The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

Hey everybody, welcome to episode 390. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward Podcast. This week we’ll cover Manual Therapy Plus Exercise & Multidisciplinary Rehab For Low Back Pain first though, 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!

Welcome back, and thanks for joining me here on the Chiropractic Forward Podcast where we talk about issues related to health, chiropractic, evidence, manipulation, this profession, and the practical application of all of it. It’s a good one today, so stand back — we’ve got some good research to get into.

Before we get rolling, here’s the usual list of things I’d love for you to do.

Go pick up my book on Amazon called The Remarkable Truth About Chiropractic; A Unique Journey Into The Research. It’s a quick, easy read and it’ll help you talk to your patients about the evidence behind what we do.

Go like and follow us on the Facebook page and if you want to be part of the conversation with other evidence-minded docs, jump into our Facebook group.

Please leave us a review on whatever platform you’re listening on. Honest reviews and subscribes are how this show gets in front of more chiropractors, so it really does make a difference.

And of course, head over to chiropracticforward.com for the show notes, the research links, and everything else we’ve got going on.

Last week, on episode 389, we covered PNF Stretching For Knee OA & A 50-Year Review Of Chiropractic Research. If you missed it, you can always go back and catch that one at chiropracticforward.com. You gotta keep up with the class.

Well, I want to start out by apologizing for it being so long since the last episode. I really do want to get back to doing the podcast more regularly. Maybe not every single week like I’ve done for seven or eight years, but at least every two or three weeks. It is something I still enjoy doing, but my time has become more and more limited in recent months.

I would say that part of that has to do with hiring a new associate and two new Nurse Practitioners, and working double time with marketing and planning ideas to get her as busy as possible as quickly as possible.

As if bringing on three new providers is not enough reason, I was also up to my neck in QME, studying and test taking for about six months. It was something I did not want to repeat twice, and the pass – fail rate for the QME test is about 50%, so I wanted to make sure that I only had to do it once. And as luck would have it, I passed the test.

So after getting my California chiropractic license and going through all of the study and prep, I am now a qualified medical evaluator in the California work comp system. What that means is I will be flying out to California from my home base in Amarillo, Texas, about once every four or five weeks to perform impairment rating exams on injured workers. Once I do an impairment rating and write a report, that goes to the disability evaluation unit, and they take my report and impairment rating, plus a lot of other factors, and combine it all in to determine the workers total disability rating, which will also determine how much they get in benefits and for how long and all of that good stuff.

So, as you can see, I’ve been really busy. On top of that, I’m firing my social media company because in the last two or three years of using them, while my YouTube channel has grown, that hasn’t turned into people coming into the office, which is the real reason for marketing, and here in 2026 I’m still not as busy as I was right before Covid hit. Now there are several factors that go into that, like relationships with PI attorneys coming and going, and the VA hiring their own providers and things like that, so it’s not all one factor, like COVID wrecked the practice and it’s just never recovered.

Still, I don’t like going backwards. I like to always move forward. And when I see other chiropractors doing paid ads everywhere and marketing like crazy, and I’m not doing any of that, and the company I’ve hired to market me is not doing any of that, then I think it’s time to make some changes. And in the day and age of AI, all of those things are well within hand if we’ve just got the time to do it. And that’s what I’ve been doing, trying to make better use of the very limited free time that I have.

I have AI walking me through building Facebook ads on my own. I’ve also been building an AI brain that holds all of my clinical information. It’s all HIPAA compliant. There’s no patient names or PHI in the brain, but as far as diagnosis, all of the certifications I’ve had, all of the learning, all of the education, all of it. I’ve built a brain that holds it all and can reference it all.

Think about it. We take courses or classes or go to conferences, and we’re lucky to just have three or four key takeaways. But what if you had a brain that you could load it all into and have access to at any point in the future, just by typing a simple question? That would be worth something, right? Well, that’s what I’ve been busy building. And I’m still building.

So, yeah, between traveling and working and all of this extra stuff on my plate, the podcast has been less frequent than planned. But I’m hoping to get back on it more regularly. And with that being said, let’s hop into the research.

The first one this week is called, “Effectiveness of adding manual therapy to exercise for pain and disability in chronic non-specific low back pain: A systematic review and meta-analysis.” by Dos Santos et al and was published in Musculoskeletal Science Practice in 2026 and that’s hotter that a jalapeno pizza Pedro!

The citation can be found in the show notes at chiropracticforward.com

Citation: Dos Santos ECS, Dos Santos AT, da Silva NA, Carneiro SR, Rampazo ÉP, Magalhães MO. Effectiveness of adding manual therapy to exercise for pain and disability in chronic non-specific low back pain: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2026 Apr;82:103508. doi: 10.1016/j.msksp.2026.103508. Epub 2026 Jan 30.

Why They Did It

Manual therapy and therapeutic exercise are both recommended for chronic non-specific low back pain, but the additional benefit of combining the two is uncertain. The researchers set out to systematically review the effects of adding manual therapy to therapeutic exercise, compared to exercise alone, on pain intensity and functional disability in adults with chronic non-specific low back pain.

How They Did It

This was a systematic review and meta-analysis of randomized controlled trials.

They included adults aged 18 to 65 with chronic non-specific low back pain lasting twelve weeks or longer.

The interventions combined joint-based manual therapy — spinal mobilization and/or manipulation — with therapeutic exercise that involved stretching, strengthening, motor control, and endurance training.

The main outcomes were pain intensity and functional disability at short-, medium-, and long-term follow-up.

What They Found

Five trials with a total of 260 participants were included.

Low-quality evidence indicated no significant short-term pain reduction with manual therapy plus exercise versus exercise alone.

However, moderate-to-low-certainty evidence showed greater improvement in disability with the combined therapy at both short-term and long-term follow-up.

Wrap It Up

The authors concluded that adding manual therapy to therapeutic exercise does not appear to provide a substantial additional short-term improvement in pain intensity compared to exercise alone, but it did produce significant benefits for functional disability in both the short and long term.

And that’s the part I want you to hang onto.

Disability — how well a person can actually function and live their life — is what matters to the patient sitting in front of you.

This is one more piece of evidence supporting the conservative, hands-on, movement-based approach that we do every single day, and it’s a reminder that manual therapy and exercise together are a powerful combination for getting people back to their lives.

The second one today is called, ‘Effectiveness of Multidisciplinary Rehabilitation in Chronic Low Back Pain: A Pragmatic Study With a Waiting List Control Group’ by Van W ingerden et al and published in European Journal of Pain in 2026 and it’s hot like an August Texas Tin Roof people.

Citation: van Wingerden JP, van Opstal T. Effectiveness of Multidisciplinary Rehabilitation in Chronic Low Back Pain: A Pragmatic Study With a Waiting List Control Group. Eur J Pain. 2026 Jan;30(1):e70209. doi: 10.1002/ejp.70209.

Why They Did It

Small-scale care providers often run into a wall when they try to demonstrate that their treatments work through randomized controlled trials, simply because RCTs are so expensive and organizationally demanding. So this group wanted to examine whether they could evaluate a multidisciplinary treatment for chronic low back pain using a waiting list as the control group instead — a more realistic option for a smaller clinic.

How They Did It

Out of 344 chronic pain patients referred to a Dutch outpatient rehabilitation clinic, 123 received treatment while 88 were placed on a waiting list.

Their main effect measures were pain on a visual analogue scale, daily limitations on the Quebec Back Pain Disability Scale, and fear of motion on the Tampa Scale for Kinesiophobia.

Data were collected at the start of treatment, at eight weeks, and at three months for follow-up — or after another eight weeks for the waitlist patients who received treatment after their waiting period.

