The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2)

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

CF 309: The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2) Today we’re going to talk about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 2) But first, here’s that sweet sweet bumper music

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OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little personality and making it profitable. We’re not the stuffy, elitist, pretentious kind of research. We’re research talk over a couple of beers. So grab you a bushel. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re spending your time with us learning together. Chiropractors – I’m hiring at my personal clinic. I need talent, ambition, smarts, personality, and easy to get along with associates. If this is you and Amarillo, TX is your speed, send me an email at [e-mail] If you haven’t yet I have a few things you should do.

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You have found yourself smack dab in the middle of Episode #309 Now if you missed last week’s episode, we talked about The WHO’s Sources For Opinion On Spinal Manipulative Therapy (Part 1). Make sure you don’t miss that info. Keep up with the class. On the personal end of things….. Hey crew, this week, we’re just kind of gearing up for Christmas because that’s a big deal. We have Christmas on a Monday this year so that’s nice and tidy, right. We don’t have to decide if we’re taking off Christmas Eve or not. It’s pretty simple this year. I have a short story about something that we went through last week here in the clinic. It jusst takes one person to really throw a monkey wrench into your week. I’ll start by saying, “Thank God I can’t prescribe medication.” Those folks have a whole extra layer of crap they have to deal with I’m sure. If you’re fresh faced and new in practice, here’s your warning, there are awful people out there in the world that just want to steal your joy for no damn reason at all. I’m better now but one of them stole mine last week. I had a patient that laid off of work. On their own. Not doctor-ordered. On the day before they decided to return to work, they came into the clinic. They told me they were only really in my clinic for their appointment to get a doctor’s note. Fine, I’m happy to see patients and I’m happy to write a note that the patient came to see me that day. Not a big deal. Pretty much every day normal stuff. The next day, the person starts harassing our front desk staffer about writing a note for them covering the days spent at home prior to their visit to our clinic. The person expected us to falsify our records and create treatment dates for them pretending they were being seen in our office. Dates they were not seen in our office. THAT’S NUTS. And immoral. And unethical. And should be embarrassing for them to even ask, much less expect and DEMAND, an office to do for them. They said I should be their advocate because I’m their doctor. If you or your patients ever thought a provider was supposed to be the patients’ advocate, get that out of your head. As you likely know, we are taught specifically, especially in the medicolegal area of healthcare, that we are NOT our patients’ advocates. We are objective care givers only. Besides that, advocating is one thing. Out and out lying and falsifying records is quite another. When the patients was told that we cannot do that, the threats started. I received an email from this person telling me that online reviews are powerful tools and that they are going to let everyone know our clinic did them wrong and make sure anyone that reads it will never come to my clinic. Really?? Using the threat of online reviews to extort a falsified doctor’s note so they don’t get into trouble at work because of their own actions? This person, who works for a big government outfit, who has probably never took a chance and built anything on their own. Who has never laid awake at night worrying about their business. Who has never poured piles of money, blood, sweat, and tears into building their own brand and reputation. Who. Has never employeed 14 people and was responsible for feeding their families. This type of person is going to try to tear us down because we wouldn’t lie for them. You cannot make this stuff up. After not getting the note they demanded, they did go ahead and leave the revenge review. We got us a 1-star out of the deal. We healthcare people cannot put people like this on blast due to HIPAA so…..we just sort of have to take it on the chin. It’s not the first time I’ve had a patient leave a completely false review but this one is the first one like this. No doubt. I have the emails and the threats. I reported the review to Yelp as false, libelous, and disparaging with the review service. Of course, Yelp doing Yelp stuff and being absolutely worthless, decided to keep the review. So…..I responded. While the reviewer just used his first name and an initial for the last, I went ahead and addressed him by his full last name. If he’s putting me on blast for no reason, I’m putting him on blast for real. Let’s get the cockroach into the daylight. After addressing him by his full name, my public response was as follows, “The first thing I would like to clear up with you that has been taught to healthcare providers through the years, is that healthcare providers are absolutely NOT advocates for patients. We cannot be advocates for our patients. We are objective caregivers. Nothing more. So you can forget that talking point. Secondly, for you to ask a healthcare provider of any type to misrepresent your treatment dates, is quite honestly shocking. We offered, and were more than happy to write you a note for the day that you were seen in our clinic. That is very customary and very appropriate. We would have even been happy to include in the note that any issue experienced was supposedly ongoing. Furthermore, we would have even been happy to leave out any part about only being in the office to get a doctors note. But we cannot, and will not pretend that we treated you on dates that we did not treat you. For you to demand that from us is quite honestly embarrassingly entitled of you. I understand that you being out of work for some amount of time might cause you issues with your supervisor. While we hate hearing that, we at Creek Stone shoulder zero responsibility in the matter and should have NEVER been expected to play a part in it in any way. You threatened to leave us a terrible review if we refused to lie for you. That will not be tolerated. In your threat to us, you claim that Yelp is a powerful tool. We absolutely understand that. While, we obviously could not prevent you from leaving us a libelous, disparaging, and legally actionable review in an attempt to prevent others from seeking care with us, we want to be clear, direct, and factual in our response. This review is nothing more than a legally actionable revenge review and we suggest you remove it immediately. Having a staff of 12 working at our clinic, and caring dearly about each one of them and their loved ones, I guess I’ll never quite understand why someone like you would try to affect our way of providing for our families. Especially when your discipline issue is your own fault.” So, I get an email that night saying that he was never asking me to falsify anything and that he would be fine with a note stating that I saw him on the date I saw him and mention that he stated that it started 3 days previous to the visit. Which would be an honest recounting of the visit I had with him. I have no problem with that. He even said he’d be happy to leave me a great review. Lol. OK, now we’re getting somewhere. I told him I have plenty of great reviews. There’s no need for that. I’m happy to provide a note recounting the encounter truthfully and honestly but I would apprecaite him removing the 1-star review. He was happy to do that and I was happy to provide an accurate note for his visit. One more joy robber vanquished. This person said they’ll never step foot in my clinic again. What a blessing. As you get busier, you get to choose who you will and who you will not do business with. I will not do business with people like this. What’s the moral? JUST BE KIND TO OTHERS. You don’t know what others deal with. Be ethical. Be generous. If you did something wrong, take responsibility for your own actions. Thast goes for provider and patient Most importantly, don’t try to tear others down based on the faults in your own actions or behavior. I tell our staff that when we have a bad one…..just remember all of the amazing, loving, and kind patients that we have all day every day. I had to take my own advice on this one. I hope the grinch takes their presents from under the tree. Item #1 Our first one continuing from part one from last week is called, “Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation” by Bronfort, et al and published in Annals of Internal Medicine in September 16, 2014. Remember; citations are in the show notes at chiropracticforward.com Bronfort G, Hondras MA, Schulz CA, Evans RL, Long CR, Grimm R. Spinal manipulation and home exercise with advice for subacute and chronic back-related leg pain: a trial with adaptive allocation. Ann Intern Med. 2014 Sep 16;161(6):381-91. doi: 10.7326/M14-0006. PMID: 25222385. Why They Did It Back-related leg pain (BRLP) is often disabling and costly, and there is a paucity of research to guide its management. The researchers wanted to determine whether spinal manipulative therapy (SMT) plus home exercise and advice (HEA) compared with home exercise and advice alone reduces leg pain in the short and long term in adults with Back-related leg pain. How They Did It

