who

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 15)

CF 334: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 15) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 15)…..it’s the final part of the series.  But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #334 Now if you missed last week’s episode, we talked about Colo-Rectal Cancer Recognition & Less Gabapentin With Chiropractic.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Up and down, peaks and valleys, getting hit and landing blows, riding the waves or gasping for air, whack-a-freaking-mole.  Slow week this week and last. Two weeks ago and May overall, we killed it. Absolutely killed it. Now, I’m wondering if we should just close the doors and call it a good career. We tried. Lol. 

Yes, that’s super dramatic.

No, we’re not closing up shop. Lol. But that’s how you get sometimes right? Damnit can’t it just be a set it and forget it thing? Well the answer is no. It cannot and will not. The competition is too great to rest solely on your reputation in the community. Yes, it helps but it’s not enough to stay where you want to be. It’s just not.  We all feel important I’m sure but here’s the brutal truth. People start to forget us the minute we go silent. You have to keep that pedal to the metal with the marketing, being involved in the community, constant weekly touches in the community, and telling your current active patients how much you appreciate referrals. They don’t always know, ya know?

So, market market market.  In separate news, I am re-engaging with the group I’ve mentioned in the past about purchasing 60% of the clinic, bringing in an associate or two, and having more time for voice-over work, real estate work, and medicolegal work in the chiropractic realm. 

If my plans are solid and actually happen…..and I have a track record of making things happen……in 2 years, I’ll have more and more time to dedicate to podcast hosting and painting and sculpting and all of the aspects of life outside of the clinic that truly feed my soul.  We’re working on it and so far, it’s looking good. It just takes time and I’ll keep you all updated as we go along. It may be something you want to consider as I go through it and come out the other side. 

Item #1

The last paper in our series is called, “The effectiveness of manual therapy and proprioceptive neuromuscular facilitation compared to kinesiotherapy: a four-arm randomized controlled trial” by Zaworski et al and published in European Journal Of Physical Rehabilitative Medicine in April of 2021. Remember, the citations can be found at chiropracticforward.com under this episode. 

Zaworski K, Latosiewicz R. The effectiveness of manual therapy and proprioceptive neuromuscular facilitation compared to kinesiotherapy: a four-arm randomized controlled trial. Eur J Phys Rehabil Med. 2021 Apr;57(2):280-287. doi: 10.23736/S1973-9087.21.06344-9. Epub 2021 Mar 2. PMID: 33650840.

Last reminder on this series. The WHO recommends spinal manipulative therapy at very low confidence. I’ve been doing this podcast every single week for over 7 years and the amount of research in favor of smt for everything but especially low back pain is honestly pretty staggering.

So, when I see the WHO recommend SMT, I’m like….well of course they do.  And then I see ‘at very low confidence’ which is the same level they recommended ultrasound, well, then I got miffed. I got ‘pressed’ as the kids say these days. Hundo P.  So I found all of the papers the WHO used to make the determination and we went through them one by one and this is the last one. 

Why They Did It

The aim of the study was to determine whether the use of combined therapy consisting of manual therapy and proprioceptive neuromuscular facilitation (PNF) is more effective than the use of manual therapy techniques, proprioceptive neuromuscular facilitation or traditional kinesiotherapy as single methods in the treatment of low back pain.

How They Did It

The setting was a Rehabilitation Department of Hospital in Parczew (Poland). The study was designed as four-arm randomized comparative controlled RCT and conducted on a group of 200 patients aged 27-55y. The patients were randomly divided into four 50-person groups:  1) group A – manual therapy;  2) B – proprioceptive neuromuscular facilitation;  3) C – manual therapy and proprioceptive neuromuscular facilitation; and  4) group D – traditional kinesiotherapy and control group.  Pain intensity was measured using VAS and Laitinen’s questionnaire.  Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS).

What They Found

There was a statistically significant difference in pain reduction (VAS Scale) between Group C (4.8 points) and Group D (3.9 points).  In all the groups there was a statistically significant reduction in a degree of disability as measured by the ODI.  A level of functional capabilities increased significantly only in Group C (8.8 points) as compared to Group D (5.7 points).

Wrap It Up

All the evaluated methods caused pain reduction which lasted for at least 2 weeks after the end of treatment.  The degree of disability as measured by ODI lowered evenly in all groups.  Patients’ functional ability improved significantly in the group treated with combined manual therapy and proprioceptive neuromuscular facilitation as compared to the group of traditional kinesiotherapy.

OK, so there’s yet another paper the WHO used that’s in favor of SMT.  I’m going to try to do a very fast summary of what we’ve learned here, folks. 

For the record, I started this series on December 14, 2023 and today is June 10, 2024.

Yes, we’ve been at it for a while now. So, what DID we learn now that we’re at the end of our efforts? For starters, they cherry picked some pretty crappy papers. One was a pilot study. Why would you place the recommendation of a modality in part on a pilot study? Not sure about that.  Many of them were very small sample sizes. 

More strikingly though were the ages of these papers? Again, we cover new and fresh papers all of the time and low back pain specifically has been covered  and covered and covered again in the last 5 – 10 years and almost all papers have been in favor of SMT.  So why on Earth is the WHO sourcing and using old papers with mostly small sample sizes? I’m talking about papers from 1978, 1985, 1986, 1992, 2003, 2004, 2007, 2011, 2012, 2012 (pilot study), 2013, 2013. 

Yes there are some papers they used that were from 2020, 2019, 2017 or so. But I’d venture a guess that well over 60% of the papers they used were over 10-12 years old and some were as old as 35 years, 38 years, and up to 46 years old. What the holy hell? For real. Wrap your damn heads around that hot garbage.  Please tell me there’s an agenda to keep chiropractors in their place without telling me there’s and agenda to keep chiropractors in their place. It’s ponderous. 

The final score is:

    • In favor of SMT: 19
    • Undetermined: 5
    • Against: 4

So, you folks do what you will with the information. I don’t know that there’s anything that can be done. It’s the WHO out there doing WHO stuff but I’m telling your right now, them rating SMT at ‘very low confidence’ is incorrect in my opinion and I feel that our little experiment proves it beyond simply ‘my opinion’. 

Keep fighting my friends. Lots of work left to do!

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world.

The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

 

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 14)

CF 331: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 14) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 14) But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #331 Now if you missed last week’s episode, we talked about Chiropractic And Benzodiazepine & Curcumin And Carpal Tunnel.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

It’s a week of still growing. I think. We are currently in the best month we’ve been in since maybe COVID times. It’s been encouraging. I think there are a few things at work and I’m not sure I’m right about any of it.  If you remember more recently, I’ve mentioned that we were in a business valley and that we were using that time to gear up with marketing and trying to make things happen that we haven’t had to make happen in a few years.

Well, Here’s what I think

We started a Cross-promotions campaign partnering with other local companies. We promote their business for one month while they promote our business for one month. 

We changed website companies 6 months ago and have moved from the mid-20s up to about position #7 now so our Google SEO is finally getting back on track and should continue to improve.

External marketing: now that we aren’t constantly battling with staff turnover every single month, we have some stability and have been more able to go around in our community marketing our clinic and taking goodies to people that we know can and will refer to us. Strengthening relationships and making people happy. 

The VA used to send us 5-6 new veterans just about every week. Then they hired their own DC out there at the hospital and the referrals went down to about 2 a month. That was a big hit but I felt that would be short-lived. There are simply too many veterans in the program for one chiro to adequately sustain the treatment on them. 

Plus, a new vet referral yesterday notified me that the DC has already put in his notice and is leaving. I’m not sure if that’s a fact or not but the point is; the VA business seems to be coming back. If they’re booked out more than 28 days, the vets get to pick where they want to go.

