CF 203: Reduced Access To Chiropractic & The Ideal Diet Today we’re going to talk about reduced access to chiropractic and we’ll talk about the ideal diet.  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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #203 Now if you missed last week’s episode, we talked about Pain And Clumsiness & Treatment Escalation. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

The resurgence continues in my clinic’s numbers. I believe we had 26 new patients this last week and about 183 or so patients. Our Nurse Prac is still building slowly. Honestly, a little slower than I expected. He is averaging around 15-20 appointments per week. Some are as simple as trigger points. Some are as extensive as hormone pellets and PRP injections. I’m telling you I’ve railed against cortisone injections for years and I still do. But lidocaine trigger points …..now that’s a different deal. I’ve been floored at how much they can make a difference for some of my patients that have been on the more pesky side with regard to some nagging pain.

Good stuff and it’s a $50 cash service so it’s not out of reach for most patients and it seems, so far, to be very effective for most. 

As with everything in life, nothing can stay good for too long, can it?

It seems the answer is no. It can’t. I left work on Friday after a great, busy, fairly stress-free week. As I was walking out the back door, my front desk employee for the last year and a half or so gives me her 2-week notice. Yep, we just got everything up and running and kicking some butt, and boom.

There are lots of reasons behind the scenes as to why she made the decision but the end story is that there was a bit of internal conflict, we’ve had some difficulties in the past with how this person handled some patients or situations, and….though we’ll miss this person’s incredible attention to detail, it’s probably a good move for all involved. We wish her the very best.

She’s a great person and a hard and dependable worker. Just a bad fit I suppose 

Now, you all know how valuable a front desk employee is. They are simply hard to replace but, it is what it is. Fortunately, and you all might listen up here, my wife took classes and became a front desk billing guru. So, she can train new front deskers, She can get them up to speed quicker than anyone I know because she’s smarter than anyone I know.  I mention this because my wife being trained so well takes a lot of burden off of us when it comes to replacing the front desk staff. It’s going to happen sooner or later and why be held hostage by employees because the owners don’t know what’s going on?

Now let’s be honest, I don’t know the front desk. That’s why at one time in my career, I absolutely WAS held hostage by the front desk. That’s why, several years ago, I found out that I lost an incredible amount of money over a 3-year time span. And when I say ‘incredible’, I’m talking around $750,000 over three years. I don’t like saying it but I’m always honest with you all. That’s the best way to be a coach or mentor or adviser.

It’s with honesty.

It wasn’t stolen or embezzled. It just wasn’t collected on and then the time passed to where it could no longer be billed and collected on. So…all of that work was just gone.  It’s not every day you find out you’ve lost around $750,000. Time and Bud Light helped me through and I’m doing OK today. You have to move beyond the things that will bring you down and keep you down if you allow them to.

But yeah, that’s why you can’t be held hostage by employees.  That’s also exactly WHY my wife got trained. So that we’d never be in that position again. And….we aren’t this time either.  We have the luxury of being able to pick and choose by personality type rather than strictly experience because we can train the skills ourselves.

So, to Indeed we go. Wading through hundreds of resumes that won’t show up when we schedule interviews. It’s insane. But, it’s a necessary evil and, I’m a Christian, so we pray for the perfect person to be led our way.  What do you need in a front desker? Personality! They are the first impression a person gets when they call on the phone. They are the first person a patient encounters when they get there and the last person they encounter on the way out. That’s as important and vital as anything.

Pain is weird and responds differently in everyone. so I don’t care if someone leaves feeling better immediately. Obviously that’s the goal but not the most important thing. What I really care about is how they feel about their experience being in our clinic and how they felt about the people they came into contact with while they were there. THAT’s what matters the most. Especially in the first visit or two. 

They can be practice builders and they can be practice killers.

This one, very key person. So…..let’s make it count shall we?? Let’s dive into the research this week. 

Item #1

This first one is called “Evaluation of Dietary Patterns and All-Cause Mortality: A Systematic Review” by English et. al. (English LK 2021) and published in JAMA Open Network on August 31, 2021, and that’s hotter than that the Texican sun in the Summer. 

Why They Did It

They wanted to answer the question, “What is the association between dietary patterns consumed and all-cause mortality?”

How They Did It

What They Found

Wrap It Up

Despite the different approaches, study designs, dietary assessment methods, geographical regions, and dietary pattern labels, the evidence demonstrated that dietary patterns associated with lower all-cause mortality risk were consistently characterized by higher intake of vegetables; legumes; fruits; nuts; either whole grains, cereals, or non-refined grains; fish; and unsaturated vegetable oils.  These patterns were also characterized by lower or no consumption of animal products (red and processed meat, meat and meat products, and high-fat dairy products), refined grains, and sweets (ie, higher in added sugars).  Labels that were assigned to the dietary patterns varied widely (eg, Mediterranean, prudent, Healthy Eating Index, DASH, and plant-based), highlighting that high-quality diets with nutrient-dense foods are associated with better health, regardless of diet type or dietary pattern name.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2783625?guestAccessKey=cea01652-195e-4ee2-ac19-d204e60b224f&utm_content=weekly_highlights&utm_term=091221&utm_source=silverchair&utm_campaign=jama_network&cmp=1&utm_medium=email

Item #2

This second one is called “The Effect of Reduced Access to Chiropractic Care on Medical Service Use for Spine Conditions Among Older Adults” by Davis et. al. (Davis M 2021) and published in the Journal of Manipulative and Physiological Therapeutics in June of 2021 and toastier than a hot toddy!

Why They Did It

The purpose of this study was to examine the extent to which access to chiropractic care affects medical service use among older adults with spine conditions.

How They Did It

What They Found

Two syllables – one word…..Day-um. 

That’s a metric crap-ton of green cheese. A gob of Benjamins. A Gaggle of American greenbacks. 

https://pubmed.ncbi.nlm.nih.gov/34376317/

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

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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  

Bibliography

The post Reduced Access To Chiropractic & The Ideal Diet appeared first on Chiropractic Forward.

CF 202: Pain And Clumsiness & Treatment Escalation Today we’re going to talk about pain that causes clumsiness and we’ll talk about treatment escalation.  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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #202 Now if you missed last week’s episode , we talked about breast plan illness and treating chronic pain centrally. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Things may have leveled out last week. We shall see. Still busy as can be but instead of 215 in a week, I believe last week was more around 185. This is exactly what we averaged weekly before COVID so I can live with that. I didn’t feel 100% overwhelmed. Tired, yeah. But not overwhelmed.  Let’s talk about the staff.  Have you ever hired a staff member that started out as a kid and just blossomed into something pretty darn special? Wouldn’t it be nice if we could predict these things? Unfortunately, hiring can be a bit of a crapshoot. The ones that look the best turn into clowns. Then you have the ones that are meh and stay meh. Then you have the ones you kind of aren’t sure about and they either sink or swim.  I found a swimmer.

I hired the daughter of one of my long-time friends. I didn’t want to hire her because I didn’t want to treat her differently because of my friendship with her mother and I also didn’t want to risk losing a friend because a problem popped up and I had to fire her daughter. Or something of that nature. You never know what’s going to happen but that was my thought process.  Anyway, she was the best applicant so I hired her. I had an office manager that had been there for roughly 11 years. She trained her up well. Her only job had been with Kohl’s so she’d been in retail and was only about 19 I think. Maybe 20. She was a kid. It took her a bit to settle in I think but once she did, she blossomed.  Fast forward a year or two and my long-time office manager got an offer for more money and she took it. This could have been catastrophic. But then this girl the had started as a kid stepped up and said, “I got it.” 

And no kidding…..she had it. She started marketing. She started setting up meetings with the staff where the weekly meetings and training had kind of fallen off. She started going to networking events. Now, a year after taking over as office manager, she’s the ‘go to’ for the entire office, she’s worked every position including billing and the front desk, and at 23 years old, I have every bit of confidence in that girl.  I told that story for no real reason but to just say ‘isn’t it a bit hinky?’ Wouldn’t it be nice to be able to bottle that up and figure out how to tell who’s going to crash and who’s going to soar? I know everyone has a different opinion on relationships in the office but my opinion, and my personality, is for my staff to be funny, professional, a little bit ornery, and a bit like family.

