Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The post SMT And Disc Regression & Biopsychosocial Factors For Hip Osteoarthritis appeared first on Chiropractic Forward.

CF 381: SMT And Reoperation Rates & The Most Expensive Condition Today we’re going to talk about SMT And Reoperation Rates & The Most Expensive Condition 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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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] Things you should do. 

You have found yourself smack dab in the middle of Episode #381 Now if you missed last week’s episode, we talked about Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture Risk Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. Nothing too crazy. Still enjoying the Fall bounce where business acts like it should act and I’m better behaved with regard to traveling all over the world. It’s weird; when you stay put, business just does better.  You remember I mentioned that I am on the medical side carousel?

We have a NP interview this afternoon so we’ll see how that goes.  I went to teh cardiologist the other day. I’m 53 and never been so I thought, maybe I’m missing out on all of the fun so let’s see what it’s all about. Well, it Ain’t all it’s cracked up to be. The first visit was fine.

The dude saiid I don’t see anything particularly concerning here but let’s do an echocardiogram and just dive in and see what’s there.  So I got that done and what do you know? I got a call from his NP saying that overall I look good BUT….the bottom of my heart contracts too much and doesn’t relax like it should. What the hell does that mean anyway??

So she recommends putting me on the lowest dose diruetics to keep the upper portion of the heart from eventually enlarging.  Well, I’m in no mood to go on life long meds but diving into these meds, they’re pretty much like taking an antiacid every day so, maybe not so bad. I’m still checking it out but will probably take them. At least until I can finally get some damn weight off. 6’4” and 275 lbs is big and I’d much rather be around 230-240 lbs. Or less.

But my body doesn’t want to be that. No matter what I do or try. It’s crazy.  The weight loss meds that work so well for everyone….yeah, I’m a non-responder. Because that’s my life. I look like I eat like a horse but I don’t. I eat fairly lightly overall day to day. It’s like my body has set it’s weight point at 275-280 and it doesn’t matter what the hell I do. It doesn’t want to budge from that spot.  So, it’s a constant battle. One that I know I’m not alone in.

Many of us struggle with it. Just trying to figure it out.  Butt the good news is, the cardio suggested I reduce stress and try to relax more. Which means I’m getting a massage this afternoon. Yay! Which also means I gotta get going on this episode so let’s hop into the research. 

Item #1

The first one is an article from Forbes called, “The Most Expensive Medical Condition Is Not What You Think” by Peter Ubel, a physician and behavioral scientist at Duke University.

It was updated in July of 2025 so it’s sizzlin like a stack of fajitas! Remember, the citations can be found at chiropracticforward.com under this episode. 

The article from Forbes reveals that the most expensive medical condition in the United States is not heart disease or diabetes, as commonly assumed, but rather low back and neck pain.  While heart disease and diabetes are both serious and costly—ranked fourth and third respectively, with expenditures of $90 billion and $111 billion annually—back and neck pain surpasses them with costs exceeding $130 billion each year.

This substantial burden is linked to the sheer number of people affected and the chronic nature of these conditions.  The article highlights that individuals suffering from low back and neck pain commonly undergo expensive diagnostic procedures like X-rays and MRIs (often unnecessarily), use pain medications, participate in physical therapy, seek chiropractic care, and may ultimately face surgery—with almost half of these operations deemed unnecessary.  The impact extends beyond the healthcare system, affecting productivity due to missed work and causing considerable suffering among adults during their most productive years.

Additionally, the piece points out a major discrepancy in government research investment: In 2021, the National Cancer Institute received over $7 billion, while the National Institute for Arthritis and Musculoskeletal and Skin Diseases (which includes spinal research) received just $685 million—barely a tenth by comparison.  The article concludes with a call to prioritize research and funding for back and neck pain to match its immense medical and financial toll on American society.

You guys know this stuff. It’s preaching to the choir but it’s also updating the knowledge base and putting numbers to it too. 

So there ya go. 

Item #2 And #2 this week 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. 

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 LSR 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 LSR 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, yielding an RR of 0.55.  In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit.

Wrap It Up This study found that adults experiencing LSR 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.

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 SMT And Reoperation Rates & The Most Expensive Condition appeared first on Chiropractic Forward.

CF 380: Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture Risk Today we’re going to talk about Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture 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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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] Things you should do. 

You have found yourself smack dab in the middle of Episode #380 Now if you missed last week’s episode, we talked about Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. It’s been a bit cray cray around here. We’re on the hamster wheel again with regards to the

nurse practitioner. Our nurse that’s been in NP school and we’ve been waiting to graduate got an offer for full time from the clinic she’s been doing her clinicals with and, just from a pure financial standpoint, she had to take it. I can only offer part time until the schedule fills up.  So….down the road we go.

Looking for a new staff member to help us grow the clinic medically and service-wise. She/He is out there. We just gotta find ‘em.  Next, you’ve heard me speak about selling part of the clinic several times over the last several years. We were going to have a final discussion after going back and forth on the contract. What changes could they live with and what could we live with in a final contract. That sort of thing.  Well, unfortunately and tragically, the CEO of the company was heading to one of their clinics in a small airplane that unbelievably crashed with no survivors. Absolutey unbelievable. His name was Dr. Justin Ramsey and he was a great guy.

