CF 311: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 4) But first, here’s th at 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 #311 Now if you missed last week’s episode, we talked about the same thing only it was Part 3.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. It’s January 2 today as I’m typing. That means a new year….a new me. Right. Not really. I’m the exact same dude I was on 12/31 with the same personality, belt line, and problems . My daughter said, “”what’s your resolution, Dad?” I said I don’t make them. I don’t believe in them. I try to better myself every day. If I need to lose weight, we don’t wait until 12/31 to decide we’re going to do it. I think of stuff and I just do it.  So, I don’t do resolutions. However, I do like motive, ambition, decisions to move in a positive direction, and overall good positive feelings. So, while I don’t engage in resolutions myself, I do support them 100%.  I’ve said here that 2023 was a tough one for me personally and professionally. No big game changers or life changers. Just irritations that had to be dealth with. It wasn’t a fun one. So I’m hoping that 2024 will be finally movign in the right direction. The changes that need to be made happen and they have the effect they were intended to have and on and on.  My hope is the same for all of you.  We should all have a little extra time on our hands for a month or so. That’s if you take insurance. Deductibles re-set in January and for some reason, people don’t like using their own money so it’ll be a bit beffore they return. Usually, if experience serves me, it’ll be around mid February to the first of March before it really ramps back up.  That means we have time to plan, prepare, review our systems, train, and market.  So let’s get to it so we can all get after it.  Item #1 The first one this week is called “Chronic low back pain and vertebral manipulation” by Ghroubi et. Al. and published in Annals of Readaptive Physical Medicine and published in October of 2007. The WHO is using a paper from 2007. Duly noted.  Remember that the citations for these papers will be in teh show notes at chiropracticforward.com episode 311 Ghroubi S, Elleuch H, Baklouti S, Elleuch MH. Les lombalgiques chroniques et manipulations vertébrales. Etude prospective à propos de 64 cas [Chronic low back pain and vertebral manipulation]. Ann Readapt Med Phys. 2007 Oct;50(7):570-6. French. doi: 10.1016/j.annrmp.2007.02.012. Epub 2007 Mar 8. PMID: 17382426. Why They Did It This study examined the short-term effectiveness of vertebral manipulation for treating chronic low back pain and disability. How They Did It Sixty-four patients were randomly assigned into two groups.  One group received 4 true vertebral manipulations (VMG), and the other group received sham manipulations (sham-VMG) under the same conditions as for the first technique.  Patients formulated assessments after the manipulations and 1 month later. What They Found
  • Patients receiving the true manipulations showed significant improvement in pain (visual analogic scale score and function)
  • (Oswestry scale). Pain improvement persisted at the second month (P=0.01). 
  • The improvement was more evident in the group that received adjustments than the sham-group. 
  • No change in perceived disability was observed in the sham-VMG.
Wrap It Up Our study confirms the efficiency of short-term vertebral manipulation for treating chronic low back pain. The assessment of vertebral manipulation effectiveness is difficult. This manual therapy must be preceeded by a specific clinical exam performed by a trained physician. Item #2 The last one this week is called, “Lumbar spinal manipulation on trial. Part I–clinical assessment” by Evans et. Al. published in Rheumatological Rehabilitation in February 1978. Yes, the WHO is basing our effectiveness partly on a paper from 1978 that had a sample of 32. Whether the information is positive or negative in the paper……should we be looking at stuff from 1978, 46 years ago, with such a small sample when we’ve seen so many more current papers come through showing effectiveness? I’m not research so it’s just a question from and enthusiastic observer. That’s all.  Evans DP, Burke MS, Lloyd KN, Roberts EE, Roberts GM. Lumbar spinal manipulation on trial. Part I–clinical assessment. Rheumatol Rehabil. 1978 Feb;17(1):46-53. doi: 10.1093/rheumatology/17.1.46. PMID: 153574.
  • Thirty-two patients with chronic low back pain were treated three times at weekly intervals with rotational manipulation. 
  • Patients with femoral or sciatic root pain were included provided they did not exhibit root compression signs. 
  • Background therapy of codeine phosphate was administered throughout. 
  • There was a significant increase in spinal flexion measured clinically during the three-week period of manipulation followed by a significant decrease in the three-week period after manipulation. 
  • The first week of manipulative treatment was more painful than the corresponding week in the control group but in the second and third weeks there was less pain in the manipulated group. 
  • Pain scores were reduced to a significant degree within four weeks of starting treatment only in the group manipulated in the first treatment period. 
  • Patients benefitting subjectively from manipulation were more likely to be older and to have had symptoms for a shorter period than those not deriving benefit. 
  • The age of onset of symptoms was significantly later in the responders.
Well, there you have it for part 4 of why the WHO recommends spinal manipulative therapy but at very low confidence.  We have TEN more episodes on this to explore. Are we enjoying this? Is it useful to you? I know I’m learning and I’m definitely covering papers we haven’t covered on the podcast before so I’m locked in and rocking. I’d love to hear form you on it.  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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  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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