I care about my staff.  I root for them and they root for me. We tease each other non-stop but we are a family. I spend more time with those girls than I spend with my own family. That’s a big deal. Why would I want a boss-employee relationship with people I basically spend my entire life with? I’d rather them be bought in. Be like family. And when they’re no longer on my team, they’re still on the team to an extent because they became part of the family.  I could be wrong but of all of the people that have worked for me over the years, I can only think of maybe 3 that left on bad terms. Out of maybe 30 or more people.

That sounds like a high turnover rate but honestly, I’ve been in the job for 24 years almost and right now alone I have 13 employees. So, there have been plenty come and go over the years for different reasons. Going back to school, leaving to have babies, moving out of town. It is what it is. 

Most just don’t leave on bad terms and that’s the way I’d like to keep it. I hear horror stories about other chiropractors throwing fits, kicking furniture, yelling down at their staff, and basically acting like children in a grown-up’s body. That’s embarrassing for them.  Leaders come in all shapes and sizes but for me, funny, professional, friendly, respectful, and family sum it up. And love. I love most of the staff that has worked for me. Yes, I paid them.

But they also dedicated themselves to my clinic. That means something and I value it.  Alright, let’s hop in

Item 1    

https://www.frontiersin.org/articles/10.3389/fpain.2021.756771/full?fbclid=IwAR1LIiNtb03NVWKifKRNNnefXg2CYDjWcUynCfIFU3WcnoqzIX58m_Rzw3Y

This one is called “Does my neck make me clumsy? A systematic review of clinical and neurophysiological studies in humans” by Harman et. al. (Harman S 2021) and published in Frontiers in Pain Research on October 11, 2021 and that’s spectacularly steamy. 

Why They Did It

Clumsiness has been described as a symptom associated with neck pain and injury. However, the actuality of this symptom in clinical practice is unclear. The aim of this investigation was to collect definitions and frequency of reports of clumsiness in clinical studies of neck pain/injury, identify objective measures of clumsiness and investigate the association between the neck and objective measures of clumsiness.

How They Did It

Six electronic databases were systematically searched,  records identified and assessed including a risk of bias.  Heterogeneity in designs of studies prevented pooling of data, so qualitative analysis was undertaken. Eighteen studies were retrieved and assessed;  the overall quality of evidence was moderate to high.  Eight were prospective cross-sectional studies comparing upper limb sensorimotor task performance and ten were case series involving a healthy cohort only. 

What They Found

Clumsiness was defined as a deficit in coordination or impairment of upper limb kinesthesia.  All but one of 18 studies found a deterioration in performing upper limb kinesthetic tasks including a healthy cohort where participants were exposed to a natural neck intervention that required the neck to function toward extreme limits.

Wrap It Up

Alterations in neck sensory input occurring as a result of requiring the neck to operate near the end of its functional range in healthy people and in patients with neck pain/injury are associated with reductions in acuity of upper limb kinesthetic sense and deterioration in sensorimotor performance. Understanding the association between the neck and decreased accuracy of upper limb kinesthetic tasks provide pathways for treatment and rehabilitation strategies in managing clumsiness. In the Fellowship program for Neuromusculoskeletal Medicine, we actually learned a great deal about this.

Which is why I’ve included it this week. We know that when sensory information comes in if there is an alteration in the signal or in it’s processing, there will be alterations in the motor portion of the sensorimotor capability leading to aberrant movements and motion.  What if incidental pops and clicks were due to faulty sensorimotor and aberrant movement? It can be due to instability, sure. But it can also be to a smudged brain map. We know that when patients have chronic low back pain, the brain map can be smudged. Our brains have a map of our bodies.

Every joint, its capabilities, and it’s limitations. Chronic pain smudges that map. We also know that a large portion of our proprioception and sensory information also comes from our deep upper cervical muscles. In combination with the inner ear and eyes.  It doesn’t take a stretch of imagination to see chronic pain, either in low back or neck, or neck dysfunction being the source of issues for balance, proprioception, and accurate motor function.  It’s all fascinating, folks! Good stuff. 

Item #2

https://www.jmptonline.org/article/S0161-4754(21)00035-X/fulltext?dgcid=raven_jbs_etoc_email

This one is called “Risk of treatment escalation in recipients vs. non recipients of spinal manipulation for musculoskeletal cervical spine disorders; an analysis of insurance claims.” by Anderson et. al (anderson BR 2021) and published in June of 2021 so hot! 

Why They Did It

The purpose of this study was to evaluate the relationship between treatment escalation and spinal manipulation in a retrospective cohort of people diagnosed with musculoskeletal disorders of the cervical spine.

How They Did It

What They Found

Wrap It Up

Among episodes of care associated with neck pain diagnoses, those associated with other care had twice the risk of any treatment escalation compared with those associated with spinal manipulation.  In the United States, over 90% of spinal manipulation is provided by doctors of chiropractic; therefore, these findings are relevant and should be considered in addressing solutions for neck pain. Additional research investigating the factors influencing treatment escalation is necessary to moderate the use of high-cost and guideline-incongruent procedures in people with neck pain. So, how many times have you seen patients that had fusions that they should have never had?

Many or most times based on MRI images from MRI’s they probably should have never had. Conservative care first, folks.  Failure to respond to conservative care. Conservative care being spinal manipulative therapy, exercise, laser, massage, acupuncture, yoga, tai chi, cognitive behavioral therapy, and I will add one from the anecdotal observation that is backed by non enough research….and that’s spinal decompression. I’ve never seen anything like it for discs and radiculopathy. Plain and simple.  Once those have been tried and failed, then you look at meds. Then you look at injections. Then you look at surgery. 

Understanding that cauda equina and progressive neurological deficits are really the main reasons for surgery. Pain, by the way, is not a reason for surgery.  No cauda equina? No altered sensory, motor, or reflexes? No surgery. 

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 https://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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

Anderson BR, M. W., Long CR, (2021). “Risk of Treatment Escalation in Recipients vs Nonrecipients of Spinal Manipulation for Musculoskeletal Cervical Spine Disorders: An Analysis of Insurance Claims.” J Manipulative Physiol Ther 44(5): 372-377.

Harman S, Z. Z., Kendall J, Vindigni D, Polus B, (2021). “Does My Neck Make Me Clumsy? A Systematic Review of Clinical and Neurophysiological Studies in Humans.” Front Pain Res 2: 756771.      

The post Pain And Clumsiness & Treatment Escalation appeared first on Chiropractic Forward.

CF 201: Breast Implant Illness & Treating Chronic Pain Centrally

Today we’re going to talk about breast implant illness and then we’ll talk about chronic pain and new research around treating it centrally vs. peripherally.  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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #201 Now if you missed last week’s episode, we talked about the state of chiropractic through ChiroUp and Chiropractic Economics. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Last week, you heard me mention spending time in Chicago at the American Council of Chiropractic Consultants and Chiropractic Forensic Sciences conference. I also mentioned getting to hang out with Dr. Michael Massey and talked a little about who Dr. Massey is and what he does. What I failed to mention is that he and Dr. Rob Pape, together, started a practice management group called Practice Mechanics. Along with that, they have a Practice Mechanics podcast and they had me on as a guest recently.  It was a lot of fun and it was me answering questions rather than asking them. It was really just a great conversation about the profession, this podcast, the book I recently released, my future goals, and all kinds of other goodies. Go to the Practice Mechanics podcast and pull the trigger on episode 10. Then sit back and laugh at my dumb answers!  It really was a great conversation and I was fortunate to have Mike and Rob bring me on and lead me through it. These last couple of months have truly been a whirlwind. As mentioned, I was just in Chicago.

At the beginning of September, I was in Washington DC.  In August we integrated with the nurse practitioner. Late August we got an intern from Parker College. Future doctor Drake Gardner from the Tulsa, OK area. Good dude with a bright future. Then, about early September our new patient per month count exploded and rose back to where it was back before the Rona invaded our lives. In fact, I broke a record. We had somewhere around 85-90 new patients in September. In just one week I had 31 new patients. By myself. And I do a thorough exam. It’s not one of those vitalistic  “live and die by the subluxation” knock down the high spot exams.

It’s not one of those exams oh crazy Chiro out in Oklahoma that tries to teach others to do like 9 new patients exams and 99 patients in 3 hours with one table. Durrr.

It’s one you would expect from an Ortho Diplomate.  Anyway, the point is not to brag but to say damnit…., I’ve been cooking. And cooking hot with gas. And also to discuss what happens when you get so busy you are running the risk of not being able to keep up.