Not only was a lot of this a business thing but, I got to know Justin fairly well and we were friends.  It’s been very hard to process on lots of different levels. Losing a friend and who knows where that puts us with selling a portion of the clinic? We don’t know. But I do know this; I’m getting up every morning and going to work and making patients feel better.  It will all fall into place as soon as it is supposed to fall into place.

That’s enough, let’s hop in. 

Item #1 The first one is called, “Reduction of Chronic Primary Low Back Pain by Spinal Manipulative Therapy is Accompanied by Decreases in Segmental Mechanical Hyperalgesia and Pain Catastrophizing: A Randomized Placebo-controlled Dual-blind Mixed Experimental Trial” by Gevers-Montaro et al and published in the Journal Of Pain in August 2024. 

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

Reduction of Chronic Primary Low Back Pain by Spinal Manipulative Therapy is Accompanied by Decreases in Segmental Mechanical Hyperalgesia and Pain Catastrophizing: A Randomized Placebo-controlled Dual-blind Mixed Experimental Trial Gevers-Montoro, Carlos et al. The Journal of Pain, Volume 25, Issue 8, 104500

Why They Did It Chronic primary low back pain (CPLBP) refers to low back pain that persists over 3 months, that cannot be explained by another chronic condition, and that is associated with emotional distress and disability.  Previous studies have shown that spinal manipulative therapy (SMT) is effective in relieving CPLBP, but the underlying mechanisms remain elusive.

How They Did It This randomized placebo-controlled dual-blind mixed experimental trial aimed to investigate the efficacy of SMT to improve CPLBP and its underlying mechanisms.  Ninety-eight individuals with CPLBP and 49 controls were recruited.  Individuals with CPLBP received SMT or a control intervention, 12 times over 4 weeks.  The primary outcomes were CPLBP intensity and disability (Oswestry Disability Index).  Secondary outcomes included pressure pain thresholds in 4 body regions, pain catastrophizing, Central Sensitization Inventory, depressive symptoms, and anxiety scores.

What They Found Individuals with CPLBP showed widespread mechanical hyperalgesia and higher scores for all questionnaires.  SMT reduced pain intensity compared with the control intervention, but not disability.  Similar mild to moderate adverse events were reported in both groups.  Mechanical hyperalgesia at the manipulated segment was reduced after SMT compared with the control intervention.  Pain catastrophizing was reduced after SMT compared with the control intervention, but this effect was not significant after accounting for changes in clinical pain

Wrap It Up Although the reduction of segmental mechanical hyperalgesia likely contributes to the clinical benefits of SMT, the role of pain catastrophizing remains to be clarified. Previous studies on the efficacy of SMT have suggested that its clinical benefits may rely on nonspecific effects.22,28,84 In contrast, a clinical trial designed to examine and control for nonspecific effects showed specific pain reduction by SMT.85  Accordingly, the present study shows that SMT produces greater pain relief compared with a control intervention that was undistinguishable from SMT.  This medium effect (η2p = .07) persisted up to 12 weeks after SMT, suggesting that SMT produces long-lasting pain relief, possibly through specific mechanisms.

Item #2 Our second one today is called, Long Dosing Intervals of Parenteral Antiosteoporosis Medications and the Decrease in Societal Fracture Risk by Fu et al published in Mayo Clinic Proceedings in January 2025 and it’s a hot one today!

Long Dosing Intervals of Parenteral Antiosteoporosis Medications and the Decrease in Societal Fracture Risk Fu, Shau-Huai et al. Mayo Clinic Proceedings, Volume 100, Issue 1, 68 – 79

Why They Did It To evaluate the relationship between different dosing intervals of antiosteoporosis medications (AOMs) and the subsequent fracture risk among patients with newly initiated AOM therapies.

How They Did It In a nationwide population-based cohort study based on Taiwan’s National Health Insurance Research Database, osteoporosis patients with 50 years of age or older who newly initiated AOM from January 1, 2008, to December 31, 2018 were included.  We categorized AOMs into short dosing intervals or long dosing intervals.  The adherence of treatment by medication possession ratio and subsequent fracture after treatment for 3 years were measured.

What They Found Among patients who initiated parenteral AOMs, the percentage of patients with high adherence increased from 33% in 2008 to 69% in 2018.  However, among patients who initiated oral AOMs, the percentage of high adherence remained stable (30%) between 2008 and 2018.  The use of parenteral AOMs increased from 1% in 2008 to 62% in 2018.  At the same time, the percentage of high adherence of those initiated AOMs significantly increased from 34% in 2008 to 61% in 2018.  The risk of subsequent fracture decreased significantly between 2008 and 2018 after controlling for all potential confounders

Wrap It Up AOMs with long dosing intervals not only increased adherence but also associated with the decrease in subsequent fracture risk at a nationwide scale. 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 Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture Risk appeared first on Chiropractic Forward.

Today we’re going to talk about Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection 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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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] Things you should do. 

You have found yourself smack dab in the middle of Episode #379 Now if you missed last week’s episode, we talked about Differences In Whiplash And Normal Neck Pain & Spinal Manipulative Therapy And Scoliosis.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Now that the Fall is upon us, things are leveling out and getting mroe and more stable around here. Which means less travel and more living in my house like a regular normal person. Except, we stayed in my hometown last weekend for my 35th high school reunion. Which is weird as hell to say. But it is what it is. I have the gray hair to prove it. 

