It’s Here: New Guides For Chiropractic That Doctors Are Ignoring

02/23/2018

In this article, we are talking about acute and non-acute low back pain. What are current healthcare guidelines? Why does it matter to chiropractic patients and non-chiropractic patients and are those in the medical field getting (and implementing) the information?

To start off the discussion, I would say that one would be completely oblivious to not understand that Chiropractic is considered to be on the fringe of healthcare by many to most in the medical field. It’s just a fact and chiropractors deal with this daily.

In other articles, I have covered the Wilk vs. AMA case1,2. I’ve covered the Doctored film by Jeff Hayes that spotlights some of the mistreatment of chiropractors. I have also covered current attacks on Texas Chiropractors by the Texas Medical Association. It is all very well-documented at this point.

Chiropractic is currently undergoing an amazing renaissance. This is due to a couple of key factors. The first being the need to develop non-pharmacological treatment recommendations in the midst of a national opioid addiction crisis3. One that has killed thousands and thousands in the last several years. The second reason being the body of high-quality research that is consistently coming to light almost every month showing the effectiveness of Chiropractic and evidence-based chiropractors.

With all of the new information and new healthcare laws emerging, the questions going forward will be, “Is the medical field and is the insurance industry listening and implementing?” We shall see. So far, the answer is, “Absolutely not.” In fact, it’s almost defiant.

Let’s begin with the most glaring denial of Federal Law by the insurance companies right now. It has to do with Section 2706 of the Patient Protection and Affordable Care Act. Also commonly known as “Obamacare.” Section 2706 of the PPACA is entitled the nondiscrimination In Health Care section of the Federal Law and is intended to keep insurance companies and health plans from keeping chiropractors and the services they provide out of the system.

It reads as follows, “A group health plan and a health insurance issuer offering group or individual health insurance coverage shall not discriminate with respect to participation under the plan or coverage against any health care provider who is acting within the scope of that provider’s license or certification under applicable State law. This section shall not require that a group health plan or health insurance issuer contract with any health care provider willing to abide by the terms and conditions for participation established by the plan or issuer. Nothing in this section shall be construed as preventing a group health plan, a health insurance issuer, or the Secretary from establishing varying reimbursement rates based on quality or performance measures.” 4

On the American Chiropractic Association’s FAQ site for 27064, they state, “It is important to understand that Section 2706 and its assurance of non-discrimination in terms of participation and coverage requires that doctors of chiropractic not be discriminated against in the provision of any “essential benefit” that is within their scope of practice.”

Here’s the rub on 2706: part of its purpose is to reimburse chiropractors performing the same services under their scope and license the same as any other professional that provides that service. For instance, under the PPACA Section 2706 Federal Law, chiropractors are to be paid the exact same for a 99203 exam code as a doctor of medicine or osteopathy is paid. Plain and simple. This is not happening. With so many chiropractors now integrating their practices with medical directors, physician assistants, nurse practitioners, and physical therapists, it is painfully clear that doctors of chiropractic are being discriminated against when it comes to reimbursements for the same codes performed. In fact, chiropractors are integrating with these other professions just so that they can finally GET the reimbursements that the other practitioners are allowed! It is madness and clearly violates Section 2706 of PPACA.

Also, there is violation of the law if an insurer does something such as applying caps on specific services provided by one healthcare provider whereas the cap does not apply to another type of provider. It is my understanding that United Healthcare has moved to a $65 visit cap on chiropractic care here in Texas.

It is the American Chiropractic Association’s opinion that a violation exists if the insurer or plan denies specific forms of care that are otherwise covered if it is a chiropractor providing the service and it is within their scope and licensing. I would suggest that a medical doctor likely gets services such as non-surgical decompression covered under insurance, but chiropractors are routinely denied coverage.

There is also a possible violation when doctors of Chiropractic are denied inclusion into a plan or group purely based on the profession. For example, it is my understanding that FirstCare won’t cover Chiropractic. There is a local insurance network that charges $200 per year for chiropractors to be included for coverage, but medical professionals pay nothing to be included. Could that be a violation of the nondiscrimination law?

In my opinion, Federal Law is being violated all over the place in regards to Section 2706 of PPACA. I’m not sure how it can be perceived any other way.

New Recommendations For Acute and Chronic Low Back Pain

Now, I would like to move on to the medical field’s updated recommendations I mentioned at the first of this article. It is becoming more and more aggravating that we chiropractors are not seeing a flood of acute and chronic low back pain patients. If you read my articles, watch my videos, or listen to my podcast with any regularity, you have no doubt been informed several times over of these new recommendations. It is my opinion that no long-held beliefs or protocols will change if new information is not continually pounded and yelled about from the top of the roofs. In marketing, experts have said that it takes a target 7 times of being exposed to information before it is received and, hopefully, acted upon.

I know that the medical field has NOT been exposed to this information at least 7 times because of two factors:

  1. I have spoken to several medical practitioners here locally and not a single one of them had heard or were aware of these new recommendations.
  2. I am not seeing an incredible, overwhelming influx of acute and chronic low back pain new patients coming through my doors as a result of medical referrals.

Is this willful disregard for the changing recommendations and a “clinging on” to old dogmatic beliefs passed down from the AMA years ago? I think some of it most certainly is.

Is it that a few bad seeds in the Chiropractic profession are giving the rest of us a bad image? I would say some of it most certainly is.

What I think it is mostly based on is the fact that medical professionals are busy, they’re stressed, and many times over-worked and they simply don’t always have the time or opportunity to stay completely up on every new recommendation or updated protocol.

With that being said, let’s be clear; the issues of low back pain, its economic impact, and the national opioid epidemic crisis in America combine to make these new recommendations that much more important.

Let’s start with the American College of Physicians. Remember, the American College of Physicians was proven in the Wilk vs. AMA case to have played a part in collaborating with the AMA in an attempt to rid the Earth of Chiropractic. I think that’s important to note as we go through the information5. In response to the opioid epidemic gripping the nation currently, the American College of Physicians developed new recommendations for treating acute and chronic low back pain.

Why They Did It

  • The American College of Physicians developed this guideline in order to provide updated recommendations on treatment of low back pain.
  • With these recommendations, the ACP hoped to influence clinicians AND patients to make the correct decision for care in acute, subacute, or chronic low back pain conditions.

How They Did It

  • They based their recommendations on a systematic review of randomized controlled trials and other systematic reviews.
  • The research they reviewed included those papers available through April of 2015.
  • The research included only those on noninvasive pharmacologic and nonpharmacologic treatments.

What They Found

  • Recommendation #1: patients with subacute or acute low back pain should seek nonpharmacologic treatments such as Chiropractic, Massage, Acupuncture, and superficial heat BEFORE resorting to non-steroidal anti-inflammatories such as Ibuprofen, Tylenol, Aleve, etc… (Graded as a strong recommendation)
  • Recommendation #2: patients with chronic low back pain should seek nonpharmacologic treatments such as Chiropractic, Exercise/Rehabilitation, Acupuncture, & Cold Laser Therapy BEFORE resorting to non-steroidal anti-inflammatories such as Ibuprofen, Tylenol, Aleve, etc… (Graded as a strong recommendation)
  • Recommendation #3: In patients with chronic low back pain that have had no relief from nonpharmacological means, the first line of treatment would consist of NSAIDs like Aleve, Tylenol, Ibuprofen, etc.. As a second-line treatment, the clinician may consider tramadol or duloxetine. Opioids would be a last option and only if all other treatments have been exhausted and failed and even then with lengthy discussion with the patient in regards to the risks and benefits of using opioids. (Graded as weak recommendation)

Let’s recap: in February of 2017, the American College of Physicians, historically a Chiropractic profession detractor and attacker, now recommends Chiropractic as a first-line treatment for acute and chronic low back pain.

Next, let us discuss the American Medical Association. If you thought the American College of Physicians was guilty of Chiropractic-hating, the American Medical Association is, or was, “Pablo Escobar” or the “El Chapo” of the attacks on the Chiropractic profession. The “El Jefe” of the Chiropractic haters, and the group that not only sat in the driver’s seat but also OWNED the entire truck of destruction back before Wilk vs. AMA came along. I believe I have been watching too much Netflix.

On April 11, 2017, the Journal of the American Medical Association published a study on their website titled “Association of Spinal Manipulative Therapy With Clinical Benefit and Harm for Acute Low Back Pain Systematic Review and Meta-analysis,” authored by Neil Page, MD et. al6. In the format of this research paper, they refer to chiropractic treatment as spinal manipulative treatment or SMT. But, because spinal manipulative therapy is what we chiropractors do the most and what we are most identified with, I’m replacing the term “SMT” with “chiropractic adjustment.”

Why They Did It

Considering that spinal manipulation, or the chiropractic adjustment, is a treatment option for acute low back pain, and that acute low back pain is one of the most common reasons for visits to the doctor’s office, the authors wanted to systematically review the studies that have been done in the past dealing with the effectiveness as well as the harms of chiropractic adjustments in the treatment of acute low back pain.

How They Did It

  • The researchers used searches of MEDLINE, Cochrane Database of Systematic Reviews, EMBASE, and Current Nursing and Allied Health Literature.
  • The search spanned 6 years from January 2011 through February 2017 for randomized controlled trials of adults with low back pain comparing spinal manipulative therapy with no treatment or with alternative treatments.
  • The accepted papers also had to measure pain or functional outcomes for up to 6 weeks.
  • The data extraction was done in duplicate.
  • The quality of the study was assessed through use of the Cochrane Back and Neck Risk of Bias tool.
  • Finally, the evidence was assessed using the GRADE criteria, which stands for Grading of Recommendations Assessment, Development, and Evaluation.
  • 26 eligible randomized controlled trials were identified and accepted.

What They Found

  • 15 of the RCTs, totaling 1,699 patients, showed moderate-quality evidence that chiropractic adjustments had a statistically significant association with improvements in PAIN.
  • 12 of the RCTs, totaling 1,381 patients, showed moderate-quality evidence that chiropractic adjustments have a statistically significant association with improvements in FUNCTION.
  • NO RCTs reported any serious harms or adverse events as a result of undergoing chiropractic adjustments.
  • There were only minor events reported like some increased pain, muscle stiffness, and headache in roughly 50%-67% of those treated in the large case series. I would be interested to hear more about this statement by the authors. That is not what we commonly see in our practice. Sometimes, if the patient is new and is not accustomed to chiropractic adjustments, they may experience some soreness or stiffness the next day, which is to be expected following a change in the body.

Wrap It Up

In true AMA fashion, instead of just coming out and saying, “Chiropractic adjustments showed moderate quality evidence for effectiveness in pain as well as in function,” the authors instead stated in conclusion, “Among patients with acute low back pain, spinal manipulative therapy was associated with modest improvements in pain and function at up to 6 weeks, with transient minor musculoskeletal harms. However, heterogeneity in study results was large.” Heterogeneity is defined as, “The quality or state of being diverse in character or content.” In my opinion, this is to give themselves and “out” by implying there was not enough focus to the RCTs to truly state their findings as fact.

Nonetheless, where the AMA is comes even remotely close to endorsing anything having to do with Chiropractic, I’ll take it. And so should those in the medical field that commonly come in contact with those seeking help for their acute and chronic low back pain.

We Should Be All Set For Success Now, Right?

