spinal manipulative treatment

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)

CF 325: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11) Today we’re going to talk about “The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)” But first, here’s that sweet sweet bumper music     Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #325 Now if you missed last week’s episode, we talked about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I see the battle coming and I’m trying to build the walls. It’s tough to go from seeing 8-10 new VA patients every week down to seeing about 1 every 2 weeks. Plus they’re reducing their visits to acute conditions only when most of these folks are chronic. They’ve been hurting literally for decades for some of them.  So, yeah, the battle is approaching so I’m trying to build walls. Now, how do we do that? We stop being lazy about marketing and, I’m a Christian so I always believe that when one door is closed, another will open and the one that opens is usually better.  All big changes in my life and business has always been for the best. Even when I thought the changes were catastrophic. This one is inconvenient and it pisses me off a bit. I’d love to have a set it and forget it type of business but it’s just not and never will be.  It’s ups and downs every week so that’s what we’re doing. We’re riding the coaster and preparing for the decrease in our numbers that’s already here and that we know will continue to get worse before it levels off and before we get our marketing in full gear and get after it again before the VA started sending the vets to us.  Yep, fully engaged now. I’ll keep you updated.  I want to congratulate Dr. Steve Brown out in Gilbert, AZ on his new peer reviewed paper that came our recently. Steve is doing good work and trying to help chiropractors stay out of trouble on the smt stroke issue that we’re all having to deal with all of the time.  I’m putting the link to Dr. Brown’s paper right here in the show notes so go grab it and check it out. https://www.cureus.com/articles/239108-plausible-mechanisms-of-causation-of-immediate-stroke-by-cervical-spine-manipulation-a-narrative-review#!/ It may save your collective asses.  Now, due to this paper Steve has the predictable drivel coming from the philosophy wonks that have a stake in the game and that’s OK. He expects that. Heck he even might welcome it with a research-backed response of his own. But, if one looks deeper than the detractors seem to have the brain space to do, his paper pretty much protects us. If we read it, we can prevent dissections most times and, should a pt. Try to state we’re responsible for a VAD the next few days or weeks after an adjustment, his paper provides some protection.  Then, about the same week, we had a knucklehead present a case study called, “Myositis Ossificans Traumatica of Bilateral Sternocleidomastoid Muscles After Chiropractor Adjustment: A Case Report” by Felix et. Al in Cureus where they implied heavily that a chiropractic adjustment was the cause of the myositis ossificans.  I’m going to leave the link here in the show notes at chiropractiforward.com under episode 325.  https://www.cureus.com/articles/234594-myositis-ossificans-traumatica-of-bilateral-sternocleidomastoid-muscles-after-chiropractor-adjustment-a-case-report#!/  I hope you’ll go to the link, scroll down to the comments and watch Dr. Brown chime in and systematically tear this crap paper apart and watch the authors basically apologize and promise to make the necessary changes.  The moral of the story is this; research isn’t here to hold us back and tear us down. It’s here to defend us, make us better, and provide more and more validity as we increase our knowledge base. That’s why I’m here. That’s why Dr. Steve Brown and so many others are here.  One of the biggest hits I see our profession take online is that we’re all quacks because the profession was founded by a belief and a magnetic mystical healer. True as that may be, the medical field once had blood letting, leaches, and lobotomies.  Research pulled them together and out of the catacombs and research will and is doing the same for us as chiropractors. I promise when research came out proving blood letting useless, there were still those that had used blood letting for decades fighting the research, attacking and discrediting the research and researchers, and doing everything they could to clutch their pearls and maintain their box of safety.  All I can say is that flat Earthers will do flat earth stuff and you can’t tell or show them anything differently. Moon landing deniers…….good luck convincing them otherwise. When a certain dogma has taken over and defined one’s life, you can’t and won’t change it.  But that will never stop new thinking, research, and forward movement.  Item #1 We are continuing the series on why the hell the WHO would recommend SMT at very low confidence which, if you’ve been following along, is the same level of confidence they give ultrasound. Well that’s BS and I went and found all of the papers they used to make this determination and we’re going through each and every of them trying to form and impression of our own.  The first one today is called, “United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care” by UK BEAM Trial Team, published in British Medical Journal in December of 2004.  UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ. 2004 Dec 11;329(7479):1377. doi: 10.1136/bmj.38282.669225.AE. Epub 2004 Nov 19. PMID: 15556955; PMCID: PMC535454. Remember, the citations can be found at chiropracticforward.com under this episode.  Why They Did It To estimate the effect of adding exercise classes, spinal manipulation delivered in National Health System or private premises, or manipulation followed by exercise to “best care” in general practice for patients consulting with back pain. How They Did It Pragmatic randomised trial with factorial design. Setting: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. Participants: 1334 patients consulting their general practices about low back pain. Main outcome measures: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. What They Found
  • All groups improved over time. 
  • Exercise improved mean disability questionnaire scores at three months by 1.4 more than “best care.” 
  • For manipulation the additional improvement was 1.6 at 12 months. 
  • For manipulation followed by exercise the additional improvement was 1.9 at three months and 1.3 at 12 months. 
  • No significant differences in outcome occurred between manipulation in NHS premises and in private premises. 
  • No serious adverse events occurred.
Wrap It Up Relative to “best care” in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months. Item #2 The second one is called, “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial” by Thomas et. Al published in JAMA Network Open in August 2020 Thomas JS, Clark BC, Russ DW, et al. Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(8):e2012589. doi:10.1001/jamanetworkopen.2020.12589 Why They Did It Low back pain (LBP) is one of the most common reasons for seeking medical care. Manual therapy is a common treatment of LBP, yet few studies have directly compared the effectiveness of thrust (spinal manipulation) vs nonthrust (spinal mobilization) techniques. To evaluate the comparative effectiveness of spinal manipulation and spinal mobilization at reducing pain and disability compared with a placebo control group (sham cold laser) in a cohort of young adults with chronic LBP. How They Did It This single-blinded (investigator-blinded), placebo-controlled randomized clinical trial with 3 treatment groups was conducted at the Ohio Musculoskeletal and Neurological Institute at Ohio University from June 1, 2013, to August 31, 2017.  Of 4903 adult patients assessed for eligibility, 162 patients with chronic LBP qualified for randomization to 1 of 3 treatment groups.  Recruitment began on June 1, 2013, and the primary completion date was August 31, 2017.  Data were analyzed from September 1, 2017, to January 20, 2020. Participants received 6 treatment sessions of 
  1. spinal manipulation, 
  2. spinal mobilization, or 
  3. sham cold laser therapy (placebo) during a 3-week period.
What They Found Coprimary outcome measures were the change from baseline in Numerical Pain Rating Scale (NPRS) score over the last 7 days and the change in disability assessed with the Roland-Morris Disability Questionnaire 48 to 72 hours after completion of the 6 treatments. A total of 162 participants with chronic LBP were randomized.  Fifty-four participants were randomized to the spinal manipulation group, 54 to the spinal mobilization group, and 54 to the placebo group.  There were no significant group differences for sex, age, body mass index, duration of LBP symptoms, depression, fear avoidance, current pain, average pain over the last 7 days, and self-reported disability.  At the primary end point, there was no significant difference in change in pain scores between spinal manipulation and spinal mobilization, spinal manipulation and placebo, or spinal mobilization and placebo.  There was no significant difference in change in self-reported disability scores between spinal manipulation and spinal mobilization, spinal manipulation and placebo or spinal mobilization and placebo.   Wrap It Up In this randomized clinical trial, neither spinal manipulation nor spinal mobilization appeared to be effective treatments for mild to moderate chronic LBP 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.      Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10)

