text neck

Breathing Through The Pain, Need For Rehab, & Forward Head Posture And Shoulder Pain

CF 164: Breathing Through The Pain, Need For Rehab, & Forward Head Posture And Shoulder Pain

Today we’re going to talk about the impact of chiropractic care on opioid use and then we’ll talk about garbage marketing in the chiropractic profession. I go off a bit. I can’t help it. They make me nuts. 

But first, here’s that sweet sweet bumper music.

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  If this episode has a different type of sound quality when compared to previous episodes, my main computer died. It choked a little and held it’s belly and rolled around in agony for about a month and then…..sadly, it straight up and died. 

So, I have another ordered and in the meantime, I’m figuring out how to do this through my MacBook Pro. Where there’s a will, there’s a way. We’ll make it happen.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

  • Like our Facebook page, 
  • Join our private Facebook group and interact, and then 
  • go review our podcast on iTunes and other podcast platforms. 
  • We also have an evidence-based brochure and poster store at chiropracticforward.com
  • While you’re there, join our weekly email newsletter. 

You have found yourself smack dab in the middle of Episode #164 Now if you missed last week’s episode, we talked about opioids and spinal pain and then we talked about vitalists’ scripts. That was about the point that I lost my mind momentarily. Because they make me crazy and all.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Wow, what a week I had last week, y’all. And I’m not talking in a good way. Oh hell no. This was one of those kick you in the face and in the backside. And when you’re falling to the ground, putting a boot in your ribs for good measure.  One word, two syllables. Day-um.  For patients that I’m comfortable with, it’s common for them to ask me how my day’s going and my go-to answer is usually something similar to, “Ah you know….pissing excellence. As usual. It becomes a habit after a while.” Yeah, not last week. I wasn’t the windshield. I was the bug. 

First thing’s first, on last Tuesday, my longest tenured employee and office manager turned in her resignation. Over 11 years, down the drain. She’s not just a staff member. She’s become my little buddy. She’s hilarious. She was also our marketing girl. Definitely a boot to the face. Pow.  But there are a lot of positives there as well. Being my longest employed staffer, she was also my highest paid so we will save a good chunk of money. We just need to make some adjustments on the marketing and things of that nature.  Then, on Wednesday, as mentioned previously, we joined the Wealthability program and we had a meeting with our new accountants they matched us with. They’re out in St. Louis. Well, they found that our previous CPA was wrong and now we have to pay a gob in taxes we weren’t expecting to pay. We can spread it out over an amount of time and it’s fixable but day-um…..

Come on man.

When you hire professionals, you expect a professional job that will prevent you from getting into trouble. Don’t you? That was a kick to the nether regions. Smack.  Then, later that afternoon, my main computer that has my entire life on it straight up died. Luckily, it had slowed a bit and I called my computer guy to come in and back it up so it can be replicated on another computer. Still, that computer won’t be here for 2 damn weeks.  Kick to the shin. Thunk. 

Then, two of my girls got the second vaccine shot and both got sicker than dogs. One missed work on Wednesday. Not that big of a deal. Just kind of sucked.  Then I got a visit from a connection that works in my Dad’s nursing home. She came to my house on Thursday night after work to tell me my Dad is being mistreated and is withering away.  Stomp to the noggin while I’m down. Snap.  There were some other little things here and there but you get the picture. Rough week. But we’re on the mend.

We’re heading the right direction this week I think. We have some good ideas and I think we are going to make some changes.  So, as a learning lesson, bad things can be used for an impetus to change course and go in a positive direction. For example, I’ve begun going down the path of fully integrating. I’m saving enough money with the departure of my manager that I can use that money toward integrating and hiring a nurse practitioner. 

This would fit my long term plan of being able to remove myself from my day to day practice. It’s a piece of the puzzle. The final piece of the puzzle would be hiring an associate. At that point, I believe my time begins to get freed up a bit.  Hopefully in five years, I’m mentoring my colleagues and teaching them how to accomplish what I’ve accomplished. I’m sharing wisdom with hungry evidence-based chiros and spreading the good news about evidence-based, patient-centered chiropractic care.  We’re going to get there.  In other news, last week wasn’t a total loss. You may have seen where the Texas Chiropractors, after a ten-year battle, put the smackdown on the Texas Medical Association. People’s elbow, Kabam!!