That is what you would think but there is new information from the White House that this simply is not the case despite the obvious ramifications. On page 57 of The President’s Commission On Combating Drug Addiction and The Opioid Crisis7 report, the authors say, “A key contributor to the opioid epidemic has been the excess prescribing of opioids for common pain complaints and for postsurgical pain. Although in some conditions, behavioral programs, acupuncture, chiropractic, surgery, as well as FDA-approved multimodal pain strategies have been proven to reduce the use of opioids, while providing effective pain management, current CMS reimbursement policies, as well as health insurance providers and other payers, create barriers to the adoption of these strategies.” This is straight from the White House.

At the bottom of page 57, you will also see that it says, “The Commission recommends CMS review and modify rate-setting policies that discourage the use of non-opioid treatments for pain, such as certain bundled payments that make alternative treatment options cost prohibitive for hospitals and doctors, particularly those options for treating immediate post-surgical pain.”

Essentially, the United States Government is admitting there is professional discrimination at the highest levels (Medicare and health insurance plans) that creates barriers to doing the smart thing. The smart thing is seeing a chiropractor for your back pain. The “Big Guys” (AKA: American College of Physicians and the American Medical Association) recommend it and the government says policies are in place to prevent patients from following those recommendations. In addition, policies that discriminate against chiropractic or chiropractors run in violation of Section 2706 of PPACA. It comes full circle.

How do we deal with this? It has to be through either the legislature at the state and federal levels or it has to be through the legal system. A guarantee I feel comfortable making is that the insurance companies will not begin enforcing it on their own. Mobilization and unification of the Chiropractic profession is likely the first step.

Some steps toward that end include:

  • Join or get involved with your state association. They’re the only ones effectively fighting for you and your rights on the state level.
  • Join or get involved with your national association. They’re the only ones effectively fighting for you and your rights on the national level.
  • If possible, build relationships with your state and national legislators.
  • Donate to all of the above in the largest amounts you are comfortable with.
  • Tell your friends and your colleagues about what is going on and help them get involved if they’re so inclined.
  • Follow the news of your industry closely and stay knowledgeable about your profession. Both the good AND the bad.

A Chiropractic profession that is unified and playing offense instead of defense is powerful and is one of the worst nightmares of some folks I know out there in the world. Personally, as a side note, I like to see people like that squirm just a little so won’t you consider helping if you haven’t before? If you do not know where to start, email me at dr.williams@chiropracticforward.com and I will help you get on your way.

Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think.And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.

Till next time……

The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia, TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.
Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.

by Jeff S. Williams, D.C.

Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com

References and Source Material

    https://www.amarillochiropractor.com/startling-medical-professional-attacks-chiropractic/

    https://www.amarillochiropractor.com/healthcare-in-texas-the-battle-against-a-monopoly-a-true-story-about-david-goliath-3/

    https://www.whitehouse.gov/sites/whitehouse.gov/files/images/The%20Underestimated%20Cost%20of%20the%20Opioid%20Crisis.pdf

    https://www.acatoday.org/Portals/60/Docs/Advocacy%20and%20Reimbursement/2706/2706-FAQs.pdf?ver=2015-12-23-125425-503

    http://annals.org/aim/fullarticle/2603228/noninvasive-treatments-acute-subacute-chronic-low-back-pain-clinical-practice

    https://jamanetwork.com/journals/jama/article-abstract/2616395?widget=personalizedcontent&previousarticle=2616379

    https://www.whitehouse.gov/sites/whitehouse.gov/files/images/Final_Report_Draft_11-3-2017.pdf




Surprise Unique Information Shows Chiropractic Works On The Brain Too

02/13/2018

In today’s article, we’re going to talk about how chiropractic affects the brain itself rather than how it affects just the musculoskeletal system.

For anyone that has paid any amount of attention to chiropractic, it’s clear that chiropractic treats muscles, bones, and the biomechanics overall. But what some people don’t commonly consider is the fact that chiropractic is effective when treating the nerves that make it all work together.

For instance, what do you think about when you think of chiropractic? More than likely, you think about back pain, neck pain, athletes, and headaches and migraines. It is unlikely that phrases like “cortical drive” or “movement related cortical potential” come to mind.

According to the author of the paper we’re going to be talking about today, “Scientists use to believe spinal manipulation was a biomechanical treatment option for spinal pain conditions. However, the growing basic science evidence suggests there may be more of a neurophysiological effect following spinal manipulation than previously realized.”

When we begin to talk about the brain, physiology, neurology, and neurological processes, you can get into some highly complicated terms and ideas. I’m going to do everything I can to put it into terms that anyone and everyone can easily process without having a year of neurology classes.

And let’s be crystal clear, I’m not a neurologist or a chiropractic neurology diplomate either with tons of extra education on the brain and nervous system specifically. Many of these terms go above MOST of our heads and MOST of the heads in the medical field as well. That is just a matter of fact. But that doesn’t mean we can’t read, comprehend, and relay the overall pertinent information, which is what we are doing here.

Basically, “What’s the big idea?” That’s what I’m trying to bring to you here without making your eyes glaze over and making you fall into a deep state of hibernation.

Now, with all of that being said, there is fascinating research coming out of New Zealand we’re going to be talking about here. We are going to talk about two papers that have been done by roughly the same group at the Centre for Chiropractic Research at the New Zealand College of Chiropractic in Auckland New Zealand. Just the name “Auckland” makes me want to go visit. I hear New Zealand is fantastic and the Lord Of The Rings was filmed there, so you know it’s stunning. If an epic is filmed in your country, then you know it must be truly epic.

The first study is titled, “Impact of Spinal Manipulation on Cortical Drive to Upper and lower Limb Muscles,” and was published in the journal ‘Brain Sciences’ in December of 2016(1).

Why They Did It

The researcher wanted to find out whether chiropractic care changes motor control. Motor control is basically the messages your brain sends your body in order make it move. Bending your arm, writing on a piece of paper, kicking your leg, or walking are examples of motor control. They assessed whether chiropractic care affected motor control for the arms as well as the legs and tried to find out if the changes may partly happen in the cortical part of the brain, which is the part that issues motor commands. Although the researchers couldn’t completely rule out the idea that chiropractic adjustments can help motor function at the actual spinal level manipulated, the theory was that some of the changes must happen in the brain itself. Basically, do chiropractors change how the brain controls muscles(2)?

How They Did It

  • They conducted two experiments to test their theory. One for the arm and one for the leg.
  • In the first, transcranial magnetic stimulation input-output curves for an upper limb muscle known as the abductor pollicis brevis were recorded.
  • They also recorded F-waves before and after spinal manipulation or the control intervention for the control group on the same subjects on two different days.
  • The researchers did the same in a separate experiment for the lower limb using the tibialis anterior muscle.

What They Found

Before getting into what they found, let’s define the term “motor evoked potential.” According to Medscape, the definition is, “Single- or repetitive-pulse stimulation of the brain causes the spinal cord and peripheral muscles to produce neuroelectrical signals known as motor evoked potentials. Clinical uses of motor evoked potential include as a tool for the diagnosis and evaluation of multiple sclerosis and as a prognostic indicator for stroke motor recovery(3).”
With that knowledge the following was noted:

  • Spinal manipulation caused an increase in maximum motor evoked potential in both muscles tested.

Wrap It Up

In a quote from the research abstract, the authors conclude, “Spinal manipulation may therefore be indicated for the patients who have lost tonus of their muscle and or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations. These results may also be of interest to sports performers. We suggest these findings should be followed up in the relevant populations.”

In another quote from the lead author, she said, “This research has big implications,” says an enthusiastic Heidi Haavik. “It is possible that patients who have lost muscle tonus and/or are recovering from muscle degrading dysfunctions such as stroke or orthopaedic operations could also benefit from chiropractic care. These findings are also very relevant to sports performers (although this too must also be followed up with more research), because it indicates that chiropractic care may help their brains to more efficiently produce greater outputs. So all in all a very exciting study!”

Guess what? They took their own advice in their conclusion and followed up this paper with another similar paper focused more specifically on athletic performance. Here’s the last paper we will discuss called, “The Effects of a Single Session of Spinal Manipulation on Strength and Cortical Drive in Athletes” published in the European Journal of Applied Physiology in January of 2018. Brand new information(5).

Why The Did It

Of course, they did it because they suggested the need for the paper in the conclusion of the previous study, but more specifically, they did it because they wanted to test if a single chiropractic adjustment could change things in the muscles of the lower leg for an elite Taekwondo athlete.

How They Did It

  • The muscle measured was the soleus muscle, which lies just under what is commonly known as the calf muscle or the gastrocnemius.
  • Soleus evoked V-waves, H-reflex, and maximum voluntary contraction of the plantar flexors from 11 elite Taekwondo athletes.
  • A randomized controlled crossover design was utilized.
  • Treatments used consisted of either spinal manipulation in the treatment group or passive movement control in the control group.
  • Outcome measurements were noted prior to treatment, immediately after treatment, 30 minutes after treatment, and an hour after treatment.

What They Found

  • Spinal manipulation was responsible for increasing each factor measured when compared to the control group.
  • The differences were considered significant through each time interval.

Wrap It Up

The authors are quoted in the conclusion of the paper as saying, “A single session of spinal manipulation increased muscle strength and corticospinal excitability to ankle plantar flexor muscles in elite Taekwondo athletes. The increased maximum voluntary contraction force lasted for 30 minutes and the corticospinal excitability increase persisted for at least 60 minutes.“

I feel that this sort of research is really just beginning and consider it in its infancy, but I also think that the results are significant enough to demand more exploration into this area of how chiropractic can affect neurology.

There is actually a court case in Texas this very minute. The appeals argument starts on February 28th down in Austin. The Texas Medical Association is attacking Texas Chiropractors’ rights to treat the “neuromusculoskeletal” system. They argue that chiropractors do not (and cannot) treat anything further than the “musculoskeletal”system. Certainly, NOT the “neuromusculoskeletal” system.

Regardless of the opinions held by those in the leadership of the Texas Medical Association and their legal team, both of these papers (and many other by the way), in my opinion, render their arguments ignorant, nit-picky, archaic, and obsolete. It’s not a question of what research is out there. It’s a question of if they can understand it or will let their pride go. My guess is, “No.” They have to prevent Chiropractic from moving into their territory at any and all costs. It is NOT about patient safety. It never has been and it never will be. It’s purely based on power and the threat of losing it.

What’s your opinion? We would love to hear it.

Just another reason to call a chiropractor TODAY!

Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think.And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.

Till next time……

The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia, TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.

Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.

by Jeff S. Williams, D.C.
Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com

Sources:

1)Haavik H, Niazi IK, Jochumsen M, Sherwin D, Flavel S, Türker KS. Impact of Spinal Manipulation on Cortical Drive to Upper and Lower Limb Muscles. Brain Sci. 2016 Dec 23;7(1).https://chiropracticscience.com/increase-cortical-drive-following-spinal-manipulation/

2)https://spinalresearch.com.au/new-study-reveals-impact-spinal-manipulation-cortical-drive-limb-muscles/

3)https://emedicine.medscape.com/article/1139085-overview

4)https://www.researchgate.net/publication/322199907_The_Effects_of_a_Single_Session_of_Spinal_Manipulation_on_Strength_and_Cortical_Drive_in_Athletes

5)Christiansen L, et. al. (2018). The Effects of a Single Session of Spinal Manipulation on Strength and Cortical Drive in Athletes. European Journal of Applied Physiology. . 10.1007/s00421-018-3799-x/fulltext.html.