Got to see a lot of folks I haven’t seen in a while and that’s always good. Some never go back. They didn’t have a good experience in high school so they care nothing about it. I get that. That wasn’t me though. I had an incredible experience. I won state in the discus and was a two-way starter and football captain, honor grad, and had a great circle of friends that I absolutely still stay in touch with and still enjoy texting and seeing every now and then.  High school was somethign else for me and I wouldn’t trade it for anything. So we go back when it’s time. 

Something I’ve been working on lately; through Facebook, a colleague reached out to me and said that with my ortho diplomate cert and my Forensics diplomate cert, that I should consider doing designated doctor work or medicolegal work out of state. She said she travels out of state once every 6-8 weeks and makes a gob of money doing so every year. 

Well hell, you don’t have to tell me twice. There absolutely SHOULD be more benfits to having Diplomates so, if I got ‘em, miight as well use them.

So, I started down the path of getting licensed elsewhere and holy guacamole what a sincere time suck pain in the ass. Wow. Absolutely stupid the hoops you gotta jump through. I’ve been licensed in TX since 1998 but I have to do mental gymnastics to add a license somewhere else?? Insantiy.  But, I’m getting there. Then, once licensed, I have to take a course that will prepare me for the Qualified Medical Examiner exam. Then I take that QME and pass it and Kablamo! I’m off to the races and adding an extra revenue source that can be maintained once I retire from actively treating patients every day. 

Which, psssst…..between me and you….if you don’t want to die in yoru practice or sell it someday desperately for pennies on teh dollar, is exactly what we should all be doing. We should be acting as if there is an end game. Because there is and none of us are getting out alive.  Why do you think I have the VoiceOver thing going? The Airbnbs thing? You think I post my paintings and my sculptures on social media so often so that I can brag? Hell no. I want a portfolio and people to know, like, and eventually buy my art. If myy paintints annd sculptures are news to you, go to www.riverhorseart.com and check it out.  The point is; I’m trying to plan for the end game. I’m trying to do what I can to maximize my end game. You should be too. 

Item #1

Our first one this week is called Association of Opioid use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrspective Cohort Analysis by Moyo et al and published in Journal of General Internal Medicine in 2024.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Moyo, P., Merlin, J.S., Gairola, R. et al. Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis. J GEN INTERN MED 39, 2097–2105 (2024). https://doi.org/10.1007/s11606-024-08799-3

Why They Did It They wanted to see if people with this opioid problem were treated differently for sudden back pain.

How They Did It The main independent variable was OUD diagnosis measured prior to the first LBP claim (i.e., index date).  Using multivariable logistic regressions, they assessed the following outcomes measured within 30 days of the index date: 

Among opioid recipients, we further assessed opioid dose and co-prescription of gabapentin.  Analyses were conducted overall and stratified by receipt of physical therapy, chiropractic care, opioid fills, or gabapentin fills during the 6 months before the index date.

What They Found

Wrap It Up

Doctors recommend starting with safer ways to treat pain (like exercises and Chiropractic therapy) instead of medicine—especially for people who’ve had problems with opioids before.  But this study found that doctors often use medicines anyway, and not enough non-medicine treatments. Specifically, the authors said this, “Medicare beneficiaries with aLBP and OUD underutilized nonpharmacologic pain therapies and commonly received opioids at high doses and with gabapentin. Complementing the promulgation of practice guidelines with implementation science could improve the uptake of evidence-based nonpharmacologic therapies for aLBP.” Which means people with back pain aren’t going to a chiro or PT nearly often enough and to compound the matter, people in the medical castles are STILL prescribing too many opioids and gabapentin whihc means they’re acting in a non-evidence-based way. 

Item #2 Our last one this week is called, “Impact of transforaminal epidural steroid injection on pain and disability outcomes by lumbar intervertebral disc herniation class: a prospective study” by Saracoglu et al and published in Pain Medicine in August of 2025 and is muy cliente me amigos. 

Tuba Tanyel Saraçoğlu, Burak Erken, Impact of transforaminal epidural steroid injection on pain and disability outcomes by lumbar intervertebral disc herniation class: a prospective study, Pain Medicine, Volume 26, Issue 8, August 2025, Pages 440–450, https://doi.org/10.1093/pm/pnaf040

Why They Did It To evaluate the effects of transforaminal epidural steroid injection on pain and disability across different lumbar disc morphologies using the Michigan State University (MSU) classification system.

How They Did It

What They Found

Wrap It Up

Transforaminal epidural steroid injection effectively reduces pain and disability across varying disc morphologies.  At the 1-month mark, pain relief was more pronounced in group 1B compared to 2A and 2AB groups, whereas at the 3-month mark, the results were similar between subgroups.  So, these groups know that these injections are short-term relief only but they’re recommending larger studies with longer follo-up to improve patient selection and optimze the tx strategies.  Instead of looking at the American College of Physician’s recommended hierarchy of treatment. While I was messing with Perplexity AI, the best research-leaning AI that I’m aware of, I asked Perplexity the following: “Qaseem et al published in the Annals of Internal Medicine by the American College of Physicians suggests a hierarchy of treatment with things like spinal manipulative therapy, exercise, massage, acupuncture, low-level laser, yoga, tai chi, mindfulness, cognitive behavioral therapy, and heat being first-line recommended therapies.

These recommendations come from the largest medical group in the world.