What They Found

The intervention group showed significant, persistent improvement in pain, in daily limitations, and in fear of motion.

Then 51 of the subjects from the waiting list went on to receive treatment, and their results were similar to those of the original intervention group.

On top of that, dysfunctional pain-coping strategies diminished during therapy.

Wrap It Up

The bottom line is that multidisciplinary rehabilitation was clearly more effective than simply being parked on a waiting list — even when those waitlisted folks were receiving other treatments while they cooled their jets.

The authors also made the point that small-scale, high-quality effect studies using a waiting list control have real scientific potential.

For those of us in conservative care, there are two takeaways here.

First, active, multidisciplinary rehab beats doing nothing or just waiting around, and that lines up with everything we preach about getting people moving. Hurt doesn’t mean harm. If you wait to feel better to move, you’re in trouble, homie.

And second, you don’t have to be a giant research institution to produce meaningful evidence — smaller clinics can and should be contributing to the body of research that supports what we do.

So there you have it. Two papers this week, both pointing in the same direction: keep people active, combine smart hands-on care with exercise, and don’t leave them sitting on a waiting list.

That’s conservative care, and that’s our corner of the world.

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. 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.

Head to the store at chiropracticforward.com for evidence-informed brochures and posters to help educate your patients and your community.

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

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk versus reward profile when it comes to non-complicated musculoskeletal complaints. Chiropractic care, when it’s at its best, tends to be safe, more cost-effective, and at least as effective — if not more so — than a lot of the other options out there. And when patients get good, evidence-based chiropractic care first, a lot of them never have to go down the road of unnecessary imaging, dependency-forming medications, spinal injections, or surgeries. Going to a evidence-based chiropractor first is the right move.

Send us an email at dr dot williams at chiropracticforward.com. Feedback and constructive criticism is a blessing, and so are subscribes and excellent reviews. It really does make a big difference.

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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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 Manual Therapy Plus Exercise & Multidisciplinary Rehab For Low Back Pain appeared first on Chiropractic Forward.

Today we’re going to talk about PNF Stretching For Knee OA And A 50-Year Review Of Chiropractic Research. 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, judgmental, 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.

You have found yourself smack dab in the middle of Episode #389.

Now if you missed our last episode, we talked about Shockwave Therapy for Hamstring Injuries and Vitamin D for Respiratory Infections. Make sure you don’t miss that info. Keep up with the class.

Sorry, it’s been a week or two since the last podcast episode. I have been traveling a little bit. I just got back from Tampa, Florida, and my mastermind meeting with Dr. Kevin Christie.

We had a great time out there. I just can’t explain to you how proud I am of that group that I’m a part of. It really does have some of the best minds and most talented individuals in the entire profession. I count myself as very fortunate for being asked to be a part of it.

One of my colleagues is Vanessa Wilczak from Jacksonville, Florida. She and I have really buried ourselves in AI, and we have made a pretty effective team with regard to coming up with some pretty cool stuff that AI can do to help us in business.

Vanessa recently took that a step further and has really created something very, very interesting. She figured out a way to make Claude work with a permanent storage or brain, if you will, so that when you are talking to Claude, it can reference and remember exactly what you’ve trained on it at all times.

So, if you consider that you can train it on all of your office stats, all of your provider contracts and pay scales. All your fee schedules. Every statter, every report that you can think of that you can run through your EHR. And everything else that you have on your computer that’s relevant, then you sort of have a chief operating officer or chief financial officer or a CEO or whatever you want to call it. that has all of the financials and all of the information it could ever possibly need to help you make decisions going forward.

That includes KPIs, or seeing gaps and opportunities that you wouldn’t normally see.

For example, I was able to have a conversation with our new provider today that included very precise facts and figures that I wouldn’t have had… access to… Just two days ago. I was also able to give her very realistic and conservative. Ideas about patient numbers and potential income in the next year, and in the next two years. Then I was able to have… an effective conversation with our front desk about… some of our stats and how we can easily improve them.

The potential is absolutely and 100% limitless when AI remembers what you have trained it on and can reference it at any point in any conversation you’re having. I’m training it on the medical side of things, too, for peptides, and IV therapy, and PRP on the research, and all of that good stuff.

So it’s basically going to be one big, huge brain. for my clinic. And I could not be more excited. Vanessa really knocked it out of the park on this. So that’s why I’ve been busy, but I felt like it had been long enough since I had put out an episode.

 So we’re gonna throw this one together fairly quickly. I hope you don’t mind, but there’s a really great paper in this episode that you’ve just got to hear about. So don’t go anywhere.

Let’s hop into the research.

Alright, let’s jump into our first paper this week and it’s a good one for those of you treating knee pain — which I’m guessing is about 100% of you listening. This one is titled…

“Effect of Proprioceptive Neuromuscular Facilitation on Pain and Joint Mobility in Knee Osteoarthritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials”

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

Hu Z, Dong J, Zeng Y, He Z, Wang Q, Luo Q. Effect of proprioceptive neuromuscular facilitation on pain and joint mobility in knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. PeerJ. 2026 Jan 16;20581. DOI: 10.7717/peerj.20581. PMID: 41561818.

Knee osteoarthritis is one of the most common and debilitating conditions we see — pain, stiffness, loss of mobility, and that slow grinding decline in quality of life. Standard medical management tends to lean on pain medications, cortisone injections, and eventually surgery. In this they explore some conservative means.

These researchers wanted to find out whether Proprioceptive Neuromuscular Facilitation — PNF — could make a meaningful difference in pain and knee range of motion for people with knee OA.

Now if you’re not super familiar with PNF, it’s a rehabilitation technique that combines passive stretching with active muscle contractions to improve flexibility, strength, and motor control.

Compared to control interventions, PNF showed significantly greater improvements in pain reduction. And it significantly improved knee active range of. Highly significant results on both fronts.

When they compared PNF qualitatively against other rehab techniques — soft tissue mobilization, neuromuscular exercise, and stretching — results were more mixed.

Not clearly better across the board, but not worse either. The strongest, most consistent signal was PNF versus no real intervention, and there it was a clear win.

PNF is a conservative technique producing significant reductions in pain and real improvements in joint mobility for knee osteoarthritis patients.

Move the patient. Restore function. Reduce pain without putting something into their body or cutting them open. Sounds good to me, what about you?/

Alright, paper number two is one I have been waiting to talk about because it is a direct shot of espresso for your chiropractic soul. This one comes to us from a group out of Duke University School of Medicine — yeah, you heard that right — Duke — and it’s titled…

“Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations”

Remember, the citations can be found at chiropracticforward.com under this episode and yes, one of our previous guests on the podcast is the esteemed Dr. Christine Goertz who we simply adore.

Trager RJ, Bejarano G, Perfecto RP, Blackwood ER, Goertz CM. Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. J Clin Med. 2024 Sep 24;13(19):5668. DOI: 10.3390/jcm13195668. PMCID: PMC11476883.

Ninety percent for low back pain. One hundred percent for neck pain. I need you to sit with that for a second. Let that percolate, people.

These are not numbers coming from a chiropractic trade publication. These are clinical practice guidelines — the formal, rigorous documents that major medical and healthcare organizations use to tell clinicians how to treat patients. And they are saying: use spinal manipulation.

This paper is a gift. Print it out. Laminate it. Put it in your waiting room. When someone asks you — a patient, a skeptical physician, an insurance reviewer — whether there’s evidence for what you do, you hand them this.

Over 50 years of growing, maturing, increasingly rigorous research culminating in guideline after guideline saying that spinal manipulation works for the spine-related disorders that walk through our doors every single day.

