stroke

The Stroke Issue – New Information

CF 261: The Stroke Issue – New Information   Today we’re going to talk about the age-old issue chiropractors continue to be burdened by. The weird myth that our adjustments cause strokes. We have some newer info I’m going to share with you on it in this week’s episode.    But first, here’s that sweet sweet bumper music    

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.    We’re the fun kind of research. Not the stuffy, high-brow, 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 261  

Now if you missed last week’s episode, we had our 5th year roundup and got ready for our 6th Season!! Hard to believe honestly. I continue to be blessed by you all.  Make sure you don’t miss that info. Keep up with the class.   

On the personal end of things…..

You probably remember me talking about Darcy Sullivan and Propel and the work they’re doing on my website. If you don’t recall or haven’t listened lately, I’m usually so busy with patients that I can’t see straight but, ever since September, I’ve been slow as hell. There are lots of factors I’m sure, but I believe website SEO and my Google ranking plays a part in it. So, I decided to act. Darcy and Propel was my first call.    They’re still in the building it out mode so no big results yet. It’s a six-month process and I’m literally only about 2 weeks into it so there’s not supposed to be a bit wow yet.   

But I did like that they had me on an intro Zoom where Darcy talked with me and we went over my site, metrics, where I could make improvements, where they could help. She gave me several options on what they could do to help. Options like they could do a little bit and teach me to do the rest all of the way up to they could do all of it for me.    If you know me, I don’t have time to learn current SEO, so I went all in. Do it all for me please and I’m happy to pay for it. Then, after I was all signed up, we had another Zoom where Darcy went over every single thing we wanted to work on and what that would look like. It really helped me see the light at the end of the tunnel and gave Propel good info on where we needed to go and how to get there.   

Now, they are making it happen. So, let’s sit back and see what happens. I’ll keep you updated.   

After the last mastermind meeting in November in the gorgeous Florida Keys, I decided that I needed to delegate more of my day. So, I started considering how I spend the majority of my day and what parts of that work can be farmed out to more virtual assistants.   

As a result, lots of the content I produce will be farmed out a little bit. I’m still in the middle of it all as oversight but my weekly blog in particular…..I’m going to farm out the meat of the content to a writer, then come in, make my edits, add anything I feel is important that was missed, make it mine, and then get it posted.    What do you spend the majority of your days and weeks doing outside of patient care? What duties can you identify that can be farmed out reasonably so that you free up your time and your brain?   Work on it and consider it.     

Item #1  

The first one today is called “Association between cervical artery dissection and spinal manipulative therapy” by Whedon, J.M., Petersen, C.L., Li, Z. et al. (Whedon 2022) and published in Journal of BMC Geriatrics on November 29, 2022. Dayum. That’s hot.    

Why They Did It   ·     

Cervical artery dissection (CAD) is a potentially serious condition that occurs when weakening and disruption of the arterial lining allow blood to get in between and separate the layers of the arterial wall.    ·     

Patients with CAD often present with neck pain or headache, may be asymptomatic or present as a stroke in progress. The blood that accumulates within the arterial wall can occlude the artery or cause a blood clot that in turn can be dislodged, leading to an ischemic stroke.   ·     They had to figure out what the associations or dangers might be. Even thought it’s already been done a ton of times. But that’s OK. A pile of research in your favor is better than just a couple of papers. So let’s do it!      

How They Did It   ·     

  • They evaluated the association between cervical spinal manipulation and CAD among older Medicare beneficiaries in the United States.  ·      It was a case-control and case-crossover design  ·     
  • It was an analysis of claims data for individuals aged 65+, continuously enrolled in Medicare Part A (covering hospitalizations) and Part B (covering outpatient encounters) for at least two consecutive years during 2007–2015. ·     
  • They created a 3-level categorical variable, (1) any cervical spinal manipulation, 2) evaluation and management but no cervical spinal manipulation and (3) neither cervical spinal manipulation nor evaluation and management.  

What They Found   ·     

The primary outcomes were occurrence of cervical artery dissection, either (1) vertebral artery dissection or (2) carotid artery dissection.  ·      The cases had a new primary diagnosis on at least one inpatient hospital claim or primary/secondary diagnosis for outpatient claims on at least two separate days. ·     

The odds of cervical spinal manipulation versus evaluation and management did not significantly differ between vertebral artery dissection cases and any of the control groups at any of the timepoints.  ·     

Results for carotid artery dissection cases were similar

Wrap It Up

Among Medicare beneficiaries aged 65 and older who received cervical spine manipulation, the association with cervical artery dissection is no greater than that among the control groups, and cervical spinal manipulation does not appear to be a significant risk factor for cervical artery dissection in this population group. If you want a complete breakdown, and shut your pie holes once and for all, summary of the research and related topice, including risk vs. benifts analysis, go to my blog at chiropracticforward.com, click on the blog link, and read the blog called Debunked: the Odd Myth That Chiropractors Cause Strokes.

You’ll have everything you need to debunk the junk. 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, “Oral Contraceptives and Ischemic Stroke Risk” by Caitlin Carlton, Matthew Banks and Sophia Sundararajan (Carlton C 2018) and published in ahajournals on March 16, 2018.  

Why They Did It   ·     

They wanted to know if there is a link in increased ischemic stroke when using oral contraceptives containing high-dose estrogens. Several meta-analyses of case–control and cohort studies attempt to clarify the relationship between modern low-dose combination estrogen–progestin oral contraceptives and stroke.   ·     

Data linking oral contraceptives to stroke is mixed, but most physicians err on the side of caution and discontinue oral contraceptives. They decided to focus on the potential role of oral contraceptives in stroke and the management of patients with stroke who use oral contraceptives.  

How They Did It   ·     

They looked at the first meta-analysis addressing ischemic stroke risk in high-dose estrogen-containing oral contraceptives users evaluated 16 studies from 1960 to 1999 and found an increased relative risk of stroke of 2.75 across estrogen dose, blood pressure, smoking status, and age.   ·      They also looked at the meta-analysis including studies from 1980 to 2002 evaluated only low-dose combination oral contraceptives and found a lower odds ratio of 2.12 for ischemic stroke. 

More recently, a study from 1995 to 2009 failed to find any increased relative risk for low-dose ethinyl estradiol formulations, estrogen-containing hormonal contraceptive patches, or vaginal rings.    

What They Found   ·     

  • Combination oral contraceptives have a lower risk of stroke than earlier formulations containing high-dose estrogens. Stroke risk in oral contraceptives users is impacted by several confounding issues, including oral contraceptives formulation, age, hypertension, smoking, and the presence of migraine with aura.  ·     
  • It is important to consider the constellation of stroke risk factors in concert with oral contraceptives formulation to determine individual stroke risk and the best contraceptive to reduce that risk in an individual woman.     
  • Wrap It Up   ·     
  • Modern combined oral contraceptive pills have a lower dose of estrogens and less risk of stroke than older contraceptive formulations   ·     
  • The risk of ischemic stroke in patients using combined oral contraceptives is increased in patients with additional stroke risk factors, including smoking, hypertension, and migraine with aura.   ·     
  • The risk of ischemic stroke because of combined oral contraceptive pills is less than the risk associated with pregnancy.    