CF 323: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 10). Yes, every other week we are covering the papers that the World Health Organization used to recommend spinal manipulative therapy at ‘very low confidence’. What we’ve seen so far are papers that are either very old, very small sample sizes, or prone to bias.  But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. 

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #323 Now if you missed last week’s episode, we talked about Young Athletes With CTE & Catastrophizing, Fear Avoidance, and Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. We just returned from the big West Texas TCA Conference down in Lubbock, TX. What a great time. It’s always great to re-connect with your tribe. I say re-connect because it’s been a good year since I was in the same room with my TCA family.  TCA, if you’re not familiar is the Texas Chiropractic Association.  Anyway, last year during this conference, I was already committed to VOAtlanta, a voice conference in Atlanta. So I couldn’t attend this one. Then for the summer ChiroTexpo event, I was on an Alaskan cruise so was unable to attend that event down in Dallas.  So yeah, it’s been over a year since I got to hang out with my Texas chiropractic clan.

It was a weekend of re-connecting, introducing our intern Dontae, to the Texas family, and even teaching.  I taught an hour course called, “Revolutionize Your Practice: Strategies For Taming Chronic Pain & The Upregulated Central Nervous System”. It’s really a 2-hour class but I’ve condensed it into and hour with the pedal to the metal. Y’all should know by now that I’m on a mission to get this message out and stop some of our chiro brethren from scaring patient into treatment plans. It really is a passion and a mission. 

If you know of any state associations or groups that need this message, please reach out at creekstonecare@gmail.com. I’d love to come share my message with your group.  Dontae, our intern got integrated into our Texas chiro family. I feel like it was the weekend of Dontae really.

