CF 369: Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall Today we’re going to talk about Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall But first, here’s that sweet sweet bumper music  

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

  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together. 

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #369 Now if you missed last week’s episode, we talked about Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Item #1

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

Item #2

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

Patients with spine-related musculoskeletal pain who consulted a chiropractor as their initial provider incurred substantially decreased downstream healthcare services and associated costs, resulting in lower overall healthcare costs compared with medical management.  The included studies were limited to mostly retrospective cohorts of large databases. Given the consistency of outcomes reported, further investigation with higher-level designs is warranted Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

The Message

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

Key Point:

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

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

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

Website http://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

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

The post Cervicogenic Headache Treatment & Seeing A Chiropractor First Means Less Expense Overall appeared first on Chiropractic Forward.

CF 368: Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation Today we’re going to talk about Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation.  But first, here’s that sweet sweet bumper music  

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

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

You have found yourself smack dab in the middle of Episode #368 Now if you missed last week’s episode, we talked about Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis. Make sure you don’t miss that info. Keep up with the class. 

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

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

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

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

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

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

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

How They Did It

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

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

Item #2

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

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

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

Wrap It Up

Overall, this study showed that SMT significantly reduced pain, improved dysfunction, and partially rectified aberrant local consistency and functional connection in patients with LDH, not only offering insights into the pathophysiology of LDH from a neurological standpoint, but also providing inspiration for the development of new therapies based on neurobiology. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

The Message

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

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

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

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

Website http://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

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

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

The post Spinal Manipulative Treatment And Biochemical Markers & SMT For Lumbar Disc Herniation appeared first on Chiropractic Forward.

CF 367: Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis Today we’re going to talk about Transcranial Direct Current for Fibromyalgia & Methotrexate For Knee Osteoarthritis But first, here’s that sweet sweet bumper music    

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

OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic.

I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #367 Now if you missed last week’s episode, we talked about Europe, SMT Review, & Informed Consent.  Make sure you don’t miss that info. Keep up with the class. 

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

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

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

Item #1

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

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

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

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

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

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

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

Item #2

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Website http://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

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

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

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

CF 366: Europe, SMT Review, & Informed Consent Today we’re going to talk about Europe, SMT Review, & Informed Consent But first, here’s that sweet sweet bumper music  

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

  OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together. 

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected] If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #366 Now if you missed last week’s episode, we talked about  Dosing Lumbar SMT & Short Term Effects of Different Forms of SMT Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Well, as mentioned when we last left off, I was headed to Europe for a VoiceOver retreat and VoiceOver retreat I did. Went, saw, and conquered.  One thing that struck me as interesting and something that maybe some of you can relate to is that I have some form of anxiety. Most of it is absolutely useless. I have it in all aspects of my life and it drives me crazy.  For example, this trip to Europe, I’ve never been across the pond before so I was losing sleep about the trip. What if a plane is late and causes us to miss our connection? What if we can’t figure out the train system? What if I have a hard time with all of the bags getting on and off the trains? What if they lose a bag on one of our flights? What if we have a hard time getting where we need to be? What if I can’t communicate with the people I need help from?

Yeah……all of that stuff.  Welcome to my brain. That’s my life on the reg, as the kids say.  I do it with the clinic too. What if it stays slow?

What if I can’t get our collectors to get it going this month? What if’s out the damn wazoo.  Now, to some extent, that’s helpful, right? Keeps you on your toes and doing what we’re supposed to be doing. On the other side of that though, it can be detrimental. It can make you miserable, stressed, and not so healthy.  Here’s the thing my mom used to tell me, “”99% of the things we worry about never ever happen.”” And she was right.  We had smooth travels in Europe.

They lost our bag on a direct flight from Edinburgh Scotland to Amsterdam but after about an hour, they found it.

Other than that, everything was smooth sailing, everyone spoke English, and we did everything we wanted with no issues.  Well, except for in Paris when their soccer team won their first-ever championship and the town had riots two nights in a row but, even that stupidity was able to be navigated through. 

Edinburgh was magical, Amsterdam was fun, Valkenburg was relaxing, and Paris was beautiful. The French folks were super nice. Don’t buy into the haters. It was great.  Now that we’ve been once, we can’t wait to return. What will our next adventure be? Time will tell.  Now tying that back into clinic life, that’s the first time in 28 years that I’ve been out of the clinic for 2 weeks straight. That’s stressful, right? It’s not the cost of a trip that keeps me from going. It’s the cost of being gone out of the clinic that keeps me from going. 

Let’s say a trip will cost $20k overall. OK, that stings a little but we can figure that out. BUT …..for round numbers and easy math….let’s say I bill out $100k per month and I’m gone for 2 weeks, that’s a loss of $50k. So that makes it a $70k trip, folks. And that freaking hurts.  Most of my career has been spent taking little 4-5 day trips leaving on a Thursday and coming back on a Monday or something like that. I’m sure you can relate. 

On this one, I worked Wednesday morning from 8-10:30 am on Wednesday and saw only about 14 patients. For the three days of that week, we saw about 100. I’m typically seeing around 150+ per week for context.  We had a coverage doc come in for three days that week I was gone all week. So they saw 86 in those 3 days. 