Well….they’re booked out so hopefully we’re starting to see the vets come back here where we can see them more regularly and take better care of them.  So those are some of the things that I think have gone right for us in the last 6 months or so. Which we desperately needed.

Honestly, in December….it was pretty bad. Reminds me of that Merle Haggard song..’If We Make It Through December’. It was slim Pickens around here in December. Which led to A LOT of brainstorming and action on my part. 

Which brings up another thing – being alone. Being the owner and chiro at your clinic can get lonely. You feel that it’s all up to you and guess what….it is. But if that bothered you, you wouldn’t have opened up in the first place now, would you?

But it can get lonely. You just learn to count on yourself. When the chips are down, you look at your history, what’s worked in the past? You look at marketing, picking yourself up, maybe innovating, maybe some team meetings, maybe a new attitude. I was ready to retire and check out this time last year.  This time this year….today….I’m in the fight and am fully engaged. And it shows in my stats and numbers. 

Let’s get to it

We are coming to an end to the WHO series and I know my friend Dr. Steve Brown will be glad to hear it. Lol.  The WHO says smt is recommended but only with very low confidence and I think that’s bunk so we’ve spent some time every other week diving into every paper they used to make that determination.  After the two we have today, we’ll have one left and then summarize it a bit. That’ll be in two weeks so look for it

Item #1

The first one today is called, “Similar Effects of Thrust and Nonthrust Spinal Manipulation Found in Adults With Subacute and Chronic Low Back Pain: A Controlled Trial With Adaptive Allocation” by Xia et al and published in Spine Journal in June of 2016.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Xia T, Long CR, Gudavalli MR, Wilder DG, Vining RD, Rowell RM, Reed WR, DeVocht JW, Goertz CM, Owens EF Jr, Meeker WC. Similar Effects of Thrust and Nonthrust Spinal Manipulation Found in Adults With Subacute and Chronic Low Back Pain: A Controlled Trial With Adaptive Allocation. Spine (Phila Pa 1976). 2016 Jun;41(12):E702-E709. doi: 10.1097/BRS.0000000000001373. PMID: 26656041; PMCID: PMC4902754.

Why They Did It

The aim of this study was to compare the short-term effects of a side-lying, thrust spinal manipulation (SM) procedure and a nonthrust, flexion-distraction SM procedure in adults with subacute or chronic low back pain (LBP) over 2 weeks.

How They Did It

  • Participants were eligible if they were 21 to 54 years old, had LBP for at least 4 weeks, scored 6 or above on the Roland-Morris disability questionnaire, and met the diagnostic classification of 1, 2, or 3 according to the Quebec Task Force Classification for Spinal Disorders. 
  • Participants were allocated in a 3:3:2 ratio to four sessions of thrust or nonthrust SM procedures directed at the lower lumbar and pelvic regions, or to a 2-week waitlist control. 
  • The primary outcome was LBP-related disability using the Roland-Morris Disability Questionnaire and the secondary outcomes were LBP intensity using the visual analog scale, the Fear-Avoidance Beliefs Questionnaire, and the 36-Item Short Form Health Survey. 
  • The study was conducted at the Palmer Center for Chiropractic Research with care provided by experienced doctors of chiropractic. 
  • Clinicians and patients were not blinded to the treatment group.

What They Found

  • Of 192 participants enrolled, the mean age was 40 years and 54% were male. 
  • Improvement in disability, LBP intensity, Fear-Avoidance Beliefs Questionnaire-work subscale, and 36-Item Short Form Health Survey-physical health summary measure for the two SM groups were significantly greater than the control group. 
  • No difference in any outcomes was observed between the two SM groups.

Wrap It Up

Thrust and nonthrust SM procedures with distinctly different joint loading characteristics demonstrated similar effects in short-term LBP improvement and both were superior to a waitlist control. How do the chiros that only think thrust, cavitations, and aggressive treatment reconcile that exactly?

I guess it’s not about the noise and more about movement then, right? That’s what I thought. 

Item #2 “Clinical research on lumbar oblique-pulling manipulation in combination with sling exercise therapy for patients with chronic nonspecific low back pain” by Wang et al and published in July 2019 in Revista da Associacao Medica Brasileira.

Wang SQ, Chen M, Wei X, Gao XX, Zhao GD. Clinical research on lumbar oblique-pulling manipulation in combination with sling exercise therapy for patients with chronic nonspecific low back pain. Rev Assoc Med Bras (1992). 2019 Jul 22;65(6):886-892. doi: 10.1590/1806-9282.65.6.886. PMID: 31340321.

Why They Did It To investigate clinical curative effects of lumbar oblique-pulling manipulation in combination with sling-exercise-therapy training on chronic nonspecific lower back pain.

How They Did It

  • A total of 60 patients with chronic nonspecific lower back pain in the Outpatient Department were included in this study. 
  • These patients were randomly divided into two groups: the observation group and the control group. 
  • The control group adopted a single sling-exercise-therapy training three times a week, while the observation group adopted lumbar oblique-pulling manipulation in combination with manipulation treatment once a week. The course of treatment lasted for four weeks.

What They Found

  1. Before and after treatment, the ODI score was compared within the group. A remarkable statistical significance was observed from the third day. At the third month of follow-up, the difference in ODI scores between these two groups was statistically significant. 
  2. Before and after treatment, it was observed that differences in VAS scores from the third day were statistically significant. 
  3. The difference in muscle strength between these two groups had remarkable statistical significance in the third month of follow-up

Wrap It Up

The effective rehabilitation function of lumbar oblique-pulling manipulation in combination with sling-exercise-therapy training in patients with chronic non-specific low back pain is superior to that of sling-exercise-therapy training alone. Still trying to figure out why they put us at very low confidence. I wonder what the hell got 80% or more and wound up with all of the confidence, quite honestly. Someone needs to track it down and let us all know.  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 the 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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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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 13)

CF 329: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 13) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 13) 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 giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #329 Now if you missed last week’s episode, we talked about current tendinopathy thoughts and chiropractic vs. medical costs.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well the week is already starting off with a bang and not in a great way either. First thing this morning, I found out one of my employee’s was abused by her ex over the weekend. Broke into her house, prevented her from leaving, and beat her while the 4-year-old was in the house. For a whole weekend.  You should see the girl’s leg. It’s insane. 

So, as an employer, what do you do? Believe it or not, this isn’t the first time we’ve had our go around with crap heads like this. I don’t understand some boys. I say boys because they’re not men. Men respect, support, and boost up women. They don’t do what this guy has been doing.  I can tell you what we do. We are pulling out all the stops to get this girl all of the help our area non-profits have to offer. We’re getting her a protective order.

We’re getting her housing. We’re getting her as far from danger as we can as quickly as we can.  I’ve put my staff on notice about this guy. He’s already called the office today, by the way. They all know his name and what he looks like and my cop friend says call 911 if he shows his face.  I have protection here should it come to that but it won’t.

This guy just likes to beat up and try to control and intimidate women that lack the confidence and support to do something about it. 

Well, she’s got that now and I think he’s going to have a hard time ever doing something like this again.  I tell you this because most of you listening are probably clinic owners yourself. In 26 years in practice, something similar with regards to being hyper aware of an individual that could come to the clinic, has happened maybe 3-5 times or so.

Once or twice it was a unstable patients. The other times, it’s been spouses, all male, all in need of hard-learned lessons. 

It’s stressful. It makes everyone in the office anxious. Being a business owner is hard and some things like this we just cannot control. But we can be aware and we can be vigilant. We can help our team mate make the best decisions and we can do our part to try to make sure she’s protected to the very best of our ability.  Like I said, my entire staff knows the plan, knows what he drives, knows his name, and knows exactly what he looks like. 

