Jeff Williams - evidence-based chiropractor

Spinal Manipulative Therapy And Benzodiazepines & Yanking Someone’s Head Off

October 26, 2023 chiropracticforward 0:23:55 0 Comments

CF 302: Spinal Manipulative Therapy And Benzodiazepines & Yanking Someone’s Head Off Today we’re going to talk about Spinal Manipulative Therapy And Benzodiazepines & Yanking Someone’s Head Off

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

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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 #302 Now if you missed last week’s episode , we talked about Excessive Generalization Of Fear Avoidance. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things….. The difference between an evidence based, patient centered practice and a vitalistic, philosophy-driven practice. In my view. The vitalists believe that a patients or as they call them, a practice member…..should be seen in the clinic A LOT. Like some feel 1x/week or 1x every 2 weeks.

Even if nothing hurts. No pain. That’s just to stay healthy and all that stuff. So, their PVA is off the charts. Some are at 80 and above. Even if no randomized controlled trials, the ACA, or any other respected guides back that up. Then, there’s the evidence-based, patient-centered model.

We depend on new patients. And a lot of them. I have to see a lot of new patients to keep the machine turning. And when I’m out for any length of time, the ripples are felt for a while. So, I was out sick for a couple of days two weeks ago. Then, the very next week, I went to Chicago and was out for 2.5 days. So, guess what that did to my practice? Yep, you guessed it. Slower than COVID. Everything for me is now compared to COVID numbers, by the way.

Anyway, it took me a week to start turning this Titanic back around and moving the other way but it’s turning. I’m back up to 44 today, which is a Monday. We’ll see how the rest of the week unfolds but it’s looking pretty good right now. I would assume a vitalist that gets sick and has to miss is still loaded up when they return because these people have been led to believe that they have to make their appointments or their lack of neck curvature will cause degeneration or their immune system will quit working or something of that nature. More power to them. It’s a good business model if all you care about is money but that’s just not a model I was ever on board with.

So, yes, it took me a week or so but we are plugged in and back on track and kicking some derierre.

Item #1

Our first one this week is called, “Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA” by Trager et. Al. and published in BMJ Open on June 12, 2022…..and it’s only lukewarm… Trager RJ, Cupler ZA, DeLano KJ, Perez JA, Dusek JA. Association between chiropractic spinal manipulative therapy and benzodiazepine prescription in patients with radicular low back pain: a retrospective cohort study using real-world data from the USA. BMJ Open. 2022 Jun 13;12(6):e058769. doi: 10.1136/bmjopen-2021-058769. PMID: 35697464; PMCID: PMC9196200.

Why They Did It Although chiropractic spinal manipulative therapy (CSMT) and prescription benzodiazepines are common treatments for radicular low back pain (rLBP), no research has examined the relationship between these interventions. We hypothesise that utilisation of manipulation for newly diagnosed radicular low back pain is associated with reduced odds of benzodiazepine prescription through 12 months’ follow-up.

How They Did It

Retrospective cohort study.
National, multicentre 73-million-patient electronic health records-based network (TriNetX) in the USA, queried on 30 July 2021, yielding data from 2003 to the date of query.
Adults aged 18–49 with an index diagnosis of rLBP were included.
Serious etiologies of low back pain, structural deformities, alternative neurological lesions and absolute benzodiazepine contraindications were excluded.
Patients were assigned to cohorts according to CSMT receipt or absence.
Propensity score matching was used to control for covariates that could influence the likelihood of benzodiazepine utilisation.
The number, percentage and OR of patients receiving a benzodiazepine prescription over 3, 6 and 12 months’ follow-up prematching and postmatching.
9206 patients age, 37.6 years, 54% male per cohort.

What They Found

Odds of receiving a benzodiazepine prescription were significantly lower in the spinal manipulation cohort over all follow-up windows prematching and postmatching.
After matching, benzodiazepine prescription at 3 months was 0.56, at 6 months 0.61 and 12 months 0.67.
Sensitivity analysis suggested a patient preference to avoid prescription medications did not explain the study findings.

