The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy

The Chiropractic Forward Podcast: Evidence-based Chiropractic Advocacy
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The Chiropractic Forward podcast clearly demonstrates how research, evidence, and experience puts Chiropractic Care firmly in consideration for integration into the mainstream healthcare. Advanced chiropractic knowledge, learning, and active chiropractic protocols have been clinically proven to be effective for mechanical pain. The newest recommendations coming from the medical world align chiropractic with the most effective protocols currently available for back and neck pain.

  1. 13H AGO

    PRP For Knee OA & Diagnosing Cervical Arterial Dissection

    CF Ep. 386: PRP For Knee OA & Diagnosing Cervical Arterial Dissection Today we’re going to talk about PRP For Knee OA & Diagnosing Cervical Arterial Dissection But first, here’s that sweet sweet bumper music     Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   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, judgmental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast. I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff together.   Hiring Plug 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 creekstonecare@gmail.com   Things You Should Do Go to Amazon and BUY my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. Easy to understand and easy to support everything you do. It’s on Amazon. Like our Chiropractic Forward Facebook page, Join our private Chiropractic Forward Facebook group, and then Review our podcast Check our website at chiropracticforward.com   You have found yourself smack dab in the middle of Episode #386 Now if you missed last week’s episode, we talked about Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally. Make sure you don’t miss that info. Keep up with the class.   On the Personal End of Things… Here we are, mid March in 2026. And what do I have going on? Well, a lot of the same as last week so let’s just hop into some advice based on what I’m currently focusing on in my life and career at 53 years old. The biggest advice to younger chiropractors is get a plan in advance. Don’t wait until you’re 48 to go, Hey, you know, at some point, I might want to retire. I had a buddy who was older than me that ended up getting cancer and passing away before he enacted any kind of retirement plan. His wife was left with a business that wasn’t worth anything with him gone, and all she could do was sell it for parts. I don’t know their finances at all. But if he hadn’t laid down some plans for her, that probably didn’t work out very good. Make plans early. I have another buddy… who ended up… having a heart attack and dying right there in his practice. He was in his 70s. Some people want to work that long, period. They love it that much. I love what I do for a living, but I don’t want to do it my whole life. I have another buddy who was in his 60s, and just a year or two ago, had a stroke, and can’t speak. So all of his patients had to go somewhere else, and he had to close down his shop and sell it off for parts. This all goes to say, for most of you, when you’re building your practice, build it to sell. Don’t name it after yourself. It’s hard to sell Williams Chiropractic to Joseph Salazar. Don’t make all of the marketing all about you. When it’s person-driven, your clinic is associated so strongly with YOU that it’s hard to remove yourself and turn it over to someone else. My practice is called Creek Stone Integrated Medical. It was Creek Stone Integrated Care before we added our medical branch. You can sell that to anybody. I think you get my point there. Build it to sell, plan early. Roth IRAs, compound interest. Maybe you get some inheritance along the way. And a side gig or two that you enjoy isn’t always the worst idea either. If you want to work your whole damn life, that’s OK. That’s just not what I want for my one and only trip on this rock. Alright, that’s it. I don’t have a lot more to share personally than that this week. I’m just getting ready for the QME test. Which will be in mid April. Once I hopefully pass that dude, one of my side gigs will be engaged, so cheers to that. Let’s get into the research.   Item #1 Our first one today is called, “Validation of a Diagnostic Support Tool for the Early Recognition of Cervical Arterial Dissection in Primary Care” by Thomas et al published in December 2024, and it’s a hot potato, Remember, the citations can be found at chiropracticforward.com under this episode. Citation: L. Thomas, M. Fowler, L. Marsh, K. Chu, Claire Muller, A. Wong, Validation of a diagnostic support tool for early recognition of cervical arterial dissection in primary care, Clinical Neurology and Neurosurgery, Volume 247, 2024, 108627, ISSN 0303-8467, https://doi.org/10.1016/j.clineuro.2024.108627. (https://www.sciencedirect.com/science/article/pii/S0303846724005146)   Why They Did It Cervical arterial dissection is one of the leading causes of stroke in young adults, and here’s the tricky part — it often shows up first looking just like everyday musculoskeletal pain. Neck pain, headache — things that walk through chiropractic and primary care doors every single day. The problem is, there are currently no validated tests to help clinicians identify it early. That means it can get missed, and a missed CeAD can mean a missed stroke. The goal of this research was to validate a diagnostic support tool that could help clinicians in primary care know when to refer urgently for imaging, when to monitor, and when it’s safe to proceed with treatment.   How They Did It This was a prospective observational study. They took adults over 18 years old presenting to a tertiary metropolitan hospital with an initial diagnosis of headache or neck pain — sound familiar? Participants were split into those with radiologically confirmed CeAD and controls without CeAD. They crunched the diagnostic values, looked at sensitivity and specificity, and then refined the tool based on what they found.   What They Found Thirty participants had confirmed CeAD and 261 were controls with non-CeAD causes of headache and neck pain. The original tool was an excellent predictor with an AUC of 0.83, but it had poor specificity — meaning too many false positives.  So they refined it. The updated tool uses four simpler, equally-weighted criteria: acute or sudden onset of pain, unusual or unfamiliar headache or neck pain, recent trauma or infection, and neurological features. Each criterion scores 1 point for a total of 4. At a cut-off of 3 out of 4, the refined tool hit 100% sensitivity and 74% specificity Wrap It Up This is pretty important for us! The refined tool shows solid clinical utility at a cut-off of 3 or higher, and the recommendation is clear: at that score, refer for vascular imaging. The authors acknowledge that further validation in emergency departments and primary care settings is still needed, but the foundation is strong. For chiropractors, this is a practical screening tool. Sudden, unusual neck pain or headache plus any neurological features in a patient under 55 should be raising flags. Know the signs, use a tool like this, and refer when the score demands it. Stroke prevention starts in our offices. You don’t wanna be a dummy and end up in court and your name run down in your town.   Item #2 The last one this week is called, “Efficacy and Safety of Platelet-Rich Plasma and Hyaluronic Acid Combination Therapy for Knee Osteoarthritis: A Systematic Review and Meta-Analysis” by Gao, Ma, Tang, Zhang, and Zuo, published in the Archives of Orthopaedic and Trauma Surgery in September of 2024. New enough to smoke!! Remember, the citations can be found at chiropracticforward.com under this episode. Gao J, Ma Y, Tang J, Zhang J, Zuo J. Efficacy and safety of platelet-rich plasma and hyaluronic acid combination therapy for knee osteoarthritis: a systematic review and meta-analysis. Arch Orthop Trauma Surg. 2024 Sep;144(9):3947-3967. doi: 10.1007/s00402-024-05442-y. Epub 2024 Jul 7. PMID: 38972025 Why They Did It Knee osteoarthritis is one of the most common degenerative joint conditions out there, and it hammers quality of life. The traditional conservative options — corticosteroids, hyaluronic acid injections, NSAIDs — offer temporary relief at best and come with real side effects. Platelet-rich plasma, or PRP, has been generating a lot of buzz as a regenerative alternative. Hyaluronic acid has been a go-to injectable for years. But what happens when you combine them? That’s what this team wanted to know. Is PRP plus HA more effective and safer than either treatment alone? How They Did It This was a systematic review and meta-analysis, the gold standard of evidence-based research. They searched MEDLINE, the Cochrane Library, EMBASE, and Web of Science for articles published up through January 2024. They only included randomized controlled trials — the highest quality study design — that directly compared PRP plus HA combination therapy against PRP alone or HA alone. Primary outcomes were pain, functional outcomes, and adverse events. They followed PRISMA guidelines, used two independent researchers for data extraction, and applied fixed or random effects models based on heterogeneity. Ten RCTs involving 943 patients were included.   What They Found The combination of PRP and HA produced more significant pain reduction and functional improvement compared to HA treatment alone. And here’s a clinically important piece — the combination therapy also appeared to have a higher safety profile than either PRP or HA used as monotherapy. In other words, you get better results AND fewer adverse events when you combine them. That’s a pretty compelling argument for combination thera