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.

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!

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!

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.

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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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 PNF Stretching For Knee OA & A 50-Year Review Of Chiropractic Research appeared first on Chiropractic Forward.

CF Ep. 388 – Shockwave Therapy for Hamstring Injuries and Vitamin D for Respiratory Infections

Today we’re going to talk about Shockwave Therapy for Hamstring Injuries and Vitamin D for Respiratory Infections.

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!

Welcome Back

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, judgmental, 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.

Things You Should Do

Go to Amazon and BUY my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. Easy to understand and easy to support everything you do. It’s on Amazon.

Like our Chiropractic Forward Facebook page.

Join our private Chiropractic Forward Facebook group.

Review our podcast on whatever platform you’re listening on — it really does make a big difference.

And then check our website at chiropracticforward.com

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Episode Number + Previous Episode Recap

You have found yourself smack dab in the middle of Episode #388.

Make sure you don’t miss that info. Keep up with the class.

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Personal Happenings

I would have to say that 2026 is really shaping up for us. I know that I’m still not back to pre-Covid numbers. However, it’s pretty standard for me to see 145 to 165 each week now.

If you’ve been a long time listener, then you may recall the days when I was seeing 180 and even sometimes 200 in a week. So we are far from those numbers currently. And I’m kind ok with that. I did not like being that rushed and that busy. It made my life fairly miserable to be honest.

However, with our new chiropractor, Dr. Easter, on board I bet we’ll see those sorts of numbers combined soon. I am impressed every single day with her and have zero doubt that her schedule will be busting at the seams before you know it.

A friend of mine is Dr. Mark King, president of motion palpation Institute, and he happens to be in my mastermind group you always hear me talk about. I believe he has somewhere between five and seven associates so I guess he’s got it figured out.

But what he said at the last mastermind meeting was that you need to be trying to give your associate somewhere around 15 new patients a month that you would personally have taken. You have to feed them to get them where they are really kicking butt and taking names and putting some money in their pockets right along with bringing patients and revenue to the clinic as well.

With credentialing and all the things involved in that, I’m not able to shift that many her way just yet. However, that is definitely the plan when we were able and strictly on sending her cash new patients and her being able to start to cultivate her own patience here and there, we already have her up to about 25 a week or so sometimes more sometimes less.

When you consider, she’s only had her license for a little over a month maybe two months, I think we’re in a good spot.

Outside of that I have been studying for the California QME exam coming up next week and hopefully we knock that sucker straight out of the park into the windshields of the cars parked in the parking lot.

And we can get well on our way performing QME‘s and building that revenue stream. QME is my path out of day today hands-on patient treatment. I’ll be 54 in August and if I can get down to just a day or 2 x 56. I’m gonna be a happy dude.

OK, that’s it. Let’s get on with the research.

 Item #1 – Radial Shockwave Therapy + Rehab for Acute Hamstring Injuries

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

Citation:

Crupnik J, Silveti S, Wajnstein N, Rolon A, Wuerfel T, Stiller P, Morral A, Furia JP, Maffulli N, Schmitz C. Radial ESWT combined with a specific rehabilitation program (rESWT+RP) is more effective than sham rESWT+RP for acute hamstring muscle complex injury type 3b: a randomized, controlled trial. British Medical Bulletin. 2025 Sep 2;155(1):ldaf009. DOI: 10.1093/bmb/ldaf009.

Why They Did It

Hamstring injuries are an absolute plague in sports. They’re one of the most common soft tissue injuries across virtually every athletic discipline — soccer, track and field, sprinting sports, you name it.

The specific type we’re dealing with in this study is a type 3b injury, which is what the Munich Muscle Injury Classification calls a bundle or interfascicular tear — a structural, partial tear of the muscle, not just a minor strain.

These are the ones that knock athletes out for weeks, and they carry a high re-injury rate.

Conservative rehab is the standard treatment, but outcomes are often frustratingly slow, and there’s a real clinical need for adjunct therapies that can accelerate tissue recovery.

Shock wave therapy has shown some promising signals in muscle healing, but at the time this trial was being designed, the evidence was thin. These researchers set out to test whether adding radial ESWT to a structured rehab program could meaningfully change the game for athletes recovering from these serious hamstring tears.

How They Did It

This was a prospective, randomized, double-blind, sham-controlled single-center trial conducted at the KinEf Sports Physiotherapy Center in Buenos Aires, Argentina.

40 semi-professional athletes with ultrasound-confirmed acute type 3b hamstring complex injuries who presented within 7 days of the injury.

The athletes were randomized into two groups: the active treatment group received real radial ESWT combined with an 8-week structured rehabilitation program; the control group received sham rESWT

Both patients and the assessors measuring outcomes were blinded to treatment assignment.

The rESWT protocol consisted of nine sessions over three weeks — three sessions per week — with 2,500 radial shock waves per session at an energy density the patient could tolerate.

The primary outcome was return-to-sport time.

Secondary outcomes included post-treatment muscle strength, patient satisfaction, and re-injury rate.

After the trial concluded, a small number of participants had their ultrasound images re-reviewed and 4 of the original 40 were re-classified as type 3a injuries and excluded — leaving a final analysis population of 36 athletes, 18 per group.

What They Found

The results clearly favored the group that received real rESWT.

The athletes who received actual shock wave therapy combined with the rehabilitation program returned to sport significantly faster than those who received sham treatment plus the same rehab.

Beyond faster return-to-sport, the rESWT group also showed superior post-treatment muscle strength and higher patient satisfaction scores.

Re-injury rates were not significantly different between groups, though the sample size was modest.

Wrap It Up

Hamstring injuries are one of the most common and one of the most aggravating injuries that active patients and athletes deal with. Return to sport after a significant type 3b hamstring tear can take weeks, and the re-injury risk hangs over the athlete’s entire return.

What this trial tells us is that we have a non-invasive, drug-free adjunct therapy — radial shock wave— that, when combined with a well-structured rehabilitation program, can meaningfully reduce recovery time and improve functional outcomes compared to rehab alone.

This is important for those of us in the chiropractic and conservative care space. ESWT is a tool that fits squarely within evidence-based conservative management. No surgery. No injections. No drugs.

Just targeted mechanical energy to the injured tissue to accelerate natural healing, combined with a progressive rehabilitation protocol. That is exactly the kind of multi-modal conservative approach that gets real results and that we should be able to offer our patients.

Now, is this a massive trial? No — 36 athletes at a single center. But it’s randomized, it’s double-blind with a sham control, it’s published in the British Medical Bulletin — a well-respected peer-reviewed journal — and the findings are clinically meaningful.

Add this to the growing body of evidence that says ESWT has legitimate utility in musculoskeletal care. If you’re working with athletes or active patients dealing with hamstring injuries, this is absolutely worth having in your clinical back pocket.

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Item #2 – Severe Vitamin D Deficiency Linked to Higher Hospitalizations for Respiratory Tract Infections

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

Citation:

Bournot AR, Hart KH, Johnsen S, Givens DI, Lovegrove JA, Ordóñez-Mena JM, de Lusignan S, Bartlett DB, Lanham-New SA, Darling AL. Association between serum 25-hydroxyvitamin D status and respiratory tract infections requiring hospital admission: unmatched case-control analysis of ethnic groups from the United Kingdom Biobank cohort. The American Journal of Clinical Nutrition. 2025. DOI: 10.1016/j.ajcnut.2025.101179.

Why They Did It

Respiratory tract infections — bronchitis, pneumonia, and their relatives — are a massive public health burden. Lower respiratory tract infections rank in the top 20 causes of death globally for people aged 50 to 74. For those 75 and older, they crack the top 10.

