CF 094: Forward ’19, Decompression Research, Curveball or Pitch Count?

Today we’re going to talk about my Forward ’19 experience, we’ll talk about decompression research, and we’ll cover some new research on whether it’s the curveball or the pitch count that injures young players on the baseball diamond. 

But first, here’s that sweet sweet bumper music 

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have rattled and rolled into Episode #94

Now if you missed last week’s episode on the bigger the disc the better and what early improvement in treatment tells you, make sure you don’t miss that info. Every episode offers some good take-aways so make sure you’re up to date and not falling behind the rest. 

I like to look at this podcast as an ongoing, fun way of learning and making each other just a little bit better every week so don’t just hop in for one episode. Stack them up one after another and, before you know it, you’re going to start retaining the info and you’re going to start recalling something we talked about down the road when you’re interacting with a patient and they ask you a question. 

You’ll see. Even though I’m the host, it happens to me. Someone will ask me a question and I’ll remember an episode we did on that topic and BOOM!! Pow!! There it is, the answer comes to me. Pretty cool. 

Forward ’19 – For you newbies here you’re probably wondering what the hell Forward ’19 is. A quick rundown is that it is a yearly seminar/conference that was born from an online Facebook group called the Forward Thinking Chiropractic Alliance aka FTCA. They have a website as well. 

The group is very much evidence-based or evidence-informed. Whichever is your preferred verbiage. The group has about 7800 or so doctors in it and they are interacting on a daily basis mostly to try and make each other better. Overall, it’s a good group. I’ve heard people griping because they see griping here and there in the group but, in general, it’s a very positive, very smart, and very helpful group. I encourage you joining it if you’re a doctor or student. 

Anyway, Forward 19 – What an event. The group puts on several events through the year but this is the key event put on by the FTCA every year. This is year #2. It was in St Louis at the campus of Logan Chiropractic College.

First thing is, holy smokes what a campus man. I bet they pay a fortune just to mow the grass. Just wow. The landscaping, the tower in the middle, and Purcer Center where it was all held. Just gorgeous. Having gone to Parker, that was the Chiro campus I’d been on and don’t get me wrong, Parker is impressive. I’d say Logan most definitely is as well. Kudos.

Speakers:

Gray Cook SFMA – SFMA stands for Selective Functional Movement Assessment – I have to admit that this was my first exposure to Gray Cook but it won’t be my last. I had heard of SFMA but was not all that familiar with it. I really enjoyed his talk and some of the concepts he puts forward. I can’t wait until I get through with my Diplomate program – hopefully in November – so that I can dive into Gray Cook’s stuff and just keep building on the knowledge pile. 

Greg Kawchuk – He is the Research Chair for the World Federation of Chiropractic. 

So, outside of the FTCA, I had little knowledge of Greg Kawchuk. But, Greg gave a speech at the World Federation of Chiropractic last year in Berlin that got some people a little fussy and some people elated. It definitely got the attention of chiropractors around the world to say the least. He gave the same speech last weekend in St. Louis and it had people on the edge of their seats. 

Backing up a bit, Greg is a dynamic speaker. One of the more humorous and engaging speakers I’ve seen in maybe forever. He’s immediately like-able and that make for a good speech from the top. The talk was all about putting the ACT back in Chiropractic. A play on the way the philosophy guys use the TOR and the TIC garbage. You know….the principled vs. un-principled hoohah. 

I happened to think that evidence-informed docs are the principled ones and if you need more info on why I think that, just go back about 3-4 episodes and listen to my podcast on the topic of Closing Patients. A principled, ethical person doesn’t carry themselves in that manner and the philosophy folks are much more likely to be out there closing patients than offering responsible treatment plans that are based on commonly accepted guidelines. In my experience at least. It’s always made me a bit hot under the collar when someone asks whether another chiropractor is principled or not. 

Makes me want to principle them in the forehead…..with a mighty slap. 

Anyway, putting the ACT back in chiropractic: he asked what are we doing right now? What are you doing right now to move the needle forward? To bring chiropractic into this current century we are in? He suggests we do a lot of sciencing and consume at least 1 science per day and I agree with him. 

Hell, here at the Chiropractic Forward podcast, we distribute about 3-4 sciences per episode so we almost got you covered for the whole week if you’re a regular listener. 

I think the part of his presentation that some took exception to was the part where he feels the evidence group may, at some point, consider a divorce from the philosophy geared group. He said it may not be an official divorce but could be very much a divorce in the way we act, carry ourselves, communicate with our patients, and things of that nature. 

He says, at the end of the day, it could be something similar to….. we went out for a pack of smokes and…..just never came back. 

Now, as you sit in your car or truck or your office hearing me say that, you can take that all in as you will. I’m going to tell you that, as a doctor that considers himself very much on the research end of things and very little on the philosophy end of it, and as a doctor that does everything he can to be ethical, honest, and all that…..it is so hard to sit and hear patients talking to me about being forced to sign of on a contract for thousands of dollars for a year long schedule for umpteen visits based on a curve correction that research suggests isn’t that big of a deal. 

It’s hard to hear about the knuckleheads in Oakland claiming they can reverse degenerative spurring by seeing someone 3x/per day for 3 weeks. It’s hard to watch Mr. man bun top not from the coffee house talking about fixing kids with no research to back his claims. 

It’s hard to hear about chiropractors scaring the crap out of patients with x-rays and convincing them that they are somehow damaged and in a dire circumstance unless they undergo 60 visits and another 3 sets of x-rays….

These are just a few of the stories. There are so so so many of them and at some point, I just don’t want to be associated with that anymore. At all. If that’s not understandable and that makes no sense to you and that makes you mad at me, well….I’d say I’m sorry but I’m just….I’m just not. 

Even though I don’t smoke in the physical meaning of the word, I think I went out for a pack of smokes and never came back about 15 years ago. 

Christine Goertz – If you are a regular listener of our podcast, you know Dr. Goertz has been on our show before and you know I’m a nerdy fan of her and her contribution to our profession. Any chance to listen to Dr. Goertz is a chance that should be seized upon. She’s a giant in our industry. 

Annie O’Connor – World Of Hurt – OK, I’m admitting something again. I wasn’t familiar with Annie O’Connor. Annie is fun and vivacious and really another very dynamic speaker but she is full of knowledge nuggets. The kind that you can really put to use. She spoke on how words can harm so how key communication can be for some patients. She talked about yellow flags and she talked about classifying pain patients so that we can help them with more efficiency. You can believe that World Of Hurt is on my reading list after Forward ’19. 

Greg Friedman – documentation  documentation. Greg is Greg. Smart, laid back, fun, and just likable immediately. It was great to get to meet him in person and share a good discussion prior to his documentation class. He’s full of excellent information and not just on documentation so, if you get a chance and you need the hours, search out a class. He’s flying all over the nation every weekend. 

Mike Massey – he shared teaching duties with Greg on the documentation class. He told me he’s a listener of our podcast and he’s an active member of the FTCA so I’ve been a fan of his for a while now. It’s always a cool deal to put the online world into a 3D context and it was sure nice to meet Dr. Massey. Hopefully next time I’ll get to sit and speak a while with him. I think our personalities probably match up pretty closely from what I can tell. 

Some of the others I got to see and speak with are Brandon Steele

Kevin Christie

Jon Morrison

Robert Jones, President Of The ACA was there the whole weekend sitting in on the classes himself. What a super guy.

Budweiser tour

Meeting people

Kris Anderson

Chris Howson

Rob Pape

Bobby Maybee

Bobby Mozafari

Mike Massey

Greg Friedman

Dale Thompson

Kevin Christie

Anne Maurer

My biggest regret is that I didn’t get any real one on one time with very many of these folks but That’s OK. All’s well.

If I didn’t come up and speak with you but you saw me there, please don’t take it personally, believe it or not, I have a bit of a shy streak. Once I’ve had a conversation with someone, it’s all good. But, if I don’t know you yet….ugh….I have a podcast. I was a traveling musicians for 7 years. Why would a guy like me be shy at all? Yeah I don’t know. I’m in control in those other situations. Maybe it’s when I’m not in control or I’m a newbie….who knows?

Anyway, if you ever see me at an event, regardless of the event, please come say hi. I’d love to meet you.

We are about to get to our two articles. One is new research on traction/decompression information for low back discs and the other is on young baseball pitchers and how the curveball isn’t the culprit. 

First though, we have backed off and rather than having two show sponsors, we have one and it’s a company you all know how much I love. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

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That’s ChiroUp.com and super double secret code Williams99. 

Item #1

The first article today is called “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis” by Cheng, et. al(Cheng Y 2019). and published in Clinical Rehabilitation in August 28, 2019. Smoking hot folks. Stand back. Watch your eyebrows!

First thing, recognize in the title there, this is a systematic review and meta-analysis. That’s at the top of the research pyramid. 

Why They Did It

To evaluate the effectiveness of traction in improving low back pain, functional outcome, and disk morphology in patients with herniated intervertebral disks.

How They Did It

• They did a big time search PubMed, Scopus, Embase, and the Cochrane Library and they did this search from the earliest record all the way up to July 2019. 
• They included RCTs that involved adult patients with low back pain associated with herniated disc confirmed by MRI or CT
• RCTs that compared lumbar traction to sham or no traction
• RCTs that provided quantitative measurements of pain and function before and after intervention. 
• The initial search came up with 3,015 records which they whittled down to 7 involving 403 patients.

What They Found

Compared to the control group, the patients that had traction showed significantly greater improvements in pain and function in the short term

The differences were not significant enough to support the long-term effects on pain and function, nor the effects on herniated disc size. 

Wrap It Up

Compared with sham or no traction, lumbar traction exhibited significantly more pain reduction and functional improvements in the short term, but not in the long term. There is insufficient evidence to support the effect of lumbar traction on herniated disk size reduction.

Here’s where I’m at on that. I use decompression. I just need to know more about this study. Did they do simple traction? Did they do a cycling pull phase from a pull to a rest phase? How much weight was the pull? How long did they do each treatment and how many treatments did they do?

There’s also patient preference and clinical experience factoring into using decompression.

Reading down through this sucker, it’s just too varied to make any assumptions. The intervention programs differed among the studies from 10 sessions to 60. The treatment protocols varied from 2 weeks to 10 weeks. Some of the studies included had no information on the weight of the pull while a handful went up to 50% of the body weight. Some of the studies used continued traction while others had intermittent traction. Some even used self-suspended, inversion table type traction. 

Are you getting a whiff of what I’m dumping here? 

Out of the 7 studies they included, only 2 measure the disc height and one measured the disc ratio. 

Overall, when you read through the paper, these authors freely admit, this is a tough one but they wanted to start somewhere. They suggest several ways to go forward and say that there are a couple of studies out there that show a trend toward long-term decompression reducing the size of a disc herniation but no longer papers have been done to investigate it. 

It’s anecdotal as hell but I’m going to go ahead and anecdote the hell of you. Right to your face. Or….to your ears as it may be. I’ve been doing decompression for about 7 years and I’ve yet to see anything as effective. Including exercises, McKenzie, all of it. In some cases, it has absolutely amazed me. But, like I said, that is anecdotal but I hope some of these really super smart researchers out there in the profession start to dial down into it and figure it out. Mostly because I know it works. I’ve just seen it too many times. 

Item #2

This last item is called “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers” by Oliver et. al(Oliver G 2019). and was published in Journal of Pediatric Orthopedics in September of 2019. Wait, it’s September of 2019 right now right? Steaming pile of fresh knowledge nuggets, big platter, sizzling. 

Why They Did It

The purpose of this study was to examine differences in pelvis, torso, and upper extremity pitching mechanics and muscle activations between the fastball, change-up, and curveball pitches in youth baseball pitchers following a simulated game.

How They did It

• 14 youth baseball pitchers with no history of injury were included
• All major muscles and mechanics were measured
• The pitchers were instructed to throw with max effort during a simulated game that provided random game situations
• They were limited to 85 pitches
• Data from 3 fastballs, curveballs, and change-ups thrown in the first and last innings were selected for analysis

Wrap it up

The principle findings of this study revealed that pitching to the age-restricted pitch count limit did not result in altered pitching mechanics or muscle activations, and no differences occurred between the 3 pitches. These results support previous research that indicate the curveball pitch is no more dangerous for youth than the other pitches commonly thrown. This is supported by the pitcher’s ability to maintain a proper arm slot during all 3 pitches and indicates that they are obtaining the spin on the ball from their grip and not by altering upper extremity mechanics.

So….it is not the curveball it seems but, rather, it’s the pitch count in young pitchers, it’s treating them like professionals when they’re still developing, it’s that they tend to play only one sport aka specialize, and that they need to be treated like developing children and human beings rather than the Dad’s lost glory or a future paycheck for the whole family. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

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

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About the Author & Host

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

Bibliography

• Cheng Y, H. C., Lin Y, (2019). “The effect of mechanical traction on low back pain in patients with herniated intervertebral disks: a systemic review and meta-analysis.” Clin Rehabil.
• Oliver G, P. H., Henning L, (2019). “Effects of a Simulated Game on Upper Extremity Pitching Mechanics and Muscle Activations Among Various Pitch Types in Youth Baseball Pitchers.” J Pediatr Orthop 39(8): 387-393.

The post Forward ’19, Decompression Research, Curveball or Pitch Count? appeared first on Chiropractic Forward.

CF 093: Big Discs Can Disappear, Chronic Pain & Chiropractic Success, The First Week Says A Lot About The Fourth

Today we’re going to talk about the resorption of lumbar disc herniations (Hint: lots of the big ones don’t need surgery at all!), we’ll talk about chronic low back pain and the success of chiropractic, and we’ll talk about how, after the first visit, you might can tell how well your patient is going to do in the long-term. 

But first, here’s that sweet sweet bumper music

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have tippy-toed quietly into Episode #93 and I do appreciate your keeping it down for me. I’ve been a little tired here lately. 

Now if you missed last week’s episode on the history of chiropractic, you need to  make sure you don’t miss that. It was really fun episode to put together. Especially for a history junkie/nerd like myself. I believe here recently September 18 to be exact, it was the anniversary of DD Palmer inventing chiropractic. We talked a little about whether he invented it or borrowed it or whatever. We talked about that in that episode. Pretty interesting. 

Other more recent episodes you need to be aware of would be the Closing Patients episode. Go learn more about that garbage please. It’s important. 

Also waaaayyyy back (old man river) episode 13 was on Debunking the Myth that chiropractors cause strokes. Enough of that trash. It’s not true and you need to know why, how, when, and how to tell others that it’s bunk info. 

For you older chiros, bunk means bad info. 

One other I think new listeners should go back and find would be about 6-8 weeks ago, episode 90 I believe. It was our mini-class basically on Decoding Chronic Pain. What priceless info. It’s like you went to a seminar and got all of the information for free straight from Dr. Anthony Nicholson. He’s crazy smart. 

Or the way they say it in Boston….he’s wicked smaht. 

I’m currently getting ready to head to St. Louis for the Forward ’19 seminar. It’s all a part of the FTCA Facebook Group and website group. By the time this episode airs, it will already have come and gone but you know I’ll tell you all about it next week. 

I’m looking forward to meeting a lot of the folks from the group that I see interacting with each other all of the time. I’m looking forward to networking and bouncing ideas off each other as well. 

There may be some cocktails in the mix as well so, you know, there’s that too. 

I’m still going through the DACO studying. I have part II coming up on November 9th. Wouldn’t it be nice if you could just get a Diplomate because you took all 300 hours and passed all of the tests and quizzes along the way? 