    17 min

  2. 6D AGO

    Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally

    CF 385: Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally Today we’re going to talk about Tears In The Shoulder Are Waaayyy Normal & Adolescent Cannabis Use Is Dangerous Long Term Mentally But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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 creekstonecare@gmail.com Things you should do.  Go to Amazon and BUY my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. Easy to understand and easy to support everything you do. It’s on Amazon. Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast  Check our website at chiropracticforward.com You have found yourself smack dab in the middle of Episode #385 Now if you missed last week’s episode, we talked about Motor Weakness In Cervical Radiculopathy & Exercise And Dementia. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Well, as you might guess, things have been crazy. I recently returned from about 6 days out in Los Angeles where I was taking a prep class for the QME exam that’s coming up this Spring. What is a QME you might ask. Well let me clear that up for you, friend. It stands for Qualified Medical Evaluator and once I’m a QME, I’ll fly out to California every 4-5 weeks or so and spend a couple of days doing impairment ratings exams on injured workers. Then fly home and do all the reports.  For the QME exam, it’s about a 50/50 pass/fail rate on that deal and I plan on passing that dude the first time around. Ain’t nobody got time to do it again. Of course, I will if I need to but I don’t plan on it, man.  Outside of that, we’ve been getting this new associate up and running and y’all, she’s just a gem. Plain and simple. I’m really proud of her. She’s smart, she’s good with patients, she’s a good adjuster, and she just gets it. You show her once and she’s got it. Lots of times better than I got it! We are working hard on our PVA. I see patients around 8-9 times lifetime. And that’s with having VA and PI patients that are compelled to come in. That’s terrible and we are underserving by strictly looking at pain.  We are transitioning into pain relief followed by the functional movement screen, and then into maintenance. We believe this will better serve the patient but will also see our PVA go from around 8-9 up to about 15 or so. I can live with that. And our assoicate is all over it as well.  I’m the one that is FMS certified but made intense notes and through the help of AI, have created a way of training her up on FMS and now, she does it better than I ever did. Plus, she has the time to do it whereas, I just don’t.  So, we have all that. Through our new nurse prac, we are bringing in peptides and getting that all up and rolling so again…..lots and lots of action here with your ol uncle Jeffro. Trust that I’m not falling behind on the podcasts because I don’t care. I am just trying to balance this crazy life.  Becomeing a QME is no joke. It Ain’t easy my friends.  Wiith that, let’s jump in on that research.  Item #1 Our first one today is called, “Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging” by Ibounig et al and published in Jama Internal Medicine in February of 2026 and check out the shizzle on that shucker!! Remember, the citations can be found at chiropracticforward.com under this episode.  Ibounig T, Järvinen TLN, Raatikainen S, et al. Incidental Rotator Cuff Abnormalities on Magnetic Resonance Imaging. JAMA Intern Med. Published online February 16, 2026. doi:10.1001/jamainternmed.2025.7903 Why They Did It Shoulder pain is a common musculoskeletal complaint often attributed to rotator cuff (RC) abnormalities. Diagnostic imaging is frequently used, but the association between RC abnormalities and shoulder symptoms remains uncertain. Objective  To determine the prevalence of RC abnormalities in a general population sample and their association with shoulder symptoms. How They Did It Population-based cross-sectional study in a nationally representative random sample of adults aged 41 to 76 years who underwent standardized clinical assessment and MRIs of the shoulders conducted from February 2023 to April 2024 in Finland.  Main Outcomes and Measures  RC tendon status was classified on MRI as normal, tendinopathic, partial-thickness tear (PTT), or full-thickness tear (FTT).  Shoulder symptoms were defined as pain or dysfunction in the preceding week.  The prevalence of RC abnormalities was compared across age groups and between symptomatic and asymptomatic shoulders, adjusting for demographic factors, concurrent MRI findings, and clinical examination. What They Found Among 602 participants, RC abnormalities on MRI were found in 595: 25% tendinopathy, 62% partial thickness tears, and 11% full thickness tears.  The prevalence and severity of abnormalities increased with age but did not differ between sexes.  RC abnormalities were present in 96% of asymptomatic shoulders (1039 of 1076) and 98% of symptomatic shoulders (126 of 128).  Only full thickness tears were more prevalent in symptomatic shoulders (14.6%) than in asymptomatic shoulders (6.5%), but this difference diminished after adjustment  Wrap It Up In this population-based study, rotator cuff abnormalities were nearly universal after age 40 years and showed poor concordance with shoulder symptoms.  These findings suggest that rotator cuff abnormalities often represent normal age-related changes rather than disease and call into question the clinical value of routine imaging for atraumatic shoulder pain. Item #2 The last one this week is one of those that continues to make me uncool amidst the rising popularity and money that has gone into its acceptance and legalizations.  It’s called, “Adolescent Cannabis Use and Risk of Psychotic, Bipolar, Depressive, and Anxiety Disorders” by Young-Wolff et all and published in JAMA Health Forum in February of 2026 and it’s smokin up the place.  Young-Wolff KC, Cortez CA, Alexeeff SE, et al. Adolescent Cannabis Use and Risk of Psychotic, Bipolar, Depressive, and Anxiety Disorders. JAMA Health Forum. 2026;7(2):e256839. doi:10.1001/jamahealthforum.2025.6839 Why They Did It As cannabis becomes more accessible and socially accepted, concerns have grown about its potential implications for adolescent mental health. While prior research has linked adolescent cannabis use to psychiatric symptoms, few large, population-based, longitudinal studies have examined associations with clinically diagnosed psychiatric disorders. Objective  To evaluate whether adolescent cannabis use is associated with an increased risk of incident psychotic, bipolar, depressive, and anxiety disorders during adolescence and young adulthood. How They Did It This cohort study included adolescents aged 13 to 17  Adolescents were followed up through age 25 years or until December 31, 2023.  Main Outcomes and Measures  Incident clinician-diagnosed psychotic, bipolar, depressive, and anxiety disorders, which were identified through electronic health records using International Classification of Disease codes.  Cox proportional hazards regression models were used to measure the strength of associations between adolescent cannabis use and incident psychiatric diagnoses, with adjustments for sex, race and ethnicity, neighborhood deprivation index, insurance type, and time-varying alcohol and other substance use. What They Found Of 463,396 adolescents included in the sample At baseline, 26,345 adolescents (5.7%) self-reported past-year cannabis use.  Past-year cannabis use was associated with an increased risk of incident psychotic, bipolar, depressive, and anxiety disorders.  The strength of the associations between cannabis use and incident depressive and anxiety disorders decreased as adolescents aged This pattern was similar but slightly attenuated after additional adjustment for past psychiatric conditions Wrap It Up This cohort study found that adolescent cannabis use was associated with increased risk of incident psychiatric disorders, particularly psychotic and bipolar disorders.  These results could inform the development of clinical and educational interventions for parents, adolescents, and clinicians, as well as protective policies to prevent or delay adolescent cannabis use in the context of expanding cannabis legalization. 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 chi