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

The Message

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

Key Point:

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

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

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

Website https://www.chiropracticforward.com  

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

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

Twitter https://twitter.com/Chiro_Forward  

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

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

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

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

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

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

Bibliography

  1. Carlton C, B. M., Sundarararajan S, (2018). “Oral Contraceptives and Ischemic Stroke Risk.” Stroke 49(4).  
  2. Whedon, J. M., Petersen, C.L., Li, Z, (2022). “Association between cervical artery dissection and spinal manipulative therapy –a medicare claims analysis.” BMC Geriatr 22(917).    

Tensile Force On Vertebral Artery During Adjustments & Exercising For Pain

CF 257: Tensile Force On Vertebral Artery During Adjustments & Exercising For Pain Today we’re going to talk about Tensile Force On Vertebral Artery During Adjustments & Exercising For Pain But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

You have found yourself smack dab in the middle of Episode #257 Now if you missed last week’s episode , we talked about Aspirin And Fall Risk & Caffeine And Child Growth. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. What’s going on with me lately? Well, still riding some inflation and recession stuff here these last two months and working on marketing and my customer experience to right the ship as quickly as possible. My trip to Florida and Thanksgiving are playing hell with some of the recoveries but that is what it is and that’s OK. That’s life. 

One of the things we started last week was ‘Your benefits re-start in January so use them while you have them.” Also, am I in too big of a hurry with patients?

Do they feel my need to be in and out or do they each feel special in some way? I am trying to slow down and be more present with each patient. More interested in them and in their story.  We can always blame outward forces when our practices slow up a bit. And that’s legit. You have to consider all aspects. Is it the economy? My website SEO? Inflation? What is the outward cause?

But also, what are the potential in-house causes? Am I too rushed? Am I no longer focused on the customer experience and only focusing on all of my stuff that has to be done instead? Is there something going on with our new patient process and our booking procedures?  Internally, have we changed anything about how we are functioning and doing things? Let’s review how we’re doing things and let’s figure it out. That’s what I’m looking at right now.

No coach or mastermind has all of the answers to a slowdown. It is up to us as business owners to diagnose the cause and the effect. At least to the best of our abilities.  I’m not dramatically slower than in August but September and October and November have been slow enough compared to my regular load that it’s past time to get it fixed and headed back in the right direction. 

And that includes looking in the mirror. We should all do that. A good leader doesn’t ask where the staff failed, but asks, where have I failed.  That’s what I’m doing. 

Also, I’m looking at where I can delegate tasks that have put me in a hurry most days. When I can’t keep up with stuff, it’s time to figure out how to farm out stuff so that I don’t feel rushed and overwhelmed all day every day.  I’m an immaculate stat keeper. That’s about to change. I have an excellent virtual assistant in Nigeria that is helping me figure out how to automate and delegate balancing bank statements, which I still do myself and stat keeping.

This will save A LOT of time on Mondays, Tuesdays, and Wednesdays freeing my brain up to work on more productive tasks like the customer experience.  Alright, enough introspective discovery for this week. Onto the research. 

Item #1

The first on today is called, “Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers” by Gorrell et. al. (Gorrell LM 2022) and published in Journal of Manual Manipulativer Therapy on November 15, 2022. Dayum. That’s hot. 

Why They Did It The vertebral artery (VA) may be stretched and subsequently damaged during manual cervical spine manipulation. The objective of this study was to measure vertebral artery length changes that occur during cervical spine manipulation and to compare these to the vertebral artery 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, vertebral arteries 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 vertebral artery 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, vertebral arteries were slack. It appears that this slack must be taken up prior to vertebral arteries 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.  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, “The Relationship Between Physical Activity and Pain in U.S. Adults” by Ray et. al. (Ray 2022) and published in Medicine and Science in Sports and Exercise on October 26, 2022. Hot potato!

Why They Did It The authors wanted to assess the relationship between physical activity (PA) and pain within the available sample, with secondary aims to assess prevalence of pain, physical activity levels, healthcare seeking behaviors, and impact of pain on daily activities and work.

How They Did It They conducted an epidemiological cross-sectional observational study utilizing National Health Interview Survey (NHIS) data from 2020.  They examined the self-reported adherence to current physical activity guidelines and the prevalence of pain.  They hypothesized those dealing with pain were less likely to meet physical activity guidelines. physical activity levels, pain prevalence, frequency, and intensity were assessed via the survey and relationships explored via modeling.

What They Found

  • 31,568, subjects
  • 12,429 (39.37%) reported pain on some days, 2,761 (8.75%) on most days, and 4,661 (14.76%) every day. 
  • The odds of engaging in physical activity decreased in a stepwise fashion based on frequency and intensity of pain reporting when compared to no pain. 
  • Importantly, physical activity is a significant correlate affecting pain reporting, with individuals engaging in physical activity (strength and aerobic) demonstrating 2 times lower odds of reporting pain when compared to those not meeting the physical activity guidelines.

Wrap It Up

There is a significant correlation between meeting physical activity guidelines and pain. Meeting both criteria of physical activity guidelines resulted in lower odds of reporting pain. Additionally, the odds of participating in physical activity decreased based on pain frequency reporting.

These are important findings for clinicians, highlighting the need for assessing physical activity not only for those dealing with pain but as a potential risk factor for minimizing the development of chronic pain. Get ‘em moving folks!

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

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

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

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

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

Bibliography

Gorrell LM, S. A., Edwards WB, Herzog W., (2022). “Vertebral arteries do not experience tensile force during manual cervical spine manipulation applied to human cadavers.” J Man Manip Ther.  

Ray, B. M. K., Kyle J.; Eubanks, James E.; Nan, Nan; Ma, Changxing; Miles, Derek, (2022). “The Relationship Between Physical Activity and Pain in U.S. Adults.” Medicine & Science in Sports & Exercise.          

CF 015: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 3 of 3)

Debunking the odd myth that chiropractors cause strokes. I’m almost done with this y’all. In this final episode of this series, we will discuss risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information.

... continue reading.

CF 014: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 2 of 3)

DEBUNKED: The Odd Myth That Chiropractors Cause Strokes Revisited

Part 2 of 3

Chirorpactic Forward Podcast Subscribe Link

Click to Subscribe!

This week we are in Episode #2 of the 3 episodes where we are systematically debunking the odd myth that chiropractors cause strokes. I’m not having it folks. The chiropractors cause strokes myth is old and tired and in need of retirement. In this episode, we will discuss research papers demonstrating and validating benefits of having cervical manipulation treatments. Or chiropractic adjustments to the neck. We will talk about the benefits, according to research, for neck pain as well as for headaches. And we’ll also talk a little about where this chiropractors cause strokes myth came from and why it perpetuates to this day.

Before we get started, I want to draw your attention to the reviews over at iTunes. If you would be kind enough to leave us a great review we sure would appreciate you! This is a new podcast and we need all the help we can get!

Right now though, it’s time for bumper music!

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go. I can’t think of a more valuable way to spend you time if you’re a chiropractor than to learn how to debunk the chiropractors cause strokes myth and shut people down on it.

