Manual & Passive Therapies For The Neck and Acupuncture For Post-Surgical Pain

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 210: Manual & Passive Therapies For The Neck and Acupuncture For Post-Surgical Pain

Today we’re going to talk about Manual & Passive Therapies For The Neck and then we’ll talk about Acupuncture For Post-Surgical Pain But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are making evidence-based chiropractic fun, profitable, and accessible while we make you and your patients better all the way around. We’re the fun kind of research. Not the stuffy, high-brow kind of research. We’re research talk over a couple of beers. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. If you haven’t yet I have a few things you should do.

• Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s a great resource for patient education and for YOU. It saves you time in putting talks together or just staying current on research. It’s categorized into sections and written in a way that is easy to understand for you and patients. Just search for it on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.
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You have found yourself smack dab in the middle of Episode #210 Now if you missed last week’s episode, we talked about Chiropractic Cost-Effectiveness & Early MRIs Lengthen Disability. Make sure you don’t miss that info. Keep up with the class.

On the personal end of things…..

Just getting ready for Christmas. We talked a little last week about marketing and how we’re trying to set up our nurse practitioner for success. I am currently going through a couple of different Fiverr sellers and creating a sales funnel. We are going to test it on our hormone pellets. Let’s keep our fingers crossed because if a sales funnel works on hormone pellets, then why wouldn’t it work for IV Therapy? PRP injections? Car Wreck patients? Spinal decompression patients? Just regular ol’ family practice patients? And on and on and on.

You could conceivably and easily figure out your services that offer the highest ROI and then you could create a sales funnel for each.

Or….as in my case, have a Fiverr salesperson that knows more about it create it. Wouldn’t that be amazing if you could spend maybe $1000 per month on all of these ads funneling people into your different systems? Then they get the automated email trickles for whichever Funnell they happen to be in? And then they start calling and making appointments?

As we all know, this is a very real thing in lots of industries. Including healthcare. I’m certain I’m not the first to consider it but it’s kind of new thinking for me personally and I’m hoping that my hormone pellet funnel test bears fruit because if it does, it’s on like Donkey Kong.

I’ll be all over it and I’ll already have the people in place that can help me do it. So, that’s exciting.

No interns from Parker picked our office here in Amarillo, TX to come to visit for the Spring so looks like we’re on our own for the first 1/3 of 2022. But that’s OK, I’ve been on my own for like 24 years so I think we’ll be alright.

On the side gig part of things, voice-over is still absolutely killing it. I never would have imagined what was possible for me in the voice-over industry. I’m still small potatoes when compared to what some of the guys make but for someone that’s only been in it for about a year, it’s been a game-changer when you consider keeping my life the same and still being able to fund other interests like real estate investing.

This year’s voice-over activities more than doubled the down payment we made on the investment property we just closed on in Lubbock, TX. If you ever need a voice-over for your phone system, an online ad, podcast, TV/Radio ad, just holler. I got you. Send me an email at [e-mail] or visit my voice-over website at www.jeffwilliamsvoice.com and we’ll connect.

Speaking of investment property, if you’ve been listening, we bought a small house in Lubbock, TX, and closed on it last week. We are turning it into a short-term rental, we’ll call it an STR for short. That’s an Airbnb or Vrbo house. And they pay very well.

Now, why live an hour and a half away from your STR? Won’t that be difficult? The answer to the first question is because, while I love my hometown of Amarillo, TX, we don’t have a Division I college with a medical school and a law school.

Lubbock has Texas Tech there so they have the concerts and the graduations and the big football games and sports and traveling professors and all of that good stuff. Things that Amarillo just doesn’t have. And it’s only an hour and a half from here so we can still get there to handle any issues. Besides that, most issues are not truly emergencies so as long as you have a dependable cleaner and a dependable handyman to be your eyes and ears on the ground and to take care of things when necessary, you don’t need to live in the same market.

People live in Ohio and self-manage their STRs in Florida or the Smokie Mountains. Self-managing remotely should not be difficult at all. The ones doing it say that it takes about 15-20 minutes per week per house to self-manage. If there’s a plumbing issue, you’d call a plumber just like you would for your own house, give them the door code to get in and handle things, and voila!

These days they have smart houses. Wireless thermostats, deadbolts, external property cameras, and water controls for the garden. You don’t have to have any contact with anyone. Just give them the code to the door. That goes for the guests as well. You can buy STRs already furnished, which is my preference. This one was not so we’re having to purchase everything new for the house. They say count on $10,000 per bedroom if you’re furnishing it. So a 3 bedroom house, we would budget $30,000 in furnishings.

Truthfully, I think we’re coming in at about 1/3 lower than that benchmark. Because I have shopper of a wife and she knows how to find the deals.

Anyway, we spent Saturday down in Lubbock setting it up and building furniture and all that good stuff. We didn’t even get close to getting it ready but we got further than we were. We’ll head back down this weekend and keep grinding until we can get it up and running and ready for our guests to have an excellent experience.

Then, we have a long-term rental here in Amarillo that we used to live in ourselves. Once we moved out, we just held onto it and rented it out. We are refinancing it currently. We will take out the money that is there with the increased value of the home and we’ll put that down on an STR in the Florida area. We’re getting our system of self-management down with this closer Lubbock property. Then we’re taking the show on the road and going bigger.

People will always go to the beach and they’ll always go to Disney so that’s the plan. Keep listening in for updates. I tend to share everything with y’all so you know I’ll be talking about it.

Now on with it.

Item #1

Let’s start off with this one called “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration” by Wong et. al. (Wong JJ 2016) and published in Spine Journal in December of 2016, As a side note, this may be the longest of any title anywhere. They should work on their naming prowess.