If you ask the older guys that did the DABCO several years ago, they’ll tell you I’m whining and I need to just shut up because they had it way worse. And you know what? They’d be right. They DID have it way worse. Still, I have a very busy practice, I have a 47 year old brain that doesn’t retain the amount it once did, and I’ve been studying for the part I and the Part II during my free time since probably May. And you know what? I’m tired of studying. Lol. 

I’m ready for it to be over and done with. Geez. Stress, studying, sustained over a long period of time….there’s absolutely a reason that we don’t have a large number of doctors getting the specialization diplomates. It’s carried out over too long of a period. But that’s just fussing. The hours of actual class have been amazing learning. I have stood under the niagara falls of knowledge nuggets people. I swear. 

I’m all in. I’m ten times better than I ever thought I was and for some things, I thought I was pretty put together. I spent a lot of years putting together and taking apart different aspects of a low back exam. I was already coming into it very much up on lumbar differential diagnosis. I’m still better than I was. 

I knew jack squat in regard to the shoulder compared to what I now know. Same goes for the hip, knee, and on down the line. 

If you need some help getting some info and starting down the track of that Ortho Diplomate, let me know. Send me and email at [email protected] and I’ll be glad to do what I can to get you going. 

We’ll get to the paper on whether discs can resorb in just a sec but first, It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99. 

Item #1

Let’s start the research part of the show with one called “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis” by M Zhong, JT Liu, H Jiang, et. al(Zhong M 2017). and published in Pain Physician in 2017. Not new enough to play the Hot stuff sound byte and not old enough to sing old man river to you. Just somewhere in between so we’ll just play some random sound byte for you here. Lol. 

You know me…..heavy on the entertainment part here. 

Anyway, here’s Why They Did It

the wanted to analyze the incidence of spontaneous resorption after conservative treatment of low back discs using CT and MRI imaging. 

How They Did It

This paper was a meta-analysis, meaning they took information from a whole bunch of previously done papers and compiled the best information that could be extracted from them to come up with their findings. 

They used a search of the literature from 1990 all the way through 2015. That’s 15 years for those of you that didn’t take mathematics in school. They used very common databases called PubMed, Embase, and the Cochrane Library to find these papers for inclusion. 

What They Found

The overall incidence of spontaneous resorption was 66.66%. Oddly enough they say that the incidence in the UK was a whopping 82% while in Japan it was only 62%. What the hell gives there? I’m not worldly enough to know the significant differences in lifestyles of those two countries to figure out why that would be. Maybe one of you world travelers can offer us some suggestions. Email me. I’d love to hear it. 

Wrap It Up

Wrapping up this paper the authors conclude, “The phenomenon of LDH reabsorption is well recognized. Because its overall incidence is now 66.66% according to our results, conservative treatment may become the first choice of treatment for LDH.”

Now what do I personally know about this? I know that was your next question that was just on the tip of your tongue so I’m going to answer it for you. 

We know, and this comes through the DACO teaching, that a couple of things can give you  clue to whether or not a herniation will eat itself. That sounds like will ferrell doing harry carry on saturday night live. If you were a hot dog….would you eat yourself? I know I would. Lol. 

Anyway….Lord help me. Anyway, a couple of things:

The make up of the herniation

The extent of migration

If there has been endplate damage / modic changes, with that, you might see some trash or garbage inside the herniation on MRI. It may look speckled. When it looks speckled, it is more stubborn and less likely to go away on its own.

On the other hand, if it’s made up of more nuclear material, it’s smoother in appearance and more likely to be able to be reabsorbed. 

On top of that, when a herniation has more than a 4mm migration, it’s further out there and the body is more likely to recognize it as an issue and more likely to do something about it by breaking it down and getting rid of it. 

This is EXCELLENT news for people with these big discs that you may have at one time thought were most certainly surgical. I used to think they were. I think a lot of surgeons probably still think they are. But not all of them are. That’s a researched fact at this point. 

Item #2

This one is called “Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain?” by I Axen, A Rosenbaum, and T Wren, et. al. and was published in Journal of Manipulative Physiological Therapeutics in 2002(Axen I 2002). Old Man River….

Why They Did It

To investigate whether 3 distinct patterns of reactions to chiropractic care predict early favorable treatment outcomes in patients suffering persistent low back pain. 

What They Found

OF the 115 patients int eh most favorable prognostic group, 84% reported to be definitely improved but the 4th visit vs. 63% of the 384 in the intermediate group, and 30% of the 116 in the least favorable prognostic group. 

Wrap It Up

“Among chiropractic patients with persistent low back pain, it is possible to predict which patients will report definite improvement early in the course of treatment.”

Basically, if you’re getting good response in the first week or so, game on. That patient is likely to have an excellent outcome. 

On to the paper on chronic low back pain patients being referred form a spine surgeon it just a second. Let’s try our best to pay the bills first. 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

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Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

Item #3

This last item is called “An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment” by Brigitte Wirth et. al. and it was published in Chiropractic & Manual Therapies in 2019(Wirth B 2019). There it is fresh outta the oven and slapped on your plate for gobblin’ purposes. 

Why They Did IT

The aim of this study was to describe the trajectories and outcomes of patients with chronic LBP referred from the spine surgery division to the chiropractic teaching clinic.

How They Did It

• The patients filled in an 11-point numeric rating scale (NRS) for pain intensity and the Bournemouth Questionnaire (BQ) (bio-psycho-social measure) at baseline and after 1 week, 1, 3, 6 and 12 months.
• The Patient’s Global Impression of Change (PGIC) scale was recorded at all time points apart from baseline
• The data was analyzed using linear mixed model analysis and repeated measures ANOVA

What They Found

• Between June 2014 and October 2016, 67 participants (31 male, mean age = 46.8 ± 17.6 years) were recruited, of whom 46 had suffered from LBP for > 1 year, the rest for > 3 months
• At baseline, mean NRS was 5.43 and mean BQ was 39.80 points
• NRS significantly decreased to 4.05 after 12 months but a significant reduction was not observed BEFORE 6 months after treatment start. So….it took time to see the difference. But don’t a lot of our evidence-informed crowd give you the poo face stink eye if you see patients more than just a couple of weeks? Food for thought judgy judgers!!
• Now, the Bourneouth Questionnaire – it significantly diminished to 29 points after 12 months and showed a significant reduction in just the first month after treatment started. 
• Also, the proportion of those showing overall improvement significantly increased from 23% after 1 week of treatment up to 47% after 1 month of treatment. 

Wrap It Up

“Chiropractic treatment is a valuable conservative treatment modality associated with clinically relevant improvement in approximately half of patients with chronic LBP. These findings provide an example of the importance of interdisciplinary collaboration in the treatment of chronic back pain patients.”

That’s some great info right there folks. Ingest it. Roll it around. Not everyone on Facebook has all of the answers. Not even your mentors have ALL of the right answers. We all have to find our own way don’t we? I know I did. 

And we all have to keep learning. Neuroplasticity is real. We keep learning. We keep growing and hopefully we keep altering our perception of what is and what can be. Research helps us do that don’t you agree?

This week, I want you to go forward with…..

Key Takeaways

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author & Host

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

Bibliography

• Axen I, R. A., Robech R, Wren T, Leboeuf-Yde C, (2002). “Can patient reactions to the first chiropractic treatment predict early favorable treatment outcome in persistent low back pain?” J Man Physiol Ther 25(7): 450-454.
• Wirth B (2019). “An observational study on trajectories and outcomes of chronic low back pain patients referred from a spine surgery division for chiropractic treatment.” BMC Chiro Man Ther 6.
• Zhong M, L. J., Jiang H, (2017). “Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis.” Pain Physician 20(1): E45-E52.

The post Big Discs Can Disappear, Chronic Pain & Chiropractic Success, The First Week Says A Lot About The Fourth appeared first on Chiropractic Forward.

CF 092: The History of Chiropractic (Do You Know What You Think You Know?)

Today we’re going to talk about the history of spinal manipulative therapy and the history of chiropractic. 

But first, here’s that sweet sweet bumper music

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #92

Now i you missed last week’s episode on the 10,000 Steps Myth, the neuro aspect of an adjustment, and sodas kill, make sure you don’t miss that info. 

Keep up with your colleagues and listen. Also, don’t miss Episode #13. I systematically debunk the myth that we chiropractors cause strokes. I’m not having it, y’all. It’s just not reality and I show you how to fight the myth. 

Also, a few episodes back we talked about Closing Patients and my opinion on that. It may not be what you think it is. 

This week has been more of just catching up. My new schedule I mentioned last week either has my world screwed epically or it’s working beautifully. Lol. Time will only tell but I’m pretty confident we’re doing just fine. 

If you missed last week, I talked about implementing a firmer policy of having patient time and new patient/paper time. 

Since doing that, we have been a bit lighter on the schedule that in recent weeks past but I am getting so much more done right now and it feels good. I have more energy at the end of the day. And doesn’t it feel good to feel good?

It’s cool. For now. If it gets much lighter on the schedule, I’ll hit the WTF? Button and switch gears. WTF….that stands for Why The Face right?Lol. 

Kidding!! I know what it means but I run a mostly clean business here!! But, the point was….. I’m not worried at all right now. 

We are about to get to all things History here but I saw an interesting thing on Facebook this week and it made me want to punt a kitten. I thought I’d share. 

I was on Facebook and saw a couple of knuckleheads coming live from a coffee house. They do it once a week. Doesn’t sound too miserable just yet, does it? It’s actually a decent idea. Get the coffee shop in on it and Facebook live it once a week from the coffee shop talking about certain issues and what your solution to the certain issues might be. Maybe take questions from the crowd there too. Not a bad idea honestly.

Hell, I’d do that myself. Problem is that I’m too damn busy to do it and I’m not a morning person so I’m not getting up early enough to do it before work. Just forget it. Freaking forget it. 

These guys are there at like 10 am on a specific day and I’m like….why aren’t you at work working on people in your work place where people work at 10 am on a work day? Lol. 

They say build it and they will come and Maybe they haven’t built it just yet so the crowds are not coming just yet. I don’t know. Maybe they just make this coffee shop thing a priority for now and choose to not be working on a work day. Either way, one day the one dude wore a cap in the video and the next week he wore a tight little top knot man bun. 

YESSSS I’m old. Yess I think it looks unprofessional. Yes…it makes me crazy like so many other things of his generation tend to do,  and yes…..I’d rather take a kick in the nuggets than to allow someone that looks and talks like him work on me or my kid. 

But…..Yes….there’s a chiropractor for everyone so…..what the hell do I know. Look the way you want I suppose. I’ve heard they have chiros in Florida and California that dress in flip flops and shorts so….when it Rome I guess. 

Here’s my deal, they target kids and parents. Nothing wrong with that. But, they are busy talking about kids that can’t concentrate at school and how there’s just a disconnect in what God meant them to be capable of and what they are currently doing and, if the parents just bring them in to the chiropractor, these guys can help the kids make the connection back and lead that kiddo to the awesome shining light of a life that God intended for them. 

Ummmm…..no you can’t. Is that judgy? Yup. Sorry, whether you admit it or not, we make snap judgements of each other. Rightly or wrongly. IT’s a fact of life. My snap judgement is…..son of a mother. Son of a motherless goat. 

There are so many great chiropractors engaged in research, engaged in diplomat programs. Engaged in taking themselves and this profession to the next level. And this crap trashes all of it. Chunks it all in to the garbage immediately. 

 They chunk it in the garage with their ‘truth’. You hear that crap all of the time now. Speak YOUR truth. We all have our own truth. When did that start exactly? There’s the truth and that’s it. There’s not your truth, my truth, my dog’s truth, some talking head on TV’s truth…..none of it. There is only THE truth. 

And the truth is I’ve seen nothing convincing about this sort of stuff. Absolutely 100% nothing to the level allowing people to get on Facebook touting the ability in a voice that says “You’re great parents. You’re doing everything for your kiddo and we know that. You just need the right kind of help.” Srsly? I you could just get the parents on your brogram…..err…I mean program. 

Come on bruh. Bro. Broseph, I can see it now, they sell brotein shakes at their office and it’s part of the brogram that Billbro Baggins and his buddy Chillbro Swaggins put together after a night of hitting the hookah. 

Show me the support for chiropractors resolving ADHD, autism, and all of that other stuff they claim to help with. Show me it in systematic trials. Maybe randomized controlled trials. Hell, just something peer reviewed and published in a reputable journal? 

But DON’T show me a damn case study or pilot study. Don’t do it or I’ll name you publicly. Lol. I can’t handle people that think case studies hold up to proper scrutiny. They do not. They’re interesting and, for the most part, that’s it. 

They could be doing these in business suits and ties and start spouting unsupported claims like this and they would still look like space cadets claiming they have been to the moon, looked back at Earth, and it is indeed flat despite all evidence to the contrary. Seriously. Srsly. 

I can’t stand this sort of gibberish. It’s a waste of time and talent. 

I’m getting to Item #1 in just a second but we can’t get started without mentioning the sponsor of the first half of our show, 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

Item #1

Now we know a little about our more recent history like chiropractors used to go to jail for treating patients. We know that the AMA has wanted us banished form Earth since our inceptions. Most chiropractors know this stuff. And you should know this stuff. 

But, I remember Dr. Anthony Nicholson, on one of his guest spots with us, I remember him mentioning that spinal manipulative therapy was actually one of the mainstays of treatment before the explosion of the physician/medical complex. I honestly did not know that. 

So, when I stumbled across this paper called “A History fo Manipulative Therapy.” I started reading. It was written by Erlan Pettman(Pettman E 2007) who is actually a PT and published in the Journal of Manual Manipulative Therapeutics in 2007, Old man river…..it’s an oldie but goodie, people. 

So, the author is a PT and this is basically his devotion to getting spinal manipulative therapy under the scope of physical therapists. Or to get more PTs to utilize it. I don’t know but, he says that the earliest reference to its use is in 400 BC back in Europe. 

Interestingly, he says that spinal manipulative therapy rose simultaneously in cultures from Indonesia, Hawaii, Japan, China and India, to Central Asia, Mexico, Nepal, Russia, and Norway. All things I did not know. He also mentions that historical reference to Greece show the first direct evidence of its use and that it was well-established at the 400 BC mark so certainly predated that time going even further back. 

Get this: Hippocrates who lived from 460-385 BC and who is referred to as the father of medicine….you know….the whole hippocratic oath thing….anyway, even back then he wrote a book on joints and described using spinal manipulative therapy. He even noted that the treatment should be followed by exercises. That’s sort of being ahead of ones time wouldn’t you agree?

This is such an interesting paper that I do hope you’ll check it out. I’m linking it in the show notes right here at this point in the text of the podcast. 

While it’s very interesting, it is also very long and you’re not going to stick with me through it. There’s enough here that I may need to do an entire episode just on this paper because it’s THAT fascinating. 

Briefly, he says that as common as spinal manipulative therapy was throughout the origins of mankind, it appears that physicians and surgeons began to abandon the acceptance of it in the 18th century. Though he can’t say exactly why, he offers that it could conceivably be from using the technique for the wrong candidate or potentially the perceived danger in manipulating a spine weakened by tuberculosis which was ravaging the population at that time. 

So that’s where the downturn started for spinal manipulative therapy and, as he says, by the 19th century, a significant part of the medical establishment has a true disdain for bonesetters and their practices. 

While there were many throwing the proverbial poo at spinal manipulative therapy, there were others with the power to recognize the obvious. Robert Jones, the founder of British Orthopaedics, wrote, “We should mend our ways rather than abuse the unqualified. Dramatic success in their hands should cause us to enquire as to the reason. It is not wise or dignified to waste time denouncing their mistakes, for we cannot hide the fact that their successes are our failures” INDEED Mr. Jones. Indeed….