    16 min

  3. FEB 5

    Motor Weakness In Cervical Radiculopathy & Exercise And Dementia

    CF 384: Motor Weakness In Cervical Radiculopathy & Exercise And Dementia Today we’re going to talk about Motor Weakness In Cervical Radiculopathy & Exercise And Dementia But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! OK, we are back and you have found the Chiropractic Forward Podcast where we are giving evidence-based chiropractic a little person ality and making it profitable. We’re not the stuffy, judgmental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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 creekstonecare@gmail.com Things you should do.  Go to Amazon and BUY my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. Easy to understand and easy to support everything you do. It’s on Amazon. Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast  Check our website at chiropracticforward.com You have found yourself smack dab in the middle of Episode #384 Now if you missed last week’s episode, we talked about Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Well February is off to a big start. I think I personally saw 175 last week which is leaps and bounds beyond what I normally see each week. Especially since COVID came around and crashed the practice. Since 2020, my average week is anywhere from 135 or so, up to about 160 on a good week. So to run 175 last week, that’s a big deal for me and a very very welcome change.  Now, if I can just get them to spread evenly in the mornings and afternoons instead of the vast majority of them only wanting to come in in the afternoons. We sit around a little in the mornings and lose our minds in the afternoons trying to keep up with everyone. It’s a problem to be honest. A good problem, of course. But a problem all the same.  Also in today’s news, after a very welcome sabbatical from traveling since my New Orleans trip last October, the travel season is kicking back in and there will be non-stop coming and going from now until probably next November. That’s my life.  In late January, I headed to Park City, Utah with my Mastermind group. I’ve only ever been to Utah when I had a layover in Salt Lake City but I’ve never seen any of the state so that was nice and I always love seeing my Mastermind family.  If you’re not in one, I encourage you to get in one. My MCM East group is sold out. But the MCM West group has openings. If you’re interested, contact Dr. Kevin Christie at modernchiropracticmarketing.com/contact Go do it! But If you do, you better tell Kevin you’re there because of me, pal! In other news, I finally got my California chiropractic license. I had to fly to Dallas to take the jurisprudence/legal test….it’s actually called the CCLE exam. That was the last step I needed out of the way to get the CA license.  I’ve also been studying up for the QME exam that will be in April. They have about a 50% pass/fail rate but the folks who attend the class I’m taking live out in Marina del Rey have more of a 80% pass/fail rate so I’m doing it. I’m ready to get this Qualified Medical Examiner licensing out of the way so I can start building that arm of my retirement income.  So, if you’re keeping track, the arms of retirement for me now include: Whatever is made from the exit of practice (percentage, buyout, etc) Airbnbs Voice over work QME work in CA Art income Music if needed Stocks, IRA’s, inheritance, and investments I didn’t start this stuff until I was almost 50 folks. Please, start considering your exit when you’re younger. There is a building phase when you cannot invest in other arms. But when you build that practice, it’s time to start keeping an eye on your exit. The sooner you start, the sooner you can act when burnout hits and trust me, burnout WILL hit.  Especially if you’re good, smart, and ambitious. Count on it.  Alright, into the research people! Item #1 Our first one today is called, “Is motor weakness in cervical radiculopathy an indication for surgery? Analysis of risk factors for poor recovery” by Kwon et al and published in European Spine in December 2025.  Remember, the citations can be found at chiropracticforward.com under this episode.  Kwon K, Park S, Song MG, Park WS, Hwang CJ, Cho JH, Lee DH. Is motor weakness in cervical radiculopathy an indication for surgery? Analysis of risk factors for poor recovery. Eur Spine J. 2025 Dec 26. doi: 10.1007/s00586-025-09677-0. Epub ahead of print. PMID: 41452372. Why They Did It To investigate the natural course of motor weakness in cervical radiculopathy and analyze risk factors associated with poor recovery. How They Did It A cohort of prospectively enrolled patients presenting with motor weakness due to cervical radiculopathy between March 2024 and March 2025 was retrospectively analyzed.  All patients were initially managed conservatively, with surgery reserved for persistent weaknesses or intolerable symptoms.  Demographic, clinical, and imaging data were reviewed.  Motor strength was assessed using the modified Medical Research Council (mMRC) scale.  Patients achieving a motor grade 4 or higher were classified as the recovery group; those who did not were assigned to the non-recovery group.  We compared both groups and evaluated possible risk factors for non-recovery. Wrap It Up Most patients with motor weakness due to cervical radiculopathy recovered functional strength within 2-3 months of conservative treatment.  However, older age, severe initial motor deficits, and persistent pain were associated with a higher risk of incomplete recovery. Item #2 Our second one today is called, “Physical Activity Over the Adult Life Course and Risk of Dementia in the Framingham Heart Study” by Marino et al and published in JAMA network Open in November of 2025 and that’s a muy en fuego. Mucho caliente.  Marino FR, Lyu C, Li Y, Liu T, Au R, Hwang PH. Physical Activity Over the Adult Life Course and Risk of Dementia in the Framingham Heart Study. JAMA Netw Open. 2025;8(11):e2544439. doi:10.1001/jamanetworkopen.2025.44439 Why They Did It The authors say that being physically active is protective against dementia. Yet, it is unknown when during the adult life course physical activity is most associated with dementia risk. Objective  To determine whether higher physical activity levels in early adult life, midlife, or late life are associated with lower risk of all-cause or Alzheimer disease (AD) dementia. How They Did It This prospective cohort study used data from the Framingham Heart Study Offspring cohort.  The offspring of participants in the original Framingham Heart Study cohort who were dementia free and had physical activity measured at baseline (early adult life, midlife, or late life) were followed up for a mean of 37.2, 25.9, or 14.5 years for the development of incident all-cause or AD dementia until December 31, 2023. Physical activity was self-reported using the physical activity index, a composite score weighted by hours spent sleeping and in sedentary, slight, moderate, or heavy activities.  Physical activity was divided into quintiles (Q). As far as outcomes, All-cause and AD dementia were classified by expert consensus based on established diagnostic criteria. What They Found This study included 1526 early adult–life, 1943 midlife, and 885 late-life participants.  There were 567 cases of incident all-cause dementia during follow-up.  Higher levels of midlife and late-life physical activity were associated with lower risk of all-cause dementia.  There were no associations between early adult–life physical activity and dementia risk.  Wrap It Up In this cohort study of adults in the Framingham Heart Study Offspring cohort, higher levels of midlife and late-life physical activity were associated with similar reductions in risk of all-cause and AD dementia.  These findings may inform future efforts to delay or prevent dementia through timing interventions during the most relevant stages of the adult life course. 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.      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

