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First Provider Matters & Neural Mobilization
CF 358: First Provider Matters & Neural Mobilization Today we’re going to talk about First Provider Matters & Neural Mobilization But first, here’s that sweet sweet bumper music
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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 #358 Now if you missed last week’s episode, we talked about Utilization and Expenditure of Chiropractic and we talked about Hormone Therapy in Females. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things….. Well, if you’re a regular listener, then you know we have gone a couple of weeks without a podcast. Unfortunately, my mother went through a battle with her health and ultimately lost that battler on January 24, 2025. She had been in the hospital for several weeks prior and every minute before work, at lunch, and after work was spent at the hospital. Not writing podcasts, as I’m sure you all understand. Then, we’ve kind of been in recovery mode. Trying to get my thoughts together and honestly…..just taking a little time to breathe. So, here we are this week. Can I tell you what some time off will do to an evidence-based practice. Day-um…. One word….two syllables….Day-um. Christmas was on a Wednesday which is a week wrecker. Then NYE was on a Wednesday, yes…a week wrecker. Then we had the snow storms and over 11 inches of snow so a couple of days off there. Then my mom’s passing then my mom’s funeral so a couple more days off there. Next thing you know a good Monday for me was 45 patients and I was looking at 28 or so. Not a good thing so fortunately, I’m getting the train back on the track now with 38 this Monday and Wednesday is looking solid as well as Thursday and Friday so I think the ball is back in play. Which takes some stress off. Oh, and while my mom is in the hospital and we don’t know if she’s going to make it, I had to take a quick trip to support my daughter’s cheer team down in Fort Worth, TX. My damn sexy pick up truck died on the way home and has been in a mechanic shop 250 miles away for the last 3-4 weeks. Then, after the funeral, my wife and I got COVID. 2025 is hating on my but we’re winners around here and, like I said, I think we’re already back on track. If you’re a praying person, I’d ask you to include us today. Include us for mom, our clinic’s health, and for a better, stronger 2025. That would be amazing of you. Now, enough woe is me, let’s get to the research.
Item #1
Our first one this week is called, “First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization” by Bise et al and published in Physical Therapy and Rehabilitation Journal in September 2023. Remember, the citations can be found at chiropracticforward.com under this episode. Christopher G Bise, Michael Schneider, Janet Freburger, G Kelley Fitzgerald, Galen Switzer, Garry Smyda, Pamela Peele, Anthony Delitto, First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization, Physical Therapy, Volume 103, Issue 9, September 2023, pzad067, https://doi.org/10.1093/ptj/pzad067
Why They Did It Costs associated with low back pain (LBP) continue to rise. Despite numerous clinical practice guidelines, the evaluation and treatments for LBP are variable and largely depend on the individual provider. As yet, little attention has been given to the first choice of provider. Early research indicates that the choice of first provider and the timing of interventions for LBP appear to influence utilization. We sought to examine the association between the first provider seen and health care utilization.
How They Did It Using 2015–2018 data from a large insurer, this retrospective analysis focused on 29,806 patients seeking care for a new episode of LBP. The study identified the first provider chosen and examined the following year of medical utilization. Cox proportional hazards models were calculated using inverse probability weighting on propensity scores to evaluate the time to event and the relationship to the first choice of provider.
What They Found The primary outcome was the timing and use of health care resources. Total health care use was lowest in those who first sought care with chiropractic care or physical therapy. Highest health care use was seen in those patients who chose the emergency department.
Wrap It Up Overall, there appears to be an association between the first choice of provider and future health care use. Chiropractic care and physical therapy provide nonpharmacologic and nonsurgical, guideline-based interventions. The use of physical therapists and chiropractors as entry points into the health system appears related to a decrease in immediate and long-term use of health resources.