Why are these not more widely recommended by AI and by primary care providers as well as surgeons?” Perplexity returned with this response which, I thought, was fairly accurate minus the part where many chiropractors are causing the issue as well. 

The AI engine responded with,  “Reasons First-Line Therapies Are Underused

Why Noninvasive Therapies Should Come First

In summary, while the largest medical group in the world encourage starting with non-drug therapies, they’re not always widely recommended because of habits, system pressures, patient expectations, and insurance rules—even though science backs their effectiveness and safety as first-line 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 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 Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection appeared first on Chiropractic Forward.

CF 378: Differences In Whiplash And Normal Neck Pain & Spinal Manipulative Therapy And Scoliosis Today we’re going to talk about Differences In Whiplash And Normal Neck Pain & SMT And Scoliosis 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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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] Things you should do. 

You have found yourself smack dab in the middle of Episode #378 Now if you missed last week’s episode, we talked about Neuroplastic Responses to Chiropractic Care & Screen Time and Depression. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well what’s new this week? Still going through the sale process with the investment group you’ve heard me talk about in some of the past episodes. It’s a lot, ya know? Selling a percentage of your lifelong blood sweat and tears and your pride and joy isn’t something you go into lightly. But I think we’re closer than we’ve ever been.  They sent us a contract, our attorney pointed out his concerns, we sent those back to them, it took about 4 months but we got the contract back and are going through it to see what we can meet in the middle on. Once we firm that up, we should be good to go with the closing.  So that’s been going in the background for a long time. Like for a few years at one level or another but more seriously here in just the last year.

Hopefully, that chapter is about closed so we can start looking at the next chapter. 

Our Parker intern is doing great. She’s smart and very capable. All new DCs need as much adjusting time as they can get. I always think the Motion Palpation Institute is the best start anyone can get. Those folks are top tier. I’m personal friends with Dr. Mark King the President of MPI and with Dr. Lindsay Mumma, who is one of their instructors. I know the level of Doctors they have leading that and really respect them all and their organization. 

I know them through our Mastermind and speaking of Mastermind, we’ll all be in New Orleans on October 22nd through that weekend. Really looking forward to being with my people and for the first time ever, we will have Dr. Kevin Christie’s East Group and West Group combined meeting.  My group is the East group and we’ve never met the folks from the West group so it’ll be a good time to build and expand the network. Good stuff and really looking forward to it.  Dr. Jay Greenstein will be there as well and it’s always a good time with Jay. He’s got the vibe down. Also, Dr. Tim Bertlesman of ChiroUp will be there as well. Put those guys on top of Kevin, Mark King, Lindsay Mumma, Ben Fergus, David Rudnick, Vanessa Wilczak, Curt Kippenburger, Anthony Houssain, Tiffany and Tyler Armstrong, and all of my other great friends…..well….it’s going to be solid. As you can imagine.  Lastly, as you know we purchased the Kinas Miracle Wave Radial Shockwave unit last month, attended the shockwave masterclass a week and a half ago out in Atlanta, and are off to the races.   

Admittedly, we are behind some of our competitiors but I think with the knowledge base we get to draw from and the masterclass under our belt, we are well-positioned to catch up, differeniate from our competitors, and build this thing! If you need the Kinas hook-up, shoot me and email at [email protected] and I’ll get you in touch with the folks that can help you get started. 

Item #1 The first one today is called, “Effects of High-Velocity Spinal Manipulation on Quality of Life, Pain and Spinal Curvature in Children with Idiopathic Scoliosis: A Systematic Review” by Piqueras-Toharias et al and published in children in 2024.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Piqueras-Toharias, M.; Ibáñez-Vera, A.J.; Peinado-Rubia, A.B.; Rodríguez-Almagro, D.; Lomas-Vega, R.; Sedeño-Vidal, A. Effects of High-Velocity Spinal Manipulation on Quality of Life, Pain and Spinal Curvature in Children with Idiopathic Scoliosis: A Systematic Review. Children 2024, 11, 1167. https://doi.org/10.3390/children11101167

Why They Did It

Scoliosis is a condition that involves deformation of the spine in the coronal plane and commonly appears in childhood or adolescence, significantly limiting a person’s life.  The cause is multifactorial, and treatment aims to improve the spinal curvature, prevent major pathologies, and enhance aesthetics.  The objective of this review was to determine whether high-velocity low-amplitude (HVLA) spinal manipulation is more effective than other treatments for children with idiopathic scoliosis (IS).

How They Did It The PubMed, Web of Science, Scopus and PEDro databases were searched for both clinical trials and cohort studies.  Methodological quality was assessed via the PEDro scale (for clinical trials) and the Newcastle–Ottawa scale (for observational studies).  The protocol of this systematic review was registered in PROSPERO (CRD42024532442).

What They Found Five studies were selected for review. The results indicated moderate improvements in pain and the Cobb angle and limited improvements in quality of life

Wrap It Up HVLA spinal manipulation does not seem to have significant effects on reducing spinal deformity in IS patients, nor does it significantly impact quality of life. 

However, this therapy may have significant effects on reducing pain in these patients.

Item #2 The last one this week is called, “Differences in the clinical presentation of chronic whiplash-associated disorders and nontraumatic neck pain: a systematic review and meta-analysis” by Junze et al and published in Pain in August 2025 and it’s a hot tamale hot tamale!

