CF 366: Europe, SMT Review, & Informed Consent Today we’re going to talk about Europe, SMT Review, & Informed Consent 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 [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #366 Now if you missed last week’s episode, we talked about  Dosing Lumbar SMT & Short Term Effects of Different Forms of SMT Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, as mentioned when we last left off, I was headed to Europe for a VoiceOver retreat and VoiceOver retreat I did. Went, saw, and conquered.  One thing that struck me as interesting and something that maybe some of you can relate to is that I have some form of anxiety. Most of it is absolutely useless. I have it in all aspects of my life and it drives me crazy.  For example, this trip to Europe, I’ve never been across the pond before so I was losing sleep about the trip. What if a plane is late and causes us to miss our connection? What if we can’t figure out the train system? What if I have a hard time with all of the bags getting on and off the trains? What if they lose a bag on one of our flights? What if we have a hard time getting where we need to be? What if I can’t communicate with the people I need help from?

Yeah……all of that stuff.  Welcome to my brain. That’s my life on the reg, as the kids say.  I do it with the clinic too. What if it stays slow?

What if I can’t get our collectors to get it going this month? What if’s out the damn wazoo.  Now, to some extent, that’s helpful, right? Keeps you on your toes and doing what we’re supposed to be doing. On the other side of that though, it can be detrimental. It can make you miserable, stressed, and not so healthy.  Here’s the thing my mom used to tell me, “”99% of the things we worry about never ever happen.”” And she was right.  We had smooth travels in Europe.

They lost our bag on a direct flight from Edinburgh Scotland to Amsterdam but after about an hour, they found it.

Other than that, everything was smooth sailing, everyone spoke English, and we did everything we wanted with no issues.  Well, except for in Paris when their soccer team won their first-ever championship and the town had riots two nights in a row but, even that stupidity was able to be navigated through. 

Edinburgh was magical, Amsterdam was fun, Valkenburg was relaxing, and Paris was beautiful. The French folks were super nice. Don’t buy into the haters. It was great.  Now that we’ve been once, we can’t wait to return. What will our next adventure be? Time will tell.  Now tying that back into clinic life, that’s the first time in 28 years that I’ve been out of the clinic for 2 weeks straight. That’s stressful, right? It’s not the cost of a trip that keeps me from going. It’s the cost of being gone out of the clinic that keeps me from going. 

Let’s say a trip will cost $20k overall. OK, that stings a little but we can figure that out. BUT …..for round numbers and easy math….let’s say I bill out $100k per month and I’m gone for 2 weeks, that’s a loss of $50k. So that makes it a $70k trip, folks. And that freaking hurts.  Most of my career has been spent taking little 4-5 day trips leaving on a Thursday and coming back on a Monday or something like that. I’m sure you can relate. 

On this one, I worked Wednesday morning from 8-10:30 am on Wednesday and saw only about 14 patients. For the three days of that week, we saw about 100. I’m typically seeing around 150+ per week for context.  We had a coverage doc come in for three days that week I was gone all week. So they saw 86 in those 3 days. 

Then, on the week I got back, I missed Monday and Tuesday. We flew in Wednesday morning from Europe and I was back at work Wednesday afternoon. Yes…..I was tired. BUT, for that week I saw 110.  So, you can see that yes…we missed out on some patients. No doubt. But we were able to minimize the damage.  Now the job I have is rebuilding the numbers. Here it is my first Monday back from vacay and we are set with 105 for the week. No, that’s not where I want to be but y’all know how that works. Our Monday patients will reschedule Wednesday and Friday and I suspect we’ll end up somewhere around 135 or 140 this week.  That’s not too much of a drop-off.

So I think my strategy may have worked. One of my mastermind colleagues shared with me that he went to Europe for two weeks and it took him a month to rebuild his clinic when he got back. And that’s with an associate. I don’t have an associate. He freaked me the hell out.  I think that we have managed to minimize the hit to our numbers and will hopefully be back to full steam by the end of the week and starting of next week.  Anyway, kind of in the weeds a bit there but I wanted to share with you all how I think we were able to leave for two weeks with minimal damage to our bottom line. Maybe it’ll come in useful for you too. Work a little on Wednesday in the morning, fly out in the afternoon, hire coverage three days the full week you’re gone, and fly in Tuesday or Wednesday morning and get back at it Wednesday afternoon. Great formula I think.  Just a tip from your ol Uncle Jeffro. 

Alright that’s it, let’s hop in. 

Item #1

Our first one this week is called “Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations” by Trager et al and published in the Journal of Clinical Medicine in August of 2024 and it’s hot enough for some hot talk! Remember, the citations can be found at chiropracticforward.com under this episode. 

Trager RJ, Bejarano G, Perfecto R-PT, Blackwood ER, Goertz CM. Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. Journal of Clinical Medicine. 2024; 13(19):5668. https://doi.org/10.3390/jcm13195668

This one is a little more than just a short thing we can breeze through so I did a little Grok AI summary and he’s what we got.  It provides a comprehensive review of chiropractic care, focusing on spinal manipulative therapy (SMT) from 1972 to 2024.

Key Points:

Conclusion: The paper underscores the growing acceptance of chiropractic SMT, supported by increasing research and guideline endorsements, particularly for musculoskeletal disorders. However, it calls for further studies to address evidence gaps and optimize clinical applications.

Item #2

Our second one this week was sent to me by my buddy, Dr. Steve Brown hailing from Gilbert, AZ. Gilbert, gateway to Tucson.  It is titled, “THE CONNECTICUT LAW ON CHIROPRACTIC INFORMED CONSENT TO CERVICAL ARTERY DISSECTION AND STROKE: A NARRATIVE REVIEW”

Dr. Brown wrote this article with Dr. Robert Cooperstein and it was published in Journal of Contemporary Chiropractic on June 2, 2025 and it’s hot hot hot, en fuego!

Brown S, Cooperstein R. THE CONNECTICUT LAW ON CHIROPRACTIC INFORMED CONSENT TO CERVICAL ARTERY DISSECTION AND STROKE: A NARRATIVE REVIEW. JCC. 2025;8(1):162-169. https://journal.parker.edu/article/139042-the-connecticut-law-on-chiropractic-informed-consent-to-cervical-artery-dissection-and-stroke-a-narrative-review

Why They Did It This paper reviews the evidence considered by the Connecticut Board of Chiropractic Examiners in their 2010 memorandum concluding 

The 2010 memorandum contains 5 Findings of Fact. An additional objective of this narrative review was to determine if there is sufficient evidence to support the Board’s third and fourth Findings of Fact.

How They Did It We analyzed the 2010 memorandum to determine what evidence was considered by the Connecticut Board in arriving at their third and fourth Findings of Fact. Analysis revealed that the Connecticut Board reviewed 3 studies. All 3 studies were acquired and reviewed.

What They Found Analysis of the Connecticut Board’s 2010 memorandum shows that they relied solely on the first conclusion of the 2008 Cassidy et al. study, Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-based Case-Control and Case-Crossover Study.

Wrap It Up We conclude that the third and fourth Findings of Fact in the 2010 memorandum of the Connecticut Board of Chiropractic Examiners are not supported by the evidence.  Patients have the right to consider whether the clinical benefits they seek are worth the inherent risks. 

The present authors therefore recommend that chiropractors include the risk of stroke and/or CAD in securing informed consent by patients to manipulation of the cervical spine.  This practice would be both evidence-based and patient-centered, and constitute an important element of the chiropractic standard of care. 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.     

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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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