CF 374: Non-surgical Disc Treatment & Cognitive Functional Therapy Today we’re going to talk about Non-surgical Disc Treatment & Cognitive Functional Therapy 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 #374 Now if you missed last week’s episode, we talked about Vertebral Artery Dissection Recognized and Referred By Chiropractor. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I got back from Florida Keys annd am doing everything I can do to catch up. I’m nowhere near being caught up so I hope you’ll understand that I’m keeping it short this week.  Our new intern is on board and getting settled in and says she’s learning fast so that’s good. We’ll have her doing the exams by next week I believe. If you have a great intern training program, send it my way at [email protected]. I’d love to see it. I have one. But I’m open to all suggestions.  We are up and running with the new shockwave machine.

While it’s going well early on, we have an obstacle we didn’t expect. The entire Eastern half of the country can get shockwave covered through the VA system.  I assumed the West part of the US was the same but it is not. Much to my chagrin. The East is served by Optum Server. The West is served by Tri-West. You’d think it’d all be Federal and uniform. Yeah, no. It’s not.  So, we put on our big boy pants and knock it out the hard way. Cash pay patients. But it’s going OK.  That’s all I have today. Between the Ukranian refugee girl being stabbed and murdered on the train in Charlotte and Charlie Kirk being shot and killed today…….I’m just not feeling it. I’m sure I’m not the only one.  2025 has been a tough one. For me nand for lots and lots of my friends. Just crazy. 

I’ll be back next week with more time and more ability to form a great thought process for you. Or, at least, a normal for your Ol’ Uncle Jeff anyway. 

Item #1 Our first one today is called, “Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review” by Melhat et al published in Jorunal of Clinical Medicine in February 2024. Sizzlin’ hot! Remember, the citations can be found at chiropracticforward.com under this episode. 

El Melhat, A.M.; Youssef, A.S.A.; Zebdawi, M.R.; Hafez, M.A.; Khalil, L.H.; Harrison, D.E. Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review. J. Clin. Med. 2024, 13, 974. https://doi.org/10.3390/jcm13040974

Why They Did It

Lumbar disc herniation associated with radiculopathy (LDHR) is among the most frequent causes of spine-related disorders.  This condition is triggered by irritation of the nerve root caused by a herniated disc.  Many non-surgical and surgical approaches are available for managing this prevalent disorder.  Non-surgical treatment approaches are considered the preferred initial management methods as they are proven to be efficient in reducing both pain and disability in the absence of any red flags.  The objective of this article is to introduce advanced and new treatment techniques, supplementing existing knowledge on various conservative treatments. It provides a comprehensive overview of the current therapeutic landscape, thereby suggesting pathways for future research to fill the gaps in knowledge. 

How They Did It Extensive exploration of recent clinical research, focusing on various non-surgical approaches for LDHR.  By exploring the effectiveness and patient-related outcomes of various conservative approaches, including physical therapy modalities and alternative therapies, therapists gain valuable insights that can inform clinical decision-making, ultimately contributing to enhanced patient care and improved outcomes in the treatment of LDHR.

What They Found Specific to our detailed review, we identified the following interventions to yield moderate evidence (Level B) of effectiveness for the conservative treatment of LDHR: patient education and self-management, McKenzie method, mobilization and manipulation, exercise therapy, traction (short-term outcomes), neural mobilization, and epidural injections.  Two interventions were identified to have weak evidence of effectiveness (Level C): traction for long-term outcomes and dry needling.  Three interventions were identified to have conflicting or no evidence (Level D) of effectiveness: electro-diagnostic-based management, laser and ultrasound, and electrotherapy.

Item #2 The last one this week is called, “Effectiveness of cognitive functional therapy for chronic spinal pain: a systematic review with meta-analysis” by Marelli et al and published in Pain Medicine in May of 2025 and it’s a hottie too!

Michele Marelli, Matteo Cioeta, Leonardo Pellicciari, Fabio Rossi, Stefania Guida, Silvia Bargeri, Effectiveness of cognitive functional therapy for chronic spinal pain: a systematic review with meta-analysis, Pain Medicine, Volume 26, Issue 5, May 2025, Pages 248–260, https://doi.org/10.1093/pm/pnaf002

Why They Did It To assess the effectiveness of cognitive functional therapy (CFT) in reducing disability and pain compared to other interventions in chronic spinal pain patients.

How They Did It Five databases were queried to October 2023 for retrieving randomized controlled trials (RCTs), including patients with chronic spinal pain and administering cognitive functional therapy.  Primary outcomes were disability and pain. Secondary outcomes included psychological factors, quality of life, patient satisfaction, and adverse events.  Two independent reviewers performed study selection, data extraction, risk of bias assessment 

What They Found Compared to other conservative interventions, cognitive functional therapy may reduce disability and pain at short-term follow-up with probable to possible clinical relevance in CLBP and with low and very low evidence certainty, respectively.  Similar results, with larger effect sizes, were observed for cognitive functional therapy compared to any unstructured or unsupervised minimal care treatments.  Efficacy persisted in longer-term follow-ups, except for comparison with other conservative interventions. The study showed positive results for cognitive functional therapy. Evidence certainty was low to very low.

Wrap It Up Cognitive functional therapy may offer clinically relevant benefits for CLBP, although the evidence remains mainly of low to very low certainty.  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.

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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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