Let’s begin this episode by thanking those of you that sent emails to me after this chiropractors cause strokes myth series kicked off last week. You guys are great. The best way you can help is to share these episodes with as many people as you can. We can get this myth debunked and we can put it to rest right here, right now. But, obviously, I can’t do it myself. I need your help to do it.

I also want to remind you that this is part 2 of a three part series on the chiropractors cause strokes myth. Last week was part one of the chiropractors cause strokes myth where we discussed some risky odds, some case specific discussion, some signs and symptoms of vertebral artery dissection, and some research dealing with common treatments within the medical profession.

Be sure to go back and listen to it if you have not. It’s essential.

Then next week we will discuss other risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information putting the chiropractors cause strokes myth to bed once and for all.

Don’t miss it folks.

Now, let’s get on with our risk vs. reward discussion with the BENEFITS of cervical manipulation therapy.

I want to start off with the benefits of cervical manipulation for neck pain specifically. Each paper mentioned includes a short description of the conclusion for each paper cited. Also each of these papers is referenced in the show notes and can be very easily reviewed independently. You have to know that I am going to absolutely murder some of these names and I don’t even care. I’m small town South y’all. I’m not fancy at all. All I can is do my best but I assure you I’m not going to do backflips trying to figure out the correct pronunciation of each of these names. Be sure though, the days of Dr. Smith or Dr. Jones doing all of the research are no longer Take this first name as an example.

  1. Korthalis-de Bos IB, et. al. – “Manual therapy (spinal mobilization) is more effective and less costly for treating neck pain than physiotherapy or care by a general practitioner[1].”
  2. Dewitte V, et. al. – “Based on key features in subjective and clinical examination, patients with mechanical nociceptive pain probably arising from articular structures can be categorized into specific articular dysfunction patterns. Pending on these patterns, specific mobilization and manipulation techniques are warranted. The proposed patterns are illustrated in 3 case studies. This clinical algorithm is the corollary of empirical expertise and is complemented by in-depth discussions and knowledge exchange with international colleagues. Consequently, it is intended that a carefully targeted approach contributes to an increase in specificity and safety in the use of cervical mobilizations and manipulation techniques as valuable adjuncts to other manual therapy modalities[2].”
  3. Dunning JR, et. al. – “The combination of upper cervical and upper thoracic HVLA thrust manipulation is appreciably more effective in the short term than nonthrust mobilization in patients with mechanical neck pain[3].”
  4. Brontfort G, et. al. – “For participants with acute and subacute neck pain, SMT was more effective than medication in both the short and long term. However, a few instructional sessions of HEA resulted in similar outcomes at most time points[4].”
  5. Puentedura EJ, et. al. – The objective of the paper was as follows: “Thrust joint manipulation to the cervical spine has been shown to be effective in patients presenting with a primary report of neck pain. It would be useful for clinicians to have a decision-making tool, such as a clinical prediction rule, that could accurately identify which subgroup of patients would respond positively to cervical thrust joint manipulation.” In the results, they showed if 3 or more of the 4 attributes were present,” the probability of experiencing a successful outcome improved from 39% to 90%[5].”
  6. Yu H, et. al. – “Chiropractic management of atlantoaxial osteoarthritis yielded favorable outcomes for these 10 patients[6].”
  7. Puentedura EJ, et. al. – “Patients with neck pain who met 4 of 6 of the CPR criteria for successful treatment of neck pain with a thoracic spine thrust joint manipulation demonstrated a more favorable response when the thrust joint manipulation was directed to the cervical spine rather than the thoracic spine. Patients receiving cervical thrust joint manipulation also demonstrated fewer transient side-effects[7].”
  8. Miller J, et. al. – “Moderate quality evidence supports this treatment combination (cervical manual therapy combined with exercise) for pain reduction and improved quality of life over manual therapy alone for chronic neck pain; and suggests greater short-term pain reduction when compared to traditional care for acute whiplash[8].”
  9. Hurwitz EL, et. al. – “Our best evidence synthesis suggests that therapies involving manual therapy and exercise are more effective than alternative strategies for patients with neck pain[9].”
  10. Muller R, et. al. – “In patients with chronic spinal pain syndromes, spinal manipulation, if not contraindicated, may be the only treatment modality of the assessed regimens that provides broad and significant long-term benefit[10].”
  11. Zhu L, et. al. – “There was moderate level evidence to support the immediate effectiveness of cervical spine manipulation in treating people with cervical radiculopathy[11].”
  12. Giles LG, et. al. – “The consistency of the results provides, despite some discussed shortcomings of this study, evidence that in patients with chronic spinal pain, manipulation, if not contraindicated, results in greater short-term improvement than acupuncture or medication[12].”
  13. Bronfort G, et. al. – “Our data synthesis suggests that recommendations can be made with some confidence regarding the use of spinal manipulative therapy and/or mobilization as a viable option for the treatment of both low back pain and neck pain[13].”

There you have a fairly thick list of research papers demonstrating the effectiveness of chiropractic adjustments for uncomplicated neck pain but neck pain is not the only reason to have a chiropractic adjustment delivered to the cervical region. Another very common reason for neck adjustments would be for the treatment of acute and chronic headaches.

In fact, I have an episode of this podcast that dealt with a paper showing the effectiveness of chiropractic for headaches. Episode #6 to be exact.

Here is a listing of papers demonstrating the benefits of cervical manipulation for headaches. Each paper mentioned includes a short description of the conclusion for each paper cited. Also each of these papers is referenced in the show notes and can be very easily reviewed independently

  1. Malo-Urries M, et. al. – “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache[14].”
  2. Espi-Lopez GV, et. al. – “In short, manual therapy techniques and manipulation applied to the suboccipital region for four weeks or more showed great improvement and in effectiveness for several aspects that measure the quality of life of a patient having suffered from tension type headaches[15].”
  3. Dunning J, et. al. – “Six to eight sessions of upper cervical and upper thoracic manipulation were shown to be more effective than mobilization and exercise in patients with cervicogenic headache, and the effects were maintained at 3 months[3].”
  4. Hurwitz EL, et. al. – “Utilization and expenditures for headache treatment increased from 2000 to 2009 across all provider groups. MD care represented the majority of total allowed charges in this study. MD care and DC care, alone or in combination, were overall the least expensive patterns of headache care. Risk-adjusted charges were significantly less for DC-only care[16].”
  5. Bronfort G, et. al. – “SMT appears to have a better effect than massage for cervicogenic headache. It also appears that SMT has an effect comparable to commonly used first-line prophylactic prescription medications for tension-type headache and migraine headache[17].”
  6. Bronfort G, et. al. – “Chiropractic is effective in acute, subacute, and chronic low back pain, migraines and headaches originating from the neck, for the treatment of some forms of dizziness, extremity and joint issues, as well as mid back and acute and subacute neck pain[18].
  7. Tuchin PJ, et. al. – “The results of this study support previous results showing that some people report significant improvement in migraines after chiropractic spinal manipulative therapy. A high percentage (>80%) of participants reported stress as a major factor for their migraines. It appears probable that chiropractic care has an effect on the physical conditions related to stress and that in these people the effects of the migraine are reduced[19].”
  8. McCrory D, et. al. – “Cervical spinal manipulation was associated with improvement in headache outcomes in two trials involving patients with neck pain and/or neck dysfunction and headache. Manipulation appeared to result in immediate improvement in headache severity when used to treat episodes of cervicogenic headache when compared with an attention-placebo control. Furthermore, when compared to soft-tissue therapies (massage), a course of manipulation treatments resulted in sustained improvement in headache frequency and severity[20].”