Then, on the week I got back, I missed Monday and Tuesday. We flew in Wednesday morning from Europe and I was back at work Wednesday afternoon. Yes…..I was tired. BUT, for that week I saw 110.  So, you can see that yes…we missed out on some patients. No doubt. But we were able to minimize the damage.  Now the job I have is rebuilding the numbers. Here it is my first Monday back from vacay and we are set with 105 for the week. No, that’s not where I want to be but y’all know how that works. Our Monday patients will reschedule Wednesday and Friday and I suspect we’ll end up somewhere around 135 or 140 this week.  That’s not too much of a drop-off.

So I think my strategy may have worked. One of my mastermind colleagues shared with me that he went to Europe for two weeks and it took him a month to rebuild his clinic when he got back. And that’s with an associate. I don’t have an associate. He freaked me the hell out.  I think that we have managed to minimize the hit to our numbers and will hopefully be back to full steam by the end of the week and starting of next week.  Anyway, kind of in the weeds a bit there but I wanted to share with you all how I think we were able to leave for two weeks with minimal damage to our bottom line. Maybe it’ll come in useful for you too. Work a little on Wednesday in the morning, fly out in the afternoon, hire coverage three days the full week you’re gone, and fly in Tuesday or Wednesday morning and get back at it Wednesday afternoon. Great formula I think.  Just a tip from your ol Uncle Jeffro. 

Alright that’s it, let’s hop in. 

Item #1

Our first one this week is called “Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations” by Trager et al and published in the Journal of Clinical Medicine in August of 2024 and it’s hot enough for some hot talk! Remember, the citations can be found at chiropracticforward.com under this episode. 

Trager RJ, Bejarano G, Perfecto R-PT, Blackwood ER, Goertz CM. Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. Journal of Clinical Medicine. 2024; 13(19):5668. https://doi.org/10.3390/jcm13195668

This one is a little more than just a short thing we can breeze through so I did a little Grok AI summary and he’s what we got.  It provides a comprehensive review of chiropractic care, focusing on spinal manipulative therapy (SMT) from 1972 to 2024.

Key Points:

Conclusion: The paper underscores the growing acceptance of chiropractic SMT, supported by increasing research and guideline endorsements, particularly for musculoskeletal disorders. However, it calls for further studies to address evidence gaps and optimize clinical applications.

Item #2

Our second one this week was sent to me by my buddy, Dr. Steve Brown hailing from Gilbert, AZ. Gilbert, gateway to Tucson.  It is titled, “THE CONNECTICUT LAW ON CHIROPRACTIC INFORMED CONSENT TO CERVICAL ARTERY DISSECTION AND STROKE: A NARRATIVE REVIEW”

Dr. Brown wrote this article with Dr. Robert Cooperstein and it was published in Journal of Contemporary Chiropractic on June 2, 2025 and it’s hot hot hot, en fuego!

Brown S, Cooperstein R. THE CONNECTICUT LAW ON CHIROPRACTIC INFORMED CONSENT TO CERVICAL ARTERY DISSECTION AND STROKE: A NARRATIVE REVIEW. JCC. 2025;8(1):162-169. https://journal.parker.edu/article/139042-the-connecticut-law-on-chiropractic-informed-consent-to-cervical-artery-dissection-and-stroke-a-narrative-review

Why They Did It This paper reviews the evidence considered by the Connecticut Board of Chiropractic Examiners in their 2010 memorandum concluding 

The 2010 memorandum contains 5 Findings of Fact. An additional objective of this narrative review was to determine if there is sufficient evidence to support the Board’s third and fourth Findings of Fact.

How They Did It We analyzed the 2010 memorandum to determine what evidence was considered by the Connecticut Board in arriving at their third and fourth Findings of Fact. Analysis revealed that the Connecticut Board reviewed 3 studies. All 3 studies were acquired and reviewed.

What They Found Analysis of the Connecticut Board’s 2010 memorandum shows that they relied solely on the first conclusion of the 2008 Cassidy et al. study, Risk of Vertebrobasilar Stroke and Chiropractic Care: Results of a Population-based Case-Control and Case-Crossover Study.

Wrap It Up We conclude that the third and fourth Findings of Fact in the 2010 memorandum of the Connecticut Board of Chiropractic Examiners are not supported by the evidence.  Patients have the right to consider whether the clinical benefits they seek are worth the inherent risks. 

The present authors therefore recommend that chiropractors include the risk of stroke and/or CAD in securing informed consent by patients to manipulation of the cervical spine.  This practice would be both evidence-based and patient-centered, and constitute an important element of the chiropractic standard of care. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world.

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

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

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

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

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

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

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

Website http://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

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

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

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

CF 365: Dosing Lumbar SMT & Short Term Effects of Different Forms of SMT Today we’re going to talk about Dosing Lumbar SMT & Short Term Effects of Different Forms of SMT But first, here’s that sweet sweet bumper music  

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

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

You have found yourself smack dab in the middle of Episode #365 Now if you missed last week’s episode, we talked about SMT And Stroke & Metformin For Knee Osteoarthritis Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

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

Item #1

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

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

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

Why They Did It

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

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

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

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

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

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

For claims associated with initial episodes of low back pain, low and moderate dose spinal manipulative therapy groups were associated with a 55% and 42% reduction, respectively, in the relative risk of any escalated spine care. Alright, that’s it. See ya in a few weeks friends! Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

