CF 373: Vertebral Artery Dissection Recognized And Referred By Chiropractor Today, we’re going to talk about Vertebral Artery Dissection Recognized And Referred By Chiropractor 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. 

You have found yourself smack dab in the middle of Episode #373 Now if you missed last week’s episode, we talked about Spinal Manipulative Therapy and Lumbar Re-operation & SMT And Fall Risk Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

First things first here; we’re gonna be short of episodes for a couple of weeks. I’m heading out early next week for a family end-of-summer trip to the Florida Keys. Key Largo, to be more specific. You guys can have Key West and all of its crazy college kid craziness. I prefer the slower, more laid-back and mature pace of Key Largo.  We go to a resort there called Playa Largo. It’s a Marriott property, and it’s just a wonderful place. Look it up. Just a tip from your ol’ Uncle Jeffro. It’s a resort with restaurants and a spa and such. Your Ol’ Uncle Jeffro has a lil birthday massage scheduled while he’s down there too.  So, we got that going on, and I’m not going to have the opportunity to get the podcast put together next week. We don’t get back that next week from Florida until Wednesday, so, yeah, I won’t have time that following week either.

So, this is it for a couple of weeks.  The new thing for me in my office is the purchase of a radial shockwave unit. We are getting up and running and figuring it out. We did a session, or a sesh as the kids call it, this morning on a vet that has had 3 surgeries on his ankle and until today, hasn’t felt anything in his leg or ankle in over a year.  He walked out today, almost in tears, because it made that much of a difference in one sesh.

That’s a pretty great start to our Shockwave journey. I’m pretty excited to see how it goes.  From our Mastermind group, we have around 25 in the group, and I think I was one of the last to get the shockwave. I think there are still 3-4 of us that have yet to get one. We have two masters of the shockwave in the group. Ben Fergus from Evanston/Chicago area actually teaches the course in the videos from the company, and David Rudnick is one of the Shockwave instructors for the masterclass that we’ll be going out to Atlanta to take in September.  So yeah, we got the smart folks in our Mastermind. Be jealous. 

That’s the big news for this week. I’m cutting it short so I can get the research put together.  Here we go. 

Item #1 Our only one this week is called “Recognition of Vertebral Artery Dissection In a High-Risk Postpartum Patient by a Chiropractic Physician” by Demetrious et al. Et al also includes some of our industry’s heavy hitters like Robert Trager, Stephen Veigh, Peter Tuchin, and my friend Ol’ Uncle David Graber.  I don’t really call him Ol’ Uncle Dave but I may now. Time will tell. This was published in Cureus on August 18, of 2025 and is sizzlin’ like steak. 

Remember, the citations can be found at chiropracticforward.com under this episode. 

Demetrious J, Trager R J, Veigh S, et al. (August 18, 2025) Recognition of Vertebral Artery Dissection in a High-Risk Postpartum Patient by a Chiropractic Physician. Cureus 17(8): e90389. doi:10.7759/cureus.90389

Why They Did It They say, “We report a case of vertebral artery dissection (VAD) in a patient with postpartum preeclampsia and underscore the contribution of chiropractic assessment in recognizing vascular pathology, facilitating neurovascular imaging, and expediting emergency intervention.”

What The Hell Had Happened? A 36-year-old woman with a history of mixed connective tissue disease presented to the emergency department five days postpartum with facial and peripheral edema, recent onset of hypertension, acute severe neck pain, headache, lightheadedness, confusion, and gait instability. 

Magnetic resonance angiography (MRA) and magnetic resonance venography of the head were performed. Small, unruptured bilateral internal carotid artery aneurysms were visualized. The patient was admitted and treated for postpartum preeclampsia. 

Upon discharge, she followed up with a neuroendovascular specialist.  Although the patient improved with preeclampsia management, concerning neurologic symptoms persisted. The patient later consulted a chiropractor, who suspected VAD. 

On the day she sought ED care, her clinical condition rapidly deteriorated. She developed a severe occipital headache and new, excruciating, left-sided posterior neck pain with radiation into the left shoulder.  The pain significantly restricted active cervical rotation bilaterally.

Visual disturbances progressed to include diplopia and intermittent scotomata described as “seeing spots,” along with worsening photophobia.  Additionally, the patient experienced dyspnea, lightheadedness, and progressive bilateral lower extremity edema that impaired ambulation.

So…..looky here folks, I’ve been preaching this stuff on the podcast for years now, and if you, as a doctor, do not know that this patient needs to be punted like a football in the Super Bowl of life, then you need to know it. This is life and death for the patient, and it’s survival or bankruptcy for you as far as your business.  You aren’t going to ‘pop it out’. Working on this patient will not work out for you. Please pay attention to these warning signs. Pay attention to what we’re talking about here. It’s really really important. 

Emergent neck MRA was recommended and performed, confirming VAD 12 days after the initial emergency department visit.  The patient was initiated on antithrombotic therapy, with subsequent resolution of symptoms and no evidence of ischemic stroke.  This case underscores the importance of maintaining a high index of suspicion for VAD in postpartum patients presenting with new-onset neurological symptoms, particularly in the context of hypertensive disorders of pregnancy and underlying connective tissue disease. 

It further illustrates the potential role of chiropractic evaluation in the early clinical recognition of vascular pathology, which may facilitate timely diagnosis and intervention and reduce the risk of stroke. So that’s the story, but I also want to highlight some things that were stated in the paper, in addition to the abstract.  It may cause ischemic stroke, particularly in young adults, and has an incidence rate of approximately two per 100,000 person-years

Notice it’s in YOUNG adults. These stroke cases you see in the news are usually young folks. Not older 

Because I don’t think it can be repeated enough times, they say, “The clinical presentation of VAD may include occipital headache, neck pain, and other potential features such as visual disturbances, dizziness, and gait abnormalities that can be indicative of brain ischemia. 

Risk factors for VAD are increasingly understood, such as hypertension, migraine, and connective tissue disorders.  A tip from your Ol’ Uncle Jeffro – Test with the Beighton Scale and do it often if you see someone that’s looking bendy. If you do an SLR on someone and their knee basically goes backward, do the Beighton. When doing ROM, if they bend right over and put their hands flat on the floor, do the Beighton. You get the idea. 

They say, “Pregnancy is an increasingly recognized risk factor for CeAD and VAD. One study reported that pregnant women had approximately two times the risk of VAD compared to non-pregnant controls, with an elevated incidence of VAD during a one-year window including pregnancy and postpartum”

The chiropractor is the one that recognized it, the chiropractor is the one that recommended the emergency MR-A, and this chiropractor is A-OK with me.  I’m sure the ER probably still asked her if she’d been adjusted by a chiropractor but, you know….that’s comes with the territory, doesn’t it? Another important consideration is that should an adjustment be deemed to CAUSE the stroke, symptoms are going to appear almost immediately. 

With regards to that, they say, “The earlier chiropractic neck manipulation warrants careful contextual analysis. A history of connective tissue disorder, pregnancy, and recent childbirth warrants consideration, as these factors may represent relative risk factors for spinal manipulative therapy.(SMT).

Although some literature suggests an association between cervical manipulation and VAD, high-quality evidence does not support a causal relationship. Importantly, this patient did not experience acute headache, dizziness, or neurological symptoms that may or may not be present in this cohort immediately following the manipulation. These symptoms emerged only postpartum, coinciding with the onset of preeclampsia.

I liked this paper enough that it’s the only one I’m doing this week. It’s important and full of information that demands our focus. So that’s what we’re doing; we’re focusing on this one and only paper this week and I want to thank the crew that put it together. You’re doing God’s work in our profession. 

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

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TuneIn https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Pr-p1089415/

About the Author & Host Dr. Jeff Williams – Diplomate of the International Academy of Neuromusculoskeletal Medicine (DIANM) 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 Vertebral Artery Dissection Recognized And Referred By Chiropractor appeared first on Chiropractic Forward.