When your schedule is full I have been told you need to either hire help or raise prices to thin the herd. How do we feel about that? I don’t know. I’m a capitalist. I don’t like turning away business. But I’m also empathetic. I don’t want to price myself out of the market and I don’t want people to wait a week to come to see me.

And….it’s only been this way for about 4 weeks. Who’s to say it’ll be this way in six months? I could hire someone and they stop piling in and then I’m screwed.  The safer bet is to raise prices a touch. You can always backtrack that by simply putting them right back where they were.

But here’s what’s going to happen. Nothing.

I’m going to be overworked and half crazy for a while until I am 100% clear that the surge in business is here to stay. Then I’m going to try to hire an associate. And I’ll be overworked like crazy until that happens. So work work work is on my horizon. I will try my best to continue this podcast as long as I can.

Right now, I’m having to type it up on a Saturday night because I simply won’t have time during the week. We’ll see how it goes. Right now, my commitment to pumping new episodes out every week is strong. I’d offer a Patreon page and maybe try to generate some income from the podcast itself but guess what? I don’t have time!! Lol.

This all sounds doom and gloom but it’s all good. I’m blessed. I hope you are blessed as well. Griping about busy makes a guy feel guilty. But I’m not griping about being busy. I’m griping about being overwhelmed and having no time to do the things I need to do every week outside of hands-on patient treatment.  That’s really what it comes down to. So stick with me. I’ll keep doing what ai do and we’ll see what comes of it, my friends.

What I do know is that I appreciate you all. Your time and attention to this podcast make it worth every second. That all turned out a little fussier than I meant. I’m usually very positive and I am positive. I’m just sharing what’s going on. I think I’m in a transition period basically. These points that stress us force us into change. My responsibility is to make certain that the change is positive and productive. 

Let’s dive in!

Item #1

The first one is called “Assessment of Silicone Particle Migration Among Women Undergoing Removal or Revision of Silicone Breast Implants in the Netherlands” by Dijkman et. al. (Dijkman HBPM 2021) and published in JAMA Open on September 20, 2021 and that’s a lotta hot!

First, if you don’t know anything about this topic, I think you might be shocked. 

Secondly, let’s talk about why I would include this paper on this podcast.

What does silicone breast implant leakage have to do with us as chiropractors? Well, one of my Facebook friends was openly discussing silicone leakage and illness and how she was getting her removed, and what a miserable time she had been having recently due to this leakage.  I’d never heard of this being an issue so I started looking into it a bit. While some older research was pretty meh about it all, more recent research has shown an association between silicone breast implants and certain autoimmune diseases.  Healthline says, “These studies suggest that silicone breast implants potentially raise your risk of developing an autoimmune disease such as rheumatoid arthritis, Sjögren’s syndrome, scleroderma, and sarcoidosis.”

They also add, “The World Health Organization and the U.S. Food and Drug Administration have identified another possible  This relates breast implants to a rare cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Additionally, breast implants are known to cause other potential risks such as:

In addition to what Healthline shared, the body of this paper says, “Breast implant illness is used to describe various complications associated with silicone breast implants, ranging from brain fog, hair loss, fatigue, chest pain, sleep disturbances, irritable bowel syndrome, headaches, chronic pain all over the body, and autoimmune diseases, such as lupus and fibromyalgia.” How many of these people do we see every day? So, it’s been on my radar way out on the periphery and when I saw this paper come through JAMA recently, it made sense to put it on your radar screens as well. How many patients do we have that could potentially be going through this and just never made the connection in their minds?

Why They Did It

To evaluate the existence of silicone gel bleed and migration over a long time period, including the period in which the newer cohesive silicone gel breast implants were used.

How They Did It

What They Found

384 women (98.8%) had silicone particles present in the tissues, indicating silicone gel bleed.  In 337 women (86.6%), silicone particles were observed outside the capsule (ie, in tissues surrounding the capsule and/or lymph nodes), indicating silicone migration.  In 47 women (12.1%), silicone particles were only present within the capsule.  In 5 women (1.2%), no silicone particles were detected in the tissues.  Patients were divided into 2 groups, with 46 women who received cohesive silicone gel breast implants and 343 women who received either an older or a newer type of breast implant.  There were no differences in silicone gel bleed or migration between groups 

Wrap It Up

In this case series including women with noncohesive or cohesive silicone gel breast implants, silicone leakage occurred in 98.8% of women, indicating silicone gel bleed, and in 86.6% of women, migration of silicone particles outside the capsule was detected.  We did not see differences in silicone gel bleed or migration between women who received the newer cohesive SBIs and those who received noncohesive SBIs. So, now it’s on your radars and this info could give you another avenue toward helping your patients get out of pain. 

Item #2 Our last one today is called, “Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain: A Randomized Clinical Trial” by Ashar et. al. (Ashar YK 2021) and published in JAMA Psychiatry on September 29, 2021 and it’s bringing the heat! They say, “Approximately 85% of cases are primary CBP, for which peripheral etiology cannot be identified, and maintenance factors include fear, avoidance, and beliefs that pain indicates injury.” I talk to my patients every day all day about beliefs, hurt vs. harm, and fear avoidance. 

Why They Did It

To test whether a psychological treatment (pain reprocessing therapy [PRT]) aiming to shift patients’ beliefs about the causes and threat value of pain provides substantial and durable pain relief from primary chronic back pain and to investigate treatment mechanisms. PRT seeks to promote patients’ reconceptualization of primary (nociplastic) chronic pain as a brain-generated false alarm. PRT shares some concepts and techniques with existing treatments for pain rand with the cognitive behavioral treatment of panic disorder.

How They Did It

What They Found

Of 151 total participants, 33 of 50 participants (66%) randomized to PRT were pain-free or nearly pain-free at posttreatment,  That’s compared with 20% randomized to placebo  And 10% randomized to usual care.  Treatment effects were maintained at 1-year follow-up

Wrap It Up

The authors concluded, “Psychological treatment centered on changing patients’ beliefs about the causes and threat value of pain may provide substantial and durable pain relief for people with chronic low back pain.” This is why the American College of Physicians included cognitive behavioral therapy in their recommendations for first-line treatments for chronic back pain. You can have all of the issues you can imagine present on an x-ray but the main culprit resides in the noggin.  Ever heard of phantom limb pain? The pain lasted so long that the pain migrated more and more into the central, pain making part of the brain too.

They finally chopped off the peripheral problem; the limb. But it still hurt. They got rid of the peripheral source but did nothing to address the central source. THAT’S what we talking about when we mention the biopsychosocial aspect of pain. It’s no longer just a biomedical approach or issue. It’s much more when we talk about chronic pain. And it’s fascinating. 

Folks, it’s about the up-regulation or sensitized central nervous system in chronic pain patients. It’s about their beliefs about their current and future abilities. It’s about fear avoidance. It’s about de-conditioning. It’s about not understanding the difference between hurt vs. harm. It’s about them being mind screwed by healthcare practitioners that didn’t understand how to properly and optimistically relay findings and a diagnosis to them.  It’s about building them back up. 

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

Store

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

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

Tweets by Chiro_Forward

YouTube

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Stitcher:

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TuneIn

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About the Author & Host

Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

The post Breast Implant Illness & Treating Chronic Pain Centrally appeared first on Chiropractic Forward.

Today we’re going to talk about the state of chiropractic and we’re going to use a couple of more recent articles I’ve come across to do it. One from Chiropractic Economics and one from our friends at ChiroUp. It’s a good one today folks! 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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #200 Now if you missed last week’s episode, we talked about Fear Avoidance & Opioids and Neuro Changes With Cannabis Use In Adolescence. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I just returned from Chicago from the American College of chiropractic consultants and the chiropractic forensic sciences conference.  It was great I got to hang out with my forward-thinking chiropractic alliance buddy Mr. Dr. Michael Massey. He was probably tired of me by the time we got done hanging out and I had to go home. Honestly, we were there from Wednesday night through Sunday morning. That’s a long time to be hanging out with someone. Hopefully, I didn’t talk his ear off.  But I learned a lot about him and his history. He’s gotten to do a lot of cool stuff and I enjoyed learning more about it. Here in Amarillo, you don’t get a lot of really cool opportunities.  For example, Dr. Massey has gotten to be on the NASCAR circuit treating the drivers.