Wrap It Up

These findings suggest that receiving CSMT for newly diagnosed rLBP is associated with reduced odds of receiving a benzodiazepine prescription during follow-up. These results provide real-world evidence of practice guideline-concordance among patients entering this care pathway. Benzodiazepine prescription for rLBP should be further examined in a randomised trial including patients receiving chiropractic or usual medical care, to reduce residual confounding. 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 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. 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

For our last one, we have “Spinal Cord Injury, Vertebral Artery Dissection, and Cerebellar Strokes After Chiropractic Manipulation” by Ramos etl al. and published in American Academy of Neurology in November of 2022 and I’m using my soundclip anyway because this is a hot topic!

Why They Did It Let’s just say it appears this provider stops at nothing. This injury to this woman happened after a visit with a chiropractor where she had cervical manipulative therapy. That’s putting it simply but it is both mine and Dr. Brown’s opinion that this was likely an axial traction move that gets all of the views on YouTube or a Y-strap type of adjustment that caused this issue. We have no way of knowing that nor are we stating that as a fact in any way.

We are simply surmising this because a simple diversified cervical break type of adjustment, to my knowledge, would be difficult to duplicate results like this. Seriously, if you saw the pictures on this, you’d know what I’m saying and would be nodding in agreement.

This isn’t fun stuff to think about or talk about but I think it’s important. It came to me through Dr. Steven Brown out in Gilbert, AZ, one of my new connections and friends through the Forensics conference I attended in Chicago a couple of weeks ago. This is from Brazil and they’re just not good at putting this sort of thing together so there’s really only a paragraph or so that I’ll just go ahead and quote here. “A 48-year-old woman with chronic neck pain presented with a history of sudden neck pain and generalized weakness during a chiropraxis session. Neurological examination showed tetraplegia with C5 sensory level. Cervical spine CT revealed a fracture affecting C5 and C6 vertebra. Cervical spine MRI confirmed spinal cord injury. Also, bilateral vertebral artery occlusion and acute cerebellar infarction were found. Bony ankylosis was found in cervical CT spine suggesting undiagnosed ankylosing spondylitis was a risk factor for spine fracture.

Other neurological lesions related to chiropraxis include vertebral artery dissection, epidural hematoma and acute disk hernition. “ Y’all the pictuures on this patient’s imaging is just awful. I’ll try to include it in the show notes if the software allows an old man to figure it out. When Dr. Brown sent over the information, he sent me his impression and review of the information as well and I’ll just share that with you now. The greatest weakness of this report is the lack of details about the CSM procedure. It is difficult to see how a properly performed CSM could cause such catastrophic injuries.

This report is brief, lacking in detail about the CSM procedure, and has only two references. Another weakness of this report was that the actual time lapse from CSM to the onset of ischemic stroke symptoms was poorly documented. The term “during” needs to be clarified in terms of seconds or minutes. The symptoms that prompted the patient to seek CSM are unknown. The catastrophic nature of the injures makes it appear the bilateral VAD was a direct result of an improperly performed CSM. However, a weakness of this report was the failure to consider that the practitioner may have failed to diagnose and refer a pre-existing cervical artery dissection. The report does not review the patient’s past medical history of risk factors for dissection or stroke. The patient’s BMI (body mass index) was not recorded.

A low BMI is a risk factor for dissection, a high BMI is a risk factor for ischemic stroke. The report does state that “bony ankylosis” was found on cervical spine CT examination, suggesting undiagnosed ankylosing spondylitis, which was a risk factor for spine fracture. However, Ramos did not verify if the patient had AS or not. A weakness of this report was the failure to verify the type of practitioner that performed the CSM.

The report states “chiropractic”, but no effort was made to verify that the practitioner was an actual Doctor of Chiropractic. Numerous cases reports have attributed CSM to a DC when another type of practitioner performed the procedure. A further weakness of this report was a failure to review the records from the practitioner performing the CSM. It is unknown if Informed Consent to the risk of stroke from CSM was obtained. The history and examination done by the practitioner of CSM are unknown. It was unknown if any neck injury occurred prior to CSM.

Ramos concluded that CSM caused the cervical artery dissection was “related to” CSM. Studies showing no evidence of a causal relationship between CSM and dissection were not referenced. However, these studies assume the CSM was properly performed. In this case, the CSM was likely not properly performed if it caused such catastrophic injuries.