• Controlled pragmatic trial with allocation by minimization conducted from 2007 to 2011.
• Research centers (Minnesota and Iowa).
• Persons aged 21 years or older with Back-related leg pain for least 4 weeks.
• 12 weeks of SMT plus home exercise and advice or home exercise and advice alone.
• The primary outcome was patient-rated Back-related leg pain at 12 and 52 weeks.
• Secondary outcomes were self-reported low back pain, disability, global improvement, satisfaction, medication use, and general health status at 12 and 52 weeks. .
• Blinded objective tests were done at 12 weeks.
• Of the 192 enrolled patients, 191 (99%) provided follow-up data at 12 weeks and 179 (93%) at 52 weeks.

What They Found

• For leg pain, SMT plus home exercise and advice had a clinically important advantage over home exercise and advice at 12 weeks but not at 52 weeks.
• Nearly all secondary outcomes improved more with SMT plus home exercise and advice at 12 weeks, but only global improvement, satisfaction, and medication use had sustained improvements at 52 weeks.
• No serious treatment-related adverse events or deaths occurred.

Wrap It Up For patients with Back-related leg pain, SMT plus home exercise and advice was more effective than home exercise and advice alone after 12 weeks, but the benefit was sustained only for some secondary outcomes at 52 weeks. Item #2 The last one this week is called, “Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial” by Bond et al and published in Journal of Manual Manipulative therapy in February of 2020. Right before the world took a dump on itself with the COVID pandemic. Bond BM, Kinslow CD, Yoder AW, Liu W. Effect of spinal manipulative therapy on mechanical pain sensitivity in patients with chronic nonspecific low back pain: a pilot randomized, controlled trial. J Man Manip Ther. 2020 Feb;28(1):15-27. doi: 10.1080/10669817.2019.1572986. Epub 2019 Mar 5. PMID: 30935324; PMCID: PMC7006726. Why They Did It The long-term goal of our study is to improve the understanding of the biological mechanisms associated with spinal manipulative therapy (SMT) in low back pain How They Did It

• This project involved a pilot randomized, blinded clinical trial of 3-week SMT in chronic nonspecific low back pain (CNSLBP) patients.
• They recruited 29 participants and randomly assigned them into either a SMT or sham SMT group.
• Pre- and postintervention, they quantified the effect of SMT on clinical outcomes (Numeric Pain Rating Scale and Oswestry Disability Index) and pressure pain threshold at local (lumbar spine), regional (lower extremity), and remote (upper extremity) anatomical sites.

What They Found

• The researchers observed a significant main effect for time signifying reduced hypersensitivity (increased pressure pain threshold) at local and regional locations at 3 weeks.
• Furthermore, they found significant main effects of time indicating improvements in pain and disability from baseline among all participants regardless of intervention.
• However, no between-group differences were observed in pressure pain threshold, clinical pain, or disability between the SMT and sham SMT groups over 3 weeks.

Wrap It Up After 3 weeks of SMT or sham SMT in chronic nonspecific low back pain patients, we found hypoalgesia at local and remote sites along with improved pain and low back-related disability Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. The world needs evidence-based, patient-centered practitioners driving the bus. The profession needs us in the ACA and involved in leadership of state associations. So quit griping about the profession if you’re doing nothing to make it better. Get active, get involved, and make it happen. Let’s get to the message. Same as it is every week. Store Remember the evidence-informed brochures and posters at chiropracticforward.com.

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

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