The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 348:  SMT Research Review & Mobile Phones And Cancer Today we’re going to talk about SMT Research Review & Mobile Phones And Cancer But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast on wherever you listen to it  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #348 Now if you missed last week’s episode, we talked about Plant vs. Animal Fat & Screen Time At Bedtime Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. It’s a Monday and, of course, we had a staffer call in sick again. It’s always Mondays it seems ya know? What the heck? But she’s one of my most dependable, most awesome-est people so I wont’ harrass her too much.  It’s a little slow today for us. We’re used to being in the 40’s for a Monday and we had 33 today so I don’t know what’s up with that but we have a goo damount tomorrow and Wednesday so, maybe it was just one of those days. And, I got A LOT done so we’re all good in the hood.  Let’s see, what’s up? I have a presentation coming up for the FTCA. For those of you not in the know, that’s the Forward Thinking Chiropractic Alliance and they’re having the October 2024 FTCA Virtual Business Summit which will be held Friday October 11-Saturday October 12. For more info, just go to www.forwardthinkingchiro.com and give it a looksee.  My presentation will center on new ways of looking at and treating chronic pain via the biopsychosocial construct. Sounds boring as hell but it’s not and we treat a lot of pain, folks so I hope you’ll join us. Hell, you might learn something.  If you’re a long time listener, you’re probably tired of hearing it. But I’m never tired of talking about it people!! I saw lots of my MCM Mastermind friends taking pictures together at the MPI Adjustathon. I didn’t even know that was a thing until I met this crazy group but I’m probably just going to have to go next year and just make it happen. My people were out there and they all had big smiles so I feel like I’m probably missing something and I hate FOMO.  I don’t have a ton to share at the moment except being an integrated clinic can be a challenge. We are replacing the Nurse Practitioner with two people. We are hirng an RN that starts next week and then another Nurse Pracititoner that will just do the hormone replacement pellets. Both are hourly staffers so that will help. Thee full time salary position was a challenge for sure when we were just building up something brand new and getting it off the groud.  We know how to do it now and should be off and running with the new crew soon. And it’s going to be great. Everyone in the office is jazzed and there’s just an electric feeling in the office and when your crew is jazzed, good thing happen.  Upward and onward Alright let’s get to the research shall we? Item #1 Our first one thiis week was posted on Facebook by Dr. David Graber I believe. It’s called, “Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations” by Trager et al and published in Journal of Clinical Medicine on August 28, 2024 so it’s smokin all over the place.  Remember, the citations can be found at chiropracticforward.com under this episode.  Trager, R.J.; Bejarano, G.; Perfecto, R.-P.T.; Blackwood, E.R.; Goertz, C.M. Chiropractic and Spinal Manipulation: A Review of Research Trends, Evidence Gaps, and Guideline Recommendations. J. Clin. Med. 2024, 13, 5668. https://doi.org/10.3390/jcm13195668 Why They Did It Chiropractors diagnose and manage musculoskeletal disorders, commonly using spinal manipulative therapy (SMT). Over the past half-century, the chiropractic profession has seen increased utilization in the United States following Medicare authorization for payment of chiropractic SMT in 1972.  How They Did It We reviewed chiropractic research trends since that year and recent clinical practice guideline (CPG) recommendations regarding SMT.  We searched Scopus for articles associated with chiropractic (spanning 1972–2024), analyzing publication trends and keywords, and searched PubMed, Scopus, and Web of Science for clinical practice guidelines addressing SMT use (spanning 2013–2024).  We identified 6286 articles on chiropractic.  The rate of publication trended upward.  Keywords initially related to historical evolution, scope of practice, medicolegal, and regulatory aspects evolved to include randomized controlled trials and systematic reviews.  What They Found The recommendations primarily targeted low back pain and neck pain; of these, 90% favored SMT for low back pain while 100% favored SMT for neck pain.  Recent clinical practice guideline recommendations favored SMT for tension-type and cervicogenic headaches.  There has been substantial growth in the number and quality of chiropractic research articles over the past 50 years, resulting in multiple clinical practice guideline recommendations favoring SMT.  These findings reinforce the utility of SMT for spine-related disorders. Wrap It Up Most chiropractic research articles and clinical practice guidelines regarding SMT have focused on spinal pain in adults.  From 1972 to 2024, research has transitioned from legal topics and case reports to randomized trials, observational studies, and evidence synthesis.  We also found that there has been substantial growth in the number and rigor of standard scientific methods of chiropractic research articles over the past 50 years, resulting in multiple clinical practice guideline recommendations favoring SMT.  These findings reinforce the clinical utility of SMT for spine-related disorders.   Item #2 Our last one this week is called, “The effect of exposure to radiofrequency fields on cancer risk in the general and working population: A systematic review of human observational studies – Part I: Most researched outcomes” by Karipidis et. Al and published by Environmental International in September of 2024 and it’s gettin’ hot up in here up in here.  Ken Karipidis, Dan Baaken, Tom Loney, Maria Blettner, Chris Brzozek, Mark Elwood, Clement Narh, Nicola Orsini, Martin Röösli, Marilia Silva Paulo, Susanna Lagorio, The effect of exposure to radiofrequency fields on cancer risk in the general and working population: A systematic review of human observational studies – Part I: Most researched outcomes, Environment International, Volume 191, 2024, 108983, ISSN 0160-4120, https://doi.org/10.1016/j.envint.2024.108983. Why They Did It The objective of this review was to assess the quality and strength of the evidence provided by human observational studies for a causal association between exposure to radiofrequency electromagnetic fields (RF-EMF) and risk of the most investigated neoplastic diseases. What They Found We included 63 aetiological articles, published between 1994 and 2022, with participants from 22 countries RF-EMF exposure from mobile phones (ever or regular use vs no or non-regular use) was not associated with an increased risk of glioma, meningioma, acoustic neuroma, pituitary tumours, salivary gland tumours, or pediatric brain tumours, with variable degree of across-study heterogeneity.  Exposure from broadcasting antennas or base stations was not associated with childhood leukaemia or pediatric brain tumor risks, independently of the level of the modelled RF exposure.  Glioma risk was not significantly increased following occupational RF exposure, and no differences were detected between increasing categories of modelled cumulative exposure levels. Wrap It Up For the analysis, commissioned by the World Health Organization, researchers reviewed 63 studies. They didn’t find any evidence that increased exposure to the type of radiation emitted from cell phones and other wireless electronics—non-ionizing radiation—causes brain cancer, even among people who spend many hours each day on their phones. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.    Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily p

CF 334: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 15) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 15)…..it’s the final part of the series.  But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast on wherever you listen to it  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #334 Now if you missed last week’s episode, we talked about Colo-Rectal Cancer Recognition & Less Gabapentin With Chiropractic.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Up and down, peaks and valleys, getting hit and landing blows, riding the waves or gasping for air, whack-a-freaking-mole.  Slow week this week and last. Two weeks ago and May overall, we killed it. Absolutely killed it. Now, I’m wondering if we should just close the doors and call it a good career. We tried. Lol.  Yes, that’s super dramatic. No, we’re not closing up shop. Lol. But that’s how you get sometimes right? Damnit can’t it just be a set it and forget it thing? Well the answer is no. It cannot and will not. The competition is too great to rest solely on your reputation in the community. Yes, it helps but it’s not enough to stay where you want to be. It’s just not.  We all feel important I’m sure but here’s the brutal truth. People start to forget us the minute we go silent. You have to keep that pedal to the metal with the marketing, being involved in the community, constant weekly touches in the community, and telling your current active patients how much you appreciate referrals. They don’t always know, ya know? So, market market market.  In separate news, I am re-engaging with the group I’ve mentioned in the past about purchasing 60% of the clinic, bringing in an associate or two, and having more time for voice-over work, real estate work, and medicolegal work in the chiropractic realm.  If my plans are solid and actually happen…..and I have a track record of making things happen……in 2 years, I’ll have more and more time to dedicate to podcast hosting and painting and sculpting and all of the aspects of life outside of the clinic that truly feed my soul.  We’re working on it and so far, it’s looking good. It just takes time and I’ll keep you all updated as we go along. It may be something you want to consider as I go through it and come out the other side.  Item #1 The last paper in our series is called, “The effectiveness of manual therapy and proprioceptive neuromuscular facilitation compared to kinesiotherapy: a four-arm randomized controlled trial” by Zaworski et al and published in European Journal Of Physical Rehabilitative Medicine in April of 2021. Remember, the citations can be found at chiropracticforward.com under this episode.  Zaworski K, Latosiewicz R. The effectiveness of manual therapy and proprioceptive neuromuscular facilitation compared to kinesiotherapy: a four-arm randomized controlled trial. Eur J Phys Rehabil Med. 2021 Apr;57(2):280-287. doi: 10.23736/S1973-9087.21.06344-9. Epub 2021 Mar 2. PMID: 33650840. Last reminder on this series. The WHO recommends spinal manipulative therapy at very low confidence. I’ve been doing this podcast every single week for over 7 years and the amount of research in favor of smt for everything but especially low back pain is honestly pretty staggering. So, when I see the WHO recommend SMT, I’m like….well of course they do.  And then I see ‘at very low confidence’ which is the same level they recommended ultrasound, well, then I got miffed. I got ‘pressed’ as the kids say these days. Hundo P.  So I found all of the papers the WHO used to make the determination and we went through them one by one and this is the last one.  Why They Did It The aim of the study was to determine whether the use of combined therapy consisting of manual therapy and proprioceptive neuromuscular facilitation (PNF) is more effective than the use of manual therapy techniques, proprioceptive neuromuscular facilitation or traditional kinesiotherapy as single methods in the treatment of low back pain. How They Did It The setting was a Rehabilitation Department of Hospital in Parczew (Poland). The study was designed as four-arm randomized comparative controlled RCT and conducted on a group of 200 patients aged 27-55y. The patients were randomly divided into four 50-person groups:  1) group A – manual therapy;  2) B – proprioceptive neuromuscular facilitation;  3) C – manual therapy and proprioceptive neuromuscular facilitation; and  4) group D – traditional kinesiotherapy and control group.  Pain intensity was measured using VAS and Laitinen’s questionnaire.  Functional disability was assessed using Oswestry Disability Index (ODI) and Back Pain Functional Scale (BPFS). What They Found There was a statistically significant difference in pain reduction (VAS Scale) between Group C (4.8 points) and Group D (3.9 points).  In all the groups there was a statistically significant reduction in a degree of disability as measured by the ODI.  A level of functional capabilities increased significantly only in Group C (8.8 points) as compared to Group D (5.7 points). Wrap It Up All the evaluated methods caused pain reduction which lasted for at least 2 weeks after the end of treatment.  The degree of disability as measured by ODI lowered evenly in all groups.  Patients’ functional ability improved significantly in the group treated with combined manual therapy and proprioceptive neuromuscular facilitation as compared to the group of traditional kinesiotherapy. OK, so there’s yet another paper the WHO used that’s in favor of SMT.  I’m going to try to do a very fast summary of what we’ve learned here, folks.  For the record, I started this series on December 14, 2023 and today is June 10, 2024. Yes, we’ve been at it for a while now. So, what DID we learn now that we’re at the end of our efforts? For starters, they cherry picked some pretty crappy papers. One was a pilot study. Why would you place the recommendation of a modality in part on a pilot study? Not sure about that.  Many of them were very small sample sizes.  More strikingly though were the ages of these papers? Again, we cover new and fresh papers all of the time and low back pain specifically has been covered  and covered and covered again in the last 5 – 10 years and almost all papers have been in favor of SMT.  So why on Earth is the WHO sourcing and using old papers with mostly small sample sizes? I’m talking about papers from 1978, 1985, 1986, 1992, 2003, 2004, 2007, 2011, 2012, 2012 (pilot study), 2013, 2013.  Yes there are some papers they used that were from 2020, 2019, 2017 or so. But I’d venture a guess that well over 60% of the papers they used were over 10-12 years old and some were as old as 35 years, 38 years, and up to 46 years old. What the holy hell? For real. Wrap your damn heads around that hot garbage.  Please tell me there’s an agenda to keep chiropractors in their place without telling me there’s and agenda to keep chiropractors in their place. It’s ponderous.  The final score is: In favor of SMT: 19 Undetermined: 5 Against: 4 So, you folks do what you will with the information. I don’t know that there’s anything that can be done. It’s the WHO out there doing WHO stuff but I’m telling your right now, them rating SMT at ‘very low confidence’ is incorrect in my opinion and I feel that our little experiment proves it beyond simply ‘my opinion’.  Keep fighting my friends. Lots of work left to do! Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.    Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical tre

CF 270: Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation   Today we’re going to talk about Spinal Manipulative Therapy Adverse Events & SMT With Lumbar Herniation   But first, here’s that sweet sweet bumper music     Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   OK, we are back and you have found the Chiropractic Forward Podcast where we are 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, look down your nose at people 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.  I’m so glad you’re spending your time with us learning together.   Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com   If you haven’t yet I have a few things you should do. Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams. Then go Like our Chiropractic Forward Facebook page, Join our private Chiropractic Forward Facebook group, and then Review our podcast on whatever platform you’re listening to Last thing real quick, we also have an evidence-based brochure and poster store at com   You have found yourself smack dab in the middle of Episode 270   Now if you missed last week’s episode , we talked about Children, Activity, and Depression and Axially Loaded MRIs. Make sure you don’t miss that info. Keep up with the class.   On the personal end of things….. Isn’t it weird?  You have one group of staff for an amount of time, they all leave, then you are forced to replace them all at once basically…..then you get so busy that your cup runneth over?   For the last 6 months I’ve been running on maybe 30-35 appointments on a Friday and 130 for the whole week. Which is abysmal for me. I have a large machine to keep running and those numbers are just barely enough.   Now, we have 52 on my schedule today, which is a Monday as I type. I’ve got 153 for the week but I’m typing at 10am on Monday morning so none of Monday’s patients have been set up for Wednesday or Friday appointments. We ended up last week at 175 appointments.   The point is not to brag but to demonstrate. You can do everything you can think of up to and including banging your head against the wall…and get nowhere if you have a staff that is not fully supporting the mission of not only getting patients better but ALSO growing your clinic.   You can meet with them, you can encourage them, you can show them the way to bonuses and extra pay, you can treat them like family, and all of the other stuff we do for our teams.   But if they’re not growth minded hustlers, they work against you. And I use hustlers in a complimentary context. A go-getter. Someone with drive. Someone that gets it and has some hustle.   That’s a hustler to me.   Don’t get me wrong here. Except for one of them, I absolutely love those girls. I would still do anything for them. No sweeter and no more caring people ever existed. You can have the most loving and caring people on the planet in place and still not be growth minded. The best people on the planet can still fall into ruts and get stuck in the daily grind.   My old team fell into bad habits that did not support growth. They were all besties. They all quit at the same time and we were forced to start completely over almost from scratch. And what seemed like a complete and utter disaster has become one of the greatest comeback stories of my career.   We’ve done some other things as well. We started with a social media company. I’ve never done that before. We hired Darcy Sullivan with Propel for our website SEO to get that back up to snuff. We know Google is the biggest driver of new patients so it makes sense to spend the money to make sure it’s on par.   But the biggest game changer has been our new staff. Hands down.   I tell you this for one reason only. If you’re down, here’s what you do and probably the order you should do it in: Take a long, hard, and very honest look at yourself and your habits. Are you doing the things you need to be doing to grow and to be successful? Are you paying attention to customer service and putting that #1? Are you properly training your staff and properly motivating them? It starts at the top so make sure you have a tight ship before you go looking anywhere else. Look at your marketing. Have you slacked on your internal and external marketing? If so, get those gaps filled. Website SEO – make sure it’s where it should be Pay very close attention to your staff. Their habits between patients. Their interactions with patients. The conversations they have with your patients on the way to therapy or rehab. Start phasing out the ones that do not fully support your mission and your clinic’s growth.   That’s the advice you’re getting this week from your Ol’ Uncle Jeffro. Hopefully I dropped some good solid knowledge nuggets on some of you.   Take it or leave it but that’s the way I see it at the moment and it’s based on the school of hard knocks over the last 6 months. And, by the way and as a side note, isn’t it interesting that at 50 years old and in practice 25 years, we still learn lessons like this? Damnit.   Alright, here we go with this week’s research.       Item #1   The first one today is called, “A retrospective analysis of the incidence of severe adverse events among recipients of chiropractic spinal manipulative therapy” by Eric Chun-Pu Chu and published in Scientific Reports on 23 January 2023. Dayum. That’s hot.     Why They Did It   This study examined the incidence and severity of adverse events (AEs) of patients receiving chiropractic spinal manipulative therapy (SMT), with the hypothesis that < 1 per 100,000 spinal manipulative therapy sessions results in a severe AE.   How They Did It   This study adhered to the Open Science Framework. The Ethics Committee of the Chiropractic Doctors Association of Hong Kong approved the study which included a waiver of patient consent.   All methods were performed in accordance with the relevant guidelines and regulations.   The current study was a retrospective database analysis of a complaints log including adverse events from January 1, 2017, through August 31, 2022.     Wrap It Up   This current study, which retrospectively studied a large dataset from integrated chiropractic clinics in Hong Kong, found that severe AEs potentially occurring in relation to SMT were rare, yielding an incidence of 0.21 per 100,000 SMT sessions.   No AEs were identified that were life-threatening or resulted in death.   The sample size of 39 AEs across 960,140 SMT sessions in 54,846 patients was insufficient to identify independent predictors of severe AEs.     Before getting to the next one,   Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.   When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors.     I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it.   Item #2   Our last one this week is called, “Effects of Lumbar Manipulation Spinal in Patients with Pain Caused by a Lumbar Disc Herniation: A Systematic Review” by Guillermo Cano-Escalera and published in Indian Journal of Physiotherapy and Occupational Therapy on 2023-01-16. Hot potato!   Why They Did It   Herniated discs usually present with pain accompanied with paresthesia and loss of muscle strength, causing limitations in the activities of daily life. Among the therapeutic strategies aimed at obtaining an improvement in the symptomatology, highlights the Osteopathic manipulation.   How They Did It   11 computerized databases were consulted. Only randomized controlled clinical trials were included. The tool for assessing the risk of bias was the one proposed by Cochrane.   What They Found   A total of 3 randomized controlled clinical trials were selected and considered low risk of bias. The results showed an improvement in all the variables measured in the experimental group of osteopathic manipulation. However, the improvement was greater in the study group that underwent surgery.   Wrap It Up   Lumbar manipulation spinal is an effective technique to improve the symptomatology of pain originating from a herniated lumbar disc. None of the participants had adverse reactions and their outcome improved significantly in the short and long term.       Alright, that’s it.