It’s a journey and this week is just a little different from our regular journey. But, we’re making it happen, getting patients better while our team helps walk her through this. 

Alright, on with the research. We are continuing our series we are doing every other week where we are trying to figure out what brand of crack the WHO was smoking when they chose and used citations to deem spinal manipulative therapy as being effective at ‘very low confidence’ recently. Two of those papers are covered in this episode. 

Item #1

Our first one today is called, “Short term trial of chiropractic adjustments for the relief of chronic low back pain“ by Waagen et al and published in Manual Medicine in 1986. This one is so old that it can hardly be found.

Literally, I had search and search Remember, the citations can be found at chiropracticforward.com under this episode. 

Waagen GN et al. Short term trial of chiropractic adjustments for the relief of chronic low back pain. Manual Med. 1986;2:63-67.

A double-blind study of the efficacy of spinal adjustive therapy delivered by chiropractors was designed and implemented at the clinic of a chiropractic college.  Nineteen patients with low back pain completed a nominal two-week period of treatment.  Nine patients in the experimental group received a series of chiropractic ‘adjustments’, while ten control patients received a comparable series of manual interventions.  Experimental patients had significantly more relief from pain than control patients immediately after being treated as measured on a 10 cm visual analogue scale.  After two weeks of treatments the experimental patients as a group exhibited significant overall pain relief, whereas improvement of patients in the control group was not significant.  Using a global index for the objective measurements of change in spinal mobility it was also concluded that experimental patients improved significantly compared to control patients  Because of the small sample size the results reported must be considered preliminary.  Modification in the research design from other trials studying manipulative therapy included the use of chiropractic adjustments as the form of manipulation, use of a realistic manual control treatment and use of a global index as an outcome measure.  So yes….it’s in our favor but….it’s a tiny sample size and it’s 38 years old. So why is the WHO using it? 

Item #2

Your second one this week is called, “Short-term usual chiropractic care for spinal pain: a randomized controlled trial” by Walker et al and published in Spine Journal 11 years ago back in 2013. 

Walker B.F et al. Short-term usual chiropractic care for spinal pain: a randomized controlled trial. Spine (Phila Pa). 2013;38(24):2071-2078. doi: 10.1097/01.brs.0000435032.73187.c7.

Why They Did It

The authors wanted to establish the short-term effectiveness of chiropractic therapy for spinal pain compared with a sham intervention and explore the predictors of chiropractic treatment satisfaction. Chiropractic treatment is widely used for spinal pain. However, a lack of sound evidence precludes conclusions about the effectiveness of chiropractic for spinal pain.

How They Did It

  • Participants were adults experiencing spinal pain, randomized to receive 2 treatments of chiropractic or sham therapy. 
  • Participants and outcome assessors were blinded to group allocation. 
  • Primary outcomes at 2 weeks were NRS and Functional Rating Index). 
  • Secondary outcomes were global change, minimum acceptable outcome, and treatment satisfaction. 
  • Treatment effects were estimated with linear mixed models for the primary outcomes. 
  • And they used logistic regression to identify differences in the secondary outcomes and explore for predictors of treatment satisfaction.

What They Found

  • One hundred eighty three participants were recruited and included in the analyses. 
  • Participants receiving chiropractic therapy reported greater improvements in pain, physical function, and were more likely to experience global improvement and treatment satisfaction. 
  • There was no between-group difference in achieving a minimally acceptable outcome. 
  • Awareness of treatment assignment and achieving minimally important improvement in pain intensity were associated with chiropractic treatment satisfaction.

Wrap It Up

Short-term chiropractic treatment was superior to sham; however, treatment effects were not clinically important. Awareness of treatment assignment and clinically important reductions in pain were associated with chiropractic treatment satisfaction

Alright, another puzzling episode of why does the WHO include garbage crap papers to decide if spinal manipulation is effective? I maintain that there is an agenda of some sorts that is bias against chiropractic. 

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 12)

CF 327: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 12)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 12) 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.    If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #327   Now if you missed last week’s episode, we talked about SMT and Cauda Equine and SMT and Discectomy.    Make sure you don’t miss that info. Keep up with the class.    On the personal end of things…..

I recently returned from my Mastermind trip out to Nashville and we had a big time. We had a company called Vision Spark come to speak with us about hiring staff the proper way and it was enlightening. I think the whole group got lots of great ideas out of it.   

Mastermind leader, Kevin Christie, shared some techniques and software he’s been using to create training modules and manuals for his office staff onboarding when necessary. Really cool stuff.    Mastermind members Emma Minx and Jonathan Saigh from Wisconsin shared a new place to find qualified hires instead of Indeed. Which is outstanding because, honestly, Indeed has trashed the hiring process. In lots of ways but since Indeed came about, we have had them not show up for interviews around 50% of the time, we have hired candidates no less than 4 times where they accepted our job, gave their 2-weeks notice at their other job and after waiting out that 2 weeks….they never showed up at our job so we had to start over…. Indeed is garbage so that’s nice to have another technique or pond to fish in.   

I got to hang out with Mike Massey for a while, which is always a pleasure. We talked about practice, bee keeping, music, and all of the worldly problems that we felt we could solve in one night.   

Mastermind Dr. Anthony Houssain out in Huntsville Alabama shared that he’s saved over $1000 a month by changing to his current credit card processor. So that will be nice to get going    I got our new billing and collections company from members Gerry Mitchell and Curt Kippenberger.   

We all went out and acted like teenagers on Broadway in Nashville for a few nights. I watched Lindsey Mumma dance and sing to Shoop by Salt n Pepa and talked to Tiffany and Tyler Armstrong about decompression.   

We’re looking forward to visiting Doug Krebs’s practice when we go out to Chicago for the next mastermind meeting.   

My point being; get you a mastermind. If you don’t know where to find one, Dr. Christie still has some room in his Western Mastermind. Mine is the Eastern Mastermind and my group is full but still room in the Western group. If you’re interested, email Dr. Christie at drkchristie@gmail.com and start the conversation.   

Item #1 We are continuing our series on why the hell the WHO has recommended spinal manipulative therapy at only very low confidence. I’m calling BS so I went and found all of the research they cited for this hullabaloo and going through it one at a time with you all here on the podcast.   

The first one is called, “Osteopathic manipulative treatment in obese patients with chronic low back pain: a pilot study” by Vismara et. Al. and published in Manual Therapy in 2012. And why the hell are they basing their opinion and recommendation of SMT on a pilot study? This is the whole point of it. For better or worse, don’t we have better research available to base the whole profession on?  

The answer is yes….yes we do.   

Remember, the citations can be found at chiropracticforward.com under this episode.   

Luca Vismara, Veronica Cimolin, Francesco Menegoni, Fabio Zaina, Manuela Galli, Stefano Negrini, Valentina Villa, Paolo Capodaglio, Osteopathic manipulative treatment in obese patients with chronic low back pain: A pilot study, Manual Therapy, Volume 17, Issue 5, 2012, Pages 451-455, ISSN 1356-689X, https://doi.org/10.1016/j.math.2012.05.002.

(https://www.sciencedirect.com/science/article/pii/S1356689X12000987)  

Why They Did It Obesity is frequently associated with various musculoskeletal disorders including chronic low back pain (cLBP). Osteopathy is a discipline emphasizing the conservative treatment of the disease in an holistic vision.  We designed a randomized controlled study to investigate whether Osteopathic Manipulative Treatment (OMT) combined with specific exercises (SE) is more effective than specific exercises alone in obese patients with cLBP.  

