CF 120: TMJ The Best Way & Axial Traction For Lumbar Disc Herniation
Today we’re talking about TMJ the best way and we talk about axial traction for the lumbar disc. 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, profitable, and accessible while we make you and your patients better all the way around. 

We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers.

I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  

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Do it do it do it. 

You have found yourself smack dab in the middle of Episode #120

Now if you missed last week’s episode , we talked about chiropractic business opportunities and how chiropractic solves the opioid issue.

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

While we’re on the topic of being smart, did you know that you can use our website as a resource? Quick and easy, you can go to chiropracticforward.com, click on Episodes, and use the search function to find whatever you want quickly and easily. With over 100 episodes in the tank and an average of 2-3 papers covered per episode, we have somewhere between 250 and 300 papers that can be quickly referenced along with their talking points. 

On the personal end of things…..

I decided to start recording the episodes the week of at this time because things are changing so quickly right now, it didn’t make sense to record something that would be heard in two weeks and would likely just be irrelevant and maybe somewhat detached from the realities of the current events. 

Besides, it’s not like I don’t have the time, right?

First thing’s first, please check with your accountant before you do anything but, it looks like the PPP loan is the way to go for a lot of the employers. I want to be honest, I have the luxury of my wife handing this for us because she is wise in thing financial, record collecting, filing….that sort of stuff. 

But my rudimentary understanding of the PPP loan is that it acts more like a grant and if the money was used to continue to pay employees, then the loan is forgivable by that amount. Now, you folks smarter than I on these matters, please correct me but that is my initial understanding of the process. 

It is worth calling your accountant right now, today, and finding out if that’s the way to go. I’ve seen so many questions about the SBA loans and this and that and what should I do and which direction should I go. Look, we are stressed and worries to the max right now. We can all agree on that. 

So, how about we lessen the stress and just ask the people that know what’s going on. That would be the accountant. Some are better than others. If you have a crappy one, find a good one! We have confidence in ours.

So far, this week, at this point, we are still paying our employees as if we are still working. We closed our office on 3/23/20 to try to do our part and help flatten the curve. When you start looking at every patient as a potential point of danger, well….that’s not the way it’s supposed to be so, it was time to close for a bit. 

I plan on beginning to treat emergency patients only on Monday April 13th. Now, honestly, if we’re being honest, that might only be 3 or 4 a week. If even that. 

Some of the things I’ll have in place. We have some gloves left over. I have an N95 mask leftover from my woodworking. No, I do not have a stockpile. I spoke with a nurse practitioner friends of mine and they are down to only one as well. They are using diluted Barbasol to disinfect the masks. Is that ideal? Well hell no. Is it something and is something better than nothing? Yes, indeed. 

I have purchased small desk fans to place in each room in order to keep the air moving and not allow any virus to hang around in aerosol form. We, of course, will be wiping, checking temps, spraying, and all of that good business but, knowing that asymptomatics can carry and spread it, well, that puts us in a precarious situation doesn’t it? So we will be requiring patients to arrive with wearing a mask, 

     the thing I’ve found particularly irritating is uneducated folks finding some humor in fake coughing. Well, that’s a quick way to get booted from my office so there will be a sign in the lobby stating that “Fake coughs are not funny at this time”. Hopefully, that will get the message across so we don’t have to deal with any of that. 

Before we closed, we even had a less than thoughtful patient trying to be funny by rubbing hands all over the door frames and mock any safety protocols. Well, it goes without saying that this just isn’t the time for the tom foolery and shenanigans. 

We will begin slowly with only one person in the office at a time and a scaled-back workforce. I don’t want a bunch of people in the office at once and, honestly, we don’t need a bunch of people in the office at once. The workload is probably not going to be back to 100% for several months. I’m not being pessimistic, I’m being realistic. 

People don’t have the confidence to go out in public. They’re scared and it’s going to be that while for some time going forward. That’s just the facts. June into July is going to look better for us all if the models hold up and are accurate. They’ve been pretty spot on so far so hopefully, it stays that way.  

If you’d like a good model to check out, I’ll put the link in the show notes. 

For most areas, it looks like June is going to be a better month for everyone involved. At least in America. But when do things return to normal? I don’t think anyone knows what’s going to happen. Assuming this is not a seasonal issue, then I’d suggest September or so before people start gaining the confidence to really go out. 

If this has a resurgence, is seasonal, or the models don’t hold up, well that changes the story. On the plus side, as you know, if they come up with a dependable and highly effective means of treating this dude, we get back to normal, with confidence, faster. Or a vaccine but the shortest time table I’ve seen ever mentioned was 12-18 months. 

If you want some good news and some confidence in a return to what we once considered normal, please go to the show notes and check out the prediction model link I provided. 