Startling Medical Professional Attacks On Chiropractic

02/09/2018

In today’s edition, we’ll be talking all about current and past attacks on our profession by the medical field heavy weights…..what’s at risk and why. In addition, we’ll be sharing some personal opinions, some facts, and some research.

If you’ve seen our videos before, then you know this is where we talk about issues related to health, chiropractic, evidence, and research and how those things all fit into a comprehensive approach for treating different conditions. Thank you for taking time out of your day to give us a read. I know your time is valuable and I will always try hard to fill our time with valuable content.

Right off the top today, I want to say that Dr. Tom Hollingsworth from Corpus Christi, TX was instrumental in helping with this edition and he is our guest on the Chiropractic Forward podcast Episode #9, where we spend about an hour discussing all of this. So, go listen to Episode #9 at www.chiropracticforward.com or on iTunes for the words straight from Dr. Hollingsworth’s mouth.

When Chiropractors start talking about the attacks we’ve endured and ARE enduring, we can go on for hours. We’re going to try to convey a very serious and meaningful message about it all right here today, but without getting into a three hour conversation.

I can only hope that all chiropractors in practice are well-aware of the trials and tribulations this amazing profession has not only been through, but overcome and grown from as a result. It is profound. The unfortunate reality is that most do not know and, if they do, they normally lack any important details to truly place their knowledge in the correct context.

As a former board member of the Texas Chiropractic Association myself and a current member of the leadership statewide, I am intimately aware of many of the issues, both current and historical.

And I think, from the top here, it’s important to say that, even though I am a TCA member and leader, my opinions may or may not represent the opinions of the TCA, but I am NOT representing the TCA in this capacity.

We have all heard the stories of chiropractors being jailed for practicing. I remember a story from a documentary by Jeff Hayes called Doctored, where a chiropractor is recalling how his father, who was also a chiropractor, was in a bowling league. There was a medical doctor on the other team that refused to bowl against his father’s team simply because the team had a chiropractor on it.

Now, let’s run through the BIG ATTACK first. Folks, if you don’t know about Wilk vs. AMA, please do yourself and all other chiropractors a big favor and go check it out. To put it into a very brief blurb, basically, after 11 years of court proceedings, Dr. Chester Wilk and four other chiropractors, led by attorney George McAndrews, ultimately prevailed in proving the American Medical Association guilty of violating the Sherman anti-trust act. Meaning the AMA and several other medical institutions like the American Hospital Association, the American College of Surgeons, the American College of Physicians, and the Joint Commission on Accreditation of Hospitals were found guilty of conspiring to eliminate chiropractic from the Earth. According to Chiro.org….”the suit claimed that the defendants had participated for years in an illegal conspiracy to destroy chiropractic. On August 24, 1987, after endless wrangling in the courts, U.S. District Court judge Susan Getzendanner ruled that the AMA and its officials were guilty, as charged, of attempting to eliminate the chiropractic profession.“

Basically the AMA and others were proven guilty of the following acts against Chiropractic:

  • Encouraged ethical complaints against doctors of chiropractic.
  • Opposed chiropractic inroads into workmen’s comp.
  • Opposed chiropractic inroads into health insurance and made it difficult for patients to get covered for chiropractic care.
  • Opposed inroads into hospitals.
  • Contained or eliminated Chiropractic schools.
  • They conducted nationwide conferences on Chiropractic.
  • Distributed anti-Chiropractic publications and propaganda.
  • Helped other organizations prepare anti-chiropractic literature.
  • Deemed it unethical for medical doctors to refer to, or accept referrals from, chiropractors.
  • And, they discouraged colleges, universities, and faculty from cooperating with chiropractic schools.

It’s funny to me that things have progressed to the point now that two of those organizations came out last year in support of Chiropractic for the treatment of acute and chronic and low back pain – the American Medical Association and the American College of Physicians.

You’d think winning the Wilk vs. AMA case would have put the battle to rest right? Well it didn’t. The Texas Medical Association has been historically more aggressive in their continuing battle to rid the world of the scourge of chiropractic. The TMA’s political arm has attacked chiropractors running for office as quacks and as being no different than Dr. Pepper or Dr. Jekyll. The TMA sent out direct mail to the voting districts with that message. Just a couple of years ago people! It’s real, it’s hate, and it’s NOW!

The worst part is that the TMA….or Evil Empire…Originator of the Opioids…..they raised over $400,000 in one dinner just a year or so ago. And they know that the Texas Chiropractic Association cannot raise that sort of money so, because they can, the attacks keep coming and the rights keep getting chipped away at while we play defense rather than offense. Wouldn’t it be nice if we could just co-exist some day? If research and evidence mattered, we could, but that would mean releasing some control on their Monopoly and the TMA is there to protect their members. That’s it. They don’t exist to protect the patient. That’s the Texas Medical Board’s job. The TMA is there to keep ANY other health profession from expanding their scope into their territory. In fact, if they can just get rid of the professions they cannot control….that’s the BIG IDEA there, folks, and you need to understand it, receive it. Feel it.

The TMA sued Texas Chiropractors challenging their right to diagnose a patient. Can you imagine? The nerve of these people. Down in Austin, Judge Rhonda Hurley ruled against chiropractors, agreeing that we cannot diagnose, but more on her later. Texas Chiropractors appealed and won the appeal. The TMA appealed that and the Supreme Court of Texas finally ruled in favor of the Texas Chiropractors after 7 years of a legal battle. You’d think that would put things to a rest right? Nope. Not with the TMA.

In referencing a blog of mine from November 11th, 2015 called “Healthcare in Texas: The Battle Against a Monopoly. A True Story About David & Goliath,” I reminded myself of some more RECENT, more MINOR attacks. I’ll put the link in the notes.

  • The Texas Medical Association attempted to remove Doctors of Chiropractic from the high school concussion oversight teams. They wanted to allow simple high school trainers, but not chiropractors.
  • The same year, the TMA attempted to remove Chiropractors’ ability to perform physical exams on school bus drivers.
  • That same year, they tried to introduce legislation to remove our ability to perform high school exams on athletes, a function chiropractors have been performing for generations.

That stuff isn’t enough, though. The TMA decided they don’t want Texas Chiropractors doing VONT testing. VONT stands for vestibular ocular nystagmus testing and neuro diplomates, only after significant extra training, are allowed to perform VONT. Not good enough for TMA since it’s messing with their territory. Since the TMA is only interested in total destruction, they saw a chance to amend the original suit and now, the suit threatens not only VONT, but also the subluxation complex, the term “Neuro” as it fits in neuromusculoskeletal, and….yes….somehow they have found a way to include our right to diagnose again. Even though we already won that case. You cannot make this stuff up folks. Chiropractors treat nerves, muscles, and bone but they don’t want “neuro” in the description. That’s really what part of the suit is. They just want chiropractors treating the musculoskeletal system. That’s it. I think the winner here is the TMA’s attorney honestly because this stuff is absolutely absurd. Or so one would think. That same Judge, Rhonda Hurley down in Austin got hold of this second case and guess what….she ruled against Texas Chiropractors once again. I think she’s either a Chiropractic hater, or she’s in the TMA’s pocket somehow, or she has a family member that is a medical doctor, or she just doesn’t understand the material very clearly. Who knows the reason?

Regardless, Texas Chiropractors get to appeal this case. Aren’t we lucky? Hopefully, the appeals court is as reasonable as the last appeals court we had to go through. But, for now, we are most definitely in jeopardy.

I’d like to take just a second to direct everyone to an excellent video on YouTube that the Texas Chiropractic Association published about a year and a half ago concerning a lot of this. The link will be in the description below, but you can also find it by going to YouTube search and entering the term “The Texas Chiropractic Defense From The Texas Medical Association A Timeline.” This ten minute video sums up what kind of constant attacks our profession is STILL enduring today. If you think you’re just showing up for work and humming along, and everything is rosy and there’s a rainbow above your office, you’re mistaken. Danger lurks at all points and even if we chiropractors in Texas win, they’ll keep coming back for more. Vigilance, being knowledgeable, and being active are the keys to continuing to enjoy your professional privileges.

The best thing we can do at this point is to stress to you all the need for you to understand the gravity of the situation here in Texas for the Chiropractic profession. Everyone knows that what happens in Texas with over 5,000 chiropractors in it will happen elsewhere. In fact, the TMA’s attorney, Mr. Bad Bragg, has previously stated that if they can get the domino to fall in Texas, he has 7 or so other states ready to follow suit, and then on and on. So, if you think this doesn’t affect you, you are incorrect. Dead wrong. Wake up. It’s bigger and badder than you.

We also know that an appeals process is expensive and it takes everyone, all chiropractors, to fight the powers we are up against.

If you would like to donate and be a part of this victory, I would direct you to the TCA, since they are leading the way on this. You can also go to www.chirotexas.org/cdi, which is a fund that pays for the appeals process, so you’ll know it’s going to the right place to help the most.

Did you know that research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic? Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please leave us a comment and let us know what you think or what suggestions you may have for us for future episodes. If you love what you hear, be sure to check out some of my other blogs and videos, check out my podcast called Chiropractic Forward which you can find at www.chiropracticforward.com. As the podcast builds, so will the website as we add more content, educational products, and a little further down the road, webinars, seminars, and speaking dates as they get added. And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.

Till next time……

The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.

Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.

by Jeff S. Williams, D.C.
Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com
http://www.chiropracticforward.com

Show Note resources

  1. http://www.chiro.org/Wilk/
  2. https://jamanetwork.com/journals/jama/article-abstract/2616395
  3. https://www.amarillochiropractor.com/healthcare-in-texas-the-battle-against-a-monopoly-a-true-story-about-david-goliath-3/
  4. The Texas Chiropractic Defense From The Texas Medical Association A Timeline.
    https://youtu.be/XHGfAQwIqNo



Brand New Information Based on Results Chiropractic Proven Effective For Low Back Pain

01/31/2018

chiropractic care helps with low back pain

This entry is all about chronic low back pain. By now, as I’ve said in the past, even traditional Chiropractor-hating, quasi-scholastic detractors are admitting that, yes, Chiropractic is indeed helpful for low back pain.

When we define “chronic” in the context of neuromusculoskeletal complaints, we define it as being a complaint that is greater than 12 weeks in duration. Right at 3 months. Some patients will come into the office having had a condition for 15-20 years. I tell them that they are more than a little stubborn to have put up with something for so long.

It is common sense that a condition that is chronic will be more difficult to treat. Also, most chronic conditions can be traced back to a biomechanical, neuromusculoskeletal origin. One of my favorite quotes is from Dr. Lee Green, Professor of Family Medicine at the University of Michigan. He said, “Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.” Although Dr. Green is referring to neck pain in this instance, “low back pain” can easily be substituted. What he says could not make more sense. It’s an easy and very concise way to understand why Chiropractic, manipulation, and mobilization are so incredibly effective above and beyond anything else for this sort of issue, including medication.

I have overheard medical doctors (more than once) talking about having back pain and just injecting themselves with something to try to get over it. I would argue that they are simply covering an underlying trigger or cause and ignoring it is to their detriment. It’s my opinion that medication for neuromusculoskeletal complaints is akin to unplugging a smoke alarm because you don’t like the noise, but, the fire is still slowly growing. What have they done to treat anything in a responsible and effective way? Nothing at all.