How They Did It Nineteen obese females with cLBP, randomized into 2 groups:  1. specific exercises + Osteopathic Manipulative Treatment and  2. specific exercises alone  were studied during the forward flexion of the spine using an optoelectronic system.  A biomechanical model was developed in order to analyse kinematics and define angles of clinical interest.  

What They Found Significant effects on kinematics were reported only for Osteopathic Manipulative Treatment + specific exercises with an improvement in thoracic range of motion of nearly 20%.  All scores of the clinical scales used improved significantly. The greatest improvements occurred in the Osteopathic Manipulative Treatment + specific exercises group.  

Wrap It Up Combined rehabilitation treatment including Osteopathic Manipulative Treatment (Osteopathic Manipulative Treatment + specific exercises) showed to be effective in improving biomechanical parameters of the thoracic spine in obese patients with cLBP.  Such results are to be attributed to Osteopathic Manipulative Treatment, since they were not evident in the specific exercises group.  We also observed a reduction of disability and pain. The clinical results should be considered preliminary due to the small sample size.  

Item #2 The last one this week is called, “Pain, Range Of Motion And Back Strength In Chronic Mechanical Low Back Pain Before and After Lumbar Mobilixation”” by Verma et al published in International Journal Of Physiotherapy and Research in 2013. 

Verma, Y., & Goyal, M. (2013). PAIN, RANGE OF MOTION AND BACK STRENGTH IN CHRONIC MECHANICAL LOW BACK PAIN BEFORE & AFTER LUMBAR MOBILISATION.

Both papers we are covering are from 2012 and 2013 so 11 and 12 years old and one of them is a pilot study. Just seeing if you all are keeping score here.   

Why They Did It Joint mobilisations in the spine are used as an integral part of the treatment and rehabilitation to alleviate pain and reduce stiffness. Mobilisation has also been used to improve muscle strength as described in the literature.  However, there is dearth of data exploring the effect of mobilisation on muscle strength in CLBP. Purpose:To investigate the effects of lumbar mobilisation on pain, range of motion and back strength chronic mechanical low back pain patients.  

How They Did It Thirty subjects with chronic back pain participated in the randomized clinical trial. The effects of lumbar mobilisation & exercises were compared with the exercises alone.  Pain levels were measured using visual analog scale, lumbar extension range of motion using modified Schobers test and strength by back-leg-chest dynamometer.  Measurements were done before & after 2 and 4 weeks respectively.  

What They Found A significantly greater improvement in pain, ROM, and strength after 4 weeks in experimental group than the control group.  

Wrap It Up This study therefore provides experimental evidence to support the use of lumbar mobilization along with the exercises for the management of patients with chronic mechanical low back pain, who responded favorably to the intervention.

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com  

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

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

Twitter https://twitter.com/Chiro_Forward  

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

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

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

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

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

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

What They Found

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

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

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

Website https://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

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

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

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9)

CF 321: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 9) But first, here’s that sweet sweet bumper music  

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

Chiropractic evidence-based products

Integrating Chiropractors

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  OK, we are back and you have found the Chiro ractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 

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

You have found yourself smack dab in the middle of Episode #321 Now if you missed last week’s episode, we talked about PT For Sciatica & Laser For Neck Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I just got back from VO Atlanta, the world’s largest VoiceOver conference. I have to say that there are a lot of regular Joe’s like me walking about that place and in the industry but, oh my goodness….there are a lot of strange folks too as you might imagine.  A very diverse group and I’m not talking just about race. Just lots of different types of folks that the mainstream of our country wouldn’t recognize as being normal. I’ll just say it that way.  So, that was fun and useful and tiring. I’m glad I went but was glad to be back home. It’s a lot like going to chiropractic conferences.

Before I got involved in the Texas Chiropractic Association, I was a long\e wolf. I’d be out there on the fringe, not a member of the TCA, and almost proudly and defiantly uninvolved.  Compare and contrast that with me now. I’m a member of just about everything I can be a member of. Including the ACA, the TCA, FTCA, the MCM Mastermind, the Texas Orthopedic group, the national Orthopedic group, the national Forensics group and on and on and on.  My network then vs. now. I had a couple of folks I went to school with. Now, I have hundreds of trusted friends in the industry to learn from, ask questions, and bounce things off of.  There’s no comparison. The voice over thing reminds me of the fact that it’s not always the learning you get inside those classrooms that is the most valuable aspect of an industry conference.

Most of the time, it’s the one-on-one connections you make over dinner or over drinks and conversations you have with random folks throughout the weekend that pay the most dividends. Don’t get into conversations asking yourself, “what can I get from this person’ though. If you’re genuine and authentic and interested in others and what YOU can do for THEM, then it’s a natural instinct that they wonder what they can do for you in return.  That’s where the value of conferences comes in. It’s the network you build over years of going to these things that pay dividends. So, if you don’t see immediate ROI on the Monday you return, not to worry. Stick with it. Plant the seeds and reap the harvest down the road. 

Now remember we are continuing our series on why the WHO has designated spinal manipulative therapy at the level of very low confidence which is the same they designated ultrasound. I went and found all of the citations for all of the papers they used to make the determination. From what we’ve covered and from what I’m seeing, they haven’t used a lot of high-quality research to make the determination. This makes me wonder if there’s an agenda at the WHO to keep the man down. Keep the chiros in their place. Who knows? But it seems sus, as the kids say these days. 

Item #1 Our first paper this week is called, “Spinal manipulative therapy and exercise for older adults with Chronic Low Back Pain: a randomized clinical trial” by Schulz et. Al and published in Chiropractic Manual Therapy on May 15, 2019.  Remember, the citations can be found at chiropracticforward.com under this episode.  Schulz C, Evans R, Maiers M, Schulz K, Leininger B, Bronfort G. Spinal manipulative therapy and exercise for older adults with chronic low back pain: a randomized clinical trial. Chiropr Man Therap. 2019 May 15;27:21. doi: 10.1186/s12998-019-0243-1. PMID: 31114673; PMCID: PMC6518769.

Why They Did It Low back pain (LBP) is a common disabling condition in older adults which often limits physical function and diminishes quality of life.  Two clinical trials in older adults have shown spinal manipulative therapy (SMT) results in similar or small improvements relative to medical care; however, the effectiveness of adding SMT or rehabilitative exercise to home exercise is unclear.

How They Did It We conducted a randomized clinical trial assessing the comparative effectiveness of adding SMT or supervised rehabilitative exercise to home exercise in adults 65 or older with sub-acute or chronic LBP.  Treatments were provided over 12-weeks and self-report outcomes were collected at 4, 12, 26, and 52 weeks.  The primary outcome was pain severity.  Secondary outcomes included back disability, health status, medication use, satisfaction with care, and global improvement.  Linear mixed models were used to analyze outcomes.  The primary analysis included longitudinal outcomes in the short (week 4-12) and long-term (week 4-52).  An omnibus test assessing differences across all groups over the year was used to control for multiplicity.  Secondary analyses included outcomes at each time point and responder analyses.  This study was funded by the US Department of Health and Human Services, Health Resources and Services Administration.

What They Found 241 participants were randomized and 230 (95%) provided complete primary outcome data.  The primary analysis showed group differences in pain over the one-year were small and not statistically significant.  Pain severity was reduced by 30 to 40% after treatment in all 3 groups with the largest difference (eight percentage points) favoring SMT and home exercise over home exercise alone.  Group differences at other time points ranged from 0 to 6 percentage points with no consistent pattern favoring one treatment.  One-year post-treatment pain reductions diminished in all three groups.  Secondary self-report outcomes followed a similar pattern with no important group differences, except satisfaction with care, where the two combination groups were consistently superior to home exercise alone.

Wrap It Up Adding spinal manipulation or supervised rehabilitative exercise to home exercise alone does not appear to improve pain or disability in the short- or long-term for older adults with chronic low back pain, but did enhance satisfaction with care.