CF 260: 5 Year Chiropractic Forward Roundup and All Time Top Ten Episodes Today we’re going to talk about our 5 Year Roundup and we highlight the All Time Top Ten Episodes But first, here’s that sweet sweet bumper music Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people 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.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smart, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #260 Now if you missed last week’s episode , we talked about Cervical Curvature & Lumbar MRI Findings In Asymptomatics – New Stuff. Make sure you don’t miss that info. Keep up with the class.  Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. On the personal end of things….. We’re not going to do a lot of personal stuff on this show. I want to first just thank those of you that have been listeners of this show. I probably over share sometimes about what’s going on with me or with my clinic.  Because of that, those of you that are long-time listeners know a lot about me. Thanks for putting up with me and coming along on this ride with me. You’ve been with me through key staff changes and huge practice changes.  You’ve been with me through adding a nurse practitioner and integrating my entire practice medically. You’ve been with me through the ‘I’m so busy I can’t keep up’ stages to the ‘I can’t figure out why I’m so slow’ stages. That’s one I’m climbing out of right now as we speak.  The reason I share so much about what I’m doing or going through is It’s cathartic. It makes me feel better to talk about it. It’s like a weekly journal and if you’re familiar with journaling, it’s helpful mentally and effective.  I know that if I’m going through it and I figure it out, then somebody else is going through it and my experience will help guide them. If you are not going through it currently, there’s a damn good chance you eventually will go through it and my experience will set you up to be able to handle it better.  So, thank you. I continue to be blessed by all of you. I’m glad you find value in what I share. I hope somewhere along the way, I have helped you to be better than you were before. That’s the daily goal for me as well as for you. We’re in it together.  Now, onto the All Time Top Ten most listened to episodes of the Chiropractic Forward podcast.  There were some surprises for me on this one. As I cover these, I’ll also leave the links to them in the show notes so you can easily go listen should you have interest.  10. Our tenth place episode is episode #114 which was titled Ten Keys to Practice Success – This one has been piling up the listens since February 11, 2020. Yep, right before the RONA came to town to wreak havoc. https://www.chiropracticforward.com/ten-keys-to-chiropractic-success/ I covered a wide range of the ten keys to my success and broke them down for you. Evidently, you and your buddies found value in it. And that makes me feel warm and fuzzy inside my belly.  9. Our ninth place goes to episode #189 where we were joined by the one and only Dr. Brett Winchester. One of the smartest and funniest human beings I think I’ve ever met in my life. Humble and amazing, Brett makes you proud to be a chiropractor and through Dr. Kevin Christie’s Florida Mastermind group, has become a friend of mine. One I greatly value.  On the episode, Brett talked about Chiropractic Excellence, Inspiration, & Being The Best Evidence-informed Chiropractor You Can Be. It is definitely worth your time.  https://www.chiropracticforward.com/w-dr-brett-winchester-chiropractic-excellence-inspiration-being-the-best-evidence-informed-chiropractor-you-can-be/ 8. Our 8th most popular episode goes to episode #139 and was called Chiropractors Affected By COVID, 2019 Opioid Overdoses, Insurance Compensation For Chiropractic. It went live on August 20, 2020 so, still in the pandemic but after a Spring and Summer of the COVID mess and we talked about some research on how it affected us as a profession, we went over fresh at the time opioid overdose info, and then we talked about how insurance companies reimburse us. You probably already know that part. You’re living it! Lol.  https://www.chiropracticforward.com/chiropractors-affected-by-covid-2019-opioid-overdoses-insurance-compensation-for-chiropractic/ 7. Coming in at #7 is episode #113 where we were joined by the current Texas Chiropractic Association President himself, the head hombre, The Illustrious Potentate from Austin, TX, Dr. William Lawson where we covered a paper he played a part in that covered new and updated guidelines on treating cervical pain.  https://www.chiropracticforward.com/w-dr-william-larson-brand-new-guidelines-on-neck-pain-treatment/ 6. At #6 we have episode #142. In this one, we covered treatment for nonoperative discs, we talked about supplementing Vitamin D3 for depression and what the research says, and we covered the bio psychosocial part of chronic pain. This one is my kind of episode. The bioqsychosocial aspect is something I just find to be fascinating and intriguing. I’m glad you all seemed to find it interesting as well.  https://www.chiropracticforward.com/nonoperative-disc-treatment-d3-for-depression-the-biopsychosocial-part-of-chronic-pain/ 5. Number 5 this year is episode #136 and it was called ‘Chiropractic’s Effect On Strength and More, Status Of Muscle Relaxers, And The Best Recovery Posture.’ This episode is a pretty standard run of the mill episode. It doesn’t have any of my real estate golden nuggets hidden within….nothing special but everyone likes it so hell yeah. I’ll take it. This one showed how to best recover your breath after exercise, how opioids are still bad, and how active-duty military personnel receiving chiropractic care exhibited improved strength and endurance, as well as reduced LBP intensity and disability, compared with a wait-list control. https://www.chiropracticforward.com/cf-136-chiropractics-effect-on-strength-and-more-status-of-muscle-relaxers-and-the-best-recovery-posture/ 4. Still in the top Five since August of 2020, it’s episode #141 called “Lancet Low Back Update & movement Disorders Mean Pain” This one has been one of the top episodes since it was first released and has stayed there. This one covers an update The Lancet released. An update on the huge low back series they came out with originally around 2016/2017 if I recall correctly. We covered the original series here on the podcast toward the very beginning of Chiropractic Forward existence.  https://www.chiropracticforward.com/lancet-low-back-update-movement-disorders-mean-pain/ 3. Our 3rd most listened to episode is #143 called ‘New Paper: Spinal Manipulation Has No Effect On Chronic Pain – Our Experts Rebuttal’. Basically, some no so flattering research came out trying to prove that spinal manipulative therapy was basically useless. For this episode, I contacted several of our profession’s experts and we gave our own rebuttal to this paper right here on the podcast. The exact conclusion of the paper we talked about said, ““In this randomized clinical trial, neither spinal manipulation nor spinal mobilization appeared to be effective treatments for mild to moderate chronic LBP.” Well, who the hell can say that? Seriously. After all of the papers in support of SMT for chronic low back, someone’s going to pop out with that? Nope.  So we talked about it and met it head on.  https://www.chiropracticforward.com/new-paper-spinal-manipulation-has-no-effect-on-chronic-pain-our-experts-rebuttal/ 2. Hitting number two all time is episode #140 with my buddy, Dr. Chris Howson of the Great State of North Dakota. We talked about Chiropractors In Hospitals & Drop Release. He should know because he is in a hospital-run outpatient clinic and is well-integrated in the medical community. He also invented the Drop Release so of course we talked about that and how he uses it. I use the

CF 252: High Blood Pressure And Cognitive Decline & Does The Popping Noise Matter? Today we’re going to talk about High Blood Pressure And Cognitive Decline & Does The Popping Noise Matter? But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow, look-down-your-nose-at-people 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.  I’m so glad you’re spending your time with us learning together.  Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, drive, smartness, and easy-to-get-along with associates. If this is you and Amarillo, TX is your speed, send me an email at creekstonecare@gmail.com If you haven’t yet I have a few things you should do.  Go to Amazon and check out my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #252 Now if you missed last week’s episode , we talked about Communicating Imaging Findings & Acupuncture For Acute Pain. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Still climbing out of the doldrums of an extended slowdown. It is what it is but shows signs of finally easing. Let’s keep our fingers crossed on that. But yeah, I think we’re back on the upswing.  We’re starting the week with 15 new patients on the schedule. I like to see about 20-25 per week but I’ll take starting the week at 15 any day. Now let’s build on it.  It’s a balancing act to try to push our medical services and build that side of the clinic while not letting your community forget that you have a chiropractor and all of the other services as well.  We post on social media twice per day. Once during the day and once in the evening. During the week, we post about services. On the weekend, we post funny stuff. Because honestly, what’s the point in posting something about PRP and saying call now? But nobody is at the clinic on the weekend. It makes no sense. So we entertain on the weekends with our posts.  It’s fun and our audience likes them and typically responds well with likes, comments, and shares.  We are still getting our TikTok game going. Check it out at creekstonecrew806 if interested. I have a 20-something doing all of the content and she’s pretty darn great at it. It’s been fun to show that personality off. We have some fun folks working here.  Nothing incredibly new or interesting to talk about this week so let’s not waste time and let’s hop right in on the research.  Item #1 The first one today is called “Impact of audible pops associated with spinal manipulation on perceived pain: a systematic review” by Moorman et. al (Moorman 2022) and published in Chiropractic and Manual Therapies on October 4, 2022, Kazow that’s hot! Why They Did It An audible pop is the sound that can derive from an adjustment in spinal manipulative therapy and is often seen as an indicator of successful treatment.  A review conducted in 1998 concluded that there was little scientific evidence to support any therapeutic benefit derived from the audible pop. Since then, research methods have evolved considerably creating opportunities for new evidence to emerge. It was therefore timely to review the evidence. How They Did It They searched PubMed, Index to Chiropractic Literature (ICL), Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Web-of-Science.  The main outcome was pain.  Two reviewers independently selected studies, extracted data, and assessed risk of bias and quality of the evidence using the Downs and Black checklist.  Results of the included literature were synthesized into a systematic review. What They Found Five original research articles were included in the review, of which four were prospective cohort studies and one a randomized controlled trial.  All studies reported similar results: regardless of the area of the spine manipulated or follow-up time, there was no evidence of improved pain outcomes associated with an audible pop.  One study even reported a hypoalgesic effect to external pain stimuli after spinal manipulation, regardless of an audible pop. Wrap It Up “While there is still no consensus among chiropractors on the association of an audible pop and pain outcomes in spinal manipulative therapy, knowledge about the audible pop has advanced. This review suggests that the presence or absence of an audible pop may not be important regarding pain outcomes with spinal manipulation.” I tell patients all of the time. Do not relate a popping noise with effectiveness. It is movement we are after. Not sounds. Sometimes the sound is a happy side effect but nothing more.  And…they last thing the  want is to be insisting on hearing a popping noise and be treated by a chiropractor that is more than happy to oblige. You can get an extremely aggressive adjustment just to hear a popping noise that doesn’t even matter in the first place and run the risk of getting injured from it.  So, focus on range of motion and movement. Not popping noises, people.  I will say this though, pain is multifactorial sometimes and placebo isn’t a cuss word. Sometimes, in my humble opinion, just the noise……well….I can see how it could make a difference in the patient’s mind only. I can see. But you can’t depend on the noise. You just can’t Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Item #2 Our second one today is called “High blood pressure linked to faster cognitive decline, dementia risk” by John Anderer (Anderer J 2022) with Study Finds and was published on October 3, 2022. Schiza, I love it hot like that.  It’s an article so let’s get to summarizing the high points.  Researchers from the University of Michigan say people with hypertension may experience a faster deterioration in their cognitive abilities (thinking skills, decision-making, memory) in comparison to those with normal blood pressure. The team performed a “study of studies” focusing on high blood pressure’s association with declining brain function over a period of several years. They gathered and analyzed datasets collected for six large prior studies. “Our findings suggest that high blood pressure causes faster cognitive decline and that taking hypertension medication slows the pace of that decline,” says lead study author Deborah Levine, M.D., M.P.H., director of the University of Michigan’s Cognitive Health Services Research Program and a professor of internal medicine at the U-M’s academic medical center” Among both Hispanics and non-Hispanics, the team observed the same pace of deteriorating thinking skills and memory linked to high blood pressure. However, when researchers focused solely on the two studies that had deliberately recruited Hispanics, they noted an undeniably faster decline in overall cognitive performance among Hispanics in comparison to the non-Hispanic white group. Importantly, though, blood pressure differences between those two groups didn’t appear to explain this cognitive decline difference. This may be due to Hispanic participants having lower blood pressure than non-Hispanic whites in these studies, researchers speculate. The same researchers behind this work conducted a similar study two years ago focusing on hypertension and cognitive outcomes among Blacks and Caucasians. That project found that blood pressure control differences over time helped explain the faster cognitive performance declines seen in Black individuals. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get in