CF 372: Spinal Manipulative Therapy and Lumbar Re-operation & SMT And Fall Risk Today we’re going to talk about Spinal Manipulativer Therapy and Lumbar Re-operation & SMT And Fall Risk 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 #372 Now if you missed last week’s episode, we talked about Pain Reprocessing Therapy & Chiropractic And Tramadol.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I’m gearing up for a few things around here. The first is that I’ve got three main pushes for the immediate, right now, as we speak. We did this in the Mastermind group you always hear me talk about. Each of us decided what our main push is. But, since I have so many things and moving parts going around here at all times, I actually have three main focuses.  They are:

So, what are my plans for each? Well, that’s what I’m figuring out while we have a little back-to-school slowdown.  To boost numbers, it makes sense to boost marketing. That could be more boosted posts on social media, targeted ad campaigns, more effective content creation, Google Ads, sales funnels, internal marketing, referral marketing, and on and on and on. 

We have a company that is helping us with Google Ads and content creation so we’re already acting there. We have a great website company so we are SEO optimized and going the right direction there. 

We could run a re-activation campaign internally. I’m not sure what that looks like off the top of my head but we can figure it out. Lots of ideas to help boost numbers.  It’s been weird since COVID, honestly. As soon as business starts building and we’re getting our numbers back, something always seems to happen. A long term attorney relationship changes hands and the new attorneys aren’t as dependable.

Or the VA hires their own chiropractor, and on and on.  It just seems like the Universe is holding us back for some reason so we’re just trying to bend the universes will back in our favor. We can do it. I’ve been doing it for years. 

On the second one, the Mastermind will be a huge help to us in getting Shockwave all launched and successful. Those folks have been all over Shockwave for the last year.  I’m not worried about #2 and shockwave at all. 

Number three is a little more difficult. Some of the medical services we have are fairly saturated. Joint regeneration like biologics and PRP…..well a lot of orthos are already doing them and who goes to this outlier over here vs. going to an ortho for that? Of course, on the other hand, a lot of orthos are quick to surgery so you have a bunch of them running patients off too.  Bio-Identical hormone pellets, lots of folks are doing Bio-T. Trigger point injections, IV Therapy, Semaglutide…..yep, it’s all pretty saturated so breaking through the noise is tough. 

It’s all marketing. How do you break through the noise? They call it the USP or unique selling proposition. Which means, what makes you different? I think what makes us different is that with the services we offer, we can treat the body in a whole body context. Medical, alternative care, exercise….everything. That part is still unique. 

Short of surgery, everything under one roof. That’s our USP and we’re going to hammer the hell out of it. 

Item #1 Our first one today is called, “Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study” by Trager et al and published in BMC Musculoskeletal Disorders in January of 2024 and es steamy, hot to the touch.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Trager, R.J., Gliedt, J.A., Labak, C.M. et al. Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study. BMC Musculoskelet Disord 25, 46 (2024). https://doi.org/10.1186/s12891-024-07166-x

Why They Did It Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms.  We hypothesized that adults receiving SMT for lumbosacral radiculopathy at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years’ follow-up.

How They Did It We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with lumbosacral radiculopathy and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023.  We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT. 

What They Found Following propensity matching there were 378 patients per cohort (mean age 61 years).  Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort. 

Wrap It Up This study found that adults experiencing lumbosacral radiculopathy at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT.  While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance.  We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture.

Item #2 Our second one today is called, “Chiropractic Spinal Manipulation and Fall Risk in Older Adults With Spinal Pain: Observational Findings From a Matched Retrospective Cohort Study” by Trager et al and yes, the man is a rock star….obviously. It was published in Cureus in October of 2024 and that’s hot as hell as well. 

Trager RJ, Burton WM, Loewenthal JV, Perez JA, Lisi AJ, Kowalski MH, Wayne PM. Chiropractic Spinal Manipulation and Fall Risk in Older Adults With Spinal Pain: Observational Findings From a Matched Retrospective Cohort Study. Cureus. 2024 Oct 24;16(10):e72330. doi: 10.7759/cureus.72330. PMID: 39583476; PMCID: PMC11585376.

Why They Did It Limited research suggests that spinal manipulative therapy (SMT) might positively influence balance, yet its association with falls remains underexplored.  We hypothesized that older adults receiving chiropractic SMT for spinal pain would have a reduced fall risk during 13 months of follow-up compared to matched controls.

How They Did It We searched >116 million patient records from TriNetX to identify adults aged ≥65 years with spinal pain.  After excluding those with major fall risk factors, we formed SMT and non-SMT cohorts, using propensity score matching  We explored the cumulative incidence of falls and fractures and negative control outcomes

What They Found

Wrap It Up This study suggests that older adults receiving SMT for spinal pain may have a reduced risk of falls.  However, given the observational nature of the study and the lack of significant differences in limb fracture incidence, the clinical significance of these findings remains uncertain.  Further research, including randomized controlled trials, is needed to explore injurious falls, care utilization, pain, and costs.

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 Spinal Manipulative Therapy and Lumbar Re-operation & SMT And Fall Risk appeared first on Chiropractic Forward.

CF 371: Pain Reprocessing Therapy & Chiropractic And Tramadol

Today we’re going to talk about Pain Reprocessing Therapy & Chiropractic And Tramadol

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 #371 Now if you missed last week’s episode, we talked about Unnecessary Surgery & Gabapentin Linked To Dementia.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. It’s back to school time which, as I mentioned last week, is traditionally our slower time of the year. What does slow time mean? It means sit around and tremble in fear that patients will never grace your door step again. It means You’re DONE in this town! Just kidding of course. What it means is you have time to clean off that pile of papers on the corner of your desk, get into that ‘Learning File’ on your computer. Take those courses you’ve been meaning to take. Get some marketing going for your practice. You know…..do the stuff you never have the time to do.  That’s what I’m doing anyway and it’s definitely what your Ol’ Uncle Jeffro suggests you get moving on too. Some of you are going to kick on the computer games. I see you!!! Don’t do it.  Invest your time.

Or waste your time. It’s totally up to you. But I suggest you invest it. You’re the hammer or your the nail, the bug or you’re the windshield. You either make things happen, watch things happen, or wonder what in the hell just happened.  You can probably guess which one I am in each scenario. Very few minutes go by in my day that are not invested in one way or another.

I’m almost 53 and I don’t have as much time to jack around as I used to have. I mean that figuratively as well as literally.  Speaking of being in a bit of a rush, I am this week so what do you say we cut the chit chat a-hole (that’s an old Nicolas Cage from The Rock reference there) and let’s get to the research. 

Item #1 The first one today is called, “Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain 5-Year Follow-Up of a Randomized Clinical Trial” by Ashar et al and published in JAMA Psychiatry on July 30, 2025 and aye carumba, es en fuego!

Remember, the citations can be found at chiropracticforward.com under this episode. 

Ashar YK, Low EL, Knight K, et al. Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: 5-Year Follow-Up of a Randomized Clinical Trial. JAMA Psychiatry. Published online July 30, 2025. doi:10.1001/jamapsychiatry.2025.1844

Why They Did It Effective treatments for chronic back pain (CBP) are lacking.1 We previously reported that a novel psychological treatment, pain reprocessing therapy (PRT), led to large reductions in CBP severity, with benefits generally maintained through 1-year follow-up.2 Here, we report clinical outcomes at the 5-year follow-up, testing the long-term durability of gains.

How They Did It This secondary analysis of a randomized clinical trial received institutional review board approval to invite participants to complete patient-reported outcome measures in 2023, 5 years after randomization. 