Many headache patients present to chiropractors after a considerable amount of time spent taking headache and migraine medications. Medications do not come without consequences. Certainly when taking long-term. Not only have they spent a considerable amount of time on medication, they often have had botox injections, steroid injections, and worse before finally going to the chiropractor.

It is a fact that patients should have the GUARANTEED of the best treatment that does the LEAST amount of harm. In that spirit, and considering that chiropractic is safe, effective, and non-pharmacologic, it makes sense that the medical field should actually PROMOTE chiropractic as a viable and valuable treatment for headaches and migraines rather than dismiss it as ineffectual and dangerous.

Having demonstrated study upon study validating the effectiveness and benefit of cervical manipulation for neck pain (acute, subacute, and chronic) and headaches (chronic, acute, subacute, tension-type, cervicogenic, and migraines), we can now focus attention on research papers and abstracts having to do with the risk of stroke instance (lack of risk) as a direct result of cervical chiropractic adjustments. Hopefully, you are getting a more clear picture of the chiropractors cause strokes myth and its absolutely foolishness.

But first, where would you think the idea of chiropractors running around stroking everyone out might come from? I believe there are at least a few root sources.

  • You guessed it: our old friend the American Medical Association and their state association underlings. This group deemed it unethical to refer to chiropractors or accept referrals FROM They tried to run us out of business by conducting conferences about chiropractic and generating literature that was anti-chiropractic. They then dispersed the misinformation down through the channels of the state medical associations all the way out to the medical doctors, nurses, and medical field profession out in the field, and then ultimately to their patient bases. The “Chiropractors Cause Strokes” myth was well within their ability to propagate. When your initiative is to rid the Earth of the chiropractic profession, you take advantage of what you can. The Federal Court decision in Wilk vs. AMA shows the AMA did just that.
  • The other likely culprit for the chiropractors cause strokes myth in my estimation would be patients visiting medical professionals after having been to a chiropractor and having suffering a stroke sometime afterward. I did not say chiropractors “causing” strokes. Research shows us that people are going to chiropractors already suffering arterial tears that are sometimes spontaneous in nature. While chiropractors have a high level of education, there are many out there that are simply untrained at catching red flags and making the proper referral. Other times, patients present with very common symptoms and there are no red flags present whatsoever. The chiropractor treats the patient thinking they are going to help improve a neck complaint or a headache while in reality they may be exacerbating a tear. When the patient reaches the medical professional, the link is easy to make for the uninformed: chiropractor causes stroke.
  • Ignorance – The simple lack of knowledge regarding the body of evidence and research that is available dealing with the chiropractors cause strokes myth perpetuates the myth. It is clear the benefits are present. It is clear the risks are not. End of story. But if one is ignorant of the literature,

This is where we are going to stop for this second episode of the chiropractors cause strokes series. Remember, it is a three part series.

KEY TAKEAWAY:

The benefit is researched and it’s real. There is no denial possible.

Be sure to tune in next week for the third and final part of the three part series. Next week, we will discuss risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information.

Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think or what suggestions you may have for us for future episodes

If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.

We cannot wait to connect again with you next week for third and final part of the debunking of the chiropractors cause strokes myth. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

Other episodes of interest include:

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

Source Material

  1. Korthals-de Bos IB, Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial. British Medical Journal, 2003. 326(7395): p. 911.
  2. Dewitte V, Articular dysfunction patterns in patients with mechanical neck pain: a clinical algorithm to guide specific mobilization and manipulation techniques. Man Ther, 2014. 19(2-9).
  3. Dunning J, Upper cervical and upper thoracic manipulation versus mobilization and exercise in patients with cervicogenic headache: a multi-center randomized clinical trial. BMC Musculoskeletal Disorders, 2016. 16(64).
  4. Bronfort G, Spinal Manipulation, Medication, or Home Exercise With Advice for Acute and Subacute Neck Pain: A Randomized Trial. Annals of Internal Medicine 2012. Ann Intern Med, 2012. 156(1): p. 1-10.
  5. Puentedura EJ, Development of a clinical prediction rule to identify patients with neck pain likely to benefit from thrust joint manipulation to the cervical spine. J Orthop Sports Phys Ther, 2012. 42(7): p. 577-92.
  6. Yu H, Upper cervical manipulation combined with mobilization for the treatment of atlantoaxial osteoarthritis: a report of 10 cases. J Manipulative Physiol Ther, 2011. 34(2): p. 131-7.
  7. Puentedura EJ, Thoracic spine thrust manipulation versus cervical spine thrust manipulation in patients with acute neck pain: a randomized clinical trial. J Orthop Sports Phys Ther, 2011. 41(4): p. 208-20.
  8. Miller J, Manual therapy and exercise for neck pain: a systematic review. Man Ther, 2010. 15(4): p. 334-54.
  9. Hurwitz EL, e.a., Treatment of neck pain: noninvasive interventions: results of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders. Spine, 2008. 33(4 Suppl): p. S123-52.
  10. Muller R, G.L., Long-term follow-up of a randomized clinical trial assessing the efficacy of medication, acupuncture, and spinal manipulation for chronic mechanical spinal pain syndromes. J Manipulative Physiol Ther., 2005. 28(1): p. 3-11.
  11. Zhu L, Does cervical spine manipulation reduce pain in people with degenerative cervical radiculopathy? A systematic review of the evidence, and a meta-analysis. Clin Rehabil, 2015.
  12. Giles LGF, M.R., Chronic spinal pain syndromes: a clinical pilot trial comparing acupuncture, a nonsteroidal anti-inflammatory drug, and spinal manipulation. J Manipulative Physiol Ther, 1999. 22(6): p. 376-81.
  13. Bronfort G, Efficacy of spinal manipulation and mobilization for low back pain and neck pain: a systematic review and best evidence synthesis. Spine, 2004. May-Jun 4(3): p. 335-56.
  14. Malo-Urries M, Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial. J Manipulative Physiol Ther, 2017. 40(9): p. 649-658.
  15. Espi-Lopez G, e.a., Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial. Eur J Phys Rehabil Med, 2016. 13(1): p. 4-13.
  16. Hurwitz EL, e.a., Variations in Patterns of Utilization and Charges for the Care of Neck Pain in North Carolina, 2000 to 2009: A Statewide Claims’ Data Analysis. J Manipulative Physiol Ther, 2016. May 39(4): p. 240-51.
  17. Bronfort G, Efficacy of spinal manipulation for chronic headache: a systematic review. J Manipulative Physiol Ther, 2001. 24(7): p. 457-466.
  18. Bronfort G, Effectiveness of manual therapies: The UK evidence report. Chiropr Osteopat, 2010. 18(3).
  19. Tuchin PJ, e.a., A randomized controlled trial of chiropractic spinal manipulative therapy for migraine. J Manipulative Physiol Ther, 2000. 23(2): p. 91-95.
  20. McCrory D, Behavioral and Physical Treatments for Tension-type and Cervicogenic Headache. Duke University Evidence-based Practice Center, Center for Clinical Health Policy Research.