Here are some low back pain statistics:

  • Low back pain is the single leading cause of disability worldwide.
  • 8 out of every ten people will experience back pain. I will admit that I have never met anyone in 45 years of life on this Earth that fits into the 20% that apparently never suffers from any low back pain.
  • Back pain is the second most common reason for visits to the doctor’s office right behind upper-respiratory infections.
  • With such gains and leaps in the medical industry as far as treatment goes, low back pain is stubbornly on the rise.
  • More than half of Americans who experience low back pain spend the majority of the work day sitting. 54% to be exact.
  • Did you know that an equal number of patients first seek help with a chiropractor as seek help with a medical practitioner for back pain?
  • Back pain in general costs $100 billion dollars every year when you factor in lost wages and productivity, as well as legal and insurance overheads.

Now that we all know more about low back pain, let’s go through some things that may put you at greater risk of suffering from the condition:

  • Age: as the spine and supporting structures begin to age and decline, the rate of low back pain will understandably increase.
  • Fitness Level: physically active people do not suffer low back pain to at the rate inactive people suffer. A healthy exercise and core building protocol can help reduce symptoms or instances of low back pain.
  • Weight Gain: Being overweight or obese and gaining weight quickly places increased strain on the low back.
  • Pregnancy: This one goes without saying. Pelvic changes and weight gain both contribute.
  • Genetics: Some forms of arthritis or other systemic conditions are genetic in nature.
  • Work: Jobs that include heavy labor and or twisting, or expose people to vibration consistently, can be problematic. Jobs that require long periods of sitting in a chair can be equally problematic.
  • Mental health factors: Many people are able to deal with chronic pain, but anxiety and depression are conditions that can cause a person to focus on the pain, which tends to raise the perceived severity and significance for the person suffering from the condition.
  • Improper backpack use: Kids suffer back pain needlessly since they are not traditionally in an age range we would consider to be a risk factor. However, backpacks used improperly are a common culprit. A backpack should never be more than 15%-20% of a child’s weight and should be carried on both shoulders with the bottom being at or about waist level.

What does the research say?

The research says a lot, to be honest. In fact, there is more research for the effectiveness of manipulation/mobilization in low back pain than for any other conditions chiropractors commonly treat. The research shows Chiropractic beating general practitioners in effectiveness as well as cost. The research also shows Chiropractic beating common medications prescribed for low back pain. It shows Chiropractic beating physical therapy alone. and Chiropractic beating epidural spinal injections for low back pain. Basically, the research is clear.

In January of 2018, a brand new research paper dealing with manipulation and mobilization was published in Spine Journal by Ian Coulter, PhD et. al. titled “Manipulation and mobilization for treating chronic low back pain: a systematic review.” Spine Journal sounds a little bit like it may be a Chiropractic publication, but it is not. Spine Journal is one of the most highly respected research journals available and is widely read by orthopedic surgeons, neurologists, and just about any other practitioner interested in the spine. This project was funded by the National Center for Complementary and Integrative Health.

Why They Did It

The authors of the paper stated that there remained questions about manipulation and mobilization efficacy, the proper dosing of the techniques, how safe they are, as well as how they compare to other treatment protocols commonly used for chronic low back pain. I have to say that I had no remaining questions but it seems that these authors did.

How They Did It

  • This paper was a systematic review and meta-analysis.
  • They searched databases for relevant studies from January 2000-March 2017.
  • They chose randomized, controlled trials that compared manipulation or mobilization to sham treatment, no treatment, other therapies, and multimodal therapeutic approaches.
  • They assessed the risk of bias using the Scottish Intercollegiate Guidelines Network.
  • Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) was applied to determine the confidence in effect estimates.
  • 51 trials were included.

What They Found

  • Within 7 trials of manipulation or mobilization, there was reduction of disability when compared to other forms of therapy.
  • Further analyses showed that manipulation specifically was responsible for significant reduction in pain and disability when put up against therapies such as exercise and physical therapy.
  • Mobilization was also significantly more effective when compared to exercise regimens for pain reduction, but not for disability.

Wrap It Up

In the conclusion of the paper abstract, the authors say, “There is moderate-quality evidence that manipulation and mobilization are likely to reduce pain and improve function for patients with chronic low back pain; manipulation appears to produce a larger effect than mobilization. Both therapies appear safe.”

As I’ve said many times, “a lot of research in your favor becomes fact.” Chiropractic has A LOT of research in its favor.

Just another reason to call a chiropractor TODAY!

Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think.And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.

Till next time……

The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.

Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.

by Jeff S. Williams, D.C.

Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com
http://www.chiropracticforward.com

Research Citation:

Coulter I, et. al. “Manipulation and mobilization for treating chronic low back pain: a systematic review and meta-analysis” The Spine Journal, Volume 0 , Issue 0 ,
http://www.thespinejournalonline.com/article/S1529-9430(18)30016-0/fulltext




Awesome Alternatives To High Blood Pressure Treatment

01/25/2018

chiropractic care to help maintain good blood pressure

In today’s article, we are going to talk about high blood pressure, what happens, how many people it affects, and what we may be able to do to help it.

I think it is responsible to start off with a disclaimer: I am not a cardiologist. I am a research-minded, evidence-based Doctor of Chiropractic that has seen a jillion people with high blood pressure throughout a 20-year career. The ideas and discussion to follow will be based on information derived from the Centers for Disease Control and Prevention, from the American Heart Institute, and from information shared through Dr. Stephen Sinatra of New York, who is a cardiologist and founder of the New England Heart Center. Ultimately, your blood pressure and heart health is something your primary practitioner and/or cardiologist should be monitoring consistently. Our intent here is not to “treat” anyone through the internet but to simply raise awareness and encourage you to pay attention and take steps to protect yourself if needed. Do not simply depend on information from the internet or Dr. Google, as I call it. If you are suffering from high blood pressure (or think you might be) make an appointment with your primary today.

Now that we’ve taken care of that, let’s get going with an easy definition of high blood pressure. According to the American Heart Association, high blood pressure is when your blood pressure, the force of the blood flowing through your blood vessels, is consistently too high.

From personal experience in treating patients, I have seen new patients having blood pressure counts of 200 over 110 before and they had NO IDEA their blood pressure was high. What does a chiropractor do in that instance? You may get different ideas from different chiropractors, but I can tell you what THIS chiropractor does in those cases. I send them either directly to their primary practitioner or the urgent care, whichever they prefer. I won’t touch them as far as chiropractic treatment until their blood pressure is under control.

There is research we will discuss in a minute showing that chiropractic is effective in controlling high blood pressure, but I will not be the one trying to get it down when it is at that level. I’ll be the one trying to help once it’s normalized. That is simply my opinion and the way I choose to go about things in my practice. As I said, other chiropractors likely have other opinions and protocols.

Next, let’s discuss some high blood pressure facts from the Centers for Disease Control & Prevention that you may not already know about concerning WHO is commonly affected:

  • Did you know that about 75 million Americans suffer from high blood pressure? That’s about a third of the population. Another way of saying that is that 1 in every 3 people have high blood pressure.
  • Unfortunately, only about half of the people with high blood pressure have the condition under control.
  • About 11 million adults in America have high blood pressure and don’t even know it.
  • High blood pressure costs America around $46 Billion every year when you account for the cost of healthcare services, medications, and days out of work.
  • High blood pressure affects women about as much as it affects men overall, but under the age of 45, more men are affected. Over the age of 65, more women have the condition.
  • When we look at race, more black people have high blood pressure than do whites and Hispanics, and of the black people having it, more women are affected than men.
  • Women having high blood pressure that then become pregnant are more likely to have complications.
  • Uncontrolled high blood pressure during the midlife phase (45-65) seems to be linked to higher risks of dementia later in life.

Here are some of those random facts that you may be able to use in a game of Trivial Pursuit somewhere down the line:

  • Did you know that too little salt can contribute to high blood pressure? We commonly associate an excess of salt with high blood pressure, but too little is an issue as well. According to Dr. Stephen Sinatra, a cardiologist from New York, it seems a good mix is keeping more than 1.8 grams of salt a day in your body while keeping sodium below 2.8 mg/day and keeping a close eye on hidden salts that can be found in canned soups, pickles, salted nuts, etc.
  • Potassium plays a part in healthy blood pressure, so it’s likely a good idea to eat foods like eggplant, squash, bananas, coconut water, and baked potatoes.
  • It’s a good idea to have the blood pressure taken in both arms since the numbers are often different from one arm to the other.
  • Cardio is great, but weight training can RAISE blood pressure. If you like to lift weights but suffer from high blood pressure, it would probably be a great idea to lift much lighter weights with higher reps in an attempt to bring down those numbers.

Now let’s talk about some of the causes of high blood pressure in patients:

  • Emotional stress
  • Being overweight
  • Environmental toxins
  • Smoking
  • Lack of exercise
  • Too much salt as well as too little salt
  • More than one or two drinks of alcohol per day
  • Age
  • Genetics

What risks do you run when leaving your high blood pressure untreated or uncontrolled? As unpleasant as it may be to discuss, it can be as serious as you may have imagined. Here are the potential outcomes of untreated high blood pressure:

  • The CDC states that over 360,000 U.S. citizens died of high blood pressure in 2013 which totals about 1,000 deaths every single day.
  • High blood pressure increases your risk of having a heart attack, of having a stroke, of having long-lasting heart failure, and of having kidney disease.

Here’s brand new and very interesting research paper I wanted to take the time to discuss. It’s by AP Wong and is titled “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review(1).”

Why They Did It

The authors state that high blood pressure is responsible for about 12.8% of all deaths globally. Considering that staggering fact, the World Health Organization has targeted a 25% reduction in high blood pressure by the year 2025 and has encouraged more evidence and research into non-conventional methods of controlling high blood pressure.

How They Did It

  • The authors of the paper had two main objectives
      1. Describe the therapeutic modalities commonly used in treating high blood pressure.
      2. Review the current level of evidence that has been attained for each.
  • The researchers used a search from 2005-2013 of the databases MEDLINE, The Cochrane Library, PUBMED, and EMBASE.
  • 23 papers were found and accepted.
  • Modalities identified in the 23 papers were fish oil, qigong, yoga, coenzyme Q10, melatonin, meditation, vitamin D, vitamin C, monounsaturated fatty acids, dietary amino-acids, chiropractic, osteopathy, folate, inorganic nitrate, beetroot juice, beetroot bread, magnesium, and L-arginine.

What They Found

The following therapies had weak to no evidence for effectiveness in treating high blood pressure:

  • Fish oil
  • Yoga
  • Vitamin D
  • Monounsaturated fatty acid
  • Dietary amino-acids
  • Osteopathy

The following therapies showed significant reduction in blood pressure:

  • Chiropractic
  • Magnesium
  • Qigong
  • Melatonin
  • Meditation
  • Vitamin C
  • Folate
  • Inorganic nitrate
  • Beetroot juice
  • L-arginine

Coenzyme Q10 has differing results. Some studies showed it had weak to no effectiveness while other studies showed it to have significant effect on the reduction of high blood pressure.

Wrap It Up

In a quote from the authors conclusion, they said, “Results from this review suggest that certain non-conventional therapies may be effective in treating hypertension and improving cardiac function and therefore considered as part of an evidence-based approach.”