The trial protocol has been published previously.2 We followed the Consolidated Standards of Reporting Trials (CONSORT) reporting guideline. In 2017 to 2018, 151 adults with CBP recruited from community settings in the Boulder-Denver metropolitan area of Colorado reporting at least 4 of 10 pain intensity were randomized to 1 of 3 conditions: PRT, placebo, or usual care (UC) PRT participants attended 1 telehealth physician session and 8 face-to-face therapist sessions aiming to help participants reframe their CBP as due to nociplastic processes,3 reduce fear and avoidance of pain, and regulate nonpain threats (eg, anxiety, difficult emotions).4  Placebo participants received 1 open-label placebo injection subcutaneously into the back, accompanied by patient education about the power of placebo.5  

All participants, including UC participants, were asked to continue any ongoing CBP care.

What They Found Of 151 participants, 113  or 75% provided 5-year follow-up data, with similar follow-up rates by randomization group.  PRT participants reported significantly lower pain intensity at 5 years than placebo and UC participants.  In the PRT group, 21 participants (55%) were nearly or completely pain free at 5 years, compared with 10 placebo participants (26%) and 13 UC participants (36%)  The largest effects were found in harm beliefs (TSK-11) and in pain attributions to mind-brain processes

Wrap It Up This 5-year follow-up of a randomized clinical trial found that PRT provided long-term pain reduction in CBP.  Whereas improved coping with chronic pain is the goal of some psychological treatments, our findings indicate that PRT can provide durable recovery from CBP for some patients.  A main limitation is that the original trial sample had low to moderate severity of CBP2; studies testing PRT in higher-severity samples are needed.

Item #2 The second one today is called, “Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data” by Trager et al and published in British Medical Journal Open in 2024 and it’s at least still smoldering. 

Trager RJ, Cupler ZA, Srinivasan R, et al Chiropractic spinal manipulation and likelihood of tramadol prescription in adults with radicular low back pain: a retrospective cohort study using US data BMJ Open 2024;14:e078105. doi: 10.1136/bmjopen-2023-078105

Why They Did It Patients receiving chiropractic spinal manipulation (CSM) for low back pain (LBP) are less likely to receive any opioid prescription for subsequent pain management.  However, the likelihood of specifically being prescribed tramadol, a less potent opioid, has not been explored.  We hypothesised that adults receiving CSM for newly diagnosed radicular LBP would be less likely to receive a tramadol prescription over 1-year follow-up, compared with those receiving usual medical care.

How They Did It Retrospective cohort study. Setting was a US medical records-based dataset including over 115 million patients attending academic health centers, queried 9 November 2023. Participants were Opioid-naive adults aged 18–50 with a new diagnosis of radicular LBP. 

What They Found

Wrap It Up

This study found that US adults initially receiving chiropractic spinal manipulation for radicular LBP had a reduced likelihood of receiving a tramadol prescription over 1-year follow-up.  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

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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 Pain Reprocessing Therapy & Chiropractic And Tramadol appeared first on Chiropractic Forward.

CF 370: Unnecessary Surgery & Gabapentin Linked To Dementia Today we’re going to talk about Unnecessary Surgery & Gabapentin Linked To Dementia 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 #370 Now if you missed last week’s episode, we talked about Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

What a crazy as hell Summer, folks. Europe, two trips to Dallas, and one to Boston the weekend before last…..then Dallas at the end of August and then Key largo at the very tail end of August.  I love travel. Please don’t get me wrong. But it plays hell on your clinic when you’re the only chiro in it. Most of you know exactly what I’m saying.

So, I’m looking forward to the kids getting back to school and everyone getting back on a schedule. The kids can’t be traveling which means my travel is dramatically reduced. Which means my patient numbers go back up! Traditionally, our slow times of the year are back to school and dead in the middle of the holidays. So, that used to start first week in August and now the kids are goign to school starting August 13th believe it or not. So now the slow down starts at the end of July. Like right now.  We’re not going to fuss though.

My travel schedule has brought on some of it so don’t sit around and piss and moan about things you brought on yourself.  Looking forward, we have a Parker intern coming in to work with us very soon and we’re always looking forward to that. She’ll be in at the end of the month or the very beginning of September. I’m not exactly sure just yet. Up here in Amarillo, about 5.5 hours NW of Dallas, we only see interns about once per year. Sometimes less. We always enjoy it though and we’re looking forward to this one too.

She seems to be a go getter and it’s always fun to watch a go getter grow.  Who knows….maybe she’ll wanna stick around with us after she graduates. Then I can quit telling all of you how we need an associate!!. I cna’t believe y’all haven’t taken me up on that yet. We have a staff change comign up in the clinic and this girl means a lot to me. I hate to see her go but with every departure comes an opportunity to have a new special person come on board and bring them in to the family and get ‘em up and running.  In the last month or so, I made one of our rock stars the manager and she is a rock start folks. This girl runs the front desk and just never seems to drop the ball about anyhting. I’ve had 20 or so front desk staff over the years. Give or take.

And this girl is heads and tails above them all. Kudos to my wife for hiring such a stud.  So I made her the manager and this is her first hire. We shall see how good she is at hiring. If she’s as good at hiring as she is at everything else, then she’ll have knocked it out of the park and settled in on the perfect staffer. I’m looking forward to it and…..I didn’t have to do all of the hiring so that’s a big plus!

Item #1

Our first one today is an oldie but a goodie. It’s called, ““Unnecessary” spinal surgery: A prospective 1-year study of one surgeon’s experience” by Epstein et al and no, it’s not THAT Epstein. It’s Nancy Epstein and it was published in Surgical Neurology in 2011.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Epstein NE, Hood DC. “Unnecessary” spinal surgery: A prospective 1-year study of one surgeon’s experience. Surg Neurol Int. 2011;2:83. doi: 10.4103/2152-7806.82249. Epub 2011 Jun 21. PMID: 21776403; PMCID: PMC3130462.

Why They Did It There are marked disparities in the frequency of spinal surgery performed within the United States over time, as well as across different geographic areas. One possible source of these disparities is the criteria for surgery.

How They Did It During a one-year period, the senior author, who is a neurosurgeon, saw 274 patients for cervical and lumbar spinal, office consultations.  A patient was assigned to the “unnecessary surgery” group if they were told they needed spinal surgery by another surgeon, but exhibited pain alone without neurological deficits and without significant abnormal radiographic findings [dynamic X-rays, MR scans, and/or CT scans]. Here’s a tip from your Ol’ Uncle Jeffro that’s in line with this, pain is not a reason to have surgery. Now I feel pretty good today so that’s easy for me to say, right? But in general, pain is not a reason for surgery. The reason for surgery should be progressive neurological deficits. Cauda equina, DTRs, motor strength, dermatomes and sensory….you get the point.  OK, let’s proceed…

What They Found Of the 274 consults, 45 patients were told they needed surgery by outside surgeons, although their neurological and radiographic findings were not abnormal.  An additional 2 patients were told they needed lumbar operations, when in fact the findings indicated a cervical operation was necessary.  In 29 patients there were one or more overlapping comorbidities.

Wrap It Up During a one-year period, 47 [17.2%] of 274 spinal consultations seen by a single neurosurgeon were scheduled for “unnecessary surgery”. The author went on to offer this in the summary of the body of the paper, “This is an underestimate of the percentage of unnecessary surgeries as the 274 patients include those coming for first opinions. If we only considered the patients coming for second opinions, then the percentage of unnecessary operations would have been considerably larger.” I have seen estimates suggesting that only 5% of spinal surgeries actually taking place day-to-day are actually necessary.

I will try to track down the source for the stat and share in a future episode for you.  To be fully honest, this is one of the things that keeps me up at night. All of the people getting unnecessary spinal surgeries because a surgeon is just way behind on their research, too arrogant to think they could be wrong, or worst….doing surgeries based purely on financial gain. 