Were you told that DD Palmer invented chiropractic? Of course you were. I was too. And, in as far as ‘chiropractic’ is an industry or a profession, he did. But, he did not invent the idea of ‘bonesetting’ through some magical discovery. At least it doesn’t appear that way in this article. 

The author talks about Andrew Taylor Still. Still was also a magnetic healer. He suffered from chronic headache and took note one day. He had fallen asleep with his neck wedged between the roots of an oak tree. Upon waking, he had no more headaches. From there he began conceiving a theory about health and how it could only be maintained and, therefore, disease defeated, through normal function of the musculoskeletal system. This was all in 1874. Still went on to create the practice of Osteopathy. Did you know that Still’s practice was only about a day’s drive from DD Palmer’s town?

An astute listener will see the parallels of where osteopathy WAS and originated very similar to where chiropractic was and originated. And very astute listeners will make note of where osteopathy is now and where some in the chiropractic profession wish to keep us…..right back where we started. No progress. No learning. No breakthroughs. Nothing. It’s dumbfounding to say the least. 

The author also talks about DD Palmer in the article. How could you not? He says that he was not the first to use the word subluxation nor was he the first to describe the use of the spinous and transverse processes as levers to adjust said subluxation. Those honors go to Johannes Hieronymi, William and Daniel Griffen, and Edward Harrison. 

Did you know that in the 1920’s chiropractic was on life support but that the GI Bill after WWII was what enabled returning soldiers to go to chiropractic college and really bolster the numbers? I didn’t know that. Pretty cool. 

Also of particular note is that in 1958, the National New from the National Chiropractic Association warned about the rising numbers of PT’s training in manipulative procedures. So…..that’s been a thing for a long time it seems. Lol. 

Just a fascinating read for us chiropractors. Go give it a look see and see what you think. I’d love to hear your impressions. Email me at [email protected] and let me know what you thought. 

It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author & Host

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

Bibliography

Pettman E (2007). “A History of Manipulative Therapy.” J Man Manip Ther 15(3): 165-174.

The post The History of Chiropractic (Do You Know What You Think You Know?) appeared first on Chiropractic Forward.

CF 091: 10,000 Steps Myth, Is An Adjustment Neuro Too, Soft Drinks, & It’s OK To Not Adjust

Today we’re going to talk about the 10,000 Steps Myth, Is An Adjustment Neuro Too, Soft Drinks, & It’s OK To Not Adjust 

But first, here’s that sweet sweet bumper music

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #91

Now if you missed last week’s episode on Healthcare, the Days Of Old,  make sure you don’t miss that info. It was a bit of a brain dump. The week before that was on Decoding Fibromyalgia and we had a great episode before that one called Closing Patients…..we’ve had a lot of beneficial discussion on Facebook come out of that episode and it’s definitely worth checking out. 

We can’t get started without mentioning the sponsor of the first half of our show, 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

In personal practice, I have to say I’m testing. What I mean is that you never have everything as cookie cutter as you’d like do you? I used to have patient time and paper time and life was good. i got plenty done but never seemed to break through as far as patient load. 

I had a new front desk scheduler come on board and she basically ignored my paper time patient time dynamic and, after some time, my practice blew up and went crazy as hell. 

Now, the key is, did the roof blow off because she put the patient preference in regard to the schedule…..did she put their wants first? So they loved it because it was so convenient? Or, was it a natural progression of practice and it happened to simply coincide?

Who the hell knows? I think we do a lot of things right so I don’t know. Here’s what I’m certain of though. If we continued putting patients wherever they wanted to be on the schedule rather than forcing them into a formatted schedule that still takes advantage of peak and most requested times…..if we continue to allow patients to run our practice rather than us running the practice….I’m quitting!! Lol

Here’s the thing, I don’t want to brag about numbers and things of that sort. I’m just telling you that it’s been at a point where, when the patients run the schedule, I have zero time to produce a great podcast, zero time to collect thoughts on anything at all, hell I don’t have time to go to the bathroom. 

So, a couple of weeks ago, I decided it was time to put a foot down. A foot down outfitted with a  steel-toed boot! We will have paper time and we will have new patient time. Period. 

Here we are with week #2 of the schedule playing out and you know what? We are a little slower today than normal. I’ve been in practice long enough to know that is not a big deal. Sometimes, it’s just that way. But there still is that part of me that wonders what in the hell? Is it the new schedule? Is it this is it that? 

Blah…. So, even 21 years later, it can be a rollercoaster. It can be a day to day, week to week, month to month thing and that drives me crazy. Mostly because I believe I have an anxiety disorder. 

Again, I share these more personal problems or issues with you all because I know some are going through the exact same thing and some younger docs WILL. 

I’ve been making plans on being at the Forward Thinking Chiropractic Alliance’s conference called Forward ’19 in St. Louis, MO….actually Chesterfield, MO but had I said that first, you’d have no damn clue where I was talking about and you’d have to get out your Google machine and waste time looking for the damn place and I don’t want to do that to you. OK?

It’s the little things I do for you all right? Anyway St. Louis on the weekend of September 20-22….it’s that weekend. They have Gray Cook as the headlineer. They also have , Greg Kawchuck, Annie O’Connor, Christine Goertz, a guy I got to know a bit through the DACO program and a great speaker and doctor, Dr. Brandon Steele, and several more. It’s a time to not miss. Plus, hell, I’ll be there. 

I’ll be staying at the Drury Inn there in Chesterfield and it’s right next door to a Cheesecake Factory so, honestly, what’s not to love about this weekend that’s coming up on us rather quickly?

They aren’t paying me to tell you about it. In fact, nobody associated with the FTCA has even asked me to mention it. But, I think it’s important and I think attendees will walk away as better doctors. That’s why I’m going. 10% better every day, week, month, and year. 10% better. 

go to https://www.forwardthinkingchiro.com/convention if you’re interested.

Item #1

We have a short one to kick this off with. It’s called ‘For Mortality, Busting The Myth of 10,000 Steps Per Day” by Jennifer Abbasi and published in the Journal of the American Medical Association in July of 2019 (Abbasi J 2019), hot cakes, hot stuff. 

Jennifer says the goal of reaching 10,000 steps every day has been a thing for a while now but, in truth, that may not actually be necessary. She said that older women who walked more than their peers and lower death rates in a recent study in JAMA Internal Medicine but….here’s the gotcha part….but the mortality benefit was seen with as few as 4400 steps. 

She says the recommendation of 10,000 steps may be disinclusive – is that a word?I think you know what I mean. She says 10,000 steps can be daunting to many. Especially older people and can actually keep them from walking any more. Whereas 4,400 is much more realistic and the that’s where the benefit is actually seen. 

Interesting stuff right there and definitely worth mention. I’m taking that to my practice. You should too. 10,000 steps may not be the gold standard.

Item #2

This is one called “Spinal manipulation therapy: is it all about the brain? A current review of the neurophysiological effects of manipulation” by Giles Gyer, Jimmy Michael (don’t trust someone with two first names), and James Inklebarger, et. al(Gyer G 2019). It was published in the Journal of Integrative Medicine in September of 2019. Hell, it’s September of 2019 right here right now. Hot potato, hot potato…..

They start out by saying that the the mechanisms underlying the pain modulatory effects of spinal manipulative therapy remain elusive. And although biomechanics and neurophysiological phenomena have been thought to play a role in the effects we see, more and more studies are showing improved outcomes suggesting peripheral, spinal, AND supra spinal mechanisms are playing a part. 

If you listen to our episode with the esteemed Dr. Christine Goertz, she was very clear in saying that we are currently a long way away from being able to say exactly how adjustments get the amazing results they get. That’s frustrating in a way isn’t it? It is for me. I want to know exactly how. 

In describing the article, she says, “The body of literature reviewed herein suggested some clear neurophysiological changes following spinal manipulation, which include neural plastic changes, alteration in motor neuron excitability, increase in cortical drive and many more.”

I have cited this article in case you want to go and find it. It’s in the show notes at chiropracticforward.com so go check it out. But I couldn’t find the whole article. At least not yet. Not until one of you awesome listeners sends it to me at [email protected] I would be grateful. 

But it is good for discussion. I actually did an episode dedicated to this topic. It was Episode #56 and I’m linking right here at this spot in the show notes so you can hear it. I actually had several people emailing me with some thanks on that one. 

The first reason this one was a big episode is because there were some knucklehead wannabe chiropractic gurus out in California claiming to have reversed spinal arthritis after two weeks of draining a patient’s bank account….errr. cough…I mean….of treating the patient 4x/day for 3 weeks. Which quickly adds up to a whole pile of steaming fresh hot brown….BS.

That episode came with pictures and illustrations in the show notes even. I was really fired up there. Lol. 

Anyway, the main reason I’m talking about that episode right now is that I provided a pretty solid description of the latest research and ideas on what an adjustment just may actually be doing for our patients. 

Basically, 

A recent paper by Anderstt et al. (2018) confirmed that cervical manipulation results in facet gaping.  This force also improves regional motion across multiple spinal levels during and post-manipulation.

“This study is the first to measure facet gapping during cervical manipulation on live humans. The results demonstrate that target and adjacent motion segments undergo facet joint gapping during manipulation and that intervertebral range of motion is increased in all three planes of motion after manipulation. The results suggest that clinical and functional improvement after manipulation may occur as a result of small increases in intervertebral ROM across multiple motion segments.” 

And according to the DACO learning

It appears that manipulation relies upon signaling properties of the muscle spindles that lie embedded in the paraspinal tissues. As the spindle registers rapid lengthening of the muscle it transduces this into a large proprioceptive barrage. 

The unique nature of a manipulation seems to alter the responsiveness of second-order neurons in the dorsal horn and make them less sensitive to incoming nociceptive signals from injured tissues.”

Adjustments are gapping the facets, improving proprioception and sensorimotor function, helping the body and brain know better where everything is and know better how it’s supposed to move thus, improving that movement and function. 

So, until new research comes out that makes us throw all of our best information out the window, that’s what I’m going with and, for evidence-informed practitioners, would suggest you adopt as well. 

Short break here….

It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Now, Item #3

This one is an obvious one and is called “Association Between Soft Drink Consumption and Mortality in 10 European Countries(Mullee A 2019)” by Amy Mullee, PhD, Dora Romaguera PhD, and Jonathan Pearson-Stuttard, BMBCh whatever the hell that is. 

Brand new info here. They took 451,743 individuals from 10 countries in Europe consuming more sugar-sweetened and artificially sweetened soft drinks. 

What they found was that those drinking more of either of those had a higher risk of all-cause mortality. Consumption of artificially sweetened soft drinks was positively associated with deaths from a circulatory disease while those consuming sugar-sweetened soft drinks suffered more deaths from digestive disease. 

So, why not cut them all out? I think water rules the day and NOT tap water by the way. I drink a lot of coffee and tea but I’m doing my best to drink more water. I know I’m supposed to. I get it but dammit it has no umph to it so water just sort of pisses me off and leaves me wanting. Lacking. And basically bitchy. 

Anyway, Item #4

This one is called “Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada” by Rivka Green, Bruce Lanphear, and Richard Hornung, et al and published in JAMA Pediatrics in August of 2019(Green R 2019). Look out hot stuff everywhere, steamin’ plate…

The question they wanted to answer was, is maternal fluoride exposure during pregnancy associated with childhood IQ in a Canadian cohort receiving optimally fluoridated water?

Their conclusion was as follows “In this study, maternal exposure to higher levels of fluoride during pregnancy was associated with lower IQ scores in children aged 3 to 4 years. These findings indicate the possible need to reduce fluoride intake during pregnancy.”

Interesting stuff. Especially for those of you that make pediatrics and prenatal care such a big part of your practice. Knowledge nuggets all over the place today. You can’t listen today and avoid getting hit in the head with at least one of them. It may slap some sense into the recipient. At least that’s the goal. 

OK, last thing I have on tap today is Item #5

It’s called “Chiropractic conservatism and the ability to determine contra-indications, non-indications, and indications to chiropractic care: a cross-sectional survey of chiropractic students” by Guillaume Goncalves, Marine Demorier, and others. I say and others because I’m not even about to try to pronounce the next name. There would be a verbal murder of probably a perfectly good name and I don’t want to play any part in that. 

It was published in BMC Chiropractic and Manual Therapies in 2019. Once again, too hot to handle, step back one….no two steps…

In the background section of the abstract, they start by saying “While there is a broad spectrum of practice within chiropractic two sub-types can be identified, those who focus on musculoskeletal problems and those who treat also non-musculoskeletal problems. The latter group may adhere to the old conservative ‘subluxation’ model. The main goal of this study is to determine if chiropractic students with such conservative opinions are likely to have a different approach to determine contra-indications, non-indications and indications to chiropractic treatment versus those without such opinions.”

What They Found

• They had 359 student respond out of 536.
• They generally recognized a number of contra-indication as well as indications for treatment
• What the problem was was in identifying non-indications for treatment. 
• The subluxation students were much more willing to treat someone even when there was nothing relevant wrong
• For example, they were much more willing to treat a 5-yr-old kid with no history of back pain or disease to prevent future back pain and to also prevent non-musculoskeletal disease. 

Wrap Up

Their conclusion was “It is concerning that students who adhere to the subluxation model are prepared to ‘operationalize’ their conservative opinions in their future scope of practice; apparently willing to treat asymptomatic people with chiropractic adjustments. The determinants of this phenomenon need to be understood.”

I can help them understand it. It’s BS passed on by wannabe gurus and colleges like Sherman and Life and was once shoveled in large amounts by Palmer and my alma mater, Parker. Although, to my understanding, those discussions are fewer and further between at Palmer and Parker these days. 

Look, I’ve made no secret, I’m not a Subby, a TOR, or a TIC. I’m an evidence-informed chiropractor. Just like Subbys and other evidence-informed chiropractors…..I too get great results for my patients. 

Unlike SOME of my Subby counterparts….not all of them….but certainly SOME of them…….I communicate with the medical field in effective ways that make sense to them, I do not take advantage of my patients, I do not use techniques and recommendations not back in part by evidence and research, I run a patient-centered practice, and don’t treat when I shouldn’t and treat when I should, and I do not try to see how many times I can run a patient through my doors based on the idea that I’m going to prevent some sort of mythical loss of curve issue 30 years in the future. Folks, we’re highly educated. It doesn’t happen that way and in 2019, we damn well know it doesn’t happen that way.

Your bank account might not like it but your patients will and they’ll know you care and they’ll know you’re different than the rest when you’re worried about them and NOT their wallet or their purse. 

The golden rule isn’t just for kiddos. IT’s for everyone regardless of age. Treat others the way you want to be treated. If you want to be treated a million times through your life because you may lose some degree of curvature in your neck, then 10/4, rock on with your bad self. 

I for one have no interest in that for myself so I’d never recommend it to anyone. Why would I? Other than financial motivation of course.

I wouldn’t.  

Before we sign off here, I made some awesome evidence-informed brochures and posters for your offices. Go check them out at the store link at chiropracticfoward.com 

While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author & Host

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

Bibliography

• Abbasi J (2019). “For Mortality, Busting the Myth of 10 000 Steps per Day.” JAMA Open 322(6): 492-493.
• Green R, L. B., Hornung R, (2019). “Association Between Maternal Fluoride Exposure During Pregnancy and IQ Scores in Offspring in Canada.” JAMA Pediatr.
• Gyer G, M. J., Indlebarger J, Tedla JS, (2019). “Spinal manipulation therapy: Is it all about the brain? A current review of the neurophysiological effects of manipulation.” J Integrative Med.
• Mullee A, R. D., Pearson-Stuttard J, (2019). “Association Between Soft Drink Consumption and Mortality in 10 European Countries.” JAMA Open.

The post 10,000 Steps Myth, Is An Adjustment Neuro Too, Soft Drinks, & It’s OK To Not Adjust appeared first on Chiropractic Forward.

