The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 325: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11) Today we’re going to talk about “The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 11)” But first, here’s that sweet sweet bumper music Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider 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 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 [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 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.
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You have found yourself smack dab in the middle of Episode #325 Now if you missed last week’s episode, we talked about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. I see the battle coming and I’m trying to build the walls. It’s tough to go from seeing 8-10 new VA patients every week down to seeing about 1 every 2 weeks. Plus they’re reducing their visits to acute conditions only when most of these folks are chronic. They’ve been hurting literally for decades for some of them. So, yeah, the battle is approaching so I’m trying to build walls. Now, how do we do that? We stop being lazy about marketing and, I’m a Christian so I always believe that when one door is closed, another will open and the one that opens is usually better. All big changes in my life and business has always been for the best. Even when I thought the changes were catastrophic. This one is inconvenient and it pisses me off a bit. I’d love to have a set it and forget it type of business but it’s just not and never will be. It’s ups and downs every week so that’s what we’re doing. We’re riding the coaster and preparing for the decrease in our numbers that’s already here and that we know will continue to get worse before it levels off and before we get our marketing in full gear and get after it again before the VA started sending the vets to us. Yep, fully engaged now. I’ll keep you updated. I want to congratulate Dr. Steve Brown out in Gilbert, AZ on his new peer reviewed paper that came our recently. Steve is doing good work and trying to help chiropractors stay out of trouble on the smt stroke issue that we’re all having to deal with all of the time. I’m putting the link to Dr. Brown’s paper right here in the show notes so go grab it and check it out. https://www.cureus.com/articles/239108-plausible-mechanisms-of-causation-of-immediate-stroke-by-cervical-spine-manipulation-a-narrative-review#!/ It may save your collective asses. Now, due to this paper Steve has the predictable drivel coming from the philosophy wonks that have a stake in the game and that’s OK. He expects that. Heck he even might welcome it with a research-backed response of his own. But, if one looks deeper than the detractors seem to have the brain space to do, his paper pretty much protects us. If we read it, we can prevent dissections most times and, should a pt. Try to state we’re responsible for a VAD the next few days or weeks after an adjustment, his paper provides some protection. Then, about the same week, we had a knucklehead present a case study called, “Myositis Ossificans Traumatica of Bilateral Sternocleidomastoid Muscles After Chiropractor Adjustment: A Case Report” by Felix et. Al in Cureus where they implied heavily that a chiropractic adjustment was the cause of the myositis ossificans. I’m going to leave the link here in the show notes at chiropractiforward.com under episode 325. https://www.cureus.com/articles/234594-myositis-ossificans-traumatica-of-bilateral-sternocleidomastoid-muscles-after-chiropractor-adjustment-a-case-report#!/ I hope you’ll go to the link, scroll down to the comments and watch Dr. Brown chime in and systematically tear this crap paper apart and watch the authors basically apologize and promise to make the necessary changes. The moral of the story is this; research isn’t here to hold us back and tear us down. It’s here to defend us, make us better, and provide more and more validity as we increase our knowledge base. That’s why I’m here. That’s why Dr. Steve Brown and so many others are here. One of the biggest hits I see our profession take online is that we’re all quacks because the profession was founded by a belief and a magnetic mystical healer. True as that may be, the medical field once had blood letting, leaches, and lobotomies. Research pulled them together and out of the catacombs and research will and is doing the same for us as chiropractors. I promise when research came out proving blood letting useless, there were still those that had used blood letting for decades fighting the research, attacking and discrediting the research and researchers, and doing everything they could to clutch their pearls and maintain their box of safety. All I can say is that flat Earthers will do flat earth stuff and you can’t tell or show them anything differently. Moon landing deniers…….good luck convincing them otherwise. When a certain dogma has taken over and defined one’s life, you can’t and won’t change it. But that will never stop new thinking, research, and forward movement. Item #1 We are continuing the series on why the hell the WHO would recommend SMT at very low confidence which, if you’ve been following along, is the same level of confidence they give ultrasound. Well that’s BS and I went and found all of the papers they used to make this determination and we’re going through each and every of them trying to form and impression of our own. The first one today is called, “United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care” by UK BEAM Trial Team, published in British Medical Journal in December of 2004. UK BEAM Trial Team. United Kingdom back pain exercise and manipulation (UK BEAM) randomised trial: effectiveness of physical treatments for back pain in primary care. BMJ. 2004 Dec 11;329(7479):1377. doi: 10.1136/bmj.38282.669225.AE. Epub 2004 Nov 19. PMID: 15556955; PMCID: PMC535454. Remember, the citations can be found at chiropracticforward.com under this episode. Why They Did It To estimate the effect of adding exercise classes, spinal manipulation delivered in National Health System or private premises, or manipulation followed by exercise to “best care” in general practice for patients consulting with back pain. How They Did It Pragmatic randomised trial with factorial design. Setting: 181 general practices in Medical Research Council General Practice Research Framework; 63 community settings around 14 centres across the United Kingdom. Participants: 1334 patients consulting their general practices about low back pain. Main outcome measures: Scores on the Roland Morris disability questionnaire at three and 12 months, adjusted for centre and baseline scores. What They Found