    22 min

  4. 12/31/2025

    Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions

    CF 383: Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions Today we’re going to talk about Platelet-Rich Plasma In Knee Osteoarthritis & Telehealth Mindfulness-Based Interventions But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY! 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, judgmental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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 creekstonecare@gmail.com Things you should do.  Go to Amazon and BUY my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. Easy to understand and easy to support everything you do. It’s on Amazon. Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast  Check our website at chiropracticforward.com You have found yourself smack dab in the middle of Episode #383 Now if you missed last week’s episode, we talked about SMT and disc regression and biopsychosocial factors for hip osteoarthritis.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. We have our new associate chiropractor up and running. Now the job is….how do we get her busy busy the quickest way possible? It’s a race to profitability, right?  Here are some of our ideas. We’d love to hear your suggestions as well if you have lots of experience in building an associate’s schedule.  First, we’re going to leverage the fact that she’s from Amarillo so she’s the local hero returning to town. We’ll do that with social media and her high school alumni network.  We’ll have her partner with local fitness studios when possible. She’s fit and she’s into fitness so that’s a perfect fit.  We’ll also see if she’s into working with youth sports programs.  We’ll do the ‘New Doc In Town’ thing. We’re going to be giving her some of my new patients when appropriate and possible. I say appropriate because a lot of big guys come to me and not too many will be pleased if I stick them with a smaller female. So they’ll have to be a good fit to pass on to her.  Visits to PT offices. The problem there is that I’m noticing PTs are offering many of the same services we offer now so they may look at her as competition now rather than a partner.  Lots of rehab and treatment videos. Videos with Q&A with our associate.  Lots of ideas but again, if you have a great strategy, I’d love to hear from you at creekstonecare@gmail.com Send them my way! Item #1 The first one this week is called, “Platelet-Rich Plasma Versus Alternative Injections for Osteoarthritis of the Knee: A Systematic Review and Statistical Fragility Index-Based Meta-analysis of Randomized Controlled Trials” by Ceding et al and published in the American Journal of Sorts Medicine in October of 2024.  Remember, the citations can be found at chiropracticforward.com under this episode.  Oeding JF, Varady NH, Fearington FW, Pareek A, Strickland SM, Nwachukwu BU, Camp CL, Krych AJ. Platelet-Rich Plasma Versus Alternative Injections for Osteoarthritis of the Knee: A Systematic Review and Statistical Fragility Index-Based Meta-analysis of Randomized Controlled Trials. Am J Sports Med. 2024 Oct;52(12):3147-3160. doi: 10.1177/03635465231224463. Epub 2024 Feb 29. PMID: 38420745. Why They Did It Based in part on the results of randomized controlled trials (RCTs) that suggest a beneficial effect over alternative treatment options, the use of platelet-rich plasma (PRP) for the management of knee osteoarthritis (OA) is widespread and increasing.  However, the extent to which these studies are vulnerable to slight variations in the outcomes of patients remains unknown. Purpose: To evaluate the statistical fragility of conclusions from RCTs that reported outcomes of patients with knee OA who were treated with PRP versus alternative nonoperative management strategies. How They Did It Systematic review and meta-analysis All RCTs comparing PRP with alternative nonoperative treatment options for knee OA were identified.  The fragility index (FI) and reverse FI were applied to assess the robustness of conclusions regarding the efficacy of PRP for knee OA.  Meta-analyses were performed to determine the minimum number of patients from ≥1 trials included in the meta-analysis for which a modification on the event status would change the statistical significance of the pooled treatment effect. What They Found In total, this analysis included outcomes from 1993 patients with Based on random-effects meta-analyses, PRP demonstrated a significantly higher rate of successful outcomes when compared with hyaluronic acid, as well as higher rates of patient-reported symptom relief, not requiring a reintervention after the initial injection treatment, and achieving the minimal clinically important difference (MCID) for pain improvement when compared with all alternative nonoperative treatments.  Wrap It Up Conclusions drawn from individual RCTs evaluating PRP for knee OA demonstrated slight robustness.  On meta-analysis, PRP demonstrated a significant advantage over hyaluronic acid as well as improved symptom relief, lower rates of reintervention, and more frequent achievement of the minimal clinically important difference for pain improvement when compared with alternative nonoperative treatment options.  Statistically significant pooled treatment effects evaluating PRP for knee OA are more robust than approximately half of all comparable meta-analyses in medicine and health care.  Future RCTs and meta-analyses should consider reporting fragility indexes and fragility quotients to facilitate interpretation of results in their proper context.   Item #2 Our last one today is called “Telehealth Mindfulness-Based Interventions for Chronic Pain The LAMP Randomized Clinical Trial” by Burgess et al and published in JAMA Internal Medicine on August 19, 2004.  Burgess DJ, Calvert C, Hagel Campbell EM, et al. Telehealth Mindfulness-Based Interventions for Chronic Pain: The LAMP Randomized Clinical Trial. JAMA Intern Med. 2024;184(10):1163–1173. doi:10.1001/jamainternmed.2024.3940 Why They Did It Importance  Although mindfulness-based interventions (MBIs) are evidence-based treatments for chronic pain and comorbid conditions, implementing them at scale poses many challenges, such as the need for dedicated space and trained instructors. Objective  To examine group and self-paced, scalable, telehealth mindfulness-based interventions, for veterans with chronic pain, compared to usual care. How They Did It This was a randomized clinical trial of veterans with moderate to severe chronic pain, recruited from 3 Veterans Affairs facilities from November 2020 to May 2022. Follow-up was completed in August 2023. Interventions  Two 8-week telehealth mindfulness-based interventions (group and self-paced) were compared to usual care (control).  The group mindfulness-based interventions was done via videoconference with prerecorded mindfulness education and skill training videos by an experienced instructor, accompanied by facilitated discussions.  The self-paced mindfulness-based interventions was similar but completed asynchronously and supplemented by 3 individual facilitator calls. The primary outcome was pain-related function using the Brief Pain Inventory interference scale at 3 time points: 10 weeks, 6 months, and 1 year. Secondary outcomes included biopsychosocial outcomes: pain intensity, physical function, anxiety, fatigue, sleep disturbance, participation in social roles and activities, depression, patient ratings of improvement of pain, and posttraumatic stress disorder. What They Found Among 811 veterans randomized, 694 participants (85.6%) completed the trial.  Averaged across all 3 time points, pain interference scores were significantly lower for both mindfulness-based interventions compared to usual care  Additionally, both mindfulness-based intervention arms had significantly better scores on the following secondary outcomes: pain intensity, patient global impression of change, physical function, fatigue, sleep disturbance, social roles and activities, depression, and posttraumatic stress disorder.  Both group and self-paced mindfulness-based interventions did not significantly differ from one another.  The probability of 30% improvement from baseline compared to control was greater for group mindfulness-based interventions at 10 weeks and 6 months, and for self-paced MBI, at all 3 time points. Wrap It Up In this randomized clinical trial, scalable telehealth mindfulness-based interventions improved pain-related function and biopsychosocial outcomes compared to usual care among veterans with chronic pain.  Relatively low-resource telehealth-based mindfulness-based interventions could help accelerate and improve the implementation of nonpharmacological pain treatment in health care systems. 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 an

