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CF Ep. 388 – Shockwave Therapy for Hamstring Injuries and Vitamin D for Respiratory Infections Today we’re going to talk about Shockwave Therapy for Hamstring Injuries and Vitamin D for Respiratory Infections. 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! Welcome Back 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. 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. Review our podcast on whatever platform you’re listening on — it really does make a big difference. And then check our website at chiropracticforward.com ──────────────────────────────────────────────────────────── Episode Number + Previous Episode Recap You have found yourself smack dab in the middle of Episode #388. Now if you missed our last episode, we talked about Water Instead of Diet Drinks & Neuromobilization In The Chronic Neck Make sure you don’t miss that info. Keep up with the class. ──────────────────────────────────────────────────────────── Personal Happenings I would have to say that 2026 is really shaping up for us. I know that I’m still not back to pre-Covid numbers. However, it’s pretty standard for me to see 145 to 165 each week now. If you’ve been a long time listener, then you may recall the days when I was seeing 180 and even sometimes 200 in a week. So we are far from those numbers currently. And I’m kind ok with that. I did not like being that rushed and that busy. It made my life fairly miserable to be honest. However, with our new chiropractor, Dr. Easter, on board I bet we’ll see those sorts of numbers combined soon. I am impressed every single day with her and have zero doubt that her schedule will be busting at the seams before you know it. A friend of mine is Dr. Mark King, president of motion palpation Institute, and he happens to be in my mastermind group you always hear me talk about. I believe he has somewhere between five and seven associates so I guess he’s got it figured out. But what he said at the last mastermind meeting was that you need to be trying to give your associate somewhere around 15 new patients a month that you would personally have taken. You have to feed them to get them where they are really kicking butt and taking names and putting some money in their pockets right along with bringing patients and revenue to the clinic as well. With credentialing and all the things involved in that, I’m not able to shift that many her way just yet. However, that is definitely the plan when we were able and strictly on sending her cash new patients and her being able to start to cultivate her own patience here and there, we already have her up to about 25 a week or so sometimes more sometimes less. When you consider, she’s only had her license for a little over a month maybe two months, I think we’re in a good spot. Outside of that I have been studying for the California QME exam coming up next week and hopefully we knock that sucker straight out of the park into the windshields of the cars parked in the parking lot. And we can get well on our way performing QME‘s and building that revenue stream. QME is my path out of day today hands-on patient treatment. I’ll be 54 in August and if I can get down to just a day or 2 x 56. I’m gonna be a happy dude. OK, that’s it. Let’s get on with the research.  Item #1 – Radial Shockwave Therapy + Rehab for Acute Hamstring Injuries Remember, the citations can be found at chiropracticforward.com under this episode. Citation: Crupnik J, Silveti S, Wajnstein N, Rolon A, Wuerfel T, Stiller P, Morral A, Furia JP, Maffulli N, Schmitz C. Radial ESWT combined with a specific rehabilitation program (rESWT+RP) is more effective than sham rESWT+RP for acute hamstring muscle complex injury type 3b: a randomized, controlled trial. British Medical Bulletin. 2025 Sep 2;155(1):ldaf009. DOI: 10.1093/bmb/ldaf009. Why They Did It Hamstring injuries are an absolute plague in sports. They’re one of the most common soft tissue injuries across virtually every athletic discipline — soccer, track and field, sprinting sports, you name it. The specific type we’re dealing with in this study is a type 3b injury, which is what the Munich Muscle Injury Classification calls a bundle or interfascicular tear — a structural, partial tear of the muscle, not just a minor strain. These are the ones that knock athletes out for weeks, and they carry a high re-injury rate. Conservative rehab is the standard treatment, but outcomes are often frustratingly slow, and there’s a real clinical need for adjunct therapies that can accelerate tissue recovery. Shock wave therapy has shown some promising signals in muscle healing, but at the time this trial was being designed, the evidence was thin. These researchers set out to test whether adding radial ESWT to a structured rehab program could meaningfully change the game for athletes recovering from these serious hamstring tears. How They Did It This was a prospective, randomized, double-blind, sham-controlled single-center trial conducted at the KinEf Sports Physiotherapy Center in Buenos Aires, Argentina. 