SUBSCRIBE!

CF 013: DEBUNKED: The Odd Myth That Chiropractors Cause Strokes (Part 1 of 3)

This week, we are going to start tackling the chiropractors cause strokes myth that has run rampant for years and I hope to once and for all dispel it. The information could not be clearer on the chiropractors cause strokes myth and we’re gonna to show it to you in a way that you can understand and in a way that allows you to show it to others. I’m done with this myth, folks!

Before we get started, I want to draw your attention to the reviews over at iTunes. If you would be kind enough to leave us a great review we sure would appreciate you! This is a new podcast and we need all the help we can get!

Right now though, it’s time for bumper music!

Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, chiropractic advocacy, and research. Thank you for taking time out of your day I know your time is valuable and I want to fill it with value so here we go.

Unfortunately, you have often read, watched, or heard me complaining about how our profession has been historically attacked by those organizations in charge of the medical profession. I hope those paying attention understand it is not just sour grapes.

It is education.

I continually bring these facts up in my articles, videos, and podcast because many of the things we talk about have their roots in our history, in the attacks our profession has sustained, and in the attacks our profession is currently battling.

From the start, let me state that research simply does NOT support the chiropractors cause strokes myth.

If you have seen the TV series called “Mythbusters,” then you know the smart red-headed guy and the bald bespectacled serious guy both, along with their rascally cohorts, took a common myth and tested its validity.

Some of the myths were outrageous and some seemed like they may actually be plausible. The show, whenever I watched it was highly entertaining and extremely educational. The entertaining part always came toward the end of the show when they would blow something to smithereens. That’s the part where the inner child in me would leap with glee. Internally of course, not externally.

This mythbusting process has already been carried out for the chiropractors cause strokes myth. Several times, in fact. Without the show-ending explosion of course. Although, at the end of this Mythbusting series, I may walk away with a mic drop if you’re all OK with that.

I say mythbusting series because there is SO MUCH information here that I have to split it into 3 different episodes for the chiropractors cause strokes podcast series. I’m pumping my own tires and I am completely full of myself on what I’m about to say here and I’m well-aware of the fact but, from what I have seen out there on the interwebs, I feel like this is, or at least CAN be, the definitive article, the definitive podcast, the definitive gathering of the information for this topic. If that is indeed the lofty goal I’m aiming for, it has to be comprehensive and somewhat exhaustive and I don’t think I can maintain your focus and interest for the entire amount of the information to be compiled into one super long episode. Dispelling the chiropractors cause strokes myth is too important to lose your attention.

I have split it into three episodes that will break up like this

The first episode, the one you’re currently listening to will include some risky odds, some case specific discussion, some signs and symptoms of vertebral artery dissection, and some research dealing with common treatments within the medical profession.

In the second episode coming next Thursday we will discuss research papers demonstrating and validating benefits of having cervical manipulation treatments. Or chiropractic adjustments to the neck. We will talk about the benefits, according to research, for neck pain as well as for headaches. And we’ll also talk a little about where this chiropractors cause strokes myth came from and why it perpetuates to this day.

In the third and final episode we will discuss risky interventions, papers having to do with the risk, or lack thereof, of chiropractic adjustments to the cervical region specifically, and then a wrap up of the information on this chiropractors cause strokes myth.

Stick with us on this.

Now, let’s dive into this first episode of the chiropractors cause stroke series.

Through the RAND institute, it is estimated that a serious, adverse reaction (such as stroke as a result to a chiropractic adjustment alone) happens in approximately 1 out of every 1 million treatments?

Let’s put that finding into perspective by comparing it to some other odds.

  • The odds of being struck and killed by lightning is 1 in 174,426 according to the National Safety Council.
  • The odds of being told to “Come on down,” on The Price Is Right is 1 in 36!
  • The odds of being born with 11 fingers or toes is 1 in 500.
  • The odds of dying from a firearms assault is 1 in 113.
  • How about this one: the odds of winning an Oscars are 1 in 11,500.

I think it’s time to move to LA!

Consider that there are 70,000+ chiropractors in the United States of America. If Doctors of Chiropractic were out in the world causing strokes “all of the time,” it would be apparent, it would be obvious, and our malpractice insurance would reflect the fact that a visit to the chiropractor comes with a considerable amount of risk. To the contrary, we chiropractors have malpractice insurance that costs chiropractors approximately 1/10th of what it costs our medical counterparts. This fact alone should dispel the chiropractors cause strokes myth.

Before we start diving off into the research too deeply, I want to talk about a case that happened within the last couple of years (February 2016) that brought the “Chiropractors Cause Strokes” myth back to the forefront. It had to do with the “Queen of Snapchat” Katie May. Katie died of a stroke at the age of 34 and, by many, it was immediately assumed the stroke was caused by her two visits to a chiropractor to treat her recent onset of neck pain.

I actually wrote about this case shortly after it originally happened. Initial reports stated that she had a horrible fall while on the set of a photoshoot, which resulted in her neck pain. Then, for some reason, this fact seemed to disappear from further reports.

Also, initial reports stated that Katie visited either the ER or a medical professional prior to her visits with a chiropractor. The family later denies this so, admittedly, there is some confusion on the matter. With this information brought back into the reporting, let’s begin breaking it all down.

Katie posted this message to Twitter: “Pinched a nerve in my neck on a photoshoot and got adjusted this morning. It really hurts! Any home remedy suggestions loves? XOXO.”

Keep that in mind as we run through things that can cause a vertebral artery dissection such as Katie May suffered. They are as follows:

  • Physical Trauma (direct blow to the neck, traffic collision, etc.)
  • Strangulation
  • Spontaneous (from underlying connective tissue disorder)

According to one paper by Debette et. al., “Trauma has been reported to have occurred within a month of dissection in 40% with nearly 90% of this time the trauma being minor[1]. “

Vertebral artery dissection (VAD) can be particularly difficult to diagnose without the use of a CT Angiogram. For instance, some common symptoms of VAD are as follows:

  • Pain and/or numbness in the same side of the face.
  • Head pain/Headache that develops gradually and can be dull or throbbing
  • In less than 1/5th of the cases of VAD, people suffer difficulty speaking or swallowing.
  • Possible unsteadiness or lack of coordination
  • Visual abnormalities
  • Hiccups
  • Nausea/Vomiting
  • Hearing loss

When one reads this list, it is easy to diagnose a VAD, right?

It rarely presents with these classic signs.

Is a medical professional or chiropractor going to refer every single one of these patients for a CT Angiogram or an MRI? Not very likely. It is simply not economically feasible to do so and good luck getting insurance companies to cover the costs of the CT Angiograms!