He’s been on the Rodeo circuit. He’s a certified coder. Which, let’s be honest, that’s not that cool really but, very impressive.  He’s gotten to teach and speak all over and just has a very interesting background. If you don’t know about Dr. Michael Massey from down around the Athens and Chattanooga area of Tennessee and of Practice Mechanics fame, make sure you go check him out.  Practice Mechanics is his and Dr. Rob Pape’s mentoring and consulting group.  Go look into practice-mechanics.com.  As far as the conference itself, it happens the first weekend in October every single year. At the same hotel. The Marriott in Oak Brook Illinois which is basically Chicago.

Just about all of the people there are pretty darn impressive and they’re on both ends of the spectrum from working for the insurance company to working for chiropractors and defendants.  They’re expert witnesses. They’re independent medical examiners. And, yes, some even work for the insurance companies. I have to tell you meeting them humanizes them to an extent even if we may not agree with every opinion they may have.  Most of the continuing education I get through the years involves a 16-hour weekend. I typically end up with 80 to 100 hours a year. Sometimes more, sometimes a touch less. But it’s usually quite a few hours through my activities with the Texas Chiropractic Association.  We have more than one event and I usually go to more than one event every year. At least a couple of the events. Then I have the orthopedic hours. And then I have the other stuff I learn and take here and there. So, I’m usually in the 80-100 hours per year range. 

This weekend was 27 hours of continuing education. These folks are serious about getting some CEs in, man. Crazy. Thursday went from 8 am until 9 pm. Friday was 8-6, and Saturday was 8-4. One-hour lunches. Class…..all day….every day.  On this deal, what had happened was….as my long-time listeners know, I got Board Certified, which means a Diplomate, also known as a Fellowship…..I got that in the Neuromusculoskeletal Medicine program in 2019. Dr. James Lehman with the University of Bridgeport contacted me last year. He said, “‘Ya know…since you already have the Neuromusculoskeletal Fellowship, you can get your Forensic Fellowship a lot easier since it’s a subspecialty of the Neuromusculoskeletal specialty.” That’s about the time that I responded with, “What’s that?” I had no idea what Chiropractic Forensics was. I thought I might be solving some sort of murder mystery or something. Anyway, Dr. Lehman explained to me that it was to bolster experience and credentials in the medicolegal arena. 

The original Fellowship took 300 hours to complete. Since Forensics is a subspecialty of it, this second Fellowship was only 100 extra hours for me to complete.  How do you say no? Well, you don’t. I did it. I got through it. And here we are. Two Fellowships within about 3 years. Where the hell did that come from? When it came to classwork, I didn’t thrive in the classroom. I hated the classroom. Sitting there for hours on end day after day…..yeah. I struggled. I was just a B student at chiropractic school. Not an overachiever. Not an underachiever.  I swore I’d never take another class. Forever and ever amen. And then, things changed. I got into research and evidence and all that good stuff. Hell, I got into learning again and I enjoyed it. I wanted to raise my game all of the sudden and there it went. And here we are. 

Old dogs can indeed learn new tricks, folks. So, keep moving forward. Keep learning. Don’t just knock down the high spots. We’re capable of so much more than that. 

Item #1

This first one is called, “Survey says 1 in 4 Americans would pay up to a $40 co-pay for chiropractic care” by the Chiropractic Economics staff (Staff 2021) and published on their site on October 6 of 2021. Hot tamale, hot tamale….get em while they’re good n hot.  It’s an article so let’s summarize and hit the high spots, shall we? They start the article by saying, “A recent survey of more than 2,000 Americans revealed that roughly 1 in 4 (24%) would “be most likely to pay a co-pay of $40 or less without hesitation.”

This survey was done by ATI Physical Therapy which they say is one of the nation’s biggest providers of PT services. I am unfamiliar with the group but their website says they have 900+ convenient locations They say that 33% of Americans think PT is among the outpatient services they would be most likely to pay a co-pay of $40 or less without any reservation or hesitation.  Other services they would be most likely to pay $40 or less for would be Urgent Care visits at 55%, regular screening or check-ups at 35%, prescriptions at 33%, and chiropractic at 24%. 

I became aware of this one from a post from Dr. Bobby Maybee in his Forward Thinking Chiropractic Alliance group. Also known as FTCA. If you’re not a member and you are evidence-based, patient-centered, I recommend you fix that situation and hop in there.  It’s a group you’ll want to just sit and lurk for a little while before you pop in and start spouting off. They, much like myself, have very little patience for the more vitalistic stuff in the profession. Once you get the lay of the land, you’ll find a group of very welcoming, friendly, productive, and very helpful doctors that you’ll be glad you became a part of. Great group. All groups have their issues but I’ve been a part of the FTCA for several years at this point and it’s a great group with great people. 

Anyway, As Dr. Maybee pointed out, Chiro Economics is looking at this information as a positive while he, and I by the way, see it as a negative. Patients value us at $40. Those that don’t value us at that price point value us as less than $40. Not a good thing. Especially when you’ve gone to the lengths to specialize and get board certified in one or more diplomates.  We’re specialists but still lumped in at $40/visit. And that’s by only 24% of Americans while PTs get 33%. When we know through Palmer/Gallup poll and other research that chiros are more cost-effective, with more patient satisfaction, and with better patient outcomes. 

The schiesters in the profession, I’m convinced, are the reason we aren’t further up the chain. And the lack of standardization. You don’t know what the hell you’re getting when going to a new chiropractor.  About the time I saw that article, I got a great email from ChiroUp (Bertelsman T 2021) with a summary of the ChiroUp dataset. I’m including the link to this in the show notes at this point in the transcript: https://chiroup.com/COPSsynopsis2021 They shared that the percentages of issues chiropractors see are as follows:

All of the extremities added up to about 14% of cases. It seems that having some extremity skills is a good addition to your toolbox but the bread and butter is the spine for chiropractors when you see that spinal issues add up to about 60% or more of the cases we see.  They say the most common chiropractic diagnoses are:

Those are the top five but I can tell you from the ortho diplomate that 40% of our low back cases are discs, 30% are facets, and 22.5% are SI issues. This information, when combined with ‘give me one finger and point to one spot where all of the pain comes from’….those two bits of information, for the vast majority of cases, will get you most of the way home for a heck of a lot of patients. 

With Lumbar facet being the top diagnosis code, it makes me wonder how good others are at diagnosing. Or….how bad I am. Do the extension/rotation test on a low back pain patient. If it doesn’t hurt, it’s about 94% or so that the issue is NOT a facet. That’s if the extension/rotation test is pain-free, it’s almost certainly not a facet issue. And a whole bunch of low back pain patients can extend and rotate without pain. So, I’m skeptical of how accurate these numbers are.  Also, a lot of times you see facet pain, it’s secondary to spinal instability. A new research paper recently estimated spinal instability at as much as 60% of low back pain cases.

That’s A LOT!!

You get those vertebrae rattling around a bit, you get sore facets. A clue is asking them if it hurts when they roll over in bed. If it does, why the hell would it hurt to roll over? There’s no weight-bearing on discs or anything like that. Instability may explain. McGill’s Big 3 plus Dead Bug may be your answer rather than continuing to mobilize segments that are already moving more than they should.  Maybe it’s weak hip abductors. If you’re not checking hip abductors with one-legged mini-squats looking for a medial deviation of the knee, then start looking. Weak hip abductors can be a missing puzzle piece to long-standing low back pain.

And, in ChiroUp’s top DXs per region, for the hip, the number one issue diagnosed is hip abductors. So some of you are doing a good job there.  On their top 3 knee dx’s we see that patellofemoral pain syndrome is #1. However, in our ortho diplomate, we’re taught that the most common knee issue is actually pes anserine. If you’ve never heard of that one, google it up and start putting a thumb on it when you have a knee issue and see what you find.  Here’s one I find quite a bit off-kilter. In the headache section, they have cervicogenic headache as the most commonly diagnosed issue. Now, understand, this is not ChiroUp’s fault. They’re simply reporting what people are diagnosing. ChiroUp is a literal game-changer and you should all be a part of it. I just want you all to be diagnosing better. That’s all.  The breakdown on headaches is as follows:

Regardless of the accuracy of diagnoses, ChiroUp reports patient satisfaction at a robust and most wonderful 92.7%. Kaya Pow! Understand that includes satisfaction with chiropractic case management for everything from plantar fasciitis and axillary nerve entrapment to the stuff that is in our wheelhouses like spinal pain and headaches.  Then we have that the average chiropractic patient’s likelihood refer others is at a delicious 96.7%. And that’s yummy to my tummy. Lip-smacking fantastic. 