40 semi-professional athletes with ultrasound-confirmed acute type 3b hamstring complex injuries who presented within 7 days of the injury. The athletes were randomized into two groups: the active treatment group received real radial ESWT combined with an 8-week structured rehabilitation program; the control group received sham rESWT Both patients and the assessors measuring outcomes were blinded to treatment assignment. The rESWT protocol consisted of nine sessions over three weeks — three sessions per week — with 2,500 radial shock waves per session at an energy density the patient could tolerate. The primary outcome was return-to-sport time. Secondary outcomes included post-treatment muscle strength, patient satisfaction, and re-injury rate. After the trial concluded, a small number of participants had their ultrasound images re-reviewed and 4 of the original 40 were re-classified as type 3a injuries and excluded — leaving a final analysis population of 36 athletes, 18 per group. What They Found The results clearly favored the group that received real rESWT. The athletes who received actual shock wave therapy combined with the rehabilitation program returned to sport significantly faster than those who received sham treatment plus the same rehab. Beyond faster return-to-sport, the rESWT group also showed superior post-treatment muscle strength and higher patient satisfaction scores. Re-injury rates were not significantly different between groups, though the sample size was modest. Wrap It Up Hamstring injuries are one of the most common and one of the most aggravating injuries that active patients and athletes deal with. Return to sport after a significant type 3b hamstring tear can take weeks, and the re-injury risk hangs over the athlete’s entire return. What this trial tells us is that we have a non-invasive, drug-free adjunct therapy — radial shock wave— that, when combined with a well-structured rehabilitation program, can meaningfully reduce recovery time and improve functional outcomes compared to rehab alone. This is important for those of us in the chiropractic and conservative care space. ESWT is a tool that fits squarely within evidence-based conservative management. No surgery. No injections. No drugs. Just targeted mechanical energy to the injured tissue to accelerate natural healing, combined with a progressive rehabilitation protocol. That is exactly the kind of multi-modal conservative approach that gets real results and that we should be able to offer our patients. Now, is this a massive trial? No — 36 athletes at a single center. But it’s randomized, it’s double-blind with a sham control, it’s published in the British Medical Bulletin — a well-respected peer-reviewed journal — and the findings are clinically meaningful. Add this to the growing body of evidence that says ESWT has legitimate utility in musculoskeletal care. If you’re working with athletes or active patients dealing with hamstring injuries, this is absolutely worth having in your clinical back pocket. ──────────────────────────────────────────────────────────── Item #2 – Severe Vitamin D Deficiency Linked to Higher Hospitalizations for Respiratory Tract Infections Remember, the citations can be found at chiropracticforward.com under this episode. Citation: Bournot AR, Hart KH, Johnsen S, Givens DI, Lovegrove JA, Ordóñez-Mena JM, de Lusignan S, Bartlett DB, Lanham-New SA, Darling AL. Association between serum 25-hydroxyvitami

Water Instead of Diet Drinks & Neuromobilization In The Chronic Neck ──────────────────────────────────────────────────────────── INTRO Today we’re going to talk about Water Instead of Diet Drinks & Neuromobilization In The Chronic Neck 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!   