CF 249: Vertebrogenic Pain – A Thought Shift & Leisure time Physical Activity Effects On Mortality Today we’re going to talk about Vertebrogenic Pain. Time for A Thought Shift & Leisure time Physical Activity Effects On Mortality But first, here’s that sweet sweet bumper music     Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #249 Now if you missed last week’s episode , we talked about steps per day and how that’s related to dementia and we talked about vets and chiropractic. What a wonderful combination.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Ugh, slow Monday man. I hate it and it give me anxiety but I’m using the extra time to make things happen, my friends. Yes indeed. This is being written on September 19th so we are still in the middle of the yearly back to school slowdown.  When back to school gets us down, what’s the best way to handle it? Frist, as I’ve mentioned in recent podcasts, you get stuff done! Start through all of the things that have been piling up. Get that stack knocked out.  Secondly, marketing wise, what has been successful for you in the past? Have you slowed down on your posting frequency on social media? Pick it up and get to posting. Has it been any community outreach or direct marketing? Time to re-engage, right? Thirdly, settle the hell down. You didn’t pee on the mayor’s dog and the whole town is not mad at you. Or me. I think this is me talking to me by the way. Lol.  Marketing is the most effective thing we can do for our clinic so we are spending this time calling and checking on patients that are more recent but have not really kept up with their schedule. Not in a bully or harrassing kind of way but a ‘staying top of mind’ kind of way and showing concern.  What are the big things that speak to people? For me and my practice specifically, I think it can be boiled down to 10 things.  No long waits Evaluation and treatment on the same day New patient appointments within 48 hours They will know the cost before their visit – at least as close as we can get to the cost Not everyone gets x-rays No pills and no surgery Online scheduling No long treatment plans Treatment by a Board Certified Orthopedic specialist Fast and efficient first appointment These go for our medical side as well as for our chiropractic side. I think hammering these points consistently is an effective strategy. And, they aren’t talking points. It’s how we do things.  Here’s another thing I’ll share with myy patients when appropriate; when I have a difficult decision to make as far as recommendations or treatment, I fall back on one principle. That principle is ‘what would I do with this person if this person were an immediate family member?’ That is a guiding principle that will get you the closest to every right answer out there that you can make.  Alright, that’s enough of the personal side of things. Let’s get to the meat and taters.  Item #1 The first one is called “Vertebrogenic Pain: A Paradigm Shift in Diagnosis and Treatment of Axial Low Back Pain” by Conger et. al. (Aaron Conger 2022) and published in Pain Medicine on July 20, 2022. Hot sauce coming up! Clinicians and researchers have long recognized that better subgrouping of individuals with CLBP is necessary for more targeted and effective treatments. Commonly described sources of CLBP include the zygapophyseal joints, sacroiliac joints, and intervertebral discs (often termed “discogenic” pain) Historically, the term “discogenic pain” has been associated with disc degeneration and internal disc disruption with the presence of fissures in the annulus fibrosus and associated nociception via branches of the sinuvertebral nerve  Previously, it was thought that pathological neurovascular ingrowth penetrated into annular fissures, leading to increased sensitivity and nociception via the sinuvertebral nerve However, more recent evidence appears to refute the occurrence of such neurovascular ingrowth in many cases In the late 1990s, a team of researchers led by Dr. Heggeness reported that vertebral bodies were richly vascularized by vertebral capillaries and innervated by nociceptors that traced back to a single source, the basivertebral nerve. Basivertebral nerve. Let’s call it the BVN, please and thank you.  It’s a branch of the sinuvertebral nerve and it densely innervates the endplates.  With progressive segmental degeneration or acute injury, altered force transfer and endplate stress can result in changes to endplate morphology and composition with concomitant impairment in permeability and transport  Vertebral bodies demonstrated endplate nociceptor densification in areas of damage that were associated with increased disc degeneration.  They also found that only 30% of annular tears in degenerated discs had pathologic neural ingrowth, compared with 90% of adjacent endplates (which were twice as densely innervated)  This distinction between annular and endplate innervation is likely due to differences in nerve ingrowth potential. For the annulus, nerve ingrowth is inhibited by physical pressure and proteoglycans whereas nerves can easily proliferate in fibrovascular bone marrow adjacent to sites of endplate damage  Accumulated damage to the discovertebral complex may result in chemical and mechanical sensitization of endplate nocioceptors  These histopathological findings led to exploration of an “endplate-driven” model of discovertebral pain, with nociception largely occurring via the BVN to a greater extent than the sinuvertebral nerve This research supports an “endplate-driven” model of anterior column degeneration and existence of a fourth distinct structural source of low back pain, popularly termed vertebrogenic pain The rest of the article goes on to talk about the research and the benefits of BVN nerve ablation. Of course, that’s not where our minds go immediately when we’re looking at a disc issue, endplate or annular.  We’re looking at movement, functionality, and things of that nature. But, I thought it was interesting because I have been taught over the years, even more recent years, that when an annulus cracks, it’s easier to become painful again because the nerves grow into that fissure and are deep toward the nucleus pulposus upon healing than they were prior to injury.  So, for that reason, we have assumed that’s why the biggest predictor of future pain is the presence of prior back pain. This updated information seems to, for the most part refute that information. And I’m OK with that. I love new knowledge. I love updating my education and staying on top of the cutting edge when I’m able to.  Before getting to the next one, Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Item #2 The last one this week is called, “Association of Leisure Time Physical Activity Types and Risks of All-Cause, Cardiovascular, and Cancer Mortality Among Older Adults” by Watts et. al. (Watts EL 2022) and published in JaMA Network Open on August 24th 2022. That’s slapy ya mama hot! Why They Did It Higher amounts of physical activity are associated with increased longevity. However, whether different leisure time physical activity types are differentially associated with mortality risk is not established..  They wanted to answer the question, “Are different types of leisure time physical activity differentially associated with mortality risks among older adults?” How They Did It NIH Cohort study of 272 550 older adults What They Found A total of 272,550 participants age at baseline, 70

CF 248: Steps Per Day And Dementia & Vets And Chiropractic Today we’re going to talk about Steps Per Day And Dementia & Vets And Chiropractic But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.    We’re the fun kind of research. Not the stuffy, high-brow, look down your nose at people kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent educational resource for you AND your patients. It saves you time putting talks together or just staying current on research. It’s categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #248 Now if you missed last week’s episode, we were joined by the one and only, my friend, Dr. Jay Greenstein and man…..what a great episode. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. First, hey, I’m hiring. I need an asscoiate. Seriously, if you go to work for a franchise people, honest talk here…..you have a cap in salary. You will adjust all day every day and on the weekends. You will work your butt straight off and you’ll never get paid more.  At a private practice, like mine for example, you’re not going to have a cap. Once your prove yourself and you’re helping build the clinic, you will get paid without a cap. You get paid for the work and effort you put in. If you want to work your tail straight off and not get paid what you’re worth, I’m not the right call for you.  If you want to work but get mentored by an ortho and forensics diplomate, play a part in this podcast, and set yourself apart from the parts of the profession you don’t like….oh….and get paid for your efforts with a potential buyout down the road, then I am exactly the guy you want to speak with.  If you think Amarillo is a great place to live and raise a family, which it absolutely is, send me an email at creekstonecare@gmail.com I want to meet you. Doesn’t matter when you hear this episode. I’m always looking for top talent and I know if you’re listening to this podcast then you are indeed top talent. Next thing, go to https://www.tecnobody.com/en/products That’s Tecnobody as in T-E-C-nobody. They literally have the most impressive clinical equipment I’ve ever seen. I own the ISO Free and am looking to add more to my office this year or next. The equipment you’re going to find over there can be marketed in your community like crazy because you’ll be the only one with something that damn cool in your office.  When you decide you can’t live without those products, send me an email and I’ll give you the hookup. They will 100% differentiate your clinic from your competitors. Second, we just got back from Vegas. I try take at least one short trip every quarter. Sometimes more. Sometimes less but we have to get out of the clinic.  Certainly after you’ve built and you’re on the way. It’s the only way you stay sane. I’m not telling you to close down the clinic and go to Europe for a month as a solo doc. Just a long weekend here and there. It’ll keep you likable. We saw Motley Crue, Def Leppard, Poison, and Joan Jett and it was a great. Just what we needed. I have to admit that I’m still on a bit of a buzz from having Jay Greenstein join me on the show last week. What a freaking gem that guy is. Don’t miss that episode. For any reason. I think that’ll be quite enough of rambling from me. Let’s get it started Item #1 The first one is called “Association of Daily Step Count and Intensity With Incident Dementia in 78 430 Adults Living in the UK” by del Pozo Cruz, et. al. (del Pozo Cruz B 2022) and published in JAMA on September 6, 2022. Pow! Hottern’ a firecracker! Why They Did It The authors wanted to find out if there is a dose-response association of daily step count and intensity with incidence of all-cause dementia among adults living in the UK? How They Did It UK Biobank prospective population-based cohort study with 6.9 years of follow-up.  A total of 78,430 of 103,684 eligible adults aged 40 to 79 years with valid wrist accelerometer data were included.  Registry-based dementia was ascertained through October 2021. What They Found This cohort study of adults assessed with wrist-worn accelerometers found that accruing more steps per day was associated with steady declines in dementia incidence risk, up to 9800 steps per day, beyond which the benefits upturned.  The dose associated with 50% of maximal observed benefit was 3800 steps per day, and steps at higher intensity (cadence) were associated with lower incidence risk. Wrap It Up The findings in this study suggest that accumulating more steps per day just under the popular threshold of 10 000 steps per day and performing steps at higher intensity may be associated with lower risk of dementia onset. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! Use the code HOTSTUFF upon purchase at droprelease.com & get $50 off your purchase. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. I love it, my patients love it, and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Item #2 Our last one this week is called “Health-Related Quality of Life Among United States Service Members with Low Back Pain Receiving Usual Care Plus Chiropractic Care vs Usual Care Alone: Secondary Outcomes of a Pragmatic Clinical Trial” by Hays et. al. (Ron D Hays 2022) and published in Pain Medicine on January 21 of 2022. Shazzaaammm! It’s sizzlin’ hot.  And I want to make note of the authors on this paper. They are among some of my very favorite researchers in our profession. There are lots of them but in particular Rober Vining, Ian Coulter, Katherine Polhman (former guest) and Christine Goertz (also a former guest) Yay for these folks. They are working for you every day.  Why They Did It This study examines Patient-Reported Outcome Measurement Information System (PROMIS®)-29 v1.0 outcomes of chiropractic care in a multi-site, pragmatic clinical trial and compares the PROMIS measures to:  Worst pain intensity from a numerical pain rating 0–10 scale,  24-item Roland-Morris Disability Questionnaire (RMDQ); and  Global improvement (modified visual analog scale). How They Did It It was a pragmatic, prospective, multisite, parallel-group comparative effectiveness clinical trial comparing usual medical care (UMC) with UMC plus chiropractic care (UMC+CC). Three military treatment facilities 750 active-duty military personnel with low back pain Linear mixed effects regression models estimated the treatment group differences.  Coefficient of repeatability to estimate significant individual change. What They Found The researchers found statistically significant mean group differences favoring UMC+CC for all PROMIS®-29 scales and the Roland-Morris Questionnaire score.  Wrap It Up Findings from this pre-planned secondary analysis demonstrate that chiropractic care impacts health-related quality of life beyond pain and pain-related disability.  Further, comparable findings were found between the 24-item Roland-Morris Questionnaire and the PROMIS®-29 v1.0 briefer scales. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.  Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm.

CF 243: Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain Today we’re going to talk about Chiropractic Adjustments To Avoid Other Procedures & Male Vets With Chronic Pain But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #243 Now if you missed last week’s episode, we talked about effectiveness Of the Neck Exercise For Disc Herniation and Supine vs. Prone MRIs. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. We have been flying all over the place this year. Honestly, I’m making up for lost time during the pandemic. 3 trips already to Florida this year for Kevin Christie’s MCM Mastermind group and another in November to meet the crew in Key Largo. Pumped about that one! As a part of the Forensics diplomate, I go to Chicago every October so we’ll be up there in a couple of months.  Not to mention trips to Texas Chiropractic Association functions. There are at least two a year for that. One in June and one in February or March.  Now, with my VoiceOver career going little bananas, I have a vo conference that I just go back from in Dallas and one in Atlanta in March.  And then anything we want to do that is not work-related. Like, go to Vegas on September 8th to see Motley Crue, Def Leppard, Poison, and Joan Jett. Can I get a hell yes from my fellow 80’s kids? Plus, I want to start visiting some of the practices of the docs in the MCM Mastermind. I’m interested in seeing what they do to make them so efficient and so successful. I can always learn from others.  This brings up a point; have any of you considered identifying you colleagues that are highly productive and very successful and asked them if you can go and hang out and visit for a day or two just to see what they do that you could possibly implement in your own clinic? We can sit in a mastermind and exchange ideas and processes but at the end of the day, it’s when you see it all in action that it sticks and effects change in how you practice and how you manage your patients.  So, I want to start fitting in some trips when I can find some space. Right now, I’m not sure where the heck I can make it fit to be honest. But, it is an investment in my company and in my clinic so I’m going to see if I can make it happen, regardless.  I’ll keep you updated. Getting a mentor is key folks. Even if the mentor come in the shape and form of several of your colleagues.  Item #1 This first one is called “Chiropractic Clinical Outcomes Among Older Adult Male Veterans With Chronic Lower Back Pain: A Retrospective Review of Quality-Assurance Data” by Davis, et. al. (Davis BA 2022) and published in Journal of Chiropractic Medicine in June of 2022, Kapow!! That’s got some heat on it.  Why They Did It The purpose of this study was to determine whether a sample of older adult male U.S. veterans demonstrated clinically and statistically significant improvement in chronic lower back pain on validated outcome measures after a short course of chiropractic care. How They Did It There were 217 individuals who met the inclusion criteria.  We performed a retrospective review of a quality-assurance data set of outcome metrics for male veterans, aged 65 to 89 years, who had chronic low back pain, defined as pain in the lower back region present for at least 3 months before evaluation.  We included those who received chiropractic management from January 1, 2010, to December 31, 2018.  Paired t tests were used to compare outcomes after 4 treatments on both a numeric rating scale (NRS) and the Back Bournemouth Questionnaire (BBQ).  The minimum clinically important difference (MCID) was set at 30% change from baseline. What They Found The mean NRS score change from baseline was 2.2 points, representing a 34.1% reduction. The mean score change for Back Bournemouth Questionnaire was 14.7 points, representing a 35.9% reduction.  The percentage of participants reaching the minimum clinically important difference for the NRS was 57% and for the Back Bournemouth Questionnaire was 59%, with 41% of the sample reaching the minimum clinically important difference for both the NRS and Back Bournemouth Questionnaire. Wrap It Up This retrospective review revealed clinically and statistically significant improvement in NRS and Back Bournemouth Questionnaire scores for this sample of older male U.S. veterans treated with chiropractic management for chronic low back pain. Before getting to the next one, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later. Item #2 This last one is great and is called, “Three Patterns of Spinal Manipulative Therapy for Back Pain and Their Association With Imaging Studies, Injection Procedures, and Surgery: A Cohort Study of Insurance Claims” by Anderson, et. al. (Anderson BR 2021) and published in Journal Of Manipulative And Physicological Therapeutics on November 1, 2021, and it’s just hot enough! Why They Did It The purpose of this study was to evaluate the relationship between procedures and care patterns in back pain episodes by analyzing health insurance claims. How They Did It They performed a retrospective cohort study of insurance claims data from a single Fortune 500 company.  The 3 care patterns analyzed were initial spinal manipulative therapy, delayed spinal manipulative therapy, and no spinal manipulative therapy.  The 3 procedures analyzed were imaging studies, injection procedures, and back surgery.  They considered “escalated care” to be any claims with diagnostic imaging, injection procedures, or back surgery.  Modified-Poisson regression modeling was used to determine relative risk of escalated care. There were 83 025 claims that were categorized into 10 372 unique patient first episodes.  Wrap It Up For claims associated with initial episodes of back pain, initial spinal manipulative therapy was associated with an approximately 30% decrease in the risk of imaging studies, injection procedures, or back surgery compared with no spinal manipulative therapy.  The risk of imaging studies, injection procedures, or back surgery in episodes in the delayed spinal manipulative therapy group was higher than those without spinal manipulative therapy. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.    Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes.  Feedba