The biggest bully of bullies got slapped the hell around by the Texas Chiropractic Association and the Texas Board of Chiropractic Examiners at the Texas Supreme Court level.  Just briefly, the TMA had sued the TCA and the TBCE approximately 10 years ago over our right to perform the VONT testing. Also known as vestibulo-ocular nystagmus test. Then that morphed into attacking our rights to diagnose and our rights to treat the Neuromusculoskeletal system rather than just the musculoskeletal system. Seemingly silly little things but, if they had won, technically, we couldn’t treat anything having to do with ‘nerve’ and we couldn’t have diagnosed our own patients so we’d depend on referrals from medical professionals……and how do you think that would have turned out in the long run?

Not good for an chiropractor on the planet because other medical associations would have precedence and would have repeated the process. Those of us in leadership positions for the TCA have been well-aware for the last decade that if we lost this case, we would be the first domino and it would effect every other chiropractor.  We lost, then we lost the appeal, then the Texas Supreme Court gave us the win. And the Texas Medical Association, the most predatory state medical association in the United States, has to cover the court costs. Oh, and on top of that, they can suck it.  We are going to have an entire episode where I’ll be joined by my fellow TCA members. Folks that have been the deepest in the trenches on this case and know every in and out of the entire process.  It’s going to be a good one so keep a lookout for that one.  Alright, let’s get to the good stuff shall we?

Item #1

This first one is called, “Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms” by Jafari, et. al. (1) and published in the Journal Of Pain in September/October of 2020. It’s not a lot hot but hot enough!

Why They Did It

This study sought to investigate effects of instructed breathing patterns on experimental heat pain and to explore possible mechanisms of action

How They Did It

  • In a within-subject experimental design, 48 healthy volunteers performed 4 breathing patterns: 
      1. Unpaced breathing, 
      2. Paced breathing (PB) at the participant’s spontaneous breathing frequency, 
      3. Slow deep breathing at 6 breaths per minute with a high inspiration/expiration ratio (SDB-H), and 
      4. Slow deep breathing at 6 breaths per minute with a low inspiration/expiration ratio (SDB-L)
  • During presentation of each breathing pattern, participants received painful heat stimuli of 3 different temperatures and rated each stimulus on pain intensity
  • Respiration, heart rate, and blood pressure were recorded.

What They Found

Compared to unpaced breathing, participants reported less intense pain during each of the 3 instructed breathing patterns.

Wrap It Up

Slow deep breathing is more efficacious to attenuate pain when breathing is paced at a slow rhythm with an expiration that is long relative to inspiration, but the underlying mechanisms remain to be elucidated. Oh…..elucidated. That’s a $5 word for the research crew there. Congrats on elucidated, folks. 

CHIROUP ADVERTISEMENT

Item #2

This one is called, “Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019” by Cieza, et. al.  (2) and published in The Lancet on December 19, 2020. Smokin’, sizzlin’, steamy pot of chili pie.  I have learned, by the way, that Frito Pies are not an American thing.  It’s just mostly a Texan thing. I have eaten Frito pies my whole damn life and didn’t figure this factoid out until just a few years ago. I play Call Of Duty here and there on xbox.

I know….I’m a nerd but I’m a killing’ nerd on occasion! I can kill real people in a fake way right there with the best of them when I want to. And I have my glasses on. And I haven’t had any more than a few beers. Lol.  Anyway, I play with a dude from Louisville, KY and he’d never heard of Frito pies. Holy cow people. There are some things you need to get tuned into if you’re not from Texas. They are as follows:

    • Frito Pie
    • Fried Okra
    • Fried squash. 

Yes, all are terrible for you so…..as a priest told me at the bar back when I went to college in Louisiana and was asking him how this whole ‘priest being in a bar’ worked out….he said, “Everything in moderation, Brother.” We should probably get back to the paper, Y’all. 

Why They Did It

Rehabilitation has often been seen as a disability-specific service needed by only few of the population. Despite its individual and societal benefits, rehabilitation has not been prioritized in countries and is under-resourced. We present global, regional, and country data for the number of people who would benefit from rehabilitation at least once during the course of their disabling illness or injury.

How They Did It

To estimate the need for rehabilitation, data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 were used to calculate the prevalence and years of life lived with disability of 25 diseases, impairments, etc. 

What They Found

  • Globally, in 2019, 2.41 billion individuals had conditions that would benefit from rehabilitation, contributing to 310 million years of life lived with disability
  • This number had increased by 63% from 1990 to 2019
  • The disease area that contributed most to prevalence was musculoskeletal disorders with low back pain being the most prevalent condition in 134 of the 204 countries analyzed.

