Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry?

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 134: Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry?

Today we’re going to talk about Sleep and Cardiovascular Issues & Can Chiropractic Learn From Podiatry? But first, here’s that sweet sweet bumper music

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

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Do it do it do it. You have found yourself smack dab in the middle of Episode #134 Now if you missed last week’s episode, we talked about getting patients back to your office during COVID, shoulder impingement, cervical manipulation, and x-rays and neurodegenerative disease. That one was FULL of great information. Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. I’ve been holding pretty steady at 80-85% of where I’d like to be in my practice. While that’s frustrating, it’s also 100% understandable and patience has to kick in and we must simply wait it out. I am an eternal optimist. Or at least I try to be. I think it’s important. For example, we are making less money BUT we are also spending less money. Not only in my office in overhead but also at home. We’re not taking trips or going and doing. We’re not eating out like we did this time last year. So, not as much money is required. We are more than meeting our monthly bills. If I really take a step back and look at it from a macro view, life is good. I have a bit of extra time to do the things I need to do outside of patient treatment and, due to less spending, a decrease in income isn’t as significant as it would have been. It’s not fun. Don’t get me wrong. Nobody that is an achiever wants to take a step back at any time. For me, it’s pedal to the metal man. Constant and sustained growth. So, even though there are legitimate reasons, it doesn’t matter. It’s still a hit to the heart to see your business shrink. But, again, being an optimist is helpful. It’s going to be alright. I asked for some recommendations in our private Facebook group about how to get your patients to return to your offices during the COVID freakout. Dr. Jerome Fryer with Dynamic Disc Designs had a great suggestion. He said, “Do a walk through video…showing the safety measures exacted. Personalized and live. Share it to your email list and social followers.” That’s a great suggestion. While I was going through all of the things I am doing on last week’s episode, I mentioned how in marketing, our job is to remove all barriers to saying, ‘Yes.’ Well, COVID is the biggest barrier we face at this time so we have to remove that barrier. We aren’t epidemiologists so we won’t be coming up with any treatments or vaccines of course. So, the way we can remove that barrier as much as possible is to show the safety measure we are taking. Talk about it, video it, demonstrate it. And let your patients see you cleaning while they’re in the office. Those coming to see you already will feel even that much more comfortable with your office when they see you taking steps to keep them and others safe. Remove the barriers to saying yes. Alright, let’s dive in Item #1 Let’s start though with this one here called “Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality” It was authored by Wang et. al.(Wang Y 2020) and appeared in JAMA on May 22 of 2020 and dammit that’s a blazing barrel of biscuits my friends. Why They Did It The authors wanted to know if there were any longitudinal patterns of habitual sleep duration associated with the subsequent risk of cardiovascular events and all-cause mortality. How They Did It

• This was a cohort study that included 52 599 participants
• 4 distinct sleep duration trajectories reported during a 4-year interval were identified.
• Compared with a stable sleep duration of 7.0 to 8.0 hours per night, normal-decreasing and low-increasing patterns were associated with increased risk of first cardiovascular events and all-cause mortality
• individuals reporting consistently sleeping less than 5.0 hours per night had the highest risk