They also share that the average improvement 30 days after initiating chiropractic care for all diagnoses is about 80%, Slap yer mama! That’s some good stuff.  Here was a particularly telling stat from a trial that suggested the percent of patients that resolved after only having standard medical care was only 17%.  That’s in contrast to 73% when chiropractic manipulation was added to standard medical care. 

ChiroUp then ventures into costs. They show a claims analysis of BC/BS of Tennessee’s low back pain claims data. It showed that care initiated with a DC saves nearly 40% on healthcare costs compared with care initiated through a medical doctor. 

Forty Freaking Percent!! Smack! KaChow! Slap!

They go on to say, “The choice of initial provider is significantly associated with the likelihood of subsequent surgery. A Spine journal study found that approximately 42.7% of injured workers who first saw a surgeon had surgery, in contrast to only 1.5% of those who saw a chiropractor.” Most of us have seen that one. I believe it was done by the state of Washington.  All of this while malpractice claims categorized by provider type shows that chiropractors come out on the bottom in a GOOD way.

We are the very least likely profession to have a malpractice claim against at only 0.6% of all claims.  And the Medical Associations always say all of their pushes are in the interest of public safety.  Are you sure? Incidentally, RNs suffered the most malpractice claims at 25.5% of the claims and physicians came in at about 16.1%. We’re way down there at 0.6%. Get out of here with that ‘public safety’ garbage.

Your comment has been found invalid and mostly stupid. 

Their conclusion says, “This 2021 COPS synopsis confirms that chiropractors demonstrate above-average performance for the essential healthcare consumer needs. Evidence-based chiropractors should play a vital role in the future healthcare model because of their ability to safely and cost-effectively deliver excellent musculoskeletal clinical outcomes with high patient satisfaction.” And they’re 100% correct.

They always are by the way. Dr. Tim Bertlesman and Dr. Brandon Steele are two of the brightest chiropractors and human beings you’ll ever meet in your life. The content they put out through ChiroUp is always right, always timely, always good, and always appropriate.  So there you have it, the state of chiropractic. We are absolutely amazing with effectiveness, patient satisfaction, outcomes, cost-effectiveness, and safety. Yet, only see a small percentage of the population, and those that we do see only see us as being worth about $40 per visit……or less.

Thank you, vitalists. Really appreciate you guys and girls.  Y’all are really special.  What a life it is to be a chiropractor. 

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 better it. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

Twitter

Tweets by 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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

The post The State Of Chiropractic Via ChiroUp & Chiropractic Economics appeared first on Chiropractic Forward.

Today we’re going to talk about fear avoidance behavior and opioids and we’ll talk about cannabis use in adolescence.  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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #199  Now if you missed last week’s episode, we talked about MRIs and Clinic Presentation & Surgery vs. Conservative Care For Discs. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

I’m headed to Chicago on Wednesday. I’m going to the American College of Chiropractic Orthopedics conference out there. When you have completed the Forensics course work as I have, you go to the conference and take the final test.  I’m just gonna lay it out there; I haven’t studied. I hope my memory is amazing. More amazing than I think my 49-year-old noggin actually is. In real life. I’ve gotten so damn busy lately, I couldn’t study if I wanted to. So, we’re going to Chicago, we’re hanging out and learning good stuff, and then we’re keeping our fingers crossed that I’m able to kick the Ol clunky car into the driveway and bring the second Fellowship back home to the Williams Estate. Ultimately, if I don’t knock it out, I’m better than I was before.

Honestly, at the price point for this one after having done the Ortho Diplomate, it was a no-brainer.  Just the part of the course that was the AMA course on Impairment was useful. It’s pretty cool how they’ve quantified disability for basically anything and everything.

Crazy crazy

As mentioned, the recovery of the clinic numbers continues. I’m the only Chiro in the clinic and I had 33 new Chiro patients just last week alone. It’s a challenge. I’m probably going to have to be looking to hire an associate sooner rather than later if this stays the way it’s been in the last month. Funny how about 6 weeks ago I was frustrated with the lack of significant recovery from the COVID era numbers. Delta was on the spike. I didn’t see anything but a longer tunnel before we saw the light.  I’m by no means convinced it’s over. But numbers are going down now. And even in the middle of the delta spike, people here were done. 100% done. Restaurants have been full. No masks and no special distancing. Concerts. The whole thing.

Kids in school with no masks.

We had a spike for sure. It didn’t get as bad as the last spike. But bad enough to get everyone’s attention. I lost some folks I know during this last one. One of my buddies is in his fourth week in the hospital with it right now.  But business is back regardless and I’m pleased to see it. 

If you’ve been following along on the NP thing, still slow going. As is expected. Slow growing, slow to get our message heard. Just slow. But busier The hormone pellets have been amazing. We’re doing the IV therapy, PRP injection, trigger point injections, medical weight loss, COVID testing,…..it’s been interesting to get a peek into this world we’ve been essentially locked out of.  Sitting here today though, not one patient on his schedule so, we talk to our current patient load. We introduce our NP to everyone. We make them all aware that he’s here and we remove barriers. Barriers like ‘fear of the unknown by just introducing him. It’s a challenge but it’s one we are fully engaged in. Stay tuned. I’ll keep you updated on our progress. 

Item #1

Item 1 this week is called “Association of Cannabis Use During Adolescence With Neurodevelopment” by Albaugh et. al. (Albaugh MD 2021) and published in JAMA Psychiatry on June 16, 2021, and it’s ablaze!

Why They Did It

To what extent is cannabis use associated with magnetic resonance imaging–measured cerebral cortical thickness development during adolescence?

How They Did It

What They Found

Wrap It Up

Results suggest that cannabis use during adolescence is associated with altered neurodevelopment, particularly in cortices rich in cannabinoid 1 receptors and undergoing the greatest age-related thickness change in middle to late adolescence.

Item #2

Number two today is called, “Anxiety and Fear Avoidance Beliefs and Behavior May Be Significant Risk Factors for Chronic Opioid Analgesic Therapy Reliance for Patients with Chronic Pain—Results from a Preliminary Study” by Silva et. al. (Marcelina Jasmine Silva 2021) and published in Pain Medicine in September of 2021 and it’s most certainly en Fuego on this day. 

Why They Did It

To describe differences between patients with chronic, non-cancer pain (CNCP) who were successfully able to cease full use of chronic opioid analgesic therapy (COAT), and those who reduced reliance on opioids,. How They Did It

What They Found

Wrap It Up

Results suggest that fear-avoidance beliefs and behavior play a significant role in refractory chronic opioid analgesic therapy reliance for patients with chronic non-cancer pain. We know this and you know this if you listen to this podcast with any regularity. We’ve covered it 100 times it seems. You should be having an ongoing conversation with your new patients about fear avoidance. 

A normal conversation that I have with new patients suffering from chronic pain sounds similar to this,

“Movement is healing. Motion is the lotion for the joints. Think about when someone has something as serious as surgery; they have them walking the halls that day or the next. Because movement is healing. 

Those that want a bottle of pills and some extra time to sit and wait for it to pass will be waiting longer and, sometimes, it never heals at all. Those that are getting back to their lives and working through the discomfort typically get better and have a better resolution of the injury. Know the difference between hurt and harm. When you’re injured, it can hurt getting back to the grind but that doesn’t mean it’s harmful. In fact, most of the time, hurt doesn’t mean harm.  Work through it and make it happen.  Most experts agree that pain lasting beyond 3 months is turning chronic and harder to treat. Taking control of chronic pain starts with understanding it so I’m going to give you an article I’ve written called Decoding Chronic Pain.

Please read it and we’ll talk about it on the next visit. In that article, there’s a recommendation for a book called “Back In Control” by David Hanscom, MD. He’s a fellow chronic pain sufferer and an orthopedic spinal surgeon. This book will give you some education and some techniques to help you with the cognitive aspect of pain, which my article addresses. You can throw acupuncture, massage, chiropractic, exercises, shot, and/or surgery at chronic pain but, many times, if you’re not also addressing the cognitive aspect of long-term pain, you likely won’t get where you want to be.