Item #2 The second paper today is called, “Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study” by Rasmussen et al published in Joint Bone and Spine in December of 2008.  Rasmussen J, Laetgaard J, Lindecrona AL, Qvistgaard E, Bliddal H. Manipulation does not add to the effect of extension exercises in chronic low-back pain (LBP). A randomized, controlled, double blind study. Joint Bone Spine. 2008 Dec;75(6):708-13. doi: 10.1016/j.jbspin.2007.12.011. Epub 2008 Nov 22. PMID: 19028434.

Why They Did It Both exercises and manipulation are recommended as basic therapy in back diseases, while a possible synergistic effect of these treatments have not been clarified.  This study was conducted to test a possible further effect of manipulation as adjunct to extension exercises for unspecific LBP.

How They Did It 72 patients with chronic LBP (mean 12 months) were examined by a specialist in manual medicine, who detected localized binding between the lumbar segments.  All patients were instructed in extension exercises, while randomized to either pretreatment with specific manipulation or control.  The patients were blinded to the manipulation, which was performed at the end of the manual examination, and repeated after two and four weeks.  The manipulator only knew the group of the particular patient just before manipulation by the end of the examination.  The primary end point was pain, measured by a visual analogue scale.

What They Found Pain in both back and leg decreased without differences between groups. Segmental binding of the low-back was associated with persisting clinical symptoms at four weeks.

Wrap It Up No additional effect was demonstrated of manipulation, when extension exercises were used as basic therapy. 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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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

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8)

CF 319: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 8).  If you haven’t been following along, the World Health Organization has recommended spinal manipulative therapy for back pain, however, they rated it at very low confidence.

Which is the same rating they gave ultrasound. We know SMT is more effective than that so I went into the recommendations, I found the papers the WHO cited as their references for their rating of SMT, and now I’m covering each and every one of them. We’re doing this every other week and now we’re on Part 8.  Also if you’re following along, you’ll know that a lot of these papers are extremely old compared so newer more impressive and more favorable papers that have emerged in more recent years.

You’ll also, if you’re like me, continue to get more and more certain that there is an agenda in the WHO leadership that keeps SMT from taking its rightful step forward in the treatment of noncomplicated Neuromusculoskeletal issues.  Stick with me, we’ll talk more about it.  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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #319 Now if you missed last week’s episode, we talked about How Specific Are Adjustments & Nerve Flossing Effectiveness.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

As I’ve discussed in recent episodes, my house, meaning my clinic, got in a bad way in 2023 and I believe we are finally on the upswing.  We have slowed down in our new patients because of Google SEO and website companies and changes. I think I’ve corrected that.  We have had inconsistent team culture in the clinic because of constant turnover. I still have work to do here but I feel like we have a more dependable team at the moment than I’ve had in the past 18 months so I’m encouraged.  Speaking of an incredible amount of turnover, our billing has been inconsistent. Inexperienced staff just let rehab and other services walk out the door without getting done. That adds up really fast and shows up in our monthly collections.

Now that my wife is up at the front desk and now that it’s become a focus for us, this is getting under control. Basically, staff knows that their comfort comes secondary to the financial health of the clinic. Meaning, whether we feel like it or not, the patients need to be doing the services we have prescribed them. We’re getting there. That’s not a black and white thing there but we are doing more of the services prescribed than we have been.  We are now on our 4th billing and collections company in the past 5 or 6 years. We just haven’t been able to find a dependable one that just does their damn job. I think we have one now.

They started in November and we hope to see the benefits in the next few weeks. I think we already are.  So, you can see what I’ve been up to. It was a swim or swim option. Not a sink or swim. Sink is never in the list of options. So we’ve been swimming and it’s showing up in progress and that makes this old man happy. 

Now, something I’ve always struggled with is treatment recommendations. I like standardization. I like Being able to tell someone confidently, I need to see you 3x/week for 2 weeks or whatever the recommendation might be. I don’t want to make it up from patient to patient. Standardization is something our profession desperately needs in my opinion.  As my colleague and friend, Dr. Brandon Steele once said in our DACO class…..if you go to the doctor with an ear infection in Dallas, NYC, Chicago, LA, or Seattle, you’re going to always get pretty much the same thing. The Standard for that profession.  If you go to a chiro, you don’t know what the hell you’re going to get.

X-rays for no reason and BAM, bait and switch….now you need 70 visits in one year to fix a curve that 20-year longitudinal studies show doesn’t really mean much of anything. You got a neck problem, bam, you need 50 visits to boost your immunity and make sure all nerve impulses are fully expressed because how can God’s full potential for you be realized if your spine is out of alignment. Yes….true story folks. True story. 

You have back pain, BAM, x-rays show degenerative spurs and if you see me 3x/day for 2 weeks, we’ll reduce the size of those spurs. Yes….true story. And that crew is holding seminars trying to teach crap like that to other suckers in our profession.  Or on the other end of the spectrum, you’ve had pain for 10 years and have a disability associated with it so it’s technically high-impact chronic pain….BAM….you can be fixed in 2 visits with a course of exercises for you to be using at home. 

It’s just not standardized.

So, through my association with Dr. Jay Greenstein from Washington DC and who is a mover and shaker in the industry and who has been active in Clinical Compass, I eventually formulated a standardized treatment protocol for my office that you might find useful as well. It’s really pretty simple. 

If it’s acute or less than 4 weeks in duration, I’ll see the patient 3x/week for 2 weeks. 

If it’s subacute, or between 4 and 12 weeks in duration, I’ll see the patient 2x/week for 3 weeks. 

If it’s chronic, or anything lasting beyond 3 months, I’ll see them 2x/week for 4 weeks. 

At the end of the protocol at each level, acute, subacute, or chronic….if the patient is doing great, we then start to stairstep the frequency out and slowly withdraw from treatment to prevent the return of the injury.

If there is not improvement or the patient gets worse at any time, we will either change treatment and try something different, or we will find a provider that has a better chance at helping the person recover. 

Now, of course, PI patients don’t fit into this schematic well so I use the Quebec Task Force on WAD for them but most of my patients will fit very well into this protocol.  It’s simple. It’s a way to standardize recommendations in my clinic from the owner to any associates. It’s an easy way for associates to get comfortable recommending treatment. And I like it so much that I made a poster out of it that you can find in the Chiropractic Forward private Facebook group.  I’ll send you one here in the US for $55 if you want one.

I’m putting one in my exam room so that when I’m doing the ROF, they’ve already read it and all I have to do is point to it and say, “‘You’re right here, and here is your recommendations. See you on M, W, and F.” Alright, good to go on all that, let’s hop in. 

Item #1 Our first one that the WHO used to keep the chiros down today is called, “Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial” by Nejati et. Al. published in Pain Physician in January of 2019. Not new, not old. Remember, the citations can be found at chiropracticforward.com under this episode.  Nejati P, Safarcherati A, Karimi F. Effectiveness of Exercise Therapy and Manipulation on Sacroiliac Joint Dysfunction: A Randomized Controlled Trial. Pain Physician. 2019 Jan;22(1):53-61. PMID: 30700068.

Why They Did It The sacroiliac joint dysfunction (SIJD) has been found to be the primary culprit for lower back pain (LBP), but it is still overlooked and treated as LBP. There are no guidelines or appropriate therapeutic protocols for SI dysfunction. Thus, there is a need for an effective treatment strategy for SI dysfunction.

Objective: To compare exercise therapy (ET), manipulation therapy (MT), and a combination of the 2 (EMT) in terms of their effectiveness in treating SI dysfunction.

How They Did It Study design: A comparative, prospective, single-blind randomized controlled trial .

