Remote Myofascial Release & Manual Versus Instrumental Spinal Manipulation

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 275: Remote Myofascial Release & Manual Versus Instrumental Spinal Manipulation

Today we’re going to talk about Remote Myofascial Release & Manual Versus Instrumental Spinal Manipulation

But first, here’s that sweet sweet bumper music

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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 [e-mail] 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.
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You have found yourself smack dab in the middle of Episode #275 Now if you missed last week’s episode, we talked about spinal stabilization for chronic pain and we talked about dry needling. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Damnit….OK…..I’m pulling out the soapbox. You ready? Here we go. I love certain aspects of this profession. I absolutely ABHOR others. One popped its ugly head up this morning. I have a brand new patient, 23 yrs old, a little knee pain I think is Pes Anserine, a little low back pain that seems facet-related, and some neck soreness. Most likely due to him self-adjusting it all of the time. He came to me from another local chiropractor. This local chiro took x-rays on him. Which is not evidence-based by the way. No trauma, no steroid use, no systemic illness, no IV drug use….he’s good. Shouldn’t have had x-rays to begin with. Regardless, because chiropractors are chiropractors, he gets x-rays and then the mind screwing begins. Guess what, he’s got a ‘tweak’ and his neck is straight and if he doesn’t handle that and get it fixed, it could be the end for him up to and including….get this…..cognitive decline. Are you with me? Freaking cognitive decline.

He’s 23 people.

Not only does he think he’ll forget his wife’s name some day if he doesn’t fix his neck, he is recommended to be treated for 4x/week for a YEAR! Who the hell needs 4x/week for a year? WHO??? In case you were curious, the answer to that question is absolutely nobody on the face of the planet. Unless they’re looking to have their spine become unstable from too much mobilization. I mean, those people maybe but that would just be out of pure ignorance. So I did some math and bam….that’s 208 visits this year. Let’s say that’s a conservative $45 per visit. I know this clinic and it’s likely more but let’s go with a safe bet. At $45 per visit that’s a grand total of $9,360. Out-freaking-standing.

This 23 yr old that needs to quit popping his own neck needs to spend almost $10k in a clinic? Insanity and if you are a predatory, ignorant chiropractor of this caliber, I want you to stop it now. Get some damn education. Because this is garbage, rubbish, and utter stupidity. Chiropractors like this should be ashamed of themselves and should surrender their license if they refuse to be moral, ethical, read research, and do smart things. If you don’t do smart things, you’re and idiot and I got zero use for you as a supposed professional.

OK, putting the soapbox away now…..

Business is weird man. Ups and downs so we keep an eye on it but don’t let us go crazy unless we notice a sustained downturn. I was in a sustained down turn from September through February. We’ve been on the upswing once we had the 75% staff turnover. I like our team and, while I think we’re coming out of the downturn, it’s not without its bumps and potholes. Last week was awful. But we had Easter and coming off of Spring Break. It’s whatever.

This week, as I type this out on a Monday, I’m looking at 127 for me for the week. Which means, if I’m right, we’ll wind up somewhere around 155 or 165 before the week is through. And I’m totally good with that. I have been playing around a lot lately with content creation, figuring out how to delegate more, and reclaim my time to the extent that I can. I’ve even been toying with the new AI stuff coming out. It’s scary but for where it is right now, it’s pretty incredible for business owners that don’t have the time they’d like to have to market. I remember when we used to just join the rotary or Kiwanis Club, run an ad in the newspaper and yellow pages, and if you were fancy, you’d run a radio ad…..maybe. That was pretty uptown. Life was pretty simple for us back then. Just get into the community and let them know you’re open for business.

There are so many more things to try to keep track of these days. It’s tough on business owners. Especially chiropractors because we are paid less and less but the price of everything has gone up and up while the price of treatment and its value in the eyes of the consumer has remained consistent with 10 years ago. Our margins are thinner and thinner. We can’t just go out and grab up a marketing rep to grow our clinic for us like the medical boys. Well, most of us can’t anyway. So, when you find tools that can lighten your burden, you figure it out. That’s what I’m doing. I suggest, if you’re behind on it, you better catch up muy pronto, mi amigo. Or you might never catch up. Early adopters are either roasted or champagne toasted. I think when it comes to AI, it’s not going anywhere so you might as well jump on and hold on tight because it’s going to get crazy in the years to come.

Item #1

The first on today is called, “Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients With Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial” by Hassan Tamartash PhD and published in Journal of Chiropractic Medicine on 14 February 2023. Dayum. That’s hot.