CF 230: Lumbar Stenosis Today we’re going to talk about lumbar stenosis 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.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #230 Now if you missed last week’s episode , we talked about T-sp Adjustments For Neck, Not Headache & Physical Activity In Children. Make sure you don’t miss that info. Keep up with the class.    On the personal end of things….. As I mentioned last week, I just finished the book called Who Not How by Dan Sullivan and another dude. Lol I can’t remember his name and don’t have time to look. Brad Hanby or something like that. Anyway, I’m on the hunt for an associate as a result. Great book and I know that with some help, not only will I have more time available to be a more effective clinic owner and doctor, but I’ll have the opportunity to grow the practice as well. It’ll be great. Give me a holler if interested in working in a busy evidence-based, patient -centered and medically integrated clinic that is making a difference int he Texas Panhandle. That’s us.  Now, I’ve started reading a book recommended to me by Ben Fergus of the GRIP method fame and a fellow member of the MCM Mastermind you’ve heard me mention. This book is called Think Again by Adam Grant. It’s all about learning to search for the things you don’t really know and be willing to re-think your thoughts and stances on things. I’m still just getting into it a bit but it’s pretty alright and it’s teaching me some stuff.  I also started a book by Gray Cook called The Business Of Movement I saw recommended by Jason Hulme recently in a Facebook group. It’s probably the Forward Thinking Chiropractic Alliance group if I’m guessing. Anyway, that one just came in the mail. Hell, I need an associate just so I’ll have time to read and get up to date. I also just joined an online class called Quadrant Analysis that I’m looking forward to diving into.  So, I’m not perfect. Don’t follow everything I do. I could do better soap notes. I could do a lot of things better but….#1 our patients are 99% likely to refer us to their friends and family #2 ChiroUp tells me our clinic has about an 80% improvement rate for any and all conditions considered. #3 I’m 49, been in this sucker for 24 years, and I can’t wait to learn more and more. We can always learn more. We can always get better. We never know it all. If I ever find an associate that wants to come to the Texas Panhandle, that’ll be one of the first things I make sure they understand. If you ever stop learning, you’re either ignorant or you’re arrogant. Each is equally appalling.  Boom, snap, pow, slap.  Some of you may have seen a post by a ‘chiropractor’ …..I use the term loosely when referring to this dummy. She put on social medial recently the following, “An ovarian cyst is a functional gift from nature to make your more attractive and fertile after a traumatic loss. An enlarged prostate is a fit from nature to make you more potent after feeling degraded as a man. Tumors are not mistakes, they are purposeful adaptations.” Bless her heart…. This little knucklehead is running around spouting this stuff and, yup you guessed it…is a chiropractor. I’m quoted in an article now saying she’s insane. Mostly because that’s my opinion and the only one I can think of that makes any sense with regard to a statement like that.  I bring it up because you have to know these loony birds are out there soiling our names and our hard work. The people that listen regularly here are normal, educated, and hard working evidence based patient centered chiropractors out there changing the world and elevating this profession beyond quack BS that has held the profession back for so long. If however you stumbled upon this podcast and you believe stuff like this is plausible, please, don’t leave. Don’t go anywhere.  Let me introduce you to evidence and research and sanity.  Before getting into the research, I have to tell you, Dr. Chris Howson, the inventor of the Drop Release tool re-activated the code! It’s live again. Use the code HOTSTUFF upon purchase at droprelease.com to get $50 off your purchase. Y’all, it makes a world of difference. Would you like to spend 5-10 minutes doing pin and stretch and all of that? Or would you rather use a drop release to get the same or similar results in just a handful of seconds. My patients love it and I know yours will too. droprelease.com and the discount code is HOTSTUFF. Go do it. Hear me now and believe me later. Let’s get to it.   Item #1 This frist one is called “Diagnosis and Management of Lumbar Spinal Stenosis A Review” by Katz et. al. (Katz JN 2022) and published in JAMA on May 3, 2022, that was just like 3 weeks ago damn the heat….It burns This is more of an article than a standard research paper so lets hit the high points with some relevant quotes from the report. “Affects an estimated 103 million persons worldwide. Most are treated nonoperatively. Approximately 600 000 surgical procedures are performed in the US each year for lumbar spinal stenosis.” The prevalence of the clinical syndrome of lumbar spinal stenosis in US adults is approximately 11% and increases with age.” “The diagnosis can generally be made based on a clinical history of back and lower extremity pain that is provoked by lumbar extension, relieved by lumbar flexion, and confirmed with cross-sectional imaging, such as computed tomography or magnetic resonance imaging (MRI)” More specifically, from my learning through the Neuromusculoskeletal diplomate program, a little clinic pearl here is the shopping cart sign. If they have to use a shopping cart to lean forward over in order to be able to walk through the grocery store, and sitting almost immediately alleviates the pain, there’s a great chance you have some stenosis on your hands. Pain on extension or extension/rotation can bolster the diagnosis.  Then, on the MRI or CT, if you see the sedimentation sign where the nerve roots stay suspended in teh central canal rather than settling on the bottom of the canal due to gravity. You now have pretty convincing evidence of stenosis.  “In a series of patients with lumbar spinal stenosis followed up for up to 3 years without operative intervention, approximately one-third of patients reported improvement, approximately 50% reported no change in symptoms, and approximately 10% to 20% of patients reported that their back pain, leg pain, and walking were worse.” That makes a strong argument for no surgery doesn’t it? Look, most do fine with targeted exercise. There is a stenosis protocol in ChiroUp if you’re not usiing the program. While I am a ChiroUp devotee, I actually use the protocol and program from Dr. Carmen Amendolia. You can find all of his info at spinemobility.com It’s excellent and we see really good results using it.  “Multiple clinical trials have studied manual therapy for spinal stenosis, including lumbar distraction mobilization, hip and sacroiliac joint mobilization, manual stretching, and muscle strengthening. In a clinical trial33 of 58 participants with lumbar spinal stenosis, 79% reported being at least somewhat better following a 6-week program that included manual therapy, treadmill walking, and strengthening and stretching exercises compared with 41% of patients randomized to the flexion exercise group. The results were similar at 1 year. Schneider et al31 randomized 259 patients with lumbar spinal stenosis to 1 of 3 treatment groups: medications with or without epidural injections, manual therapy with individualized exercise, and group exercises. Participants randomized to manual therapy combined with individual exercises had improved their Zurich Claudication Questionnaire scores significantly more at the 2-month follow-up (mean difference, 2.0; 95% CI, 0.4 to 3.6) than did those randomized to medications with or without injections. Participants randomized to group exercises had similar improvement to those receiving medications and/or epidural injections (mean difference, −0.4; 95% CI, −2.1 to 1.3). The differences between groups were negligible at 6 months.” “Epidural steroid injections may offer modest short-term pain relief but do not appear to last more than 3 weeks.” “Long-term benefits of epidural steroid injections for lumbar spinal stenosis have not been demonstrated. Surgery appears effective in carefully selected patients with back, buttock, and lower extremity pain who do not improve with conservative management. “   Wrap Up Lumbar spinal stenosis affects approximately 103 million people worldwide and 11% of older adults in the US. First-line therapy is activity modification, analgesia, and physical therapy. Long-term benefits from epidural steroid injections have not been established. Selected patients with continued pain and activity limitation may be candida

CF 211: Chiropractic And Colicky Babies & Breathing With Thoracic Outlet Syndrome Today we’re going to talk about chiropractic and colicky babies and we talk about thoracic outlet syndrome and breathing.  But first, here’s that sweet sweet bumper music Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #211 Now if you missed last week’s episode, we talked about Manual & Passive Therapies For The Neck, and then we’ll talk about Acupuncture For Post-Surgical Pain. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Well, it’s the new year now. What do you do to prepare for the New Year?? Do people still do the resolutions….new year, new me type of thing? That just seems so 10 years ago doesn’t it? For me, people ask me about that and I’m like, I just think of stuff as I go along and I just do them. I wish it were all more contrived or planned out but it’s just not. I took up painting last year and I took up investing in real estate last year as well. Those weren’t things I planned out and storyboarded or something smart like that.  For painting, I saw a painting I really liked and thought, “” Wouldn’t that be amazing if I could do that myself?” So I started watching YouTube videos to learn and I joined a bunch of Facebook groups. I sat back and soaked in everything painting and once I was confident, we were off and running.  Real Estate, money has always been in real estate and it always will be. It’s like the saying, “ Real Estate….they’re not making any more of it.” One day I stumbled on a podcast that changed my thinking and gave me tools to be confident. For free. It was inspiring so I soaked up podcasts and private FB groups and away we went. I just spent all day yesterday working on our short-term rental in Lubbock TX and evaluated some property in Orlando this morning.  I think there are planners and then there are do-ers. I’m a do-er. Sometimes it may seem a bit haphazard but for the most part, I noticed an opportunity or I get some inspiration, then I go into the fact-finding part of it. I identify the places I can soak up education, and I attack it trying to get all of the knowledge I can get. I did the same with music, and sculpting, voice-over, and furniture building. I’m definitely a fact finder.  Once I have the facts and have some confidence, I act. THAT’s the key. Acting upon your knowledge. Paralysis by analysis is a very real thing and if you simply sit on the bench studying, you miss the opportunities and watch as others are doing. It’s not fun to get lapped because you were too nervous Nelly to get into the game.  I’ve been frightened to get a nurse practitioner but have wanted to do it for years. I finally made the time to get educated on the process, I signed up for some help and mentorship, and I hired a lawyer that knew the process and the legalities of the whole thing. And here we are. Now I have a medical clinic. I was stuck in the analysis phase for 5 or more years. Don’t do that folks. Those that win act with some level of boldness. Not stupidity or ignorance. But boldness.  So, storyboard it, vision board it, whatever works for you the best. But don’t sit on your hands thinking. Search out the knowledge, get smart on your topic of interest, and then act.  If you’re going to have a resolution this year, make the simple idea of ‘Acting’ as part of it. “” I will lose weight, I will get more exercise in 2022, I will be a better husband, brother, son, Dad in 2022, and will grow my business in 2022, and I’ll do it all because I act upon the education is search out.” So do that.  Item #1 This first one is called, “Respiratory dysfunction in individuals with thoracic outlet syndrome” by Saglam, et. al. (Saglam M 2020) and published in Journal of Manipulative and Physiological Therapeutics in July of 2020. Why They Did It The purpose of this study was to compare pulmonary function and respiratory muscle strength and endurance in individuals with thoracic outlet syndrome (TOS) and healthy participants. How They Did It Sixty-two individuals with TOS and 47 healthy individuals participated in this study.  Pulmonary function testing was performed using a spirometer.  Respiratory muscle strength (maximal inspiratory pressure [MIP] and maximal expiratory pressure [MEP]) were measured using a mouth pressure device.  Respiratory muscle endurance was tested at 35% maximal inspiratory pressure and measured as the time in seconds from the start of the test to voluntary exhaustion. Age distribution and physical characteristics were similar between the groups What They Found If I go through this information as it is written, you’ll get glossy eyes, start thinking about why you drive in a parkway and park in a driveway, why apartments are buildings that are all mostly attached, and I’ll lose you so we’re hopping to the wrap-up. I told you, we’re the AC/DC of chiropractic research people.  Wrap It Up Expiratory flow rate and respiratory muscle strength and endurance may be adversely affected in TOS. Trunk muscles perform both postural and breathing functions. Therefore, disruption in one function may negatively affect the other. Item #2 The last one today is called, “Clinical Evidence of Vestibular Dysregulation in Colicky Babies Before and After Chiropractic Treatment vs. Non-colicky Babies” by Hoeve et. al. (Hoeve’ J 2021) and published in Frontiers in Pediatrics in May of 2021 and bam, lets kick the heat up on this mamma jamma.  Why They Did It To date, after 65 years of research that was primarily directed at differentiating between normal and colicky crying, the cause of infantile colic remains elusive and no definitive cure has been found. Given the general absence of pathology, colicky crying is widely considered the extreme end of a spectrum of normal crying behavior.  However, evidence gleaned from scattered sources throughout the literature suggests that infantile colic may be the behavioral expression of physiological brainstem dysregulation, particularly of the vestibular and autonomic systems.  The purpose of this study is to present a five-point clinical index of vestibular (hyper) activity and its application to investigate vestibular dysregulation in colicky and non-colicky babies. How They Did It One hundred and twenty consecutive colicky babies were evaluated using this index, before and after a very gentle vibratory treatment, and compared to 117 non-colicky babies. What They Found Again, this results information isn’t audio friendly, it’s very technical, and you’ll be wandering off in your brain asking yourselves all of the great mysteries like Why isn’t phonetic spelled the way it sounds? Why are there interstate highways in Hawaii? Why are there flotation devices under plane seats instead of parachutes? Wrap It Up Colicky babies are not just infants who cry a lot. They also show clinical evidence of vestibular dysregulation. Treatment aimed at relaxing tight sub-occipital musculature by means of gentle vibrational stimulation may be effective in decreasing vestibular hyperactivity, signifying an improvement in brainstem regulation. The vestibular index opens the prospect for development into a tool toward an objective and practical clinical diagnosis of infantile colic. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.        Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to

CF 222: Forward Head Posture And Spinal Manipuative Therapy Effectiveness Today we’re going to talk about spinal manipulative therapy and forward head posture.  But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #222 Now if you missed last week’s episode , we talked about The Importance of Movement & Steps. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Business is back. Time is getting more limited. Especially for someone like me that tends to bite off as much as I can possibly chew. It’s a bad habit of mine but I always seem to be in hyperdrive. I get everytihng done and I have to say a whole bunch of ‘no’s’ in order to get it all done…..but I do indeed typically get most of it done.  It would not be possible without a To Do list. I keep it open in a document on my computer. It’s a life saver. The problem right now is that I have abotu 15-20 items on it that need to be done. So how do you address that? Prioritize them.  Put them in order from most important to least. I also list them keeping in mind the time and energy each will take to complete. Not to mention the fact that I do what I can to identify which can be delegated and how they’ll be delegated.  Meaning, my office manager is typically overwhelmed. I want to limit what gets delegated to her and try to utilize the other 4 girls that work for us on our chiropractic and medical side of the office.  So, which tasks are the most important or the most time sensitive. Then, which tasks can be easy and fast ‘wins’ so I can pop them out and knock them off with ease. Like an important phone call or email I’m supposed to send. Then delegate what can be delegated to the people most capable. Up to and including virtual assisstants.  I have a VA in South Africa, one in Nigeria, and one in India. Those are for the chiro side of things. I also have one for voice over marketing and he’s in Pakistan. When you’re busy busy, a VA can be the difference in being heavily buried vs. being slightly buried.  So, when you have an integrated office like I do, a voice over side gig that is demanding more and more time, and real estate investments…..VAs are lifesavers. If you are interested in exploring the world of VAs, look into upwork.com, fiverr.com is an excellent site as well. There are virtual networks here in America as well. There is one that I’ve heard great things about based in the Phillipines called virtualstaff.ph.  Alright, just a tip from your ol’ Uncle Jeffro. Now, let’s get to the research, shall we? Item #1 This one is called “Clinical Effectiveness and Efficacy of Chiropractic Spinal Manipulation for Spine Pain” by Gevers-Montoro, et. al. (Gevers-Montoro C 2021) and published in Frontiers In Pain on October 25 of 2021. Aye chi wa wa… Why They Did It For the vast majority of patients with back and neck pain, a specific pathology cannot be identified as the cause for their pain, which is then labeled as non-specific. In a growing proportion of these cases, pain persists beyond 3 months and is referred to as chronic primary back or neck pain. To decrease the global burden of spine pain, current data suggest that a conservative approach may be preferable.  One of the conservative management options available is spinal manipulative therapy (SMT), the main intervention used by chiropractors and other manual therapists.  The aim of this narrative review is to highlight the most relevant and up-to-date evidence on the effectiveness and efficacy of SMT for the management of neck pain and low back pain.  Wrap It Up SMT may be as effective as other recommended therapies for the management of non-specific and chronic primary spine pain, including standard medical care or physical therapy.  Currently, SMT is recommended in combination with exercise for neck pain as part of a multimodal approach. It may also be recommended as a frontline intervention for low back pain.  Despite some remaining discrepancies, current clinical practice guidelines almost universally recommend the use of SMT for spine pain.  Due to the low quality of evidence, the efficacy of SMT compared with a placebo or no treatment remains uncertain. Therefore, future research is needed to clarify the specific effects of SMT to further validate this intervention. In addition, factors that predict these effects remain to be determined to target patients who are more likely to obtain positive outcomes from SMT. They say that the main gap identified in clinical research on SMT for spine pain lies in the low quantity and quality of studies addressing its efficacy against inactive controls. Hence, the effects of SMT against placebo or sham SM remain uncertain. This parallels the state of research on most interventions for spine pain, as no treatment has been demonstrated to be superior to any other or to placebo Item #2 Our last one this week is called “The association between forward head posture and non-specific neck pain: A cross-sectional study” by Bahat et. al. (Sarig Bahat H 2022) and published in Physiotherapy Theory & Practice.  And this one should get the CBP people riled up.  Mostly because it’s more and more apparent that you don’t need to charge your patients $5,000 for 80 visits this year to correct a curve issue or forward head posture that honestly likely doesn’t cause much of an issue long term.  Why They Did It Poor posture is traditionally associated with various musculoskeletal disorders. Consequently, educators in the musculoskeletal field have been teaching postural observation as part of the physical assessment. Forward head posture (FHP) is hypothesized to be associated with neck pain; however, evidence in this topic remains inconclusive. To investigate the association between FHP and neck pain intensity, disability, and cervical kinematics in individuals with neck pain compared to asymptomatic individuals. A secondary aim of this study was to explore the possible effect of a head-mounted display (HMD) used in a virtual reality (VR) assessment on FHP. How They Did It The study was conducted with 43 volunteers  20 asymptomatic individuals, 23 individuals with neck pain Aged 19 to 62.  FHP was assessed by measuring craniovertebral angle on profile photographs.  Secondary outcome measures included pain intensity, the neck disability index (NDI) questionnaire, and neck kinematics using specialized virtual reality software. What They Found There were no significant differences between individuals with neck pain and asymptomatic individuals in FHP The neck pain group demonstrated a restricted range of motion and slower neck movements (p < .05).  We found no significant correlation between FHP and visual analog scale, NDI, and most neck kinematic measures. Wrap It Up Our findings cannot support a clinically applicable association between FHP and neck pain. I know there is research to the contrary but those projects are typically low quality and performed by one of the biggest stakeholders who owns a company that promotes treating patients based on forward head posture and decreased cervical curvature. So that stakeholder has a specific and direct bias. The research likely reflects that.  At the end of the day, my recommendation is to not treat patients like a sales target. They don’t usually need $5,000 of treatment over 80 visits in a year to fix a lack of curve that longitudinal research suggests is of little to no consequence.  Treat them like you’d treat your mom or your child. Period.  Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.  Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the