Item #2 Our second one this week is called, “Efficacy of neural mobilization and Maitland accessory mobilization in patients with tennis elbow- randomized controlled trial” by Jain et al and published in Journal Of Bodywork and Movement Therapies in April of 2024 and……why not??? Because it’s Hot! Chanchal Jain, Manu Goyal, Saumya Kothiyal, Efficacy of neural mobilization and Maitland accessory mobilization in patients with tennis elbow- randomized controlled trial, Journal of Bodywork and Movement Therapies, Volume 38, 2024, Pages 525-533, ISSN 1360-8592, https://doi.org/10.1016/j.jbmt.2024.01.013. (https://www.sciencedirect.com/science/article/pii/S1360859224000287)
Why They Did It The objective of the study was to evaluate the efficacy of Maitland accessory mobilization and neural mobilization in patients with tennis elbow.
How They Did It Twenty-five patients meeting the selection criteria were randomly assigned to three experimental groups: Group C (conventional treatment), Group B (neural mobilization), and Group A (Maitland mobilization). Quality of life was assessed using the Patient Rated Tennis Elbow Evaluation (PRTEE), while pain, range of motion, and grip strength were evaluated using the Visual Analog Scale (VAS), a universal goniometer, and a handheld dynamometer. The interventions were administered three times per week for four weeks to the respective groups.
What They Found The results of the between-group analysis demonstrated significant differences in pain (p = 0.018) and quality of life (p = 0.045) among the three groups.
Wrap It Up After a 4-week intervention, all three groups exhibited notable improvements in discomfort levels, grip strength, and quality of life. Notably, Group B (neural mobilization) demonstrated the most substantial increase in range of motion (ROM) compared to Groups A and C. Consequently, incorporating neural mobilization into the treatment plan is recommended for patients experiencing Tennis Elbow. 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.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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 http://www.chiropracticforward.com
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
iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link https://player.fm/series/2291021
Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
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
The post First Provider Matters & Neural Mobilization appeared first on Chiropractic Forward.
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CF 358: First Provider Matters & Neural Mobilization Today we’re going to talk about First Provider Matters & Neural Mobilization But first, here’s that sweet sweet bumper music
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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 #358 Now if you missed last week’s episode, we talked about Utilization and Expenditure of Chiropractic and we talked about Hormone Therapy in Females. Make sure you don’t miss that info. Keep up with the class.
On the personal end of things….. Well, if you’re a regular listener, then you know we have gone a couple of weeks without a podcast. Unfortunately, my mother went through a battle with her health and ultimately lost that battler on January 24, 2025. She had been in the hospital for several weeks prior and every minute before work, at lunch, and after work was spent at the hospital. Not writing podcasts, as I’m sure you all understand. Then, we’ve kind of been in recovery mode. Trying to get my thoughts together and honestly…..just taking a little time to breathe. So, here we are this week. Can I tell you what some time off will do to an evidence-based practice. Day-um…. One word….two syllables….Day-um. Christmas was on a Wednesday which is a week wrecker. Then NYE was on a Wednesday, yes…a week wrecker. Then we had the snow storms and over 11 inches of snow so a couple of days off there. Then my mom’s passing then my mom’s funeral so a couple more days off there. Next thing you know a good Monday for me was 45 patients and I was looking at 28 or so. Not a good thing so fortunately, I’m getting the train back on the track now with 38 this Monday and Wednesday is looking solid as well as Thursday and Friday so I think the ball is back in play. Which takes some stress off. Oh, and while my mom is in the hospital and we don’t know if she’s going to make it, I had to take a quick trip to support my daughter’s cheer team down in Fort Worth, TX. My damn sexy pick up truck died on the way home and has been in a mechanic shop 250 miles away for the last 3-4 weeks. Then, after the funeral, my wife and I got COVID. 2025 is hating on my but we’re winners around here and, like I said, I think we’re already back on track. If you’re a praying person, I’d ask you to include us today. Include us for mom, our clinic’s health, and for a better, stronger 2025. That would be amazing of you. Now, enough woe is me, let’s get to the research.