Why They Did It

In 2008, the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders (Neck Pain Task Force) found limited evidence on the effectiveness of manual therapies, passive physical modalities, or acupuncture for the management of whiplash-associated disorders (WAD) or neck pain and associated disorders (NAD). This review aimed to update the findings of the Neck Pain Task Force, which examined the effectiveness of manual therapies, passive physical modalities, and acupuncture for the management of WAD or NAD.

How They Did It

• This was a systematic review and best evidence synthesis.
• The sample includes randomized controlled trials, cohort studies, and case-control studies comparing manual therapies, passive physical modalities, or acupuncture with other interventions, placebo or sham, or no intervention.
• They systematically searched five databases from 2000 to 2014
• Studies with a low risk of bias were stratified by the intervention’s stage of development (exploratory vs. evaluation) and synthesized following best evidence synthesis principles.
• They screened 8,551 citations, and 38 studies were relevant and 22 had a low risk of bias.

What They Found Evidence from seven exploratory studies suggests that

1. for recent but not persistent NAD grades I-II, thoracic manipulation offers short-term benefits;
2. for persistent NAD grades I-II, technical parameters of cervical mobilization (eg, direction or site of manual contact) do not impact outcomes, whereas one session of cervical manipulation is similar to Kinesio Taping; and
3. for NAD grades I-II, strain-counterstrain treatment is no better than placebo.

Evidence from 15 evaluation studies suggests that (1) for recent NAD grades I-II, cervical and thoracic manipulation provides no additional benefit to high-dose supervised exercises, and Swedish or clinical massage adds benefit to self-care advice; (2) for persistent NAD grades I-II, home-based cupping massage has similar outcomes to home-based muscle relaxation, low-level laser therapy (LLLT) does not offer benefits, Western acupuncture provides similar outcomes to non-penetrating placebo electroacupuncture, and needle acupuncture provides similar outcomes to sham-penetrating acupuncture; (3) for WAD grades I-II, needle electroacupuncture offers similar outcomes as simulated electroacupuncture; and (4) for recent NAD grades III, a semi-rigid cervical collar with rest and graded strengthening exercises lead to similar outcomes, and LLLT does not offer benefits.

Wrap It Up

Our review adds new evidence to the Neck Pain Task Force and suggests that mobilization, manipulation, and clinical massage are effective interventions for the management of neck pain. It also suggests that electroacupuncture, strain-counter strain, relaxation massage, and some passive physical modalities (heat, cold, diathermy, hydrotherapy, and ultrasound) are not effective and should not be used to manage neck pain I don’t know what to think about this one, to be honest.

In one part it seems they don’t assign any effectiveness to manipulation but then in the conclusion, they say it’s an effective intervention. What gives? Who the hell knows. All I have access to is the abstract. I can tell you that while anecdotal, you can’t convince me that manipulation doesn’t provide significant relief. Sometimes immediately. You’ve seen them come in with a locked up neck and one adjustment increases their range of motion immediately and pain levels are reduced fairly quickly. Combined with some exercise and strain/counterstrain, they leave the office skipping down the street and singing along with Louie Armstrong on ‘What a wonderful world.” I know systemic reviews are high-level research. I’ve just seen so many other papers showing impressive effectiveness that this one doesn’t really move me one way or the other.

Item #2

Last one today is called, “Effects of Acupuncture on Postoperative Pain After Total Knee Replacement: Systematic Literature Review and Meta-Analysis” by Ko et. al. (Hsing Fang Ko 2021) and published in Pain Medicine on June 21, 2021…damnit….so hot.

Why They Did It They wanted to identify the analgesic effectiveness of acupuncture after total knee replacement by systematic review.

How They Did It

• A search of randomized controlled trials was conducted in five English medical electronic databases and five Chinese databases.
• Two reviewers independently searched in five English medical electronic databases and five Chinese databases.
• Two reviewers independently retrieved related studies, assessed the methodological quality, and extracted data with a standardized data form.
• Meta-analyses were performed with all-time-points meta-analysis.
• A total of seven studies with 891 participants were included.

What They Found

• The meta-analysis results indicated that acupuncture had a statistically significant influence on pain relief.
• The subgroup analysis results showed that acupuncture’s effects on analgesia had a statistically significant influence.
• Electroacupuncture frequency ranged between 2 and 100 Hz.

Wrap It Up

As an adjunct modality, the use of acupuncture is associated with reduced pain and the use of analgesic medications in postoperative patients. In particular, ear acupuncture 1 day before surgery could reduce analgesia. Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in the leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week.

Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!

The Message

I want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk vs reward ratio because spinal pain is primarily a movement-related pain and typically responds better to movement-related treatment rather than chemical treatments like pills and shots. When compared to the traditional medical model, research and clinical experience show us patients can get good to excellent results for headaches, neck pain, back pain, and joint pain to name just a few. It’s safe and cost-effective can decrease surgeries & disability and we do it through conservative, non-surgical means with minimal hassle to the patient. And, if the patient treats preventatively after initial recovery, we can usually keep it that way while raising the overall level of health!

Key Point:

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

Contact

Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference.

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

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About the Author & Host

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

Bibliography

• Hsing Fang Ko, C.-H. C., PhD, Kai-Ren Dong, Hsien-Chang Wu (2021). “Effects of Acupuncture on Postoperative Pain After Total Knee Replacement: Systematic Literature Review and Meta-Analysis,.” Pain Med 22(9): 2117-2127.
• Wong JJ, S. H., Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G, Carroll LJ, Ameis A, Ammendolia C, Brison R, Nordin M, Stupar M, Taylor-Vaisey A, (2016). “Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration.” Spine J 16(12): 1598-1630.

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