CF 219: Neurodynamic Moves Solve Problems – So Does The Inversion Table Today we’re going to talk about inversion tables and Neurodynamic exercises.  But first, here’s that sweet sweet bumper music Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #219 Now if you missed last week’s episode , we talked about Masterminds  – chiropractic masterminds and the MCM Mastermind I’m in specifically with Dr. Kevin Christie. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. What a weekend down in Lubbock, TX for the Texas Chiropractic Association’s MidWinter conference. I got to hang out with my friend Dr. Tim Bertlesmen. What a guy, what a teacher, and what a positive force for our entire profession.  Sitting through one of his courses is like having golden knowledge nuggets just chunked at you from a nerf gun. Pow, pow, kablam, splat. Just like that. Over and over. Only you don’t dodge the nuggets. You just step right into them and let them sink right in. He as good as it gets out there.  One of his nuggets I’ll share with you is hip abductors. If you are not assessing your new patients for weak hip abductors, get to researching and make it happen, muy pronto mi amigo.  Luckily, in my coursework with the Diplomate of the International Academy of Neuromusculoskeletal Medicine, Dr. Bertlesman is an instructor and taught us about hip abductors a few years ago. Now, my secret is out!! Lol. Really though, be checking those hip abductors because they can be the missing puzzle piece to longstanding low back pain, hip pain, knee pain and chondromalacia patellae, and ankle and foot problems. Up to and including plantar fasciitis.  I got to teach while at the conference. I’ve taught a couple of courses for the TCA but they were COVID-era virtual courses. This was the first 2-hour live crowd presentation that I’ve been the presenter on and I have to say; I was a tad anxious but once I got started and into the material, it went very well and smoothly.  I had some good buddies in the crowd so it was even a bit like a conversation rather than a presentation. I had several tell me that was the most they’ve taken away from a course in several years. Made me feel good and gave me encouragement that I’m going in the right direction.  Then if you’ve been listening, you know I have a rental down there on Airbnb so spent Sunday at the rental staining the deck and the fence. A not-so-nice end to the seminar weekend.  Business seems to be picking back up which seems to be directly related to the omicron variant settling back down here in the Texas Panhandle. But, we can’t discount the fact that more people are meeting their deductibles in mid-February to early March as well.  Either way, who cares? It equals to more business! Onward to research Item #1 I’m just going to say that I got the research today from ChiroUp’s research roundup and thank you again to Dr. Tim Bertlesmen and Dr. Brandon Steele for being outstanding.  This one is called “Lumbar disc disease: the effect of inversion on clinical symptoms and a comparison of the rate of surgery after inversion therapy with the rate of surgery in neurosurgery controls” by Mendelow et. al. (Alexander D. Mendelow 2021) and was published in Journal of Physical Therapy Science in 2021 so it’s hot hot hot.  Why They Did It We have previously shown inversion therapy to be effective in a small prospective randomised controlled trial of patients with lumbar disc protrusions. Our purpose now was to measure symptoms and to compare the surgery rate following inversion for 85 participants with the surgery rate in 3 control groups. How They Did It Each of the 85 inverted participants acted as their own control for the “symptomatic” part of the study.  In the “Need for surgery” part of the study, one control group was made up of similar patients with leg pain and sciatica who were referred to the same clinic in the same year.  Two additional control groups were examined: the original control group from the pilot trial and the lumbar disc surgery waiting list patients. What They Found Inversion therapy relieved symptoms: there were improvements in the Visual Analogue Score, Roland Morris and Oswestry Disease indices, and Health Utility Score compared with their pre-treatment status.  Also, the 2-year surgery rate in the inversion participants in the registry (21%) was significantly lower than in the matched control group (39% at two years and 43% at four years). It was also lower than the surgery rate in the other 2 control groups. Wrap It Up Inversion therapy relieved symptoms and avoided surgery. And let me tell you personally, we do decompression, we do inversion, we do McKenzie….we have lots of ways of going at low back pain. I’ve seen inversion poo poo’ed in evidence-based FB groups. I’m telling you, they don’t know what they’re talking about, for the right patient, inversion can be a game-changer.  Insurance won’t pay for it but the patient will if it’s reasonable and makes sense.  Item #2 The second one today is called “Effect of Neural Mobilization Exercises in Patients With Low Back-Related Leg Pain With Peripheral Nerve Sensitization: A Prospective, Controlled Trial” by Alshami et. al. (Ali M. Alshami 2021) and published in the Journal of Chiropractic Medicine in June of 2021 and it’s hot hot hot as well If you don’t know what Neurodynamic moves, exercises, etc are….go Google up nerve flossing or nerve gliding or neurodynamic exercises. That should get you up to speed.  Why They Did It The aim of this study was to investigate the short-term effect of slider and tensioner exercises on pain and range of motion (ROM) of straight leg raise (SLR) and slump tests in patients with low back-related leg pain with peripheral nerve sensitization. How They Did It It was a prospective, controlled trial,  51 patients with low back-related leg pain with peripheral nerve sensitization  They were divided into 3 treatment groups:  slider (slider neural mobilization exercise + transcutaneous electric nerve stimulation [TENS]),  tensioner (tensioner neural mobilization exercise + TENS), and  control (only TENS).  Each patient received 6 sessions over 2 weeks.  The following outcomes were measured at baseline and after the first, third, and sixth sessions: visual analog scale (VAS) for pain and ROM of SLR and slump tests were performed for the symptomatic side. What They Found Compared with controls, patients receiving the slider and tensioner exercises showed a greater decrease in pain at the third and sixth sessions  There was a significant difference in the ROM of the SLR test between the slider and controls at only the sixth session  Patients in the slider and tensioner groups demonstrated greater improvements in the ROM of slump test at all sessions compared with controls  There were no significant differences between the slider and tensioner groups in any outcome at any session. Wrap It Up Patients in both slider and tensioner neural mobilization exercise groups demonstrated improvements in pain and ROM in patients with low back-related leg pain with peripheral nerve sensitization compared to those in the control group. Item #3 Number three today is called “Effectiveness of Neural Mobilization Techniques in the Management of Musculoskeletal Neck Disorders with Nerve-Related Symptoms: A Systematic Review and Meta-Analysis with a Mapping Report”‘ by Varangot-Reille et. al. (Clovis Varangot-Reille 2021) and published in Pain Medicine on October 11, 2021, steamy plate of knowledge nuggets coming up! Why They Did It The objective was to assess the effectiveness of neural mobilization (NM) techniques in the management of musculoskeletal neck disorders with nerve-related symptoms (MND-NRS). How They Did It They conducted a systematic review with meta-analysis, using pain intensity, disability, perceived function, cervical range of motion, and mechanosensitivity as the main outcome measures. The systematic review included 22 studies Wrap It Up Neural mobilization appeared to be effective to improve overall pain intensity when embedded in a physiotherapy treatment in the management of musculoskeletal neck disorders with nerve-related symptoms. When compared with no intervention, it was effective to improve neck rotation, disability, and function.  However, it was not superior to other types of treatments in improving overall pain intensity, neck pain intensity, arm pain intensity, cervical range of motion and disability, except for mechanosensitivity. Item #4 I’m an overachiever today, our fourth paper is called, “Neurodynamics is an effecti

CF 216: Return To Play After Herniation & Water vs. PT Exercises Today we’re going to talk about return To Play After Herniation & Water vs. PT Exercises But first, here’s that sweet sweet bumper music Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group, and then  Review our podcast on whatever platform you’re listening to  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #216 Now if you missed last week’s episode , we talked about the MCM Mastermind that I am a member of & we talked about CAM Acceptance Among Medical Specialists. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I’m still settling back in after that Florida mastermind that we talked about last week. Still getting my mind wrapped around the information and the best ways to implement the ideas.  One of my biggest obstacles to practice has been good, evidence-based, patient-centered guidelines for dosing. Meaning, how many times should a patient be seen? Well, one of the mastermind members is Dr. Jay Greenstein. If you don’t know him, I suggest you get that remedied muy pronto mi amigo.  Jay has done a lot of work with Clinical Compass and based on research in the Journal of Manipulative and PHhysiologica Therapies and based on Haas’s research in Spine, Dr. Greenstein has been kind enough to guide me along.  Here’s a lesson for me and for listeners. As far along as you are, whether in the beginning, in middle, or toward the end, you can always learn. Now, instead of saying 3x/week for a couple of weeks, and then we’ll see where you’re at….instead of that, I have firm, research-based, Clinical Compass-approved recommendations for what I tell them.  My biggest gap is patient stick-to-it-iveness. I may see 80 new patients a month but still only see 650 visits that month. Because my new patients don’t typically make it to the first re-exam.  It’s not like I don’t know this problem. It’s always been an issue. Some of us have money issues. We do the stuff to make more money but we’re not always sure we deserve more money or deserve to live well, blah blah blah. That’s the mental health aspect of dealing with money.  I turned financial talks over to the staff because I’m not good with money discussions when it comes to people paying me. I’m fine when I’m talking about stuff I’m doing to try to make money. I’m not good when we’re talking about me making money from someone. It’s just what it is.  Here’s the thing though, if I know it’s backed and supported and even encouraged as far as guidelines, then it’s on. I have no problem with making the recommendations and making them stronger.  So, there you are. Once my recommendations are better, my income improves immediately. This means I can easily training those under me and comfortably hire more providers, etc. All from one thing; more effective communication with my new patients from the get-go.  Also, I’m reading the book Traction: Get a Grip on Your Business by Gino Wickman. This was recommended by several in the MCM Mastermind so I’m already in Chapter 6 on this sucker and wondering why I didn’t read it years ago. It’s there to help identify issues, communicate more effectively with your team, and get the right people in the right seats.  What are you working on professionally this week? Email me at dr.williams@chiropracticforward.com. I’d love to hear it.  Let’s hop in Item #1 The first one today is called “Return to Play After Symptomatic Lumbar Disc Herniation in Elite Athletes: A Systematic Review and Meta-analysis of Operative Versus Nonoperative Treatment” by Sedrak, et. al. (Sedrak 2021) and published in Sports Health on Feb 10 of 2021 and only a year old is still significantly steamy.  Why They Did It The prevalence of symptomatic lumbar disc herniation (LDH) in athletes can be as high as 75%. For elite athletes diagnosed with LDH, return to play (RTP) is a major concern, and thus comparing surgical with nonoperative care is essential to guide practitioners and athletes, not just in terms of recovery rates but also the speed of recovery. The purpose of this systematic review is to provide an update on RTP outcomes for elite athletes after lumbar discectomy versus nonoperative treatment of lumbar disc herniations. How They Did It Systematic review and meta-analysis A search of the literature was conducted using 3 online databases (MEDLINE, EMBASE, and PubMed) to identify pertinent studies. What They Found Twenty studies met the inclusion criteria and were included in this review.  Overall, 663 out of 799 patients (83.0%) returned to play in the surgical group and  251 out of 308 patients (81.5%) returned to play in the nonoperative group.  No statistically significant difference for return to play rate was found  The mean time to return to play for patients undergoing lumbar discectomy was 5.19 months, and 4.11 months for those treated conservatively. Wrap It Up There was no significant difference in return to play rate between athletes treated with operative or nonoperative management of LDHs, nor did operative management have a faster time to return to play.  Athletes should consider the lack of difference in return to play rate in addition to the potential risks associated with spinal surgery when choosing a treatment option.  Clear enough on that, folks? You don’t even need my commentary on it. That’s as plain English as you can get right? Item #2 The second one today is called “Efficacy of Therapeutic Aquatic Exercise vs Physical Therapy Modalities for Patients With Chronic Low Back Pain A Randomized Clinical Trial” by Peng et. al. (Peng M 2022) and published in JAMA Network Open on January 7, 2022, booyah it’s on fire.  Why They Did It To assess the long-term effects of therapeutic aquatic exercise on people with chronic low back pain. How They Did It This was a 3-month, single-blind randomized clinical trial with a 12-month follow-up period A total of 113 people with chronic low back pain were included in the experiment. Participants were randomized to either the therapeutic aquatic exercise or the physical therapy modalities group.  The therapeutic aquatic exercise group received aquatic exercise, whereas the physical therapy modalities group received transcutaneous electrical nerve stimulation and infrared ray thermal therapy.  Both interventions were performed for 60 minutes twice a week for 3 months. What They Found Compared with the physical therapy modalities group, the therapeutic aquatic exercise group showed greater alleviation of disability, with adjusted mean group differences after the 3-month intervention, at the 6-month follow-up, and at the 12-month follow-up At the 12-month follow-up point, improvements were significantly greater in the therapeutic aquatic exercise group vs the physical therapy modalities group in the number of participants who met the minimal clinically important difference in pain Wrap It Up The therapeutic aquatic exercise program led to greater alleviation in patients with chronic low back pain than physical therapy modalities and had a long-term effect up to 12 months. This finding may prompt clinicians to recommend therapeutic aquatic exercise to patients with chronic low back pain as part of treatment to improve their health through active exercise rather than relying on passive relaxation. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.      Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively af