    14 min

  5. 12/11/2025

    SMT And Disc Regression & Biopsychosocial Factors For Hip Osteoarthritis

    CF 382: SMT And Disc Regression & Biopsychosocial Factors For Hip Osteoarthritis Today we’re going to talk about SMT And Disc Regression & Biopsychosocial Factors For Hip Osteoarthritis But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!     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, judgmental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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 creekstonecare@gmail.com Things you should do.  Go to Amazon and BUY my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. Easy to understand and easy to support everything you do. It’s on Amazon. Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast  Check our website at chiropracticforward.com You have found yourself smack dab in the middle of Episode #382 Now if you missed last week’s episode, we talked about SMT And Re-operation Rates & The Most Expensive Condition.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Well, if you’re a dedicated listener, then you know the last podcast episode was roughly three weeks ago. That’s a little crazy.  But there are a couple of factors at play on that.  It’s hard to keep pouring energy and time into something that doesn’t seem to grow. I mean, I’ve been doing this podcast every single week until recently. That’s 381 episodes, every single week, for almost 8 years. And our listenership is still just about the same it’s ever been. There is little to zero engagement in the Facebook private group and, after a while, the piss and vinegar starts to empty out. It really would help if those of you that know and love Chiropractic Forward posted about it now and then and shared relevant episodes with your groups and network. Whether that’s on Facebook or just a text with the link. It’s all helpful and growing the listenership really would make the effort mean more and more for me personally. Now, understand, I feel a commitment to those of you that are true blue fans and we’re going to still keep pumping the episodes out as I’m able. It just can’t be my priority right now. Here’s why: I am entering into the serious back half of my chiropractic career and am making plans ahead of time. That includes me going through my CA licensure and entering into some designated doctor work out on the West Coast.  In addition to that new venture, I have made two significant and huge hires. I finally found an associate chiropractor to come in and help blow the lid off of this practice. I also just hired a nurse practitioner with a decade of experience under her belt and a belly full of excitement. These folks are going to demand a good portion of my time and attention and trust me, the ROI on them will be much more significant than the ROI on this podcast. Lol.  So, as you can see, lots of moving parts here, the sale of the clinic is off for now due to the passing of the owner of the purchasing group, and it’s time to buckle up, hunker down, and make things happen.  That’s where it’s at. Let’s hop into the research.  Item #1 Our first one today is called, “Is regression in lumbar disk herniation possible by spinal mobilization? A single-blind randomized controlled clinical study” by Taskaya et al and published in International Journal of Osteopathic Medicine in June 2025 and that’s hotter than a chili pepper.  Remember, the citations can be found at chiropracticforward.com under this episode.  Is regression in lumbar disk herniation possible by spinal mobilization? A single-blind randomized controlled clinical study Taşkaya, Burhan et al. International Journal of Osteopathic Medicine, Volume 56, 1007 I want to thank Dr. Mark King, President of Motion Palpation Institute for sending this one to me. Mark is an incredible person and such a valuable friend and colleague. He is one who makes you proud to be a chiropractor.  Why They Did It This study aimed to examine the impacts of spinal mobilization practices on herniation distance, disc height, and facet joint distance, as well as functional status, pain, range of motion (ROM), and flexibility in lumbar disc herniation (LDH) patients. How They Did It Thirty-two participants participated in the study, divided into an Intervention and Control Group.  Radiological findings were evaluated by MRI before and after the study.  The Back Performance Scale, Visual Analogue Scale, The S, and The Sit and Reach Test were assessed before, after, and at three months.  The control group received ten sessions of stabilization exercises for five weeks, two sessions per week.  In the intervention group, spinal mobilization applications were applied in addition to stabilization exercises What They Found Intra-group analysis revealed significant reductions in herniation distance, increases in facet joint distance, pain alleviation, functional improvement, enhanced flexibility, and extended ROM in both groups  Notably, a significant increase in disc height was observed exclusively in the Intervention Group.  Inter-group analysis revealed no significant differences between the groups post-intervention Wrap It Up Mobilization applications applied in LDH patients may have a positive effect on radiological findings, functional status, pain, ROM, and flexibility. May…..MAY, they say…….lol. OK Boomers…..ugh. I can’t wait until they are finally forced to recognize the effectiveness and cost saving of our industry for non-complicated musculoskeletal conditions.  Item #2 The second one this week is called, “Psychosocial factors are associated with altered pain processing in individuals with hip osteoarthritis: a cross-sectional study” by Sergooris et al and published in Pain Medicine March 24th, 2025 and it’s still a steaming supper special! Abner Sergooris, Jonas Verbrugghe, Bruno Bonnechère, Timo Meus, Maaike Van Den Houte, Kristoff Corten, Katleen Bogaerts, Annick Timmermans, Psychosocial factors are associated with altered pain processing in individuals with hip osteoarthritis: a cross-sectional study, Pain Medicine, Volume 26, Issue 8, August 2025, Pages 468–476, https://doi.org/10.1093/pm/pnaf030 Why They Did It Alterations in central pain processing are hypothesized to underlie the discordance between pain and radiographic osteoarthritis severity, as well as the association between psychological trauma and pain sensitivity. This cross-sectional study explored whether psychosocial factors and traumatic experiences are associated with central pain processing in individuals with hip osteoarthritis. How They Did It Independent variables included sociodemographic information, traumatic experiences, psychiatric disorders, symptoms of anxiety and depression, fear-avoidance, perceived injustice, general self-efficacy, perceived stress, social support, and pain-related variables.  Thermal quantitative sensory testing was used to assess central pain processing through heat pain thresholds, temporal adaptation and summation, and conditioned pain modulation.  Least absolute shrinkage and selection operator (LASSO) regression analyses were performed. What They Found One hundred thirty-three individuals with hip osteoarthritis were included.  Sex differences were identified in measures of central pain processing.  In combination with biological and pain-related factors, psychosocial factors explained between 11% and 21% of the variance in central pain processing.  The selection of biopsychosocial variables and the direction of their effect differed between male and female participants.  Inconsistent results were found with regard to the association between traumatic experiences and central pain processing. Wrap It Up Psychosocial factors contributed to the variance in quantitative sensory testing outcomes beyond the influence of biomedical variables.  Different associations were found in male and female participants between psychosocial factors and central pain processing.  Inconsistent results were found with regard to the association between traumatic experiences and altered central pain processing. 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.          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 prima

