoughts on each topic or technique. I also have created downloads, checklists, and examples to show what my stuff looks like.  Just go to udemy.com and do a search on Marketing An Evidence-Based Chiropractic Practice and check it out. It will grow and expand in the coming months and if you get just one patient from the ideas shared in it, it paid for itself. Now imagine if you get a bunch….well then it’s priceless. udemy.com and the course is called Marketing and Evidence-based Chiropractic Practice. Item #2 Item #2 is called “Coconut Oil’s Health Halo A Mirae, Clinical Trials Suggest” by Jennifer Abbasi (Abassi J 2020)and published in JAMA on April 8, 2020….hot cakes, smokin’ hotcakes.  This one is an article so let’s just get to the highlights.  She starts by saying that clinical trials don’t support the public’s positive perception of coconut oil. She points to a study that was published in Circulation that found coconut oil actually increases low-density lipoprotein cholesterol (which is the bad kind of cholesterol) and offers no benefit for weight, blood glucose, or inflammation markers.  She says coconut oil has been marketed as a miracle for about a decade and a 2016 New York Times survey showed 72% of Americans consider it a health product. This while on 37% of nutritionists felt it was beneficial when compared to other oils.  What they’ve learned more recently include:
  • Compared to nontropical vegetable oils, coconut oil significantly increased total cholesterol. 
  • Coconut oil did not significantly affect triglycerides or markers of glycemia, inflammation, and body fat compared with others
  • Researchers calculated that coconut oil use could translate to a 6% increase risk of major vascular events and a 5.4% increase in teh risk of coronary heart disease mortality. 
There’s much more to the article so I encourage you to find it and read it if you’re interested in coconut oil but in summary: Coconut oil should not be viewed as a healthy oil for cardiovascular disease risk reduction and limiting coconut oil consumption because of its high saturated fat content is warranted and it offers no proven health benefits compared to other cooking oils and seems detrimental on important blood lipids. As such, the prudent approach would be to avoid it in comparison to other cooking oils” Item #3 Alright here’s we arrive at the main event. This brand new article coming out on May 4, 2020….there’s a serious amount of sizzle on this sucker and not just because it’s brand new but also because a large number of chiropractors are going to call shenanigans on it. The topic of chiropractors helping boost immune function through spinal manipulative therapy has been such a hot topic on social media since this pandemic started that I won’t get on and read a general chiropractic group and it’s posts. I won’t do it. My eyes start rolling out of my damn head so why intentionally punish myself? Honestly.  This article is called “A united statement of the global chiropractic research community against the pseudoscientific claim that chiropractic care boosts immunity” and is authored by the biggest of the big chiropractic researchers that include Pierre Cote, Andre Bussieres, JD Cassidy….hello stroke research…Jan Hartvigsen, Greg Kawchuk, Charlotte Leboeuf-Yde, Silvano Mior, Michael Schneider and more than 140 signatories.  It was published in Chiropractic and Manual Therapies just a week or so ago as I mentioned.  Background – As I said this pandemic has made chiropractors lose their minds. Including myself, if I’m being honest. Not about the immune system. But about safety and keeping myself and my people and patients safe.  Anyway, they say that during this time, the ICA posted reports claiming that chiropractic care can impact the immune system. These claims aren’t in line with the WHO and the World Federation of Chiropractic.  The researchers reviewed the two reports posted by the ICA on their website on March 20th and the 28th. They explored the method used to develop the claim that SMT can boost the immune system and they discuss the scientific merit of the claim. They go on to explain why the claim lacks scientific credibility and is dangerous to the public.  Get this; over 150 researchers from 11 countries reviewed and endorsed this article and response.  Some of the more notable quotes include: Advancing extraordinary claims without providing extraordinary evidence should raise significant concerns about the scientific validity of the ICA’s position. In their reports, the ICA claims that individuals who received chiropractic care during the 1918 Spanish flu pandemic were 51 to 91 times less likely to die than those who were treated by medical doctors.  These effect sizes are too large to be trustworthy and are a red flag of pseudoscience because extraordinary claims require extraordinary evidence. Using data from a 100-year-old non-published, non-randomized controlled trial to suggest that chiropractic adjustments reduce mortality from the flu is scientifically and socially irresponsible. We consider that proclaiming the benefits of chiropractic adjustment/spinal manipulation on immunity during a pandemic is plainly irresponsible and demonstrates a lack of understanding of science, the coronavirus pandemic, and public health risks. By only citing basic science experiments, the ICA appears to have overlooked the WHO guidance on implementation research, which clearly states that basic science experiments do not provide relevant justification for the implementation of a health intervention We call on the ICA to explain why it does not adhere to internationally accepted standards of research implementation but instead rely on unconnected basic science studies when linking chiropractic care to immune system function. Pseudoscience has the potential to mislead and misinform at any time; even more so in the midst of a pandemic when the public is vulnerable. The current coronavirus pandemic demands that we act responsibly by adopting sound public health practices as recommended Their conclusion is that, in the ICA reports, they provided no valid clinical scientific evidence that chiropractic care can impact the immune system. Not only that but they call on political and regulatory forces to hold accountable those making the claims.  Alright, that’s it. Y’all be safe. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.  Key Takeaways Store Remember the evidence-informed brochures and posters at chiropracticforward.com.     
Chiropractic evidence-based products