Wrap It Up In this study, sleep duration trajectories with lower or unstable patterns were significantly associated with increased risk of subsequent first CVEs and all-cause mortality. Longitudinal sleep duration patterns may assist in more precise identification of different at-risk groups for possible intervention. People reporting consistently sleeping less than 5 hours per night should be regarded as a population at higher risk for CVE and mortality. Before we get to the next paper, I want to tell you a little about this new tool on the market called Drop Release. If you’re into IASTM also known as instrument-assisted soft tissue manipulation, then it’s your new best friend. Heck if you’re just into getting more range of motion in your patients, then it’s your new best friend. Drop Release is a revolutionary tool that harnesses the body’s built-in protective systems to make muscles relax quickly and effectively. This greatly reduces the time needed for soft tissue treatment, leaving more time for other treatments per visit, or more patients per day. Its inventor, Dr. Chris Howson, from the great state of North Dakota has is a listener and friend. He offered our listeners a great discount on his product. When you order, if you put in the code ‘HOTSTUFF’ all one word….as in hot stuff….coming up!! If you enter HOTSTUFF in the coupon code area, Dr. Howson will give you $50 off of your purchase. Go check out Drop Release at droprelease.com and tell Dr. Howson I sent you. Item #2 Item #2 is one I got from Dr. David Wedemeyer who resides out in Costa Mesa, California. I have no idea how I didn’t know about this one already. It’s called “How can chiropractic become a respected mainstream profession? The example of podiatry” by Donald Murphy, et. al.(Murphy D 2008) and published in Chiropractic Osteopathy in 2008. Why They Did It The chiropractic profession has succeeded to remain in existence for over 110 years despite the fact that many other professions that had their start at around the same time as chiropractic has disappeared. Despite chiropractic’s longevity, the profession has not succeeded in establishing cultural authority and respect within mainstream society, and its market share is dwindling. In the meantime, the podiatric medical profession, during approximately the same time period, has been far more successful in developing itself into a respected profession that is well integrated into mainstream health care and society. The objective here was to present a perspective on the current state of the chiropractic profession and to make recommendations as to how the profession can look to the podiatric medical profession as a model for how a non-allopathic healthcare profession can establish mainstream integration and cultural authority. We suggest the chiropractic profession consider several questions that speak to the different histories of the chiropractic and podiatric profession. Why are podiatrists better integrated into hospitals and other multidisciplinary facilities than chiropractors? Why are most schools of podiatry integrated into the university system, while chiropractic schools (with very few exceptions) are not? Why did the AMA not try to “contain and eliminate” the podiatric medical profession (despite the several turf battles podiatry has had with the orthopedic specialty)? Why were podiatrists not thrown in jail in the early days for practicing medicine without a license? How did podiatrists gain the level of cultural authority that they currently enjoy, despite having the same duration of existence and a smaller number of practitioners than chiropractic? Discussion One important reason podiatry succeeded in establishing itself in mainstream health care was its traditional dedication to public health. Podiatrists became active members of the American Public Health Association (APHA) as far back as the 1950s, embracing and contributing to the advancement of accepted public health initiatives, in cooperation with others involved in public health. Podiatrists slowly gained an image as proponents of public health, at a time when many chiropractors aggressively (and dogmatically, without evidence opposed many public health measures such as vaccination and water fluoridation. One immediate action step that individual chiropractic physicians can make is to join and become active in the APHA. This would be one of the best ways for chiropractors to have an influence on public health policy. Spinal pain is an enormous public health issue, as the vast majority of Americans will develop a painful back or neck that will require treatment sometime in their lives It is also vital that those chiropractors who dogmatically oppose common public health practices, such as immunization and public water fluoridation, cease such unfounded activity. Authors say they are concerned that the common perception (which is well supported, in our experience) that chiropractors are only interested in “selling” a lifetime of chiropractic visits may be one of the primary factors behind our low standing in the minds of members of the public. This is supported by a Canadian study which found that when the public was educated about “subluxation”, the cornerstone of many chiropractors’ “lifetime treatment plans”, members of the public actually developed a negative view, and were more likely to want to consult a medical doctor to see if they had a subluxation prior to seeing a chiropractor They say that we chiropractors must take a critical look at our educational institutions, find what is substandard, and correct those deficiencies. One of the problems that we encounter frequently in our interaction with chiropractic educational institutions is the perpetuation of dogma and unfounded claims. Examples include the concept of spinal subluxation as the cause of a variety of internal diseases and the metaphysical, pseudo-religious idea of “innate intelligence” flowing through spinal nerves, with spinal subluxations impeding this flow. These concepts are lacking in a scientific foundation and should not be permitted to be taught at our chiropractic institutions as part of the standard curriculum. Much of what is passed off as “chiropractic philosophy” is simply dogma, or untested (and, in some cases, untestable) theories which have no place in an institution of higher learning, except perhaps in a historical context. Faculty members who hold to and teach these belief systems should be replaced by instructors who are knowledgeable in the evidence-based approach to spine care and have adequate critical thinking skills that they can pass on to students directly, as well as through teaching by example in the clinic. They say consideration should also be given to upgrading admission requirements to chiropractic schools. In podiatric medicine, such upgrading, which included the requirement of the Medical College Admission Test (MCAT), a requirement of medical school admission, is considered one of the significant events in the profession’s history, giving the profession legitimacy in its calls for parity with medicine Continuing with education, they say it is essential that the chiropractic profession establish hospital-based residencies. There is a tremendous void in how chiropractic graduates develop any meaningful hands-on clinical experience with real patients in real-life situations. Perhaps the most important factor that helped the podiatric medical profession to flourish was the fact that podiatrists had a clear identity and