Setting: Sports Medicine Department of Rasoul Akram Hospital.

Methods: A total of 51 patients with lower back or buttock pain resulting from SI dysfunction were randomly assigned to 1 of 3 study groups: exercise therapy, manipulation therapy, or a combination of the 2.  The exercise therapy group received posterior innominate self-mobilization, sacroiliac joint stretching, and spinal stabilization exercises.  The manipulation therapy group underwent posterior innominate mobilization and SI Joint manipulation.  Lastly, the combination group received manipulation maneuvers followed by exercise therapy. Pain and disability were assessed at 6, 12, and 24 weeks after the intervention

What They Found All 3 groups demonstrated significant improvement in pain and disability scores compared to the baseline (P < 0.05).  The difference among these therapeutic protocols was found to be a function of time.  At week 6, manipulation therapy showed notable results, but at week 12, the effect of exercise therapy was remarkable.  Finally, at week 24, no significant difference was observed among the study groups. A major limitation of the present study is lack of a control group receiving a type of intervention other than the experimental protocols. Another limitation is the short duration of follow-ups.

Wrap It Up Exercise and manipulation therapy appear to be effective in reducing pain and disability in patients with Si dysfunction. However, the combination of these 2 therapies does not seem to bring about significantly better therapeutic results than either approach implemented separately.

Item #2 The last one today is called, “Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study” by Nambi et. Al published in European Journal of Physical Rehabilitation Medicine in December of 2018. Not new, not old.

Nambi G, Kamal W, Es S, Joshi S, Trivedi P. Spinal manipulation plus laser therapy versus laser therapy alone in the treatment of chronic non-specific low back pain: a randomized controlled study. Eur J Phys Rehabil Med. 2018 Dec;54(6):880-889. doi: 10.23736/S1973-9087.18.05005-0. Epub 2018 Apr 24. PMID: 29687966.

Why They Did It Low back pain (LBP) is a common musculoskeletal disorder causing pain and disability in most of the countries. In recent years, new approaches such as Spinal manipulation and laser therapy have been considered as an alternative to conventional exercise and also found contradicting results in terms of its effectiveness.

Aim: A study to compare the combined effects of spinal manipulation, Laser and exercise versus Laser and exercise alone in chronic non-specific low back pain (cnLBP).

How They Did It Design: Randomized control study.

Setting: Subjects with cnLBP were treated with spinal manipulation, Laser and exercise in outpatient department for four weeks.

Population: Three hundred and thirty subjects who fulfilled the selection criteria were randomized (1:1:1 ratio) into spinal manip-laser-exercise (N.=110), Laser-Exercise (N.=110) and control group (N.=110).

Methods: The outcome measurements were Visual Analog Scale (VAS), Modified Modified Schober Test (MMST) Roland and Morris Disability Questionnaire (RMDQ), Physical Health Questionnaire-9 (PHQ-9) and Health Related Quality of Life-4 (HRQOL-4).  Baseline and follow-up measurements were measured at 4 weeks, 6 and 12 months by a blinded investigator.

What They Found Three hundred and twenty-six subjects completed the intervention and 304 completed the 12-month follow-up.  Demographic variables show homogeneity between the groups and ANOVA analyses showed significant improvement (P<0.001) in pain reduction (VAS), flexion range of motion (MMST), functional disability (RMDQ), depression status (PHQ-9), and quality of life (HRQOL-4) in spinal manipulation-laser-exercise group compared to the other two groups at one-year follow-up.

Wrap It Up Spinal manipulation combined with laser therapy and conventional exercise is more effective than laser therapy and conventional exercise alone in chronic non-specific low back pain. I mean….isn’t this one by itself enough to raise SMT above that of the level of ‘very low confidence’? That one alone? That randomized controlled trial? No? No wonder so many mistrust the WHO on so many different issues. It makes no sense to me.    Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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

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

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

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

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7)

CF 317: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 7) But first, here’s that sweet sweet bumper music