Chen, Junzea; Farrell, Scott F.a; Huang, Wanyun Irenea; Cagnie, Barbarab; Murillo, Carlosb; Sterling, Michelea,*. Differences in the clinical presentation of chronic whiplash-associated disorders and nontraumatic neck pain: a systematic review and meta-analysis. PAIN 166(8):p 1738-1756, August 2025. | DOI: 10.1097/j.pain.0000000000003554

Why They Did It

Health outcomes may be worse for individuals with whiplash-associated disorders (WAD) compared to nontraumatic neck pain (NTNP), and clinical characteristics may differ.  This systematic review examined evidence comparing WAD and NTNP in terms of pain, disability, psychological status, quality of life, measures of nociceptive processing, movement, sensorimotor, and muscle function.

How They Did It Studies were identified through electronic database searches and included after screening against predefined eligibility criteria. Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CI) were calculated. Associations between MDs with demographics and study characteristics were explored using meta-regression. Certainty of evidence was assessed using Grades of Recommendation, Assessment, Development, and Evaluation. Sixty-one studies were eligible with 45 included in meta-analysis.

What They Found Individuals with WAD reported 

No between-group differences were found for dizziness symptoms, stress, anxiety, balance, and local cold sensitivity. 

Wrap It Up Certainty of evidence was mostly moderate.  Individuals with chronic WAD have a worse clinical presentation compared to those with chronic non-traumatic neck pain, which has implications for patient assessment and management. 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 Differences In Whiplash And Normal Neck Pain & Spinal Manipulative Therapy And Scoliosis appeared first on Chiropractic Forward.

CF 377: Neuroplastic Responses to Chiropractic Care & Screen Time And Depression Today we’re going to talk about Neuroplastic Responses to Chiropractic Care & Screen Time And Depression 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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 12-er.  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 me and we’re 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] Things you should do. 

You have found yourself smack dab in the middle of Episode #377 Now if you missed last week’s episode, we talked about Acupuncture For Chronic Low Bac k And Spinal Manipulative Therapy for Acute Neck Pain Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. I just recently returned from the Academy Of Shockwave Excellence Masterclass out in Atlanta, GA and now, I’m a master in Shockwave.  In case you are wondering, I started on this path and journey because of my Mastermind group that you always hear me talking about. Two of our members are instructors and masters in Shockwave. Dr. Ben Fergus in Evanston, IL and Dr. David Rudnick from Boynton Beach, FL.  These two guys are freaks on the. Shockwave and they BOTH use Kinas radial and focused shockwave units. So, I ordered Kinas, then attended the Masterclass, and now, I’m up and running and pissing some excellence. 

If you are entertaining the thought of getting shockwave, I want you to send me an email at [email protected] and let’s talk about it. It is my understanding that this is the only group that has a materclass academy that really gets you and your staff trained. If you just get a manual from the manufacturer and don’t really get traning, then this is your group. I encourage you to get going on it. Send me an email and I’ll point you the right direction. [email protected]

Item #1 Our first one is called “Role of Sleep and White Matter in the Link Between Screen Time and Depression in Childhood and Early Adolescence” by Santos et al published in JAMA Pediatrics on September 1, 2025 and it’s hotter than Angelina.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Lima Santos JP, Soehner AM, Biernesser CL, Ladouceur CD, Versace A. Role of Sleep and White Matter in the Link Between Screen Time and Depression in Childhood and Early Adolescence. JAMA Pediatr. 2025 Sep 1;179(9):1000-1008. doi: 10.1001/jamapediatrics.2025.1718. PMID: 40549406; PMCID: PMC12186512.

Why They Did It To identify the association between screen time during late childhood and depressive symptoms in early adolescence, and to investigate whether these associations are mediated by sleep duration and white matter organization.

How They Did It Prospective study was conducted from January 2024 to June 2024.  Data from the Adolescent Behavior Cognitive Development (ABCD) Study were used  Children and their parent/caregiver were recruited across 21 US cities.  Participants with no past/current psychiatric disorders were selected for analyses.  Outcomes included screen time assessed using a self-report questionnaire, sleep duration assessed using the Munich Chronotype Questionnaire, and depressive symptoms characterized using the Child Behavior Checklist.  Neurite orientation dispersion and density imaging and a tract profile approach were used to characterize the orientation dispersion index of 3 white matter tracts that are known to be implicated with depression: cingulum bundle, forceps minor, and uncinate fasciculus. Analyses included 976 participants

What They Found Each additional hour of daily screen time at T1 (defined as aged 9-10 years old) was associated with a 0.12-point increase in Child Behavior Checklist depressive score at T2 (defined as aged 11-13 years old).  Shorter sleep duration and worse cingulum bundle organization at T2 mediated 36.4% of the association between more screen time and more depressive symptoms.

Wrap It Up Results of this study show that more screen time in late childhood was associated with more depressive symptoms, potentially due to shorter sleep and worse white matter organization during early adolescence.  These findings emphasize the importance of promoting healthy habits and balancing screen time with adequate sleep.

Item #2 Our last one today is called, “Neuroplastic Responses to Chiropractic Care: Broad Impacts on Pain, Mood, Sleep, and Quality of Life” by Haavik et al and published in Brain Science in 2024. 