The Message

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

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

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

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

Website http://www.chiropracticforward.com

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

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

Twitter https://twitter.com/Chiro_Forward

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

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

Player FM Link https://player.fm/series/2291021

Stitcher: https://www.stitcher.com/podcast/the-chiropractic-forward-podcast-chiropractors-practicing-through

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

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

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

CF 364: Spinal Manipulative therapy And Stroke & Metformin For Knee Osteoarthritis Today we’re going to talk about SMT And Stroke & Metformin For Knee Osteoarthritis But first, here’s that sweet sweet bumper music  

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

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

You have found yourself smack dab in the middle of Episode #364 Now if you missed last week’s episode, we talked about Lateral Lumbar Stenosis & Manual Therapy Combined With PT Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

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

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

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

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

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

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

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

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

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

Item #1

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

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

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

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

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

Why They Did It

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

How They Did It

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

What They Found

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

Wrap It Up

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

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

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

But in Chaibi they say these are the key symptoms:

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

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

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

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

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

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

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

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

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

Wrap It Up These results support use of metformin for treatment of symptomatic knee osteoarthritis in people with overweight or obesity. Because of the modest sample size, confirmation in a larger clinical trial is warranted. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

The Message

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

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

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

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

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

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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 Spinal Manipulative Therapy And Stroke & Metformin For Knee Osteoarthritis appeared first on Chiropractic Forward.

CF 363: Lateral Lumbar Stenosis & Manual Therapy Combines With PT

Today we’re going to talk about Lateral Lumbar Stenosis & Manual Therapy Combines With PT

But first, here’s that sweet sweet bumper music

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

OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable.

We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. 

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together. 

Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [email protected]

If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #363

Now if you missed last week’s episode, we talked about Coffee In The Morning & PRP Beats Cortisone In Meta-Analysis.

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

On the personal end of things….. Still progressing on the sale of 60% of the clinic. That’s an ongoing process, of course. It’s hard to turn over almost 30 years of blood, sweat, and tears but I’m also tired of blood, sweat, and tears, if you know what I mean. Lol.  We are in the part of it all now where we’ve been sent a contract and have hired a contract attorney down in Dallas to review it and make sure we’re not doing anything entirely stupid. I trust this company and really like the folks running it. Quite a bit as a matter of fact. 

But, let’s face it; it’s a business and when the contract is generated by them, it probably favors them. Of course. It’s important to spend the money and hire your own advocate just to make sure. Regardless of your feelings of the folks running it. At the end of the day, it’s your baby and it’s your future so you gotta have an advocate so you know what you’re getting into.  That’s where we are with that. Just waiting on that process to play out. And I’ll keep you updated as always.  What else? I have my MCM Mastermind meeting in Charleston next weekend so don’t be surprised if I don’t have the chance to get an episode out next week.

Daddy’s gotta work and all. 

Then we’re planning the European extravaganza starting May 21st. Never been to Europe so I don’t have a clue what to expect but we’ll dummy through it all and get it figured out.  I’m starting to see some patients come back now. Now that the Winter is lifting, people have recovered from the holidays, and deductibles are getting met….they’re starting to return slowly but surely.

Also, the VA hired their own chiro a year ago or so and we saw our veterans having to go to the VA for treatment.  We lost a ton of business with that little move but, great news! Their chiropractor quit so we’re seeing the vets returning again too! Lots of familiar faces finally coming back to see us.  I’m not in the 180 appointments per week range that I really like but we’re climbing. We’re probably around 145-155 or so this week. Not too far off.  Alright, no reason for idle chat, let’s just hop in. 

Item #1 First one this week is called, “Lateral Lumbar Spinal Stenosis: Associations With the Oswestry Disability Index, Visual Analogue Scale, and Magnetic Resonance Imaging” by Norisyam et al and published in Cureus 12/13/23 Remember, the citations can be found at chiropracticforward.com under this episode. 

DOI: 10.7759/cureus.50475 Review began 12/04/2023 Review ended 12/07/2023 Published 12/13/2023 © Copyright 2023 Norisyam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC- BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Why They Did It Degenerative lumbar spinal stenosis is a communal problem in the sixth decade of life involving L4/L5 and L5/S1 levels. Lateral spinal stenosis is often underestimated because of no established relationship between the clinical symptoms and MRI findings.  We conducted a study to establish an association between the degree of anatomical lateral stenosis, posterior disc height, and disc degeneration from MRI with the daily disability and pain severity for lateral lumbar spinal stenosis

How They Did It This was a cross-sectional study involving 121 patients with distinct clinical symptoms of lateral lumbar spinal stenosis evaluated from February 2018 to December 2019.  The clinical data were evaluated using the Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS), while MRI was assessed qualitatively for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration. 

What They Found The analysis of 121 patients showed the mean age of the patients was 58.7 ± 7.1 years old.  The number of female patients was higher compared to male patients, 52.9% and 47.1%, respectively.  97.5% of the patients were married or cohabiting, and 76.0% had an abnormal body mass index.  49.6% of the patient presented with a crippling disability with ODI assessment, while 59.5% presented with high pain intensity with VAS assessment.  MRI assessment of anatomical grading lateral stenosis of L4/L5 level revealed that 45.5% of the patients had grade 2 lateral recess stenosis, 63.6% had grade 2 foraminal stenosis, and 44.6% had extraforaminal stenosis.  L5/S1 level analysis showed that 43.0% had grade 2 lateral recess stenosis, 62.0% had grade 2 foraminal stenosis, and 29.8% had extraforaminal stenosis.