With all of the information combined from the articles used as source material, including the research paper, the Alternative means of treating high blood pressure may include:

  • CHIROPRACTIC – we will talk more about this in just a moment.
  • Coenzyme Q10 – More discussion on Coenzyme Q10 later.
  • Magnesium
  • Ribose
  • L-arginine
  • RestricT carbohydrates
  • Use olive oil – consider adopting the use of the Mediterranean Pan-Asian diet which is a non-inflammatory diet.
  • Cutting sugar out of your diet is crucial for those suffering from high blood pressure.
  • Less alcohol is best, but a glass of wine a day has shown benefits.
  • No processed juices from the grocery store. They’re packed full of useless and damaging sugars.
  • Exercise protocols
  • Lose weight – only a five pound reduction can make a difference.
  • Stop smoking!
  • Qigong
  • Melatonin
  • Meditation
  • Vitamin C
  • Folate
  • Inorganic nitrate
  • Beetroot juice

Besides this study, there are several other suggesting Chiropractic plays an important role in reducing or controlling blood pressure.

In one from 1988 by Yates, et. al. called “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial,” they showed how anxiety and blood pressure were significantly reduced following chiropractic treatment(2).

In another very interesting study through the University of Chicago Medicine from March 14, 2007, and led by George Bakris, MD (director of the hypertension center at the University of Chicago Medical Center, researchers did the following:

  • They took 50 Chicago-area citizens having high blood pressure.
  • All had misaligned C1 vertebrae measured on x-ray.
  • They were randomly divided into a treatment group consisting of a chiropractic adjustment and a sham group where no treatment was actually performed.
  • The participants were assessed at the beginning of treatment, after the chiropractic adjustment, and at the end of eight weeks.

What They Found

The authors stated that the improvement in blood pressure for both systolic and diastolic were similar to that seen when giving patients two different blood pressure medications at the same time. Not only that, but the reduction in the blood pressure continued in the eighth week!

Wow!!!

Just another reason to call a chiropractor TODAY!
Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think.And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.
Till next time……

The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.

Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.

by Jeff S. Williams, D.C.

Chiropractors in Amarillo
Spinal Decompression Amarillo
Creek Stone Integrated Care
http://www.amarillochiropractor.com
http://www.creekstonecare.com

Research Citations

(1) Wong AP, et al. “Review: Beyond conventional therapies: Complementary and alternative medicine in the management of hypertension: An evidence-based review.” Pak J Pharm Sci. 2018 Jan;31(1):237-244.
https://www.ncbi.nlm.nih.gov/m/pubmed/29348109/

(2) Yates RG, et. al. “Effects of chiropractic treatment on blood pressure and anxiety: a randomized, controlled trial.” J Manip Physical Ther. 1988 Dec;11(6):484-8.
https://www.ncbi.nlm.nih.gov/pubmed/3075649

(3) Bakris, G. Journal of Human Hypertension, advance online publication, March 2, 2007. Grassi, G. Journal of Human Hypertension, advance online publication, January 25, 2007.George Bakris, MD, director, hypertension center, University of Chicago. Marshall Dickholtz Sr., DC, Chiropractic Health Center, Chicago.
http://www.uchospitals.edu/news/2007/20070314-atlas.html

Other Source Material:

https://www.cdc.gov/bloodpressure/facts.htm

https://www.cdc.gov/features/highbloodpressure/index.html

http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/GettheFactsAboutHighBloodPressure/The-Facts-About-High-Blood-Pressure_UCM_002050_Article.jsp#.WmYUYyOZNBw

https://www.drsinatra.com/6-surprising-blood-pressure-facts-everyone-should-know




Astounding Expert Information On Immediate Headache Relief

01/18/2018

get treatment for headaches with chiropractic in Amarillo

This week, we’re going to discuss headaches. It’s common for people to look at chiropractors as “spine people” and “back doctors”. What people don’t commonly know is that chiropractors can knock it straight out of the park when it comes to treating headaches. Yes, I said, “Knock it out of the park.” That’s an old metaphor comparing baseball players hitting home runs and I’m telling you, chiropractors mostly hit home runs on headache cases.

I have to admit that I was a terrible baseball player. I played college football and I’m Texan born and raised, where football is King, so I should probably put it in football terms. In football terms, you might say that we chiropractors have a record of 80-yd touchdown passes when it comes to headaches. We return headache punts for a score almost every time. We pick-six those suckers. That’s probably enough to drive the point home.

Not every single headache of course. I’ve met my match several times over my 20 years in practice. But I don’t think it’s too bold to say that about 80%-90% of headache patients improve. And not just improve, but DRAMATICALLY improve.

Before we get into the research, let me take a minute to give you just a couple of personal experiences in treating headache patients in my practice here in Amarillo.

Case #1: We will call this patient Andy McFuddlesticks just because I’m feeling a little goofy today. That sounds a little like a Harry Potter character, doesn’t it?

Andy had experienced migraines his whole life and was around 40 years old at the time we crossed paths. He had been to all of the medical doctors. He had endured injections in his suboccipital region. I don’t recall what the injection was exactly because this was about 18 years ago. I don’t believe they did botox for migraines at that point in time. He had gone through nuclear bone scans as well. Andy McFuddlesticks had been through it all, you might say.

He came to see me only a few times. It was frustrating that he didn’t finish his treatment plan but the reason he didn’t finish is satisfying. Andy only came a handful of times because the headaches were gone. After all of the years and procedures, just a few visits to a very new and green chiropractor made them vanish. How do I know? Well, I was in a civic organization with his brother who confirmed months later that his brother was doing great and had not had a headaches since seeing me. How is Andy 18 years later? I have no idea. I switched towns, but I know he did great for a long time and we are putting that one in the “win” column.

Case #2: Sally McGullicutty I believe was her name. Red hair. Irish. Anyway, Sally had migraines for years. I actually knew Sally personally and had been friends for some time. Evidently I was not skilled at getting my message out on how successfully we can deal with headaches because it took Sally way longer than it should have taken her to make an appointment with us.

Sally shared with me that she had migraines, on average, several times a week and once or twice every month would find herself in a dark bathroom floor sitting my the toilet throwing up. How awful of an existence is that? I cannot even imagine being forced to live that way. I say it often but it bears repeating, “Pain can absolutely change a person.” Not only the person but it can change everyone around the person that is consistently in and out of contact with them.

After approximately 2-4 weeks of working with Sally, she just started to not have the migraines anymore! I would say she “magically” recovered, but chiropractors know this isn’t accurate. We got the right joints moving, we got the right muscles to relax, and we got out of the way and let the body do the rest. There’s no magic in that. It’s just common sense to chiropractors.

Fast forward a few years and Sally is still a patient and Sally comes here for other reasons and conditions from time to time, but she doesn’t visit because of migraines anymore. She just doesn’t have them.

I could absolutely go on and on with examples from personal experience in my practice. I have 20 years of dealing with headaches and I can tell you, Chiropractors are modern day headache whisperers.

Let’s dive into a little research just to show you what I’m talking about. There are more studies we’ll go over in the future, but I want to touch on two this week. One new study and one older.

The first one is the more recent research paper and comes to us from a group in Spain. The lead author was Miguel Malo-Urries, PT, PhD with the University of Zaragoza Aragon Spain and it was published in Journal of Manipulative and Physiological Therapeutics in the November-December 2017 issue, Volume 40, Issue 9, Pages 649-658. The study was titled “Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial.” What a name. Wouldn’t you agree?
Did you catch that word, “Translatoric?” I’m going to define that for you. Translatoric is not commonly known in the Chiropractic verbiage or vernacular. At least, I don’t recall it from my education at Parker University in Dallas, but that was eons ago. I have gray sideburns now. It has been a while. The authors of the paper all have PT behind their names, so we have physical therapists setting the terms for the research project. Understanding this, the use of translatoric makes more sense.

I found a site that gives a pretty good definition of Translatoric Spinal Manipulation. The term Translatoric Spinal Manipulation or TSM “consists of a series of high and low-velocity manipulative spinal techniques, which emphasize the use of small amplitude, straight-line (or translatoric) traction, and gliding impulses delivered parallel or perpendicular to an individual vertebral joint or movement segment. Furthermore, TSM emphasizes the use of either direct manual stabilization or the use of spinal pre-positioning to restrict the amount of motion occurring at adjacent spinal segments during the translatoric impulse.” The website goes on to say, “Delivering translatoric impulses (in the form of disc traction, disc glides, facet traction and facet gliding) to an individual joint or spinal motion segment while using stabilization provides the manual therapist with a manipulative tool that has a predictable effect in terms of pain reduction and motion restoration with minimal potential risk of patient injury.”

Do you know what that sounds like to me? It sounds like a “Chiropractic Adjustment.” Another term it sounds like is “Spinal Manipulative Treatment/Therapy.” Something we chiropractors have been doing for over 100 years and have been called crazies and quacks for doing. It sounds like the exact thing that the medical world has blamed as being responsible for strokes. Of course, they don’t have a clue what they’re talking about, but translatoric spinal manipulation is nothing more than a Chiropractic Adjustment.

Now that that is clear, let’s get back into the research.

Why They Did It

The good folks in Spain performing Translatoric Spinal Manipulation rather than Chiropractic Adjustments wished to assess the response in terms of range of motion and pain in patients suffering cervicogenic headaches.

How They Did It

  • The paper included 82 patients.
  • The patients ranged in age from about 25-55 or so.
  • All patients suffered from cervicogenic headaches.
  • The patients were randomly split up into two groups. One was a control group and one was a treatment group.
  • The treatment group received Chiropractic Adjustments…..I’m sorry…Translatoric Spinal Manipulation.
  • The control group received no treatment or sham treatment.
  • The researchers tested Cervical range of motion, they tested the pressure pain thresholds over the upper trapezius muscles, the C2-3 zygapophyseal joints and suboccipital muscles were tested, and the current headache intensity were all measured on the Visual Analog Scale prior to the Chiropractic adjustment and right after.
  • The testing was done by two blinded investigators.

What They Found

  • Afterward, the Chiropractic Adjustment group had significantly increased range of motion in the neck region overall as well as in the flexion-rotation test.
  • And, while there were no changes in the pain thresholds, patients reported significantly lower intensity in their headaches!

Wrap It Up

The quote from the authors themselves reads as follows, “Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with cervicogenic headache.”

There you have it straight from physical therapists performing chiropractic adjustments but calling it something else. I want to be honest here: the frustrating part of this isn’t necessarily the fact that PTs are doing cervical chiropractic adjustments. Heck, chiropractors have been doing PT for years, but the physical therapists claim ownership of the term, so the chiropractic industry just calls it exercise rehab.

Although their doing adjustments may be irritating on some level, the most irritating thing is that a certain aspect of the physical therapy community and a larger aspect of the medical community have spent years ridiculing, mocking, and belittling generations of chiropractors. And now, doctors of osteopathy and physical therapists are trying to do the exact same thing without going through any chiropractic training. You would think they would at least release a statement saying, “You know, we have thrown rocks at chiropractors for years but it turns out they were right all along so, since we can’t beat them, we’re going to just join them.”

Wouldn’t that be refreshing?

Now, let’s go over the older study before I start getting too ugly about the whole deal.

This one is by GV Espi-Lopez et. al. and is called, “Do manual therapy techniques have a positive effect on quality of life in people with tension-type headache? A randomized controlled trial.” It was published in the European Journal of Physical and Rehabilitation Medicine on February 29th of 2016.