Why They Did It The purpose of this study was to evaluate the effects of myofascial release technique of a remote area on lumbar elasticity and low back pain (LBP) in patients with chronic nonspecific LBP.

How They Did It

• For this clinical trial, 32 participants with nonspecific LBP were assigned to a myofascial release group (n = 16) or a remote release group (n = 16).
• Participants in the myofascial release group received 4 sessions of myofascial release to the lumbar region. The remote release group received 4 myofascial release sessions to the crural and hamstring fascia of the lower limbs.
• Low back pain severity and elastic modulus of the lumbar myofascial tissue were assessed before and after treatment by the Numeric Pain Scale and ultrasonography examinations.

What They Found The mean pain and elastic coefficient in each group before and after myofascial release interventions were significantly different (P ≤ .0005). The results showed that the changes in mean pain and elastic coefficient of the 2 groups after myofascial release interventions were not significantly different from each other.

Wrap It Up The improvements in the outcome measures for both groups suggest that remote myofascial release was effective in patients with chronic nonspecific LBP. The remote myofascial release of the lower limbs reduced the elastic modulus of the lumbar fascia and LBP. Before getting to the next one,

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Item #2

Our last one this week is called, “Effects of Manual Versus Instrumental Spinal Manipulation on Blood Flow of the Vertebral and Internal Carotid Arteries in Participants With Chronic Nonspecific Neck Pain: A Single-Blind, Randomized Study” by Burcu Kocabey and published in Journal of Chiropractic Medicine on 14 February 2023. Hot potato!

Why They Did It The aim of this study was to compare the hemodynamic effects of manual spinal manipulation (MSM) and instrumental spinal manipulation (ISM) on the vertebral artery (VA) and internal carotid artery (ICA) in participants with chronic nonspecific neck pain (NNP).

How They Did It

• Thirty volunteers aged 20 to 40 years old with nonspecific neck pain over 3 months duration were included.
• Participants were randomly divided into the following 2 groups: (1) spinal manipulation group (n = 15) and (2) instrumental spinal manipulation group (n = 15). Ipsilateral (intervention side) and contralateral (opposite side of intervention) VAs and internal carotid arteries were evaluated using spectral color Doppler ultrasound before and immediately after manipulation.
• Measurements were recorded by visualizing the internal carotid artery carotid sinus (C4 level) and the VA at the V3 segment (C1-C2 level).
• The blood flow parameters of peak systolic velocity, end-diastolic velocity, resistive index, and volume flow (only for VA) were evaluated. The spinal segment, in which biomechanical aberrant movement was detected by palpation in the upper cervical spine, was manually manipulated in the spinal manipulation The same methodology was performed for the instrumental spinal manipulation group using an Activator V instrument (Activator Methods).

What They Found

• Intragroup analysis exhibited no statistically significant difference between the spinal manipulation and instrumental spinal manipulation groups in terms of peak systolic velocity, end-diastolic velocity, resistive index of ipsilateral and contralateral internal carotid artery and VA, in addition to volume flow of both VAs preintervention and postintervention.
• Within the intergroup analysis, there was a significant difference in ipsilateral internal carotid artery peak systolic velocity in the spinal manipulation
• Other parameters did not show any significant difference

Wrap It Up

Manual and instrumental spinal manipulations applied to the upper cervical spine in participants with chronic nonspecific neck pain did not appear to alter blood flow parameters of the VAs and internal carotid arteries. 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.

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Connect

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

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About the Author & Host

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

Bibliography

Hassan Tamartash, Farid Bahrpeyma, Manijhe Mokhtari Dizaji,
Effect of Remote Myofascial Release on Lumbar Elasticity and Pain in Patients With Chronic Nonspecific Low Back Pain: A Randomized Clinical Trial,
Journal of Chiropractic Medicine,
Volume 22, Issue 1,
2023,
Pages 52-59,
ISSN 1556-3707,
https://doi.org/10.1016/j.jcm.2022.04.002.
(https://www.sciencedirect.com/science/article/pii/S1556370722000645)

Burcu Kocabey, Dilber Karagözoğlu Coşkunsu, Koray Güven, Mustafa H. Ağaoğlu, Selvi Yüce,
Effects of Manual Versus Instrumental Spinal Manipulation on Blood Flow of the Vertebral and Internal Carotid Arteries in Participants With Chronic Nonspecific Neck Pain: A Single-Blind, Randomized Study,
Journal of Chiropractic Medicine,
Volume 22, Issue 1,
2023,
Pages 1-10,
ISSN 1556-3707,
https://doi.org/10.1016/j.jcm.2022.05.006.
(https://www.sciencedirect.com/science/article/pii/S1556370722000876)

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