    15 min

  6. 11/13/2025

    SMT And Reoperation Rates & The Most Expensive Condition

    CF 381: SMT And Reoperation Rates & The Most Expensive Condition Today we’re going to talk about SMT And Reoperation Rates & The Most Expensive Condition But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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 creekstonecare@gmail.com Things you should do.  Go to Amazon and BUY my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. Easy to understand and easy to support everything you do. It’s on Amazon. Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast  Check our website at chiropracticforward.com You have found yourself smack dab in the middle of Episode #381 Now if you missed last week’s episode, we talked about Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture Risk Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Nothing too crazy. Still enjoying the Fall bounce where business acts like it should act and I’m better behaved with regard to traveling all over the world. It’s weird; when you stay put, business just does better.  You remember I mentioned that I am on the medical side carousel? We have a NP interview this afternoon so we’ll see how that goes.  I went to teh cardiologist the other day. I’m 53 and never been so I thought, maybe I’m missing out on all of the fun so let’s see what it’s all about. Well, it Ain’t all it’s cracked up to be. The first visit was fine. The dude saiid I don’t see anything particularly concerning here but let’s do an echocardiogram and just dive in and see what’s there.  So I got that done and what do you know? I got a call from his NP saying that overall I look good BUT….the bottom of my heart contracts too much and doesn’t relax like it should. What the hell does that mean anyway?? So she recommends putting me on the lowest dose diruetics to keep the upper portion of the heart from eventually enlarging.  Well, I’m in no mood to go on life long meds but diving into these meds, they’re pretty much like taking an antiacid every day so, maybe not so bad. I’m still checking it out but will probably take them. At least until I can finally get some damn weight off. 6’4” and 275 lbs is big and I’d much rather be around 230-240 lbs. Or less. But my body doesn’t want to be that. No matter what I do or try. It’s crazy.  The weight loss meds that work so well for everyone….yeah, I’m a non-responder. Because that’s my life. I look like I eat like a horse but I don’t. I eat fairly lightly overall day to day. It’s like my body has set it’s weight point at 275-280 and it doesn’t matter what the hell I do. It doesn’t want to budge from that spot.  So, it’s a constant battle. One that I know I’m not alone in. Many of us struggle with it. Just trying to figure it out.  Butt the good news is, the cardio suggested I reduce stress and try to relax more. Which means I’m getting a massage this afternoon. Yay! Which also means I gotta get going on this episode so let’s hop into the research.  Item #1 The first one is an article from Forbes called, “The Most Expensive Medical Condition Is Not What You Think” by Peter Ubel, a physician and behavioral scientist at Duke University. It was updated in July of 2025 so it’s sizzlin like a stack of fajitas! Remember, the citations can be found at chiropracticforward.com under this episode.  The article from Forbes reveals that the most expensive medical condition in the United States is not heart disease or diabetes, as commonly assumed, but rather low back and neck pain.  While heart disease and diabetes are both serious and costly—ranked fourth and third respectively, with expenditures of $90 billion and $111 billion annually—back and neck pain surpasses them with costs exceeding $130 billion each year. This substantial burden is linked to the sheer number of people affected and the chronic nature of these conditions.  The article highlights that individuals suffering from low back and neck pain commonly undergo expensive diagnostic procedures like X-rays and MRIs (often unnecessarily), use pain medications, participate in physical therapy, seek chiropractic care, and may ultimately face surgery—with almost half of these operations deemed unnecessary.  The impact extends beyond the healthcare system, affecting productivity due to missed work and causing considerable suffering among adults during their most productive years. Additionally, the piece points out a major discrepancy in government research investment: In 2021, the National Cancer Institute received over $7 billion, while the National Institute for Arthritis and Musculoskeletal and Skin Diseases (which includes spinal research) received just $685 million—barely a tenth by comparison.  The article concludes with a call to prioritize research and funding for back and neck pain to match its immense medical and financial toll on American society. You guys know this stuff. It’s preaching to the choir but it’s also updating the knowledge base and putting numbers to it too.  So there ya go.  Item #2 And #2 this week is called, “Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study” by Trager et al and published in BMC Musculoskeletal Disorders in January of 2024.  Trager, R.J., Gliedt, J.A., Labak, C.M. et al. Association between spinal manipulative therapy and lumbar spine reoperation after discectomy: a retrospective cohort study. BMC Musculoskelet Disord 25, 46 (2024). https://doi.org/10.1186/s12891-024-07166-x Why They Did It Patients who undergo lumbar discectomy may experience ongoing lumbosacral radiculopathy (LSR) and seek spinal manipulative therapy (SMT) to manage these symptoms.  We hypothesized that adults receiving SMT for LSR at least one year following lumbar discectomy would be less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT, over two years’ follow-up. How They Did It We searched a United States network of health records (TriNetX, Inc.) for adults aged ≥ 18 years with LSR and lumbar discectomy ≥ 1 year previous, without lumbar fusion or instrumentation, from 2003 to 2023.  We divided patients into two cohorts: (1) chiropractic SMT, and (2) usual care without chiropractic SMT.  What They Found Following propensity matching there were 378 patients per cohort (mean age 61 years).  Lumbar spine reoperation was less frequent in the SMT cohort compared to the usual care cohort, yielding an RR of 0.55.  In the SMT cohort, 72% of patients had ≥ 1 follow-up SMT visit. Wrap It Up This study found that adults experiencing LSR at least one year after lumbar discectomy who received SMT were less likely to undergo lumbar spine reoperation compared to matched controls not receiving SMT.  While these findings hold promise for clinical implications, they should be corroborated by a prospective study including measures of pain, disability, and safety to confirm their relevance.  We cannot exclude the possibility that our results stem from a generalized effect of engaging with a non-surgical clinician, a factor that may extend to related contexts such as physical therapy or acupuncture. 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.    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 offer