So, I agree with everything Dr. Brown has to say here and will add that bias against chiros is present here. However, if this is a chiropractor that nearly yanked this woman’s head from her torso, I would be biased against he or she as well. Even as a chiropractor myself. Just because something gets a ton of views on social media or YouTube does not mean it’s amazing and without risk. You’re all smart enough to know that you see the wins on videos. You don’t see the fails. I’ve seen a YouTube chiro almost yank a 70+-year-old tiny woman off of the table.

She had to lay there and recover for a good 3-5 mintues. Is that really what we enjoy or want to be known for? Of course it isn’t. I want to be known for the woman that came to see me with lumbar radciulopathy that was developing mild foot drop and we were able to get her by. And fully recovered.

Or the veteran that couldn’t sleep or function and who’s neck made all kinds of crunchy sounds and since seeing me, it no longer makes noise and he’s feeling much better. Or the patients that was 35 and came in on a walker. He’d been to the ER twice before with bowel and bladder symptoms consistent with cauda equina but they never even did an MRI on him. I had a talk with him, told him exactly what he need to go to the ER and tell them and the next thing you know, he went through emergency surgery and now he’s back to leading a full and functional life.

It’s not just me. You men and women have those stories too if you’ve been in practice long enough. These things don’t get views on YouTube and these patients aren’t typically dressed in yoga pants. You know what I’m saying here. But, they are the patients that we need to be known for.

Keep plugging away. It’s a hell of a lot better time to be a chiropractor in 2023 than it was in 2000. I can guarantee it. Cooperation between evidence-based chiropractors and medical professionals is at an all time high and I only see it getting better from here.

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!

The Message

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

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

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

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

Website https://www.chiropracticforward.com

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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

Motor Control Stiffening & Spinal Manipulation And The Vertebral Artery

July 20, 2023 chiropracticforward 00:13:13 0 Comments

CF 289: Motor Control Stiffening & Spinal Manipulation And The Vertebral Artery

Today we’re going to talk about Motor Control Stiffening & Spinal Manipulation And The Vertebral Artery

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!

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 #289

Now if you missed last week’s episode, we talked about COVID delayed surgeries and lumbar stenosis. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

What a day and what a week. In trying to keep up with the work/life balance thing, my wife and I took our 16 year old daughter to the Taylor Swift show up in Denver last weekend. From here in Amarillo, TX, that’s about a 7 hour drive. Not terrible overall and for a big portion of the drive you have mountains to look at so it’s all good.

We found an app called Autio that is co-owned by Kevin Costner. Along your drive, certain things are marked on the app and there are stories about the area you’re driving through that you can listen to while you’re driving through it. Pretty cool and definitely adds another layer to your drive if you’re a traveler like we are.

TSwift brough in 73,000 screaming fans and it was the second night of a 2-night stand there in Denver. That’s just unreal, honestly. The numbers and money are just staggering when you think about it.

Now, beyond that, we’re just ramping up some new marketing ideas, working on updating my stats, and getting ready to go to Alaska. We’re going on a cruise in a week and a half or so. If I can, I’m going to pre-record some episodes. If I just don’t have time to do that, you’ll be out of an episode for a week or two and we’ll pick it back up on my return. .

Most of you know how it goes. It’s tough to be gone and it’s even tougher to catch up when you return. But I’ll do my very best.

Let’s hop in.

Item #1

The first one today is called “Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study” by Meisingset et. al. and published in BMC Musculoskeletal Disorders onMarch 17, 2015.

Why They Did It

Neck pain is associated with several alterations in neck motion and motor control. Previous studies have investigated single constructs of neck motor control, while few have applied a comprehensive set of tests to investigate cervical motor control. This comparative cross- sectional study aimed to investigate different motor control constructs in neck pain patients and healthy controls.

How They Did It

A total of 166 subjects participated in the study,
91 healthy controls (HC) and
75 neck pain patients (NP) with long-lasting moderate to severe neck pain.
Neck flexibility, proprioception, head steadiness, trajectory movement control, and postural sway were assessed using a 3D motion tracking system (Liberty).