Item #2 Our second one today is called “Risk of dementia following gabapentin prescription in chronic low back pain patients” by Eghrari et al and publisehd in Regional Anesthesia & Ain Medicine in July 2025 and that’s hotter than a Texas tin roof in August. If you know, you know…that’s pretty hot. 

Eghrari NB, Yazji IH, Yavari B, Van Acker GM, Kim CH. Risk of dementia following gabapentin prescription in chronic low back pain patients. Reg Anesth Pain Med. 2025 Jul 10:rapm-2025-106577. doi: 10.1136/rapm-2025-106577. Epub ahead of print. PMID: 40639955.

Why They Did It Gabapentin is widely used to treat chronic pain, but its association with cognitive decline and dementia remains unclear. This study examined whether gabapentin prescription is associated with dementia in adults with chronic low back pain.

How They Did It We conducted a retrospective cohort study using the TriNetX national database of de-identified patient records from 2004 to 2024.  Adults diagnosed with chronic low back pain were included; those with prior gabapentin use, dementia, epilepsy, stroke, or cancer were excluded.  Propensity score matching controlled for demographics, comorbidities, and pain medications.  Patients were stratified by age and gabapentin prescription frequency.  Primary outcomes were dementia and mild cognitive impairment.

What They Found 26,416 adults we analyzed following propensity-score matching.  Patients with six or more gabapentin prescriptions had an increased incidence of dementia and mild cognitive impairment   When stratified by age, non-elderly adults prescribed gabapentin had over twice the risk of dementia and mild cognitive impairment compared to those not prescribed gabapentin.  Risk increased further with prescription frequency: patients with 12 or more prescriptions had a higher incidence of dementia and mild cognitive impairment than those prescribed gabapentin 3-11 times.

Wrap It Up Gabapentin prescription in adults with chronic low back pain is associated with increased risk of dementia and cognitive impairment, particularly in non-elderly adults.  Physicians should monitor cognitive outcomes in patients prescribed gabapentin. 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 – Diplomate of the International Academy of Neuromusculoskeletal Medicine (DIANM) 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 Unnecessary Surgery & Gabapentin Linked To Dementia appeared first on Chiropractic Forward.

CF 369: Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall Today we’re going to talk about Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall 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 #369 Now if you missed last week’s episode, we talked about Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, we had July 4th Independence Day celebration last weekend so that was a nice little 3-day weekend, right? I’m sure we all made the best use of our holidays. Hopefully you all still have all of your fingers and toes.  I haven’t seen it from any chiropractic colleagues but this weekend has been a lesson in the incorrect way to use social media. I really don’t care what your political views are. I 100% don’t care. The Texas floods happened this weekend and I think the body count is up to 91 at the typing of this. Lots of kids in the Christian camp and all of that. Heart breaking. I can’t even allow myself to think about it because it’s just too much.  I’m a life long Texan and while I don’t live anywhere near the flooding, I know a ton of people in the area and they are kin in some way. We are related at Texans and it means more to me than maybe someone from Oregon or New York for example. I think that’s understandable. 

I saw where folks are posting for political points and it’s just gross. It’s a mental condition for some of these folks. DOGE made cuts to different parts of the government that included the National Weather Service so now natural disasters are, of course, because of Republicans. Now, when did cutting wasteful spending from the government become a bad thing?/ Honestly, that used to be a bipartisan, American idea.

But…..yeah, not so much these days. What if these ares of the govt. were overfunded and over staffed well-beyond what was needed? Does it make sense to cut staff to the regular, appropriate amount that services are not lost while waste is eliminated? Isn’t that possible too? Of course it is. But I’m getting off topic here.  I’m seeing this kind of post like Texas deserves everything they get, MAGA voted for it, now they can deal with it, and garbage like that.  If you wonder about me, I’ll be straight up with you and if you don’t like it, I could not care less. I’m fiscally conservative and socially I lean a little more Liberal. I find positives and negatives on both sides of the aisle and before I let memes or cable news get me fired up about something, I research it and form an educated opinion. 

If social media has taught me anything, it’s that a high percentage of my fellow humans do NOT do that. They just go spouting garbage, further dividing others, and keeping our world at a level of intensity that I’ve never seen before.  It’s awful when one side acts like the other side is literally, not figuratively, responsible for natural disasters and killing 91 people, including children. When all they had to do was research to find out that forecasting gave over 3 hours of advance notice of potential flooding and the totals were as accurate as they could have been for that kind of storm. NWS officials and meteorologists stated that the NWS offices were adequately staffed. The storm was beyond what models could predict with any precision, and while the warnings were released, local dissemination was slow.

But, it tracks because if you recall, Hurricane Katrina was Bush’s fault too. I remember well. 

So, with no education, we get social media posts like this from a Houston, TX pediatrician, “May all visitors, children, non-MAGA voters and pets be safe and dry. Kerr country MAGA voted to gut FEMA. They deny climate change. May they get what they voted for. Bless their hearts.” And Bless their hearts is rarely meant in a complementary way in the South, in case you were unaware.  Which led to this doctor being promptly and immediately fired. Her name is Dr. Christina Propst and she was with Blue Fish Pediatrics in Houston if you want to look into it yourself. 

The page at Blue Fish Pediatrics that used to have her bio now says, “This past weekend, we were made aware of a social media comment from one of our physicians. The individual is no longer employed by Blue Fish Pediatrics. As we previously mentioned in our original statement, we strongly condemn the comments that were made in that post. That post does not reflect the values, standards, or mission of Blue Fish Pediatrics. We do not support or condone any statement that politicizes tragedy, diminishes human dignity, or fails to clearly uphold compassion for every child and family, regardless of background or beliefs. We continue to extend our full support to the families and the surrounding communities who are grieving, recovering, and searching for hope. Sincerely, Blue Fish Pediatrics Leadership Team”

She gone!! And good for them. She’s 100% wrong and they are right. Unfortunately, she’s not even close to being the only one with that kind of mentality. She’s just the most famous one at the moment. And trust me, something like this is NOT why any of you want to be famous. One more tip from your Ol’ Uncle Jeffro, friends. 

Anyway, the point here is, yeah…I’m pretty spicy about how such a disaster has been politicized. It’s my state and I know people in the disaster. It’s more personal sure. I’m self aware on it. I also understand those that are concerned that DOGE cut too much and I understand those that hate Trump with every ounce of their being. I don’t personally like the guy myself so I get it. But there should be a self-governer within us that stops us from being a terrible person.  It goes both ways too. Let’s be fair. Thee Biden Administration was BLASTED just last year.However, the criticism you saw during the North Carolina flooding last year was not that Biden Administration caused the flood but that the response to take care of the people was a disaster in and of itself. I don’t recall anyone blaming the flooding on the administration itself though, or how NC voted, or any of that.

This Texas flood has been a whole different deal in my experience. 

One side is literally saying that the other side caused the death and destruction through cuts in various programs leading to a lack of proper warning leading to deaths, etc. Well, that’s just not the truth and it’s a little insane but the bigger point here is what is a good look on social media and what is not.  I mean, I get the school shootings. If that brings up the topic and a further discussion of stricter gun laws and things like that, I think that’s a legitimate discussion and a fair one to have. But a natural disaster?

Come on bruh……that’s embarrassing for you folks posting like that. 

If you are friends with me on social media, you may notice that I don’t engage in political discussions much and when I do, I am careful about it. I do not run one side down. I do not post about things when I’m pissed and I CERTAINLY don’t take a stance without educating myself thoroughly. 