CF 206: Vertebral Dysfunction Alters Neuro Function & The Gender Of Your Provider May Matter Today we’re going to talk about Vertebral Dysfunction Alters Neuro Function & The Gender Of Your Provider May Matter But first, here’s that sweet sweet bumper music Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group, and then  Review our podcast on whatever platform you’re listening to  We also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #206 Now if you missed last week’s episode , we talked about Chiropractic Adjustments For The Cervical Spine Really Work & Lumbar Radiculopathy Treatment. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Alright, let’s see, where are we this week? We’ve got 51 patients today and our intern just left Who the hell knows? But we’ll get through them all and before you know it, I’ll be headed home to eat some din din. We can be overwhelmed sometimes and then we just go to work and work through them all one by one. Next thing you know, you did it.  This is being written and recorded just prior to Thanksgiving so we’re taking off Thursday and Friday. So kind of like a 4 day little holiday. I’m excited as hell about that. Mostly because I’m not driving anywhere. It’s really going to be 4 days of sitting around the house, enjoying family, and giving some Thanks along the way. I have a whole lot to be thankful for. I’ve been very blessed.  Many of you know I’m a musician. I used to be a traveling musician. I’d work for four days every week and then hop in the van with the boys and pull a trailer all over Texas, Oklahoma, New Mexico, Colorado, and even out to Arizona….every single weekend. We’d play like that for 6 months straight without having a weekend off. We’d be home here in Amarillo every 4-6 weeks but we’d still be playing. We used to average around 115 or 120 or so shows per year. It was amazing. Chiropractic was plan B, folks.  It was so much fun. You can’t describe driving down the highway and hearing your song on the radio for the first time. You can’t describe what it feels like when you put an album out and then travel for a show 8 hours away and see the people out in the crowd singing along to your songs that you wrote. It’s addicting. It’s absolutely a drug. People give up everything to chase that kind of feeling. I know I did. I was just fortunate enough to have been a chiropractor the whole time so I could fall back on that if all didn’t work out.  And when my wife and I started having kiddos, that’s exactly what I did. I gave everyone else a good 8-10 year head start on me. I was out trying to be something I felt was special. And we did pretty darn good for quite a while. Then it was time to do something else and re-focus energy somewhere else. It’s funny. They say energy goes where focus flows. Or something like that. I’ve never been a halfway kind of dude. I’m obsessive. If I’m going to do something, I want to do it well, efficiently, and more than competently.  So, then it was time to get serious about chiropractic. Here we are 13 years after getting off of the road and we just integrated the clinic and I don’t know how I’m going to keep up today. That’s when you just sit back and try not to gripe about success or a job well done. That’s when you step back, look at it with fresh, new eyes, and be grateful. I’m a Christian so for folks like me, it’s when we thank God for our blessings.  Speaking of blessings, many of you know I’ve turned a lot of energy and attention to real estate investing recently. Well, we just closed on a house in Lubbock, TX and we’re going to turn it into a short-term rental. We are going through the process of getting everything in place and set up. It’s tough because it’s the first one. So, we’re learning. The next one will be easier because the systems will be in place. This one is a bit challenging but it’ll all be worth it.  Wifi deadbolts, routers, wifi thermostats, ring doorbell cameras, dishes, laundry soap, a dependable cleaning crew, a good handyman, and on and on. But we’ll get there. And it’s going to be great. I’ll keep you updated if you like.  Just some free-flow thoughts there. I hope you don’t mind. This podcast isn’t always only educational. Sometimes it’s my therapy, ya know.  Item #1 The first one is called “The contemporary model of vertebral column joint dysfunction and impact of high-velocity, low-amplitude controlled vertebral thrusts on neuromuscular function” by Haavik et. al. (Haavik H 2021) and published in European Journal of Applied Physiology in October of 2021it’s so damn hot.  Why They Did It There is growing evidence that vertebral column function and dysfunction play a vital role in neuromuscular control. This review summarises the evidence about how vertebral column dysfunction, known as a central segmental motor control (CSMC) problem, alters neuromuscular function and how spinal adjustments and spinal manipulation alters neuromuscular function. How They Did It The current review summarises the contemporary model that provides a biologically plausible explanation for central segmental motor control problems, the manipulable spinal lesion.  This review also summarises the contemporary, biologically plausible understanding about how spinal adjustments enable more efficient production of muscular force.  The evidence showing how spinal dysfunction, spinal manipulation and spinal adjustments alter central multimodal integration and motor control centers will be covered in a second invited review. What They Found Many studies have shown spinal adjustments increase voluntary force and prevent fatigue, which mainly occurs due to altered supraspinal excitability and multimodal integration.  The literature suggests physical injury, pain, inflammation, and acute or chronic physiological or psychological stress can alter the vertebral column’s central neural motor control, leading to a central segmental motor control problem.  The many gaps in the literature have been identified, along with suggestions for future studies. Wrap It Up Spinal adjustments of central segmental motor control problems impact motor control in a variety of ways. These include increasing muscle force and preventing fatigue. These changes in neuromuscular function most likely occur due to changes in supraspinal excitability. The current contemporary model of the central segmental motor control problem, and our understanding of the mechanisms of spinal adjustments, provide a biologically plausible explanation for how the vertebral column’s central neural motor control can dysfunctional, can lead to a self-perpetuating central segmental motor control problem, and how HVLA spinal adjustments can improve neuromuscular function. Item #2 The last one is called “Variations in Processes of Care and Outcomes for Hospitalized General Medicine Patients Treated by Female vs Male Physicians” by Sergeant et. al. (Sergeant A 2021) and published in JAMA on July 16, 2021 and that’s a lot hot.  Why They Did It They wanted to answer the question, “Is physician gender associated with mortality and other patient outcomes in a general internal medicine inpatient setting? How They Did It It was a retrospective cross-sectional study including patients admitted to general medical wards at 7 hospitals in Ontario, Canada, between April 1, 2010, and October 31, 2017.  The association of physician gender with patient outcomes was examined while adjusting for hospital fixed effects, patient characteristics, physician characteristics, and processes of care.  All patients were admitted to a general internal medicine service through the emergency department and were cared for by a general internist or family physician-hospitalist.  Patients were excluded if length of stay was greater than 30 days or if the attending physician cared for less than 100 hospitalized general medicine patients over the study period.  A total of 171,625 hospitalized patients with a median age of 73 years were included What They Found Patients were cared for by 172 attending physicians (54 female physicians and 118 male physicians.  In fully adjusted models, female physicians ordered more imaging tests, including CTs, MRIs, and Ultrasounds.  Patients treated by female physicians had lower in-hospital mortality. This difference persisted after adjustment for patient characteristics but was no longer statistically different after adjustment for other physician characteristics.  The difference was similar after further adjustment for processes of care. Wrap It Up Patients cared for by female physicians had lower mortality rates than those treated by male physicians, adjusting for patient characteristics. This finding was nonsignificant after adjustment for other physician char

CF 201: Breast Implant Illness & Treating Chronic Pain Centrally Today we’re going to talk about breast implant illness and then we’ll talk about chronic pain and new research around treating it centrally vs. peripherally.  But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for your patient education and for you. It saves time in putting talks together or just staying current on research. It’s categorized into sections and it’s written in a way that is easy to understand for practitioner and patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group, and then  Review our podcast on whatever platform you’re listening to  We also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #201 Now if you missed last week’s episode, we talked about the state of chiropractic through ChiroUp and Chiropractic Economics. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Last week, you heard me mention spending time in Chicago at the American Council of Chiropractic Consultants and Chiropractic Forensic Sciences conference. I also mentioned getting to hang out with Dr. Michael Massey and talked a little about who Dr. Massey is and what he does. What I failed to mention is that he and Dr. Rob Pape, together, started a practice management group called Practice Mechanics. Along with that, they have a Practice Mechanics podcast and they had me on as a guest recently.  It was a lot of fun and it was me answering questions rather than asking them. It was really just a great conversation about the profession, this podcast, the book I recently released, my future goals, and all kinds of other goodies. Go to the Practice Mechanics podcast and pull the trigger on episode 10. Then sit back and laugh at my dumb answers!  It really was a great conversation and I was fortunate to have Mike and Rob bring me on and lead me through it. These last couple of months have truly been a whirlwind. As mentioned, I was just in Chicago. At the beginning of September, I was in Washington DC.  In August we integrated with the nurse practitioner. Late August we got an intern from Parker College. Future doctor Drake Gardner from the Tulsa, OK area. Good dude with a bright future. Then, about early September our new patient per month count exploded and rose back to where it was back before the Rona invaded our lives. In fact, I broke a record. We had somewhere around 85-90 new patients in September. In just one week I had 31 new patients. By myself. And I do a thorough exam. It’s not one of those vitalistic  “live and die by the subluxation” knock down the high spot exams. It’s not one of those exams oh crazy Chiro out in Oklahoma that tries to teach others to do like 9 new patients exams and 99 patients in 3 hours with one table. Durrr. It’s one you would expect from an Ortho Diplomate.  Anyway, the point is not to brag but to say damnit…., I’ve been cooking. And cooking hot with gas. And also to discuss what happens when you get so busy you are running the risk of not being able to keep up. When your schedule is full I have been told you need to either hire help or raise prices to thin the herd. How do we feel about that? I don’t know. I’m a capitalist. I don’t like turning away business. But I’m also empathetic. I don’t want to price myself out of the market and I don’t want people to wait a week to come to see me. And….it’s only been this way for about 4 weeks. Who’s to say it’ll be this way in six months? I could hire someone and they stop piling in and then I’m screwed.  The safer bet is to raise prices a touch. You can always backtrack that by simply putting them right back where they were. But here’s what’s going to happen. Nothing. I’m going to be overworked and half crazy for a while until I am 100% clear that the surge in business is here to stay. Then I’m going to try to hire an associate. And I’ll be overworked like crazy until that happens. So work work work is on my horizon. I will try my best to continue this podcast as long as I can. Right now, I’m having to type it up on a Saturday night because I simply won’t have time during the week. We’ll see how it goes. Right now, my commitment to pumping new episodes out every week is strong. I’d offer a Patreon page and maybe try to generate some income from the podcast itself but guess what? I don’t have time!! Lol. This all sounds doom and gloom but it’s all good. I’m blessed. I hope you are blessed as well. Griping about busy makes a guy feel guilty. But I’m not griping about being busy. I’m griping about being overwhelmed and having no time to do the things I need to do every week outside of hands-on patient treatment.  That’s really what it comes down to. So stick with me. I’ll keep doing what ai do and we’ll see what comes of it, my friends. What I do know is that I appreciate you all. Your time and attention to this podcast make it worth every second. That all turned out a little fussier than I meant. I’m usually very positive and I am positive. I’m just sharing what’s going on. I think I’m in a transition period basically. These points that stress us force us into change. My responsibility is to make certain that the change is positive and productive.  Let’s dive in! Item #1 The first one is called “Assessment of Silicone Particle Migration Among Women Undergoing Removal or Revision of Silicone Breast Implants in the Netherlands” by Dijkman et. al. (Dijkman HBPM 2021) and published in JAMA Open on September 20, 2021 and that’s a lotta hot! First, if you don’t know anything about this topic, I think you might be shocked.  Secondly, let’s talk about why I would include this paper on this podcast. What does silicone breast implant leakage have to do with us as chiropractors? Well, one of my Facebook friends was openly discussing silicone leakage and illness and how she was getting her removed, and what a miserable time she had been having recently due to this leakage.  I’d never heard of this being an issue so I started looking into it a bit. While some older research was pretty meh about it all, more recent research has shown an association between silicone breast implants and certain autoimmune diseases.  Healthline says, “These studies suggest that silicone breast implants potentially raise your risk of developing an autoimmune disease such as rheumatoid arthritis, Sjögren’s syndrome, scleroderma, and sarcoidosis.” They also add, “The World Health Organization and the U.S. Food and Drug Administration have identified another possible  This relates breast implants to a rare cancer called breast implant-associated anaplastic large cell lymphoma (BIA-ALCL). Additionally, breast implants are known to cause other potential risks such as: scarring breast pain infection sensory changes implant leakage or rupture” In addition to what Healthline shared, the body of this paper says, “Breast implant illness is used to describe various complications associated with silicone breast implants, ranging from brain fog, hair loss, fatigue, chest pain, sleep disturbances, irritable bowel syndrome, headaches, chronic pain all over the body, and autoimmune diseases, such as lupus and fibromyalgia.” How many of these people do we see every day? So, it’s been on my radar way out on the periphery and when I saw this paper come through JAMA recently, it made sense to put it on your radar screens as well. How many patients do we have that could potentially be going through this and just never made the connection in their minds? Why They Did It To evaluate the existence of silicone gel bleed and migration over a long time period, including the period in which the newer cohesive silicone gel breast implants were used. How They Did It It was a single-center case series,  Capsule tissue and lymph node samples were collected from women who underwent removal or revision of silicone breast implants from January 1, 1986, to August 18, 2020 Data were extracted from the pathological reports and revision of the histology if data were missing.  All tissues were examined using standard light microscopy A total of 365 women had capsular tissue removed, including 15 patients who also had lymph nodes removed, and 24 women had only lymph nodes removed.  Exposures  Silicone breast implants. The main outcome was presence or absence of silicones inside or outside the capsule.  389 women with silicone breast implants What They Found 384 women (98.8%) had silicone particles present in the tissues, indicating silicone gel bleed.  In 337 women (86.6%), silicone particles were observed outside the capsule (ie, in tissues surrounding the capsule and/or lymph nodes), indicating silicone migration.  In 47 women (12.1%), silicone particles were only present within the capsule.  In 5 women (1.2%), no silicone particles were detected in the tissues.  Patients were divided into 2 groups, with 46 women who received cohesive silicone gel breast implants and 343 women who received either an older or a newer type