What They Found

Neck flexibility was lower in neck pain patients compared to healthy controls, indicated by reduced cervical ROM and conjunct motion.
Movement velocity was slower in neck pain patients compared to healthy controls.
Tests of head steadiness showed a stiffer movement pattern in neck pain patients compared to healthy controls, indicated by lower head angular velocity.
Neck pain patients patients departed less from a predictable trajectory movement pattern (figure of eight) compared to healthy controls, but there was no difference for unpredictable movement patterns (the Fly test).
No differences were found for postural sway in standing with eyes open and eyes closed.
However, neck pain patients patients had significantly larger postural sway when standing on a balance pad.
Proprioception did not differ between the groups.
Largest effect sizes were found for neck and head steadiness.
Neck flexibility was the only construct that showed a significant association with current neck pain, while peak velocity was the only variable that showed a significant association with kinesiophobia.

Wrap It Up

Neck pain patients patients showed an overall stiffer and more rigid neck motor control pattern compared to healthy controls, indicated by lower neck flexibility, slower movement velocity, increased head steadiness and more rigid trajectory head motion patterns.
Only neck flexibility showed a significant association with clinical features in neck pain patients

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 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.

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, “Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers” by Lindsay M. Gorrell,Andrew Sawatsky, W Brent Edwards & Walter Herzog and published in Taylor and Francis Online on 15 Nov 2022. Hot potato!

Why They Did It

The objective of this study was to measure VA length changes that occur during cervical spine manipulation and to compare these to the VA failure length.

How They Did It

Piezoelectric ultrasound crystals were implanted along the length of the VA (C1 to C7) and were used to measure length changes during cervical spine manipulation of seven un-embalmed, post-rigor human cadavers.

Arteries were then excised, and elongation from arbitrary in-situ head/neck positions to first force (0.1 N) was measured. Following this, VA were stretched (8.33 mm/s) to mechanical failure. Failure was defined as the instance when VA elongation resulted in a decrease in force.

What They Found

From arbitrary in-situ head/neck positions, the greatest average VA length change during spinal manipulation was 5.1%

From arbitrary in-situ head/neck positions, arteries were elongated on average 33.5% prior to first force occurrence and 51.3% to failure.

Average failure forces were 3.4 N

Wrap It Up

Measured in arbitrary in-situ head/neck positions, VA were slack. It appears that this slack must be taken up prior to VA experiencing tensile force.

During cervical spine manipulations (using cervical spine extension and rotation), arterial length changes remained below that slack length, suggesting that VA elongated but were not stretched during the manipulation.

However, in order to answer the question if cervical spine manipulation is safe from a mechanical perspective, the testing performed here needs to be repeated using a defined in-situ head/neck position and take into consideration other structures (e.g. carotid arteries).

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!

The Message

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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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

Meisingset I, Woodhouse A, Stensdotter AK, Stavdahl Ø, Lorås H, Gismervik S, Andresen H, Austreim K, Vasseljen O. Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study. BMC Musculoskelet Disord. 2015 Mar 17;16:56. doi: 10.1186/s12891-015-0517-2. PMID: 25888215; PMCID: PMC4377005.

Lindsay M. Gorrell, Andrew Sawatsky, W Brent Edwards & Walter Herzog (2023) Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers, Journal of Manual & Manipulative Therapy, 31:4, 261-269, DOI: 10.1080/10669817.2022.2148048

Where To Adjust & Types Of Adjustments

February 2, 2023 chiropracticforward 00:24:35 0 Comments

CF 265: Where To Adjust & Types Of Adjustments

Today we’re going to talk about knowing where to adjust and different types of spinal manipulation

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!

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 #265 Now if you missed last week’s episode, we talked about potential early diagnosis of spondylolysis as well as clinical guides on low back pain treatment.

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

On the personal end of things…..

Alright folks, I just got back from Fort Lauderdale hanging out with my MCM Mastermind family of chiropractors. What a good time. We have some new practitioners in the group. Fresh blood! New docs to learn from and new docs to teach. It’s such a diverse group but all evidence-based. No vitalistic voodoo. Which is why it’s the right spot for me. We learned from Ray Tuck. Now, Ray has around 9 clinics and his talk was about being the CEO of your company and let’s face it, I’m the worker mule in mine so it hit home with me and gave me some inspiration and some great ideas.