Wrap It Up There was no significant association between the clinical symptoms of pain and disability and the MRI findings for the anatomical gradation of lateral spinal stenosis, the magnitude of posterior disc height, and the extent of disc degeneration.  A comprehensive clinical evaluation remains essential for an accurate diagnosis, emphasizing the necessity of appropriately correlating MRI findings with their clinical significance.

I would add that in the Ortho Diplomate, it was made clear that it is not the grade of stenosis or the size of the holes that matters. What matters is what’s happening to the stuff going through the holes. For lack of a better term.  If the stuff in the holes is inflamed, stenosis would be more pronounced, basically.  Here in my clinic, a good combination for stenosis has been an anti-inflammatory diet, low level laser, and the Dr. Carmen Amendolia protocol. It’s been impressive. Just a lil tip from your ol Uncle Jeffro. 

Item #2 Our second one today is called “The Influence of Active, Passive, and Manual Therapy Interventions on Escalation of Health Care Events After Physical Therapist Care in Veterans With Low Back Pain” by Mayer et al and published in Physical Therapy and Rehabilitation Journal in July of 2024 and it’s hotter n a pancake off the griddle. 

John M Mayer, Michael Jason Highsmith, Jason Maikos, Charity G Patterson, Joseph Kakyomya, Bridget Smith, Nigel Shenoy, Christopher L Dearth, Shawn Farrokhi, The Influence of Active, Passive, and Manual Therapy Interventions on Escalation of Health Care Events After Physical Therapist Care in Veterans With Low Back Pain, Physical Therapy, Volume 104, Issue 10, October 2024, pzae101, https://doi.org/10.1093/ptj/pzae101

Why They Did It The objective of this study was to examine the associations between active, passive, and manual therapy interventions with the escalation-of-care events following physical therapist care for veterans with low back pain (LBP).

How They Did It A retrospective cohort study was conducted in 3,618 veterans who received physical therapist care for LBP between January 1, 2015 and January 1, 2018.  The Department of Veterans Affairs (VA) Corporate Data Warehouse was utilized to identify LBP-related physical therapist visits and procedures, as well as opioid prescription and non–physical therapy clinic encounters.  The association between physical therapist interventions with 1-year escalation-of-care events were assessed using adjusted odds ratios from logistic regression.

What They Found Nearly all veterans (98%) received active interventions, but only a minority (31%) received manual therapy.  In the 1-year follow-up period, the odds of receiving an opioid prescription were 30% lower for those who received manual therapy in addition to active interventions, as compared with patients who received only active interventions.  Moreover, the odds of receiving primary care, specialty care, and diagnostic testing were 30% to 130% higher for patients who received electrical stimulation or more than 1 passive intervention in addition to active treatments, as compared with patients who received only active interventions.

Wrap It Up The use of manual therapy along with active interventions was associated with reduced prescription of opioids, while utilization of specific passive interventions such as electrical stimulation or multiple modalities in conjunction with active interventions resulted in increased escalation-of-care events. The use of active interventions, which is supported by most clinical practice guidelines, was the cornerstone of physical therapist care for veterans with LBP.  However, the use of clinical practice guideline–recommended manual therapy interventions was low but associated with reduced opioid prescriptions. I would extend that to include spinal manipulative therapy, just continues to pile up.

And up and up and up. Sooner or later, the healthcare industrial complex (whatever that might be) HAS to pay attention and at some point, it will start to be outside of the standard of care when medical providers ignore it. 

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/

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

About the Author & Host Dr. Jeff Williams – 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 Lateral Lumbar Stenosis & Manual Therapy Combined With PT appeared first on Chiropractic Forward.

CF 362: Coffee In The Morning & PRP Beats Cortisone In Meta-Analysis Today we’re going to talk about Coffee In The Morning & PRP Beats Cortisone In Meta-Analysis But first, here’s that sweet sweet bumper music  

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

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

You have found yourself smack dab in the middle of Episode #362 Now if you missed last week’s episode, we talked about Healthcare Expenditures & Sleep And Pain Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Hey hey, here’s another for you this week. I used to be so solid with this podcast. Every single week without fail. Just banging ‘em out.  Here’s what I noticed. It doesn’t make any difference. Consistency didn’t seem to matter when it came to listenership. We just reached a peak number and it just stays there. No matter what I do. I don’t have the opportunity to plan and do interviews these days. I’d love to. I just don’t have the time and lots of weeks, I just don’t have the energy to be honest.  Life has been hitting pretty heavy in the last 3-4 months so my consistency has been a bit off. I am trying to get better.  Another issue is that, as I’ve discussed several times here on the podcast, I am bringing in a partner organization. Bringing them into our practice to help me grow more and depend less on my sole efforts to accomplish that goal. With that though comes some time-consuming activities.

Like a call with the transition team every Tuesday afternoon. Which used to be when I would get the podcast all wrapped up and recorded. So that’s been a challenge. 

Plus I decided to hire a personal trainer twice a week to get this 52 year old body of mine back into some sort of healthy shape. I’m not getting any younger and if I keep waiting until I have more time to make it a priority, well, sooner or later, I’m just going to run out of time all together.  I tell my patients that the best way to create a new habit is to have buy in and accountability so hiring a personal trainer makes a lot of sense. I decided to take my own advice. Leg day was a few days ago and I’m still walking around my office like I have a stick stuck up my butt. I’m so sore, y’all. It’s real. 