The main reason is that as soon as you take any stance, you lose half of your audience immediately. HALF. That’s up to and including saying you’re proud to be an American this year. Which is almost just la la land stuff to me. WHY would you purposefully lose half of your patient base and/or get blasted on social media and made famous for the wrong reasons? When all you had to do was shut the hell up and just discuss it amongst your inner circle?  My spouting off here this week is not really taking one side over the other, though I think anyone posting to score political points on this deal is sick.  It’s more about it being in extremely poor taste and is just a bad look to run to the keyboard every time a disaster takes place so that you can ‘one up’ the other side and score some imaginary points.

Do you really think you’ll somehow change someone’s mind because of a stupid post on Facebook? I got some news for you friend…..you’re wasting your time, emotions, and energy because…..psssst…..nobody gives a damn. Not one single damn. We just aren’t that important. I’m sorry to break it to you.  And, again, I do not care what side you’re on. The kind of thinking that leads to this kind of posting is problematic and if that describes you, start figuring out what broke inside of you and what caused it so that you can fix it and ultimately….do better, be better, and raise kids that turn out better than you. 

If I’m describing you, fix it or stay off of social media. Your practice, your employees, and your patients will be appreciative of your efforts. I promise. Nobody and I mean NOBODY wants to have to work with THAT person day in and day out.  It truly is the very worst of us and, unfortunately, social media has allowed it to step into center stage. And it’s gross. 

Item #1

Our first one today is one I got from Dr. Mark King of Cincinnati and of Motion Palpation Institute fame. Mark is a good friend of mine and if he sends me something, better believe I’mma look at it.  It’s called, “Comparative safety and efficacy of manual therapy interventions for cervicogenic headache: a systematic review and network meta-analysis” by. Xu et al and published in Frontiers of Neurology on May 15, 2025 and it’s may caliente y en fuego! Remember, the citations can be found at chiropracticforward.com under this episode.  https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1566764/full https://doi.org/10.3389/fneur.2025.1566764

Why They Did It

To evaluate and compare the safety and efficacy of spinal manipulation, mobilization, and massage for the management of cervicogenic headache (CGH) using meta-analytic techniques.

How They Did It

Comprehensive searches were conducted in Cochrane, Embase, PubMed, and ClinicalTrials.gov to identify studies investigating the effects of manipulation, mobilization, and massage on pain, disability, and physical function in patients with CGH.  Key outcomes included pain severity (visual analog scale, VAS), Neck Disability Index (NDI), Flexion-Rotation Test (FRT), and Headache Disability Inventory (HDI) at various follow-up timepoints.

What They Found

Fourteen studies totaling 1,297 CGH patients were included.  Standard pairwise meta-analysis revealed that sustained natural apophyseal glides (SNAG) mobilization produced significantly greater improvements compared to non-sustained natural apophyseal glides interventions in VAS, Neck Disability Index, Flexion-Rotation Test, and Headache Disability Inventory, with benefits maintained over time.  Cervical Spinal Mobilization exhibited significantly greater VAS reductions compared to exercise, massage, and mobilization, while mobilization was superior to exercise and massage for VAS.  For Neck Disability Index, Cervical Spinal Mobilization was significantly better than exercise, but no other between-group differences were observed.

Wrap It Up

In patients with CGH, sustained natural apophyseal glides mobilization can significantly improve pain and function, with benefits maintained in the long-term.  Additionally, Cervical Spinal Mobilization may be the most effective short-term intervention for reducing pain and disability compared to mobilization, massage, and exercise, although clinician expertise appears to be an important factor.

Item #2

Our last one this week is called, “Cost of chiropractic versus medical management of adults with spine-related musculoskeletal pain: a systematic review” by Farabaugh et al and published in Chiropractic & Manual Therapies on March 6, 2024. It’s steamy….but not hot. 

Why They Did It

The cost of spine-related pain in the United States is estimated at $134.5 billion. Spinal pain patients have multiple options when choosing healthcare providers, resulting in variable costs. Escalation of costs occurs when downstream costs are added to episode costs of care. The purpose of this review was to compare costs of chiropractic and medical management of patients with spine-related pain.

How They Did It

A Medline search was conducted from inception through October 31, 2022, for cost data on U.S. adults treated for spine-related pain.  The search included economic studies, randomized controlled trials and observational studies.  All studies were independently evaluated for quality and risk of bias by 3 investigators and data extraction was performed by 3 investigators.

What They Found

The literature search found 2256 citations, of which 93 full-text articles were screened for eligibility.  Forty-four studies were included in the review, including 26 cohort studies, 17 cost studies and 1 randomized controlled trial.  All included studies were rated as high or acceptable quality.  Spinal pain patients who consulted chiropractors as first providers needed fewer opioid prescriptions, surgeries, hospitalizations, emergency department visits, specialist referrals and injection procedures.

Wrap It Up

Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management.  The included studies were limited to mostly retrospective cohorts of large databases. Given the consistency of outcomes reported, further investigation with higher-level designs is warranted 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 Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall appeared first on Chiropractic Forward.

CF 368: Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation Today we’re going to talk about Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation.  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 #368 Now if you missed last week’s episode, we talked about Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. Things are clicking along this Summer. Still getting back up to steam. We have the big Texas Chiropractic Association ChiroTexpo coming up this weekend in Frisco, TX which is basically Dallas.  This is our state convention. We usually have around 400 or so attendees. Good stuff. It’s a great time to reconnect to old TCA buddies and to connect with the newer, younger group coming up in the Association and some of the newer folks are just brilliant. It’s a joy to see. 

I’m still involved. I’ve been involved for a long time now on the state level. I’ve been in the seat when we were fighting the Texas Medical Association for our right to diagnose or for our right to keep acupuncture or for our right to keep the Neuro aspect of neuromusculoskeletal…..I’ve been there. And I can tell you that you tend to form a bond with those that are in the seats next to you and across from you when you’re in the middle of these battles.  If you are not involved in your state association or the ACA, I cannot encourage you quite enough to raise your hand and jump in. There are only 25% of chiropractors in the state of Texas that are members of our association.

But I promise, 100% of them want their rights to practice protected.  That’s a damn promise. Take that to the bank folks.  Well, that’s taking instead of giving, isn’t it? That’s actually the definition of it and, honestly, the apathy in our industry is straight up appalling. Most just don’t know what’s going on in their own profession on a state or a national level.  I can give you time after time when I was able to call my fellow TCA connections and friends and bounce something off of them. Whether it was an idea or a problem. They’ve come through for me a million times.  I had an evidence-based chiro tell me they don’t get involved because they’re state association is all vitalists. Wouldn’t you think that THAT WOULD BE THE PERFECT REASON TO GET INVOLVED?

Well, is the perfect reason but it was being used as an excuse to continue being a lazy taker rather than a giver.  I get to influence who speaks at our events. Don’t you think that’s important? If you have a ton of vitalists influencing your membership, that’s no bueno mi amigo. But if you have top-notch genius evidence-based chiros speaking, well, I can only imagine that it would make an incredible impact. And it does.  I had a buddy, Dr. Ben Fergus, say something that I thought was just wonderful. He said, “The body responds to force and repetition.” I use that with my patients all day every day now. Because it’s true. I’d say the same goes for changing your profession. Your profession responds to positive forces used repetitively.

Over time, vitalists will dwindle. They’ll always be amongst us. I’m not a fool. But they will eventually be out of the drivers’ seats and more toward the back of the short bus.  But ONLY if our evidence-based, high-performing doctors get off their asses, get involved, and make it happen. Otherwise, we keep sitting back watching it happen and bitching to each other about it non-stop.  So….this is your call. Google your state association, get the name and contact info for your states executive director and/or executive committee members, then email them and tell them you’d like to get more involved. Raise your hand. They’re desperate for active members. Alright, go google it up and send that email right now, then come back and let’s cover some research!