CF 090: Healthcare Of Old – Days Gone By

Today we’re going to talk about how healthcare has changed – gone are the days of this and gone are the days of that. And there will be plenty of room for me to spread some personality in there too. If you’re a regular listener, you know I’m never lacking an opinion. 

But first, here’s that sweet sweet bumper music

OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun and accessible while we make you and your patients better all the way around. Welcome, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #90

We can’t get started without mentioning the sponsor of the first half of our show, 

Let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that actually saves you money. Instead of spending money on cable TV or looping a DVD over and over in your lobby, the bite-sized videos are specifically made to inform your patients about the importance of chiropractic, healthy living, and to encourage referrals while, at the same time, presenting the benefits of all of the different products and services that you offer. Specific to your office.

That’s right. It works by using a tailor-fit video playlist that only promotes the products and services offered in your specific practice. Not only that but the videos are updated automatically on a weekly basis so there’s no need to manually update your playlist AND you don’t have to learn any complicated software. You get to just set it and forget it. And don’t we busy doctors need just that?

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription.

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial.

We have some great stuff this week. It’s a short week due to Labor Day so this episode may run a little short and that’s OK. I try to not get too long winded. I think I went on about 45 minutes when we talked about Closing Patients two episodes ago.

But, a little gripe session never hurt anyone. If you’ve ever wondered whether Closing patients is right or wrong, get my take by going and listening to episode #88. I lay it out pretty clearly there. 

And don’t forget, last week’s podcast about Fibromyalgia. New info on fibro and treatment. Good stuff there in episode #89

Item #1

I want to start with an article that kind of struck me as…..huh….interesting. It’s called ‘The Old Days of Medicine Are Gone” by Michael Weiss(Weiss M 2019) and it was published in MedPage Today on January 17, 2019. Hot potato, heads up now. 

Weiss is a cardiologist and I have cited this article in the show notes over at chiropracticforward.com. This article refers to medical doctors specifically but there are a lot of parallels that we doctors of chiropractic can relate to. 

The article starts by saying that in the last 5-6 years, physicians have become less and less powerful. So have their patients. This disempowerment is due to a lot of things according to this article. Chief among them are:

• Health management organizations
• Managed care and 
• The insurance exchange

Mr. Weiss says that all of these factors have taken power from the doctors and put the power into the hands of the large insurance companies and in the hands of the government. Well, that’s been going on for at least a generation. 

I remember a pencil pusher with an insurance company several years ago, a person who doesn’t have any kind of degree other than following prompts on a computer…..I remember them telling me how to treat a patient. What they needed. How many times….I was stunned. I will just say that I had a strongly worded conversation that I’m certain went in one ear, bounced around in that dude’s empty noggin, and fell out the other without making any impact. 

But I remember thinking, we are allowing insurance companies, the guys with a financial stake and a financial bias, we are allowing these people to tell us how and when to treat patients when they’ve never seen them in their lives. These patients are just numbers on a page to these companies and they’re going to tell us how to treat them. 

Same goes for the government. Whether it’s a popular opinion or not, makes not one damn to me. I’m going to tell you that when you put all of your healthcare decisions in the hands of one big fat, red-taped fat bureuacratic entity that has already screwed up Medicare and Social Security for no reason at all, due to both sides of a messed up aisle, well, you are once again numbers on a page and sometimes you get what you deserve. Of course that doesn’t mean everything’s peachy and we don’t need some changes to the healthcare system. We most certainly do. Universal healthcare medicare for all though…..I don’t see how that is the solution. Again, one fat, slow, dumb entity that has a history of screwing up big programs isn’t what I personally want making all of the healthcare decisions for me and my family but to each their own. 

Getting back to the article, Mr. Weiss says this physician disempowerment was basically a money grab on the parts of these powers and on the part of the pharmaceutical industry. Well…..of course. I think all that goes without saying doesn’t it? But I’m glad someone is indeed actually saying it. We should be shouting it out loud but, will it change anything? Politicians won’t do anything about it when big pharma is in their pockets and they’re scared of the insurance companies. 

Anyway, he says that doctors’ incomes have been progressively on the decline for years. Can i get an ‘amen’ on that my people. Testify!!  He says this cash-strapped generation of physicians have been forced out of private practice into working for hospitals and huge conglomerates and that gone are the days of Wednesday off for golf, gone are the days of being called a doctor rather than a provider, gone are the days of being respected, gone are the days when patient’s would say “But what does the doctor say?” rather than “Will the insurance pay?”, gone are the days when a physician could direct care they deemed necessary. Even the prescription pad is becoming useless since insurance doesn’t cover a lot of the scripts written these days. 

He says gone are the days when a physician could sit down and perform a detailed and thorough examination. Instead, we have be busted down to being typists, chaotic clerks, mindlessly clucking away at meaningless electronic health records benefiting only large entities. Hallelujah!! 

In order to make money these days, it has to be quantity and, unfortunately, quality many times suffers. For better or worse. When your income goes down, you see more to maintain the income you have built your life around. Quality of care suffers. Not intentionally. Nobody is morally corrupt typically. It’s just a natural consequence. You have bills to pay and you’ll figure out a way. 

Take a radiologist. They used to get about $35 for reading a neck series. Now, after Obamacare, they make $7-$10. I happen to know a radiologist very well so you can trust what I’m telling you. At least here in Texas. Could be different in your area. What happens when you income gets reduced by roughly 2/3 but you still have a big house and some extra toys you have purchased? 

Maybe you have a big garage sale and get rid of the extra fat? Ah hell no, that’s not what happens. Instead of 5 films read in 30 minutes you read 10. Think you might have an elevated risk of missing something? Of course you do. 

Back to the article….I keep getting side-tracked, he says gone are the days when a physician had the luxury of utilizing their skills of observation. He says now there are cookbook guides that have become the puppet masters of the physicians. I’d like to go on record right now, as part of a profession that has no standardization whatsoever…..I’m all for researched and evidence-backed guides. I love it. Give us some guides. Hell, don’t just give them to us, FORCE us to abide by them. Please? Lol. Just make sure they weren’t generated by a damn insurance company. That’s all. 

He says gone are the days of decent hospital stays and the days of when a patient could be cured of infections from a decent stay at the hospital. Now, he claims that patients are kicked out of the hospital early and take the buggies back to their community and spread them which leads to resistant buggies. I’d argue that commonly prescribing antibiotics when it’s a virus was problematic and the cause of a lot of resistance back in the day as well? He left that out oddly enough. 

He hit on a HUGE one when he says gone are the days of reasonable costs for a doctor visit or a drug co-pay. Now, since Obamacare, we see double and triple premiums, up to $100 co-pays, and double or triple deductibles. 

This sucker continues but, before I get to the rest of it, I need to talk about one of our amazing sponsors here at the show. It’s good to support the people that support you don’t you think? Well, ChiroUp certainly supports evidence-based practices. 

If you’re a regular listener of our podcast, you know I used it since about June of 2018. Let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99. 

Back to the article, Mr. Weiss says gone are the days of visiting an ER and getting immediate care as if illness is the priority. Instead, we gotta get that co-pay covered first. 

He claims the days of physicians not having to worry about a patients insurance are gone. But…haven’t those days been gone since the 80’s or so? Honestly? That’s not something new. He says though that the insurance companies have encouraged minute clinics where the nurse pracs, and he says soon the pharmacists, will be giving the medical advice. 

He doesn’t seem to like this idea much but he’s OK with people waiting for hours to see a ‘physician’ because there aren’t enough of them. I’m pretty OK with nurse practitioners for the more mundane stuff. Plus, in my experience, NPs are more likely to refer to chiropractors for whatever reason. 

While Mr. Weiss is right to some extent, a lot of this is just whining in my opinion. The traditional physician doctor had their run with all of the power, the glory, and the golden ticket they cash when they get their medical degree. And, to an extent, they damn well still have a certain amount of power, glory, and golden ticket status. Although to a lesser extent currently. Admittedly. 

It’s one of the last quotes of the article that gets my goat a bit. He says, “Physicians’ voices have been drowned out, their plights buried, leaving their patients helpless,,,,”

Well freaking whaaaa Weiss. Yes, chiropractic has the status it has in healthcare right now because a certain portion of its practitioners refuse to progress. In fact, they work to inhibit any progress and cripple any efforts to expand the profession. Yep, it’s there and it’s undeniable but, when we talk about having voices drowned out, plights buried, and helpless patients, let’s go a little deeper. 

I’ve said it a million times but the medical field is going to look back on spinal fusions in 20 years and wonder what the hell they were thinking. I think I heard where lumbar fusion surgery has gone up 500+% in the last decade or so with little to zero hard stats that show any improvement in outcomes. 

Oh looky there, I see a herniation. Let’s cut that out and you should be good as new. We know so much more now. We know you can’t cut out pain. We know you don’t treat an image. You treat the patient in front of you because most of the time, there is little to no correlation between what you see on an x-ray and what the person’s pain generator is. 

We know now that chronic pain is mostly in the central nervous system. Not out in some peripheral part of the body. You cannot typically get rid of chronic pain by cutting something out. We know more and more now that it just doesn’t work that way. 

Yet, I feel confident promising you that right now, several fusions across the country are taking place. As I type this out. We also know that less than half of those fusion surgeries will be successful, right?

We know this stuff. Yet, they continue. Unabated. So, while I agree that insurance, the government, and the whole managed care concept have screwed up our healthcare system, I would say that physicians have played very key parts in their own downfall. Hello….opioid crisis anyone? Unnecessary surgery? Surgeries for the wrong candidates? Super bugs from overprescribing? Any of this ringing any bells? 

Have you heard the podcast called Dr. Death? Basically, a so called spinal surgeon down in Plano, TX maimed several patients and even killed several and the hospitals protected him and enabled him to keep hurting people over and over and over again. 

It’s not just insurance companies and big pharma that has cause any fall from grace. And let’s be clear, I don’t think there’s been a fall from grace. Go to a hospital and see the interactions. Everyone still defers very clearly to the physician and I don’t see that changing. It’s just now they have to work more, follow rules, and get paid less. I think that’s the big gripe. 

And to that I’d say, welcome to my world friend. Welcome to my world. 

But again, it’s not just the system. Medical doctors have done their part. And, as a chiropractor, I’d argue that part of that is they have largely ignored the American College of Physicians’ recommendations to try spinal manipulative therapy, exercise, massage, acupuncture, yoga, thai chi, and heat first for back pain. 

Those are the first-line recommendations and they are in concert with The Lancet papers on low back pain, the CDC, the FDA, the Joint Commission, The White House, and just about anyone else with any sense at all when it comes to non-complicated musculoskeletal pain. Yet, as I said, fusions are going on all over the country right now. As I speak. That’s when only 5% of back pain sufferers truly need surgery. 

When does someone truly need spinal surgery? When they hurt? Nope. Not usually anyway. Remember, you can’t cut pain out. Outside of an obvious case of a spinal fracture, tumor…..the bad bad stuff….I think it’s commonly accepted that surgery is necessary in a loss of bowel or bladder function, saddle anesthesia – cauda equina- type stuff, or a progressive neural deficits. 

So, if only 5% of back pain sufferers truly need surgery, why are so many still happening every day? After all of the research and after all of the updated recommendations?

Well, I’d say it’s financial. Get this, according to the American Medical Group Association’s Physician Compensation Survey says their research spine surgeons make $688,500 a damn year on average. 

Me personally, I’m doing pretty well in practice. But, it took me 16 years before I really started putting the pedal to the metal. Now part of that was my fault because I was traveling around playing music. Part of it was chiropractic’s fault because we have a system that eats its own. 

Either way, check this out, it took me 16 or so years to really build but, for an orthopedic surgeon, during the first two years of employment, bring in $400k and by their third year, $670k. Allied Physicians reported the maximum orthopedic spine surgeon salary was $1,352,000. 

Crazy. We have some chiropractors that make that kind of money but it’s not many and it’s not very likely. 

Anyway, I agree with some aspects of the article. Other aspects make me chuckle because, although it’s to a much lesser extent, physicians of our day are dealing with some of the things we’ve been dealing with for years and years. 

If we could just communicate with them the fact that we evidence-based chiropractors can play such a big part in helping them treat their patients and getting them back to work and back to life, I probably would have more sympathy. 

Hell, people come to us because we’re experts in what we do, because we are safe, and because we’re effective but, a large part of the medical field looks at us like stumbling idiots playing doctor and hurting our patients. While that may be true for some in our profession as well as for some in THEIR profession (hello Dr. Death), for the most part, we are all highly educated, highly capable doctors getting patients well. 

Maybe when they begin seeing us in that light, we start to see some sort of deeper, more meaningful integration. It’s started here and there in some pockets of awesomeness but not in general. It’s still a goal worth chasing. 

That’s assuming we chiropractors can get our of our own way. Otherwise, if I were a medical doctor, I wouldn’t want any part of something I could only explain as pseudoscience. I WOULD however be interested in a healthcare discipline that had the randomized controlled trials backing the meat of their modality. Count me in on that. 

And that’s the way I see it today. 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author & Host

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

Bibliography

Weiss M (2019). “The old days of medicine are gone.” Medpage Today – KevinMD.com.

The post Healthcare Of Old – Days Gone By appeared first on Chiropractic Forward.

CF 088: Decoding Fibromyalgia & Fibro Treatment

Today we’re going to talk all about fibromyalgia. How many patients come to you diagnosed with Fibromyalgia? I don’t know about you but I have a lot of them in my practice. How much do you know? What are the treatment recommendations? What’s the cause? 

OK, we are back with some important information to make you better which makes your patients better. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic   Forward podcast.  

You did the hippy hippy shake into Episode #88. does everyone remember that song from the 80s or 90s or whenever the hell that was? 

We can’t get started without mentioning the sponsor of the first half of our show, 

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I just signed up to be at the Forward ’19 event in St. Louis from September 20-22. I’ve been in the FTCA group and a member of the website for some time so it’ll be good to see these folks in person, put some voices to the faces, and learn some good stuff. 

Remember, 10%. 10% better every day, every month, every year. I’ve completed the DACO coursework but trust me, I’m nowhere near knowing it all. Continually attending events like this is the right step toward excellence though. I feel pretty confident in saying that. 

If you want to be at the event, go to https://www.forwardthinkingchiro.com/convention and get yourself signed up. It should be a good return on investment if my information is correct. 

No, I don’t have a secret code, I’m not paid to tell you about the event. It’s just that Forward ’19 is an evidence-informed conference and as a person that considers themselves evidence-informed, I feel like it my duty to an extent to make sure you all know about these things. It is on me to promote evidence-informed events when and if I know about them. 

Before we get into any research on Fibro, for the newbies in the crowd, let’s define fibro shall we? According to the Mayo Clinic website it as follows:

“Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.”

Alright, that’s a good start right there and, if you listened to our free two-part masterclass episodes with Dr. Anthony Nicholson called Decoding Chronic Pain, if you listened to those, you heard a lot about a sensitized or up-regulated central nervous system. Those were episodes 79 and 80 and they are priceless if you are interested in solving the chronic pain enigma. I’m linking them in the show notes. GO LISTEN. Make yourself better. 

Fibromyalgia is thought to be another consequence of this sensitized, up-regulated central nervous system we have discussed so many times here.  

A combination of things are playing a part but, in general, there are five main elements to the causation of Fibro

THE FIVE MAIN ELEMENTS

1. There is a familial and genetic predisposition – family members of fibro patients have an 8 fold increased risk
2. There are environmental stressors acting as triggers – such as physical trauma, psychological and emotional stress, and even infections. 
3. There is dysfunction of the hypothalamic pituitary axis and autonomic nervous system
4. There are functional impairments in pain and sensory processing
5. There are cognitive, behavioral and psychological impairments

According to Dr. Anthony Nicholson from the CDI DACO program, It is a brain that has essentially switched into over-protective mode and now remains caught in that state. 