If Katie did indeed visit a medical professional after her fall, they missed it. Unfortunately, it seems obvious that the chiropractor missed it as well. That does not, however, mean the two professionals are inept. As the website for emedicine.com states, “The focal signs may not appear until after a latent period lasting as long as three days, however, and delays of weeks and years also have been reported[2].”

With that being said, I don’t want to be completely biased here. If a healthy person shows up with a headache and neck pain BUT has a history of recent trauma, more exploration is advised, without question. Knowing this, I can relay countless stories of medical doctors having made bad decisions as well. I have heard countless stories throughout my twenty years of practice. Ultimately, we are all human which is why chiropractors and medical doctors both carry malpractice insurance. But, as I mentioned before, chiropractors’ malpractice is approximately 1/10th that of their medical counterparts because, basically, we do not typically cause any harms in our patients.

As we go through more and more papers, it should be clear that Katie likely suffered the VAD as a result of the fall during the photo shoot and the VAD was missed by the medical professionals (if she did indeed go) and then certainly missed by the chiropractor BUT, the chiropractor almost certainly did not CAUSE the VAD. There’s no we he helped it and could have even potentially exacerbated it, but it is highly doubtful and exceedingly rare that he could have been the CAUSE of it.

Some time later, the Los Angeles coroner reported that the chiropractor was responsible for Katie’s death. This finding really opened the door to all of the chiropractic haters to bash away at the profession.

The LA coroner’s office is an appointed position that, in some states, requires little training, to be quite honest. While I am unaware of this particular coroner’s level of training and expertise, this coroner has been under scrutiny for being understaffed and underfunded to mention just a couple of issues. In addition, I would argue that simply because a man or a woman is a county coroner, does not mean they are above being affected by bias or by their profession’s long-held beliefs and teachings. I would say they most certainly are not above influence and, in my opinion, are highly likely to be affected by them. When they are told by their schools, their national and state associations, and their mentors that chiropractors cause strokes, don’t you think they probably believe it?

I would also argue that the coroner likely has little to zero knowledge of the current body of research regarding cervical manipulation and the instance of stroke. How could an educated person aware of the body of literature on the matter decide otherwise?

For years, I have experienced nurses, physician assistants, medical doctors, and others in an online setting claiming that chiropractic adjustments are dangerous and ineffective. A common theme amongst them is, “It happens all of the time.” We see it “all of the time.” Research proves the notion is a lie.

I would like to be less dramatic or inflammatory in my wording but I do not know of another way to describe it.

Let’s assume that this myth has its base rooted in some sort of fact. Let us be clear. It does not. But, for argument sake, let us say that it does. At that point, we would need to assess the benefits of chiropractic treatment vs. the risks of chiropractic treatment.

In Southern terms, “Is the squeeze worth the push?”

Is there a return on the investment?

Again, this is purely for argument sake because the chiropractors cause strokes myth is not real to start with but playing the devil’s advocate can be of use and is almost always entertaining.

Before we step into deeper water with the research papers, let us discuss benefits & effectiveness vs. risk for some common treatments for spinal complaints in the medical world. If the discussion is focused on doing away with cervical adjustments, what then would be the alternatives and how effective are they? Basically, if the medical field is looking in OUR backyard, maybe we should take a peek into theirs as well.

Keep in mind that all of the research we discuss will be cited in the show notes so that those of you that wish can easily research these independently on your own.

  • The opioid crisis cost the US economy $504 billion dollars in 2015 and a total of $221 billion to $431 billion in lost economic output due to there being 33,000 opioid-related deaths in 2015[3].
  • There were 63,600 opioid-related deaths in 2016, which was an increase of 21% from the 2015.[4].
  • Chou R, et. al. – Although the steroid injections for radiculopathy showed some short-term relief in pain and short-term increase in function, the benefits seen in the patients were only small and short-term only. There was no effect long-term and no affect on whether or not the person had surgery eventually. The evidence in this paper suggested there was no effectiveness at all for the treatment of spinal stenosis[5].
  • Epstein N, et. al. – “Although not approved by the Food and Drug Administration (FDA), injections are being performed with an increased frequency (160%), are typically short-acting and ineffectiveover the longer-term, while exposing patients to major risks/complications[6].”
  • Peterson CK, et. al. – “Subacute/chronic patients treated with SMT (spinal manipulative therapy) were significantly more likely to report relevant “improvement” compared with CNRI (CERVICAL NERVE ROOT INJECTION) patients.There was no difference in outcomes when comparing acute patients only[7].”
  • Chou R, et. al. – “Epidural corticosteroid injections for radiculopathy were associated with immediate improvements in pain and might be associated with immediate improvements in function, but benefits were small and not sustained, and there was no effect on long-term risk of surgery. Evidence did not suggest that effectiveness varies based on injection technique, corticosteroid, dose, or comparator. Limited evidence suggested that epidural corticosteroid injections are not effective for spinal stenosis or nonradicular back pain and that facet joint corticosteroid injections are not effective for presumed facet joint pain[5].”
  • Chou R, et. al – “Surgery for radiculopathy with herniated lumbar disc and symptomatic spinal stenosis is associated with short-term benefits compared to nonsurgical therapy, though benefits diminish with long-term follow-up in some trials. For nonradicular back pain with common degenerative changes, fusion is no more effective than intensive rehabilitation, but associated with small to moderate benefits compared to standard nonsurgical therapy[8].”
  • Maghout J, et. al. – “Use of intervertebral fusion devices rose rapidly after their introduction in 1996. This increased use was associated with an increased complication risk without improving disability or reoperation rates[9].”

 

At this point, it is clear the medical field has its own issues to concentrate on and improve upon when it comes to spinal pain and the treatment of it. It is my opinion these facts are but only a few of the concerns in the medical field and, if taken individually, are much more concerning than any one single issue that can be found within the chiropractic profession.

This is where we are going to stop for this first episode of the Chiropractors cause strokes series. Remember, our” chiropractors cause strokes” series is a three part series.

Be sure to tune in next week for the second part of the three part series. Next week, we will be talking about the benefits, according to research, for neck pain as well as for headaches. And we’ll also talk a little about where this myth came from and why it perpetuates to this day.

You may also consider listening to a recent episode in which we covered some great new research on treating neck pain conservatively through chiropractic care. Check it out at https://www.chiropracticforward.com/2018/03/08/proven-means-to-treat-neck-pain/

­­­­­­­­Please feel free to send us an email at dr dot williams at chiropracticforward.com and let us know what you think about the chiropractors cause strokes myth or what suggestions you may have for us for future episodes.

If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website with more content, products, and chances to learn.