Haavik, H.; Niazi, I.K.; Amjad, I.; Kumari, N.; Ghani, U.; Ashfaque, M.; Rashid, U.; Navid, M.S.; Kamavuako, E.N.; Pujari, A.N.; et al. Neuroplastic Responses to Chiropractic Care: Broad Impacts on Pain, Mood, Sleep, and Quality of Life. Brain Sci. 2024, 14, 1124. https://doi.org/10.3390/brainsci14111124

What This Study Found: Chiropractic Care and Brain Changes This 2025 research paper looked at how chiropractic care (spinal adjustments) affects the brain, particularly focusing on people with chronic lower back pain. Here’s what they discovered, explained simply:

The Main Question: The researchers wanted to understand how chiropractic care works in the brain. They knew it helped people feel better, but they wanted to see what was actually changing in the brain itself.

What They Did: The study recruited 122 participants with chronic low back pain and gave them chiropractic care approximately three times per week for four week.s They used brain scans (EEG), measured nerve responses, tracked sleep with Fitbit devices, and asked people about their quality of life.

The Big Discovery: The researchers found that chiropractic care changed how a specific brain network called the “Default Mode Network” (DMN) functions. Think of the DMN as the part of your brain that’s active when you’re daydreaming, thinking about yourself, or reflecting on your life. Chronic problems, such as chronic musculoskeletal pain, as well as common chronic disorders such as anxiety and depression have been found to have clear deficits in access, engagement and disengagement of the DMN

Why This Matters: It is thought that when suffering is ongoing long-term the feelings of pain may become part of one’s internal self-story, and, similarly, ongoing worry can develop into anxiety and ongoing sadness can become depression. In other words, chronic pain can literally become part of your identity.

What Improved: After four weeks of chiropractic care, participants showed:

The Bottom Line:

The current findings provide compelling evidence for why chiropractic care, that includes the HVLA adjustments directed towards subluxated segments, can impact not only chronic pain symptoms, but also influence anxiety and depression symptoms.  The study suggests that chiropractic adjustments don’t just help with pain directly—they actually change how your brain processes sensory information and how you think about yourself and your pain, which can break the cycle of chronic pain becoming part of your identity. This research helps explain why some people with chronic pain find relief through chiropractic care and why that relief extends beyond just physical symptoms to include mental health improvements.

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 Neuroplastic Responses to Chiropractic Care & Screen Time And Depression appeared first on Chiropractic Forward.

CF 376: Acupuncture For Chronic Low Back & Spinal Manipulative Therapy For Acute Neck Pain Today we’re going to talk about Acupuncture For Chronic Low Back & Spinal Manipulative Therapy For Acute Neck Pain 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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 12-er. 

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 me and we’re learning together. 

You have found yourself smack dab in the middle of Episode #376. Can you believe I’ve done 376 episodes of this podcast?/ That’s weird to think. Doing 376 reps of anything is a lot. Much less something like this. I’m in the 8th year of doing this. Weird.  Now if you missed last week’s episode, we talked about Neural Mobilization & Cannabis And Heart Attacks And Strokes.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

As part of the Kinas Shockwave purchase, a staff member and I are headed to Atlanta this weekend for the shockwave masterclass where we will learn master level shockwave. Or at least that is what the name implies! Which is awesome because I get to learn from one of my fellow Mastermind members and friends, Dr. David Rudnick out of Boynton Beach, FL which is basically Boca Raton. David is the man and I’m looking forward to learning from him.

He and Dr. Ben Fergus from Evanston, Illinois (Chicago) are the Shockwave masters and both are in my Mastermind. Which is incredibly handy.  I’ve said it before but it stands repeating that any time you can get into a room where you are not the smartest or most capable, that is a room you desperately want to be in. That is definitely the case with my Mastermind group. 

Now, let’s talk about business. It’s coming back and coming back strong. We just had to get out of Summer and the travel season that comes with the Summer. Getting everyone back on a schedule has made all the difference in the world.  Another thing is that we recently had a local chiro suffer a stroke. From what I hear, he is able and capable, but unable to speak or communicate efficiently or effectively. So at 72, he’s had to call it quits and retire. 

While unfortunate and terrible, it means that many of his patients have somehow found their way here to our clinic. So we had a big number of new patients last week and continuing into this week and most of them are from that clinic.  So, it’s been a plus for our clinic for sure but nothing to celebrate. This chiro was an excellent person and, from all indicators, a great chiro whose patients really loved.  Now the challenge here is that we need to figure out how to blend with these new ones.

Imagine going to a brand new chiro when you’ve been going to the same one for years and years. That’s a difficult thing.  So, it’s clear I’m different so I have to make sure I explain at length why they might hear something different from me vs. their old chiro without bashing their old chiro. It’s OK to say something like, “‘While I agree with Dr. So and so on this, I can tell you that just in the last few years, research has started suggesting this on this issue over here.” Or something similar. So they know you’re on top of your crapola but you’re not trashing the other or throwing them under the bus.  That’s important. They need to know you’re sensitive to them having to come see you and they need to know that you really appreciate them being here and you’d like for them to become a part of your practice. 

I also tell them what Clinical Compass tells us on their treatment schedule but, remember, they’ve been going to the chiro a long time. They have their schedule and their routine. So you can commonly hear me say, “Clinical Compass suggests starting at twice per week for a month but you’ve been going for a while and you know what works for you so use me how you would like and I’ll see you on your next visit.”