Why They Did It

Although there have been lots of studies that prove the impact of manual therapy and spinal mobilization for frequency and intensity of pain suffered from tension type headaches, there have been no studies in regards to the effectiveness of the same therapies for the quality of life for the people suffering from them. The authors of this paper wished to focus on patient quality of life.

How They Did It

  • The study was a randomized, single blinded, controlled clinical trial.
  • Comprised of 62 women and 14 men.
  • Aged between 65 years old all the way down to 18 years old.
  • All subjects suffered from chronic tension type headaches or episodic tension type headaches.
  • The subjects were categorized into four separate groups: suboccipital inhibitory pressure, suboccipital spinal manipulation, a combination of the two together, and then a control group.
  • An SF–12 questionnaire was used to help assess the subjects’ quality of life at both the beginning of treatment, the ending of the treatment, as well as at the one month follow-up.

What They Found

  • The suboccipital inhibition group improved significantly in their quality of life at the one month mark as well as improvements in moderate physical activities.
  • Not the control group, but all other treatment groups had an improvement in physical activities, pain, and social functioning at the one month mark.
  • After treatment, as well as that the one month mark, the combined treatment category had improved vitality.
  • Following treatment and at the one-month mark, both groups that had manipulation to the suboccipital region also showed improved mental health.

Wrap It Up

All three therapy approaches showed significant effectiveness toward improving the quality of life, however the combined treatment therapy had the most dramatic change for the good.

In short, manual therapy techniques and manipulation applied to the suboccipital region for four weeks or more showed great improvement and in effectiveness for several aspects that measure the quality of life of a patient having suffered from tension type headaches.

These are just a couple of studies to get us started off on the right foot. There are several more I will be sharing in the future so stay tuned.

Just another reason to call a chiropractor TODAY!

Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think.And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.

Till next time……

The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.

Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.

Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.

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http://www.jmptonline.org/article/S0161-4754(16)30281-0/fulltext?elsca1=etoc&elsca2=email&elsca3=0161-4754_201711_40_9_&elsca4=Physical%20Medicine%20and%20Rehabilitation%7CHealth%20Professions
https://www.optp.com/Translatoric-Spinal-Manipulation-for-Physical-Therapists-Book-and-DVD
https://www.amarillochiropractor.com/get-rid-of-migraines-and-headaches-once-and-for-all/




Valuable & Reliable Expert Advice On Clinical Guides For Your Practice

01/10/2018

This week’s entry is going to be a little more geared to chiropractic practitioners rather than patients.

Many of us tend to wander around on our own islands for years without any sort of mentorship or guidance. If I’m being honest, and I am, I was that way myself until about 11 or so years ago when I decided to start paying attention. In fact, there are still times I find myself researching the latest standards of practice and guidelines to make sure that I am not an outlier in my profession without even realizing that I’m one. Healthcare tends to change so quickly that it is a scenario I would assume occurs more often than we think.

This sort of information can admittedly be monotonous and can give you a headache. Some LOVE to dive into long text and technical terms, but I’m guessing most do not. That is why I am offering it in different forms.

Different people communicate in different ways. Some prefer email. Some prefer texts. I like videos, while others prefer blogs. Podcasts, Reddit, etc… It’s all a part of communicating in the best, most effective way possible. With this in mind, I offer you this information in blog form, on YouTube in a video, and in Podcast form in the hopes that you guys and gals out there can digest it and maybe even RECEIVE it rather than just simply take note of it, before moving on to something else.

The impetus for this week’s information comes from a blog I read that was recently published on the American Chiropractic Association’s blog. You can find this at www.ACAtoday.org/blog. The blog was posted December 28, 2017. It was titled “Research Review: Clinical Practice Guideline: Chiropractic Care for Low Back Pain,” and was submitted by Dr. Shawn Thistle(1). Dr. Thistle is the founder of RRS Education, which is a continuing education company providing weekly research reviews. Much like we do right here on my blog, on YouTube, or as part of the Chiropractic Forward Podcast.

I have used Dr. Thistle’s article here as the template and simply “overdubbed” and commented on it as I went through it.

In this article, Dr. Thistle reviews a research paper called “Clinical Practice Guideline: Chiropractic Care for Low Back Pain,” The lead author and researcher for the paper was Dr. Gary Globe who has a Masters in Business, a Doctor of Chiropractic, and a PhD. The paper was published in the Journal of Manipulative & Physiological Therapeutics in Volume 30, Issue 1, in 2016(2).

Basically, we are doing a review of a review. You may wonder why this is even necessary to do on my part. I feel it’s necessary because I believe my calling is to take more difficult or more boring concepts, terms, and ideas and to then strip them down into a very understandable and more palatable form. A transfer of information, if you will. Hopefully I can get that information distributed to folks that need it. If we just left it at this blog, it is my assumption that the people that really need the information may not get it. In other words, the people that read the American Chiropractic Association’s blog probably have already familiarized themselves with much of this information. However, people that do not read their blog likely do not keep up with Chiropractic research either. If they’re not involved, then they’re just not involved usually. They may be outliers in the profession because they have likely never been exposed to this sort of evidence-based information.

I’m hoping that’s where I come into the picture.

First, why would chiropractors be interested in guidelines of any sort? I would share with you that a frustrating part of our profession for me personally is that there seems to be no standardization that is widely followed or respected by chiropractors as a population. Some practitioners in Chiropractic may think that’s a great thing and that that’s what is unique about Chiropractic. I am of the thought that it’s a good thing when you go to a practitioner of any style and you can feel comfortable knowing there are professional standards of care being followed by your caregiver. It’s when practitioners have not educated themselves or have not, at least, been somewhat in tune to what’s going on in their profession that they may start to be considered outliers and can run the risk of getting themselves into some sort of trouble professionally. Nobody wants that.

Let’s be clear; following guidelines don’t mean that the practitioner has no autonomy or that there is no professional decision-making going on. They are just that: guidelines. General guidelines that not only help your decision-making process, but also give you something to refer to should there be any questions down the road about your treatment plans or protocols. I call that “standing on solid ground.”

When you have so many webinar and seminar folks trying to scare chiropractors into buying their courses and marketing to them by triggering the fear of either being sued or jailed if they don’t buy, well….standing on solid ground is always a bit liberating.

Be honest here, how does it look when one chiropractor tells the patient they need to be seen 55 times this year and this happens just one or two weeks before a doctor with the second opinion says the standards of practice require 18 visits over the next 2 months or so for the same issue? Of course, that reflects poorly on the first chiropractor but wouldn’t you agree that it also reflects poorly on Chiropractic in general?

I am in no way saying that there are not conditions requiring 55 visits so don’t send me any hate email. I’m simply using a generalized example here. I’ve always felt that treatment should have a start, it should have a finish, it should be responsible and have smart recommendations, and upon completion, should enter the maintenance phase. If we aren’t giving good recommendations, then we simply are not doing our job. But it’s also my opinion that if you’re not staying on top of research and current standards of practice, then that also means you’re not doing your job.

Now that we talked about standards of practice and guidelines, let’s dive into this research and guideline summary.

Why They Did It

Everyone should know by now that low back pain is the leading cause of disability around the world. Research has continued to show over and over that chiropractors are highly effective when it comes to low back pain. Even traditional chiropractic haters, at this point, mostly concede the fact. The goal of this research project seems to be focused on providing some sort of standardization and guideline protocol for an easier and smoother transition into an integrated setting in the medical world. The project focused on nonspecific low back pain.

How They Did It

The authors underwent a comprehensive search of the literature. They found 270 relevant articles. After screening the 270 articles, only 18 where accepted for the paper. Of those 18, 16 of the papers were accepted as high-quality.

Here’s where we get into the thick of it. They break their points down into the following categories: general considerations, informed consent, severity and duration of conditions, examination procedures for lower back pain, treatment frequency and duration, initial course of care for low back disorders, revaluation and re-examination, benefit vs. risk, contraindications and cautions, and chronic pain management for spinal disorders.

Let’s dive into those sections a little further point by point and try to make some sense of it all.

General Considerations.

  • If a patient gets chiropractic treatment in the acute pain phase, they usually have full recovery of the complaint. Even though they may have full recovery, recurrence of the pain can be common.
  • If not treated properly in the beginning, it could turn chronic with increased disability.
  • Practitioners, at all times, should be mindful of red flags and yellow flags. In case you don’t know, yellow flags are usually associated with chronic pain or disability. Some examples may be negative coping strategies, poor self efficacy beliefs, fear of avoidance behavior, and distress. That’s according to Dynamic Chiropractic, Nov. 30, 2002, Vol. 20, Issue 25 by Craig Liebenson, DC. Patients with high yellow flag scores should not be labeled with an injured back. For example, telling the patient they have a ruptured disc may not be the best idea. Your treatment should reduce dependency on medication and encourage active treatment rather than passive treatment and should include self-treatment protocols(3).
  • The authors of this paper feel that the goal of chiropractic should be improving the patients’ functional capacity as well as educating them to accept responsibility for their own health.

Informed Consent:

Chiropractors often get into trouble because they lack a proper informed consent procedure.

  • Basically, informed consent is communication between your office and a patient that results in the patient giving you authorization for treatment.
  • An informed consent should include a clear explanation of the diagnosis, of your examination, and what you propose to do as far as treatment. This should include treatment options and possible risks involved.
  • If the person appears to be of sound mind to perform an informed consent, you have satisfied recommendations, assuming they have no further questions.

Examination Procedures for Low Back Pain:

  • While there is no limit to what the examination includes, there should at minimum be a health history, an examination that includes range of motion, orthopedic tests, and/or neurological testing, and further diagnostics when indicated. These may include lab tests or imaging.
  • This report says that range of motion should not be used to determine a person’s functional status but can be used as part of the exam to assess regional mobility.
  • As part of the exam process, they don’t recommend routine imaging for diagnostic tests in cases of nonspecific low back pain.
  • With that being said, if serious pathology is suspected or if someone is having neurological issues associated with it, then of course further diagnostics would be appropriate.
  • While the authors are not proponents of regular imaging, MRIs are indicated when the low back complaint is associated with symptoms of stenosis or radiculopathy.
  • Another condition in which a practitioner may consider getting imaging would be when the patient has not responded to a reasonable, responsible short-term conservative protocol or if you have reason to suspect something else is going on such as spondylolisthesis.

Severity & Duration of Conditions:

This is a really simple section that can cause confusion by those that have just never had the information or have forgotten it.

  • An acute complaint refers to something that has been experienced for less than six weeks (1.5 months).
  • A subacute symptom has lasted between six and 12 week (1.5 months to just under 3 months).
  • A chronic condition is something that has lasted 12 weeks minimum (3 months).
  • A recurrence means the return of the symptom that is suspected to be similar to their original complaint.

