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  

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

  • Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. 
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You have found yourself smack dab in the middle of Episode #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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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

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