Wrap It Up

The authors wrap up their thoughts with this, “To our knowledge, this is the first study to produce a global estimate of the need for rehabilitation services and to show that at least one in every three people in the world needs rehabilitation at some point in the course of their illness or injury. This number counters the common view of rehabilitation as a service required by only few people. We argue that rehabilitation needs to be brought close to communities as an integral part of primary health care to reach more people in need.”

I will add that the vitalists that think they can only adjust their way out of every damn condition or complaint need to get in the back of the line and just keep quiet. If you are going to be current rather than look like a dumb dumb, then you need to understand that a good, learned chiropractor knows that we do not only mobilize with adjustments, stretching, and things of that nature. But we also much know when to stabilize through strengthening activities.  If you’re just hitting the high spots on all of your patients, you need to be better and raise you game. Mr. Vitalist…..I’m talking to you. 

Item #3

The last one today is called, “Does forward head posture change subacromial space in active or passive arm elevation?” By Dehqan, et. al. (3) and published in the Journal of Manual and Manipulative Therapy on November 30, of 2020 and that’s about the right amount of hot Why They Did It Forward head posture (FHP) is one of the most common musculoskeletal disorders that appears to affect the shoulder joint through the shared muscles between the head and neck area and the shoulder girdle. The present study compared the acromiohumeral distance between individuals with normal head and neck alignment and those with moderate and severe FHP in active and passive arm elevation.

How They Did It

  • Based on the craniovertebral angle, 60 volunteers were selected and equally distributed among three groups, including group one with normal head and neck alignment, group two with moderate FHP and group three with severe FHP
  • The space between the humeral head and the acromion was measured in 10°, 45° and 60° of active and passive arm elevation as the acromiohumeral distance.

What They Found

  • The acromiohumeral distance was only different between the three groups at 45° arm elevation angle, and this difference was significant between groups one and three
  • In active and passive arm elevation, increased arm elevation angle reduced the subacromial space significantly
  • Also, in each arm elevation angle, the subacromial space differed significantly between the active and passive arm elevations.

Wrap It Up

They concluded, “The acromiohumeral distance was significantly lower in the severe FHP group than the group with normal head and neck alignment in the 45° active arm elevation angle, which could be due to the changed tension in tissues between active and passive arm elevation and also the maximum muscle activity in the 45° active arm elevation angle.”

Shoulder impingement folks.

I didn’t know anything about it until I went through he DACO program. Which is now the Neuromusculoskeletal Diplomate. It’s a real estate issue and when you have an upper cross type setup, forward head posture, you decrease the real estate.  Increase the real estate, decrease the issue in this sort of a setup.  Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. 

Store

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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 preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

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

Contact

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

Connect

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

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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

  1. Hassan Jafari, Ali Gholamrezaei, Mathijs Franssen, Lukas Van Oudenhove, Qasim Aziz, Omer Van den Bergh, Johan W.S. Vlaeyen, Ilse Van Diest, Can Slow Deep Breathing Reduce Pain? An Experimental Study Exploring Mechanisms, The Journal of Pain, Volume 21, Issues 9–10, 2020, 1018-1030
  2. Cieza A, Causey K, Kamenov K, Hanson SW, Chatterji S, Vox T, Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: a systematic analysis for the Global Burden of Disease Study 2019. 396 (10267), P2006-2017, December 19, 2020.
  3. Behdokht Dehqan, Cyrus Taghizadeh Delkhoush, Majid Mirmohammadkhani & Fatemeh Ehsani (2020) Does forward head posture change subacromial space in active or passive arm elevation?, Journal of Manual & Manipulative Therapy, DOI: 10.1080/10669817.2020.1854010

 

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

CF 050: Chiropractic Care – Text Neck, Headaches, Migraines

Today we’re going to talk about headaches, migraines, neck pain, and our favorite topic here at the Chiropractic Forward Podcast, yes….we’ll talk about Chiropractic care. Specifically, chiropractic care for the headaches, migraines, and neck pain. 

Hold on though, make way, get in the Soul Train dance line because here’s that bumper music

Integrating Chiropractors

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

You have skidded all fast and furiously into Episode #50

Let’s talk a bit about the DACO program. For those that don’t know, that’s the Diplomate of American Chiropractic Orthopedists program I’m slowly trudging through. 