Are you familiar with the term ‘phantom limb pain’? How can a limb that is no longer attached and got burned up in an oven still hurt? It’s because they treated the peripheral source of the pain but did nothing to address the central, cognitive aspect of the issue. So the part of the brain that makes up the pain experience continues to make that pain experience happen. Even after it’s gone. That’s also why research has shown that when a chronic pain sufferer has absolutely perfect surgery for anything, they have a 60% chance of developing new chronic pain at the new site of insult or surgery. Because their pain-making mechanism is on high alert and uses pain as the protection mechanism. 

Part of improving and moving past it is to not avoid activities that you love and that feed your soul. If you start backing away from these activities, that’s called fear avoidance, and avoiding things can lead to deconditioning after only about 7 days for most. Not only that, but it takes a hell of a lot longer to re-condition.  So, fight back, move, hurt but work through it, and take control of this.  We’ll help you move, we’ll help work on balance, we’ll help with proprioception, we’ll help you discover what you’re still capable of doing. You do the exercises and move on your own at home.

Go for walks. Just move as much as you can.  Just know that you’re not stuck this way. Do you have any questions? OK, let’s get to work.”

Boom. That’s it.

Or something like that. Sometimes it’s shorter. Sometimes it’s longer and more involved. I’ve sat and talked to patients for an hour or more just to have them go and give me a 3 or 4-star review on Google because I didn’t get a good pop out of their back and they don’t feel any better after one visit. 

You know how it is.

That kind of stuff makes you want to stomp kittens and club baby seals but then there are those that you are able to save their lives on some level.

They’re the ones we’re here for so keep it all in the proper context and do the best you can every day.  Those are the ones that need us to be on top of our games.  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 better it. 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 & disabilities and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

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

Contact

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

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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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

The post Fear Avoidance & Opioids and Neuro Changes With Cannabis Use In Adolescence appeared first on Chiropractic Forward.

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

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

The post MRI’s and Clinic Presentation & Surgery vs. Conservative Care For Discs appeared first on Chiropractic Forward.

CF 197: Extruded Discs – Surgery or No Surgery? Today we’re going to talk about extruded discs – surgery or no surgery? This one may surprise some of you.  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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #197 Now if you missed last week’s episode , we talked about How Car Wrecks Contribute To Future Neck and Back Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

Alright, I’m feeling pretty good today. Last week was the very first time since February of 2020 that we hit the average weekly visit number that we were doing. I don’t know if that came out right. Before Rona, we were averaging 185 visits per week in 2019.  Rona came along and the best we’ve been able to eke out was about 160. Maybe 165. With the rollercoaster ups and downs of the Rona outbreaks, that number has been down but since February of 2020, it’s never been any higher than that.  Until last week. Last week, by myself, I hit 187. 23 of them were new patients. When you are evidence-based and patient-centered, you don’t hold on to patient unnecessarily for extended visits and treatment schedules so, unfortunately, you live and die by your new patient count. 

Fortunately for me, I’m to a point that new patients aren’t a huge concern. I always have my eye on the count, but it doesn’t give me anxiety these days. We are pretty established here in my community and it tends to mostly take care of itself. Thank my good Lord.  I don’t know if you’ve listened this long but back in February of 2020, the 14th to be exact, my wife and I took a trip to Key Largo. It was amazing.

I left a bustling, busy as hell practice to go on vacation. There was some concern about this COVID stuff but nothing crazy.  In fact, I remember asking my wife on the way to Florida if we should take a mask just in case they told us we needed one. She told me if I brought a mask, that she’d punch me in the nose. Lol. Yes, I have that kind of a wifey. She’s a feisty Texas woman, ya know.  After a week in The Keys, I came back to a ghost town. And then it got worse. I swore I’d never go on vacation again if it was going to tank my practice like that. Well, obviously, it was COVID. And it’s taken a year and a half to start to reclaim our lost business.

But, at 45 patients today as I type this and 5 of them being new patients, this week is looking good too.  Here’s the best news about it all; this is in the midst of a BIG resurgence of COVID here in Amarillo locally. They are adding numbers at the rate they were adding them back in the worst of times. But people are done with it. They just are.  I was one of the first group of providers to be vaccinated here locally. My friends and connections in the medical world here called me when it first came available. They recognized that we work in very close proximity with patients and reached out. Most of my staff and I accepted. I’ve been vaccinated since January 2021. 

I just got the booster on August 26th. It’s a personal thing for each of us but, when you have had a hit on your business like I have, and you’ve had all of the ups and downs, and you’re just now getting back to where you left off after basically losing a year and a half…….well, I’m not about to take a chance on getting sick and being out for 2-4 weeks and watching my business go to crap again.  Including me, I have 12 employees.

That includes 4 CA’s, 3 LMT’s, an NP, an acupuncturist, an esthetician, a billing pro, and I have an intern from Parker College here. These people have families, mortgages, bills, car payments, and gambling debts just to name a few things.  The point is, when you’re the main provider and breadwinner, for me, it’s up to us to be as responsible as we can to make sure we are able to do our jobs.  For example,  here in Amarillo, TX, we are fairly close to the Colorado and New Mexico mountains. About 3 and a half hours to NM and about 5 or so to Colorado. Pretty close. We grew up going skiing in the mountains.

But it dawned on my during my last trip a few years ago; they call them accidents for a reason.  If I fall and break a wrist or twist a knee up, I could be out of a job for up to 6 weeks or more. Well hell, in most cases, that’s more time out than COVID would take you out. I’m the major provider at this time for this clinic. I can’t allow that. So, I gave up snow skiing. It’s not worth it to me.  Why should the pandemic be looked at any differently? For me, it shouldn’t be.  Anyway, I got a little sidetracked there.

Things are going well. I’m hoping business is back to normal and stays normal. For me and for you. We have all fought hard and deserve it.  Now, let’s get some folks to feeling better shall we? Let’s hop into research having to do with large extruded discs.  Once upon a time, I would send them straight to a Neurosurgeon. Not so quickly these days. Knowledge and clinical experience tell me to think twice. Especially in the absence of progressive neurological deficits. 

Item #1

Item one is called “Spontaneous Regression of a Large Lumbar Disc Extrusion” by Ryu et. Al (Ryu Sung-Joo 2010) and published in the Journal of Korean Neurosurgical Society back in 2010. It’s got a little dust on it but not a ton.  

Why They Did It

They say that Although the spontaneous disappearance or decrease in size of a herniated disc is well known, that of a large extruded disc has rarely been reported. This paper reports a case of spontaneous regression of large lumbar disc extrusion. The disc regressed spontaneously with clinical improvement and was documented on a follow-up MRI study 6 months later. 

How They Did It

What They Found

Wrap It Up

CHIROUP ADVERTISEMENT

Item #2

Our last one is called “Spontaneously disappearing large herniated lumbar disc fragment”’ by Reddy et. al. (Reddy UV 2014) and published in the Journal of Orthopaedics and Allied Sciences in 2014. As impactful as this information is, why do you think there aren’t more studies on it that are recent? Could it because it suggests they shouldn’t be doing surgery on these large extruded discs?

Why They Did It There are reports of spontaneous regression of large extruded disc; however, the exact underlying mechanism and management of such cases remains controversial. We report a 40-year-old female who opted for conservative management for a large extruded lumbar disc. Follow-up magnetic resonance imaging (MRI) showed complete disappearance of the disc fragment; however, there were degenerative changes in the upper and lower adjacent margins of the vertebral body.  Herniated lumbar disc is one of the common causes of low back pain and smaller disc herniations tend to regress over a period of time; and thus, the pain is known to improve with conservative management. 

How They Did It

What They Found

The exact timing for spontaneous regression of the protruded disc material is not known; however, it ranges from few weeks to months. The fastest regression of the fragmented disc material was reported in 2 months.

Wrap It Up

Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so 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 https://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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

The post Extruded Discs – Surgery or No Surgery? appeared first on Chiropractic Forward.

Today we’re going to talk about How Car Wrecks Contribute To Future Neck and Back Pain. I have two different papers with what I thought were surprising conclusions in one way or another. Not only did I find themm a bit surprising but I don’t think the defense attorneys in PI cases will like either paper much. Just an assumption on my part. All of that coming up in this episode. 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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #196 Now if you missed last week’s episode , we talked about Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain. Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

We just ended our fourth week as an integrated practice and starting our fifth. It’s a struggle. I’m not going to lie. You see the money going out but you don’t see it coming in. That’s why, to pull this off, you need to be a busy Chiro and you need to have reserves in place.