Pretty simple but delicate too 

That’s the dance we’ve been doing lately. OK, here is this week’s research. 

Item #1 Our first one this week is called, “Acupuncture for Chronic Low Back Pain in Older Adults: A Randomized Clinical Trial” by DeBar et al and published in JAMA Open on September 12, 2025. Hell yeah it’s hot! Remember, the citations can be found at chiropracticforward.com under this episode. 

DeBar LL, Wellman RD, Justice M, et al. Acupuncture for Chronic Low Back Pain in Older Adults: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(9):e2531348. doi:10.1001/jamanetworkopen.2025.31348

Why They Did It To determine the effectiveness of standard acupuncture (SA) or standard acupuncture plus maintenance (enhanced acupuncture [EA]) to improve CLBP-related disability relative to usual medical care (UMC) at 3, 6, and 12 months after randomization.

How They Did It This multisite, 3-arm, parallel-group randomized clinical trial of older adults with CLBP collected data from 4 US health care systems in 3 geographic areas and compared SA and enhanced acupuncture treatment with UMC only.  Both standard acupuncture, which was 8-15 treatment sessions over 12 weeks plus UMC,  and enhanced acupuncture, whiich was standard acupuncture plus 4-6 maintenance sessions during the next 12 weeks, were provided  Participants were randomized to the 3 groups. The primary outcome was CLBP-related disability measured by a baseline-to-6-month change in the Roland-Morris Disability Questionnaire (RMDQ) score. 

What They Found The trial identified 800 individuals who were randomized to 3 groups  At 6 months, RMDQ change scores were significantly better in both the SA and EA groups compared with the UMC only group  SA and EA change scores did not differ significantly from one another.  Benefits were still present at 12 months.  Pain intensity exhibited a relative benefit of EA over SA at 6 months, and both acupuncture groups had significant improvement over UMC. 

Wrap It Up The findings of this randomized clinical trial of older adults with CLBP suggest that acupuncture needling provided greater improvements in back pain–related disability at 6 months and at 12 months compared with UMC alone. 

Item #2 Our second one today is called, “Efficacy and safety of spinal manipulative therapy in the management of acute neck pain: a systematic review and meta‐analysis” by Diao et al and published in BMC on May 1, 2025 and that’s a steamy plate of goodness. 

Diao Y, Liu Y, Pan J, Chen J, Pan J, Liao M, Liu H, Liao L. Efficacy and safety of spinal manipulative therapy in the management of acute neck pain: a systematic review and meta-analysis. Syst Rev. 2025 May 1;14(1):97. doi: 10.1186/s13643-025-02855-7. PMID: 40312450; PMCID: PMC12044948.

Why They Did It This study aims to comprehensively evaluate the efficacy and safety of SMT in the treatment of acute neck pain.

How They Did It A thorough search was conducted in PubMed, Embase, Web of Science, PEDro, and Cochrane Library databases, covering all studies from inception to March 20, 2023.  Mean differences (MD) with 95% confidence intervals (CIs) were calculated to assess outcomes such as pain intensity, cervical range of motion, and disability.  The PEDro Scale and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were utilized to evaluate the methodological quality and strength of evidence.

What They Found Eight randomized controlled trials (RCTs) with 965 patients were included.  Their PEDro scores ranged from 4-9.  Forest plot analysis showed SMT was better than the control in reducing pain and improving cervical range of motion in all measured aspects.  It also significantly reduced disability scores.  No serious adverse events were reported.

Wrap It Up The evidence supports the use of SMT as an effective and safe intervention for reducing pain, improving cervical range of motion, and decreasing disability in patients with acute neck pain.  These findings provide valuable insights for clinical practitioners and highlight the potential of SMT as a viable therapeutic option in managing acute neck pain.

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 Acupuncture For Chronic Low Back & Spinal Manipulative Therapy For Acute Neck Pain appeared first on Chiropractic Forward.

CF 375: Neural Mobilization & Cannabis And Heart Attacks And Strokes Today we’re going to talk about Neural Mobilization & Cannabis And Heart Attacks And Strokes 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 #375 Now if you missed last week’s episode, we talked about Non-surgical Disc Treatment & Cognitive Functional Therapy.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, now that school’s back in and people are getting back on a schedule, I am starting to see patients returning. Which is quite a relief. I was starting to wonder if I pissed on the mayor’s dog or something and made the whole town mad at me. It’s been slow all summer long and that’s no fun.  While this week is still slower than I like to see, the new patients are well on the rise. I think I have 18 new patients this week and that’s A-OK with me.  Especially when you factor in that we have what is called the Tri-State Fair going on here. It’s a week long thing and people will literally take out small loans to take their family to this thing. Which is something we don’t really understand but, yeah, it’s a real thing.  The fair typically slows us down but this year, we’re on the rise while the fair is happening and that’s even better news. 

Our intern from Parker is doign great. She’s really smart, very professional, and seems to be learning a ton. She asks great questions and seems pretty happy with her experience. Which is great. We don’t get a ton of interns here in Amarillo so it’s nice to have an extra set of hands around the clinic. Especially and extra set of hands that we enjoy having around. She’s been great.  Still getting goign with the launch of Shockwave here in the clinic. Still introducing it to our patients and so far, they love it. As an old college football player myself, I’m using it as well. Both shoulders and low back to start with. Once I get them in shape, we’ll move to the knees and a hammy. Hey if you pay for something, you might as well be engaging in some healthcare too. That’s just another tip from your Ol’ Uncle Jeffro.  Before we get to the research I’ll leave you with this. Go Cowboys!