    13 min

  7. 11/06/2025

    Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture Risk

    CF 380: Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture Risk Today we’re going to talk about Low Back Chronic Pain & Osteoporosis Medications and the Decrease in Societal Fracture Risk But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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 creekstonecare@gmail.com Things you should do.  Go to Amazon and BUY my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. Easy to understand and easy to support everything you do. It’s on Amazon. Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast  Check our website at chiropracticforward.com You have found yourself smack dab in the middle of Episode #380 Now if you missed last week’s episode, we talked about Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. It’s been a bit cray cray around here. We’re on the hamster wheel again with regards to the nurse practitioner. Our nurse that’s been in NP school and we’ve been waiting to graduate got an offer for full time from the clinic she’s been doing her clinicals with and, just from a pure financial standpoint, she had to take it. I can only offer part time until the schedule fills up.  So….down the road we go. Looking for a new staff member to help us grow the clinic medically and service-wise. She/He is out there. We just gotta find ‘em.  Next, you’ve heard me speak about selling part of the clinic several times over the last several years. We were going to have a final discussion after going back and forth on the contract. What changes could they live with and what could we live with in a final contract. That sort of thing.  Well, unfortunately and tragically, the CEO of the company was heading to one of their clinics in a small airplane that unbelievably crashed with no survivors. Absolutey unbelievable. His name was Dr. Justin Ramsey and he was a great guy. Not only was a lot of this a business thing but, I got to know Justin fairly well and we were friends.  It’s been very hard to process on lots of different levels. Losing a friend and who knows where that puts us with selling a portion of the clinic? We don’t know. But I do know this; I’m getting up every morning and going to work and making patients feel better.  It will all fall into place as soon as it is supposed to fall into place. That’s enough, let’s hop in.    Item #1 The first one is called, “Reduction of Chronic Primary Low Back Pain by Spinal Manipulative Therapy is Accompanied by Decreases in Segmental Mechanical Hyperalgesia and Pain Catastrophizing: A Randomized Placebo-controlled Dual-blind Mixed Experimental Trial” by Gevers-Montaro et al and published in the Journal Of Pain in August 2024.  Remember, the citations can be found at chiropracticforward.com under this episode.  Reduction of Chronic Primary Low Back Pain by Spinal Manipulative Therapy is Accompanied by Decreases in Segmental Mechanical Hyperalgesia and Pain Catastrophizing: A Randomized Placebo-controlled Dual-blind Mixed Experimental Trial Gevers-Montoro, Carlos et al. The Journal of Pain, Volume 25, Issue 8, 104500 Why They Did It Chronic primary low back pain (CPLBP) refers to low back pain that persists over 3 months, that cannot be explained by another chronic condition, and that is associated with emotional distress and disability.  Previous studies have shown that spinal manipulative therapy (SMT) is effective in relieving CPLBP, but the underlying mechanisms remain elusive. How They Did It This randomized placebo-controlled dual-blind mixed experimental trial aimed to investigate the efficacy of SMT to improve CPLBP and its underlying mechanisms.  Ninety-eight individuals with CPLBP and 49 controls were recruited.  Individuals with CPLBP received SMT or a control intervention, 12 times over 4 weeks.  The primary outcomes were CPLBP intensity and disability (Oswestry Disability Index).  Secondary outcomes included pressure pain thresholds in 4 body regions, pain catastrophizing, Central Sensitization Inventory, depressive symptoms, and anxiety scores. What They Found Individuals with CPLBP showed widespread mechanical hyperalgesia and higher scores for all questionnaires.  SMT reduced pain intensity compared with the control intervention, but not disability.  Similar mild to moderate adverse events were reported in both groups.  Mechanical hyperalgesia at the manipulated segment was reduced after SMT compared with the control intervention.  Pain catastrophizing was reduced after SMT compared with the control intervention, but this effect was not significant after accounting for changes in clinical pain Wrap It Up Although the reduction of segmental mechanical hyperalgesia likely contributes to the clinical benefits of SMT, the role of pain catastrophizing remains to be clarified. Previous studies on the efficacy of SMT have suggested that its clinical benefits may rely on nonspecific effects.22,28,84 In contrast, a clinical trial designed to examine and control for nonspecific effects showed specific pain reduction by SMT.85  Accordingly, the present study shows that SMT produces greater pain relief compared with a control intervention that was undistinguishable from SMT.  This medium effect (η2p = .07) persisted up to 12 weeks after SMT, suggesting that SMT produces long-lasting pain relief, possibly through specific mechanisms. Item #2 Our second one today is called, Long Dosing Intervals of Parenteral Antiosteoporosis Medications and the Decrease in Societal Fracture Risk by Fu et al published in Mayo Clinic Proceedings in January 2025 and it’s a hot one today! Long Dosing Intervals of Parenteral Antiosteoporosis Medications and the Decrease in Societal Fracture Risk Fu, Shau-Huai et al. Mayo Clinic Proceedings, Volume 100, Issue 1, 68 – 79 Why They Did It To evaluate the relationship between different dosing intervals of antiosteoporosis medications (AOMs) and the subsequent fracture risk among patients with newly initiated AOM therapies. How They Did It In a nationwide population-based cohort study based on Taiwan’s National Health Insurance Research Database, osteoporosis patients with 50 years of age or older who newly initiated AOM from January 1, 2008, to December 31, 2018 were included.  We categorized AOMs into short dosing intervals or long dosing intervals.  The adherence of treatment by medication possession ratio and subsequent fracture after treatment for 3 years were measured. What They Found Among patients who initiated parenteral AOMs, the percentage of patients with high adherence increased from 33% in 2008 to 69% in 2018.  However, among patients who initiated oral AOMs, the percentage of high adherence remained stable (30%) between 2008 and 2018.  The use of parenteral AOMs increased from 1% in 2008 to 62% in 2018.  At the same time, the percentage of high adherence of those initiated AOMs significantly increased from 34% in 2008 to 61% in 2018.  The risk of subsequent fracture decreased significantly between 2008 and 2018 after controlling for all potential confounders Wrap It Up AOMs with long dosing intervals not only increased adherence but also associated with the decrease in subsequent fracture risk at a nationwide scale. 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.      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, patien