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

Chiropractic evidence-based products

Integrating Chiropractors

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do. 
  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com
You have found yourself smack dab in the middle of Episode #317 Now if you missed last week’s episode, we talked about Chronic Pain Central Sensitization & Patient Barriers To Physical Therapy.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Alright, we’re keeping it a little short this week because I’m going to the Bahamas Thursday through Monday. Now, if you’re a regular listener, you’re probably like…..last week you were talking about having a collections issue and stressing and now you’re going on a trip out of town. That seems like poor money management Ol’ Uncle Jeffro.  And that’s when I would say, you’re right. Lol. I’d say it’s nunya damn business but then I’d say…..yeah. I’m with you on that. I don’t really want to go because, for the first time in a month or so, it looks like my numbers are returning to where I want them and I’m building some steam so taking Thursday, Friday, and Monday off is tough. But…..a wise mentor once told me, you have to get out and go on a non-work-related vacation once per quarter or you’ll never survive.  Heres the deal, back in December, before the collections issue was realized, I told my wife, Hey honbun, you hate any jewelry I buy you, you won’t allow me to get you any clothes, you won’t allow me to get anything for the house because you didn’t get it and match your style, blah blah blah.  So, instead of more useless crap…..instead of buying things, we’re going to start buying experiences. Instead of gifts to each other, we bought a Valentine’s trip to The Bahamas. So it’s non-refundable and basically already paid for anyway so what do you do? You go to the damn Bahamas and try to get some rest.  2023 and the beginning of 2024 have literally been the hardest, most challenging times of my 26 year career in chiropractic. Personally and professionally. But mostly professionally. It’s been a grind, it’s been tough, and I wouldn’t recommend a year like we had on anyone.  We are currently hiring our 4th front desk girl and our third CA position has seen 4 or 5 turnovers in the last year. A couple of those kind of hurt personally, if I’m being honest. They were people I cared about.  Now that seems to reflect poorly on me but if we’re being honest here, I’ve never had an issuue with keepign folks for 3 years or so minimum. I had a manager for 11 years that still comes back to visit. I had another that was here 6 years or so.  The point being, I’m as fun and relaxes in real life as I hope I am here on theh podcast. We laugh and have fun and I don’t believed I’ve ever raised my voice to a staff member in 26 years. No matter how mad I get. Sometimes, we just have a run of bad luck. I’ve gone from about 65-70 new patients per month down to about 45-55. Not a huge hit for a month but carry that out over a year and……one word two-syllables…..Day-um.  Then throw in the fact that we’re on our 4th billing/collecting group in the last 5-6 years. That’s been a nightmare and cost me crazy money. Now we’re in a battle with a PI attorney in Houston that wormed his way into the Texas Chiropractic Association and, despite having signe Assignment Of Benefits and Letter of Protection on 7 different patients, is refusing to pay us around $27,000.  It’s a journey folks and 2023 was a bumpy road on that journey. Lots of potholes but I’m ever the optimist and, with our latest biller/collector, I think we’re in a good spot. Hopefully clinic numbers begin responding.  We’ve taken the necessary steps to remedy what’s been going on here. For those reasons, we are goign to the damn Bahamas and we are goign to eat, drink, and be merry and save it for when we get back. Trust me, the stress will still be here so we might as well just leave it here at the office when we leave.  So let’s continue our hunt for the reason behind the WHO recommending SMT but at ‘very low confidence’, which is at the same level as ultrasound. Not to diminish the effects of ultrasound but seriously, I’ve never seen ultrashound deliver the immediate results that spinal manipulative therapy can deliver.  We’ve learned so far that the WHO is using some garbage research to base this recommendation on. Old, out-dated studies, small sample sizes, and studies that just literally make no sense at all for the most part. Let’s see what Part 7 reveals.  Item #1 The first one today is called, “Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial” by Licciardone et. Al. and published in Spine in July of 2003. Which is 21 years old at this point. OK….duly noted…..so cold that it’s frozen solid….got it… Remember, the citations can be found at chiropractscforward.com under this episode.  Licciardone JC, Stoll ST, Fulda KG, Russo DP, Siu J, Winn W, Swift J Jr. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine (Phila Pa 1976). 2003 Jul 1;28(13):1355-62. doi: 10.1097/01.BRS.0000067110.61471.7D. PMID: 12838090. Why They Did It The authors wanted to determine the efficacy of osteopathic manipulative treatment as a complementary treatment for chronic nonspecific low back pain. They say, “Osteopathic manipulative treatment may be useful for acute or subacute low back pain. However, its role in chronic low back pain is unclear.” How They Did It This trial was conducted in a university-based clinic from 2000 through 2001.  91 met the eligibility criteria.  They were randomized, with 82 patients completing the 1-month follow-up evaluation, 71 completing the 3-month evaluation, and 66 completing the 6-month evaluation.  The subjects were randomized to osteopathic manipulative treatment, sham manipulation, or a no-intervention control group, and they were allowed to continue their usual care for low back pain.  The main outcomes included the SF-36 Health Survey, a 10-cm visual analog scale for overall back pain, the Roland-Morris Disability Questionnaire, lost work or school days because of back pain, and satisfaction with back care. What They Found As compared with the no-intervention control subjects, the patients who received osteopathic manipulative treatment reported greater improvements in back pain, greater satisfaction with back care throughout the trial, better physical functioning and mental health at 1 month, and fewer cotreatments at 6 months.  The subjects who received sham manipulation also reported greater improvements in back pain and physical functioning and greater satisfaction than the no-intervention control subjects.  There were no significant benefits with osteopathic manipulative treatment, as compared with sham manipulation. Wrap It Up Osteopathic manipulative treatment and sham manipulation both appear to provide some benefits when used in addition to usual care for the treatment of chronic nonspecific low back pain. It remains unclear whether the benefits of osteopathic manipulative treatment can be attributed to the manipulative techniques themselves or whether they are related to other aspects of osteopathic manipulative treatment, such as range of motion activities or time spent interacting with patients, which may represent placebo effects. Alright John C Licciardone, DO, MS, MBA, FACPM. ….Go to his experts website and find the following.  https://experts.unthsc.edu/en/persons/john-licciardone Dr. Licciardone’s research focuses on prevention and treatment of chronic pain. He holds the Richards-Cohen Distinguished Chair in Clinical Research and directs the Osteopathic Research Center, including its PRECISION Pain Research Registry. The latter studies precision medicine and biopsychosocial approaches to pain management, including use of pharmacogenetics to optimize opioid prescribing and avoid unintended consequences of their use. He received a Midcareer Investigator Award from the National Institutes of Health (NIH) and served as an expert panelist for NIH in the area of chronic pain. He recently served on the Work Group that developed NIH’s Federal Pain Research Strategy. Dr. Licciardone is recognized by Expertscape as the leading international expert in osteopathic manipulation, and has served as a consultant to the World Health Organization on regulatory and safety issues relating to osteopathy in Europe and other nations. He directed the OSTEOPATHIC Trial, a five-year study funded by NIH that demonstrated substantial improvements and recovery from chronic low back pain with osteopathic manipulation. He is presently a Co-Investigator in the $14 million Prevention of Acute to Chronic Back Pain Trial (PACBAC Trial), a national study to assess the efficacy of patient self-management and spinal manipulation in preventing chronic low back pain. Item #2 Our second one today is by the same author and is called, “Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial” by Liccardone et al published in Annals Of Family Medicine in March of 2013 so…..it’s only 11 years old then.  Licciardone JC, Minotti DE, Gatchel RJ, Kearns CM, Singh KP. Osteopathic manual treatment and ultrasound therapy for chronic low back pain: a randomized controlled trial. Ann Fam Med. 2013 Mar-Apr;11(2):122-9. doi: 10.1370/afm.1468. PMID: 23508598; PMCID: PMC3601389. Why They Did It We studied the efficacy of osteopathic manual treatment (OMT) and ultrasound therapy (UST) for chronic low back pain. How They Did It A randomized, double-blind, sham-controlled, 2 × 2 factorial design was used to study OMT and UST for short-term relief of nonspecific chronic low back pain.  The 455 patients were randomized to OMT or sham OMT, and to UST or sham UST main effects groups.  Six treatment sessions were provided over 8 weeks.  Intention-to-treat analysis was performed to measure moderate and substantial improvements in low back pain at week 12.  Five secondary outcomes, safety, and treatment adherence were also assessed. What They Found There was no statistical interaction between OMT and UST.  Patients receiving OMT were more likely than patients receiving sham OMT to achieve moderate  and substantial improvements in low back pain at week 12.  These improvements met the Cochrane Back Review Group criterion for a medium effect size.  Back-specific functioning, general health, work disability specific to low back pain, safety outcomes, and treatment adherence did not differ between patients receiving OMT and sham OMT.  Nevertheless, patients in the OMT group were more likely to be very satisfied with their back care throughout the study.  Patients receiving OMT used prescription drugs for low back pain less frequently during the 12 weeks than did patients in the sham OMT group Ultrasound therapy was not efficacious. Wrap It Up The OMT regimen met or exceeded the Cochrane Back Review Group criterion for a medium effect size in relieving chronic low back pain.  It was safe, parsimonious, and well accepted by patients. Item #3 As a quick bonus, I was looking the dude up and found this paper: It’s called, “Osteopathic Medical Care With and Without Osteopathic Manipulative Treatment in Patients With Chronic Low Back Pain: A Pain Registry–Based Study” by….again…..Licciardone et al and pulished in Journal of Osteopathic Medicine in February of 2020 but they WHO didn’t use this one for whatever reason…..let’s see what it says.  Licciardone, John C. and Gatchel, Robert J.. “Osteopathic Medical Care With and Without Osteopathic Manipulative Treatment in Patients With Chronic Low Back Pain: A Pain Registry–Based Study” Journal of Osteopathic Medicine, vol. 120, no. 2, 2020, pp. 64-73. https://doi.org/10.7556/jaoa.2020.016   Why They Did It To assess osteopathic medical care and the effectiveness of OMT for chronic low back pain in a real-world setting without the constraints of a rigid research protocol.   How They Did It An observational study of 445 adults with chronic low back pain who had an established osteopathic physician (ie, DO) or allopathic physician (ie, MD)  It was conducted within the PRECISION Pain Research Registry from April 2016 through February 2019.  Primary outcome measures included a numerical rating scale for low back pain intensity, the Roland-Morris Disability Questionnaire for back-related functioning, and use of nonsteroidal anti-inflammatory drugs or opioids for low back pain.   What They Found A total of 79, 48, and 318 patients, respectively, were treated by DOs who used OMT, DOs who did not use OMT, or MDs.  Patients treated by DOs who used OMT reported significantly lesser low back pain intensity and back-related disability than patients treated by MDs.  Patients treated by DOs who used OMT also reported less frequent use of nonsteroidal anti-inflammatory drugs or opioids   There were no significant differences in primary outcomes between DOs who did not use OMT and MDs   Wrap It Up This study of community-based patients in a pain research registry supports the effectiveness of OMT as an integral component of osteopathic medical care for chronic low back pain.  Patients treated by DOs who did not use OMT did not experience better results than patients treated by MDs in any primary outcome measure.  But…..the WHO didn’t include this. Maybe because it was an observational study rather than an RCT. Who knows? But this says SMT is an integral component of back pain whereas the others are less flattering.  It just feels dirty, WHO….it feels dirty! Don’t let those damn chiropractors get a head of steam or we’ll ALL be out of a job!! Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.    Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

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

Chiropractic evidence-based products

Integrating Chiropractors

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

The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

CF 315: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6)

Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 6).