CF 200: The State Of Chiropractic Via ChiroUp & Chiropractic Economics Today we’re going to talk about the state of chiropractic and we’re going to use a couple of more recent articles I’ve come across to do it. One from Chiropractic Economics and one from our friends at ChiroUp. It’s a good one today folks! But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for your patient education and for you. It saves time in putting talks together or just staying current on research. It’s categorized into sections and it’s written in a way that is easy to understand for practitioner and patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group, and then  Review our podcast on whatever platform you’re listening to  We also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #200 Now if you missed last week’s episode, we talked about Fear Avoidance & Opioids and Neuro Changes With Cannabis Use In Adolescence. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I just returned from Chicago from the American College of chiropractic consultants and the chiropractic forensic sciences conference.  It was great I got to hang out with my forward-thinking chiropractic alliance buddy Mr. Dr. Michael Massey. He was probably tired of me by the time we got done hanging out and I had to go home. Honestly, we were there from Wednesday night through Sunday morning. That’s a long time to be hanging out with someone. Hopefully, I didn’t talk his ear off.  But I learned a lot about him and his history. He’s gotten to do a lot of cool stuff and I enjoyed learning more about it. Here in Amarillo, you don’t get a lot of really cool opportunities.  For example, Dr. Massey has gotten to be on the NASCAR circuit treating the drivers. He’s been on the Rodeo circuit. He’s a certified coder. Which, let’s be honest, that’s not that cool really but, very impressive.  He’s gotten to teach and speak all over and just has a very interesting background. If you don’t know about Dr. Michael Massey from down around the Athens and Chattanooga area of Tennessee and of Practice Mechanics fame, make sure you go check him out.  Practice Mechanics is his and Dr. Rob Pape’s mentoring and consulting group.  Go look into practice-mechanics.com.  As far as the conference itself, it happens the first weekend in October every single year. At the same hotel. The Marriott in Oak Brook Illinois which is basically Chicago. Just about all of the people there are pretty darn impressive and they’re on both ends of the spectrum from working for the insurance company to working for chiropractors and defendants.  They’re expert witnesses. They’re independent medical examiners. And, yes, some even work for the insurance companies. I have to tell you meeting them humanizes them to an extent even if we may not agree with every opinion they may have.  Most of the continuing education I get through the years involves a 16-hour weekend. I typically end up with 80 to 100 hours a year. Sometimes more, sometimes a touch less. But it’s usually quite a few hours through my activities with the Texas Chiropractic Association.  We have more than one event and I usually go to more than one event every year. At least a couple of the events. Then I have the orthopedic hours. And then I have the other stuff I learn and take here and there. So, I’m usually in the 80-100 hours per year range.  This weekend was 27 hours of continuing education. These folks are serious about getting some CEs in, man. Crazy. Thursday went from 8 am until 9 pm. Friday was 8-6, and Saturday was 8-4. One-hour lunches. Class…..all day….every day.  On this deal, what had happened was….as my long-time listeners know, I got Board Certified, which means a Diplomate, also known as a Fellowship…..I got that in the Neuromusculoskeletal Medicine program in 2019. Dr. James Lehman with the University of Bridgeport contacted me last year. He said, “‘Ya know…since you already have the Neuromusculoskeletal Fellowship, you can get your Forensic Fellowship a lot easier since it’s a subspecialty of the Neuromusculoskeletal specialty.” That’s about the time that I responded with, “What’s that?” I had no idea what Chiropractic Forensics was. I thought I might be solving some sort of murder mystery or something. Anyway, Dr. Lehman explained to me that it was to bolster experience and credentials in the medicolegal arena.  The original Fellowship took 300 hours to complete. Since Forensics is a subspecialty of it, this second Fellowship was only 100 extra hours for me to complete.  How do you say no? Well, you don’t. I did it. I got through it. And here we are. Two Fellowships within about 3 years. Where the hell did that come from? When it came to classwork, I didn’t thrive in the classroom. I hated the classroom. Sitting there for hours on end day after day…..yeah. I struggled. I was just a B student at chiropractic school. Not an overachiever. Not an underachiever.  I swore I’d never take another class. Forever and ever amen. And then, things changed. I got into research and evidence and all that good stuff. Hell, I got into learning again and I enjoyed it. I wanted to raise my game all of the sudden and there it went. And here we are.  Old dogs can indeed learn new tricks, folks. So, keep moving forward. Keep learning. Don’t just knock down the high spots. We’re capable of so much more than that.  Item #1 This first one is called, “Survey says 1 in 4 Americans would pay up to a $40 co-pay for chiropractic care” by the Chiropractic Economics staff (Staff 2021) and published on their site on October 6 of 2021. Hot tamale, hot tamale….get em while they’re good n hot.  It’s an article so let’s summarize and hit the high spots, shall we? They start the article by saying, “A recent survey of more than 2,000 Americans revealed that roughly 1 in 4 (24%) would “be most likely to pay a co-pay of $40 or less without hesitation.” This survey was done by ATI Physical Therapy which they say is one of the nation’s biggest providers of PT services. I am unfamiliar with the group but their website says they have 900+ convenient locations They say that 33% of Americans think PT is among the outpatient services they would be most likely to pay a co-pay of $40 or less without any reservation or hesitation.  Other services they would be most likely to pay $40 or less for would be Urgent Care visits at 55%, regular screening or check-ups at 35%, prescriptions at 33%, and chiropractic at 24%.  I became aware of this one from a post from Dr. Bobby Maybee in his Forward Thinking Chiropractic Alliance group. Also known as FTCA. If you’re not a member and you are evidence-based, patient-centered, I recommend you fix that situation and hop in there.  It’s a group you’ll want to just sit and lurk for a little while before you pop in and start spouting off. They, much like myself, have very little patience for the more vitalistic stuff in the profession. Once you get the lay of the land, you’ll find a group of very welcoming, friendly, productive, and very helpful doctors that you’ll be glad you became a part of. Great group. All groups have their issues but I’ve been a part of the FTCA for several years at this point and it’s a great group with great people.  Anyway, As Dr. Maybee pointed out, Chiro Economics is looking at this information as a positive while he, and I by the way, see it as a negative. Patients value us at $40. Those that don’t value us at that price point value us as less than $40. Not a good thing. Especially when you’ve gone to the lengths to specialize and get board certified in one or more diplomates.  We’re specialists but still lumped in at $40/visit. And that’s by only 24% of Americans while PTs get 33%. When we know through Palmer/Gallup poll and other research that chiros are more cost-effective, with more patient satisfaction, and with better patient outcomes.  The schiesters in the profession, I’m convinced, are the reason we aren’t further up the chain. And the lack of standardization. You don’t know what the hell you’re getting when going to a new chiropractor.  About the time I saw that article, I got a great email from ChiroUp (Bertelsman T 2021) with a summary of the ChiroUp dataset. I’m including the link to this in the show notes at this point in the transcript: https://chiroup.com/COPSsynopsis2021 They shared that the percentages of issues chiropractors see are as follows: Lumbosacral at 36% – which makes sense. It’s the leading cause of disability in the world and has only gotten worse over the last 20 years. If you’re not a low-back ninja, that’s your first mission right there.  Neck pain at about 18% Thoracic pain at about 6.5% Then shoulder, hip, knee, foot and ankle, elbow, and last but not least the hand and wrist.  All of the extremities added up to about 14% of cases. It seems that having some extremity skills is a good addition to your toolbox but the bread and butter is the spine for ch

CF 195: Spinal Manipulative Therapy vs. Opioids and Young Elite Pitchers, Hips, and Elbow Pain Today we’re going to talk about spinal manipulative therapy vs. opioid therapy for Medicare-aged patients and we’ll talk about young elite pitchers, their hips, and pain. Stick around.  But first, here’s that sweet sweet bumper music Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group and interact, and then  go review our podcast on iTunes and other podcast platforms.  We also have an evidence-based brochure and poster store at chiropracticforward.com While you’re there, join our weekly email newsletter.  You have found yourself smack dab in the middle of Episode #195 Now if you missed last week’s episode , we talked about Lumbar Fusion Compared To No Fusion, Disc Research, and PT vs. Chiropractic.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. On the personal end of things, we just got back from Washington DC. It was a go go go whirlwind kind of thing that every single American needs to experience. It’s powerful. The buildings were meant to inspire and awe and intimidate foreign leaders. So what do you think they do to regular ol commoners like me and you? Pretty impressive. Even if you dislike most politicians like I dislike most politicians. Day 1 was getting there. We got up at 4:00am to get to the 6 am flight. Got to DC by 1:30. Hopped onto the metro and boom, we’re at the hotel. If you’ve never experienced the DC Metro, hell that is reason enough to go all by itself. It’s a work of art and I’m constantly fascinated by it. You can go just about anywhere you want easily and in no time with no traffic. That doesn’t mean there no walking involved though. Bring a pair of walking shoes my friends. The first full day we logged over nine miles. The second full day was about 8 and a half miles. Same on the third. Bout 5-6 miles on the fourth day.  Unless you’re doing the bus tours and all, you’re in fir walking. Plain and simple. I’m always good for 5-6 miles. 9-10 in a day is a bit more than I want. I can do it, but it’s damn sure extra. But, we saw the Lincoln Memorial, WWII memorial, Vietnam Wall, Washington monument, White House, Capitol, air and space museum, natural history museum, American history museum, national art gallery with this hemisphere’s only Da Vinci painting, Mt Vernon, Arlington National Cemetery and the changing of the guard, Old Town Alexandria, and much much more. It was a go-cation and I’m glad to be back home so I can sleep and get some rest. It’s bad when going to work is a vacation from your vacation. Professionally, just getting into the swing of things with our Nurse Practitioner. He’s catching on slowly but surely. It’s happening. Never fast enough. But I see it happening. We’re also getting into the swing of things with our Parker Intern.  He’s a good guy. Seems to be a smart guy and seems to click right along with everything we do so all’s well there. It’s been fun teaching him. So, I’m still playing catch-up from being gone so let’s hop in. Item #1 This first one is called “Initial Choice of Spinal Manipulation Reduces Escalation of Care for Chronic Low Back Pain among Older Medicare Beneficiaries”’ by Whedon et. al. (Whedon JM 2021) and published in Spine Journal on May 11 of 2021. Schiza!!! Es Caliente!  I just combined German and Spanish. Please make note. And recognize.  Why They Did It The objective of this study was to compare long-term outcomes for Spinal Manipulative Therapy (SMT) and Opioid Analgesic Therapy (OAT) regarding escalation of care for patients with chronic low back pain (cLBP). How They Did It They combined elements of cohort and crossover-cohort design. They examined Medicare claims data spanning a five-year period.  They included older Medicare beneficiaries with an episode of cLBP beginning in 2013.  They analyzed the cumulative frequency of encounters indicative of an escalation of care for cLBP, including hospitalizations, emergency department visits, advanced diagnostic imaging, specialist visits, lumbosacral surgery, interventional pain medicine techniques, and encounters for potential complications of cLBP. What They Found SMT was associated with lower rates of escalation of care as compared to opioid Analgesic Therapy.  The adjusted rate of escalated care encounters was approximately 2.5 times higher fi the initial choice of care was opioid analgesic therapy vs. if the initial choice was SMT Wrap It Up Among older Medicare beneficiaries who initiated long-term care for cLBP with opioid analgesic therapy, the adjusted rate of escalated care encounters was significantly higher as compared to those who initiated care with spinal manipulative therapy Item #2 I want to thank my friends at ChiroUp for finding this one. They’re always on top of it at ChiroUp. Don’t forget to use my code, Williams15 if you want to sign up with them for a discount! Number 2 this week is called, “Restriction in the hip internal rotation of the stride leg is associated with elbow and shoulder pain in elite young baseball players” by Sekiguchi et. al. (Sekiguchi T 2019) and published in the Journal of Shoulder and Elbow Surgery in September of 2019. Ahhhh the days of pre-pandemic.  Why They Did It Evidence is scarce concerning the relationship of physical dysfunction of the trunk and lower extremities with elbow and shoulder pain in young baseball players. This study aimed to examine the association of joint flexibility of the trunk and lower extremities and dynamic postural control with elbow and shoulder pain among elite young baseball players. How They Did It They analyzed baseball players (aged 9-12 years) who participated in the National Junior Sports Clubs Baseball Festival.  Range of motion in external rotation and internal rotation (IR) of the hip, as well as the finger-to-floor distance and heel-to-buttock distance, was measured.  The straight-leg-raise test was also conducted.  Dynamic postural control was evaluated using the Star Excursion Balance Test.  Multivariable logistic regression analyses were conducted to examine the association of physical function with the elbow or shoulder pain incidence. Of 210 players surveyed, 177 without elbow or shoulder pain were included in the analysis. What They Found Of the participants, 16 (9.0%) reported having elbow or shoulder pain during the tournament.  Participants with the incidence of elbow or shoulder pain had a significant restriction in hip IR of the stride leg compared with those without pain  There were no significant associations of other joint flexibilities and the Star Excursion Balance Test with elbow or shoulder pain. Wrap It Up Decreased hip IR range of motion of the stride leg was significantly associated with the elbow or shoulder pain incidence.  Players, coaches, and clinicians should consider the physical function of the trunk and lower extremities for the prevention of elbow and shoulder pain. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Alright, that’s it for this week. Y’all go out and piss some excellence. Get involved in your state association and the ACA. Our profession needs evidence-based, patient-centered chiropractors driving the ship. So get in, get involved, and make the profession what you will.  Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.      Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculo

CF 193: Patellofemoral Pain, Sleep For Pain, and Physical Disuse Today we’re going to talk about patellofemoral pain, sleep for pain, and physical disuse But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group and interact, and then  go review our podcast on iTunes and other podcast platforms.  We also have an evidence-based brochure and poster store at chiropracticforward.com While you’re there, join our weekly email newsletter.  You have found yourself smack dab in the middle of Episode #193 Now if you missed last week’s episode , we talked about To Do lists, frailty, and we talked about pain and lost work days. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. This one will be a bit short today. My time will loosen up eventually and I’ll be able to dive deeper into some of the things going on around the office that you may relate to. But today ain’t that day. If you listened last week, you know that I believe in a To Do list and I believe in making it the priority if you’re going to be productive and if you ever hope to complete your epic saga of world domination. I’m stepping on the gas on the AMA Impairment Rating course because the national conference in Chicago is in October. That’s not too far off so it’s time to get down to bidniz. I’m elbows deep researching and generating a medical weight loss protocol for my clinic. Not only that, but I’m researching and creating a protocol for PRP Hair Restoration. It’s pretty dang cool and the research has shown how effective it is. But, the main reason I need to be a bit brief this morning is that today is our first day and onboarding of our Parker University intern. He’ll be with us through the end of November so he gets plenty of time to find all of my screw-ups.  Admit it. You don’t do everything perfectly. Research tells us that we can’t adjust as precisely as we were taught. Yet, in our documentation, we’re supposed to notate the very specific levels of adjustment. We all must reconcile these things within our way of functioning.  Academia is one thing. Real-life is quite another.  For example, the college dinged my records when I sent them a sample for auditing purposes. One of their reasons was that on a PI, I didn’t provide a full robust diagnosis on the first visit. Well, what they didn’t ask me was why. The reason being that most PIs have been nowhere prior to showing up at our clinics. They’ve not had x-rays. They had traumatic onset so, with regards to Choosing Wisely, we should be getting x-rays.  What if I did an exam right away without imaging just because academia says I need that dx on day one? I’ve had a fractured neck in my office before. We didn’t have a clue until the Xrays. What if I go pushing, pulling, and tugging on a fractured Cervical vertebra? Nope…..not here academia. Ding those notes all you want but I’m going to put a generalized place keeping dx like cervicalgia on the file until the x-rays come back clear. Then I’ll do the exam safely. Then I’ll assess a more appropriate diagnosis.  So there! Now, how to responsibly teach these things to an intern while still keeping within academic teachings and parameters?  We shall see. Let the adventure begin. Item #1 This first one this week is called, “Osteopathic Manipulative Treatment Versus Exercise Program in Runners With Patellofemoral Pain Syndrome: A Randomized Controlled Trial” by Zago et. al. (Zago J 2020) and published in the Journal of Sports Rehabilitation on in December of 2020 and that’s hot because I said it’s hot… Why They Did It The authors say that the effects of an exercise program for the treatment of patellofemoral pain syndrome are well known. However, the effects of osteopathic manipulative treatment (OMT) are unclear. Their objective was to evaluate the effects of OMT versus exercise on knee pain, functionality, plantar pressure in middle foot (PPMF), posterior thigh flexibility (PTF), and range of motion of hip extension in runners with patellofemoral pain syndrome. How They Did It It was a randomized controlled trial It was performed in a human performance laboratory There was a total of 82 runners with patellofemoral pain syndrome that participated The participants were randomized into 3 groups: OMT, EP, and control group.  The OMT group received joint manipulation and myofascial release in the lumbar spine, hip, sacroiliac joint, knee, and ankle regions.  The EP group performed specific exercises for lower limbs. The control group received no intervention. The main evaluations were pain through the VAS, functionality through the Lysholm Knee Scoring Scale, dynamic knee valgus through the step-down test, PPMF through static baropodometry, PTF through the sit and reach test, and range of motion through fleximetry.  The evaluations were performed before the interventions, after the 6 interventions, and at 30-day follow-up. What They Found There was a significant pain decrease in the OMT and EP groups when compared with the control group.  OMT group showed increased functionality, decreased plantar pressure in middle foot, and increased posterior thigh flexibility. The range of motion for hip extension increased only in the EP group. Wrap It Up Both OMT and EP are effective in treating runners with patellofemoral pain syndrome.  CHIROUP ADVERTISEMENT   Item #2 This second item is called, “Machine learning suggests sleep as a core factor in chronic pain” by Miettinen et al. (Miettinen T 2021) and published in Pain in January of 2021 and it sizzles… Why They Did It The authors say that patients with chronic pain have complex pain profiles and associated problems.  Subgroup analysis can help identify key problems. How They Did It They used a data-based approach to define pain phenotypes and their most relevant associated problems There were 320 patients in the study undergoing tertiary pain management. They identified 3 patient phenotype clusters Wrap It Up If I try to get into the particulars of this paper, most of which I don’t understand and I’m relatively sure 90% of the rest don’t understand either if I get into it, our eyes will gloss over and we’ll question our life choices.  Instead, we’re going to skip to the important part of the conclusion. They say, “Machine learning suggested sleep problems as key factors in the most difficult pain presentations, therefore deserving priority in the treatment of chronic pain.” We have talked about it here before but, if you are not lining your chronic pain patient out with some very solid sleep recommendations, you’re not sign everything you can to help them. It’s clear that getting good sleep is key to getting on top of chronic pain. I commonly recommend a book to my chronic pain patients that says the same. It’s called ‘Back In Control’ by David Hanscum, MD. He’s a chronic pain sufferer but he’s also an orthopedic spinal surgeon so…..he’s no dummy walking around bumping into walls.  Sleep is part of the process. So make sure you’re recommending it to your chronic pain patients. Item #3 This last one has the longest name ever given to a research paper in the known history of mankind. It is, “Physical disuse contributes to widespread chronic mechanical hyperalgesia, tactile allodynia, and cold allodynia through neurogenic inflammation and spino-parabrachio-amygdaloid pathway activation” by Ohmichi et. al.  (Ohmichi Y 2020)and published in Pain in August of 2020 and that’s just hot enough people! And can I just say that with a title this long, this Ohmichi had to of been trying to compensate? You know, like when a small person buys a huge truck. Something like that. I feel like these folks could work on their naming process a bit. That’s all I’m saying.  Why They Did It Physical disuse could lead to a state of chronic pain typified by complex regional pain syndrome type I due to fear of pain through movement (kinesiophobia) or inappropriate resting procedures.  However, the mechanisms by which physical disuse is associated with acute/chronic pain and other pathological signs remain unresolved. We have previously reported that inflammatory signs, contractures, disuse muscle atrophy, spontaneous pain-like behaviors, and chronic widespread mechanical hyperalgesia based on central plasticity occurred after 2 weeks of cast immobilization in chronic post-cast pain (CPCP) rat model. Wrap It Up As with the last paper we discussed, this one really gets into the weeds and my goal here is to make research more palatable so we’re going to go to the conclusion because that’s what really matters the most here.  They conclude that physical disuse contributes to dystrophy-like changes, spontaneous pain-like behavior, and chronic widespread pathological pai