We’ve known for a while that vitamin D has a role in immune function — it has documented antibacterial and antiviral properties. There’s been growing evidence that vitamin D deficiency may increase susceptibility to respiratory infections.

But what was missing was hard, large-scale population data specifically tying vitamin D levels to actual HOSPITALIZATIONS for respiratory infections.

This team out of the University of Surrey — working with colleagues from the University of Reading and Oxford — set out to fill that gap using one of the largest health databases in the world.

How They Did It

This was the largest study of its kind.

The researchers analyzed NHS data from the UK Biobank — a massive cohort study with linked health records.

They looked at 36,258 participants between the ages of 40 and 69.

Vitamin D levels were measured via blood samples and cross-referenced against linked NHS hospital admission records for respiratory tract infections.

Participants were categorized into vitamin D status tiers, with severe deficiency defined as below 15 nanomoles per liter, and sufficient levels defined as 75 nmol/L or above.

They used survival analyses and binary logistic regression models to determine the relationship between vitamin D status and the rate of hospitalization.

The analysis accounted for confounders including age, sex, BMI, lifestyle factors, socioeconomic status, and existing health conditions.

What They Found

Here’s the headline: people with severe vitamin D were 33 percent more likely to be hospitalized for a respiratory tract infection compared to those with sufficient levels.

That’s a significant, clinically meaningful finding backed by a dataset of over 36,000 people.

And the dose-response relationship is interesting. And basically the better your Vitamin D levels, the lower your risk of being hospitalized.

The researchers also examined whether ethnicity modified this relationship, since vitamin D levels vary across ethnic groups — white participants had higher median levels, while Asian participants had lower.

Despite those baseline differences, the association between deficiency and hospitalization risk was consistent across all ethnic groups.

The risk of being severely deficient, however, falls disproportionately on ethnic minority communities, which is a public health equity issue worth flagging.

Additional risk factors tied to higher hospitalization included obesity, male sex, being over 60, lower income, and statin use.

Wrap It Up

We know from the research that vitamin D deficiency is extremely common. Estimates suggest up to a billion people worldwide are deficient. A BILLION. And here we have one of the largest population studies ever conducted on this topic showing that severe deficiency is directly and significantly associated with a higher rate of landing in the hospital with a respiratory infection.

This matters for us as practitioners in integrative, whole-person care. We are not just treating spines — we are caring for people. If your patients are walking around with severe vitamin D deficiency, you have an opportunity to identify that and address it.

Especially your older patients, your patients with chronic conditions, those who work indoors

The recommendation to supplement — particularly in winter months when sunlight exposure is limited — is well-supported and straightforward.

It’s safe. It’s cheap. It’s widely available. And the data suggests it may be keeping your patients out of the hospital.

That kind of simple, evidence-based preventive intervention is exactly the kind of whole-person care we should be championing. Test your patients’ vitamin D. Talk to them about supplementation. It matters.

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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 & Social Media Links

https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP: https://www.facebook.com/groups/1938461399501889/

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iTunes: https://itunes.apple.com/us/podcast/chiropractic-forward-podcast-chiropractors-practicing/id1331554445?mt=2

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TuneIn: https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Prp1089415/

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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

The post Shockwave Therapy for Hamstring Injuries and Vitamin D for Respiratory Infections appeared first on Chiropractic Forward.

────────────────────────────────────────────────────────────

INTRO

Today we’re going to talk about Water Instead of Diet Drinks & Neuromobilization In The Chronic Neck

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!

WELCOME BACK

Hello, everybody. Welcome back to the Chiropractic Forward Podcast. I’m Dr. Jeff Williams, and I’m glad you’re spending a few minutes of your day with me. This is the podcast where we don’t just talk about chiropractic — we build the case for it, one piece of research at a time. Evidence-based, patient-centered, and unapologetically.

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THINGS TO DO

Real quick — just a few things I’d love for you to do:

Number one — if you haven’t already, grab a copy of my book on Amazon. It’s a great resource and it helps support the show.

Number two — come join us on Facebook. Find our page and our group and be part of the conversation.

Number three — and this one I’ll come back to in a minute — please take a moment to leave us a review on whatever podcast platform you’re using. It genuinely helps.

And number four — visit chiropracticforward.com for more content, resources, and information about what we do.

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EPISODE RECAP

This is Episode #387. Last week, in Episode #386, we talked about Exercise & Nutrition In Low Back Pain & Migraine In Chiropractic Patients. If you haven’t had a chance to listen to that one yet, go back and check it out.

Good stuff. You gotta keep up with the class!

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PERSONAL HAPPENINGS

Alright, let’s talk a little bit about life around here before we get into the research.

I’ve been listening to a new podcast lately that I’m really enjoying — it’s called Dan Snow’s History Hit. Currently I’m working through episodes about military commanders, and they’ve been covering Erwin Rommel. And I have to tell you — I’ve been fascinated by Rommel since I was a kid. I remember watching some documentary when I was young, and they called him the Desert Fox — and I mean, come on. That’s an incredible nickname. Obviously, as a kid you don’t fully grasp the horrors of what the Nazis represented, but you figure that out pretty quickly as you get older. Even so, Rommel as a military figure has always been a genuinely interesting study to me. If you’re into military history at all, check out Dan Snow’s History Hit. Good podcast.

Speaking of podcasts, I would really appreciate it if you would take a minute to review and share this podcast with colleagues you think would benefit from it.

Look, I’ll be honest with you — we spent some time on cruise control, just recording episodes and letting them ride. And that’s fine, but I really want to see growth and real traction here. I want to get to the point where, when somebody asks for a chiropractic podcast recommendation, there are fifteen people immediately pointing to this one.

I’m biased, obviously — but I genuinely believe that evidence-based, patient-centered information is the best thing we can do for our profession and for our communities. Anything that reduces the noise and elevates the people doing it right is good for everyone. So I’d appreciate your help spreading the word.

In other news — I am deep in study mode right now. I’m preparing to take the Qualified Medical Evaluator examination out in California. That test is in April, and I hear they run about a fifty-fifty pass-fail ratio — which is honestly pretty humbling. I do not plan on being on the fail side of that equation, so I am busting my hump to make sure I’m well prepared.

I’ll tell you though — when you’re 53 and you’ve got everything going on in your life that I have going on, sitting down to study isn’t always the easiest thing in the world.

But the tools available now versus when I was in school are just incredible. One thing that’s really helping me is an app called Brainscape. Essentially it’s a flashcard system, but the smart part is that it has you rate how well you know each card — and the cards you don’t know very well keep coming back more frequently until you rate them higher.

That’s a genuinely smart design. There’s also a website called Stuvia that has practice tests and learning materials that have been helpful. Add in a prep class on top of all of that, and I feel like I’m going in well-prepared. But as I always say — we shall see.

And one more piece of good news from the clinic. Our acupuncturist’s husband got a job offer in Missouri, so she and her family will be relocating in May. That’s bittersweet — we love her — but here’s the stroke of luck: our brand new associate, fresh out of chiropractic school, was already interested in learning acupuncture. She’s going through the certification process right now and has her test in April. If all goes well, she’ll be ready to step right in line as soon as our current acupuncturist leaves.

That means she’ll essentially be paying for herself almost immediately, once she takes over the VA acupuncture patients and our regular acupuncture caseload. I like to say even a broken clock is right twice a day — and sometimes God just smiles down on his people. This one felt a little like both.

Alright. Let’s get into the research.