Otherwise, it could be doomed. Unless you’re a hype machine. A marketing mastermind that fills the schedule before the integration even takes place. Let’s be honest, most of us just aren’t. I know the value of marketing. I know how to market on a fundamental level. But it’s hard. It’s hard to get your message out there and it’s hard to break through.

So, week one, maybe 4-5 appointments. Week two, maybe 18 appointments. Week 2 was about the same. Then last week was maybe only 8-9. So it’s up and down. We aren’t covering the salary but, we have reserves set back AND I’m fortunate enough to be busy.  The trick is just getting the message out and I feel like we’re doing that both externally as well as internally.

We have in-office brochures, flyers, and posters. Email marketing, social media, and all that good hoopla. It’s happening. We’re making it happen. 

In other news, I recovered from my five days in Washington DC. Geez. What a go-cation. It’s not the cost of taking a trip. It’s the cost of being gone. How much money you lose by not being in the office. That’s the real number and it just kills me!! So, I don’t think about it because I truly believe we need to be taking a trip once per quarter. You have to so you don’t lose your damn mind. It’s just a must.

Speaking of, I have a trip in just about three weeks to Chicago for business to finish off my Fellowship in Forensics. I’m looking forward to that and to networking with everyone involved with that whole side of the profession. Multiple streams of income folks. I do it inside the office as well as outside. Speaking, mentoring, authoring, medico-legal, Ortho fellowship, personal injury, family, triwest, acupuncture, massage, laser, esthetician, Texas Chiropractic Association, Texas Council of Chiropractic Orthopedists, Nurse Prac, and everything that falls under that.

That’s inside.

Outside is music, voice-over, art, real estate investing, and all kinds of other things I’m looking at.  What would it be like to just do a couple Of things?  Who knows? That’s just not me.  I make myself crazy but I honestly don’t know any other way. 

If you were thinking you could get into business for yourself and sit on the computer half the day fiddle assing on the computer, I got news. Your competition is out there getting Diplomates, certifications, and expertise to run circles around you.

Get busy.

Or wonder where all of those new patients are going since they don’t seem to be coming to see you.

Item #1

Alright, let’s hop in with our first one today called “Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis” by Nolet et. al. (Nolet PS 2019) and published in PM&R in November of 2019. In case you didn’t know, PM&R stands for physical medicine and rehabilitation. 

Why They Did It

They say in the abstract that neck injury resulting from a crash is associated with a high rate of chronicity. Prognosis studies indicate 50% of injured people continue to experience NP a year after the collision. This is difficult to interpret due to the high prevalence of NP in the general population. In other words, those that have not been in a car wreck still have neck pain, right? The stated goal of the authors here was to summarize the literature that has examined the association between a motor vehicle collision (MVC) related neck injury and future neck pain (NP) when compared to the population that has not been exposed to neck injury from a crash.

How They Did It

What They Found

Wrap It Up

They wrap it up by saying, “There was a consistent positive association among studies that have examined the association between MVC-related neck injury and future neck pain. These findings are of potential interest to clinicians, insurers, patients, governmental agencies, and the courts.” I see personal injury patients. This is good info for their reports, their file, and their attorneys if they’re represented. 

Item #2 This one is called, “Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis” by Nolet, et. al.  (Paul S. Nolet 2020)and this one was published in Accident Analysis and Prevention in 2020.  It’s not that hot but I’m using it anyway just because I like it and cuz I say so….

Why They Did It The purpose of this study is to summarize the evidence for the association between exposure to a motor vehicle collision (MVC) and future low back pain (LBP).

How They Did It

What They Found

Wrap It Up

There was a consistent positive association in the critically reviewed literature that investigated the risk of future LBP following an acute MVC-related injury. For the patient with chronic low back pain who was initially injured in a MVC, more often than not (63 % of the time) the condition was caused by the MVC.  Thats a lot right, folks? Look, it’s obvious to say an injury was caused by a car wreck. It’s common as a chiropractor to hear patients tell you that their neck pain started with a car wreck they had 20 years before. We hear it all of the time.  But for reals, 57% for the neck and 63% of the back?

That’s solid and flies directly in the face of the other side of the courtroom when they try to tell jurors that the forces experienced in a low-speed impact are about the same as stepping off of a curb on the street. This is, by the way, one of the most ridiculous things I’ve ever heard in my entire life but an argument that they most certainly use periodically.  Fools!!!! The fools we must suffer in life!! I’m sure plenty of folks refer to me in the same manner. It is what it is. Let’s all just try to be the least of the fools…., if that makes any sense at all. 

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 so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. 

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

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

  The Message

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

Key Point:

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

Contact

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

Connect

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

Website

Social Media Links

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

Chiropractic Forward Podcast Facebook GROUP

https://www.facebook.com/groups/1938461399501889/

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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger

Bibliography

Nolet PS, E. P., Kristman VL, Murnaghan K, Zeegers MP, Freeman MD (2019). “Exposure to a Motor Vehicle Collision and the Risk of Future Neck Pain: A Systematic Review and Meta-Analysis.” PM R. 11(11): 1228-1239.  

Paul S. Nolet, P. C. E., Vicki L. Kristman, Kent Murnaghan, Maurice P. Zeegers, Michael D. Freeman (2020). “Exposure to a motor vehicle collision and the risk of future back pain: A systematic review and meta-analysis.” Accid Anal and Prev 142.          

The post How Car Wrecks Contribute To Future Neck and Back Pain appeared first on Chiropractic Forward.

CF 195: Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain Today we’re going to talk about spinal manipulative therapy vs. opioid therapy for Medicare-aged patients and we’ll talk about young elite pitchers, their hips, and pain. Stick around.  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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #195 Now if you missed last week’s episode , we talked about Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic.  Make sure you don’t miss that info. Keep up with the class. 

On the personal end of things…..

On the personal end of things, we just got back from Washington DC. It was a go go go whirlwind kind of thing that every single American needs to experience. It’s powerful. The buildings were meant to inspire and awe and intimidate foreign leaders. So what do you think they do to regular ol commoners like me and you? Pretty impressive. Even if you dislike most politicians like I dislike most politicians. Day 1 was getting there.

We got up at 4:00am to get to the 6 am flight. Got to DC by 1:30. Hopped onto the metro and boom, we’re at the hotel. If you’ve never experienced the DC Metro, hell that is reason enough to go all by itself. It’s a work of art and I’m constantly fascinated by it. You can go just about anywhere you want easily and in no time with no traffic. That doesn’t mean there no walking involved though. Bring a pair of walking shoes my friends. The first full day we logged over nine miles. The second full day was about 8 and a half miles. Same on the third. Bout 5-6 miles on the fourth day.  Unless you’re doing the bus tours and all, you’re in fir walking. Plain and simple. I’m always good for 5-6 miles. 9-10 in a day is a bit more than I want. I can do it, but it’s damn sure extra. But, we saw the Lincoln Memorial, WWII memorial, Vietnam Wall, Washington monument, White House, Capitol, air and space museum, natural history museum, American history museum, national art gallery with this hemisphere’s only Da Vinci painting, Mt Vernon, Arlington National Cemetery and the changing of the guard, Old Town Alexandria, and much much more.

It was a go-cation and I’m glad to be back home so I can sleep and get some rest. It’s bad when going to work is a vacation from your vacation.

Professionally, just getting into the swing of things with our Nurse Practitioner. He’s catching on slowly but surely. It’s happening. Never fast enough. But I see it happening. We’re also getting into the swing of things with our Parker Intern.  He’s a good guy. Seems to be a smart guy and seems to click right along with everything we do so all’s well there. It’s been fun teaching him. So, I’m still playing catch-up from being gone so let’s hop in.

Item #1

This first one is called “Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain among Older Medicare Beneficiaries”’ by Whedon et. al. (Whedon JM 2021) and published in Spine Journal on May 11 of 2021. Schiza!!! Es Caliente!  I just combined German and Spanish. Please make note. And recognize. 

Why They Did It

The objective of this study was to compare long-term outcomes for Spinal Manipulative Therapy (SMT) and Opioid Analgesic Therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP).