We cannot wait to connect again with you next week. From Creek Stone, my office here in Amarillo, TX, home of the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

 

References

  1. Debette S, “Pathophysiology and risk factors of cervical artery dissection: what have we learnt from large hospital-based cohorts?”. . Current Opinion in Neurology, 2014. 27(1): p. 20-8.
  2. Lang E. Vertebral Artery Dissection. Emergency Medicine 2017 January 18]; Available from: https://emedicine.medscape.com/article/761451-overview.
  3. Mutikani L. Opioid crisis cost U.S. economy $504 billion in 2015: White House. 2017; Available from: https://www.reuters.com/article/legal-us-usa-opioids-cost/opioid-crisis-cost-u-s-economy-504-billion-in-2015-white-house-idUSKBN1DL2Q0.
  4. Glenza J. Life expectancy in US down for second year in a row as opioid crisis deepens. 2017 December 21; Available from: https://www.theguardian.com/us-news/2017/dec/21/us-life-expectancy-down-for-second-year-in-a-row-amid-opioid-crisis.
  5. Chou R, Epidural Corticosteroid Injections for Radiculopathy and Spinal Stenosis: A Systematic Review and Meta-analysis. Ann Intern Med, 2015. 163(5): p. 373-81.
  6. Epstein N, The risks of epidural and transforaminal steroid injections in the Spine: Commentary and a comprehensive review of the literature. Surg Neurol Int, 2013. 4(Suppl 2): p. S74-93.
  7. Peterson CK, Symptomatic, Magnetic Resonance Imaging-Confirmed Cervical Disk Herniation Patients: A Comparative-Effectiveness Prospective Observational Study of 2 Age- and Sex-Matched Cohorts Treated With Either Imaging-Guided Indirect Cervical Nerve Root Injections or Spinal Manipulative Therapy. J Manipulative Physiol Ther, 2016. 39(3): p. 210-7.
  8. Chou R, Surgery for low back pain: a review of the evidence for an American Pain Society Clinical Practice Guideline. Spine, 2009. 34(10): p. 1094-109.
  9. Maghout J, e.e., Lumbar fusion outcomes in Washington State workers’ compensation. Spine (Phila Pa 1976), 2006. 31(23): p. 2715-23.

CF 007: Awesome Alternatives To High Blood Pressure Treatment

In today’s podcast, we are going to talk about high blood pressure, what happens, how many people it affects, and what we may be able to do to help it. Today is all about high blood pressure and I’m going to admit to you….in researching for this week’s podcast, even I learned new things about high blood pressure and I’m betting you will too. If you love what you hear, be sure to check out www.chiropracticforward.com. As this podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added.

Welcome to the podcast today, Dr. Jeff Williams here with Creek Stone here in Amarillo, TX and I’m your host for the Chiropractic Forward podcast where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a listen. I know your time is valuable and I will always try hard to fill our time with valuable content.

You have fallen head first into episode #7 this week and I want to welcome you. We are going to have more fun that headbutting an i-beam..which I actually did on accident one time when I was a kid. I was running away from someone while playing tag and was looking over my shoulder wrhen smack…now I have a scare on the side of my noggin 35-40 years later. This is how I am certain we will have more fun with this episode.

Speaking of fun, with this being a brand new podcast, I can’t tell you how much fun it is to check the stats of the show and see people tuning in and finding value in our ideas and in information we have to share with you.

I think it is responsible to start off with a disclaimer: I am not a cardiologist. I am a research-minded, evidence-based Doctor of Chiropractic that has seen a jillion people with high blood pressure throughout a 20-year career. The ideas and discussion to follow will be based on information derived from the Centers for Disease Control and Prevention, from the American Heart Institute, and from information shared through Dr. Stephen Sinatra of New York, who is a cardiologist and founder of the New England Heart Center. Ultimately, your blood pressure and heart health is something your primary practitioner and/or cardiologist should be monitoring consistently. Our intent here is not to “treat” anyone through the internet but to simply raise awareness and encourage you to pay attention and take steps to protect yourself if needed. Do not simply depend on information from the internet or Dr. Google as I call it. If you are suffering from high blood pressure (or think you might be) make an appointment with your primary today.

Now that we’ve taken care of that, let’s get going with an easy definition of high blood pressure. According to the American Heart Association, high blood pressure is when your blood pressure, the force of the blood flowing through your blood vessels, is consistently too high.

I want to tell you all why, at times, I should have high blood pressure. It’s because I have a teenager. Yes, I have a 15 year old high school kid and he’s why. Lol. Not really, as far as teenagers go, he could be soooo much worse. Other than his need to be right conflicting with my need to be right, he’s a sweetheart.

Other reasons may be a busted pipe in the pool house when we had a major freeze. I know I know…first world problems… I happen to be the owner of a european great dane…..enough said. That girl can tear some stuff up when she gets bored.

I also have a huge Leonberger dog. Look it up. They’re beautiful but the hair…I’m telling you, it’s a job to stay clean. I could make cushions out of the amount of hair that dog generates.

The animals at my house at this point would include two dogs, a cat (not my choice), two guineas, and two turtles..and that doesn’t even include my 10 year old daughter and my teenage son… I probably have some mice too if I’m guessing right.

Not to mention I’m an actively practicing chiropractor running a busy practice and all of the stressors that come with it. Own your own business they said, be your own boss they said….you’ll be able to do whatever you want. Heck, I don’t have time to think twice and I certainly don’t have a lot of time to sit around and generate content. I’m busy humpin it and making a living. I’m not out on the lecture circuit just yet and having dinner and a drink in the hotel bar. Lol. I’m at work all day every day. I have stress people!! That’s all I’m saying.

But seriously, I have actually been very fortunate and have not had to battle with high blood pressure yet. Thank the good Lord. I am just lucky I think.

From personal experience in treating patients, I have seen new patients having blood pressure counts of 200 over 110 before and they had NO IDEA their blood pressure was high. What does a chiropractor do in that instance? You may get different ideas from different chiropractors but I can tell you what THIS chiropractor does in those cases. I send them either directly to their primary practitioner or the urgent care, whichever they prefer. I won’t touch them as far as chiropractic treatment until the blood pressure is under control.

There is research we will discuss in a minute showing chiropractic is effective in controlling high blood pressure but I will not be the one trying to get it down when it is at that level. I’ll be the one trying to help once it’s normalized. That is simply my opinion and the way I choose to go about things in my practice. As I said, other chiropractors likely have other opinions and protocols.

Next, let’s discuss some high blood pressure facts from the Centers for Disease Control & Prevention that you may not already know about concerning WHO is commonly affected:

  • Did you know that about 75 million Americans suffer from high blood pressure? That’s about a third of the population. Another way of saying that is that 1 in every 3 people have high blood pressure. 
  • Unfortunately, only about half of the people with high blood pressure have the condition under control.
  • About 11 million adults in America have high blood pressure and don’t even know it.
  • High blood pressure costs America around $46 Billion every year when you account for the cost of health care services, medications, and days out of work.
  • High blood pressure affects women about as much as it affects men overall but under the age of 45, more men are affected. Over the age of 65, more women have the condition.
  • When we look at race, more black people have high blood pressure than do whites and Hispanics, and of the black people having it, more women are affected than men.
  • Women having high blood pressure that then become pregnant are more likely to have complications.
  • Uncontrolled high blood pressure during the midlife phase (45-65) seems to be linked to higher risks of dementia later in life.