He goes on to say, “Consider the clinical landscape for a moment…

Chiropractors see patients with painful movement machinery and diagnose functional M/S disorders; Gastroenterologists see this same class of patients and diagnose functional bowel disorders and non-ulcer dyspepsia; dentists diagnose functional TMJ disorders, urologists are confronted with unexplained pelvic pain, vulvodynia and irritable bladder; and neurologists evaluate unexplained facial pain and chronic headache.  

And if all of these conditions could be due to central nervous system dysfunction, it could explain why we see all of them respond together to a management approach that is able to switch this hyper-vigilant central neurology back to a more normal level of sensory interpretation.  

And could it be that that reduces the abnormal motor and autonomic behaviors that are driven by a brain that perceives the body to be in danger or under threat?“

Some of the biggies on the differential diagnosis list are

• hypothyroidism
• anemia
• diabetes
• and undiagnosed cancer

Also middle aged women are the most likely to have fibro so you’ll want to explore 

• Rheumatoid arthritis
• Lupus
• Osteoarthritis
• and Polymyalgia Rheumatica 

Luckily Perrot, et. al. came up with a hell of a screening tool. In fact they found that a positive answer to more than 5 of the following 6 questions had a sensitivity of 90.5% and a specificity of 85.7% when differentiating Fibro from other conditions like RA, ankylosing spondylitis and osteoarthritis. 

Would you like to know the questions? Well of course you would. Here they are

1. I have pain all over my body
2. My pain is accompanied by continuous and very unpleasant general fatigue
3. My pain feels like burns, electric shocks or cramps
4. My pain is accompanied by other unusual sensations throughout my body, such as pins and needles, tingling or numbness
5. My pain is accompanied by other health problems such as digestive problems, urinary problems, headaches or restless legs
6. My pain has a significant impact on my life, particularly on my sleep and my ability to concentrate, making me feel slower generally

A key part to getting these patients well again is to get their brains to un-learn that movement is painful. Introducing the fact that movement doesn’t necessarily hurt can be done through nice, gentle adjustments wouldn’t you agree? When you think about it?

Understanding the difference between hurt and harm. Sometimes, we need these people moving whether it hurts a bit or not and, as confidence, strength, and ability increases, you’ll see they have un-learned that movement is bad and that it hurts. 

One of the biggest things with fibro patients is understanding that they just don’t inhibit pain very well. 

A point of particular interest here is that Evidence suggests that opioid pathways are normal or even increased in activity, which probably explains why opioids are generally ineffective analgesics in these patients

On the other hand, serotonin and noradrenalin systems are under-active, which explains why most compounds that raise both serotonin and noradrenalin (such as tricyclic antidepressants, duloxetine and tramadol) have been shown to be effective in controlling symptoms in FM patients.

I’m not going to pretend to be a genius here. This is all info from my DACO learning and Dr.s Anthony Nicholson and Matthew Long with CDI in Australia. THEY really are the geniuses in my opinion. 

They say, “a useful approach with patients be to encourage exercise to stimulate her CNS system but avoid activities that are too intense as this may sensitize them further.  Also, improving posture and movement habits is likely to reduce the effect of fatigue on the major postural muscles that drive a constant nociception.”

They point to a systematic review by Schneider (2009), strong evidence supports aerobic exercise and cognitive behavioral therapy (CBT); moderate evidence supports massage, resistance training, acupuncture and spa therapy; and limited evidence exists for spinal manipulation, movement re-training, vitamin and herb supplements and dietary approaches.

Overall, the evidence strongly recommends a multifactorial approach that emphasizes education, targeted medications, exercise and cognitive therapy.

Let’s get to a few papers real quick and then we’ll wrap up our Fibro episode, shall we? I have papers covering resistance training and chiro when treating women with fibro, I have tobacco use in fibro patients, and I have acupuncture for fibro…..

Real quick though, I need to recognize one of our show sponsors. If you’re a regular listener of our podcast, you know I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the Chiropractic Forward train. 

Let me tell you about it. 

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You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

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That’s ChiroUp.com and super double secret code Williams99. 

Item #1

The first one is called “Tobacco Use in Fibromyalgia Is Associated With Cognitive Dysfunction: A Prospective Questionnaire Study.” by L. Ge, R D’Souza, and T Oh and published in Mayo Clinic Proceedings: Innovations, Quality & Outcomes in February 2019(Ge L 2019). Hot stuff, stand back…

Why They Did It

To evaluate the association between smoking and cognitive function in patients with fibromyalgia

How They Did It

• They surveyed 668 patients with fibro. 
• They were categorized by smoking status
• They did outcome measures on all sorts of things including cognitive function, symptom severity, quality of life, fatigue, sleep, anxiety, and depression. 

What They Found

“In patients with fibromyalgia, smoking is a risk factor for cognitive dysfunction. Moreover, smokers with fibromyalgia were more likely to report increased severity of fibromyalgia symptoms, worse quality of life, more sleep problems, and increased anxiety compared with nonsmokers with fibromyalgia.”

As a sidenote

Did that one surprise anyone? Smoking is awful. It’s awful all around for everything, every condition, and even the way you smell. It’s awful. If you smoke like I used to years ago, get a book called, “The Easy Way To Quit Smoking” by Alan Carr and start seeing it for what it is. 

You smoke because you’re bored? How boring is it to stand outside in the cold wind smoking a cigarette by yourself?

You smoke because it gives you confidence? How confident are you when are anxious about how you smell or what smoking is doing to your health on a daily basis. 

Smoking does the exact opposite of what you think it’s doing, basically. 

Exit sidenote

Item #2

The second paper I have here is called “Effects of Resistance Training and Chiropractic Treatment in Women with Fibromyalgia” by Lynn Panton, Arturo Figueroa, and a gaggle of others. It was published in The Journal Of Alternative and Complementary Medicine in March of 2009(Panton L 2009). Old man river….

Yes it’s 10 years old but that doesn’t matter. 

Why They Did It

The objective of this study was to evaluate resistance training & resistance training combined with chiropractic treatment on fibro in women.

How They Did It

Both groups finished sixteen weeks of resistance training consisting of 10 exercises performed two times per week. Of course, one group had only the resistance training while the other added in chiropractic treatment two times per week. 

What They Found

“In women with FM, resistance training improves strength, FM impact, and strength domains of functionality. The addition of chiropractic treatment improved adherence and dropout rates to the resistance training and facilitated greater improvements in the domains of functionality.”

Item #3

Our last item is called “Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials” by Xin-chang Zhang, Hao Chen, Wen-tao Xu, et. al. published in Journal of Pain Research in January of 2019(Zhang X 2019). Hot potato, get ‘em while they’re hot. 

Why They Did It

The stated goal here was to determine the effect and safety of acupuncture therapy on the pain intensity and quality of life in patients with FM.

How They Did It

There was a search done through PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, and one and on. They were collecting randomized controlled trials to performa  meta-analysis according to the Cochrane systematice review method. 

They identified 12 studies that fit the criteria

What They Found

The meta-analysis showed that acupuncture was significantly better than sham acupuncture for relieving pain and improving the quality of life. At long-term, the effect of acupuncture was also superior to that of sham acupuncture without any serious adverse events. 

Payah

So there you have it. Tell me you learned something. Tell me you picked up a fibro nugget and tell me you’re better for having listened.  Send me an email at [email protected] 

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

Connect

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

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About the Author & Host

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

Bibliography

• Ge L, D. S. R., Oh T, (2019). “Tobacco Use in Fibromyalgia Is Associated With Cognitive Dysfunction: A Prospective Questionnaire Study.” Mayo Clin Proc Innov Qual Outcomes 3(1): 78-85.
• Panton L, F. A., Kingsley JD, (2009). “Effects of Resistance Training and Chiropractic Treatment in Women with Fibromyalgia.” J Altern Complement Med 15(3).
• Zhang X, C. W., Xu W, (2019). “Acupuncture therapy for fibromyalgia: a systematic review and meta-analysis of randomized controlled trials.” J Pain Res 12: 527-542.

The post Decoding Fibromyalgia & Fibro Treatment appeared first on Chiropractic Forward.

CF 088: Closing Patients – Helpful or Destructive?

Today we’re going to talk about what closing patients in chiropractic is, we’ll talk about where it comes from, and we’ll talk about if it’s a positive or a negative. Plenty here to be provocative I must admit. Listen up and then make up your own mind. 

But first, here’s that oh how sweet it is bumper music

OK, we are back with some important information to make you better which makes your patients better. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have collapsed into Episode #88

No research today. Only Opinion. I didn’t even include any sponsors in this episode because it might be seen as controversial to an extent and, if there’s some sort of uproar, I don’t want them in the crossfire. Now….

I believe the business of being trusted and an authority of sorts is to be objective. Regular listeners have heard me talk about the medical realm and failed surgeries, etc. I state over and over that I am a chiropractic advocate. 

I am an advocate. Just listen to all 87 previous episodes and you will clearly see where I stand on the big stuff. BUT, if we do not have the ability or the honesty to police our own, then we’ll never be able to pull out of red-headed step-child status. 

We will forever be ridiculed and mocked. And that’s because the bad apples spoil the whole basket. 

It’s been a while since I’ve been able to just do a brain dump on a certain topic. I think the last time I did that was back when I talked about religion being brought into chiropractic.

I’ve been seeing more and more terminology like this lately and it’s time to address it and meet it head on. 

Let’s get something perfectly straight here: I’m about to piss some people off. Let’s also be clear on the fact that I’m already pissed off so I don’t give a damn if I do. I have been for a while. It’s been stewing and simmering and, after a while, it’s time to talk about it. 

Hell that’s the whole point of having a podcast. Promote what I agree with and find value in and spotlight cockroaches when I identify them. Having a platform to sound off on has been so cathartic. You have no idea. It helps in so many ways. It’s probably why I don’t have to go to therapy. 

As I have said, I am seeing the term ‘closing patients’ more and more and you know what? I’m mostly seeing it from wannabe gurus that aren’t even freaking chiropractors!!! They are trained at spouting their horns and touting their skills but never bought in enough to actually be a chiropractor. No, they just prey on chiropractors. 

Does that register? Closing patients! They’re fine with the term closing and the idea because it’s not their profession, their profession is marketing, so what the hell do they care if they trash the profession and whatever reputation we have scratched out? As long as they continue to fool well-meaning chiropractors into paying them, they don’t give one single damn what it takes.

As I said, the real unfortunate thing is that they go around jazzing up actual real chiropractors to the point that now many chiropractor actually think closing patients is a good and an acceptable idea.

Here’s the thing: it’s black and white. There’s good and there’s evil. There’s right and there’s wrong. Closing patients is straight up 100% wrong. And in my opinion, borderline evil.

I posted on our private Chiropractic Forward Facebook group the other day asking for opinions on closing patients. Good, bad, pros, cons, etc.… I value our tribe and their wisdom.

For a more general opinion, I asked in the Chiropractic Facebook group. That’s what it’s called…..just Chiropractic. You’ll find birds of all feathers in there so I figured I’d get some crazy answers and some in the middle answers. 

I really didn’t though. It seems that most, if not all, were essentially against the idea of closing patients.

Here’s what I got. Some that I highly respect say that if you’re NOT giving good solid recommendations and the telling them what it costs, then you’re not doing your job. 

One colleague wrote that patients want a doctor. Not a friend. Damn straight.

On this, all of us absolutely agree. 

Although a report of findings and recommendations and a financial talk could be viewed as closing patients,  that’s not necessarily what I mean when I refer to closing patietns. Not in my mind anyway. 

Being a doctor certainly comes with the responsibility of telling patients what you think is wrong, what you think they should do to fix it, and how much that would cost. That’s just being an ethical professional regardless of what business we are working in. 

I’m talking about manipulation of information and manipulation of emotions to get a desired effect that benefits the practice more than it benefits the patient. That’s what I’m talking about.

There was a reason I never really got down a good report of findings. It’s because I never felt comfortable with it. It never felt right because it wasn’t me. So I just went to what felt right. That doesn’t mean those of you that are good at a report of finding are doing something bad. I’m referring to a closing patients sort of ROF that I was once force fed. That’s what I’m talking about. 

What felt right was telling patients what I think, what I recommend, asking them if they have questions, and then getting started. It’s pretty damn simple honestly and I have more patients and business than I can handle. 

To tell me that my only way to succeed is to learn tactics and manipulation, we just have to disagree. Our values are not in alignment. Adjust that won’t you? 

I heard one guru say that our job is to identify or uncover what the patient’s pain is keeping them from doing or accomplishing and then leveraging that information against them by focusing on that shortfall in order to make a sale. To get a desired outcome.

Really? That’s what my job is? Are you sure? Because I thought it was to give my patients the very best recommendations that I can based on education and experience and then be there to help and guide them regardless. All these years and I was getting it wrong. All I needed was this 20 something person to help me get it right. Insert eye roll. 

When closing patients in chiropractic, he says we NEED to be focused on it. For example, if a patient comes to us with back pain, that’s not what we need to focus and work them over about. No….we should be working them over about what the back pain keeps them from doing…..THAT’s what they really care about so THAT’S what we pounce on like a grizzly on a salmon.

So, uncovering the ‘pain point’ of a patient just isn’t something I think smart, capable, educated doctors should be concerning themselves with. It’s called morals and ethics. 

They act like being unethical builds the fat wallets so that the fat wallets can further chiropractic. So…..I don’t want that kind of chiropractic being furthered. At all. Not a millimeter. Ever. I want it to die and go away never to be heard from again. 

A previous guest on our podcast, Dr. David Graber up in New Jersey is literally one of the smartest people I know and he had this to say about it, 

“When the Chiropractic profession started relying on business and sales techniques for practice building they did use approaches to ” close the sale” of care to patients. 

It’s a transaction- based approach with a winner and a loser. It’s positioned the doctor-patient relationship as a competition or Confrontation. This became especially prominent with long-term care and prepayments plans.

The alternative is open the relationship rather than close the sale, because there’s nothing to sell. A report of findings now is exactly that, a report of findings and options given. Respect for the patient’s autonomy in decision-making and service over sales. It’s becoming a partner not a competitor with our patients.”

He’s so damned smart. I wish I could have the eloquence to put things the way he does. He makes it look easy. 

What he’s talking about is being patient-centered, not doctor-centered. That’s really the whole point of the whole damn episode I think. Being a partner with our patients is being patient-centered. Not dominating them through whatever means necessary.

If you think some chiropractors’ shenanigans aren’t making it online? You’re crazy. People are posting it everywhere. Names, dates, events, quoting the doctors word for word. Things don’t happen in a vaccuum anymore in the year 2019. 

Here are a couple of stories I found on the interwebs while researching this episode about closing patients. 

This first one is an experience a woman had when she visited the chiropractor. Luckily, she didn’t swear off chiropractors completely after the experience but who could have blamed her if she did?

She preframed this sucker as a cautionary tale to all those who are easily persuaded by emotional sales pitches. She went to a fair and got on one of those spine check doohickeys that checks balance from one side to the other and high shoulders and all that crap. 

The lady told he she was carrying 9 more pounds of weight on one side of the body than the other and her head is 2 inches too far forward and one shoulder is higher causing her head to tilt the other way to compensate. 

All of the sudden, a care-free girl out shopping at the town fair who stopped to have her spine checked for a little fun change-up in her daily routines is thinking, “Oh damn…this sounds awful.”