All of that to say that I am trying to get back to being consistent with the episodes. I would ask that you try to help me as well. Help me to get this podcast out to others. Recommend us, review the podcast wherever you do your listening. Advocate for us. We are trying to change the profession by bringing it closer to the center of the healthcare industry instead of some outlying satellite floating by itself in outer space.  Sharing is easy, I ask you to help me and, by proxy, help the profession. 

Item #1 The first one today is called, “Drinking coffee only in the morning lowers risk of death from any cause” by the StudyFinds Staff and research by Dr. Lu Qi at Tulane University. It was released on January 8, 2025 and that’s a hot one.  Remember, the citations can be found at chiropracticforward.com under this episode. 

https://academic.oup.com/eurheartj/article/46/8/749/7928425?login=false Xuan Wang, Hao Ma, Qi Sun, Jun Li, Yoriko Heianza, Rob M Van Dam, Frank B Hu, Eric Rimm, JoAnn E Manson, Lu Qi, Coffee drinking timing and mortality in US adults, European Heart Journal, Volume 46, Issue 8, 21 February 2025, Pages 749–759, https://doi.org/10.1093/eurheartj/ehae871

Why They Did It

A recent study led by Dr. Lu Qi at Tulane University, published in the European Heart Journal, examined the impact of coffee consumption timing on mortality risks.  Analyzing data from over 40,000 American adults, researchers identified two primary groups: “morning-type” coffee drinkers, who consumed coffee between 4 a.m. and noon, and “all-day-type” drinkers, who spread their intake throughout the day. 

The study found that morning coffee drinkers had a 16% lower risk of death from all causes and a 31% lower risk of death from heart disease compared to non-coffee drinkers.  Notably, those who consumed two to three cups in the morning experienced a 29% reduction in all-cause mortality risk. In contrast, individuals who drank coffee throughout the day did not exhibit significant mortality benefits. 

The researchers suggest that consuming coffee later in the day may disrupt circadian rhythms and melatonin production, potentially diminishing coffee’s health benefits. Additionally, coffee’s anti-inflammatory properties may be more effective when aligned with the body’s natural inflammatory cycles, which are higher in the morning.

These findings indicate that not only the quantity but also the timing of coffee consumption plays a crucial role in its health effects.  While the study highlights an association between morning coffee consumption and reduced mortality risk, it does not establish causation.  Further research is needed to understand the underlying mechanisms and to determine if adjusting coffee consumption timing can directly influence health outcomes.  Nonetheless, these insights may inform future dietary guidelines, emphasizing the importance of considering not just what we consume, but also when we consume it.

Item #2

The second one today is. “PLATELET-RICH PLASMA VERSUS CORTICOSTEROID IN THE TREATMENT OF KNEE OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS” by Wang et al and published in Georgian Medical News in April of 2024 and that’s hot enough for some hot talk. 

Wang R, Xie Y, Xie L, Liu J, Jia J, Chen X, Wu Q. PLATELET-RICH PLASMA VERSUS CORTICOSTEROID IN THE TREATMENT OF KNEE OSTEOARTHRITIS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS. Georgian Med News. 2024 Apr;(349):169-182. PMID: 38963222.

Why They Did It

The aim of this meta-analysis is to evaluate the clinical effectiveness of intra-articular injections of platelet-rich plasma (PRP) versus corticosteroid (CS) in treating knee osteoarthritis (KOA). 

How They Did It

A comprehensive search of the PubMed, Embase, and Web of Science databases was conducted for literature on intra-articular PRP and CS injections for the treatment of knee osteoarthritis, with the search period extending to December 2023.  The risk of bias was assessed using the Cochrane Risk of Bias tool, and statistical analysis was subsequently carried out using Review Manager 5.4.1 software.  The efficacy of PRP versus CS injections across various studies was compared based on the weighted mean difference and 95% confidence interval for scores from the Visual Analogue Scale (VAS), Knee Osteoarthritis Outcome Score (KOOS), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).  In our analysis, we incorporated twelve studies encompassing a total of 801 joints, of which 404 were in the PRP group and 397 in the CS group. 

What They Found

The PRP group was significantly reduced the VAS score than CS group in 3-month, 6-month and 9-month; PRP group was significantly reduced the WOMAC total score compared to CS group in 1-month, 6-month, 9-month and 12-month; In 3-month and 6-month, PRP group were significantly increased the KOOS pain relief score, the KOOS activities of daily living scores and the KOOS quality of life score compared to CS group; PRP group also were significantly increased the KOOS sports score in 3-month compared to CS group.  The leukocyte-poor PRP (LP-PRP) group had significantly reduced VAS scores compared to CS group. 

Wrap It Up

Recent findings indicate that intra-articular injections of PRP yield superior results in alleviating pain and enhancing functionality in individuals with knee osteoarthritis, as opposed to CS injections.  During short-term follow-up, no significant difference was observed between knee injections of PRP and CS. 

However, the benefits of PRP injections primarily become apparent in the medium to long-term management of clinical symptoms, including pain relief, enhancing patients’ quality of life, increasing activities of daily living, and improving sports capabilities.