• All groups improved over time.
• Exercise improved mean disability questionnaire scores at three months by 1.4 more than “best care.”
• For manipulation the additional improvement was 1.6 at 12 months.
• For manipulation followed by exercise the additional improvement was 1.9 at three months and 1.3 at 12 months.
• No significant differences in outcome occurred between manipulation in NHS premises and in private premises.
• No serious adverse events occurred.

Wrap It Up Relative to “best care” in general practice, manipulation followed by exercise achieved a moderate benefit at three months and a small benefit at 12 months; spinal manipulation achieved a small to moderate benefit at three months and a small benefit at 12 months; and exercise achieved a small benefit at three months but not 12 months. Item #2 The second one is called, “Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial” by Thomas et. Al published in JAMA Network Open in August 2020 Thomas JS, Clark BC, Russ DW, et al. Effect of Spinal Manipulative and Mobilization Therapies in Young Adults With Mild to Moderate Chronic Low Back Pain: A Randomized Clinical Trial. JAMA Netw Open. 2020;3(8):e2012589. doi:10.1001/jamanetworkopen.2020.12589 Why They Did It Low back pain (LBP) is one of the most common reasons for seeking medical care. Manual therapy is a common treatment of LBP, yet few studies have directly compared the effectiveness of thrust (spinal manipulation) vs nonthrust (spinal mobilization) techniques. To evaluate the comparative effectiveness of spinal manipulation and spinal mobilization at reducing pain and disability compared with a placebo control group (sham cold laser) in a cohort of young adults with chronic LBP. How They Did It This single-blinded (investigator-blinded), placebo-controlled randomized clinical trial with 3 treatment groups was conducted at the Ohio Musculoskeletal and Neurological Institute at Ohio University from June 1, 2013, to August 31, 2017. Of 4903 adult patients assessed for eligibility, 162 patients with chronic LBP qualified for randomization to 1 of 3 treatment groups. Recruitment began on June 1, 2013, and the primary completion date was August 31, 2017. Data were analyzed from September 1, 2017, to January 20, 2020. Participants received 6 treatment sessions of

1. spinal manipulation,
2. spinal mobilization, or
3. sham cold laser therapy (placebo) during a 3-week period.

What They Found Coprimary outcome measures were the change from baseline in Numerical Pain Rating Scale (NPRS) score over the last 7 days and the change in disability assessed with the Roland-Morris Disability Questionnaire 48 to 72 hours after completion of the 6 treatments. A total of 162 participants with chronic LBP were randomized. Fifty-four participants were randomized to the spinal manipulation group, 54 to the spinal mobilization group, and 54 to the placebo group. There were no significant group differences for sex, age, body mass index, duration of LBP symptoms, depression, fear avoidance, current pain, average pain over the last 7 days, and self-reported disability. At the primary end point, there was no significant difference in change in pain scores between spinal manipulation and spinal mobilization, spinal manipulation and placebo, or spinal mobilization and placebo. There was no significant difference in change in self-reported disability scores between spinal manipulation and spinal mobilization, spinal manipulation and placebo or spinal mobilization and placebo. Wrap It Up In this randomized clinical trial, neither spinal manipulation nor spinal mobilization appeared to be effective treatments for mild to moderate chronic LBP 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. Today we’re going to talk about Cancer-Finding Blood Tests & Neck Pain Treatment Differs By Initial Provider 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!

The Message I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website

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