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ITEM #1

The First one today is called, “Effects of Replacing Diet Beverages with Water on Sustained Weight Loss and Type 2 Diabetes Remission — An 18-Month Randomized Clinical Trial” by Farshci et al and was presented at the 85th Scientific Session of American Diabetes Associaiton in Chicago in 2025 and it’s a hot one, stand back

Remember the citations are in the show notes in this episode.

Citation

Farshchi, M., Madjd, A., & Farshchi, H.R. (2025). Effects of Replacing Diet Beverages with Water on Sustained Weight Loss and Type 2 Diabetes Remission — An 18-Month Randomized Clinical Trial. Presented at the 85th Scientific Sessions of the American Diabetes Association, Chicago, IL. Abstract 586-P. Published in Diabetes, 74(Supplement 1).

Why They Did It

About one in five Americans drinks a diet beverage every single day. And for a long time, the conventional wisdom was that diet sodas were a safe substitute for full-sugar drinks — especially for people trying to manage their weight or their blood sugar. After all, they’re calorie-free, right?

Well, some emerging research started suggesting that diet beverages might be affecting the body differently than water, and that maybe the “free pass” thinking wasn’t as solid as we assumed.

So these researchers set out to do something no one had done before in this specific population: a long-term, randomized clinical trial looking at what happens when women with type 2 diabetes actually replace their diet drinks with water — and track those results over 18 months.

How They Did It

What They Found

Wrap It Up

The researchers concluded that sustained replacement of diet beverages with water after meals in women with type 2 diabetes may promote greater weight reduction and offer meaningful benefits in glycemic control and long-term diabetes remission.

And look — this is important information for us as chiropractors and conservative care providers. We deal with patients every single day who are managing metabolic conditions, carrying extra weight, dealing with inflammation.

Diet and lifestyle are always part of that conversation. And what this study is telling us is that the advice is almost embarrassingly simple: drink water.

Not a diet soda. Not a zero-calorie something. Water.

A small change with potentially enormous consequences for long-term health. That’s the kind of practical, evidence-based lifestyle counseling we can offer our patients every day without a prescription pad.

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ITEM #2

The second one today is called ‘Routine Physical Therapy With and Without Neural Mobilization in Chronic Musculoskeletal Neck Disorder with Nerve-Related Symptoms: Systematic Review and Meta-Analysis’.

And you know, if they’d have just tried a little harder, I feel they could have made that title just a scootch longer if we’re being honest. This one was doen by Lopez-Pardo et al in 2024.

Citation

López-Pardo, M.J., Calvache-Mateo, A., Martín-Núñez, J., Heredia-Ciuró, A., López-López, L., Valenza, M.C., & Cabrera-Martos, I. (2024). Routine Physical Therapy with and without Neural Mobilization in Chronic Musculoskeletal Neck Disorders with Nerve-Related Symptoms: Systematic Review and Meta-Analysis. Healthcare, 12(12), 1225. https://doi.org/10.3390/healthcare12121225

Why They Did It

How They Did It

What They Found

Wrap It Up

So what do we take away from this? The authors concluded that adding neural mobilization to routine physical therapy is a clinically meaningful upgrade over minimal intervention for patients dealing with chronic neck conditions and nerve-related symptoms.

The treatment approach is showing genuine benefit for pain relief and disability reduction. And for us in the chiropractic world, this is validating.

Neural mobilization techniques — neurodynamic work — are conservative, manual-based interventions that fit squarely in what we do and I use it and recommend it daily in our clinic.

Patients with chronic neck pain and radiculopathy-type symptoms are some of the most challenging cases in our offices, and here we have systematic review-level evidence saying that adding these techniques to a physical therapy routine makes a real difference.

If you haven’t incorporated neural mobilization or neurodynamic testing and treatment into your practice toolkit, this is a good time to consider it. The evidence is building, and it points in the right direction.

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Alright, that’s going to do it for Episode #387 of the Chiropractic Forward Podcast. Two great papers today — one reminding us that the simplest interventions can be the most powerful, and one confirming that what we do in the treatment room for chronic neck pain with nerve symptoms has solid evidence behind it. That’s the kind of research that makes me proud to be in this profession.

As always, thank you for being here, thank you for caring about evidence and about doing right by your patients. That’s what this podcast is about and that’s what this profession deserves.

────────────────────────────────────────────────────────────

Don’t forget to check out our store at chiropracticforward.com. We’ve got resources and tools for chiropractors who want to stay sharp and keep building their practices on a solid foundation.

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

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.

Subscribe Button

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

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https://www.facebook.com/chiropracticforward/

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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

The post Water Instead of Diet Drinks & Neuromobilization In The Chronic Neck appeared first on Chiropractic Forward.

Today we’re going to talk about PRP For Knee OA & Diagnosing Cervical Arterial Dissection

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, judgmental, 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.

Hiring Plug 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 #386

Now if you missed last week’s episode, we talked about Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally.

Make sure you don’t miss that info. Keep up with the class.

On the Personal End of Things…

Here we are, mid March in 2026. And what do I have going on?

Well, a lot of the same as last week so let’s just hop into some advice based on what I’m currently focusing on in my life and career at 53 years old.

The biggest advice to younger chiropractors is get a plan in advance. Don’t wait until you’re 48 to go, Hey, you know, at some point, I might want to retire.

I had a buddy who was older than me that ended up getting cancer and passing away before he enacted any kind of retirement plan. His wife was left with a business that wasn’t worth anything with him gone, and all she could do was sell it for parts. I don’t know their finances at all. But if he hadn’t laid down some plans for her, that probably didn’t work out very good.

Make plans early.

I have another buddy… who ended up… having a heart attack and dying right there in his practice. He was in his 70s. Some people want to work that long, period. They love it that much.

I love what I do for a living, but I don’t want to do it my whole life.

I have another buddy who was in his 60s, and just a year or two ago, had a stroke, and can’t speak. So all of his patients had to go somewhere else, and he had to close down his shop and sell it off for parts.

This all goes to say, for most of you, when you’re building your practice, build it to sell. Don’t name it after yourself. It’s hard to sell Williams Chiropractic to Joseph Salazar. Don’t make all of the marketing all about you. When it’s person-driven, your clinic is associated so strongly with YOU that it’s hard to remove yourself and turn it over to someone else.

My practice is called Creek Stone Integrated Medical. It was Creek Stone Integrated Care before we added our medical branch.

You can sell that to anybody. I think you get my point there.

Build it to sell, plan early. Roth IRAs, compound interest. Maybe you get some inheritance along the way. And a side gig or two that you enjoy isn’t always the worst idea either.

If you want to work your whole damn life, that’s OK. That’s just not what I want for my one and only trip on this rock.

Alright, that’s it. I don’t have a lot more to share personally than that this week. I’m just getting ready for the QME test. Which will be in mid April. Once I hopefully pass that dude, one of my side gigs will be engaged, so cheers to that. Let’s get into the research.

Item #1

Our first one today is called, “Validation of a Diagnostic Support Tool for the Early Recognition of Cervical Arterial Dissection in Primary Care” by Thomas et al published in December 2024, and it’s a hot potato,

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

Citation: L. Thomas, M. Fowler, L. Marsh, K. Chu, Claire Muller, A. Wong,

Validation of a diagnostic support tool for early recognition of cervical arterial dissection in primary care,

Clinical Neurology and Neurosurgery,

Volume 247,

2024,

108627,

ISSN 0303-8467,

https://doi.org/10.1016/j.clineuro.2024.108627.

(https://www.sciencedirect.com/science/article/pii/S0303846724005146)

Why They Did It

Cervical arterial dissection is one of the leading causes of stroke in young adults, and here’s the tricky part — it often shows up first looking just like everyday musculoskeletal pain. Neck pain, headache — things that walk through chiropractic and primary care doors every single day.