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 Coffee In The Morning & PRP Beats Cortisone In Meta-Analysis appeared first on Chiropractic Forward.

CF 361: Healthcare Expenditures & Sleep And Pain Today we’re going to talk about Healthcare Expenditures & Sleep And Pain But first, here’s that sweet sweet bumper music  

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

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

You have found yourself smack dab in the middle of Episode #361 Now if you missed last week’s episode, we talked about Selling Part Of The Clinic, Females Controlling High Blood Pressure, & Muscle Strength and Cardiorespiratory Fitness Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Sorry I missed last week’s episode. I have a trip to Atlanta for the big VOAtlanta voice over conference. If you’ve listened for some time, then you know that I moonlight as a voice actor. It started during covid and basically turned into a full time job on top of my full time job. It’s something that can be done in a robe in my basement. No overhead. No employees. Just a microphone, agents, managers, and clients if you can get ‘em! So, considering the money that can be made in VoiceOver, it’s worth chasing and exploring. I’d be a fool not to. I’m not in my 5th year of vo and have reached the level that a lot voice actors strive for. I have a national agent out of Beverly Hills and I have a management company out of New York City. Both are achievements that any vo is hungry for so I am super grateful and have been blessed beyond description.  In addition to these, I have accumulated around 10 regional agencies as well. On top of that, I’m on several rosters for producers and marketing agencies across the country. 

You can probably feel that this isn’t really a hobby. It’s a thing and it’s a thing that keeps growing so it’s pretty exciting. To the point that I have auditions coming in as I type this right now!  VOAtlanta is the country’s largest gathering each year of voice talent from across the world. Not just the USA. There were folks from Ireland, England, New Zealand, Venezuela and more. All over. There are typically around 1,000 or more vo folks at the Atlanta show.  As you might imagine, there are a lot of regular ol’ folks like me there but there are also what you would picture Los Angeles, Hollywood, eccentric creatives to be. It’s a mish mash of folks from all walks and you what? It’s pretty cool.

Of course I hang out with folks more like me the most but I’ve made friends from all walks of the world and it’s a pretty cool thing overall. 

So yeah, that was last week and this week is a chiro conference in Lubbock, TX. In the words of Ferris Bueller, life moves pretty fast my friends, if you don’t stop and look around, you might miss it.  I’ve been very active in the Texas Chiropractic Association for years and years now.

Probably since about 2008. So, about 16 years now. I’ve served on the Board, as the PI chair, as the chair for fundraising, and as the Director of Dept of Scientific Affairs. Which is all cool and all very useful but what I got out of it and still get out of it, is far beyond anything put into it.  I have friends that I call family from all over the State of Texas. Some are in pretty influential positions in our industry. Any time I have an issue, I have a network of plugged-in friends that can help guide me and advise me and you can’t beat that with a big ol’ stick, my friends. That means something. 

Also, I misspoke last episode when I mentioned bringing in a private equity partner.

They technically are NOT a private equity partner. They are a true partner that invests in the clinic and helps you grow it in size, capability, and finances.  We have been doing weekly 1 hour transition calls to get ready for the sale and all that goes with it. We are excited. It’s going to be work but, once the work is put in for the first few months, then we should be hitting the cruise control and watching things grow as some of the responsibility is gradually taken off of my shoulders.  Maybe I’ll start to breathe and sleep better. Won’t that be nice?? I’ll keep you updated as we go through the process. 

Item #1

Our first one this week is called, “Fatigue, sleep disturbance, and pain interference in children and adolescents with chronic pain: a longitudinal study” by Roman-Juan et al and published in Pain in April 2025…..hell that so en fuego, it hasn’t even happed yet!! Remember, the citations can be found at chiropracticforward.com under this episode. 

Roman-Juan, Josepa,b; Ceniza-Bordallo, Guillermoc; Sánchez-Rodríguez, Elisabeta,b; Jensen, Mark P.d; Miró, Jordia,b,*. Fatigue, sleep disturbance, and pain interference in children and adolescents with chronic pain: a longitudinal study. PAIN 166(4):p 927-935, April 2025. | DOI: 10.1097/j.pain.0000000000003432

Why They Did It

How They Did It

What They Found

Findings revealed that sleep disturbance, pain intensity, and pain interference co-occurred at both time points.  Higher levels of sleep disturbance, pain intensity, and pain interference at first assessment predicted higher levels of sleep disturbance, pain intensity, and pain interference at follow-up, respectively.  Higher levels of pain interference at first assessment predicted higher levels of sleep disturbance at follow-up while controlling for initial levels of sleep disturbance.  Furthermore, fatigue was found to mediate the association between first assessment and follow-up sleep disturbance, the association between first assessment and follow-up pain interference, and the association between first assessment pain interference and follow-up sleep disturbance.

Wrap It Up Basically, this study used a fancy math model to look at how sleep problems, pain levels, and the way pain affects daily life are connected over time.  They checked these things at two different points and found that if you had more sleep issues, stronger pain, or bigger problems because of pain at the first check, you’d likely have more of those same issues later on.  Also, if pain was messing up your life a lot at first, it could make your sleep worse later, even if you account for how bad your sleep was to begin with.  On top of that, feeling tired seemed to play a role in linking these problems together—so it helped explain why early sleep or pain issues led to worse sleep or pain problems later. In the ortho diplomate I went through, it was very clear in the curricula and in the research that a big component of pain, regardless of age, is a lack of sleep and if one were to engage in more sleep, they tend to suffer less pain. Ideal sleep was somewhere around 7-8 hours for adults. More around 9+ hours for kiddos if I recall correctly.  So, turn the phone and the TV off and get some damn sleep people! 