Item #1
Our first one this week is called, “First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization” by Bise et al and published in Physical Therapy and Rehabilitation Journal in September 2023. Remember, the citations can be found at chiropracticforward.com under this episode. Christopher G Bise, Michael Schneider, Janet Freburger, G Kelley Fitzgerald, Galen Switzer, Garry Smyda, Pamela Peele, Anthony Delitto, First Provider Seen for an Acute Episode of Low Back Pain Influences Subsequent Health Care Utilization, Physical Therapy, Volume 103, Issue 9, September 2023, pzad067, https://doi.org/10.1093/ptj/pzad067
Why They Did It Costs associated with low back pain (LBP) continue to rise. Despite numerous clinical practice guidelines, the evaluation and treatments for LBP are variable and largely depend on the individual provider. As yet, little attention has been given to the first choice of provider. Early research indicates that the choice of first provider and the timing of interventions for LBP appear to influence utilization. We sought to examine the association between the first provider seen and health care utilization.
How They Did It Using 2015–2018 data from a large insurer, this retrospective analysis focused on 29,806 patients seeking care for a new episode of LBP. The study identified the first provider chosen and examined the following year of medical utilization. Cox proportional hazards models were calculated using inverse probability weighting on propensity scores to evaluate the time to event and the relationship to the first choice of provider.
What They Found The primary outcome was the timing and use of health care resources. Total health care use was lowest in those who first sought care with chiropractic care or physical therapy. Highest health care use was seen in those patients who chose the emergency department.
Wrap It Up Overall, there appears to be an association between the first choice of provider and future health care use. Chiropractic care and physical therapy provide nonpharmacologic and nonsurgical, guideline-based interventions. The use of physical therapists and chiropractors as entry points into the health system appears related to a decrease in immediate and long-term use of health resources.
Item #2 Our second one this week is called, “Efficacy of neural mobilization and Maitland accessory mobilization in patients with tennis elbow- randomized controlled trial” by Jain et al and published in Journal Of Bodywork and Movement Therapies in April of 2024 and……why not??? Because it’s Hot! Chanchal Jain, Manu Goyal, Saumya Kothiyal, Efficacy of neural mobilization and Maitland accessory mobilization in patients with tennis elbow- randomized controlled trial, Journal of Bodywork and Movement Therapies, Volume 38, 2024, Pages 525-533, ISSN 1360-8592, https://doi.org/10.1016/j.jbmt.2024.01.013. (https://www.sciencedirect.com/science/article/pii/S1360859224000287)
Why They Did It The objective of the study was to evaluate the efficacy of Maitland accessory mobilization and neural mobilization in patients with tennis elbow.
How They Did It Twenty-five patients meeting the selection criteria were randomly assigned to three experimental groups: Group C (conventional treatment), Group B (neural mobilization), and Group A (Maitland mobilization). Quality of life was assessed using the Patient Rated Tennis Elbow Evaluation (PRTEE), while pain, range of motion, and grip strength were evaluated using the Visual Analog Scale (VAS), a universal goniometer, and a handheld dynamometer. The interventions were administered three times per week for four weeks to the respective groups.
What They Found The results of the between-group analysis demonstrated significant differences in pain (p = 0.018) and quality of life (p = 0.045) among the three groups.
Wrap It Up After a 4-week intervention, all three groups exhibited notable improvements in discomfort levels, grip strength, and quality of life. Notably, Group B (neural mobilization) demonstrated the most substantial increase in range of motion (ROM) compared to Groups A and C. Consequently, incorporating neural mobilization into the treatment plan is recommended for patients experiencing Tennis Elbow. 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.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
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 http://www.chiropracticforward.com
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
iTunes https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2
Player FM Link https://player.fm/series/2291021
Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through
TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/
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
The post First Provider Matters & Neural Mobilization appeared first on Chiropractic Forward.
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