Item #1 The first one this week is called ,”Changes in biochemical markers following a spinal manipulation – a systematic review update” by Sampath et al and published in Journal of Manual & Manipulative Therapy in August of 2023.  Remember, the citations can be found at chiropracticforward.com under this episode.  Kovanur Sampath, K., Treffel, L., P.Thomson, O., Rodi, J. D., Fleischmann, M., & Tumilty, S. (2023). Changes in biochemical markers following a spinal manipulation – a systematic review update. Journal of Manual & Manipulative Therapy, 32(1), 28–50. https://doi.org/10.1080/10669817.2023.225218

Why They Did It The aim of this systematic review was to update the current level of evidence for spinal manipulation in influencing various biochemical markers in healthy and/or symptomatic population.

How They Did It

What They Found There was low-quality evidence that spinal manipulation influenced various biochemical markers (not pooled).  There was low-quality evidence of significant difference that spinal manipulation is better than control in eliciting changes in cortisol levels immediately after intervention.  Low-quality evidence further indicated (not pooled) that spinal manipulation can influence inflammatory markers such as interleukins levels post-intervention. There was also very low-quality evidence that spinal manipulation does not influence substance-P, neurotensin, oxytocin, orexin-A, testosterone and epinephrine/nor-epinephrine.

Wrap It Up Spinal manipulation may influence inflammatory and cortisol post-intervention. However, the wider prediction intervals in most outcome measures point to the need for future research to clarify and establish the clinical relevance of these changes.

Item #2

Our last one this week is called, “Brain plasticity following lumbar disc herniation treatment with spinal manipulation therapy based on resting-state functional magnetic resonance imaging” by Du et al and published in Heliyon in September of 2024 and that’s just hot enough! https://www.cell.com/heliyon/fulltext/S2405-8440(24)13734-6

Why They Did It As a prevalent spine disorder, Lumbar disc herniation (LDH) has been affecting more than 2 % of the worldwide population and is characterized by uncertain causes and recurring episodes.  Studying the brain activity of patients could potentially provide insights into its pathogenesis and significantly enhance therapy.  Therefore, we here examined brain function in patients under Spinal Manipulative Therapy (SMT).  By analyzing regional homogeneity (ReHo) at different frequency bands, we identified the discrepancies in brain activity between LDH patients and healthy people, highlighting the frequency dependence of spontaneous low-frequency oscillations among patients with LDH.

How They Did It The test subjects underwent a single fMRI scan upon enrollment.  Patients with LDH underwent their initial functional MRI scan after completing the VAS and C-SFODI scales.  They then completed a second assessment of the VAS and C-SFODI scales, along with another fMRI scan, after receiving six adjustments. The clinical evaluation indicators were as follows: 

Wrap It Up

Overall, this study showed that SMT significantly reduced pain, improved dysfunction, and partially rectified aberrant local consistency and functional connection in patients with LDH, not only offering insights into the pathophysiology of LDH from a neurological standpoint, but also providing inspiration for the development of new therapies based on neurobiology. 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 Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation appeared first on Chiropractic Forward.

CF 367: Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis Today we’re going to talk about Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis 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 #367 Now if you missed last week’s episode, we talked about Europe, SMT Review, & Informed Consent.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. OK, on to week two of my post-Europe, post-14-day vacation. The first 2-week vacation I’ve taken in almost 30 years. The vacay I was anxious about and borderline freaking about because I thought my practice would be a ghost town when I got back.  In last week’s episode, I gave you a precise guideline of how I was able to avoid the ghost town scenario so I won’t re-hash it. Go listen to episode #366 if interested in my exact timeline and strategy.  Remember, I want to see around 165 for so per week but have been a little slow this year for many reasons. One would be me losing both my Mom and my Dad within 2 months of each other and my truck dying and having to be replaced within that time frame at the same time. There’s no way that doesn’t affect your work life in some way.  So, although I want to see 165+, this year I’ve been seeing closer to 140 or so per week. Not something I’ve been happy about either.

Several factors play in on that. One being that the VA hired a chiropractor and all of the veterans went away. That was a big hit. But that chiro went back to Pennsylvania and now the veterans are returning. Thank the good Lord.  All of that to tell you this: I’m looking at 151 on the schedule at the moment and that’s on a Tuesday so we’ll end up with more as we have new ones pop on and some re-schedule. Maybe we’ll wind up around 160+ and that’s in June, which is not typically our busiest time of the year. 

Once again, take that vacation!! One more tip from your Ol’ Uncle Jeffro. 

Item #1

Our first one today is called, “Home-Based Transcranial Direct Current Stimulation vs Placebo for Fibromyalgia A Randomized Clinical Trial” by Caumo et al and published in JAMA Network Open on June 6, 2025 and that’s D-Day hot damnit!! Remember, the citations can be found at chiropracticforward.com under this episode. 

Caumo W, Franca BR, Orzechowski R, et al. Home-Based Transcranial Direct Current Stimulation vs Placebo for Fibromyalgia: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(6):e2514262. doi:10.1001/jamanetworkopen.2025.14262

Why They Did It Previous trials with smaller samples and shorter follow-up periods showed that multiple-session home-based anodal transcranial direct current stimulation (A-tDCS) on the left dorsolateral prefrontal cortex (DLPFC) improved fibromyalgia symptoms. However, the duration of the effect, the influence of exercise and pain neuroscience education (PNE), and the role of placebo remain unclear.

Objective  To evaluate whether A-tDCS targeting the left DLPFC, combined with exercise and PNE, is more effective than sham tDCS in reducing pain and disability, based on placebo-test responses (responders vs nonresponders).

How They Did It This double-blind, sham-controlled randomized clinical trial enrolled women aged 18 to 65 years with fibromyalgia.  Participants were randomized to receive the real deal or the sham treatment between April 2022 and April 2024.  They were treated at home and at the outpatient Clinical Research Center

What They Found I’m not going to tell you. Because I want you to enjoy this podcast and not question your life choices by listening to it so instead of diving head first into weeds most of us do not frequent, we’ll just go to the Wrap Up 

Wrap It Up This trial found that anodal transcranial direct current stimulation along with exercise and pain neuroscience education improved disability due to pain, especially in placebo test responders. The findings support fibromyalgia management and enhance understanding of dorsolateral prefrontal cortex-related placebo effects. Just another feather in your cap if you have Fibro patients that are at the end of their ropes and you can send them somewhere or tell them about some new research you just became aware of that could potentially help.  Just a random tip from your Ol’ Uncle Jeffro. 

Item #2

Our last one this week is called, “Low-Dose Methotrexate for the Treatment of Inflammatory Knee Osteoarthritis A Randomized Clinical Trial” by Zhu et al published in JAMA Intern Med on June 2, 2025……the roof is on fire!

Zhu Z, Yu Q, Leng X, et al. Low-Dose Methotrexate for the Treatment of Inflammatory Knee Osteoarthritis: A Randomized Clinical Trial. JAMA Intern Med. Published online June 02, 2025. doi:10.1001/jamainternmed.2025.1359

Why They Did It A recent study reported that methotrexate may reduce joint pain in patients with inflammatory hand osteoarthritis (OA). However, it remains unknown whether methotrexate has similar effects on inflammatory knee OA.

Objective  To examine whether methotrexate has symptom-relieving and disease-modifying effects for participants with knee OA and effusion-synovitis.

How They Did It This multicenter, placebo-controlled randomized clinical trial was conducted at 11 sites in China between July 18, 2019, and January 15, 2023.  Community-dwelling patients with inflammatory knee OA with effusion-synovitis on magnetic resonance imaging were included. Participants were randomly assigned (1:1) to receive methotrexate, up to 15 mg weekly, or placebo using block randomization, stratified by study site. The primary outcomes were knee visual analog scale (VAS) pain change and effusion-synovitis maximal area change, over 52 weeks in the intention-to-treat population.

