CF 310: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 3) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 3) 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 #310 Now if you missed last week’s episode, we talked about the same thing we’ll be covering this week but that was part 2 and we are about to get going with part 3 so hold your shorts.  Go back and listen to last week’s when you have time because you need to Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Well, Christmas was yesterday so I just have the holiday hangover today basically. Not from alcohol. I didn’t drink a drop yesterday. Just the activity, the family, the food, and the goign from here to there. Everything involved with a big holiday.  It’s been a tough year for me and my family. We are still recovering from a key passing in our family last year. The ripples were felt all year this year as well. An incredible amount of staff turnover, the like of I’ve never seen in 26 years of practice. And so much more. It was a tough one. While I know a new year makes no real difference, I’m hoping to put 2023 to bed and move to a positive, optimistic, properous 2024 full of more peace for me and my family.  After Chritmas……I’m tired. My normal bed time is around 1:00 am. Last night I was in bed and asleep by about 10:30. When I’m out that early, you know I had all I wanted. Maybe I’m just getting old.  This goes for young, mid, and old…..what are your practice plans?/ what’s the end game? Are you aiming to die in your office still working on patients? Which is fine. It’s just the question that needs to be answered. We get out of college and we start working. Day after day. Many times without thinking of the endgame which, when we’re younger, we don’t think will ever actually happen because we are, of course, indestructible.  Well, my friends, take it from your ol’ Uncle Jeffro, the day does indeed come for all of us. The chiropractor that made me want to be a chiropractor, Dr. Jerry Whitehead from Perryton, TX, just passed away. Sad but true. So what’s the end game? My advice…..build it to sell it. Maybe not in the next 5 years. Maybe not in the next 25 years. But if you build it to sell it, when you’re ready, you have a sell-able product with systems and staff in place to continue what you started.  Imagine an investor or another chiropractor that has it all laid out before them and all they have to do is sign on the line and it’s theirs.  So, my plan for example, is to get an associate in place. Then get another associate in place so there is redundancy. If one leaves us, the remaining one is there to train the next. I want to pay them in a way that the thought of leaving here and having to start their own thing just makes them want to puke. I got that idea from another very successful chiro.  Open up the books, show them your overhead and let them know how hard it is to run the show. Then pay them enough that the thought of giving up that money and having to be in control of all of that stress and management just makes them sick to their stomach.  Then, work into a management position. Also, if you haven’t named your practice yet, don’t do ‘Last Name Chiropractic’. What if I named mine Williams Chiropractic and someone named Bradburn bought it? Well now they have to completely re-brand or keep a name that’s not even theirs. We are Creek Stone for a reason. I like the imagery of the name but it’s also non-descript so anyone can buy it and comfortably continue building the brand.  I try to continuously strike a balance between building trust in me and my name with my community but also let the brand be the marketer instead of having my name and face on every bit of marketing. The less my name and face is in all of the branding, the easier it is for someone else to buy it and not have to overcome the transition of going from my name and face to theirs. If the brand is strong, it will stand on its own instead of depending on my name and image. Also, start thinking now, “What is your exit number?” Assuming you will exit at some point. I have a number in mind for me to have all bills covered, all debts paid, and have plenty fo retirement. With VoiceOver, that number has been significantly reduced by the way. Side gigs that can carry into and sustain retirement are pretty damn nice. We have airbnbs and VoiceOver helping us out on the deal.  I have a plan that I set into motion around 3 years ago and it’s really been paying off so, if all of the pieces fit together, I can ideally be in at least partial retirement by 55 or 56 I think. I hope.  My mom says thats too early. That I’m not old enough to retire. I responded to her, “Who the heck told you that?” Probably some corporation that needs their workers to stay in place into their late 60’s. I’ve workd hard since I was 14. I’m 51. I’m a musician, singer/songwriter, sculptor, painter, futrniture builder, voice actor, landlord, husband, and dad. I’m not wanting to retire. I just want to retire from every day, all day patient care. That’s all.  Anyway, if we were to make New Year’s resolutions, mine would be that my plan keeps taking shape and my financial future keeps going in the right direction to gain more and more freedom of my time. Time is not replaceable and we’re either wasting it or we are investing it. Time cannot be purchased so I’m doing everyhting I can to make the most of what time I have left.  Some thoughts for you with this new year coming up on us.  Item #1 Our first one this week is on the WHO’s list and it’s called, “Spinal Manipulative Therapy for Chronic Lower Back Pain in Older Veterans: A Prospective, Randomized, Placebo-Controlled Trial” by Dougherty et. Al. and was published in Geriatric Orthopedic Surgical Rehabiliation in December of 2014.  Citations are in the show notes.  Dougherty PE, Karuza J, Dunn AS, Savino D, Katz P. Spinal Manipulative Therapy for Chronic Lower Back Pain in Older Veterans: A Prospective, Randomized, Placebo-Controlled Trial. Geriatr Orthop Surg Rehabil. 2014 Dec;5(4):154-64. doi: 10.1177/2151458514544956. PMID: 26246937; PMCID: PMC4252156. Why They Did It Chronic lower back pain (CLBP) is problematic in older veterans. Spinal manipulative therapy (SMT) is commonly utilized for CLBP in older adults, yet there are few randomized placebo-controlled trials evaluating SMT. How They Did It The purpose of the study was to compare the effectiveness of SMT to a sham intervention on pain (VAS, SF-36), disability (Oswestry Disability Index), and physical function (SF-36 subscale, Timed Up and Go) by performing a randomized placebo-controlled trial at 2 Veteran Affairs Clinics. What They Found
  • Older veterans (≥ 65 years of age) who were naive to chiropractic were recruited. 