No worries though, the chiro office offered her a $20 preliminary screening at the center to include 2 x-rays, a spinal exam, a foot screening….the whole shubang, for $20. Awesome. Way to value your services random chiropractor screening at a town fair that has nothing to do with health.

Luckily for this lady, her husband smelled a skunk.  

She went to the appointment, paper work, intial intake with the staff, and then the chiropractor arrives. She asked if she could do a few more exams of the spine. Following this exam, she said in a grave voice that she has some serious concerns about the neck and spine. 

IN FACT, she would like to take two more x-rays than scheduled in order to check out a few other things. She reassured me that I wouldn’t need to pay for these x-rays — they would just send the bill to my insurance, and if insurance wouldn’t cover it, they would eat the cost. 

The patient thought WOW, they must really care about the well-being of their patients to take this financial risk! 

Then, sent home with a follow-up appointment scheduled. Not before the chiro reminder her how urgent it is for her to come back and get treatment started as soon as possible. Makes me want to pull what is left of my hair out of my head. 

She left that first appointment sincerely afraid that there was something seriously wrong that only chiropractic was able to fix. She was leaving that first appointment basically in tears. She didn’t sleep at all that night. She was thinking, “What if I lay with my hnead at the wrong angle….would that make her neck even more crooked?”

Follow up appointment, seated in an education room when whe underwent a lesson in the philosophy of chiropractic. They told her that by the time we feel pain, our bodies are down to 40% health which means that if we feel healthy, we really aren’t. Holy guacamole. Crap fire and just save the damn matches won’t you?

All of our illnesses come down to subluxation which only chiropractic has the answer for, blah blah blah.

Then the x-rays. These are her exact words, “First we looked at the before and after x-rays of people whose lives and health were transformed at the Wellness Center. 

Next we compared *healthy* spines (people who have regular readjustments) with *unhealthy* spines (people who just don’t care about their health and don’t want to live past 65). 

Finally, we looked at the x-rays of a few tragic people who did not get the treatment they needed and whose spines were COMPLETELY COMPACTED. Dr. Amy then asked if I was ready to go look at my films — and I responded by bursting into tears.

She goes on, “When I saw my x-rays, my first thought was, “Wow, it’s not as bad as I thought! My spine doesn’t look like a 70-year-old!” But still lurking was the shadow of what might be — the ghost of future spines, if you will — if I didn’t pursue a full chiropractic treatment plan. 

Dr. Amy and I talked through my x-rays, and I learned that my spine is only at stage one degeneration (something they NEVER see in a 28-year-old!) — in other words, still terrible, but treatable. 

By this time she was fully convinced that 

1. I needed chiropractic care, 
2. it should start right away, 
3. this Wellness Center should be the one to offer this care, and 
4. it would save my life.

Guess what she got….you just guess! That’s right, she got a 12-week treatment plan, 3 visits a week for the low low basement bargain price of $2,800. 

The office, because they’re so giving and kind and genuinely caring offered her an 18-month payment plan at $140/month. For treatment she didn’t even need in the first damn place!!

Remember, even if you don’t hurt, you’re still sick? Good Lord jumpin’ jehovah. The lady told the doc that she needed to run it by her hubs before signing a contract. Like a contract belongs in healthcare in the first place but whatever. It’s outlawed now. At least in Texas. 

Anyway, the doc told her to come back the next day with her husband so that he could get a free screening with x-rays as well. Lol. These people. The hubs wasn’t buying it. She couldn’t believer her husband wasn’t more concerned that she was 28 years old and already had stage I degeneration of her spine!

He talked her down, she went and finally did some of her own research, and realized she had took a big swig of the snake oil. 

Yes, of course chiropractic could have helped her with her neck that had been a bit sore recently. Yes, a chiropractor’s office was exactly where she belonged. But no, not in an office like that where she was manipulated emotionally and almost financially. 

Here’s a lovely ditty about one of those beloved ‘free dinners with the doc.” Ugh. That’s a whole different episode, isn’t it?

Anyway, here’s what happened. the first thing is that the flyer advertising all but hid the fact that a chiropractor was the presenter. 

Quoted in this article was Robert Puleo of the California Board of Chiropractic Examiners. He said, ““It reeks of snake oil. There are some chiropractors out there who want to make a buck any way they can.” And: “The chiropractor holding such seminars tries to sign people up for months of office visits that can cost thousands of dollars.”

Ummm….yes. Exactly. You think chiropractors keep buying dinner because they’re nice people? Hell no. They’re trying to scare people into a close and a sale. 

The attendee to the dinner mentioned in the article said it consisted of four parts:

1. Trust building – that’s where the presenter talks about their education and why they’re super double awesome and should be trusted. Can I just say that I immediately do not trust someone giving a free meal to prospective targets? I just don’t. Regardless of education. 
2. Medicine bashing – This is where they talk about the inefficiency and poor quality of the US healthcare system. You all know the dance. I know that waltz myself. I can tell you all kinds of numbers and frame out the inefficiencies in a bunch of different ways. When it’s there, it’s there and I don’t mind that dance because they don’t mind bashing on chiropractors all of the time. 
3. The product being sold – he was selling some laser therapy for neuropathy. The same stuff I believe that I just saw where an LA doc was on TV being accused of selling stuff that doesn’t work. Guess what? That dude was selling at a free dinner as well. I just never wanted to be a salesman. I just wanted to be a doctor and help people. Maybe I’m crazy. 
4. Recommending consultations – Basically come see me at the office for $29 so I can sell you on thousands. Whne the attendee asked how much the laser service costs, he was told, “Oh, the doctor sets that amount.” So…..you can’t just tell me the cost? And…is there a dual fee schedule? Like, the doctor sets different costs? Because it it’s not a dual fee schedule, then the price is already set and, in that case, you should be able to simply tell me the price. Right?

I guess being upfront, transparent, and honest doesn’t quite fit into the dessert menu does it?

Last thing I’ll touch on is the RELIGIOUS ROF – For a more extensive exploration of this, listen to episode #61 of this podcast. It covers it at length but, in short, I’m a Christian so let’s not think I’m an atheist bashing on Christians. That would be a biased discussion wouldn’t it?

This is a non-biased discussion about it so settle down fellow Christians. 

Here is a script from a management company that uses or used a person’s faith against them to close a sale, ““Mary, I’m concerned. I’m really concerned about you. When you don’t continue your plan to remove the subluxations that are interfering with God’s life force allowing it to innately flow from above down through your body in order to heal you, you’re not allowing God to do his part and heal your body. I understand that it’s hard getting here…but I have an opening at 5:30 tonight so we’ll see you then and let’s get you that life-saving adjustment tonight ok?”

You can’t make it up and, as a Christian, I find it dissappointing to say the very least that a fellow Christian would think this sort of manipulation and sales tactics is permissable in any way, shape, form, or fashion. 

It’s just awful. All for the sake of closing a sale. Are we really that desperate? Obviously some at least think they are and maybe there’s no other way to make money. 

You want to know how to build a company? How to build trust in a brand? I’ll share it right here. Instead of the religious manipulation script I just read, say this:

“Mary, I’d never try to tell someone how to spend their money or how to take care of themselves because that’s none of my business. My job is to tell you what I think would be the best for you based on the idea that you live right next door and have no travel concerns, and you have all of the time and money in the world. What would I think would be best for you? Then there’s reality and my job is to be here for you however you want to use me. We don’t hassle our patients about their recommendations. Just do me a favor if you can’t do what I recommend, don’t tell people that chiropractic didn’t work. OK? Tell them you weren’t able to do what the chiropractor recommended. Is that fair?”

See how simple it is?

Look, we all want to get rich while we help change the lives of our patients. But where does the switch happen where it’s OK to work patients to the point of emotional breakdown just so that they’ll sign up for countless visits over the course of a year or more? How does that switch go from being a new doc excited to work with the population into a manipulative street corner huckster schooled in the art of emotional manipulation? 

How does that moral compass get swapped approximately 180 degrees to the point that money is more important than superior patient care? And….reputation. I would argue that your reputation absolutely precedes you. Especially the smaller the town or area that you practice. 

One of my very respected colleagues, Dr. Gregg Friedman, who also happens to be a nationally known speaker, shared this thought with me when I asked about closing, “Closing a patient” looks like a sales technique and makes me want to puke. It does not create a positive image of chiropractic in the minds of the public we strive to serve. Just my opinion.” Spot on, nailed it. 

There are about 45 chiropractors in my area give or take. I know how about 80% of them practice because patients tell me. I’ll bet about 80% of those chiropractors know how I practice. For better or worse. I say worse because they only see my failures and I only see theirs. BUT….we still have a general idea of who the chiros in our area are, how they practice, and if they’re reputable. 

Basically, would you send you brother, sister, or mom to them? How about your child? If you’d send your family member to yourself, maybe you’re in a good spot. I can’t answer that. If you have systems set in place that manipulate information, manipulate a patient’s emotions, and manipulate words to make the practice a lot of money……and you’d still send you kid to that…..we need to talk. 

Let’s dive in a little bit more. Now, those of you that use this, and firmly believe in it, are going to be pissed right now. 

“Who the hell is this guy, what make him think he can question this or that, blah blah blah?”. I’ll tell you who I am. Nobody particularly special is who I am. In many ways I’m no smarter than the people that use some of this stuff. In some ways I am. 

I’m a bit of a research nerd – a dude with what I like to hope is an EDUCATED opinion and I’m a dude with an opinion that just happens to have figured out how to record and air podcasts, build a crowd, and talk about his opinions. That’s all. If you don’t like my opinion, go get your own podcast and crowd, go figure that out and talk about what’s important to you. 

There are already lots of them out there. Go call your company something like Chiro Closers, hustling chiros, chiro shrimp, or cervical correction academy specialist association or whatever the hell you can come up with that gets attention, or sounds important. Hell, I have half a mind to buy the domain www.chiroclosersareus.com and just have a landing page that says, 

“Hey, welcome…I’m not selling you anything. I just want you to know that closing people in healthcare is not patient-centered, it’s not quality care, it’s not being the doctor that you are, and you can be just as successful if you be the doctor, diagnose well, make good responsible recommendations for care, be a partner with your patient in their recovery, be sincere, really really care about them, and then be there however they decide they want to use you.”

Bam….secret to success nugget. 

Right there. If you didn’t listen or zoned off, rewind that about 15 seconds. You don’t have to buy it packaged up a million different ways from wannabe gurus. It’s really so so simple folks.

Back to the point: One of the most common reasons for big money, long-term plans I hear from patients when we’re talking about their previous chiropractor was that they saw an x-ray of their neck and it was straight. And to get that curve back, it was going to take 65 visits over 14 months at a cost of $4,500 (I’m making those numbers up but you get the point). All to get that curve back. 

Now, can we be honest a sec? You can go tell me to jump in the river. You can tell me I’m only about treating pain..and you’d have a fair point… You can call me a medipractor. You can call me whatever names you like but be serious, thoughtful, and maybe even non-philosophical for a minute. 

I believe, and my experience suggests, that a straighter curve is a consequence of simply being alive for a whole bunch of years. I believe that not having a curve when a patient is 50 years old is NOT going to impact their lives so much that they need to pay me as much as a surgical co-pay would be for surgery? What if I improve the curve a few degrees? Is it really that big of a deal that made that big of a difference?

The ONLY research I’ve seen on straight necks that made much sense was more recent. We covered it here on the podcast. It said it may lead to some degeneration of I believe it was C6/7 but, overall, impact of it was minimal. 

Other research you may have seen on this may come from other gurus that have conducted their own research. 

How nice is it to be able to say you conduct your own research, not have it peer reviewed or published in any respected journals, and then say it backs up your method so that people buy your products? That’s nice. Funny how that stuff works right? And so convenient. 

THAT’S what I mean by manipulating information. 

Let’s re-visit the title of this episode. Just repeat it a time or two. Closing patients. Let’s add a couple of words. Closing patients on care.

For me, that’s an oxymoron. If you care, are you going to manipulate patients with words and emotions? The correct answer is hell no you’re not.

Put yourself in the patient’s place real quick. 

Do you, in a healthcare setting, EVER wish to be closed? Other than an incision of course…. as my good friend Dr. Tyce Hergert in Southlake, TX says. Lol. 

The answer is no. At least I sure as hell don’t want to be closed. Not under the fear of losing my ability to function 30 years in the future. Not under a fear like that that no research I’ve ever seen can back up. 

As mentioned above, you want to be told what is wrong, you want to know how to fix it, and you want to know how much that costs. You might be interested in any other treatment options as well. You might want to know if you could just undergo a trial period of treatment first to see how you respond to care before deciding on anything else.

ALL OF THOSE should be on the table and your patient should know that, at the end of the day, your job is to be the doctor and give them your best recommendations while also understanding that you are there to help them to the best of your ability regardless of what they decide. 

Again, we should be our patients’ partners, not their boss, not dominating them, not running the show regardless. 

In the end, remember the three pillars of a patient-centered, evidence-informed practice. They are of course, 1) the best external evidence, 2) individual clinical expertise, and 3) get this…..pay attention….patient values and expectations. 

Not the doctors values and expectations. 

Key Takeaways: be a partner with your patients. Do not be a domineering, street corner snake oil salesman. Please. Those that do this give all of us a bad reputation. I have gone through the DACO diplomate program. Countless chiropractors around the globe highly educate themselves and take great pride in the results they can get for their patients. 

When you go about business like we’ve been discussing here, you discredit all of us almost immediately in the minds of those patients. Who then turn around and tell their family and friends and then go and post it on their blogs or tell a TV reporter about it who then tells everyone in the world in one way or another. 

Cut your crap. Enough is enough. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author & Host

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

The post Closing Patients – Helpful or Destructive? appeared first on Chiropractic Forward.

CF 087: Chiropractic in Active Duty Military, Early Care in Whiplash, Chronic Discs & The Sinuvertebral Nerve

Today we’re going to talk about Chiropractic care in Active Duty Military folks, we’ll talk about Early Care in Whiplash victims, and we’ll talk about Chronic Discs & The Sinuvertebral Nerve. What’s the what what on that?

But first, here’s that smooth like chocolate mousse bumper music

And away we go..… Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have back flipped into Episode #87. Kind of like the kid at the town swimming pool when you were in school. I could never do that. Pissed me off too. Of course, I never cracked my noggin on the bottom of the pool either so there’s that I suppose. 

We have some pretty cool stuff to talk about this week but, before we get started, let’s talk about GoChiroTV for your lobby. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living. To encourage referrals and to present the benefits of all of the different products and services you offer.

It works by using a tailor-fit video playlist that only promotes the products and services available in your practice. Not only that but the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can just set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription and you can’t hardly beat that deal. 

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial. Take your practice to the next level with GoChiroTV. Introduction

As regular listeners already know, I’m going through the Diplomate of the Academy of Chiropractic Orthopedists and I really don’t have much to share on that end of things. I got past Part I and am studying for Part II which is coming up in November. Overall, it’s been enjoyable. I do a lot of extra continuing education anyway so, might as well get some letters after my name for my effort don’t you think? You know I’ll keep you updated as I go. 

Here and there, when the spirit hits me, I’ll post some interesting stats from the DACO coursework on our Chiropractic Forward facebook page or in the Chiropractic Forward private group so you can be looking in there for that. 

Item #1

We’re going to start with this one. It’s called, “Chiropractic services in the active duty military setting: a scoping review” written by Mior, Sutton, and To, et. al(Mior S 2019). It was published in BMC Chiropractic and Manual Therapies in July 2019. Hot stuff….serving it up fresh folks…

They start by pointing out the obvious and that’s that musculoskeletal injuries are really a big deal to military folks. Hell yeah they are. I’ve had patients that have fallen from helicopters before. That doesn’t typically happen in the civilian population, now does it?