purpose; the podiatric medical profession was founded on the purpose of filling a need in society – the care of problems of the foot. They did not invent a “lesion” and a “philosophy” and try to force it on the public. They certainly did not claim that all disease arose from the foot, without any evidence to support this notion The podiatric medical profession focused on a particular set of problems for which allopathic medicine had little interest and a limited ability to deal with effectively, i.e., common foot disorders The chiropractic profession must establish a clear identity and present this to society. In the beginning, DD Palmer invented a lesion, and theory behind this lesion, and developed a profession of individuals who would become champions of that lesion. This is not what credible professions do. Based on all the evidence regarding chiropractic practice and education, there is only one societal need (but it is a huge one) that chiropractic medicine has the potential to meet: non-surgical spine care. Our education and training is focused on the spine, and clearly, if there is a common bond among all chiropractors, it is spine care No matter how one looks at it, or what one would like reality to be, chiropractic medicine is about back pain, neck pain, and headache. Instead of fighting that fact (or denying it), we should embrace it fully and focus on becoming society’s go-to profession for disorders in this area. The World Federation of Chiropractic (WFC) has taken an important step in establishing a clear identity for chiropractors as “The spinal health care experts in the health care system”. It is critical that other state, provincial and national associations follow the lead of the WFC. Fidelity to the social contract. They say when an individual consults a member of any of the medical professions, it is reasonably expected that the advice and treatment that he or she receives is based in science, not metaphysics or pseudoscience. In addition, it is reasonably expected that the services he or she receives are being provided for the primary purpose of benefiting the patient, and not for any other reason. The financial benefit to the professional is secondary and results from the degree of the clinical benefit received by the patient. Patients place their faith in the professional, and trust that they will not be subject to fraud, abuse, or quackery. This is the social contract as it applies to chiropractic physicians. Oh, how many times has my audience heard me railing against doctor-centered, clinic-centered practices? Just in the last month or so actually. Lol. We feel it is important here to briefly contrast and compare podiatry and foot reflexology. While the two professions have always been distinct, there is a commonality in that each focuses its treatment efforts on the foot; however, this is where any resemblance between the two professions ends. Podiatric medicine is a science-based profession dedicated to the diagnosis and treatment of foot disorders. Foot reflexology is a metaphysically-based group consisting of non-physicians who believe that many physical disorders arise from the foot. Podiatrists have rejected foot reflexology as an unproven and unscientific practice, and do not consider it part of mainstream podiatric practice. Thus, it would be quite unreasonable to think that podiatry and foot reflexology could ever exist under one professional roof. Yet, this is the very untenable situation in which we find ourselves in the chiropractic profession. Chiropractic has frequently been described as being two professions masquerading as one, and those two professions have attempted to live under one roof. One profession, the “subluxation-based” profession, occupies the same metaphysical and pseudoscientific space as foot reflexology. The other chiropractic profession – call it “chiropractic medicine” as we do in this commentary – has attempted to occupy the same scientific space as the podiatric profession. Alas, the marriage of convenience between these two chiropractic professions living under one roof has not worked. We find science-based practitioners and organizations alongside quasi-metaphysical, pseudoreligious, pseudoscientific practitioners, and organizations. The result is continually battling with a huge waste of energy and resources, while professional growth stagnates. We must finally come to the painful realization that the chiropractic concept of spinal subluxation as the cause of “dis-ease” within the human body is an untested hypothesis. It is an albatross around our collective necks that impedes progress. Wrap It Up “The chiropractic profession has great promise in terms of its potential contribution to society and the potential for its members to realize the benefits that come from being involved in a mainstream, respected, and highly utilized professional group. However, there are several changes that must be made within the profession if it is going to fulfill this promise.” I could add my own thoughts here but listeners of the show know what I think about it. I agree with every word and I bitch and fuss and get in a huff about this stuff all of the time. I don’t know that getting in a huff all of the time is useful or helpful. I think it lessens my outrage if I’m outraged all of the time. So, I’m settling down here lately. I want to make points but not in a truly negative sense. I want to disagree without being disagreeable. That’s not to say I’m not going to lose my marbles here and there. I will. This profession provides so many opportunities for lost marbles, It’s something you can count on. But, I’d like for the lost marbles to be fewer and farther between with more building rather than breaking. If that makes sense. Alright, that’s it. Y’all be safe. Keep changing the world and our profession from your little corner of the world. Continue taking care of yourselves and taking care of your neighbors. Tough times are upon us but, the sun will shine again. Trust it, believe it, count on it. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

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 preventativly after initial recovery, we can usually keep it that way while raising the overall level of health! Key Point: At the end of the day, patients should have the guarantee of having the best treatment that offers the least harm. When it comes to non-complicated musculoskeletal complaints…. That’s Chiropractic! Contact Send us an email at dr dot williams at chiropracticforward.com and let us know what you think of our show and tell us your suggestions for future episodes. Feedback and constructive criticism is a blessing and so are subscribes and excellent reviews on podcast platforms. We know how this works by now. If you value something, you have to share it, interact with it, review it, talk about it from time to time, and actively hit a few buttons to support it here and there when asked. It really does make a big difference. Connect We can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward. Website

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• Murphy D, S. M., Seaman D, Perle S, Nelson C, (2008). “How can chiropractic become a respected mainstream profession? The example of podiatry.” Chiropr Osteopat 16(10).
• Wang Y, W. J., Chen S, (2020). “Association of Longitudinal Patterns of Habitual Sleep Duration With Risk of Cardiovascular Events and All-Cause Mortality.” JAMA Open 3(5).

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