If you’ve been following along with the podcast, I’ve had a hell of a Fall this year. Numbers down, staffing issues, two deaths in the family…..just lots of stuff piling up that isn’t normally part of our existence. On the staffing stuff, I lost my office manager that’s been with me 5 years. That was 3 weeks ago. Then, her bestie that works for me quit. That was 2 weeks ago. Then, while I was in Florida, their other bestie that works here sent me a text. It was a Friday night and she decided that she had just completed her last day of work. No two weeks notice. I guess that would show too much respect or gratitude. Lol. Anyway, if you’re keeping count, that’s 3 employees gone in 3 weeks. I only have 4 full timers to start with. To say it’s a challenge this week is to minimize things. It’s a big thing.

BUT I have a super hero wife who is here today and who is killing it just like she kills anything she does. I’ve been slow since September. I’ll promise you, with my wife up front, I’m going to be so busy I’m not going to know what the hell to do with myself. Then, we have two new girls. One is on her 3^rd week here and one is on her 2^nd week here. We just ran about 32 in one morning and they knocked it out of the park. So……the story is, we’re OK and if you have a lot of turnover, you’re going to be OK.

We can only do our best. I’ve done everything I know to be good to my staff, treat them like my family, be so good to them and foster an environment that is so fun and positive that they’d never dream of leaving. Yeah, that doesn’t work. I am who I am. I’ll always treat my people well and take care of them and feel protective of them.

But no more backflips trying to hold onto people. Not anymore. There are so many lessons available to us if we just make sure we’re paying attention.

That’s the negative. The positive is this; I have a true opportunity to re-set. To put my values and culture out there for the new staff to buy into and understand. I can cultivate what I want this place to always be without any old baggage preventing the message from hitting home.

What are my values? I’m glad you asked:

Customer Service
Evidence based
Patient centered
Honesty
Ethical
Morals
Character
Trustworthiness
Authentic
Kind
Supportive
Responsible
High level
Family and
Loving

It’s vital this new crop of staff members understand these things. Understand who we are as owners. Another thing I learned from Ray Tuck this weekend is don’t be afraid to open up the books and show your staff. You don’t have to show what you’re making each year or any of that but make sure they understand that you’re not buying a yacht while you bitch at them about the things you need from them. Show them your margins are much thinner than they might have imagined.

It has an impact on them. Also, we are considering hiring two part-timers rather than one full-timer. That will cut down on burn out, they’ll get to see their kids more, they can cover each other’s shifts, and if one quits, there is built-in redundancy to prevent any freak outs. The one staying can simply train the next part timer. Sounds like a solid solution to me. That right there is one benefit of being in a mastermind. Smart people giving you thoughts that are a little out of the box but that are working for them. So, with my wife in control until new hires are up to speed, we about to kill it and you’ll all be happy to never hear me bellyaching about having a light schedule. Lol.

Item #1

The first on today is called, “Review of methods used by chiropractors to determine the site for applying manipulation” by Triano et al and published in Journal of Chiropractic & Manual Therapies on 21 October 2013. Why They Did It The authors did the study to evaluate the literature on the validity and reliability of the more common methods used by doctors of chiropractic to inform the choice of the site at which to apply spinal manipulation.

How They Did It

Structured searches were conducted in Medline, PubMed, CINAHL and ICL, supported by hand searches of archives,
The quality of evidence was ranked using QUADAS for validity and QAREL for reliability, as appropriate.

What They Found

A total of 2,594 titles were screened from which 201 articles met all inclusion criteria. The spectrum of manuscript quality was quite broad, as was the degree to which the evidence favored clinical application of the diagnostic methods reviewed.
The most convincing favorable evidence was for methods which confirmed or provoked pain at a specific spinal segmental level or region.
There was also high-quality evidence supporting the use, with limitations, of static and motion palpation, and measures of leg length inequality.
Evidence of mixed quality supported the use, with limitations, of postural evaluation.
The evidence was unclear on the applicability of measures of stiffness and the use of spinal x-rays.
The evidence was of mixed quality, but unfavorable for the use of manual muscle testing, skin conductance, surface electromyography and skin temperature measurement

Wrap It Up

A considerable range of methods is in use for determining where in the spine to administer spinal manipulation. The currently published evidence falls across a spectrum ranging from strongly favorable to strongly unfavorable in regard to using these methods.