In some countries, recently America was added to the list, chiropractic care is being used more and more to manage these injuries. Which brings to mind….y’all….the VA just sent me a WWII veteran today!! Just this morning. He was in France and Germany from 1944 through the end of the war in 1945. Made my entire month, y’all. Seriously. How fascinating. Imagine the things he’s seen. 

I told him that, when I hear people bitching about Obama or Trump or politics or anything else really….I always think about their generation and that time and wonder what they were thinking about the world. Rationing supplies, sons, brothers, sisters, fathers, and mothers scattered from one end of the globe to the other. What did they think?

You know what he told me? He said, “We didn’t think the world was coming to an end. We just thought one thing and that was putting an end to it and we had to put an end to Germany to do that. That was all we were thinking.”

Pretty interesting. I get to spend time with this dude for several weeks. I’ll report back with any super awesome nuggets he chooses to pass on to me. 

Anyway, sorry for the sidebar there, back to the paper at hand. 

How They Did It

• They used systematic reviews of relevant databases including military collections and hand searches were conducted from inception up to October 22,2018. 
• They included peer-reviewed English literature with qualitative and quantitative designs, describing chiropractic practice and services delivered to active duty military worldwide. The data was put into evidence table and sorted by study type. 

Geez….sentences like that make me truly happy I am personally not a researcher myself. How boring. Lol. But thank God some are bent that way and like it. 

Now, What They Found

• 497 articles were screened and they whittled that down to only 20 that fit the criteria. 
• Back pain with and without radiculopathy accounted for most complaints. 
• They identified two recent randomized trials that reported improved pain, disability, and satisfaction when adding chiropractic care to usual medical care compared to usual medical care alone in management of low back pain….I believe Dr. Christine Goertz, one of our previous guests was involved in at least one of those papers. 

Wrap It Up

“Two recent RCTs provide evidence of comparative effectiveness of adding chiropractic care to usual medical care. Despite the reported use of chiropractic services in Australia, Canada, and the US, there is little available published evidence related to the nature, use, and outcomes of chiropractic care in active duty military. Our review suggests the need for further qualitative, descriptive, and clinical trial data worldwide to inform the role and value of chiropractic services in active duty military globally.”

So basically they did a lot of work to say, “Yeah, we’re not sure. We need more research.” Lol. Isn’t that the way it usually goes though?

I’m going to go ahead a anecdote the crap out of you here. As I mentioned before, we see a good number of veterans that the VA sends over. Every single one of them have been in the middle of chronic pain syndrome. I have had more than one of them tell me that they are going to kill themselves if they cannot get something done about their pain. 

The VA is stopping all opioids, as they most certainly should. Veterans don’t like this. The opioids were their safety nets and whether they really helped or not, the vets thought they helped and just like a placebo, that may have been enough to make a difference for them. 

So now it’s other things. They come in still on gabapentin and things of that nature but no more opioids and they’re pissed. But here’s the deal, when you start asking about their service, what years they were in, and where they were sent, you start to see the walls break down a bit. 

That’s when you demonstrate good solid knowledge through your exam and communication. By the time to finish up, if you do it right, you have a new patient and a new friend who’s excited to see where this thing might go. 

Almost all of them have responded positively. Yes, absolutely there are some here or there that don’t get the results we want for them but, without a doubt, the vast majority of them start sleeping better (which is one of the most common complaints), they stop hurting at the levels they previously experienced, and they start becoming more active. They come in laughing and they look forward to being here. 

Researchers can have all of the questions in the world and I’m glad they do and I’m glad they’re trying to answer them but, for me, I don’t have to know exactly how it works physiologically. I just practice good solid evidence-based chiropractic and I have the joy of sitting back and watching what happens. It truly is astounding y’all. 

We’re going to talk about whiplash and early intervention. Good idea or bad idea? It may not be what you think it is. 

First, since we mentioned evidence-based chiropractic, 

Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99.

Alright, Item #2

This one is called, “Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result?” written by Cote, Hogg-Johnson, Cassidy, et. al. and published in Arthritis & Rheumatology in 2007(Cote P 2007). Oldie but a goodie here if you’re doing personal injury work. 

Why They Did It

The stated goal here is to test the reproducibility of the finding that early intensive care for whiplash injuries is associated with delayed recovery. 

How They Did It

• Data from a cohort study of 1,693 adults suffering whiplash was looked at. 
• They picked apart 8 different patterns of care between GPs, chiropractors, and specialists
• And they used Cox models to estimate the association between patterns of care and time to recovery

What They Found

“The observation that intensive health care utilization early after a whiplash injury is associated with slower recovery was reproduced in an independent cohort of patients. The results add to the body of evidence suggesting that early aggressive treatment of whiplash injuries does not promote faster recovery. In particular, the combination of chiropractic and general practitioner care significantly reduces the rate of recovery.”

Well what the hell do we do with that information exactly? What exactly is meant by the term ‘early aggressive’? What is meant by chiropractic care? Does that just mean spinal manipulative therapy? Or does that mean spinal manipulative therapy, exercise/rehab, therapy, and all the good things we use to make people better?

My answer to you is “Hell if I know.” The abstract doesn’t give that information. But what I can tell you is, the more we are able to utilize motion and movement, the faster they heal up. You take that to the bank from your ole pal Uncle Jeffro. 

Item #3

Look, when I read the title of this next one, I don’t want your eyes glossing over and you losing your ability to stay awake. I damn sure don’t want you turning off the podcast or fast forwarding. Just hold on a damn second. 

This one is called “A comprehensive review of the sinuvertebral nerve with clinical applications.” It was written by Brian Shayota, T.L. Wong, and Donald Fru, et. al. and published in Anatomy & Cell Biology in 2019(Shayota B 2019). Hot cakes, servin em fresh. 

When it comes to disc pain, the sinuvertebral nerve is a hot topic amongst anatomists. Bet you didn’t know that, right? Why would that be? Well, they say, “Knowledge of the nerve has been used to design a variety of diagnostic and treatment procedures for chronic discogenic pain. This paper reviews the anatomy and clinical aspects of the sinuvertebral nerve.”

The sinuvertebral nerve, associated with the discogenic type (pain from an injured vertebral disc), accounts for approximately 26%–39% of patients with low back pain. 

Well that’s important now isn’t it?

“Although the sinuvertebral nerve fibers are said to terminate in the outer anulus, it is now widely accepted that this end point is not permanent. Studies of healthy patients normally show neural penetration of the anulus at about 3 mm.” And the plot thickens!!

They continue, “However, degenerative discs have shown penetration of nerve fibers as far as the inner one third in one study [38], and into the nucleus pulposus in another.”

“Discogenic pain is not limited to the lower back. Overactivation of the C1–C3 sinuvertebral nerves is now considered the cause of most cervicogenic headaches.”

Wrap It Up

“Recent studies have shown that the sinuvertebral nerve can be traced as far as the outer three layers of the lamella in healthy patients, but can go as far as the nucleus pulposus in degenerative discs. The nerve has also been implicated in discogenic pain. Yet only recently has its role been extensively studied, providing opportunities for the development of newer diagnostic and treatment techniques to combat the debilitating consequences of its pathology. Provocative discography is still the gold standard for diagnosing discogenic pain. While these procedures have proved advantageous in discogenic pain management, much more work needs to be done to improve their accuracy and efficacy. The sinuvertebral nerve has also been linked to cervicogenic headaches, but more research is needed to clarify its involvement in this condition.

Pretty cool stuff right there folks!!

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author & Host

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

Bibliography

Cote P, H.-J. S., Cassidy JD, (2007). “Early aggressive care and delayed recovery from whiplash: isolated finding or reproducible result?” Arthritis Rheum 57(5): 861-868.

Mior S, S. D., To D, (2019). “Chiropractic services in the active duty military setting: a scoping review.” BMC Chiro Man Ther 27(45).

Shayota B, W. T., Fru D, (2019). “A comprehensive review of the sinuvertebral nerve with clinical applications.” Anat Cell Biol 52(2): 128-133.

The post Chiropractic in Active Duty Military, Early Care in Whiplash, Chronic Discs & The Sinuvertebral Nerve appeared first on Chiropractic Forward.

CF 086: Sports Performance / Chiropractic Care Standardization / Proprioception 

Today we’re going to talk about Sports Performance / Chiropractic Care Standardization / Proprioception 

But first, here’s that arm like a big fuzzy coat bumper music

OK, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have tripped into Episode #86 and when I say tripped, I don’t mean so much the LSD kind of trip but more like the I’m an idiot and fell face first in a room full of people sort of tripped. So, welcome you fools!! Lol. I kid, I joke. I’m honored to have you here today. We have some good stuff to cover. 

Before we get started, let’s talk about GoChiroTV. GoChiroTV is a patient education system for your office that elminates the need for cable TV or looping the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living. To encourage referrals and to present the benefits of all of the different products and services you offer.

It works by using a tailor-fit video playlist that only promotes the products and services available in your practice. Not only that but the videos are replaced automatically on a weekly basis. There’s nothing complicated. You truly can just set it and forget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions. That’s CFP19, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription and you can’t hardly beat that deal. 

Go visit GoChiroMedia.com to check out the demo reels and get started on your free trial. Take your practice to the next level with GoChiroTV.

Introduction

We’re here to advocate for chiropractic while we also make your life easier using research and some good solid common sense and smart talk. 

Personal Happenings

I always feel that, if I share personal experiences with you guys, first you’ll know me as a person better and I don’t see anything wrong with that. Second, you may identify and sympathize. Third, if you can’t necessarily identify with what I go through, you may be able to learn from it if you get to that point. 

With that I’ll say that 2019 has been quite the year for us around my office. New faces, lots of new patients, and less and less time to do things outside of seeing patients. My work/life balance is out of balance at the moment and I’m afraid my health is starting to show some dents in the armor. 

I think I have an undiagnosed anxiety thing and, typically, I’m very good at managing anxiety and stress and having 4 or 5 balls up in the air at the same time. I’m a juggler people. And I have been for quite a long time. 

But, in January, something clicked. Something changed. I don’t say this to brag. I say this to explain. My practice numbers just started to climb during a time that we are traditionally slow. Really slow. The holidays are usually a time when you just know you’re going to have extra time to catch up on all of those things that have been piling up in front of you. Back to school time as well right? It’s always been a down time for me for one reason or another. 

Yeah, well, not this year. The holidays only got busier. Much busier. The kids go back to school in two weeks and there’s been no slow down this Summer. Which is awesome. But my problem is, I don’t know what I did to cause the influx. If I knew, you better believe I’d be repeating it!! Over and over and over. 

The end story is, growing is great but growing can be stressful. That’s why they call it growing pains right? Think about it: how many staff member do I need to handle the patient load? Am I over staffed or understaffed? Do I need an associate? Which one is the right one? Will they take care of things like it’s their own and they care? Where do I get good contract for one? I have a bathroom that needs tiled and I have an Air conditioner that need’s replaced. My dog pissed on the carpet this morning. Blah blah blah. 

You all know how it goes. Every aspect of practice has stressors. When you’re new in practice and don’t have a heavy load, you’re sitting looking at your watch, playing on the computer, hopegully you’re out marketing, and you’re stressed about how you’re going to provide for your family. 

I’m aware that being too busy is a nice problem to have. I don’t want to come off as a spoiled brat here. I’m just saying that I have been stressed and it’s starting to affect me a bit. We have been blessed and we are going to take blessings and we are going to turn them into more blessings for us and for our patients and staff. 

It’s just getting through some of the mud and muck along the way. I just need to keep my anxiety under the surface a little longer. Lol. So that nobody thinks I’m insane. 

I’ve fooled them this long haven’t I?

On another note, Charlie Manson. Y’all, I was fascinated by their shenanigans when I was in high school but got over it. Every now and then I’ll see something about it and I’ll perk up and listen but I went to see the new movie Once Upon A Time In Hollywood. 

I’ve been seeing where some hate it and some love it and I’ve seen a bunch of ehhh comments but I gotta tell you. I’m firmly in the hell yeah category. Brad Pitt and Leo DiCaprio knocked that sucker straight out of the parking out onto the parking lot. It was funny, it was vintage, it was nostalgic, and no…..of course it didn’t happen that way but it was excellent. 

If you went, shoot me an email at [email protected] and tell me what you thought. I can share you thoughts next week on the podcast. Or you can get on our Facebook page or our private Facebook group and we can discuss. 

Item #1

Let’s get to our first item here. It’s titled “The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence” and written by Meliss Corso, Silvan Mior, Satrah Batley, et. al. It was published in BMC Chiropractic and Manual Therapies in June 2019. Brand new…..hot stuff people. (Corso M 2019)

Why They Did It

The authors wanted to perform a systematic review regarding the effect spinal manipulative therapy has on athletic performance in asymptomatic adults. 

What They Found

They concluded “The preponderance of evidence suggests that SMT in comparison to sham or other interventions does not enhance performance-based outcomes in asymptomatic adult population. All studies are exploratory with immediate effects. In the few studies suggesting a positive immediate effect, the importance of such change is uncertain. Further high-quality performance specific studies are required to confirm these preliminary findings.”

That doesn’t mean we can’t help with pain and discomfort which aids in better performance. But it does suggest that, if a person feels great, getting spinal manipulative therapy isn’t very likely to make any difference in how fast they are or how far they can throw. 

Item #2

This one is called “The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain” by JA Quan, et. al and was published in the Journal of Manipulative and Physiological Therapeutics in June 2015 so 4 years old. (Quon JA 2015)

Why They Did It

The aim of this study was to determine if effectiveness differs between community-based doctors of chiropractic administering standardized evidence-based care that includes high-velocity low-amplitude spinal manipulative therapy (SMT) for acute low back pain (LBP).

How They Did It

• A secondary analysis of randomized controlled trial and observational pilot study data was performed with nonrandom allocation to 4 DCs. 
• Patients included those with Quebec Task Force categories less than or equal to 2 and acute LBP of 2 to 4 weeks’ duration. 
• The intervention included high-velocity low-amplitude SMT. 
• Outcomes assessed using Roland Disability Questionnaire (RDQ) at 24 weeks. 

What They Found

The findings of this study show that regardless of the treating DC, most patients with acute LBP without radiculopathy appear to experience consistent levels of improvement in terms of BP and general PF after receiving guidelines-based treatment that include s a component of standardized HVLA SMT.

If we dive into the paper, they mention that until now, inconcsistency hasn’t been regarded as a significant barrier to chiropractors getting referrals from the medical realm. Butthere are guarded attitudeds about chiropractors when we’re talking about quality of care and that’s been confirmed in other papers. 

In fact, in a survey of 487 Canadian and American orhtopedic surgeons, they found that about 71% of them held either a neutral or a negative view of chiropractors. That means only 29% of them looked at us in a positive way. 29%. Dammit

Also, when you break down that 71% of neutral or negative….you get 26% were neutral but 45% were in the negative category. Dammit. 

73% of orthopedic surgeons thought chiropractors provided unnecessary treatment. Yeah, they’d probably just do better if you intubated them, knocked them completely out, and drove screws through the bones of their spine to fixate the segments on top of each other and then sewed them back up, and then sent them home with a bunch of pills. That’d probably be much more necessary. Sure thing chief. 

Hell, 52% of them thought chiropractors make their patients dependent on short-term relief. I will say that it feels good to feel good and why wouldn’t a patient want to feel good as often as they can? But putting the shoe on the other foot here, let’s assume they’re right, isn’t being addicted to safe, conservative, non-invasive treatment better than being addicted to opioids or some sort of medication? Our nation’s opioid crisis suggests it is better. 

The paper itself is really a preliminary study and meant to further knowledge and information for other papers down the line but I found it more interesting because of the orthopedic survey discussion. Pretty interesting. And….disappointing I’d add but that was 4 years ago. Maybe those numbers are changed a bit from then to now? Not sure. 