What They Found Of 278 participants screened, 215 participants, and 175 (81%) completed the trial.  Changes in VAS pain and effusion-synovitis maximal area were not significantly different between the methotrexate and placebo group over 52 weeks.  No significant between-group differences were found for any of the pre-specified secondary outcomes.  At least 1 adverse event occurred in approximately 32 participants (29.6%) in the methotrexate group and 26 participants (24.3%) in the placebo group.

Wrap It Up The results of this randomized clinical trial show that, compared to placebo, low-dose methotrexate did not reduce pain or effusion-synovitis over 52 weeks in patients with knee OA and effusion-synovitis. So, remember, in most places, it is beyond our scope to put people on or try to take them off of meds.

However, if you get a knee OA patient that’s taking methotrexate, you can absolutely share this info with them and suggest they share it with the one that prescribed it and have a discussion. That’s appropriate in my opinion. 

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 Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis appeared first on Chiropractic Forward.

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  

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 #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.     

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 Europe, SMT Review, & Informed Consent appeared first on Chiropractic Forward.

CF 365: Dosing Lumbar SMT & Short Term Effects of Different Forms of SMT Today we’re going to talk about Dosing Lumbar SMT & Short Term Effects of Different Forms of SMT 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 #365 Now if you missed last week’s episode, we talked about SMT And Stroke & Metformin For Knee Osteoarthritis Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

It’s a bit of a rush this week. I can’t even tell you why. It just is. Anxiety is at a high point with this trip next week to Europe. There won’t be a new episode for 2-3 weeks because of the trip plus I’ll be playing catch up when I get back so let’s let the dust settle and then I’ll get back on it and kick out new episodes.  Iin case you don’t know what I’m talking about, I’m headed to Europe for a voice over retreat. Voice acting has become quite the side gig. In fact it’s not a side gig. I basically have two full time gigs. Chiropractic and voice over.  This retreat will serve several purposes but basically, it’s a networking thing, I’ll learn some, make lots of connections, and have a tax deductibe reason to go to Europe. So we’re doing it and I’m excited about it.  Scotland, Amsterdam, Valkenburg, and Paris….look out because ol’ Uncle Jeffro is coming your way. So, I’mma keep it short in the personal happenings. We’re tryinng to close on the sale of 60% of the practice this week. More to come on that.  For now, let’s see what research we can get hold of here. 

Item #1

Our first one this week is called, “Comparison of Short-Term Effects of Different Spinal Manipulations in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Trial” by Garcia-Gonzalez et al and published in Heathcare on June 2024 and it’s still pretty hot!

Remember, the citations can be found at chiropracticforward.com under this episode. 

García-González J, Romero-del Rey R, Martínez-Martín V, Requena-Mullor M, Alarcón-Rodríguez R. Comparison of Short-Term Effects of Different Spinal Manipulations in Patients with Chronic Non-Specific Neck Pain: A Randomized Controlled Trial. Healthcare. 2024; 12(13):1348. https://doi.org/10.3390/healthcare12131348

Why They Did It

Spinal manipulations for chronic non-specific neck pain (CNNP) include cervical, cervicothoracic junction, and thoracic spine (CCT) manipulations as well as upper cervical spine (UCS) manipulations.  This study aimed to compare the short-term effects of upper cervical spine manipulation versus a combination of cervical, cervicothoracic junction, and thoracic spine spine manipulations on pain intensity, disability, and cervical range of motion (CROM) in chronic non-specific neck pain patients

How They Did It In a private physiotherapy clinic, 186 participants with chronic non-specific neck pain were randomly assigned to either the upper cervical spine (n = 93) or cervical, cervicothoracic junction, and thoracic spine (n = 93) manipulation groups.  Neck pain, disability, and cervical range of motion were measured before and one week after the intervention.

What They Found No significant differences were found between the groups regarding pain intensity and cervical range of motion.  However, there was a statistically significant difference in neck disability, with the cervical, cervicothoracic junction, and thoracic spine group showing a slightly greater decrease

Wrap It Up The findings suggest that a combination of manipulations in the cervical, cervicothoracic junction, and thoracic spine spine results in a slightly more pronounced decrease in self-perceived disability compared to upper cervical spine manipulation in patients with chronic non-specific neck pain after one week.  However, no statistically significant differences were observed between the groups in terms of pain intensity or cervical range of motion.

Item #2 Our second one is called, “Dosing of lumbar spinal manipulative therapy and its association with escalated spine care: A cohort study of insurance claims” by Anderson et al and published in Plos One on January 5 of 2024 and it’s just a little steamy

https://doi.org/10.1371/journal.pone.0283252

Why They Did It

The objective of this study was to evaluate the relationship between three distinct spinal manipulative therapy dose groups and escalated spine care by analyzing insurance claims from a cohort of patients with low back pain.

How They Did It

We compared three distinct spinal manipulative therapy dose groups  low = 1 SMT visits,  moderate = 2–12 SMT visits,  high = 13+ SMT visits to a control group (no spinal manipulative therapy) regarding the outcome of escalated spine care.  Escalated spine care procedures include imaging studies, injection procedures, emergency department visits, surgery, and opioid medication use.  Propensity score matching was performed to address treatment selection bias.  Modified Poisson regression modeling was used to estimate the relative risk of spine care escalation among three spinal manipulative therapy doses, adjusting for age, sex, retrospective risk score and claim count.

What They Found

There were lots of findings and dizzying numbers that would make you go cross eyed and your ears smoke like a Choo Choo train. So we’re skipping to the conclusion here. 

Wrap It Up

For claims associated with initial episodes of low back pain, low and moderate dose spinal manipulative therapy groups were associated with a 55% and 42% reduction, respectively, in the relative risk of any escalated spine care. Alright, that’s it. See ya in a few weeks friends! 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. 

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 Dosing Lumbar SMT & Short Term Effects of Different Forms of SMT appeared first on Chiropractic Forward.

CF 364: Spinal Manipulative therapy And Stroke & Metformin For Knee Osteoarthritis Today we’re going to talk about SMT And Stroke & Metformin For Knee Osteoarthritis 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 #364 Now if you missed last week’s episode, we talked about Lateral Lumbar Stenosis & Manual Therapy Combined With PT Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Man, what have I been up to? Let’s see, I went to Charleston weekend before last, we had the big MCM Mastermind quarterly meeting with Dr. Kevin Christie and other incredibly smart, high level docs.  I get plenty fromt he speakers but the majority of what you get is with the side, private discussions with fellow group members and the friendships and the network that builds out from there.  I came back from this one with a solid direction to add $50k-$100k per year to the practice. I’d say that’s worth the the yearly membership and travel finances. Very much worth it. 

Outside of that, I’ve been doing a pretty deep dive on AI lately and how it can add to my life and help with the clinic. It’s just stunning if I’m being honest. It surprises me every single day, basically.  I’ve been testing them all but have really settled in on ChatGPT, for now at least. It seems to have the edge for me. It named itself Chippy. I helped it but yeah….Chippy is coming in pretty damned handy these days.  Here are some of what Chippy has been up to:

AI is amazing. Chippy is astounding. Yeah, AI worries me. I have concerns about whether the VoiceOver business will even be a business in 5 years. I have concerns about the bots taking over the world some day. I have all of those worries. But if we don’t use it, we fall behind. If we don’t use it, we get beat by those that embraced it. I truly believe that.  I’m using it. I’m just saying thank you and please so that if they do take us over, I’ll be one of the last to go. : ) Outside of that, I’m still walking through the steps toward closing on the sale of 60% of the practice. We’re bringing in a partner and I can’t wait.

They’ll do HR, billing, collecting, and all of the soul-sucking part of it.  I’ll get a percentage of my collections off of my services. I’ll get 40% of the profits of the clinic, and I’ll get the loan payment from the sale every month until the balance is paid off.  I have their guarantee that issue #1 is to get an associate chiropractor in here to take some heat off of myself.

