CF 180: What Sitting On Your Butt Will Get You & Catastrophizing An MRI Result Today we’re going to talk about sitting on your butt and we’ll talk about catastrophizing from an image. But first, here’s that sweet sweet bumper music
OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.
- Like our Facebook page,
- Join our private Facebook group and interact, and then
- go review our podcast on iTunes and other podcast platforms.
- We also have an evidence-based brochure and poster store at chiropracticforward.com
- While you’re there, join our weekly email newsletter.
You have found yourself smack dab in the middle of Episode #180 Now if you missed last week’s episode, we talked about the alarming rising death rate among the working-age population and we discussed the role nutrition can play in chronic pain. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things…..
It’s going to be a short one this week. I have to fit a full week if work responsibilities into three days because I’m taking off Thursday through Tuesday. My wife and kids and I are heading out to New Orleans to get fat and drink funny drinks. I love Louisiana. I was in the football team at West Texas State for one semester before transferring to Northwestern Louisiana in Natchitoches. Same town Steel Magnolias was filmed in. Absolutely gorgeous. Going from the Texas Panhandle to Louisiana was a culture shock y’all. Whole different wonderful world. I tell people that you simply cannot spend any amount of real-time in Louisiana without absolutely falling in love with the people, the music, the culture, the food…..the VIBE. It’s special. We like to travel. I’ve told you here several times that you need a trip at least once per quarter. Something to look forward to. Something to work toward. Once we see a place, it’s time to move on and see something else. There are too many places to see in the world to be going back to the same ol’ places all of the time.
Except for New Orleans. We go back just as often as we get the opportunity to.
It’s somewhat close and we love it So, we’re going this week. And I have to keep it short. The medical integration is going slowly. Business is steady but not Pre- Covid numbers. I’m frustrated with that if Imm. Ring honest and I’m always honest with you all. It’s really kind of pissing me off. But I’m a Christian. It’s not always in my hands. Good luck looks a whole lot like hard hard work. So do what’s right. Treat people right. Love folks. It’ll work out. Just be prepared and try to be a learn it all instead of a know it all. Here we go. But first, let’s hear from our amazing, practice-changing sponsors!
The first item up is called “The Association Between Leisure-time Physical Activity, Sedentary Behavior, and Low Back Pain: A Cross-sectional Analysis in Primary Care Settings” by Lemes, et. al.  and published in Spine Journal on May 1, 2021 Hot tamale, hot tamale….get ‘em while they’re good ’n’ hot!
Why They Did It To investigate the association between leisure-time physical activity (LTPA) and low back pain (LBP) in adults from primary care settings, and to explore how sedentary behavior influences this association.
How They Did It
- Cross-sectional analysis of an ongoing longitudinal study with adults from Bauru, Brazil – that was 557 individuals.
- Data on physical activity, sitting time, LBP, BMI, and chronic diseases were assessed by face-to-face interviews, physical evaluation, and medical records.
- Sociodemographic, behavioral, and health variables were used as covariables in the multivariable models.
What They Found
- The fully adjusted model showed that active participants were 33% less likely to have LBP when compared with those insufficiently active
- A significant association was found for active participants who spent less than 3 h/day sitting but not for those who spent 3 h/day or more in sedentary activities
- An inverse association of LTPA with LBP was observed in obese participants, but not in those with normal BMI and overweight.
Wrap It Up
Leisure-time physical activity was inversely associated with the prevalence of LBP in adults from primary care. This association was influenced by sedentary behavior and BMI.
Our last one this week is called, “The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials” by Rajasekaran, et. al.  and published in European Spine Journal in March of 2021. Pork chops and hot sauce.
Why They Did It Inappropriate use of MRI leads to increasing interventions and surgeries for low back pain (LBP). We probed the potential effects of a routine MRI report on the patient’s perception of his spine and functional outcome of treatment. An alternate ‘clinical reporting’ was developed and tested for benefits on LBP perception.
How They Did It In Phase-I, 44 LBP patients were randomized to Group A who had a factual explanation of their MRI report or Group B, who were reassured that the MRI findings showed normal changes. The outcome was compared at 6 weeks by VAS, PSEQ-2, and SF-12. In Phase-II, clinical reporting was developed, avoiding potential catastrophizing terminologies. In Phase-III, 20 MRIs were reported by both routine and clinical methods. The effects of the two methods were tested on four categories of health care professionals (HCP) who read them blinded on their assessment of the severity of disease, possible treatment required, and the probability of surgery.
What They Found
- Both groups were comparable initial by demographics and pain.
- After 6 weeks of treatment, Group A had a more negative perception of their spinal condition, increased catastrophization, decreased pain improvement, and poorer functional status(p = significant for all).
- The alternate method of clinical reporting had significant benefits in the assessment of lesser severity of the disease, shift to lesser severity of intervention and surgery in three groups of HCPs.
Wrap It Up
Routine MRI reports produce a negative perception and poor functional outcomes in LBP. Focused clinical reporting had significant benefits, which calls for the need for ‘clinical reporting’ rather than ‘Image reporting’. Words matter, folks. Words matter. If you’re telling people that they have abnormal degeneration or an abnormally straightened cervical spine and telling them how concerned you are for their future if they don’t spend 70 visits and $5,000 this year to fix it……blah blah blah. If you’re doing this, you either don’t understand stuff and you need to do a lot more sciencing……or…..or you’re predatory, unethical, and a sorry human being that needs to reconsider how you treat your fellow humans.
Sorry, I realize that’s harsh. But it’s the truth. If you are taking images and using them to scare people into treatment to build your clinic and your numbers, you are in the wrong business. Go sell cars. This is healthcare and people’s very lives and the quality of their lives are involved. Learn to communicate in a positive, optimistic manner. Learn to get people moving and functioning.
Learn to address the biopsychosocial aspect of pain. Learn to use it in the patient’s favor, not in your favor. Just learn if you don’t know these things. Raise the game. If you have the chance, and you do, why not just be a big deal then? Let’s all be big deal by being learn it alls. Being ethical, moral, honest, and loving. Oh, and by acting responsibly based on the model of evidence-based, patient-centered care. We have companies out there teaching chiropractors how to ‘close’ patients. What clowns. That’s clown stuff folks. Don’t do it. Raise the game. Way too many shenanigans have been going on in this profession for way too long. Alright, that’s it. Y’all be safe. Keep changing our profession from your little corner of the world. Keep taking care of yourselves and everyone around you. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week.
Store Remember the evidence-informed brochures and posters at chiropracticforward.com.
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.
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
Player FM Link https://player.fm/series/2291021
About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger
1. Lemes ÍR, P.R., Turi Lynch BC, Codogno JS, Oliveira CB, Ross LM, Araújo Fernandes R, Monteiro HL,, The Association Between Leisure-time Physical Activity, Sedentary Behavior, and Low Back Pain: A Cross-sectional Analysis in Primary Care Settings. Spine (Phila Pa 1976), 2021. 46(9): p. 596-602. 2.
2. Rajasekaran S, D.C.R.S., Pushpa BT, Ananda KB, Ajoy Prasad S, Rishi MK,, The catastrophization effects of an MRI report on the patient and surgeon and the benefits of ‘clinical reporting’: results from an RCT and blinded trials. Eur Spine J, 2021.