Item #1 The first on etoday is called, “Neural mobilisation effects in nerve function and nerve structure of patients with peripheral neuropathic pain: A systematic review with meta-analysis”’ by Bittencourt et al and published in PLOS One on November 8, 2024 and it’s a lil bit smoky.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Neural mobilisation effects in nerve function and nerve structure of patients with peripheral neuropathic pain: A systematic review with meta-analysis

Why They Did It

To assess the effects of neural mobilisation on nerve function and nerve structure of patients with peripheral neuropathic pain.

How They Did It

A systematic review with meta-analysis was conducted.  Eligibility criteria included controlled trials or quasi-experimental studies comparing neural mobilisation versus sham, active or inactive control in adults with peripheral neuropathic pain.  Primary outcomes were the change in peripheral nerve cross-sectional area.  Secondary outcomes included nerve echogenicity, nerve excursion and nerve conduction. 

What They Found

Eleven randomised controlled trials and four quasi-experimental studies (total sample = 722 participants) were included.  Thirteen studies included participants with carpal tunnel syndrome.  Two studies examined the cross-sectional area, revealing improvements (i.e., a reduction) in the cross-sectional area after the neural mobilisation.  Neural mobilisation improved motor and sensory conduction velocity in short-term, compared to control.  Neural mobilisation did not alter distal motor or sensory latency.

Wrap It Up

Neural mobilisation seems to improve the cross-sectional area and sensory conduction velocity.  Neural mobilisation was superior to control in improving motor conduction velocity in patients with peripheral neuropathic pain with moderate quality evidence.  Distal motor or sensory latency presented similar results compared to other interventions.  Our findings should be interpreted cautiously since most studies included patients with carpal tunnel syndrome.

Item #2

Here we go….Ol Uncle Jeffo is being uncool again and trying to tell people what to do with their recreational drug habits. I’m not trying to tell you what to do. I’m not your real mom.  But if you’re going to do it, at least know the real risks and not what your bud dealer Ernie told you about the safety.  Yes, I know alcohol is worse and all the other pro-weed arguments. I get it. We actually tried outlawing alcohol in the 30’s because it’s so bad. I get it. But just because alcohol is legal does not mean weed is good, safe, and smart for legalization. Why make two things legal when you don’t have to? Keep it for medical use without abusing the term and disrespecting those that actually need it for medical use. Hell yeah, Francis.

But don’t legalize it. It’s ridiculous.  With my total uncoolness now being on full display, the last one today is an online article called, “Cannabis use raises risk of heart attack and stroke more than cocaine, other drugs, major review suggests Marijuana users may face twice the risk of cardiovascular death, research finds” by Angelica Stabile with Fox News and posted June 19, 2025 and aye carumba!!! Es muy caliente!!

https://www.foxnews.com/health/cannabis-use-raises-risk-heart-attack-stroke-more-than-cocaine-other-drugs-major-review-suggests

Here it is summarized in a nutshell: A major new study has found some concerning links between marijuana (cannabis) use and heart problems. Here’s what the research shows in simple terms:

The Big Study: French researchers looked data from over 400 million patients across 24 different studies to see how cannabis affects heart health. It was a “meta-analysis,” so it’s no small thing.

The Scary Numbers: The study found cannabis users had a 29% higher chance of heart attacks, 20% higher risk of strokes, and twice the risk of dying from heart problems The risks were especially high for people who used cannabis at least once a week.

More Dangerous Than Expected:  Surprisingly, one study found cannabis was a bigger predictor of heart attacks than other illegal drugs like cocaine and opioids This challenges what many people assume about cannabis being “safer.”

Young People at Risk:  The dangers weren’t just for older adults either. Several studies found higher risks for younger people, including those aged 15-22 and 18-36 Women appeared to face higher risks than men.

Why This Matters:  As more states legalize marijuana and more people (including seniors) use it, doctors are seeing more emergency room visits related to cannabis.  A medical expert compared marijuana’s effects on the heart and lungs to cigarette smoking.

The Bottom Line:  While medical marijuana can help some patients with serious conditions, this research suggests regular cannabis use carries real heart risks that many people don’t realize.  The researchers say doctors should ask all heart patients about cannabis use, just like they ask about smoking or drinking.

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 Neural Mobilization & Cannabis And Heart Attacks And Strokes appeared first on Chiropractic Forward.

CF 374: Non-surgical Disc Treatment & Cognitive Functional Therapy Today we’re going to talk about Non-surgical Disc Treatment & Cognitive Functional Therapy But first, here’s that sweet sweet bumper music  

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #374 Now if you missed last week’s episode, we talked about Vertebral Artery Dissection Recognized and Referred By Chiropractor. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

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

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

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

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

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

Why They Did It

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

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

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

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

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

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

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

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

Wrap It Up Cognitive functional therapy may offer clinically relevant benefits for CLBP, although the evidence remains mainly of low to very low certainty.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.   

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic!

Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms.  We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. 

Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.

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 Non-surgical Disc Treatment & Cognitive Functional Therapy appeared first on Chiropractic Forward.

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.

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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    

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