If you’ve been following along, and I hope you have…The WHO updated their recommendations recently for pain. Spinal maniuplative therapy was include so we’re on the menu. But, they rated SMT at very low confidence, which is the same as what they rated ultrasound. So, in the eyes of the WHO, smt may be about as effective as ultrasound. Yeah, we’re call BS so we are going through each paper they used to make this determination and they all, except for a few, are old, outdated, and pretty much stink. We’ll talk about it…. 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. 
  • Like our Chiropractic Forward Facebook page, 
  • Join our private Chiropractic Forward Facebook group, and then 
  • Review our podcast on wherever you listen to it 
  • Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com

You have found yourself smack dab in the middle of Episode #315 Now if you missed last week’s episode, we talked about Omnivorous vs Vegan and SMT For Chronic Neck Pain.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Another day, another dollar by friends. Here we are at the end of January 2024 and if all works well and if you’re an insurance or hybrid clinic, then you know that you’ve been a little slower because the deductibles re-set in January for the most part and people don’t like to spend their own money.  But, about a month or so is as long as many of them ever want to go without going to the chiropractor and that’s OK.

The point being that hybrid clinics like mine should start seeing increased numbers in February. It may be mid to late February but we should see us start getting busier for sure.  In the meantime, I’ve started focusing more and more on marketing. I feel like I’m pretty dangerous when I have the time to be. Right now, I have the time to be. I used to sit around brainstorming ideas for marketing, memes, content, and all that entails. Then I’d create my own original stuff and post it.  I haven’t done that in forever it seems but here lately, and unfortunately, I’ve had some extra time to give those things attention again. I like a challenge and so I’m on it. I’ve targeted the demographics I want targeted.

The ones I think that the economy and who happens to be the President will have no control over economically. We’ve re-newed our efforts in getting our message to these people.  In addition, we’ve re-newed our efforts in our public outreach. Face to face, person to person outreach. Dan Kennedy says, YCDBSOYA, You can’t do business sitting on your ass. You’re moving forward or falling behind. You’re the window or the bug. You either make things happen in your life or you sit around wonder what the hell just happened.  So that’s what’s up with Creek Stone on this Monday, January 29th.

I have 35 on the schedule when I typically have 45. You carry that out throughout the week, that’s 50 less per week which is 200 less appointments per month. That’s unacceptable.  I’ve had less new patients lately as well. I think my Google SEO has dimished since going with a very reputable company a few years ago so we switched it up and went with a new website company that I know gets results. That’s brand new.  I also got to looking at our new patients demographics and it looks like we’re seeing fewer VA patients recently. That’s worth investigating and diving into.  If you’re not doing these thing regularly, might get on it. It’s whack-a-mole folks. You can never hit the auto-pilot button and sit back and just do the work if you’re the owner. It’s a constant battle. Enjoy the great times and ride that wave. When things start popping up out of nowhere, dig in, have some grit, and wait for that next wave.  Alright, here we go with the research today. 

Item #1

The first one today is called, “Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial” by Krekoukias, et al., published in 2017 in the Journal of Manual Manipulative Therapy.  Remember, the citations can be found at chiropractscforward.com under this episode.  Krekoukias G, Gelalis ID, Xenakis T, Gioftsos G, Dimitriadis Z, Sakellari V. Spinal mobilization vs conventional physiotherapy in the management of chronic low back pain due to spinal disk degeneration: a randomized controlled trial. J Man Manip Ther. 2017 May;25(2):66-73. doi: 10.1080/10669817.2016.1184435. Epub 2016 Jun 23. PMID: 28559665; PMCID: PMC5430451.

Why They Did It The authors wanted to examine the efficacy of spinal mobilization in subjects with low back pain (LBP) and associated spinal disk degeneration.

How They Did It Seventy-five subjects suffering from chronic LBP were randomly allocated into 3 groups of 25 subjects.  Each group received five treatment sessions with the first group receiving manual therapy (MT) (spinal mobilization), the second a sham treatment, and the third conventional physiotherapy (CP) (stretching exercises, transcutaneous electrical nerve stimulation, and massage).  Subjects were assessed for their pain intensity using the numerical pain rating scale and for their self-reported disability using the Oswestry and Roland-Morris Questionnaire at baseline and after the completion of the five treatment sessions.

What They Found Paired t-tests showed a significant improvement for all outcome measures in the manual therapy and conventional physiotherapy group.  Analysis of covariance revealed that the manual therapy group had significant improvement in all outcome measures in comparison with the sham and conventional physiotherapy group, whereas no significant difference was observed between the sham and conventional physiotherapy group

Wrap It Up Manual Therapy is preferable to conventional physiotherapy in order to reduce the pain intensity and disability in subjects with chronic LBP and associated disk degeneration.  The findings of this study may lead to the establishment of spinal mobilization as one of the most preferable approaches for the management of LBP due to disk degeneration.

Item #2 The last one is, “The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial” by Koes published in Spine journal in 1992 and they’re using 1992 to make this determination in 2024 because there’s no better and more current  Koes BW, Bouter LM, van Mameren H, Essers AH, Verstegen GM, Hofhuizen DM, Houben JP, Knipschild PG. The effectiveness of manual therapy, physiotherapy, and treatment by the general practitioner for nonspecific back and neck complaints. A randomized clinical trial. Spine (Phila Pa 1976). 1992 Jan;17(1):28-35. doi: 10.1097/00007632-199201000-00005. PMID: 1531552.

Why They Did It As you see in the title of the paper, the plan was to test the effectgiveness of manual therapy, physiotherapy, and treatment by a general practitioner on back and neck pain

How They Did It It was a randomized controlled trial The effectiveness of manual therapy, physiotherapy, continued treatment by the general practitioner, and placebo therapy (detuned ultrasound and detuned short-wave diathermy) were compared for 256 patients with nonspecific back and neck complaints lasting for at least 6 weeks. The principle outcome measures were severity of the main complaint, global perceived effect, pain, and functional status. These are presented for 3, 6, and 12 weeks follow-up. 

What They Found Both physiotherapy and manual therapy decreased the severity of complaints more and had a higher global perceived effect compared to continued treatment by the general practitioner.  Differences in effectiveness between physiotherapy and manual therapy could not be shown. 

Wrap It Up A substantial part of the effect of manual therapy and physiotherapy appeared to be due to nonspecific (placebo) effects. From 1992 – Placebo seems to be why smt appears to be effective. We know that placebo can and should play a part in a patient’s recovery. And we can leverage placebo in our favor too. Placebo has a bad name for some reason. In the biopsychosocial construct we should be using to our advantage all of the time.  Encouraging and positive words, little pain free wins….these things play a part in neuroplasticity and moving it in our direction and moving the patient away from chronic pain. 

That doesn’t mean that smt is placebo only and there have been plenty of papers shwoing the effectiveness of SMT beyond placebo in teh last 10 years or more. This paper is liteerally 32 years old. What in the holy hell are they using this paper for in 2024? I can’t explain it.  To be fair, I suppose the Gate Theory from the 1960s is still relevant so why can’t this paper still be relevant, right?/

But I’d argue that the Gate Theory is gamechanging big stuff. This paper, in my opinion, isn’t in the same ball park with regard to impact and effectiveness. As knowledge base expands, more recent and more relevant knowledge replaces outdated knowledge. This paper should be replaced and not be relevant when recommending SMT for treatment.  My two cents.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

Chiropractic evidence-based products

Integrating Chiropractors

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The Message

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

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

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

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

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