The problem is, there are currently no validated tests to help clinicians identify it early. That means it can get missed, and a missed CeAD can mean a missed stroke.

The goal of this research was to validate a diagnostic support tool that could help clinicians in primary care know when to refer urgently for imaging, when to monitor, and when it’s safe to proceed with treatment.

How They Did It

This was a prospective observational study.

They took adults over 18 years old presenting to a tertiary metropolitan hospital with an initial diagnosis of headache or neck pain — sound familiar?

Participants were split into those with radiologically confirmed CeAD and controls without CeAD.

They crunched the diagnostic values, looked at sensitivity and specificity, and then refined the tool based on what they found.

What They Found

Thirty participants had confirmed CeAD and 261 were controls with non-CeAD causes of headache and neck pain.

The original tool was an excellent predictor with an AUC of 0.83, but it had poor specificity — meaning too many false positives.

 So they refined it.

The updated tool uses four simpler, equally-weighted criteria:

Each criterion scores 1 point for a total of 4.

At a cut-off of 3 out of 4, the refined tool hit 100% sensitivity and 74% specificity

Wrap It Up

This is pretty important for us! The refined tool shows solid clinical utility at a cut-off of 3 or higher, and the recommendation is clear: at that score, refer for vascular imaging.

The authors acknowledge that further validation in emergency departments and primary care settings is still needed, but the foundation is strong. For chiropractors, this is a practical screening tool.

Sudden, unusual neck pain or headache plus any neurological features in a patient under 55 should be raising flags. Know the signs, use a tool like this, and refer when the score demands it.

Stroke prevention starts in our offices. You don’t wanna be a dummy and end up in court and your name run down in your town.

Item #2

The last one this week is called, “Efficacy and Safety of Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy for Knee Osteoarthritis: A Systematic Review and Meta-Analysis” by Gao, Ma, Tang, Zhang, and Zuo, published in the Archives of Orthopaedic and Trauma Surgery in September of 2024. New enough to smoke!!

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

Gao J, Ma Y, Tang J, Zhang J, Zuo J. Efficacy and safety of platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2024 Sep;144(9):3947-3967. doi: 10.1007/s00402-024-05442-y. Epub 2024 Jul 7. PMID: 38972025

Why They Did It

Knee osteoarthritis is one of the most common degenerative joint conditions out there, and it hammers quality of life. The traditional conservative options — corticosteroids, hyaluronic acid injections, NSAIDs — offer temporary relief at best and come with real side effects.

Platelet-rich plasma, or PRP, has been generating a lot of buzz as a regenerative alternative. Hyaluronic acid has been a go-to injectable for years. But what happens when you combine them? That’s what this team wanted to know. Is PRP plus HA more effective and safer than either treatment alone?

How They Did It

This was a systematic review and meta-analysis, the gold standard of evidence-based research. They searched MEDLINE, the Cochrane Library, EMBASE, and Web of Science for articles published up through January 2024.

They only included randomized controlled trials — the highest quality study design — that directly compared PRP plus HA combination therapy against PRP alone or HA alone.

Primary outcomes were pain, functional outcomes, and adverse events.

They followed PRISMA guidelines, used two independent researchers for data extraction, and applied fixed or random effects models based on heterogeneity.

Ten RCTs involving 943 patients were included.

What They Found

The combination of PRP and HA produced more significant pain reduction and functional improvement compared to HA treatment alone. And here’s a clinically important piece — the combination therapy also appeared to have a higher safety profile than either PRP or HA used as monotherapy.

In other words, you get better results AND fewer adverse events when you combine them. That’s a pretty compelling argument for combination therapy in the right patient population.

Wrap It Up

This meta-analysis adds meaningful evidence to the growing case for regenerative, non-surgical options for knee OA.

PRP combined with hyaluronic acid outperformed HA alone on both pain and function, and the safety profile was favorable.

For chiropractors and other conservative care providers, this is a reminder that our patients don’t have to choose between suffering and surgery.

Orthobiologic options like PRP, especially in combination with HA, are showing real promise. This is the direction musculoskeletal medicine is heading — patient-centered, conservative, and regenerative.

That’s our lane.

Closing

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 & Social Media Links

Website: http://www.chiropracticforward.com

Facebook: https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP: https://www.facebook.com/groups/1938461399501889/

Twitter: https://twitter.com/Chiro_Forward

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TuneIn: https://tunein.com/podcasts/Health–Wellness-Podcasts/The-Chiropractic-Forward-Podcast-Chiropractors-Prp1089415/

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 PRP For Knee OA & Diagnosing Cervical Arterial Dissection appeared first on Chiropractic Forward.

CF 385: Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally

Today we’re going to talk about Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally 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 #385 Now if you missed last week’s episode, we talked about Motor Weakness In Cervical Radiculopathy & Exercise And Dementia. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, as you might guess, things have been crazy. I recently returned from about 6 days out in Los Angeles where I was taking a prep class for the QME exam that’s coming up this Spring. What is a QME you might ask.

Well let me clear that up for you, friend. It stands for Qualified Medical Evaluator and once I’m a QME, I’ll fly out to California every 4-5 weeks or so and spend a couple of days doing impairment ratings exams on injured workers. Then fly home and do all the reports.  For the QME exam, it’s about a 50/50 pass/fail rate on that deal and I plan on passing that dude the first time around. Ain’t nobody got time to do it again. Of course, I will if I need to but I don’t plan on it, man. 

Outside of that, we’ve been getting this new associate up and running and y’all, she’s just a gem. Plain and simple. I’m really proud of her. She’s smart, she’s good with patients, she’s a good adjuster, and she just gets it. You show her once and she’s got it. Lots of times better than I got it! We are working hard on our PVA. I see patients around 8-9 times lifetime. And that’s with having VA and PI patients that are compelled to come in. That’s terrible and we are underserving by strictly looking at pain.  We are transitioning into pain relief followed by the functional movement screen, and then into maintenance. We believe this will better serve the patient but will also see our PVA go from around 8-9 up to about 15 or so.

I can live with that. And our assoicate is all over it as well.  I’m the one that is FMS certified but made intense notes and through the help of AI, have created a way of training her up on FMS and now, she does it better than I ever did. Plus, she has the time to do it whereas, I just don’t.  So, we have all that. Through our new nurse prac, we are bringing in peptides and getting that all up and rolling so again…..lots and lots of action here with your ol uncle Jeffro. Trust that

I’m not falling behind on the podcasts because I don’t care. I am just trying to balance this crazy life.  Becomeing a QME is no joke. It Ain’t easy my friends.  Wiith that, let’s jump in on that research. 

Item #1

Our first one today is called, “Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging” by Ibounig et al and published in Jama Internal Medicine in February of 2026 and check out the shizzle on that shucker!! Remember, the citations can be found at chiropracticforward.com under this episode.  Ibounig T, Järvinen TLN, Raatikainen S, et al. Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA Intern Med. Published online February 16, 2026. doi:10.1001/jamainternmed.2025.7903

Why They Did It Shoulder pain is a common musculoskeletal complaint often attributed to rotator cuff (RC) abnormalities. Diagnostic imaging is frequently used, but the association between RC abnormalities and shoulder symptoms remains uncertain. Objective  To determine the prevalence of RC abnormalities in a general population sample and their association with shoulder symptoms.

How They Did It Population-based cross-sectional study in a nationally representative random sample of adults aged 41 to 76 years who underwent standardized clinical assessment and MRIs of the shoulders conducted from February 2023 to April 2024 in Finland. 