Everyone loved the guy. He’s hard to not like, honestly.

He’s going to be super successful when he gets his feet under himself.  Like I said last week, conferences aren’t all about what you learn in the sessions. It’s as much about the connections and your network. The stronger your network, the stronger the provider. I promise. Raise your hand, step forward, and get involved. You’ll be glad you did. 

Also, I got to hang out with my buddy, Dr. Benjamin Fergus from Evanston, Illinois and the GRIP program. Ben is just phenomenal. He knows his stuff and has been a big big hit with our providers each time he’s taught for the TCA.  Good times. But now, back to work so let’s get the research rolling. 

Item #1 Our first one today is called, “Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome?” By Senna et. Al. and published in Spine on August 15, 2011 Remember, the citations can be found at chiropracticforward.com under this episode.  Senna MK, Machaly SA. Does maintained spinal manipulation therapy for chronic nonspecific low back pain result in better long-term outcome? Spine (Phila Pa 1976). 2011 Aug 15;36(18):1427-37. doi: 10.1097/BRS.0b013e3181f5dfe0. PMID: 21245790.

Why They Did It To assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic nonspecific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low back conditions after an initial phase of treatments.

How They Did It Sixty patients, with chronic, nonspecific LBP lasting at least 6 months, were randomized to receive either 

  1. 12 treatments of sham SMT over a 1-month period, 
  2. 12 treatments, consisting of SMT over a 1-month period, but no treatments for the subsequent 9 months, or 
  3. 12 treatments over a 1-month period, along with “maintenance spinal manipulation” every 2 weeks for the following 9 months. 

To determine any difference among therapies, they measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-, 4-, 7-, and 10-month intervals.

What They Found Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period.  However, only the third group that was given spinal manipulations (SM) during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation.  In the non-nmaintained SMT group, however, the mean pain and disability scores returned back near to their pre-treatment level.

Wrap It Up SMT is effective for the treatment of chronic nonspecific LBP. To obtain long-term benefit, this study suggests maintenance SM after the initial intensive manipulative therapy. That one’s not only in our favor and a RCT, but it’s also in support of ongoing wellness. Nice paper for the home team. Put a check in the win column for the good guys!

Item #2 The second one today is called, “Immediate effects of joint mobilization compared to sham and control intervention for pain intensity and disability in chronic low back pain patients: randomized controlled clinical trial” by Tavares, et. Al. published in Revisita Dor in 2017. Tavares FAG, Chaves TC, Silva ED, Guerreiro GD, Gonçalves JF, Albuquerque AAA de. Immediate effects of joint mobilization compared to sham and control intervention for pain intensity and disability in chronic low back pain patients: randomized controlled clinical trial [Internet]. Revista Dor. 2017 ; 18( 1): 2-7.[citado 2024 mar. 25 ] Available from: https://doi.org/10.5935/1806-0013.20170002  

Before jumping into this one, this paper was in Spanish and I couldn’t find the English version anywhere so I ran it through Google’s AI engine called Gemini and it spit the English version right out for me! Bam. Another tip from your ol’ uncle Jeffro!

Why They Did It One of the possible treatments for chronic low back pain is joint mobilization. There is moderate evidence in the literature on the effects of mobilization for chronic low back pain, however, few studies have used sham mobilization as a comparison group.  The objective of this study was to evaluate the effects of lumbar joint mobilization on the following outcomes: pain intensity and disability in patients with chronic low back pain.

How They Did It 60 individuals of both sexes were selected with the following eligibility criteria: age between 18 and 55 years, who had non-specific chronic low back pain for at least three months.  The selected volunteers were randomly assigned to three groups of 20 individuals: joint mobilization group, sham mobilization group, and control groups.  All groups were evaluated by the same blinded researcher and answered the following instruments before and immediately after the 10 intervention sessions: 

  • Numerical pain scale for pain intensity assessment, 
  • Oswestry Disability Index for pain-related disability assessment, and 
  • Catastrophic Thinking Scale for pain-related catastrophization assessment.

What They Found

  • Significant pre- and post-treatment differences were observed for the pain intensity variable in the mobilization and the sham groups. 
  • In the comparison between the intervention groups, a significant difference was found in the mean pain intensity value between mobilization versus control groups

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website 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    

Where To Adjust & Types Of Adjustments

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, heres that sweet sweet bumper music

 

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.   We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers.   I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.   Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com   If you haven’t yet I have a few things you should do.

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

 You have found yourself smack dab in the middle of Episode #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 3rd week here and one is on her 2nd 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.    

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Integrating Chiropractors

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The Message

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

Key Point:

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

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

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

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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).