Integrating Chiropractors

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 can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.  Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website
Home
Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Abassi J (2020). “Coconut Oil’s Health Halo a Mirage, Clinical Trials Suggest.” JAMA 323(16): 1540-1541. Heffler K, S. D., Subedi K, (2020). “Association of Early-Life Social and Digital Media Experiences With Development of Autism Spectrum Disorder-Like Symptoms.” JAMA Pediatr.

The Evidence For Some Surgeries, Searching for How We Help, and Opioid vs. Non-Opioid

CF 078: The Evidence For Low Back Surgery, Searching for How We Help, and Opioid vs. Non-Opioid

Today we’re going to talk about evidence for low back surgery, we’ll talk about if spinal manipulative therapy is partyly in the brain, opioid information for back, hip, or knee osteoarthritis….what does the research say?

But first, cool like a velvet Elvis, here’s that bumper music

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. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have flip flopped into Episode #78

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Store

I should have in my first order of the decompression brochures in in just a few days. These dudes are going to look great. I’ll put some pics in the show notes and in the email we send out once a week to our email list. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

Personal Happenings

I’ve been asked to emcee the Texas Chiropractic Association’s President’s Gala which will be during the ChiroTexpo event in Dallas, TX on June 8th. 

I’m trying to figure out if I need to be making fun of everyone I introduce or not. Maybe I should trip them? You know we chiropractors….some of us can’t take a joke right? We’ll see how it goes. Most of the guys and gals in the TCA are pretty good with having fun. 

I always heard that people don’t join state associations because they think they’re made up of a bunch of old white dudes sitting around bitching. 

Well, not at the TCA, people. We have young people and certainly not all white. That doesn’t happen in Texas these days. We are a pretty mixed state in regard to ethnicity. We are also mixed in respect to gender. Several smart and highly capable women are either on the board or in a position of influence. Heck, we have a female going through the executive chairs starting in June. I’m excited to hear her ideas and see where we go under her direction. This girl is making it happen. She has young ones too. Nothing slows her down it seems. 

Let’s get to the topics today. 

Item #1

The first item we’re talking about is called “Randomised trial support for orthopaedic surgical procedures” authored by Hyeung Lim, Sam Adie, Justine Naylor, and Ian Harris(Lim HC 2014) and published in Plos One in June 13, 2014. 

This is an interesting one because we think that the surgical procedures we undergo have been fully validated. Fully vetted. Hell, you wouldn’t lay someone open unless it’s been researched and proven beyond a doubt to fix the issue would you? One would think so…..but…..let’s dive in a bit. 

Why They Did It

The authors wanted to investigate the proportion of orthopedic procedures supported by evidence from randomized controlled trials. Trials that compared surgical procedures to non-surgical alternatives. 

How They Did It

  • Orthopedic procedures conducted in 2009, 2010 and 2011 across three metropolitan teaching hospitals were identified, grouped and ranked
  • Searches of the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Database of Systematic Reviews (CDSR) and the Database of Abstracts of Reviews of Effects (DARE) were performed to identify RCTs evaluating the most commonly performed orthopaedic procedures
  • A risk of bias analysis was conducted for included studies using the Cochrane Collaboration’s Risk of Bias tool
  • 9,392 orthopedic procedures were performed across the index period

What They Found

Of the 83 RCTs, 23% were classified as supportive of operative intervention.23%. Twenty three percent were supportive of operative intervention. 

Only 37% of the total volume of procedures were supported by at least one RCT showing surgery to be superior to a non-operative alternative. ONLY 37% y’all. 

19.6% of the total volume of procedures were supported by at least one low risk of bias RCT showing surgery to be superior to a non-operative alternative.

Sounds crazy right? 

Of the most common orthopedic surgical interventions….the most common…..of those surgeries, less than 20% of them had a low risk of bias randomized controlled trial backing them up. 

I have some problems with cussing in my personal life but I’m determined to keep this show mostly PG-13 but man. 

That’s just shocking. Cutting people open with no better evidence than that. 

One word – two syllables. Day-um. 

The Conclusion was “The level of RCT support for common orthopaedic procedures compares unfavourably with other fields of medicine.” 

Good Lord I hope the other areas of medicince have more scientific support. 

What procedures are we talking about? Let’s be fair, we’re mostly spine people and the majority of the procedures their taling about here have nothing to do with the back. They’re talking about things like:

  • Knees
  • Hips
  • Intrnal fixation of proximal or shaft fracture of the femur
  • Ankle fracture fixation
  • Shoulder arthroscopy
  • Arthroscopy of the ankle…….no studies at all. Lol

It’s just crazy to think about. If we’re talking about evidence-based practice, is this it? 20% of our profession is about half crazy I think. Well, that’s about the same number of procedures they do that only have one RCT with low bias risk. 