I say slowly. You have 3 years to finish. But, I’m a doer if you can’t tell. I’m a worker bee if you will. When I start something, I want to finish. I don’t like unfinished bidness. I don’t like things flapping out in the wind. I want to start it and then I want to finish it quickly and move on to the next thing. 

Getting 300 hours is never going to get done quickly. Especially when you are the sole doctor in a busy practice not getting home until 7 pm or even later sometimes. Such is my life. A curse and a blessing depending on the day and my outlook on that particular day. 

However, I believe I’m on a path to finish it up in about a year from when I started. Probably much sooner. For example, I knocked out 12 hours last week. That’s pretty solid but, we had a snow day and I took advantage of being stuck at home. 

I crawled down into my basement man cave, got in my blankie and jammies with an iPad on my belly, leaned the recliner back and got some education. 

So far, I have 40 hours of the 250 online hours done and 40 hours of the 50 live hours required. In total, I’m 80 hours into a 300-hour course. Rocking and rolling folks. Rocking and rolling. 

Some of the more recent courses I’ve completed were hip pain in children, joint hypermobility disorders, TMJ, and thoracic outlet syndrome. These courses are fascinating. 

The offer is there. If you need help getting started on yours, send me an email at dr.williams@chiropracticforward.com I’ll be glad to get you on your way. 

Speaking of getting in touch, I want to ask you to go to chiropracticforward.com and sign up for our newsletter. It makes everything easier. 

Now onto a discussion that took place on our Facebook page a couple of weeks ago that I thought was particularly interesting. 

I will put it in the show notes for you if you’d like to see the meme….funny word. My son loves it when we mispronounce it. You should try it with your kids if they’re old enough to get embarrassed by their parents.  

Anyway, the picture I posted was of a contemplative Kermit the Frog and it said, “Me when a patient tells me another chiropractor wanted 5 sets of x-rays over 9 months of treatment to correct something research doesn’t support.”

Now, let me set the stage here. The impetus for this was that one of my patients moved down to Georgia. Her daughter started having some headaches and pain so she went and got an MRI. 

The results of the MRI showed the issue to be out of the scope of chiropractic. Regardless, you guessed it, she got a recommendation for 5 sets of x-rays over 9 months of treatment. 

Absolute scare care riduculosity. 

Here’s where it got a little sticky. A colleague got on that post and expressed some dissatisfaction that I would post something like that. I guess he didn’t like my airing dirty laundry. Which is cool. I don’t mind at all but here’s what happened for me on the deal. 

I sat down and crafted a very PC response I think and in doing so, I had an opportunity to reflect on the podcast, the reason for it, and what we’ve done in just the past year. 

Here are some highlights that came to mind for me:

  1. You don’t make an omelet without cracking some eggs and I think some difference of opinion is to be expected and it’s something I just need to get used to. 
  2. I think I created this podcast to do whatever I could to move this profession forward. 
  3. Forward to me means providing research like we do every week but also to educate others, to suggest new research avenues, to encourage specialization and higher education, to push for integration, and to call out and discourage the behavior I feel holds us back from moving forward. 

If you aren’t active on our Facebook page, I’d encourage you to stop in and say, “Hi.” Tell us if you’re digging the podcast. Share some research you’ve found. Maybe give us a suggestion for a future podcast. We’re here. We also have a private Facebook group if you’d like to join the private group. 

OK, research for this week, here we go with paper #1

This one is called “Characteristics of Chiropractic Patients Being Treated For Chronic Low Back and Neck Pain[1].” The lead author is PM Herman and the paper was published in August of 2018 in the Journal of Manipulative Physiological Therapeutics. 

https://www.ncbi.nlm.nih.gov/pubmed/30121129

Get your marketing hat on for this one people. 

Why They Did It

Since chronic low back and neck pain are so prevalent, and since spinal manipulation is a common non-pharma treatment for them, the authors wanted to determine the characteristics of the type of patient that visits the chiropractor. 

How They Did It

  • They collected data from chiropractic patients in regard to regions and states, sites, providers and clinics, and patients. 
  • The data was collected through an iPad questionnaire given at the chosen sites. 
  • They had 518 chronic low back pain patients complete it while 347 chronic neck pain patients finished theirs. They also had 1159 do both. 