Treatment Frequency & Duration:

  • The authors indicate that most patients respond to your care, but that the treatment frequency and duration may change depending on the patient themselves. They may have other issues, including red and yellow flags, that extend or alter in some way the duration or the frequency of treatment. Again, the practitioner must always be mindful of the red and yellow flags.
  • The paper suggests that the effectiveness of care should be evaluated both subjectively and objectively during or after each course of care. In our office, we use the Functional Rating Index (FRI) every single day upon the patient’s arrival. We also use outcome assessment questionnaires fairly often. We use them for a baseline during the initial treatment, again at each re-examination, and then again upon the conclusion of the treatment schedule. In addition to that, our patients are asked to rate their pain on the Visual Analog Scale (VAS) for each complaint at each visit. It takes seconds. Yes, it’s subjective and can have a wide variance from day to day for the same person, but when you are keeping these types of records, you are standing on more solid ground if anything about you or your treatment ever comes into question. Not to mention, it’s just better for the patient to be kept track of in this manner.
  • Here is a quasi-answer to a big question. The question I’m referring to is, “How often should I see someone?” Well, the full answer is not in this paper but there are hints at it. The researchers here suggest that a therapeutic trial of chiropractic is usually between 6 and 12 visits that takes anywhere from 2 to 4 weeks to complete. That seems to be about the average. For further insight into generally accepted treatment protocols, you may try looking at the Council on Chiropractic Guidelines & Practice Parameters (CCGPP) guidelines(4).

Initial Course of Care for Low Back Disorders

  • The best evidence of efficacy is in High Velocity/Low Amplitude manipulation and in mobilization.
  • A good starting point in care is passive physiotherapy like electric stim, cold laser, ultrasound, etc for pain. Additionally, a practitioner should attempt to educate the patient about their complaint and set in place recommendations for self-management of the complaint.
  • As the authors state, physiotherapy shouldn’t be used individually or isolated as the lone means of treatment. As I tell my patients, “There is a mountain of evidence for manipulation/mobilization, for certain physiotherapies, and for exercise/rehab but the best evidence show the greatest effectiveness comes from the three being combined and integrated into a treatment protocol that is reasonable and makes sense.” How it is used will come down to practitioner judgement and patient preference.
  • The authors here state that they cannot recommend the use of lumbar supports like bracing, taping, or orthoses because the research just isn’t there to support it at this time.
  • Active care, otherwise known as exercise/rehab, should become a bigger and bigger part of all chiropractic clinical protocols. I often will try to relate this to patients in a way that makes sense in the medical world. When appropriate I may say something like, “What happens on the day after someone has a knee replacement, appendectomy, or a C-section? They have them up walking, which may seem counterproductive to do so soon after a surgery. In fact, for low back pain, a common recommendation used to be to go home, get in bed, and wait it out. But, they realized that movement is healing. Part of the healing is getting the joints moving properly through manipulation and joint mobilization, but that’s just part of it. Another big aspect of it is exercise/rehab; both here in the office and at home.”
  • The more you explain why you want them performing exercise/rehab and the more you stress that exercise/rehab is part of the protocol from the very start, the less resistance you tend to run into later down the road.

Re-examination & Re-evaluation

  • After your initial recommendations are fulfilled, then what? You need to determine whether any further treatment is indicated and why it’s indicated. What was the patient’s response to your care?
  • If you threw everything in your office including the kitchen sink at someone for 2-4 weeks for 6-12 visits and saw little to no improvement, do you think any further treatment is likely to bring about positive change? Not very likely. It’s times like these that I swallow my pride and, in the best interest of the patient and my reputation, I find them a referral to a reputable practitioner that may be better-suited to address the complaint. I wouldn’t want a family member of mine treated any differently so I don’t treat patients any differently.
  • On the other hand, if the patient’s complaint is resolved, you should perform a final exam and outcome assessment questionnaire, make sure the patient is adequately educated on your recommendations going forward (exercise, maintenance care, etc.), and then release the patient from the active care protocol.

Benefit vs. Risk

  • The authors state that chiropractic care is remarkably safe and effective, certainly when compared to our medical counterparts. Even though we all know this already, it never hurts to re-state the obvious. I hope you don’t mind.
  • The paper says that serious adverse reactions to chiropractic care tend to only happen to the tune of 1 in 1 million patient visits when referring to treatment for low back pain.
  • The authors went a little further by saying that, while adverse reactions were very rare, other more mild-moderate events were noticed like muscle soreness or stiffness. We see this in my office here and there as well. If they have never been to a chiropractor and then get sore after the first one or two visits, one could compare that to going to the gym after laying off for an extended time. You are doing something new and something different with the body. It makes sense for people to get a little sore sometimes.

Contraindications & Cautions:

Have you always been completely aware and knowledgeable on what constitutes a hard contraindication to chiropractic care? The authors try to help us all out here so listen up. This is a biggie. Since I feel the importance of knowing these are paramount to your longevity in practice, I am going to quote these conditions directly from the source(1) for accuracy. Don’t be caught having treated these conditions.

  • General Conditions: severe osteoporosis, multiple myeloma, osteomyelitis, local primary bone tumors where osseous integrity is questionable, local metastatic bone tumors, Paget’s disease.
  • Neurological Conditions: progressive or sudden neurological deficit (including cauda equina syndrome) or spinal cord tumors demonstrating neurological compromise (care may be appropriate after specialist investigation and clearance.)
  • Inflammatory Conditions: rheumatoid arthritis in active systemic stage (or locally in the presence of inflammation or atlantoaxial instability), inflammatory phase of ankylosing spondylitis or psoriatic arthritis, or Reiter’s syndrome (reactive arthritis).
  • Bleeding Disorders: congenital or acquired, unstable aortic aneurysm, etc.
  • Other: structural instability, inadequate physical exam, or inadequate SMT training/skills.

Chronic Pain Management for Spinal Disorders:

These conditions can no longer be referred to as “acute” or “uncomplicated” as they are beyond 3 months in duration at the point of being labeled “chronic” and other factors must be considered in a robust treatment protocol. Some complications may include:

  • Work environment, including ergonomics
  • Work requirements
  • Comorbidities. Some may wonder, “What the heck is that?!?” Well, that is when you have two or more other conditions occurring in addition to the initial diagnosis. Low back pain in addition to arthritis and diabetes is an example. Low back pain in addition to obesity and depression could be another.
  • The history of the conditions’ prior treatments
  • Lifestyle factors including bad habits
  • Other psychological factors which may include depression, anxiety, etc….

Whew….that was a lot, right?
With such an amount of information to wade through, I would say, that Dr. Thistle did a great job of reviewing this paper for the American Chiropractic Association’s blog and I hope, in turn, that I have been able to bring even more clarity and maybe even relate it to my personal practice and your practice in a way that really drives home the need for more regulation and practice standards in our profession.

As the internet and the “Age of Information” has brought the world together, I believe the days of being a lone wolf and/or being an outlier may be numbered. When they say that ignorance is not a defense, that especially rings true now that information is at our very fingertips at all times of the day no matter where we may be.

You may agree with me that this is a good thing. You may disagree and think I’m off my rocker for wanting some standards in the profession. That’s OK. Differences in opinions is American to the core. Usually what triumphs is reason and, if you find these guidelines or those of the CCGPP to be reasonable guides, I hope you will consider giving them more thought and maybe even implement them into your regular treatment protocols.

Regardless of how you go about practicing, I’m a firm believer that we chiropractors can absolutely change the world when it comes to the treatment of non-complicated neuromusculoskeletal conditions of the body. Not just low back pain either, but the whole shebang. As I said last week, if we were wrong in what we do as a profession, we would have been wiped off the face of the Earth years ago. Lord knows they tried and keep trying.

We are still here because we are naturally right, but, we give our detractors ammunition for the battle when we are not holding ourselves and our profession to certain reasonable and responsible standards.

https://www.acatoday.org/News-Publications/ACA-Blogs/ArtMID/6925/ArticleID/315/Research-Review-Clinical-Practice-Guideline-Chiropractic-Care-for-Low-Back-Pain
https://www.ncbi.nlm.nih.gov/pubmed/26804581
http://www.dynamicchiropractic.com/mpacms/dc/article.php?id=15493
http://clinicalcompass.org




And Instantly, Treatment Of Back Pain Changes Due To Increase In Opioid-related deaths

01/05/2018

get healthy back pain treatment with chiropractic care in amarillo, texas

The opioid crisis cost the US economy $504 billion dollars in 2015, according to an article from Reuters this year written by Lucia Mutikani and Ginger Gibson. The authors of the article were relaying information taken from the White House Council of Economic Advisers (CEA).

There is no reason to expect this number to improve any time soon, either. If indicators are correct, as numbers become more available for 2016 and 2017, you’ll see this amount explode.

The opioid crisis has reached the point that President Trump was forced to declare it a public health emergency.

The article goes on to discuss the fact that there was a total of $221 billion to $431 billion in lost economic output due to there being 33,000 opioid-related deaths in 2015. The wide range in dollar amounts is to take into account the fact that there are several different models, but I think you get the idea. It’s incredibly significant.

“The crisis has worsened, especially in terms of overdose deaths which have doubled in the past ten years,” the CEA said. Wow. And, if I’m correct, you can compare the crisis to a fire. While it may have taken 10 years to double (which is bad), I believe the rate of expansion of the problem has increased exponentially.

The article wraps up by citing the U.S. Centers for Disease Control and Prevention as saying more than 100 Americans die daily from related overdoses. On top of that, new information is out that opioid-related deaths have now surpassed breast cancer. I love that the NFL does the pink uniforms during October, which is Breast Cancer Awareness Month, but I’m wondering if now we’ll start seeing a specific color and more awareness for the Opioid Addiction Awareness Month or something of that nature. It’s bad, y’all.

https://www.reuters.com/article/legal-us-usa-opioids-cost/opioid-crisis-cost-u-s-economy-504-billion-in-2015-white-house-idUSKBN1DL2Q0

How bad is it? It’s so bad that a recent article in The Guardian says that B>overall life expectancy in the US has declined for the second year in a row as a result of the opioid crisis. Can you imagine? It’s the first time in 50 years that the US life expectancy has gone down for 2 years in a row. The last time was the year of our Lord, nineteen hundred and sixty-three!

The article in The Guardian was written by Jessica Glenza and was published on December 21, 2017. In the article, she shares that there were 63,600 opioid-related deaths in 2016 which was an increase of 21% from the 2015. These numbers came from the National Center for Health Statistics.

As I hinted in the beginning of this blog, early indications for 2017 aren’t looking very bright. Robert Anderson of the National Center for Health Statistics says of 2017, “It doesn’t look any better.” Anderson goes on to say, “We haven’t seen more than two years in a row in declining life expectancy since the Spanish flu – 100 years ago,” said Anderson. “We would be entering that sort of territory, which is extremely concerning.”

There are guesstimates that this crisis is going to take a good 10-20 years to turn around now that multiple generations are already hooked.

https://www.theguardian.com/us-news/2017/dec/21/us-life-expectancy-down-for-second-year-in-a-row-amid-opioid-crisis

Realizing that the first phase of the opioid crisis was started by physicians over-prescribing these opioids, the American Medical Association and the American College of Physicians have really stepped up in a way that I would believe most alternative caregivers would describe as rather unexpected considering the history of these organizations. They have consistently and constantly attacked – verbally, in the courts, and legislatively – just about any and all alternative healthcare protocols up to this point in history.

However, in new recommendations put out in February of 2017, the American College of Physicians have now started recommending Chiropractic, Massage, and/or Acupuncture as first-line treatment for acute and chronic low back pain before even taking an over-the-counter anti-inflammatory drugs such as Aspirin, Tylenol, or Ibuprofen.

Quickly thereafter (2 months), the American Medical Association published an article in its journal called Journal of the American Medical Association (JAMA) in support of the updated recommendations made by the American College of Physicians.