Item #2 Our second and last one this week is called, “Comparative Analysis of Individuals With and Without Chiropractic Coverage Patient Characteristics, Utilization, and Costs” by Legorreta et al and published in JAMA Internal Medicine in October of 2004. Not hot but definitely worth covering.  Legorreta AP, Metz MD, Nelson CF, Ray S, Chernicoff HO, DiNubile NA. Comparative Analysis of Individuals With and Without Chiropractic Coverage: Patient Characteristics, Utilization, and Costs. Arch Intern Med. 2004;164(18):1985–1992. doi:10.1001/archinte.164.18.1985

Why They Did It Back pain accounts for more than $100 billion in annual US health care costs and is the second leading cause of physician visits and hospitalizations.  This study explores the effect of systematic access to chiropractic care on the overall and neuromusculoskeletal-specific consumption of health care resources within a large managed-care system.

How They Did It A 4-year retrospective claims data analysis comparing more than 700 000 health plan members with an additional chiropractic coverage benefit and 1 million members of the same health plan without the chiropractic benefit.

What They Found Members with chiropractic insurance coverage, compared with those without coverage, had lower annual total health care expenditures ($1463 vs $1671 per member per year).  Having chiropractic coverage was associated with a 1.6% decrease in total annual health care costs at the health plan level. Back pain patients with chiropractic coverage, compared with those without coverage, had lower utilization (per 1000 episodes) of plain radiographs, low back surgery, hospitalizations, and MRIs.  Patients with chiropractic coverage, compared with those without coverage, also had lower average back pain episode–related costs ($289 vs $399).

Wrap It Up Access to managed chiropractic care may reduce overall health care expenditures through several effects, including 

Systematic access to managed chiropractic care not only may prove to be clinically beneficial but also may reduce overall health care costs. Tis study was led by an MD and this study was published in 2004. Later, in about 2016/17, in Qaseem et al, the American College of Physicians published their recommendations for first line therapies for back pain, both acute and chronic. They included SMT, exercise, massage, acupuncture, and low level laser. All things that are encompassed by chiropractic care.  Why is the wheel turning so damn slowly? They say it takes 15 years for research to come out and for it to trickle down to the PCPs and it to become regularly and widely implemented. Well, that was 20 years ago. And here we are.

Still struggling like that squirrel trying to get a nut. It’s exhausting isn’t it? Still, it’s better in 2024 than it was in 2004. No doubt. Progress moves slowly. Especially when you have a loud, obnoxious factions of your profession trying desperately to hold you back in 1897.  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 Healthcare Expenditures & Sleep And Pain appeared first on Chiropractic Forward.

CF 360: Selling Part Of The Clinic, Females Controlling High Blood Pressure, & Muscle Strength and Cardiorespiratory Fitness Today we’re going to talk about Selling Part Of The Clinic, Females Controlling High Blood Pressure, & Muscle Strength and Cardiorespiratory Fitness But first, here’s that sweet sweet bumper music  

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

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

You have found yourself smack dab in the middle of Episode #360 Now if you missed last week’s episode, we talked about ‘Do physicians follow guidelines and updated chiropractic trends’. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I just returned from a trip to Ft. Worth for a business thing. I mentioned last episode that I am potentially selling 60% interest in the clinic here to a private equity group out of Houston.  You know, selling 60% of your blood sweat and tears over the course of 25 years or so….that’s a hard thing to come to terms with. But, when you consider some factors, it starts to shine up like a bright shiny penny.  For example, I live in Amarillo, TX.

While I love my city, there aren’t a ton of chiros busting down the gates to be established here. If I wanted to sell my practice on the market by myself, I’d be hard pressed to find a buyer. If I DID actually find a buyer, I don’t think I could get what I’d want for it at all.  How many stories do I need to hear about chiros that are ready to retire not being able to sell their practices so they’re basically just SOL and have to shut the doors and get nothing for their years of work? How many of those do I have hear before I actually take them to heart and believe them?

This group is offering more for 60% than I believe I could get for 100% on my own. Basically.  Another thing is that I’m 52 and while I am young for retirement when we consider other professions, I am getting to an age that a full day take more of a toll on my body and my energy than I’d like to admit. When I see 45 patients in one day at 52 vs when I was 42….there’s just a damn difference. 

Here’s the most important factor; I’ve had COVID 5-6 times now and I’ve only missed 1 day of work. I know some of you are clutching pearls right now but I didn’t always know at that exact time that I actually had COVID and just to safe, I always wore a mask and was OCD about keeping my hands clean. 

The point is; that’s not fair to me, it’s not fair to my patients, it’s not fair to my family, and it’s not fair to my employees that LITERALLY EVERYTHING depends on my presence in the clinic. IF I’m out, everything suffers. I’m a fool and I’m irresponsible if I don’t do everything I can to make this clinic and the lives of my people more stable.  If I get sick sick, if I need a surgery, if I break a bone…..everybody is wondering if they need to find a new job.