Main Outcomes and Measures  RC tendon status was classified on MRI as normal, tendinopathic, partial-thickness tear (PTT), or full-thickness tear (FTT).  Shoulder symptoms were defined as pain or dysfunction in the preceding week.  The prevalence of RC abnormalities was compared across age groups and between symptomatic and asymptomatic shoulders, adjusting for demographic factors, concurrent MRI findings, and clinical examination.

What They Found

Wrap It Up

In this population-based study, rotator cuff abnormalities were nearly universal after age 40 years and showed poor concordance with shoulder symptoms.  These findings suggest that rotator cuff abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain.

Item #2 The last one this week is one of those that continues to make me uncool amidst the rising popularity and money that has gone into its acceptance and legalizations.  It’s called, “Adolescent Cannabis Use and Risk of Psychotic, Bipolar, Depressive, and Anxiety Disorders” by Young-Wolff et all and published in JAMA Health Forum in February of 2026 and it’s smokin up the place.  Young-Wolff KC, Cortez CA, Alexeeff SE, et al. Adolescent Cannabis Use and Risk of Psychotic, Bipolar, Depressive, and Anxiety Disorders. JAMA Health Forum. 2026;7(2):e256839. doi:10.1001/jamahealthforum.2025.6839

Why They Did It As cannabis becomes more accessible and socially accepted, concerns have grown about its potential implications for adolescent mental health. While prior research has linked adolescent cannabis use to psychiatric symptoms, few large, population-based, longitudinal studies have examined associations with clinically diagnosed psychiatric disorders.

Objective  To evaluate whether adolescent cannabis use is associated with an increased risk of incident psychotic, bipolar, depressive, and anxiety disorders during adolescence and young adulthood.

How They Did It This cohort study included adolescents aged 13 to 17  Adolescents were followed up through age 25 years or until December 31, 2023. 

Main Outcomes and Measures  Incident clinician-diagnosed psychotic, bipolar, depressive, and anxiety disorders, which were identified through electronic health records using International Classification of Disease codes.  Cox proportional hazards regression models were used to measure the strength of associations between adolescent cannabis use and incident psychiatric diagnoses, with adjustments for sex, race and ethnicity, neighborhood deprivation index, insurance type, and time-varying alcohol and other substance use.

What They Found Of 463,396 adolescents included in the sample At baseline, 26,345 adolescents (5.7%) self-reported past-year cannabis use.  Past-year cannabis use was associated with an increased risk of incident psychotic, bipolar, depressive, and anxiety disorders.  The strength of the associations between cannabis use and incident depressive and anxiety disorders decreased as adolescents aged This pattern was similar but slightly attenuated after additional adjustment for past psychiatric conditions

Wrap It Up This cohort study found that adolescent cannabis use was associated with increased risk of incident psychiatric disorders, particularly psychotic and bipolar disorders.  These results could inform the development of clinical and educational interventions for parents, adolescents, and clinicians, as well as protective policies to prevent or delay adolescent cannabis use in the context of expanding cannabis legalization. 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

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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 Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally appeared first on Chiropractic Forward.

CF 384: Motor Weakness In Cervical Radiculopathy & Exercise And Dementia Today we’re going to talk about Motor Weakness In Cervical Radiculopathy & Exercise And Dementia But first, here’s that sweet sweet bumper music  

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

OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little person ality and making it profitable. We’re not the stuffy, judgmental, 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 #384 Now if you missed last week’s episode, we talked about Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. Well February is off to a big start. I think I personally saw 175 last week which is leaps and bounds beyond what I normally see each week. Especially since COVID came around and crashed the practice. Since 2020, my average week is anywhere from 135 or so, up to about 160 on a good week. So to run 175 last week, that’s a big deal for me and a very very welcome change.  Now, if I can just get them to spread evenly in the mornings and afternoons instead of the vast majority of them only wanting to come in in the afternoons. We sit around a little in the mornings and lose our minds in the afternoons trying to keep up with everyone. It’s a problem to be honest. A good problem, of course. But a problem all the same.  Also in today’s news, after a very welcome sabbatical from traveling since my New Orleans trip last October, the travel season is kicking back in and there will be non-stop coming and going from now until probably next November.

That’s my life. 

In late January, I headed to Park City, Utah with my Mastermind group. I’ve only ever been to Utah when I had a layover in Salt Lake City but I’ve never seen any of the state so that was nice and I always love seeing my Mastermind family.  If you’re not in one, I encourage you to get in one. My MCM East group is sold out. But the MCM West group has openings. If you’re interested, contact Dr. Kevin Christie at modernchiropracticmarketing.com/contact Go do it!

But If you do, you better tell Kevin you’re there because of me, pal!

In other news, I finally got my California chiropractic license. I had to fly to Dallas to take the jurisprudence/legal test….it’s actually called the CCLE exam. That was the last step I needed out of the way to get the CA license.  I’ve also been studying up for the QME exam that will be in April. They have about a 50% pass/fail rate but the folks who attend the class I’m taking live out in Marina del Rey have more of a 80% pass/fail rate so I’m doing it. I’m ready to get this Qualified Medical Examiner licensing out of the way so I can start building that arm of my retirement income. 

So, if you’re keeping track, the arms of retirement for me now include:

I didn’t start this stuff until I was almost 50 folks. Please, start considering your exit when you’re younger. There is a building phase when you cannot invest in other arms. But when you build that practice, it’s time to start keeping an eye on your exit. The sooner you start, the sooner you can act when burnout hits and trust me, burnout WILL hit.  Especially if you’re good, smart, and ambitious. Count on it.  Alright, into the research people!

Item #1

Our first one today is called, “Is motor weakness in cervical radiculopathy an indication for surgery? Analysis of risk factors for poor recovery” by Kwon et al and published in European Spine in December 2025.  Remember, the citations can be found at chiropracticforward.com under this episode. 

Kwon K, Park S, Song MG, Park WS, Hwang CJ, Cho JH, Lee DH. Is motor weakness in cervical radiculopathy an indication for surgery? Analysis of risk factors for poor recovery. Eur Spine J. 2025 Dec 26. doi: 10.1007/s00586-025-09677-0. Epub ahead of print. PMID: 41452372.

Why They Did It To investigate the natural course of motor weakness in cervical radiculopathy and analyze risk factors associated with poor recovery.

How They Did It A cohort of prospectively enrolled patients presenting with motor weakness due to cervical radiculopathy between March 2024 and March 2025 was retrospectively analyzed.  All patients were initially managed conservatively, with surgery reserved for persistent weaknesses or intolerable symptoms.  Demographic, clinical, and imaging data were reviewed.  Motor strength was assessed using the modified Medical Research Council (mMRC) scale.  Patients achieving a motor grade 4 or higher were classified as the recovery group; those who did not were assigned to the non-recovery group.  We compared both groups and evaluated possible risk factors for non-recovery.

Wrap It Up

Item #2 Our second one today is called, “Physical Activity Over the Adult Life Course and Risk of Dementia in the Framingham Heart Study” by Marino et al and published in JAMA network Open in November of 2025 and that’s a muy en fuego. Mucho caliente. 

Marino FR, Lyu C, Li Y, Liu T, Au R, Hwang PH. Physical Activity Over the Adult Life Course and Risk of Dementia in the Framingham Heart Study. JAMA Netw Open. 2025;8(11):e2544439. doi:10.1001/jamanetworkopen.2025.44439

Why They Did It The authors say that being physically active is protective against dementia. Yet, it is unknown when during the adult life course physical activity is most associated with dementia risk.