    15 min

  8. 10/16/2025

    Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection

    CF 379: Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection Today we’re going to talk about Opioids And Low Back Pain & Transforaminal Epidural Steroid Injection But first, here’s that sweet sweet bumper music   Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!   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, judgemental, elitist, puffing on a pipe, pretentious kind of research. We’re research talk over a couple of beers. So grab you a 6-er.  I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward podcast.  I’m so glad you’re lending me your ear, spending your time with me and we’re learning this stuff 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 creekstonecare@gmail.com Things you should do.  Go to Amazon and BUY my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. Easy to understand and easy to support everything you do. It’s on Amazon. Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast  Check our website at chiropracticforward.com You have found yourself smack dab in the middle of Episode #379 Now if you missed last week’s episode, we talked about Differences In Whiplash And Normal Neck Pain & Spinal Manipulative Therapy And Scoliosis.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Now that the Fall is upon us, things are leveling out and getting mroe and more stable around here. Which means less travel and more living in my house like a regular normal person. Except, we stayed in my hometown last weekend for my 35th high school reunion. Which is weird as hell to say. But it is what it is. I have the gray hair to prove it.  Got to see a lot of folks I haven’t seen in a while and that’s always good. Some never go back. They didn’t have a good experience in high school so they care nothing about it. I get that. That wasn’t me though. I had an incredible experience. I won state in the discus and was a two-way starter and football captain, honor grad, and had a great circle of friends that I absolutely still stay in touch with and still enjoy texting and seeing every now and then.  High school was somethign else for me and I wouldn’t trade it for anything. So we go back when it’s time.  Something I’ve been working on lately; through Facebook, a colleague reached out to me and said that with my ortho diplomate cert and my Forensics diplomate cert, that I should consider doing designated doctor work or medicolegal work out of state. She said she travels out of state once every 6-8 weeks and makes a gob of money doing so every year.  Well hell, you don’t have to tell me twice. There absolutely SHOULD be more benfits to having Diplomates so, if I got ‘em, miight as well use them. So, I started down the path of getting licensed elsewhere and holy guacamole what a sincere time suck pain in the ass. Wow. Absolutely stupid the hoops you gotta jump through. I’ve been licensed in TX since 1998 but I have to do mental gymnastics to add a license somewhere else?? Insantiy.  But, I’m getting there. Then, once licensed, I have to take a course that will prepare me for the Qualified Medical Examiner exam. Then I take that QME and pass it and Kablamo! I’m off to the races and adding an extra revenue source that can be maintained once I retire from actively treating patients every day.  Which, psssst…..between me and you….if you don’t want to die in yoru practice or sell it someday desperately for pennies on teh dollar, is exactly what we should all be doing. We should be acting as if there is an end game. Because there is and none of us are getting out alive.  Why do you think I have the VoiceOver thing going? The Airbnbs thing? You think I post my paintings and my sculptures on social media so often so that I can brag? Hell no. I want a portfolio and people to know, like, and eventually buy my art. If myy paintints annd sculptures are news to you, go to www.riverhorseart.com and check it out.  The point is; I’m trying to plan for the end game. I’m trying to do what I can to maximize my end game. You should be too.  Item #1 Our first one this week is called Association of Opioid use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrspective Cohort Analysis by Moyo et al and published in Journal of General Internal Medicine in 2024.  Remember, the citations can be found at chiropracticforward.com under this episode.  Moyo, P., Merlin, J.S., Gairola, R. et al. Association of Opioid Use Disorder Diagnosis with Management of Acute Low Back Pain: A Medicare Retrospective Cohort Analysis. J GEN INTERN MED 39, 2097–2105 (2024). https://doi.org/10.1007/s11606-024-08799-3 Why They Did It They wanted to see if people with this opioid problem were treated differently for sudden back pain. How They Did It The main independent variable was OUD diagnosis measured prior to the first LBP claim (i.e., index date).  Using multivariable logistic regressions, they assessed the following outcomes measured within 30 days of the index date:  nonpharmacologic therapies (physical therapy and/or chiropractic care), and  prescription opioids.  Among opioid recipients, we further assessed opioid dose and co-prescription of gabapentin.  Analyses were conducted overall and stratified by receipt of physical therapy, chiropractic care, opioid fills, or gabapentin fills during the 6 months before the index date. What They Found Most people got less help like physical therapy or chiropractic care if they had opioid use disorder. Instead, these people were more likely to get strong medicines (opioids), sometimes in higher amounts, and were also given another medicine called gabapentin. Wrap It Up Doctors recommend starting with safer ways to treat pain (like exercises and Chiropractic therapy) instead of medicine—especially for people who’ve had problems with opioids before.  But this study found that doctors often use medicines anyway, and not enough non-medicine treatments. Specifically, the authors said this, “Medicare beneficiaries with aLBP and OUD underutilized nonpharmacologic pain therapies and commonly received opioids at high doses and with gabapentin. Complementing the promulgation of practice guidelines with implementation science could improve the uptake of evidence-based nonpharmacologic therapies for aLBP.” Which means people with back pain aren’t going to a chiro or PT nearly often enough and to compound the matter, people in the medical castles are STILL prescribing too many opioids and gabapentin whihc means they’re acting in a non-evidence-based way.    Item #2 Our last one this week is called, “Impact of transforaminal epidural steroid injection on pain and disability outcomes by lumbar intervertebral disc herniation class: a prospective study” by Saracoglu et al and published in Pain Medicine in August of 2025 and is muy cliente me amigos.  Tuba Tanyel Saraçoğlu, Burak Erken, Impact of transforaminal epidural steroid injection on pain and disability outcomes by lumbar intervertebral disc herniation class: a prospective study, Pain Medicine, Volume 26, Issue 8, August 2025, Pages 440–450, https://doi.org/10.1093/pm/pnaf040 Why They Did It To evaluate the effects of transforaminal epidural steroid injection on pain and disability across different lumbar disc morphologies using the Michigan State University (MSU) classification system. How They Did It Prospective cohort study. A single center pain management clinic. A total of 168 patients with single-level lumbar disc herniation at L4-L5 or L5-S1 treated with transforaminal epidural steroid injection.  Patients were divided into 7 subgroups according to the Michigan State University classification based on MRI findings. The numerical rating scale (NRS) for pain and Oswestry Disability Index (ODI) for assessing disability were measured at baseline, 1-month and 3-months post-procedure. What They Found Transforaminal epidural steroid injection significantly reduced NRS and ODI scores in all groups.  At 1-month follow-up, NRS scores of group 1B were significantly lower than those of groups 2A and 2A; at the 3-month follow-up, no differences were observed between the groups.  Although ODI scores improved over time, they did not exhibit significant differences among the subgroups throughout the study period. Wrap It Up   Transforaminal epidural steroid injection effectively reduces pain and disability across varying disc morphologies.  At the 1-month mark, pain relief was more pronounced in group 1B compared to 2A and 2AB groups, whereas at the 3-month mark, the results were similar between subgroups.  So, these groups know that these injections are short-term relief only but they’re recommending larger studies with longer follo-up to improve patient selection and optimze the tx strategies.  Instead of looking at the American College of Physician’s recommended hierarchy of treatment. While I was messing with Perplexity AI, the best research-leaning AI that I’m aware of, I asked Perplexity the following: “Qaseem et al published in the Annals of Internal Medicine by the American College of Physicians suggests a hierarchy of treatment with things like spinal manipulative therapy, exercise, massage, acupuncture, low-level laser, yoga, tai chi, mindfulness, cognitive beh

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The Chiropractic Forward podcast clearly demonstrates how research, evidence, and experience puts Chiropractic Care firmly in consideration for integration into the mainstream healthcare. Advanced chiropractic knowledge, learning, and active chiropractic protocols have been clinically proven to be effective for mechanical pain. The newest recommendations coming from the medical world align chiropractic with the most effective protocols currently available for back and neck pain.

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