  • A total of 136 were included in the study with 69 being randomly assigned to SMT and 67 to sham intervention. 
  • Patients were treated 2 times per week for 4 weeks (which is roughly the Clinical Compass guides for chronic pain) assessing outcomes at baseline, 5, and 12 weeks postbaseline. 
  • Both groups demonstrated significant decrease in pain and disability at 5 and 12 weeks. 
  • At 12 weeks, there was no significant difference in pain and a statistically significant decline in disability scores in the SMT group when compared to the sham intervention group. 
Wrap It Up
  • The SMT did not result in greater improvement in pain when compared to our sham intervention; however, SMT did demonstrate a slightly greater improvement in disability at 12 weeks. 
  • The fact that patients in both groups showed improvements suggests the presence of a nonspecific therapeutic effect.
This was in 2014. I think we could makes some educated guesses here in almost 2024 that that could be do to SMT affecting and supporting functional movement, proprioceptive input, and encouragement as far as activity. This could go toward what you’ve heard me mention with regard to Reframe the conversation. Reprogramming basically.  As a side note, after being in this thing 26 years, It’s really hard for me to imagine no difference in the pain levels. Even if just short term. I find it odd but the sample size is honestly small here.  Who knows? But there it is and this is one of the papers the WHO used to recommend SMT but at very low level of confidence.  Item #2 Our last one today is called, “The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial” by Didehdar et. Al. and published in Irish Journal of Medical Science in May of 2020.  Didehdar D, Kamali F, Yoosefinejad AK, Lotfi M. The effect of spinal manipulation on brain neurometabolites in chronic nonspecific low back pain patients: a randomized clinical trial. Ir J Med Sci. 2020 May;189(2):543-550. doi: 10.1007/s11845-019-02140-2. Epub 2019 Nov 26. PMID: 31773541. Why They Did It In patients with chronic nonspecific low back pain (NCLBP), brain function changes due to the neuroplastic changes in different regions. They aimed to evaluate the brain metabolite changes after spinal manipulation, using proton magnetic resonance spectroscopy How They Did It In the current study, 25 patients with chronic nonspecific low back pain aged 20-50 years were enrolled.  Patients were randomly assigned to lumbopelvic manipulation or sham.  Patients were evaluated before and 5 weeks after treatment by the Numerical Rating Scale (NRS), the Oswestry Disability Index (ODI), and proton magnetic resonance spectroscopy What They Found After treatment, severity of pain and functional disability were significantly reduced in the treatment group vs. sham group  After treatment, N-acetyl aspartate (NAA) in thalamus, insula, dorsolateral prefrontal cortex (DLPFC) regions, as well as choline (Cho) in the thalamus, insula, and somatosensory cortex (SSC) regions, had increased significantly in the treatment group compared with the sham group.  A significant increase was further observed in N-acetyl aspartate in thalamus, anterior cingulate cortex (ACC), and somatosensory cortex regions Also, a significant increase was observed in glutamate and glutamine levels of thalamus.  There was no significant difference in terms of brain metabolites at baseline and after treatment  in the sham group. Wrap It Up In the patient with low back pain, spinal manipulation affects the central nervous system and changes the brain metabolites. Consequently, pain and functional disability are reduced. Nice. I’m not going to pretend to be a Neuro wonk but that’s nice.  There is a response when things are done to us. Of course. I see this come up with the insistence that adjustments improve the immune system. OK, but for how long? And is the improvement about the same is getting hit in the butt with a 2×4?  I don’t know the answers to those questions by the way. But, until we do, it’s probably not responsible to advertise that spinal manipulative therapy increases the immune system. If I see an ad that says, “Come in and get you adjustment to ward off COVID and flu,” my face is going to split and my eyes will roll out of my head. Because……just….no. Don’t do it please.  That was a slight tangent so let’s just stop here.  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.     

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Chiropractic evidence-based products

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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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