In general, the stronger and more favorable evidence is for those procedures which take a direct measure of the presumptive site of care– methods involving pain provocation upon palpation or localized tissue examination.

Procedures which involve some indirect assessment for identifying the manipulable lesion of the spine–such as skin conductance or thermography–tend not to be supported by the available evidence.

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 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. 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, “Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain” by Michael Schneider and published in PubMed on February 15, 2015. Hot potato!

Why They Did It

This study was a comparative effectiveness trial of manual-thrust manipulation (MTM) versus mechanical-assisted manipulation (MAM); and manipulation versus usual medical care (UMC).

How They Did It

A total of 107 adults with onset of LBP within the past 12 weeks were randomized to 1 of 3 treatment groups: manual-thrust manipulation, mechanical-assisted manipulation, or usual medical care. Outcome measures included the Oswestry LBP Disability Index (0-100 scale) and numeric pain rating (0-10 scale).

Participants in the manipulation groups were treated twice weekly during 4 weeks; subjects in usual medical care were seen for 3 visits during this time. Outcome measures were captured at baseline, 4 weeks, 3 months, and 6 months.

What They Found

Linear regression showed a statistically significant advantage of manual-thrust manipulation at 4 weeks compared with mechanical-assisted manipulation and usual medical care.

Responder analysis, defined as 30% and 50% reductions in Oswestry LBP Disability Index scores revealed a significantly greater proportion of responders at 4 weeks in manual-thrust manipulation (76%; 50%) compared with mechanical-assisted manipulation (50%; 16%) and usual medical care.

Similar between-group results were found for pain: manual-thrust manipulation; mechanical-assisted manipulation; and usual medical care. No statistically significant group differences were found between mechanical-assisted manipulation and usual medical care, and for any comparison at 3 or 6 months.

Wrap It Up

It was found that manual-thrust manipulation provides greater short-term reductions in self-reported disability and pain scores compared with usual medical care or mechanical-assisted manipulation. 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!

The Message

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!

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

Website https://www.chiropracticforward.com

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

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

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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

Schneider M (2015). “Comparison of spinal manipulation methods and usual medical care for acute and subacute low back pain: a randomized clinical trial.” Spine Feb 15; 40(4): 209-217.

Triano, J. J., Budgell, B., Bagnulo, A (2013). “Review of methods used by chiropractors to determine the site for applying manipulation.” Chiropr Man Therap 21(36).

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

June 16, 2022 chiropracticforward 00:17:22 0 Comments

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!

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.
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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 creekstonecare@gmail.com 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!

The Message

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/

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

May 21, 2020 chiropracticforward 00:19:33 0 Comments

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

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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.

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

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Social Media Links https://www.facebook.com/chiropracticforward/ Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/ Twitter Tweets by Chiro_Forward YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2 Player FM Link https://player.fm/series/2291021 Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/ About the Author & Host Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger Bibliography 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.

Chiropractic Forward Podcast - Jeff Williams, DC

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

June 13, 2019 chiropracticforward 00:25:35 0 Comments

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

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 dr.williams@chiropracticforward.com 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?

The Message

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.

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About the Author & Host

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

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

January 10, 2019 chiropracticforward 00:31:04 0 Comments

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.

spinal manipulation

Spinal Manipulative Therapy And Benzodiazepines & Yanking Someone’s Head Off

Motor Control Stiffening & Spinal Manipulation And The Vertebral Artery

The first one today is called “Evidence for a general stiffening motor control pattern in neck pain: a cross sectional study” by Meisingset et. al. and published in BMC Musculoskeletal Disorders onMarch 17, 2015.

Where To Adjust & Types Of Adjustments

CF 265: Where To Adjust & Types Of Adjustments

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

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

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

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

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