CF 192: To-Do Lists, Frailty, and Pain & Lost Work Days Today we’re going to talk about To-Do Lists, Frailty, and Pain & Lost Workdays But first, here’s that sweet sweet bumper music Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioners as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group and interact, and then  go review our podcast on iTunes and other podcast platforms.  We also have an evidence-based brochure and poster store at chiropracticforward.com While you’re there, join our weekly email newsletter.  You have found yourself smack dab in the middle of Episode #192 Now if you missed last week’s episode, we talked about chiropractic preventing opioids and chiropractic adverse events. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I am starting week three of the medical integration. It’s stressful but it’s exciting too. Every day I’m convinced more and more that we picked the right nurse practitioner. Super smart and excellent with patients.  I’m lying if I act like there’s no anxiety in this deal though. Damn. The money flying out the doors in a direction is almost stunning. With little money coming in on the medical side. Everything has to start at ground zero. That’s a given. Everything has to grow from seed. That’s a given.  The trick is to get to maturity and profitability as quickly as humanly possible. That’s what we’re trying to do.  We’ve been doing social media and are about to do a direct Mail piece as well. We’re trying to get this thing on its feet muy pronto! Switching gears here, how do you stay productive? My means of staying productive is really pretty simple. I keep a ToDo list and I follow it daily. I have it broken down into two sections. One is a grid. The days of the week are along the top of the grid. What HAS to be accomplished are listed below the day it has to be done. Then, I have a simple list outside of the grid. They’re things that need to be done when time allows. Outside of the must-do’s they’re the need to do’s if you will. So, for example, on Mondays, I have to write, record, edit, and upload the podcast. It’s a scramble from start to finish when I also have 40 or more patients to contend with as well. Sometimes I get it all done. Sometimes I just get it written and record it as time allows the rest of the week Don’t forget about email. I get at least 50-100 every day so that’s a job all by itself sometimes. I unsubscribe as often as I can. I don’t like garbage and minutiae. Can’t have it. No time for that. Tuesdays, it’s my clinic’s blog that has to be written, the corresponding video is recorded, and it’s uploaded to YouTube and Facebook. Again, all accomplished between patients. I get off on Tuesdays around 2 pm. Sometimes that extra afternoon time is used to catch up. Sometimes I go home, work out, do voice-over, and then take classes toward the Forensics Diplomate. As you can see, Monday and Tuesday is go time. Wednesdays I  write and send a mass email to my emailing list with the blog and video I recorded the day before included. Usually, things start to loosen up a bit by the time Wednesday rolls around and I’m able to give attention to the Need To-Dos. Some marketing and all that good stuff. Thursdays I upload the new podcast episode, I post it on Facebook, I send out an email to my list, and lost it in our private Facebook group. Then marketing, patients, voice-over, another website project I’m working on, and whatever else crosses the desk. Friday, I get off at 1 pm. The afternoon is spent catching up, taking classes, getting in phone calls with people that think they just have to get you on a phone call, or I hit happy hour if I’m lucky. So that’s my week. I don’t get on phone calls. If it can’t be texted or emailed, don’t bother. I don’t talk to salespeople. I don’t entertain anything that takes me off task if I can help it. I can’t. So that’s how I get it all done. The list is my priority and I make sure each item is accomplished. It keeps me on track, it keeps this podcast rolling, it keeps my clinic rolling, and it keeps my brain from exploding. Tel me how you stay on track. I’d love to hear about it. Email me at dr.williams@chiropracticforward.com Item #1 The first one today is called “The Predictability of Frailty Associated with Musculoskeletal Deficits: A Longitudinal Study” by Tembo et. al. (Tembo 2021) and published in Calcified Tissue Interrnational……which is as niche-y as niche can be and it was published on May 20 of 2021. Good Lawd….the heat.  Why They Did It They wanted to investigate and quantify the predictability of frailty associated with musculoskeletal parameters.  How They Did It It was a longitudinal study Involved 287 men over 50 years old Baseline musculoskeletal measures included  femoral neck bone mineral density appendicular lean mass index whole-body fat mass index lower limb strength Frailty at the 15 year follow-up was defined as > or = to 3 of the following 1. Untintentional weight loss 2. Weakness 3. Low physical activity 4. Exhaustion 5. Slowness What They Found 48 men were frail. That’s 16.7% Musculoskeletal models were better predictors of frailty Musculoskeletal parameters improved the predictability model as measured by AUROC for frailty after 15 years Wrap It Up In general, muscle models performed better compared to bone models. Musculoskeletal parameters improved the predictability of frailty of the referent model that included lifestyle factors. Muscle deficits accounted for a greater proportion of the risk for frailty than did bone deficits. For getting musculoskeletal health could be a possible avenue of intervention in regards to frailty. CHIROUP ADVERTISEMENT Item #2 This one is called “Guideline adherence and lost workdays for acute low back pain in the California workers’ compensation system” by Gaspar et. al. (Gaspar FW 2021) and published in PLoS ONE on June 17, of 2021 and that’s stuh, stuh, stuh, steamy people.  Why They Did It The authors wanted to quantify the influence of adherence to guideline-recommended interventions in the first week of treatment for an initial low back pain (LBP) injury on lost workdays. How They Did It It was a retrospective cohort of California’s workers’ compensation claims data from May 2009 to May 2018 41 diagnostic and treatment interventions were abstracted from the medical claims for workers with acute LBP injuries and compared with guideline recommendations. Lost workdays within 1-year post-injury were compared by guideline adherence using quantile regressions. Of the 59,656 workers who met the study inclusion criteria, 66.1% were male and the average (SD) age was 41 (12) years What They Found The median number (IQR) of lost workdays was 27 (6–146) days.  In the first week of treatment, 14.2% of workers received only recommended interventions, 14.6% received only non-recommended interventions, and 51.1% received both recommended and non-recommended interventions Opioid prescriptions fell 86% from 2009 to 2018 Workers who received only guideline-recommended interventions experienced significantly fewer lost workdays (11.5 days; 95% CI: -13.9, -9.1), a 29.3% reduction, than workers who received only non-recommended interventions The percentage of workers receiving only recommended interventions increased from 10.3% to 18.2% over the 9 years. Wrap It Up When workers received guideline-recommended interventions, they typically returned to work in fewer days. The majority of workers received at least one non-recommended intervention, demonstrating the need for adherence to guideline recommendations. Fewer lost workdays and improved quality care are outcomes that strongly benefit injured workers. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus so get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.  Store Remember the evidence-informed brochures and posters at chiropracticforward.com.    Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disabi

CF 190: Obesity In Youths With Chronic Pain, The Healing Journey of Pain, and Fibromyalgia Treatment Today we’re going to talk about obesity in youth and chronic pain, we’ll talk about fibromyalgia and hyperbaric oxygen chambers, and we’ll talk about chronic pain and the healing journey.  But first, here’s that sweet sweet bumper music Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around.  We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.   If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s an invaluable resource for your patient education and for you. It can save you time in putting talks together or just staying current on research. It’s categorized into sections so that the information is easy to find and it’s written in a way that is easy to understand for practitioner as well as patient. You have to check it out. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Then go Like our Facebook page,  Join our private Facebook group and interact, and then  go review our podcast on iTunes and other podcast platforms.  We also have an evidence-based brochure and poster store at chiropracticforward.com While you’re there, join our weekly email newsletter.  You have found yourself smack dab in the middle of Episode #190 Now if you missed last week’s episode , we were joined by the amazing Dr. Brett Winchester from the St. Louis area. This doctor is just phenomenal in everything he does and says and we are all fortunate to have him in this profession. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Day 1 of our nurse practitioner starting is today. This morning has, of course, had its hiccups. We have the EHR where we have him set up but he has to have his own login and password and all that good stuff so that’s been one challenge so far.  Just getting oriented with where all of the stuff is, lidocaine, lab tubes, swabs, blah blah blah. Still waiting on the autoclave and still getting the malpractice policy in place this morning. What a process that’s been.  But we knew there’d be hiccups, and we’re getting them addressed. Then I have my regular life to contend with. I have patients to treat and a podcast to write so here we go. Short and sweet on this one because my cup is running over this morning.  Item #1 Our first item today is called “Obesity in Youth with Chronic Pain: Giving It the Seriousness It Deserves” by Hainsworth et. al. (Keri R Hainsworth 2021) and published in Pain Medicine in June of 2021 and day-um…..that’s hot! Why They Did It The aim of this commentary is to review the current science on co-occurring chronic pain and obesity in children and adolescents. In so doing, we also highlight some of the current gaps in knowledge. It is our hope that this commentary will draw attention to an overlooked area of research and clinical endeavors within the field of pediatric pain. The authors note that it is becoming increasingly clear that we should be familiar with this research. Both chronic pain and obesity have been rising in children for some time and studies are showing that obesity exacerbates the negative outcomes associated with chronic pain.  In addition, accumulating research exists on all facets of the co-occurrence of chronic pain and obesity in adults. Given all this, the paucity of research in this area of pediatric chronic pain and obesity is at a minimum, disheartening, and at a maximum, unconscionable. Ooooweee! That’s like putting a white glove on and smacking some clown around the room a little bit, isn’t it? I like it. It give me a little tickle.  Here are their main points: On average, it can take 2 years longer for youth with obesity to be referred to a pediatric pain clinic than it does for youth with a normal weight Pediatric patients with CPO have health-related quality of life that is more impaired in every domain than patients with chronic pain and a healthy body mass index percentile Although systemic inflammation is commonly elevated in youth with obesity, patients with CPO have significantly higher levels of systemic inflammation than those with chronic pain alone or obesity alone  Children with CPO are at increased risk of being treated as though they bear more responsibility for their health (and by extension, their pain) than youth without obesity and are at increased risk of pain dismissal and biased medical care CPO in children and adolescents is associated with more impaired physical functioning and lower levels of physical activity than youth with chronic pain alone or obesity alone Further, parents report that their children with CPO (particularly girls) have greater functional disability (one of the most important outcomes in our field) than parents of youth with chronic pain and a normal body mass index While multidisciplinary pain management programs work well for patients with a healthy weight, this is not true for those with comorbid obesity. Patients with a healthy weight improve in functional disability within 3 months of intake, whereas patients with CPO stagnate First, even though we as clinicians and researchers need to address obesity in the context of chronic pain, we must be extremely thoughtful about how we move forward. Weight is a very sensitive subject, therefore, the call for more research in this area must strongly consider the need for sensitivity. CPO is the co-occurrence of a typically “invisible,” debilitating condition coupled with a condition so visible that it is sadly associated with victimization from important people in the child’s life, including peers, parents, and teachers Second, we would do well to closely follow the admonitions and advice of our colleagues whose primary clinical and research focus is on obesity and stigma. Suggestions from these experts include first recognizing that weight bias exists even among pediatric health care providers [20]. Additionally, language must be very carefully considered. Puhl et al. [20] offer the practical and sensitive suggestion to ask the patient and family about preferred words or terms in discussions about weight-related health Third, like other health care professionals, we would benefit from a greater understanding of the complexity of obesity and the “potential benefits and disadvantages of introducing weight-management discussions with patients” [14](p865). Certainly, there will be times when weight-related discussions would be contraindicated by the patient’s and/or family’s psychological or emotional state. However, when weight needs to be raised in relation to a child’s chronic pain, it may be best received in the context of health implications. Obesity is a multifactorial disease with strong genetic contributions. It is also associated with systemic inflammation, metabolic syndrome, and increased risk for diabetes and cardiovascular disease, as well as chronic pain. In fact, most are unaware that obesity is a risk factor for migraines in pediatric populations. That said, weight-related health or weight-related pain discussions cannot focus entirely on losing weight. For many, it is a struggle to change their weight status, and even if it is possible, this process takes time. We must not ignore managing pain while we wait for possible weight reduction. CHIROUP ADVERTISEMENT Item #2 Our second one today is called “Evaluation of a Hyperbaric Oxygen Therapy Intervention in Individuals with Fibromyalgia” by Curtis et. al.(K Curtis 2021)  and published in Pain Medicine in June of 2021…….pork chops and apple sauce.  Why They Did It To evaluate the feasibility and safety of hyperbaric oxygen therapy (HBOT) in patients with fibromyalgia (FM). How They Did It A total of 17 patients completed the study A cohort study with a delayed treatment arm used as a comparator. Hyperbaric Medicine Unit, Toronto General Hospital, Ontario, Canada. Eighteen patients diagnosed with FM according to the American College of Rheumatology and a score ≥60 on the Revised Fibromyalgia Impact Questionnaire. Participants were randomized to receive immediate HBOT intervention (n = 9) or HBOT after a 12-week waiting period HBOT was delivered at 100% oxygen at 2.0 atmospheres per session, 5 days per week, for 8 weeks Both groups were assessed at baseline, after HBOT intervention, and at 3 months’ follow-up. What They Found HBOT-related adverse events included mild middle-ear barotrauma in three patients and new-onset myopia in four patients The efficacy of HBOT was evident in most of the outcomes in both groups This improvement was sustained at 3-month follow-up assessment. Wrap It Up HBOT appears to be feasible and safe for individuals with FM. It is also associated with improved global functioning, reduced symptoms of anxiety and depression, and improved quality of sleep that was sustained at 3-month follow-up assessment. I don’ tank about you but I’m not going to go out and buy an oxygen chamber this afternoon but, it’s interesting and I’ve always heard positive things about them so this one peaked my interest a bit. I figured it would with you as well.  Item #3 The last one is called “A Healing Journey with Chronic Pain: A Meta-Ethnography Synthesizing 195 Qualitative Studies” by Toye et. al. and also published in Pain Medicine in June of 2021….Smoke sho