Stay strong, stay faithful, take good care of yourselves physically and mentally, and take care of your neighbors. 

Item #1

Let’s get started with this one called “Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis” authored by La Touche, et. al(La Touche R 2020). and published in Pain Medicine on March 17 of 2020 – I cannot hold this for it is too hot at this time….

Why They Did It

To assess the effectiveness of cervical manual therapy (MT) on patients with temporomandibular disorders (TMDs) and to compare cervico-craniomandibular manual therapy vs cervical manual therapy.

How They Did It

• The first thing that jumps out at me on this paper is that it is a systematic review and meta-analysis which means it’s at the top of the food chain……or research pyramid…..when it comes to reliability. Meaning, this is great information. 
• They searched PubMed, EMVASE, PEDro, and Google Scholar with and end date of February 2019
• Two independent reviewers performed the data analysis and assessed the relevance of the randomized clinical trials 

What They Found

• For cervical manual therapy, they included three studies that showed statistically significant differences in pain intensity reduction and an increase in master pressure pain thresholds, with a large clinical effect
• Also the results showed an increase in temporals pressure pain thresholds with a moderate clinical effect
• The Meta-analysis included two studies on cervical manual therapy vs. cervico-cranialmandibular manual therapy and showed statistically significant differences in pain intensity reduction and pain-free maximal mouth opening, with large clinical effect. 

Wrap It Up

The authors wrapped their thoughts up by concluding “Cervical manual therapy treatment is more effective in decreasing pain intensity than placebo manual therapy or minimal intervention, with moderate evidence. Cervico-craniomandibular interventions achieved greater short-term reductions in pain intensity and increased pain-free motion over cervical intervention alone in TMJ/TMD and headache. Low evidence.”

Item #2

Our second and last paper this week is called “Effectiveness of Traction in Young Patients Representing Different Stages of Degenerative Disc Disease” authored by Kuligowski, et. al(Kuligowski R 2019). and published in the journal of Orthopedics, Traumatology, and Rehabilitation on June 30 of 2019. It’s warm but not quite hot… Dangit. I don’t get to use my beloved sound bit. But, it’s still less than a year old so listen up!

Why They Did It

The authors say that traction techniques are a popular method of treating lumbar disc herniation. The type of lumbar disc herniation (protrusion, extrusion) in young people appears to determine patients’ clinical status, necessitating diversification of treatment methods with regard to the type of damage.

How They Did It

• They enrolled 37 people aged 22-35
• The subjects had MRIs, which determined if they went to the protrusion group or the extrusion group
• During treatment, patients were in the supine position
• They were given three-dimensional traction using a manual therapy belt – I’m going to admit ignorance on what exactly constitutes 3-dimensional traction. In a search for a definition, you find all kinds of belts and contraptions, table, you name it. So, if you know the answer to exactly what they’re talking about here in this paper, shoot me an email so we can be clear on it. Email me at [email protected]
• Oswestry questionnaire, MRC scale, Numeric Rating Scale, SLR test, Passive Lumbar Extension test and measurements of lumbar segment mobility were used for clinical evaluation. 

What They Found

• An analgesic effect was noted with regard to the Oswestry and the Numeric Rating Scale. There was statistically significan differences observed in the case of parameters reflecting the subjective evaluation of disability and pain levels on the Outcome Assessments. 
• These differences were clear and statistically significant with more pronounced changes observed it the group of patients with the protrusion group. 
• The subjects improved clinically with regard to the Passive Lumbar Extension and the Straight Leg Raiser
• A statistically significant result was observed with regard to subjective pain levels on the NRS, again, with a better result in the protrusion group. Which I think is to be expected. Both groups improved in most measures with protrusion having the best results. But also keep in mind on the extrusions, outside of this paper, we know that an extrusion with migration is more likely to be self-absorbed by the body so it’s not all doom and gloom even for the extrusion group. 

Wrap It Up

1. The type of intervertebral disc damage determines the functional status of young people with degenerative disc disease. 
2. The study demonstrated and confirmed a positive effect of traction on the functional status of subjects with lumbar disc herniation. 
3. Traction techniques are safe and can be successfully used in the treatment of LDH.

Key Takeaways

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The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots.

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

It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. 

And, if the patient treats preventativly after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

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

That’s Chiropractic!

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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

• Kuligowski R, D.-B. A., Skrzek A, (2019). “Effectiveness of Traction in Young Patients Representing Different Stages of Degenerative Disc Disease.” J Orthop Tramuatol Rehabil 21(3): 187-195.
• La Touche R, G. S., Garcia B, (2020). “Effect of Manual Therapy and Therapeutic Exercise Applied to the Cervical Region on Pain and Pressure Pain Sensitivity in Patients with Temporomandibular Disorders: A Systematic Review and Meta-analysis.” Pain Med.

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