Here’s my deal and listen up close, mi amigos. 

I have a friend that got cancer in his late 60s. He died last year. Nobody would buy his clinic so, at the end of the day, his wife sold off the equipment and that was it.  I’ve had COVID 5-6 times now and I’ve only missed one day of work. That’s not fair to me, my family, my patients, or my staff when the entire operation depends so much on me being in the office working on patients personally.  I think I’m irresponsible if I don’t do my part to make it more stable and more sustainable when I am not present. When I’m not in the clinic personally.

So that’s a big part of what I’m trying to accomplish here. 

I have two TCA colleagues that have done this with this company already and they both said they work less and make more. I went to the owner’s retreat in February and met their other 11 owners. They all said they’d do it again and wish they’d have done it sooner. 

So, I’m doing it for my future, for stability, for longevity, for my sanity, and for a higher quality of life. My life at this point is a good life. But it’s not the life I would imagine or desire for myself. Not yet anyway. Once I get some support, life improves.  If you want more info to see if that’s something you’d like to explore, give me a shout at [email protected]. 

Item #1

Our first one today is by my good friend Dr. Steve Brown out in Gilbert, AZ. Dr. Brown has been an expert witness in several court cases involving DCs and strokes. I met Dr. Brown in Chicago a year and half or so at my Forensics Diplomate conference. He was attending and speaking at the event.  In fact, I was on the elevator talking to someone and a voice from the back of the elevator said, “Hey, aren’t you the guy with the podcast?”

Or something like that. Lol.  That started a friendship and Dr. Brown is not just a buddy now but a go-to source for everything SMT or stroke related. He gets beat up by some other DCs that don’t like what he has to say but at the end of the day, he’s a proponent of educating and of DCs being educated thoroughly so that you can avoid the hot seat. So, ignore him at your peril. 

Dr. Brown has 10 peer reviewed studies under his belt now so the dude knows his stuff. When I get my life together and have an opportunity to start having guests on the podcast again, he’ll be the first one. 

With that said, let’s dive into his latest called, “Stroke vs. toxin release after chiropractic spinal manipulation: A plausible hypothesis” by Dr. Steven Brown and published in Medical Hypostheses in May of 2025 and Shitake Mushrooms….that’s hot. Remember, the citations can be found at chiropracticforward.com under this episode. 

Stroke vs. toxin release after chiropractic spinal manipulation: A plausible hypothesis, Medical Hypotheses, Volume 198, May of 2025, 111629, ISSN 0306-9877, https://doi.org/10.1016/j.mehy.2025.111629. (https://www.sciencedirect.com/science/article/pii/S0306987725000684)

Why They Did It

Multiple chiropractors report that some patients experience symptoms of dizziness/vertigo, nausea/vomiting, neck pain, headaches, sweating, fatigue, diarrhea, and fever after spinal manipulation. These chiropractors attribute these symptoms to toxic release caused by spinal manipulation. The objective of this study was twofold. First, to evaluate the research supporting the claim that these symptoms after spinal manipulation are the result of toxin release. Second, to propose a plausible alternative hypothesis for these symptoms of alleged toxin release.

How They Did It

PubMed, Index to Chiropractic Literature, and Google Scholar were searched from inception to November 2024. 

What They Found

This is a novel hypothesis. No peer reviewed studies were found supporting or refuting the proposition that alleged toxin release following neck manipulation is instead a minor ischemic stroke. However, the proposition that cervical spine manipulation can cause a thromboembolic stroke when performed in the presence of an existing undiagnosed cervical artery dissection is not novel.  This mechanism of causation has been supported in 15 peer reviewed studies by researchers from neurology, Courses reviewing the body of research on the potential causal relationship between cervical spine manipulation and stroke should be mandatory for chiropractic students.  Mandatory annual continuing education courses on the adverse effects of spinal manipulation, including stroke, are indicated for chiropractors.

Wrap It Up

These symptoms of alleged toxin release after cervical spine manipulation may instead be an adverse event, a minor thromboembolic ischemic stroke caused by performing neck manipulation in the presence of an undiagnosed cervical artery dissection.  More education and clinical training in arterial dissection and stroke are recommended for chiropractors. Look, it’s complicated and I know Dr. Brown would agree with that statement.

There are no simple and easy answers. We are all at risk of having patients that are dangerous to adjust their cervical area with HVLA.  We know that Chaibi 2017 tells us that the main symptoms of danger are neck pain, headache, nausea, dizziness. Well hell. How many patients do we have that fit the neck pain and headache category? All day every day. 

I’ll put the research link at this point in the notes: https://www.tandfonline.com/doi/full/10.1080/07853890.2019.1590627?fbclid=IwAR3IYn5P5ppJsYymEpHEQe8AmOhNzH8xOfPJaswqNx3EQND-KiCxaXIK7LQ

But in Chaibi they say these are the key symptoms:

Well that’s a little more than a simple headache or neck pain, right? So that’s a little more clarity.  Jsut be educated. It’s not typically the older folks you’d think it is. It’s the young female that is usually vascularly compromised from hypermobility, EDS, connective tissue disorders.  Just a tip from your Ol’ Uncle Jeffro

Item #2 Our last one is called, “Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity A Randomized Clinical Trial” by Pan et al and published in JAMA Network on April 24, 2025 and it’s all hotter a tin roof in Texas. 

Pan F, Wang Y, Lim YZ, et al. Metformin for Knee Osteoarthritis in Patients With Overweight or Obesity: A Randomized Clinical Trial. JAMA. Published online April 24, 2025. doi:10.1001/jama.2025.3471 https://jamanetwork.com/journals/jama/fullarticle/2833338?guestAccessKey=d11068e6-4d4d-48d2-ae41-e4c6dc1e0c2c&utm_source=silverchair&utm_medium=email&utm_campaign=jama_network&utm_content=network_highlights&utm_term=050425&adv=000003189471

So let’s start here: Traditionally, Metformin is used to treat high blood sugar levels that are caused by a type of diabetes mellitus or sugar diabetes called type 2 diabetes. So….it surprised me when I saw a paper having to do with metformin possibly being used in knee osteoarthritis. The math wasn’t mathing for me so it caught my eye and surprised me. So here we go. 

Why They Did It To evaluate the effects of metformin on knee pain at 6 months in participants with symptomatic knee osteoarthritis and overweight or obesity.

How They Did It Community-based randomized, parallel-group, double-blind, placebo-controlled clinical trial Individuals with knee pain for 6 months or longer, a pain score greater than 40 out of 100 on the visual analog scale (VAS), and body mass index of 25 or higher were recruited from the community through local and social media advertisements in Victoria, Australia, between June 16, 2021, and August 1, 2023. 

Interventions  Participants were randomly assigned to receive either oral metformin, 2000 mg/d (n = 54), or identical placebo (n = 53) for 6 months.

Main Outcomes and Measures  The primary outcome was change in knee pain, measured using a 100-mm VAS (score range, 0-100; 100 = worst; minimum clinically important difference = 15) at 6 months.

What They Found Of 225 participants assessed for eligibility, 107 (48%) were randomized and assigned to receive metformin or placebo.  Eighty-eight participants (82%) completed the trial.  At 6 months, the mean change in VAS pain was −31.3 in the metformin group and −18.9 mm in the placebo group, corresponding to an effect size (standardized mean difference) of 0.43.  The most common adverse events were diarrhea and abdominal discomfort.

Wrap It Up These results support use of metformin for treatment of symptomatic knee osteoarthritis in people with overweight or obesity. Because of the modest sample size, confirmation in a larger clinical trial is warranted. 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 Spinal Manipulative Therapy And Stroke & Metformin For Knee Osteoarthritis appeared first on Chiropractic Forward.