How They Did It

What They Found

Wrap It Up

Among older Medicare beneficiaries who initiated long-term care for cLBP with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher as compared to those who initiated care with spinal manipulative therapy

Item #2

I want to thank my friends at ChiroUp for finding this one. They’re always on top of it at ChiroUp. Don’t forget to use my code, Williams15 if you want to sign up with them for a discount! Number 2 this week is called, “Restriction in the hip internal rotation of the stride leg is associated with elbow and shoulder pain in elite young baseball players” by Sekiguchi et. al. (Sekiguchi T 2019) and published in the Journal of Shoulder and Elbow Surgery in September of 2019. Ahhhh the days of pre-pandemic. 

Why They Did It

Evidence is scarce concerning the relationship of physical dysfunction of the trunk and lower extremities with elbow and shoulder pain in young baseball players. This study aimed to examine the association of joint flexibility of the trunk and lower extremities and dynamic postural control with elbow and shoulder pain among elite young baseball players.

How They Did It

What They Found

Wrap It Up

Alright, that’s it for this week. Y’all go out and piss some excellence. Get involved in your state association and the ACA. Our profession needs evidence-based, patient-centered chiropractors driving the ship. So get in, get involved, and make the profession what you will.  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 https://www.chiropracticforward.com

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About the Author & Host Dr. Jeff Williams – Fellow of the International Academy of Neuromusculoskeletal Medicine – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger  

Bibliography

Sekiguchi T, H. Y., Yabe Y, Tsuchiya M, Itaya N, Yoshida S, Yano T, Sogi Y, Suzuki K, Itoi E (2019). “Restriction in the hip internal rotation of the stride leg is associated with elbow and shoulder pain in elite young baseball players.” J Shoulder Elbow Surg 29(1): 139-145.  

Whedon JM, K. A., Toler AW, Bezdjian S, Rossi D, Uptmor S, MacKenzie TA, Lurie JD, Hurwitz EL, Coulter I, Haldeman S, (2021). “Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain among Older Medicare Beneficiaries.” Spine (Phila Pa 1976).        

The post Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain appeared first on Chiropractic Forward.

CF 194: Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic Today we’re going to talk about how lumbar fusion compares to no surgery, we’ll talk about a 30 year study on discs, and we’ll talk about PT vs. Chiro  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 making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do. 

You have found yourself smack dab in the middle of Episode #194 Now if you missed last week’s episode , we talked about patellofemoral pain, sleep for pain, and physical disuse. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. OOOWEEEE…..If you’ve been listening, you know I’ve been goind through my second fellowship program. This second one is the Forensics fellowship. Several hours are taken on ChiroCredit. There’s a 20 hour course on the AMA Guides on Impairment. And there’s a 20 live course I’ll be doing to wrap this dude up. It’s in Chicago in October. Then I’m done.  Then, I can turn my full attention to making our new Nurse Practitioner famous locally, making sure our Parker intern is set up for success, and getting life back to some sense of normal.  I got the COVID booster shot last week and am headed to Washington DC for the Labor Day weekend. This will probably air just after I get back so updates on the scene in DC on the next episode. Hopefully the covid resurgence hasn’t made the experience a soup sandwich. We shall see.  I was 8 months out from when I got the vaccine. The booster came from a nurse practitioner friend of mine. The first shot I got back in December……I felt nothing at all. The second shot 23 days after that, my arm got sore. That’s it. Nothing else at all. This booster shot, my arm got sore as expected. I got it on a Thursday afternoon. She brought it over here to my clinic and gave it to us. Because she’s super sweet and more than awesome.  I went to work on Friday. I had almost 40 patients between 8 am and 1 pm and, while I didn’t necessarily struggle, I didn’t love life that day. I was tired. I really wanted to be in bed pretty much. I didn’t feel absolutely awful or anyhting like that. I just didn’t feel particularly good and didn’t really want to be here in the clinic, answering the same questions we always answer, and acting like I felt great and was a happy happy dude when all I really wanted was to just be in bed taking a nap.  Then I did go home and take a nap after work. I slept for a couple of hours and woke up feeling much better.  Then I woke up the next day and felt great again. No issues. All back to normal. People act like we are sheeple if we get it. Like we are the experiment. Maybe we are. I don’t give a damn. I have a thriving, successful practice with no partner or associate to fill the gap if I get sick and have to stay home.  First of all, I like feeling good. I don’t want to be sick. If I can do something that the data shows clearly prevents the virus and/or severe illness from the virus, I’m going to do it. When your clinic bills what mine bills each month, and you don’t care at all about losing that income for 2-4 weeks…..maybe a lot more than that…..then you can call me names. You can call me an experiment.  For me, I’m making smart business decisions. Not to mention the fact that after millions and millions of vaccinations globally with very few issues, I’m a hell of a lot more concerned about a proven killing and/or long-term debilitating virus like COVID than I am the vaccine.  So, my opinions and what’s right for me may not be right for you annd that’s OK. But I’ll be damned if anyone is going to act smarter, wiser, or more high and mighty than I because I got a freaking vaccine. Those that behave that way can straight up stick it in your ear or whatever other place you can think of.  On the other hand, if you got the vaccine, don’t be a jackhole if someone you know doesn’t want it. It’s new. People are scared of it. They’ve been misled in many situations. They’ve been misdirected on social media. It is what it is. You do you. Let’s all do us and realize we share this space. I’d a lot rather see disagreement with an undercurrent of love instead of disagreement with a smoggy fog of hate and disdain.  It’s 2021. Let’s all grow up and evolve.  Item #1 This first one this week is called, “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis” by Xu et. al. (Xu W 2021) and published in World Neurosurgery in February of 2021….hot mama, stand back.  Why They Did It They wanted to evaluate the efficacy and safety of lumbar fusion versus nonoperative care for the treatment of chronic low back pain associated with degenerative disk disease. How They Did It

What They Found The 2 interventions exhibited little difference in regard to short- and long-term Oswestry Disability Index and visual analog scale scores for back and leg pain, except that lumbar fusion might bring about lower additional surgery rate, and higher complication rate in the long term. Wrap It Up The present meta-analysis determined that fusion surgery was no better than nonoperative treatment in terms of the pain and disability outcomes at either short- or long-term follow-up. It is necessary for clinicians to weigh the risk of complications associated with fusion surgery against additional surgeries after nonoperative treatment. Item #2 This second one is called, “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study” by Saaksjarvi (Sääksjärvi S 2020) and published in Spine Journal in 2020. It’s steamy….but not that hot anymore.  Why They Did It The aim of this study was to investigate whether early lumbar disc degeneration (DD) in young low back pain (LBP) patients predicts progression of degenerative changes, pain, or disability in a 30-year follow-up. How They Did It

What They Found

Wrap It Up In young LBP patients, early degeneration in lumbar discs predicts progressive degenerative changes in the respective discs, but not pain, disability, or clinical symptoms. Hallelujah.  Item #3 This last one is called, “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation” by Nima Khodarkarami ´(Khodakarami N 2020) and published in Healthcare journal in 2020.  Why They Did It Given that there are costs and benefits with either PT or Chiropractic for the treatment of low back pain, the remaining question is in a short period of time which of these treatments is optimal?  A decision tree analytic model was used for estimating the economic outcomes. The findings showed that the total average cost in the chiropractic group was $48.56 lower than the PT group.  The findings also showed that the daily adjusted life years (DALY) in the chiropractic group was 0.0043 higher than the PT group.  Chiropractic care was shown to be a cost-effective alternative compared with PT for adults with at least three weeks of LBP over six months. 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 so 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 https://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 – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger   Bibliography Khodakarami N (2020). “Treatment of Patients with Low Back Pain: A Comparison of Physical Therapy and Chiropractic Manipulation.” Healthcare 8(1): 44.   Sääksjärvi S, K. L., Luoma K, Paajanen H, Waris E, (2020). “Disc Degeneration of Young Low Back Pain Patients: A Prospective 30-year Follow-up MRI Study.” Spine (Phila Pa 1976) 45(19): 1341-1347.   Xu W, R. B., Luo W, Li Z, Gu R, (2021). “Is Lumbar Fusion Necessary for Chronic Low Back Pain Associated with Degenerative Disk Disease? A Meta-Analysis.” World Neurosurg 146: 298-306.    

The post Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic appeared first on Chiropractic Forward.