Here are some of those random facts that you may be able to use in a game of Trivial Pursuit somewhere down the line:

  • Did you know that too little salt can contribute to high blood pressure? We commonly associate an excess of salt with high blood pressure but too little is an issue as well. According to Dr. Stephen Sinatra, a cardiologist from New York, it seems a good mix is keeping more than 1.8 grams of salt a day in your body while keeping sodium below 2.8 mg/day while keeping a close eye on hidden salts that can be found in canned soups, pickles, salted nuts, etc.
  • Potassium plays a part in healthy blood pressure so it’s likely a good idea to foods like eggplant, squash, bananas, coconut water, and baked potatoes.
  • It’s a good idea to have the blood pressure taken in both arms since the numbers are often different from one arm to the other.
  • Cardio is great but weight training can RAISE blood pressure. If you like to lift weights but suffer from high blood pressure, it would probably be a great idea to lift much lighter with higher reps in an attempt to bring down those numbers.

Now let’s talk about some of the causes of high blood pressure in patients:

  • Emotional stress
  • Being overweight
  • Environmental toxins
  • Smoking
  • Lack of exercise
  • Too much salt as well as too little salt
  • More than one or two drinks of alcohol per day.
  • Age
  • Genetics

What risks do you run when leaving your high blood pressure untreated or uncontrolled? As unpleasant as it may be to discuss, it can be as serious as you may have imagined. Here are the potential outcomes of untreated high blood pressure:

  • The CDC states that over 360,000 U.S. citizens died of high blood pressure in 2013 which totals about 1,000 deaths every single day.
  • High blood pressure increases your risk of having a heart attack, of having a stroke, of having long-lasting heart failure, and of having kidney disease.

Here’s brand new and very interesting research paper I wanted to take the time to discuss. It’s by AP Wong and is titled “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review(1).”

Why They Did It

The authors state that high blood pressure is responsible for about 12.8% of all deaths globally. Considering that staggering fact, the World Health Organization has targeted a 25% reduction in high blood pressure by the year 2025 and has encouraged more evidence and research into non-conventional methods of controlling high blood pressure.

How They Did It

  • The authors of the paper had two main objectives

1. Describe the therapeutic modalities commonly used in treating high blood pressure.

2. Review the current level of evidence that has been attained for each.

  • The researchers used a search from 2005-2013 of the databses MEDLINE, The Cochrane Library, PUBMED, and EMBASE.
  • 23 papers were found and accepted.
  • Modalities identified in the 23 papers were fish oil, qigong, yoga, coenzyme Q10, melatonin, meditation, vitamin D, vitamin C, monounsaturated fatty acids, dietary amino-acids, chiropractic, osteopathy, folate, inorganic nitrate, beetroot juice, beetroot bread, magnesium, and L-arginine.

What They Found

The following therapies had weak to no evidence for effectiveness in treating high blood pressure:

  • Fish oil
  • Yoga
  • Vitamin D
  • Monounsaturated fatty acid
  • Dietary amino-acids
  • Osteopathy

The following therapies showed significant reduction in blood pressure:

  • Chiropractic
  • Magnesium
  • Qigong
  • Melatonin
  • Meditation
  • Vitamin C
  • Folate
  • Inorganic nitrate
  • Beetroot juice
  • L-arginine

Coenzyme Q10 has differing results. Some studies showed it had weak to no effectiveness while other studies showed it to have significant effect on the reduction of high blood pressure.

Wrap It Up

In a quote from the authors conclusion, they said, “Results from this review suggest that certain non-conventional therapies may be effective in treating hypertension and improving cardiac function and therefore considered as part of an evidence-based approach.”

With all of the information combined from the articles used as source material, including the research paper, the Alternative means of treating high blood pressure may include:

  • CHIROPRACTIC – we will talk more about this in just a moment
  • Coenzyme Q10 – More discussion on Coenzyme Q10 later.
  • Magnesium
  • Ribose
  • L-arginine
  • RestricT carbohydrates
  • Use olive oil – consider adopting the use of the Mediterranean Pan-Asian diet which is a non-inflammatory diet.
  • Cutting sugar out of your diet is crucial for those suffering from high blood pressure.
  • Less alcohol is best but a glass of wine a day has shown benefits.
  • No processed juices from the grocery store. They’re packed full of useless and damaging sugars.
  • Exercise protocols
  • Lose weight – only a five pound reduction can make a difference
  • Stop smoking!
  • Qigong
  • Melatonin
  • Meditation
  • Vitamin C
  • Folate
  • Inorganic nitrate
  • Beetroot juice

Besides this study, there are several other suggesting Chiropractic plays an important role in reducing or controlling blood pressure.

In one from 1988 by Yates, et. al. called “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial,” they showed how anxiety and blood pressure were significantly reduced following chiropractic treatment(2).

In another very interesting study through the University of Chicago Medicine from March 14, 2007, and led by George Bakris, MD (director of the hypertension center at the University of Chicago Medical Center, researchers did the following:

  • They took 50 Chicago-area citizens having high blood pressure.
  • All had misaligned C1 vertebrae measured on x-ray
  • They were randomly divided into a treatment group consisting of a chiropractic adjustment and a sham group where no treatment was actually performed.
  • The participants were assessed at the beginning of treatment, after the chiropractic adjustment, and at the end of eight weeks.

What They Found

The authors stated that the improvement in blood pressure for both systolic and diastolic were similar to that seen when giving patients two different blood pressure medications at the same time. Not only that, but the reduction in the blood pressure continued in the eighth week!

Wow!!!

When Chiropractic is at its best, you cannot beat the risk vs reward ratio. Plain and simple. Spinal pain is a mechanical pain and responds better to mechanical treatment rather than chemical treatment such as pain killers, muscle relaxants, and anti-inflammatories.

Just another reason to call a chiropractor TODAY!

Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please feel free to send us an email at dr.williams@chiropracticforward.com and let us

know what you think or if you have any suggestions for future episodes. And remember

to help us spread the word by sharing our podcast with your colleagues, your friends,

and your family.

From Creek Stone in Amarillo, TX and the flight deck of the Chiropractic Forward

podcast, this is Dr. Jeff Williams saying upward, onward, & forward.

Research Citations

(1) Wong AP, et al. “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review.” Pak J Pharm Sci. 2018 Jan;31(1):237-244.

https://www.ncbi.nlm.nih.gov/m/pubmed/29348109/

(2) Yates RG, et. al. “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial.” J Manip Physical Ther. 1988 Dec;11(6):484-8.

https://www.ncbi.nlm.nih.gov/pubmed/3075649

(3) Bakris, G. Journal of Human Hypertension, advance online publication, March 2, 2007. Grassi, G. Journal of Human Hypertension, advance online publication, January 25, 2007.George Bakris, MD, director, hypertension center, University of Chicago. Marshall Dickholtz Sr., DC, Chiropractic Health Center, Chicago.

http://www.uchospitals.edu/news/2007/20070314-atlas.html

Other Source Material:

https://www.cdc.gov/bloodpressure/facts.htm

https://www.cdc.gov/features/highbloodpressure/index.html

https://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/The-Facts-About-High-Blood-Pressure_UCM_002050_Article.jsp#.WmYUYyOZNBw

https://www.drsinatra.com/6-surprising-blood-pressure-facts-everyone-should-know