Objective  To determine whether higher physical activity levels in early adult life, midlife, or late life are associated with lower risk of all-cause or Alzheimer disease (AD) dementia.

How They Did It This prospective cohort study used data from the Framingham Heart Study Offspring cohort.  The offspring of participants in the original Framingham Heart Study cohort who were dementia free and had physical activity measured at baseline (early adult life, midlife, or late life) were followed up for a mean of 37.2, 25.9, or 14.5 years for the development of incident all-cause or AD dementia until December 31, 2023. Physical activity was self-reported using the physical activity index, a composite score weighted by hours spent sleeping and in sedentary, slight, moderate, or heavy activities.  Physical activity was divided into quintiles (Q). As far as outcomes, All-cause and AD dementia were classified by expert consensus based on established diagnostic criteria.

What They Found

Wrap It Up

In this cohort study of adults in the Framingham Heart Study Offspring cohort, higher levels of midlife and late-life physical activity were associated with similar reductions in risk of all-cause and AD dementia.  These findings may inform future efforts to delay or prevent dementia through timing interventions during the most relevant stages of the adult life course. 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 Motor Weakness In Cervical Radiculopathy & Exercise And Dementia appeared first on Chiropractic Forward.

  CF 383: Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions Today we’re going to talk about Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions 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, judgmental, 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 #383 Now if you missed last week’s episode, we talked about SMT and disc regression and biopsychosocial factors for hip osteoarthritis.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things….. We have our new associate chiropractor up and running. Now the job is….how do we get her busy busy the quickest way possible? It’s a race to profitability, right? 

Here are some of our ideas. We’d love to hear your suggestions as well if you have lots of experience in building an associate’s schedule.  First, we’re going to leverage the fact that she’s from Amarillo so she’s the local hero returning to town. We’ll do that with social media and her high school alumni network.  We’ll have her partner with local fitness studios when possible. She’s fit and she’s into fitness so that’s a perfect fit. 

We’ll also see if she’s into working with youth sports programs.  We’ll do the ‘New Doc In Town’ thing. We’re going to be giving her some of my new patients when appropriate and possible. I say appropriate because a lot of big guys come to me and not too many will be pleased if I stick them with a smaller female. So they’ll have to be a good fit to pass on to her.  Visits to PT offices. The problem there is that I’m noticing PTs are offering many of the same services we offer now so they may look at her as competition now rather than a partner. 

Lots of rehab and treatment videos. Videos with Q&A with our associate.  Lots of ideas but again, if you have a great strategy, I’d love to hear from you at [email protected] Send them my way!

Item #1

The first one this week is called, “Platelet-Rich Plasma Versus Alternative Injections for Osteoarthritis of the Knee: A Systematic Review and Statistical Fragility Index-Based Meta-analysis of Randomized Controlled Trials” by Ceding et al and published in the American Journal of Sorts Medicine in October of 2024. 

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

Oeding JF, Varady NH, Fearington FW, Pareek A, Strickland SM, Nwachukwu BU, Camp CL, Krych AJ. Platelet-Rich Plasma Versus Alternative Injections for Osteoarthritis of the Knee: A Systematic Review and Statistical Fragility Index-Based Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2024 Oct;52(12):3147-3160. doi: 10.1177/03635465231224463. Epub 2024 Feb 29. PMID: 38420745.

Why They Did It Based in part on the results of randomized controlled trials (RCTs) that suggest a beneficial effect over alternative treatment options, the use of platelet-rich plasma (PRP) for the management of knee osteoarthritis (OA) is widespread and increasing.  However, the extent to which these studies are vulnerable to slight variations in the outcomes of patients remains unknown.

Purpose: To evaluate the statistical fragility of conclusions from RCTs that reported outcomes of patients with knee OA who were treated with PRP versus alternative nonoperative management strategies.

How They Did It Systematic review and meta-analysis All RCTs comparing PRP with alternative nonoperative treatment options for knee OA were identified.  The fragility index (FI) and reverse FI were applied to assess the robustness of conclusions regarding the efficacy of PRP for knee OA.  Meta-analyses were performed to determine the minimum number of patients from ≥1 trials included in the meta-analysis for which a modification on the event status would change the statistical significance of the pooled treatment effect.

What They Found In total, this analysis included outcomes from 1993 patients with Based on random-effects meta-analyses, PRP demonstrated a significantly higher rate of successful outcomes when compared with hyaluronic acid, as well as higher rates of patient-reported symptom relief, not requiring a reintervention after the initial injection treatment, and achieving the minimal clinically important difference (MCID) for pain improvement when compared with all alternative nonoperative treatments. 

Wrap It Up Conclusions drawn from individual RCTs evaluating PRP for knee OA demonstrated slight robustness.  On meta-analysis, PRP demonstrated a significant advantage over hyaluronic acid as well as improved symptom relief, lower rates of reintervention, and more frequent achievement of the minimal clinically important difference for pain improvement when compared with alternative nonoperative treatment options.  Statistically significant pooled treatment effects evaluating PRP for knee OA are more robust than approximately half of all comparable meta-analyses in medicine and health care.  Future RCTs and meta-analyses should consider reporting fragility indexes and fragility quotients to facilitate interpretation of results in their proper context.

Item #2

Our last one today is called “Telehealth Mindfulness-Based Interventions for Chronic Pain The LAMP Randomized Clinical Trial” by Burgess et al and published in JAMA Internal Medicine on August 19, 2004. 

Burgess DJ, Calvert C, Hagel Campbell EM, et al. Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Intern Med. 2024;184(10):1163–1173. doi:10.1001/jamainternmed.2024.3940

Why They Did It Importance  Although mindfulness-based interventions (MBIs) are evidence-based treatments for chronic pain and comorbid conditions, implementing them at scale poses many challenges, such as the need for dedicated space and trained instructors.

Objective  To examine group and self-paced, scalable, telehealth mindfulness-based interventions, for veterans with chronic pain, compared to usual care.

How They Did It This was a randomized clinical trial of veterans with moderate to severe chronic pain, recruited from 3 Veterans Affairs facilities from November 2020 to May 2022. Follow-up was completed in August 2023.

Interventions  Two 8-week telehealth mindfulness-based interventions (group and self-paced) were compared to usual care (control).  The group mindfulness-based interventions was done via videoconference with prerecorded mindfulness education and skill training videos by an experienced instructor, accompanied by facilitated discussions.  The self-paced mindfulness-based interventions was similar but completed asynchronously and supplemented by 3 individual facilitator calls. The primary outcome was pain-related function using the Brief Pain Inventory interference scale at 3 time points: 10 weeks, 6 months, and 1 year. Secondary outcomes included biopsychosocial outcomes: pain intensity, physical function, anxiety, fatigue, sleep disturbance, participation in social roles and activities, depression, patient ratings of improvement of pain, and posttraumatic stress disorder.

What They Found

Wrap It Up

In this randomized clinical trial, scalable telehealth mindfulness-based interventions improved pain-related function and biopsychosocial outcomes compared to usual care among veterans with chronic pain.  Relatively low-resource telehealth-based mindfulness-based interventions could help accelerate and improve the implementation of nonpharmacological pain treatment in health care systems.

Alright, that’s it.

Keep on keepin’ on.

Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

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

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

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

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

Website http://www.chiropracticforward.com

Social Media Links https://www.facebook.com/chiropracticforward/

Chiropractic Forward Podcast Facebook GROUP https://www.facebook.com/groups/1938461399501889/

Twitter https://twitter.com/Chiro_Forward

YouTube https://www.youtube.com/channel/UCtc-IrhlK19hWlhaOGld76Q

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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 Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions appeared first on Chiropractic Forward.

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.