This is a great spot to take a short break to talk about ChiroUp. If you’re a regular listener of our podcast, you I use it and I’ve told everyone how amazing it is since about June of 2018. Well now they’re a sponsor of our show and we are really excited to have ChiroUp on board the train. 

Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99. 

I’m trying to save you people some money here alright?Trust me, you’re not going wrong with ChiroUp. In fact, in studying for the Diplomate of the Academy of Chiropractic Orthopedists part two exam, I’m studying the orthopedic tests and videos from the ChiroUp website. It’s phenomenal. 

Anyway, on to Item #3

It’s called “Neck proprioception compensates for age-related deterioration of vestibular self-motion perception” by G Schweigart, RD Chien, and T. Mergner. It was published in Experimental Brain Research all the way back in 2002. Bringing the old man out of the archives here. (Schweigart G 2002)

Why They Did It

Vestibular functions are known to show some deterioration with age. Vestibular deterioration is often thought to be compensated for by an increase in neck proprioceptive gain. That’s what the authors were studying here….. this presumed compensatory mechanism.

What They Found

Generally, we hold that the transformation of the vestibular signal from the head down to the trunk proceeds further to include the hip and the legs as well as the haptically perceived body support surface; by this, subjects yield a notion of support kinematics in space. 

As a consequence, spatial orientation is impaired by chronic vestibular deterioration only to the extent that the body support is moving in space, while it is unimpaired (determined by proprioception alone) during body motion with respect to a stationary support.

Just to add a little sidebar here: did you know that muscle spindles are our motion detectors? Think about this. There are 16 muscle spindles per gram of muscle in our fingers. Our hands and fingers are highly sensitive with regard to proprioception arent they? Think of a musician playing with their eyes closed. 

You know exactly where your fingers are without looking at them or really even thinking about them. How about typing? You don’t look right?

Now, we only have about 2 muscle spindles per gram of muscle in the traps. Which makes sense. Why do we proprioceptively need to know where our traps are? They’re attached to our axial skeleton. They’re not going anywhere. They’re not out flapping in the wind like our hands right?

Here’s the weird deal though: in our deeper cervical muscles, we have 242 muscle spindles per gram of muscle. That IS our axial skeleton basically so why so many spindles? There’s no flapping out in the wind with the upper cervical muscles either. But, it is the connection between our head and the rest of our body. 

It is to the point that anatomists look at the upper cervical muscles as more of a proprioceptive organ rather than as simply muscles. 

Our three proprioceptive inputs are the eys, the vestibular organ, and the muscles of the upper cervical area. When you do a Romberg’s test and you remove proprioceptive input from the eyes, and the vestibular organ….., part of what you are measuring is the input from the upper cervical region. 

It’s fascinating. Absolutely fascinating when you dive off into it a bit and I encourage to do so.  

Store

Part of making your life easier is having the right patient education tools in your office. Tools that educate based on solid, researched information. We offer you that. It’s done for you. We are taking pre-orders right now for our brand new, evidence-based office brochures available at chiropracticforward.com. Just click the STORE link at the top right of the home page and you’ll be off and running. Just shoot me an email at [email protected] if something is out of sorts or isn’t working correctly. 

If you’re like me, you get tired of answering the same old questions. Well, these brochures make great ways of educating while saving yourself time and breath. They’re also great for putting in take-home folders. 

Go check them out at chiropracticforward.com under the store link. While you’re there, sign up for the newsletter won’t you? We won’t spam you. Just one email per week to remind you when the new episode comes out. That’s it. 

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author & Host

Dr. Jeff Williams – Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & VloggerBibliography

Corso M, M. S., Batley S, (2019). “The effects of spinal manipulation on performance-related outcomes in healthy asymptomatic adult population: a systematic review of best evidence.” BMC Chiro Man Ther 27(25).

Quon JA (2015). “The Chiropractic Hospital-Based Interventions Research Outcomes Study: Consistency of Outcomes Between Doctors of Chiropractic Treating Patients With Acute Lower Back Pain.” J Man Physiol Ther 38(5): 311-323.

Schweigart G, C. R., Mergner T, (2002). “Neck proprioception compensates for age-related deterioration of vestibular self-motion perception.” Exp Brain Res 147(1): 89-97.

The post Sports Performance / Chiropractic Care Standardization / Proprioception appeared first on Chiropractic Forward.

CF 085: Highly Paid Drug Dealers, Keto Diet News, Axial Traction, Stroke Research

Today we’re going to talk about Highly Paid Drug Dealers, Keto Diet News, Axial Traction, Stroke Research

But first, here’s that cool like a velvet Elvis bumper music

K, we are back. Welcome to the podcast today, I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

You have tip toed into Episode #85

Man, we have a show for you today. I’m still cleaning out some archives. Some papers that have been building up while we have been having guests. Some great guests that we have had more recently have been Dr. Anthony Nicholson from Australia who plays such a big part in the DACO program. The guy is a genius and eveyrone in our profession should know about him. We talked about decoding chronic pain just a few weeks ago so listen. What are you waiting for?

Then we had the chiropractor for Florida State, Dr. John Van Tassel and he is just a wise, accomplished, mentor that you need to go and hear what he has to say. Again, what are you waiting for? Go now!

Speaking of the DACO, I went to Dallas, I drove to the University of Texas in Arlington, TX …..that’s between Dallas and Ft. Worth for you out-of-towners…and I sat in a little cublicle next to some college kid with a bad case of the sniffles and I took my part one exam toward getting my Diplomate of the Academy of Chiropractic Orthopedists. 

I had heard from several sources that it was a hard test and that there really was no way in particular to prepare for the test because it is literally all over the map. And my sources did not tell any fibs people. 

There were the most random, crazy questions on that thing. Things I’d never think to study because we didn’t learn them but, it seems my guessing picker was in order on that day because I passed. Or….they took pity on my and passed me because I’m a swell dude. Either way, I passed. 

Don’t let my experience with this test dissuade you from going through the DACO by the way. The test is being changed and updated for the next round and I suspect it will be more relevant to the course teachings. That’s my guess anyway. 

So, now it’s on to part two in November.  I am taking a two-week break from studying and then I’ll dive back into that rigamarole.  

I’m happy to introduce a new sponsor for the Chiropractic Forward Podcast called GoChiroTV. GoChiroTV is a patient education system for your office that will eliminate the need for running cable TV or the same DVDs over and over again in your waiting room. The bite-sized videos are specifically made to inform your patients about the importance of chiropractic and healthy living, encourage referrals, and present the benefits of all the different products and services you offer.

It works by using a tailored-fit video playlist that will only promote the products and services available at your practice, and the videos are replaced automatically on a weekly basis. There’s no need to manually update your playlist or learn any complicated software. You truly can set it and f orget it.

Listeners of the Chiropractic Forward Podcast can use the promo code CFP19 at checkout to get 15% off all subscriptions, which also comes with a 45-day free trial to see if it’s right for your practice. Your discounted rate will be locked in for as long as you have a subscription. 

So visit GoChiroMedia.com (that’s g-o-c-h-i-r-o-m-e-d-i-a-.com) to check out the demo reels, and to get started on your free trial. Take you practice to the next level with GoChiroTV.

Introduction

Let’s get on to the research shall we?

Item #1

Our first paper here is one  from NPR called “Opioid-Maker Insys Admits To Bribing Doctors, Agrees To Pay $225 Million Settlement” and was published in June of 2019. The title leads us….you know where it’s going. (Emanuel G 2019)

Insys Therapeutics, an opioid manufacturer, has agreed to pay $225 million to settle the federal government’s criminal and civil investigations into the company’s marketing practices. As part of the settlement, Insys Therapeutics admitted to bribing doctors to prescribe its opioid painkiller.” Oh my….do tell!

The courts proved that the company set up a fake “speaker program.” The doctors involved were not paid to give speeches, but were paid to write prescriptions of the company’s fentanyl-based medication called Subsys. 

And, you guessed it…..many times the painkiller was prescribed to patients who did not need it.

The founder of Insys Therapeutics, John Kapoor, is among the highest ranking pharmaceutical executives to be convicted amid the opioid epidemic. Sentencing of the former billionaire is scheduled for September.

Highest paid drug dealers in the world right there. 

Item #2 is called “Changes in Spinal Height After Manual Axial Traction or Side Lying: A Clinical Measure of Intervertebral Disc Hydration Using Stadiometry” by Dylan Rubinic, a physical therapist. It was published in the Journal of Manipulative and Physiological Therapeutics in the March/April 2019. Hot stuff right here. (Rubinic D 2019)

Why They Did It

The authors were trying to figure out what effects axial traction have on someone compared to side lying when it comes to increased spine height after sustained loading. 

How They Did It

21 patients with no symptoms were used. 

They either had traction force for 2 rounds of 3 minutes

Or they had sustained side lying for 10 minutes

Spine height was measured with a stadiometer. 

What They Found

There was a significant increase in the height after both manual therapy AND sustained side lying. Well what the hell does that tell us then?

Wrap It Up

This was a preliminary paper to set the stage for futre papers but it’s interesting. They say, “Both manual axial traction force and sustained side-lying position were equally effective for short-term change in spine height after a loaded walking protocol among healthy asymptomatic individuals.” So does that mean that traction is no good? I don’t see that at all here. I say there was little to no difference in asymptomatic, healthy spines when done for three minutes. 

That’s all I see. What about compressed, degenerated, or dehydrated discs with annular fissures and without annular fissures with associate radiculopathy and without associated radiculopathy…..and and and and and. 

Lots of stuff to look at but at least they’re looking at it and I look forward to finding out where it all goes. 

Item #3

Keto diets. The current big thing. Item #3 is called “The Ketogenic Diet for Obesity and Diabetes—Enthusiasm Outpaces Evidence” by Shivam Joshi, MD, Robert Ostfeld, MD, and Michelle McMacken, MD and was published in JAMA Internal Medicine on July 15 2019. Brand spankin new people. (Joshi S 2019)

Before we dive into Keto Diets, let’s take a sec to talk about ChiroUp.

Have you heard about the #1 online resource for chiropractors? Well, let me tell you about it. 

ChiroUp is changing the way we practice by simplifying patient education and here’s what I mean: 

In a matter of seconds, you can send condition-specific reports to your patients with recommendations for treatment, for their activities of daily living, & for their exercises. 

You can see how this saves you time – no more explaining & re-explaining your patient’s care, because they have access to it at their fingertips. 

You can be confident that your patients are getting the best possible care, because the reports are populated based on what the literature recommends and isn’t that re-assuring? All of that work has been done FOR you. 

There are more than 1000 providers worldwide using ChiroUp to empower their treatments, patients, & practice – Including myself! **Short testimony**

If you don’t know what it’s all about or you’d like to check it out, do yourself a favor and go to Chiroup.com today to get started with your FREE TRIAL – Use code Williams99 to pay only $99/month for your first 6 months

That’s ChiroUp.com and super double secret code Williams99. 

OK, on to the article. 

They start by acknowledging the keto craze but say that the excitement doens’t necessarily equal the effectiveness or the evidence in supporting it. 

The point out that a metanalysis of 13 studies lasting more than a year showed that a keto diet shwoed less than one kilogram of additional weight loss over high carb, low fat diets. Hmmmmm very interesting….

IN addition, a different meta-analysis showed energy expenditure and fat loss was greater with low-fat diets vs. a keto diet. 

I’m going to quote the article directly here because they say it better than I can. They say, “In terms of the risk-benefit balance of the ketogenic diet, the potential adverse effects may give one pause. 

A review of the literature on ketogenic diets for the treatment of pediatric epilepsy reveals multiple adverse effects, ranging from the relatively benign but inconvenient “keto flu,” to less common but deadlier occurrence of cardiac arrhythmias from selenium deficiency. 

Other documented adverse effects include nephrolithiasis, constipation, halitosis, muscle cramps, headaches, diarrhea, restricted growth, bone fractures, pancreatitis, and multiple vitamin and mineral deficiencies.

The greatest risk, however, of the ketogenic diet may be the one most overlooked: the opportunity cost of not eating high-fiber, unrefined carbohydrates. Whole grains, fruits, and legumes are some of the most health-promoting foods on the planet. They are not responsible for the epidemics of type 2 diabetes or obesity, and their avoidance may do harm.”

Item #4

In our continuing series of showing anyone thinking that chiropractors cause strokes that they are the equivalent of archaeic flat Earthers, we go with this paper called, “Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial” by Nicholas Moser, Silvano Mior, Michael Noseworthy, et. al. It was published in BMJ Open in 2019.(Moser N 2019) 

Why Thye Did It

Their stated goal in the paper is quoted as, “We aimed to determine whether cervical spine manipulation is associated with changes in vertebral artery and cerebrovascular haemodynamics measured with MRI compared with neutral neck position and maximum neck rotation in patients with chronic neck pain.

They did it at The Imaging Research Centre at St. Joseph’s Hospital in Hamilton, Ontario, Canada. I have to say, I love those damn Canadians. They really do a great job on bringing quality and important research to the table for this profession. 

They used 20 patients here with a mean age of 32 and mean neck pain lasting 5.3 eyars. 

They tested maximal neck rotation followed by cervcial manipulation and/or

Cervical manipulation followed by maximal neck rotation. 

What They Found

“Our results are in accordance with previous work, which has shown a decrease in blood flow and velocity in the contralateral vertebral artery with head rotation. This may explain why we also observed a decrease in blood velocity with manipulation because it involves neck rotation. Our work is the first to show that cervical manipulation does not result in brain perfusion changes compared with a neutral neck position or maximal neck rotation. The changes observed were found to not be clinically meaningful and suggests that cervical manipulation may not increase the risk of cerebrovascular events through a haemodynamic mechanism.”

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 instead of chemical treatments like pills and shots.

When compared to the traditional medical model, research and clinical experience show that many patients get good or excellent results through chiropractic for headaches, neck pain, back pain, joint pain, to name just a few.

Chiropractic care is safe and cost-effective. It can decrease instances of surgery & disability. Chiropractors normally do this through conservative, non-surgical means with minimal time requirements or hassle to the patient. 

And, if the patient develops a “preventative” mindset going forward from initial recovery, chiropractors can likely keep it that way while raising the general, overall level of health of the patient!

Key Point:

Patients should have the guarantee of having the best treatment offering the least harm.

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 or tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on iTunes and other podcast services. Y’all know how this works by now so help if you don’t mind taking a few seconds to do so.

Help us get to the top of podcasts in our industry. That’s how we get the message out. 

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

Chiropractic Forward Podcast Facebook GROUP

Twitter

YouTube

iTunes

Player FM Link

Stitcher:

TuneIn

About the Author & Host

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

Bibliography

Emanuel G (2019). “Opioid-Maker Insys Admits To Bribing Doctors, Agrees To Pay $225 Million Settlement.” NPR.

Joshi S, O. R., McMacken M, (2019). “The Ketogenic Diet for Obesity and Diabetes—Enthusiasm Outpaces Evidence.” JAMA Intern Med.

Moser N, M. S., Noseworthy M, (2019). “Effect of cervical manipulation on vertebral artery and cerebral haemodynamics in patients with chronic neck pain: a crossover randomised controlled trial.” BMJ Open 9(5).

Rubinic D, K. V., Dudley J, Owens SC, (2019). “Changes in Spinal Height After Manual Axial Traction or Side Lying: A Clinical Measure of Intervertebral Disc Hydration Using Stadiometry.” J Manipulative Physiol Ther 42(3): 187-194.

The post Highly Paid Drug Dealers, Keto Diet News, Axial Traction, Stroke Research appeared first on Chiropractic Forward.