Is it evidence-informed? I don’t know. That still sound awfully low to even consider it evidence-informed. 

I don’t know all of the answers and I don’t pretend to. Do what you do, but…..why they hell do they question spinal manipulation and say we have weak evidence to perform it? What? Stupid. 

Makes me want to cuss in Spanish.

Item #2

This one is just building on what we understand about what a manipulation does. It doesn’t answer any questions definitively but it does lay more groundwork for the future. 

It’s called “Spinal manipulation therapy: is it all about the brain? A current reveiew of the nurophysiological effects of manipulation.” It is authored by Gile Gyer, Jimmy Michael (never trust a guy with two first names. Especially if he’s left handed), Jame INklebarger, and Jaya Tedla. Published in the Journal of Integrative Medicine in May of 2019(Gyer G 2019). 

Hot stuff coming up

Why They Did It

While spinal manipulation has become more and more accepted after being more and more validated by research, the fact remains that we still don’t know exactly HOW it works and according to my interview with Dr. Christine Goertz in Episode 67, we are far away from having that satisfaction. The authors say there are certainly biomechanical and neurophysiological reasons for it’s effectiveness, 

The paper says, “Although both biomechanical and neurophysiological phenomena have been thought to play a role in the observed clinical effects of spinal manipulation, a growing number of recent studies have indicated peripheral, spinal and supraspinal mechanisms of manipulation and suggested that the improved clinical outcomes are largely of neurophysiological origin.”

“The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more.” The nerual plastic changes part of that is really fascinating. It was once thought that the brain is the brain and we just start chipping away at brain cells as we age and go stupid stuff. Lol. 

They’re finding out that the brain changes. It can be trained. It can be built sort of like a muscle but in a neural sense. It’s fascinating. But that’s a different episode all together. 

I don’t have access to this full paper but, the point is, they’re trying to find out HOW we are effective through spinal manipulation and they recommend we plan for long-term follow up studies to help us determine the clinical significance of the neural responses that happen from spinal manipulation. 

Pretty interesting stuff there. 

Item #3

Last one for this week. It’s called “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain: The SPACE Randomized Clinical Trial.” It was authored by Dr. Erin Krebs, MD et. al(Krebs E 2018). and published in JAMA on March 6 of 2018 so a little over a year ago. 

The question to answer here was, “For patients with moderate to severe chronic back pain or hip or knee osteoarthritis pain despite analgesic use, does opioid medication compared with nonopioid medication result in better pain-related function?”

How They Did It

They had 240 patients and found that the use of opioid vs. nonopioid medication did not result in significantly better pain-related function over 12 months. But they may have gotten some folks addicted in on the way to the conclusion. Lol. 

Basically, this study says stay away from opioids for moderate to severe chronic back pain or hip and knee osteoarthritis. the official conclusions was, “Treatment with opioids was not superior to treatment with nonopioid medications for improving pain-related function over 12 months. Results do not support initiation of opioid therapy for moderate to severe chronic back pain or hip or knee osteoarthritis pain.”

Boom. Pop. Pow.

I feel like I’m preaching to the choir here but you never know who listens. 

Speaking of that, Dr. David Graber shared with me that after his episodes with us, he got an email all the way from Switzerland from a chiropractor that was pretty jazzed by his comments and thoughts and Dr. Graber wanted me to know that we are indeed reaching folks and influencing on some level. 

I can’t tell you how incredibly satisfying that is. Every now and then, I get a little bit of encouraging feedback but honestly, not enough. You never know what the reach is. Are you enjoying the show? Are you listening regularly? Send me an email at [email protected] and let me know. I love to hear from you guys. I really do. 

Not only is it inspirational like filling up your gas tank…..but feedback can help me direct the show in a direction that I know you guys are interested in or focused on. Feed back only helps me learn more and get better so send me an email won’t you?

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 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 instead of chemical treatments like pills and shots.

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

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

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

Bibliography

  • Gyer G, M. J., Indlebarger J, Tedla JS, (2019). “Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation.” J Integrative Med.
  • Krebs E (2018). “Effect of Opioid vs Nonopioid Medications on Pain-Related Function in Patients With Chronic Back Pain or Hip or Knee Osteoarthritis Pain The SPACE Randomized Clinical Trial.” JAMA 319(9): 872-882.
  • Lim HC, A. S., Naylor JM, Harris IA (2014). “Randomised Trial Support for Orthopaedic Surgical Procedures.” PLoS One 9(6).

CF 056: What Does A Spinal Manipulation Do In Medical Terms & What I Despise About My Profession

Today we’re going to talk about what a chiropractic spinal manipulation is, we’ll talk about what it does and what happens there. We’re also going to talk about what I sincerely despise about our great profession. Depending on how fired up I get here, this one should be a good episode.

... continue reading.