What They Found

  • Most of the sample were highly-educated
  • Most were non-hispanic
  • White females were the dominant demographic for race and gender
  • Few used narcotics
  • Avoiding surgery was the most important reason they chose chiropractic care 
  • Over 90% of the patients reported high satisfaction with their care

That should give you some good ideas when trying to figure out who you should be marketing to. I can lead the horse to water but I cannot show the snout into the pond and make the horse drink it up. 

Text Neck

I picked this one out because I saw a discussion on Facebook last week about Text Neck. The question posed was, isn’t text neck just a new term for an old problem? Is text neck just a scare tactic?

That was the general gist of the post. 

While I did not respond, I do have an opinion on text neck. I do not think it’s an old problem. I mean, let’s back up a bit. Poor posture is most certainly an age-old problem. No doubt about it. 

However, at no other point in our time in history that I’m aware of, have little bitty children all the way up to mid-aged and elderly people had a reason to be sitting in one spot for hours with their head flexed forward, bent down almost into their laps. It pains me to see some of the kids these days. 

My poor son. Not so much my daughter right now but my son….my goodness. That kid…I’ll look at him sometimes and he has somehow balled himself up into what I can only describe as something resembling a roly-poly or an armadillo. His head bent at 90 degrees looking at his phone in his lap. Basically, the epitome of text neck.

It must really suck being a chiropractor’s kid. I’ve taken pictures of it before when he wasn’t looking. As you probably know, you can draw on pictures on your phones. So I took that picture then drew big red marks exploding out of his neck. Then, while he’s sitting there on his phone, he gets the picture in a text. 

It’s awesome. You all should try it sometime if for no other reason than to give yourselves a laugh. 

Next Paper

This paper is called, “Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study” and it was published in the Journal of Manipulative and Physiological Therapeutics as well[2]. The lead author was Andrew Portelli and it was published in February of 2018. 

https://www.jmptonline.org/article/S0161-4754(17)30010-6/fulltext?elsca1=etoc&elsca2=email&elsca3=0161-4754_201802_41_2_&elsca4=Physical%20Medicine%20and%20Rehabilitation%7CHealth%20Professions

Why They Did It

The purpose of this study was to evaluate if young people with insidious-onset neck pain who spend long periods on mobile electronic devices (known as “text neck”) have impaired cervical proprioception and if this is related to time on devices.

What They Found

“The participants with text neck had a greater proprioceptive error during cervical flexion compared with controls. This could be related to neck pain and time spent on electronic devices.”

This message has been brought to you by an uncool parent of a teenager. 

Paper #3

This one is called, “Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial[3].” and it was published in Spine journal in February of 2018. 

https://www.ncbi.nlm.nih.gov/pubmed/29481979/

Why They Did It

The optimal number of visits for the care of cervicogenic headache with spinal manipulative therapy is unknown so the authors hoped to identify the dose-response relationship between visits and chronic headache outcomes…. and to evaluate the efficacy of chiropractic by comparison with a light-massage control.

What They Found

The authors’ conclusion was as follows, “There was a linear dose-response relationship between SMT visits and days with CGH. For the highest and most effective dose of 18 SMT visits, CGH days were reduced by half and about 3 more days per month than for the light-massage control.”

So, you guys and gals that want to take evidence-based to the extreme and get people out of your office in only 3 or 4 visits, you may not be hitting the number of visits that work the best. Everyone is different right? Everyone heals differently. Here we have 18 visits being the most effective for chronic cervicogenic headache. 

Good info to keep in mind. 

Integrating Chiropractors

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment instead of chemical treatments like pills and shots.

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

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

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

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

That’s Chiropractic!

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

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

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:

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

Bibliography

1. Herman PM, Characteristics of Chiropractic Patients Being Treated for Chronic Low Back and Neck Pain. J Manipulative Physiol Ther, 2018.

2. Portelli A, Cervical Proprioception in a Young Population Who Spend Long Periods on Mobile Devices: A 2-Group Comparative Observational Study. J Manipulative Physiol Ther, 2018. 41(2): p. 123-128.

3. Haas M, Dose-response and efficacy of spinal manipulation for care of cervicogenic headache: a dual-center randomized controlled trial. Spine, 2018: p. S1529-9430.

CF 012: Proven Means To Treat Neck Pain

CF 033: Did You Need Proof That Chiropractors Help Headaches?

CF 005: Valuable & Reliable Expert Advice On Clinical Guides For Your Practice