We can’t have that and bringing in a partner is how we’re going to be bigger, stronger, and more stable.  They’re going to help me bring in an associate, when the finances make sense, they’re going to help bring in a PT, and they’re going to help bring in pain management services. 

When you combine these with the fact that we already have a young and slowly building medical brand, acupuncture, massage, etc….these things should all contribute to a very well-rounded, comprehensive clinic that can run should I happen to be absent. 

And lastly, I want to travel while my hips and knees allow me to travel. I want to paint and sculpt and make music and do my voiceover and do more of the things that feed my soul. Instead of ONLY the things that feed my family. I need more of a mix. The longer I live, the less time I have to live.  So it’s time to make a move and make it count.  See? When you really start to break it down and put it into context, selling 60% doesn’t seem quite so awful now does it?? 

Plus, the clinic doesn’t change. We’re already successful. They don’t want to change what make my clinic what it is. They just want to add to it and optimize what we’re already doing so well.  Yes please. And pay me while we’re at it and allow me to get off of the damn hamster wheel I’ve been on for 27 years. 

So….that’s what’s up with me. Ft. Worth was an owner’s meeting for this group and I met with and made friends with chiros and PTs and MDs from around the state of Texas.  All of them except for one, when I asked them if they were happy and would they sell part of their clinics again…..all but one said absolutely and if I’d have known about them sooner, I’d have done it sooner. And I have two good TCA buddies that have been with this group for over 3-4 years or so and they say they’re working less and making more money and would absolutely do it again. 

There you have it. I’ll talk more about this as I go through the selling process but now you know my thinking on it and why, for me, the price is right and why we’re doing it.  More to come.

Here’s this week’s research.

Item #1 Our first on today is called, “Hypertension Management in Women With a Multidisciplinary Approach” by Nobakht et al and published in the Mayo Clinic Proceedings in March 2025 and that’s This Month kind of HOT!!

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

Hypertension Management in Women With a Multidisciplinary Approach Nobakht, Niloofar et al. Mayo Clinic Proceedings, Volume 100, Issue 3, 514 – 533

Why They Did It Current clinical practice guidelines were established by several organizations to guide the diagnosis and treatment of hypertension in men and women in a similar manner despite data demonstrating differences in underlying mechanisms. Few publications have provided a contemporary and comprehensive review focused on characteristics of hypertension that are unique to women across their life spectrum. 

How They Did It We performed a computerized search using PubMed, OVID, EMBASE, and Cochrane library databases between 1995 and 2023 that highlighted relevant clinical studies, challenges to the management of hypertension in women, and multidisciplinary approaches to hypertension control in women, including issues unique to racial and ethnic minority groups Basically they found the following:

They say 626 million women are living with hypertension and in the US, nearly 1 in 2 adults has it.  Hypertension is more prevalent with black women at 45.3% followed by white, hispanic, and asian all very close to each other in the 31% range. 

Some risk factors are oral contraceptives, salt sensitivity, and endocrine conditions. Pregnancy, of course. Menopause as well.  Some of the multidisciplinary recommendations are as follows:

DASH diet

Weight loss

Physical activity

Stress management

Adequate sleep

Limiting alcohol consumption

Smoking cessation

Recommendations of the review are:

Item #2

The second one this week is called, “Comparison of Muscle Strength and Cardiorespiratory Fitness in Relation to Cardiovascular and All-Cause Mortality: The Copenhagen City Heart Study” by Schnohr et al and published in Mayo Clinic Proceedings in March 2025 and it’s all so damn hot. 

Comparison of Muscle Strength and Cardiorespiratory Fitness in Relation to Cardiovascular and All-Cause Mortality: The Copenhagen City Heart Study Schnohr, Peter et al. Mayo Clinic Proceedings, Volume 100, Issue 3, 488 – 498

Why They Did It To compare the association between muscle strength (MS), cardiorespiratory fitness (CRF), and all-cause and cardiovascular disease (CVD) mortality.

How They Did It The Copenhagen City Heart Study is a prospective longitudinal study comprising a random sample of adults; they excluded participants with a history of coronary heart disease or cancer, leaving 9,896 men and women for analyses.  A self-administered questionnaire at baseline documented self-rated muscle strength and cardiorespiratory fitness, categorized as low, moderate, or high.  Muscle strength was measured in 3,299 participants by a hand grip strength of the dominant hand with isometric dynamometry.  Multivariable adjusted analyses were performed adjusting for potential confounders.

What They Found During follow-up of 27 years, 4,971 all-cause deaths and 2,128 cardiovascular disease deaths occurred.  Compared with moderate cardiorespiratory fitness, high cardiorespiratory fitness was associated with lower all-cause mortality and lower cardiovascular disease mortality.  There were approximately 10% higher risk reductions for cardiorespiratory fitness than for muscle strength in comparing high with moderate levels for both all-cause and cardiovascular disease mortality; comparing moderate with low levels, cardiorespiratory fitness was 19% better than muscle strength for decreasing risk of all-cause mortality and 33% better for reducing cardiovascular disease mortality.  The self-rated muscle strength reports corresponded well with the hand grip results.

Wrap It Up Both cardiorespiratory fitness and muscle strength are inversely associated with cardiovascular disease mortality and all-cause mortality, but of the 2, cardiorespiratory fitness confers stronger protection. 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      

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