Current Tendinopathy Thoughts & Chiropractic Vs. Medical Costs

CF 328: Current Tendinopathy Thoughts & Chiropractic Vs. Medical Costs Today we’re going to talk about Current Tendinopathy Thoughts & Chiropractic Vs. Medical Costs  But first, here’s that sweet sweet bumper music

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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. 
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You have found yourself smack dab in the middle of Episode #328 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 12).  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I have a good friend that just recently went through a health scare. As he told me, this is how it went; he was on his back porch or patio down on the Texas gulf when he woke up in the ER.  Yeah, it was about that simple. Just tooling around doing his stuff and the next thing you know, waking up in the hospital not knowing what the hell, where, why or come here from sic ‘em. 

He said, “Ultrasound was negative bilaterally for lower extremity DVT’s. Echocardiogram was negative for heart damage of clots. Labs negative for stroke or heart attack. Head and neck CT clear. All they found was chest CTA of pulmonary emboli. And I don’t know where they are in the lungs or if there’s 2 or 50.  I have no idea why or when I fell on my back porch. I could’ve been out 30 seconds or 6.5 hrs. There’s a lot I don’t know. It bothers the hell outta me. It was dumb luck or divine intervention I made it back inside to my phone to call 911. I remember about 90 seconds total of EMT’s.” Now, why am I telling you about my friend’s little journey, here??  Because it’s crazy and I’m glad he is still around to tell the tale. I told him that the only thing mildly comforting about it all is that when it’s our time to go, there is a good chance we won’t know it or feel it. 

That’s my positive take away.

And…..It’s a reminder to make our days count and tell our people how much we love them And…..it’s a helluva a reminder to work your butt off. That’s what we do when we’re trying to build a business, changer generational wealth for our family, and leave a legacy or sorts. BUT…..and it’s a big but that I’m so very guilty of to this very day…….make time for the work life balance and hugging your people. 

It’s a reminder for us to try our best to have goals and a dream but to be absolutely grateful and satisfied with the here and now as well. Today is the gift. We’re not guaranteed tomorrow. It’s hard to focus on that when you’re buried in the mud and muck but I want to strive to do better than I have been doing, being more positive, being more patient, being more understanding, but still just as driven and goal-oriented as I’ve always been.  We’re going to get tired no matter how much we make ourselves grin. But if we can keep an eye on our blessings and the good things and our friends and our family and our amazing patients, then I don’t know about you, but I bet my days will for sure be better overall.  I’m tired today. I’m poopered you might say.

My business has been slower due to a thing or two that are simply out of my hands. But, I’m grateful. I have health, I have my friends, family, and still have a pretty dang solid business and education. We gonna be fine.  See? I already feel better and thanks to my buddy who gave me his blessing to share the story with you.  He also asked me to share a blurb from James 4:14 that says, “Why, you do not even know what will happen tomorrow. What is your life? You are a mist that appears for a little while and then vanishes.”

Alright, lets get on with the research shall we? We got some good ones this week!

Item #1

The first one today is called, “Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice” by Canosa-Carro et al published in Disease-a-Month in October of 2022.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Lorena Canosa-Carro, María Bravo-Aguilar, Vanesa Abuín-Porras, Jaime Almazán-Polo, Guillermo García-Pérez-de-Sevilla, Isabel Rodríguez-Costa, Daniel López-López, Emmanuel Navarro-Flores, Carlos Romero-Morales, Current understanding of the diagnosis and management of the tendinopathy: An update from the lab to the clinical practice, Disease-a-Month, Volume 68, Issue 10, 2022, 101314, ISSN 0011-5029, https://doi.org/10.1016/j.disamonth.2021.101314. (https://www.sciencedirect.com/science/article/pii/S0011502921001905)

Why They Did It

Tendinopathy is currently diagnosed as a clinical hypothesis based on the patient symptoms and physical context. One of the main goals of current clinical management is to personalize treatment approaches to adapt them to the many different needs of the population. Even when the pathoetiology of tendinopathy is unclear, there is a wide array of treatments available to treat and manage tendinopathy. Although tendinitis usually debuts with an inflammatory response, the majority of chronic tendinopathies do not present inflammation and so the choosing of treatment should vary depending on severity, compliance, pain and duration of symptoms.

This research paper examines tendinopathy, a common overuse injury. While the exact cause is unclear, repetitive stress likely plays a role.  Common treatments focus on managing symptoms and preventing future issues. Exercise, especially eccentric exercises, is the gold standard for treatment. However, other exercises like isometric training may also be helpful. Importantly, increasing exercise load gradually (10% rule) is crucial to avoid further injury.

Wrap It Up Current advances and research in tendinopathy shows that even though there is still a lot we do not know, conservative treatment through exercise and load management should be the first source of treatment, aided by other conservative treatments like ShockWave.  Surgical approach should only be used as a last resource once the conservative options have failed after six to twelve months of treatment.  Future research lines are necessary in order to achieve a consensus of exercises dosage, intensity and type.


Item #2

Our last one today is called “Cost of chiropractic versus medical management f adults with spine-related musculoskeletal pain: a systematic review” by Farabaugh et al and published in Chiropractic & manual Therapies in 2024 and it’s gettin hot in here!

Farabaugh, R., Hawk, C., Taylor, D. et al. Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review. Chiropr Man Therap 32, 8 (2024). https://doi.org/10.1186/s12998-024-00533-4

Why They Did It

The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain.

How They Did It

A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain. The search included economic studies, randomized controlled trials and observational studies. All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators.

What They Found

The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility. Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial.  All included studies were rated as high or acceptable quality. Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures.

Wrap It Up

Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management.  The included studies were limited to mostly retrospective cohorts of large databases. Given the consistency of outcomes reported, further investigation with higher-level designs is warranted. 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!


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. 


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 – Diplomated of the International Academy of Neuromusculoskeletal Medicine (DIANM) 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