It took a national emergency of epic proportions started in part by the medical profession itself, but now, finally, we have some realistic and responsible recommendations coming from the medical field on safe and conservative means of treating uncomplicated musculoskeletal conditions. I would say they need to go ahead and expand it to the entire musculoskeletal system, but acute and chronic low back pain is a good starting point I suppose.

In the end, it is my firm belief that patients are entitled to the best treatments that do the least harm. There is nothing out there safer and more effective than chiropractic, massage, and/or acupuncture.

Through the years, I have carried with me a wonderful quote by Dr. Lee Green, a Professor of Family Medicine at the University of Michigan. He said, ”Neck pain is a mechanical problem, and it makes sense that mechanical treatment works better than a chemical one.”

Doesn’t it?




Great News: Chiropractic Outpaces Muscle Relaxants

12/29/2017

get professional chiropractic care in Amarillo, Texas

Did you know that you are 75% to 85% likely to experience low back pain in your lifetime? Those are some pretty good odds. Or, bad odds, depending on how you look at it.

By the way, I’d like to meet the 15%-25% that don’t have back pain. Wouldn’t you? Maybe these folks have been marked by God for greatness that just can’t be achieved if they’re suffering from back pain. They’re the ones looking at everyone else like, “What the heck is wrong with you people?”

How do you make it through a lifetime without back pain? That just doesn’t seem right to me. Someday, I plan on having a talk with God about this deal. I’m kind of mad about it.

Believe it or not, I remember life without back pain. I specifically remember being a kid, taking a hot shower, and thinking about adults that always gripe about back pain. I had recently heard an adult talking about how standing in a hot shower made their back feel better, so that’s what made me think about it.

I thought, “That must really stink to always be hurting like that.” Well then I was smart enough to play college football and go to chiropractic school where chiropractors get to use each other as guinea pigs to learn how to help others. Yes, you could say I donated my body to science in a way. Regardless of the reasons, I am well-acquainted with the occasional back pain. It has been intense a few times. To the point of crawling to the bathroom because I couldn’t walk to get there. It’s been years since that was the case but I certainly have empathy for my patients that come through the doors like that. It can be pure misery and it’s no wonder at all why people would look to medication for a quick fix for such intense, non-stop pain. If I’m being honest, when I remember that pain, I would be be looking for anything and everything to make it stop too.

Here’s the problem though: there are but a few things that can help immediately. The good news, here, is that Chiropractic is one of the very BEST answers for this issue. The even better news is that the American Medical Association and the American College of Physicians now agree with me on this as of 2017.

That leads us into this article’s source material, which is a research paper by KT Hoiriis called “A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain.” It was published in the Journal of Manipulative Physiological Therapeutics in the July-August issue in 2004 and can be found on pages 388-398.

Why They Did It

Considering the fact that we are almost all going to suffer from low back pain at some point in our lives and considering the fact that acute pain will generally resolve and chronic pain is tough to treat, the authors of this paper were interested in trying to assess the responsiveness of SUBacute low back pain to different treatments available. The treatment the authors chose to compare were Chiropractic treatments vs. muscle relaxants and placebos.

How They Did It

  • The platform chosen by the researchers was a randomized, double-blind clinical trial. It is high-quality information when done with this sort of design.
  • They chose 192 patients that had suffered low back pain for a time period between 2 and 6 weeks in duration.
  • The patients were randomly split into three different groups for the purpose of the project.
  • They each underwent 2 weeks of treatment. One group with Chiropractic, one with muscle relaxants, and one with placebos.
  • The Outcome Assessments were performed through the use of the Visual Analog Scale (VAS), the Oswestry Disability Questionnaire, and the Modified Zung Depression Scale.
  • These assessments were performed at the beginning of treatment (baseline), at two weeks, and at the conclusion of the treatment which was at the four week mark.
  • In addition to the Assessments previously mentioned, Schobers’s flexibility test, acetaminophen usage, and the Global Impression of Severity Scale (GIS) were assessed at the 2 week mark and at the 4 week mark.

What They Found

  • The baselines were essentially the same in all of the Outcome Assessments, except for in the Global Impression of Severity Scale.
  • The subjects that actually finished the trial, 146 in all, had their data combined, revealing pain, disability, and depression, and the Global Impression of Severity Scale had ALL decreased significantly while flexibility for the low back was not altered.
  • Statistical differences through the groups showed that the chiropractic patients improved more than the control group and in terms of the Global Impression of Severity Scale, the chiropractic patients also improved more than the placebo group AS WELL AS the muscle relaxants group.
  • Wrap It Up

    Chiropractic was more beneficial than placebo in reducing pain and more beneficial than either placebo or muscle relaxants in reducing GIS.

    While this is good news from 2004, there are studies subsequent to this one showing how Chiropractic outpaces medication in the treatment of low back pain. These are part of the reason that they American Medical Association and the American College of Physicians recently published articles and papers recommending Chiropractic as first-line of treatment for acute and chronic low back pain before even taking acetaminophen or aspirin. That’s huge folks.

    Just another reason to call a chiropractor TODAY!

    Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!
    Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think.And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.

    Till next time……

    The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
    Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.
    Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.

    by Jeff S. Williams, D.C.
    Chiropractors in Amarillo
    Spinal Decompression Amarillo
    Creek Stone Integrated Care
    http://www.amarillochiropractor.com
    http://www.creekstonecare.com

    Source Material
    Hoiriis KT, et. al., “A randomized clinical trial comparing chiropractic adjustments to muscle relaxants for subacute low back pain.” J Manip Physiol Ther. 2004 Jul-Aug;27(6):388-98.
    https://www.ncbi.nlm.nih.gov/pubmed/15319761




Evidence-Backed Reason To Add Chiropractic

12/12/2017

get expert chiropractic care in Amarillo, Texas

In a recent article that I wrote, I mentioned how the Canadian health system was ahead of the American health system. Not in the traditional sense but, when speaking about the groundwork their government is laying in respect to the chiropractic profession and its integration into the overall healthcare system in Canada.

The American healthcare system is lagging far behind Canada in that respect.

Imagine that you live in a rural community. Some of you actually do live in a rural community in the middle of nowhere so that won’t be much of a leap for you. Now imagine that your choice of healthcare practitioners is only limited to 2 or 3 medical doctors. In addition, imagine that one or two of the three or four doctors in town like to prescribe pills rather than actually try to deal with the root of a musculoskeletal issue.

In a case such as that, you had better hope that the one or two remaining doctors in that town are rock stars when it comes to treating non-complicated musculoskeletal issues. Unfortunately, the chances are that he or she will not be a rockstar for musculoskeletal issues. They may be excellent at dealing with obesity, diabetes, heart disease, and high blood pressure. However, research is clear that medical doctors don’t graduate medical school with a high degree of proficiency in musculoskeletal issues.

That is simply a fact of life, not a knock against medical schools or medical doctors.

Now that the American College of Physicians as well as the American Medical Association have come out with updated recommendations that recommend chiropractic, acupuncture, and massage as first-line treatments for acute and chronic low back pain, the doors are going to be kicked wide open for Chiropractic to start shining. Finally. This is especially important for those living in small towns that are well-removed from larger cities with a wider healthcare practitioner selection.

With that in mind, I offer this latest research paper.

This one was published in the Journal of Manipulative and Physiological Therapeutics. It’s brand-new (2017) and was published in November of 2017. The title of the paper is called “Management of back pain related disorders in the community with limited access to healthcare services: a description of integration of chiropractors as service providers.” and the lead author was Dr. Peter Emary.

Why They Did It

The authors of this paper wanted to attempt to evaluate the value of chiropractic service for back pain patients when integrated into the Canadian healthcare system in a multidisciplinary, primary care setting.

How They Did It

  • Canadian medical doctors and/or nurse practitioners began referring their back pain patients at the Community Health Center to chiropractors for treatment.
  • The information from their treatment was collected over a two-year process from January 2014 to January 2016 and consisted of questionnaires that the patients completed before they began treatment and at the conclusion of the chiropractic treatment.

What They Found

  • The questionnaires containing quality information were collected from 93 patients.
  • The mean age was 49 years old and 66% of them were unemployed.
  • 77% of the patients experienced their back pain for over a month and 68% of those described it as being constant.
  • The questionnaires used in the information collection process were the Bournemouth Questionnaire, Bothersomeness, and global improvement scales.
  • A significant majority of the patients treated with chiropractic care enjoyed outstanding improvement in their condition upon the conclusion of treatment.
  • 82% of the patients reported a significant reduction in the amount of pain medication they were taking.
  • 77% of the patients had no visits with their primary doctor while they underwent chiropractic treatment.
  • 93% of the patients were fully satisfied by the care they received while treating with a chiropractor.
  • And for the cherry on the top, the patients also completed a EuroQol5 Domain questionnaire and almost 40% reported better overall, general health improvement upon completion of chiropractic treatment.
  • Wrap It Up

    To wrap up this article, I simply offer a quote from the paper itself, “Implementation of an integrated chiropractic service was associated with high levels of improvement and patient satisfaction in a sample of patients of low socioeconomic status with subacute and chronic back pain.”

    I believe that wraps it up better than I could ever do it myself, so we will just end it right there.

    Source material:
    Emary P, et. al., “Management of Back Pain-related Disorders in a Community With Limited Access to Health Care Services: A Description of Integration of Chiropractors as Service Providers” November-December 2017(40), 9, 635-642

    Just another reason to call a chiropractor TODAY!
    Research and clinical experience shows that, in about 80%-90% of headaches, neck, and back pain, in comparison to the traditional medical model, patients get good or excellent results with Chiropractic. Chiropractic care is safe, more cost-effective, it decreases your chances of having surgery, and it reduces your chances of becoming disabled. We do this conservatively and non-surgically. In addition, we can do it with minimal time requirements and minimal hassle on the part of the patient. And, if the patient develops a “preventative” mindset going forward from initial recovery, we can likely keep it that way while raising the general, overall level of health!

    Please feel free to leave a comment and tell me your thoughts. I’d love to hear what you think.And….SHARE, SHARE, SHARE!! We cannot make a difference without your help.

    Till next time……
    The Amarillo Chiropractor Blog is written by Dr. Jeff Williams.
    Amarillo TX Amarillo Pain & Accident Chiropractic Clinic provides customized chiropractic care to the Amarillo TX, Canyon TX, Pampa TX, Happy TX, White Deer TX, Dumas TX, Groom TX, Conway TX, Panhandle TX, Claude TX, Clarendon TX, Borger TX, Tulia TX, Hereford TX, Fritch TX, Bushland TX, and Vega TX communities.

    Visit our main website at www.amarillochiropractor.com for customized Chiropractic in Amarillo TX. Choose several options to schedule your appointment: call (806) 355-3000 or click the button below for our contact info.

    by Jeff S. Williams, D.C.
    Chiropractors in Amarillo
    Spinal Decompression Amarillo
    Creek Stone Integrated Care
    http://www.amarillochiropractor.com
    http://www.creekstonecare.com




Jeff Williams, DC


Serving the Panhandle for 15 years, and spending several of those years as an Amarillo chiropractor, Dr. Williams has seen it all with conditions ranging from various car wreck or auto injury to whiplash, scoliosis, herniated discs, sciatica, neck “cricks” and pinched nerves, neck pain, back pain, and low back pain, to migraines and sports injuries. I have a dream job in a dream practice where we get to help people on a daily basis. We have been very fortunate and truly blessed.


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