WELCOME BACK Hello, everybody. Welcome back to the Chiropractic Forward Podcast. I’m Dr. Jeff Williams, and I’m glad you’re spending a few minutes of your day with me. This is the podcast where we don’t just talk about chiropractic — we build the case for it, one piece of research at a time. Evidence-based, patient-centered, and unapologetically. ────────────────────────────────────────────────────────────. ──────────────────────────────────────────────────────────── THINGS TO DO Real quick — just a few things I’d love for you to do: Number one — if you haven’t already, grab a copy of my book on Amazon. It’s a great resource and it helps support the show. Number two — come join us on Facebook. Find our page and our group and be part of the conversation. Number three — and this one I’ll come back to in a minute — please take a moment to leave us a review on whatever podcast platform you’re using. It genuinely helps. And number four — visit chiropracticforward.com for more content, resources, and information about what we do. ────────────────────────────────────────────────────────────   EPISODE RECAP This is Episode #387. Last week, in Episode #386, we talked about Exercise & Nutrition In Low Back Pain & Migraine In Chiropractic Patients. If you haven’t had a chance to listen to that one yet, go back and check it out. Good stuff. You gotta keep up with the class! ──────────────────────────────────────────────────────────── PERSONAL HAPPENINGS Alright, let’s talk a little bit about life around here before we get into the research. I’ve been listening to a new podcast lately that I’m really enjoying — it’s called Dan Snow’s History Hit. Currently I’m working through episodes about military commanders, and they’ve been covering Erwin Rommel. And I have to tell you — I’ve been fascinated by Rommel since I was a kid. I remember watching some documentary when I was young, and they called him the Desert Fox — and I mean, come on. That’s an incredible nickname. Obviously, as a kid you don’t fully grasp the horrors of what the Nazis represented, but you figure that out pretty quickly as you get older. Even so, Rommel as a military figure has always been a genuinely interesting study to me. If you’re into military history at all, check out Dan Snow’s History Hit. Good podcast. Speaking of podcasts, I would really appreciate it if you would take a minute to review and share this podcast with colleagues you think would benefit from it. Look, I’ll be honest with you — we spent some time on cruise control, just recording episodes and letting them ride. And that’s fine, but I really want to see growth and real traction here. I want to get to the point where, when somebody asks for a chiropractic podcast recommendation, there are fifteen people immediately pointing to this one. I’m biased, obviously — but I genuinely believe that evidence-based, patient-centered information is the best thing we can do for our profession and for our communities. Anything that reduces the noise and elevates the people doing it right is good for everyone. So I’d appreciate your help spreading the word. In other news — I am deep in study mode right now. I’m preparing to take the Qualified Medical Evaluator examination out in California. That test is in April, and I hear they run about a fifty-fifty pass-fail ratio — which is honestly pretty humbling. I do not plan on being on the fail side of that equation, so I am busting my hump to make sure I’m well prepared. I’ll tell you though — when you’re 53 and you’ve got everything going on in your life that I have going on, sitting down to study isn’t always the easiest thing in the world. But the tools available now versus when I was in school are just incredible. One thing that’s really helping me is an app called Brainscape. Essentially it’s a flashcard system, but the smart part is that it has you rate how well you know each card — and the cards you don’t know very well keep coming back more frequently until you rate them higher. That’s a genuinely smart design. There’s also a website called Stuvia that has practice tests and learning materials that have been helpful. Add in a prep class on top of all of that, and I feel like I’m going in well-prepared. But as I always say — we shall see. And one more piece of good news from the clinic. Our acupuncturist’s husband got a job offer in Missouri, so she and her family will be relocating in May. That’s bittersweet — we love her — but here’s the stroke of luck: our brand new associate, fresh out of chiropractic school, was already interested in learning acupuncture. She’s going through the certification process right now and has her test in April. If all goes well, she’ll be ready to step right in line as soon as our current acupuncturist leaves. That means she’ll essentially be paying for herself almost immediately, once she takes over the VA acupuncture patients and our regular acupuncture caseload. I like to say even a broken clock is right twice a day — and sometimes God just smiles down on his people. This one felt a little like both. Alright. Let’s get into the research. ──────────────────────────────────────────────────────────── ITEM #1 The First one today is called, “Effects of Replacing Diet Beverages with Water on Sustained Weight Loss and Type 2 Diabetes Remission — An 18-Month Randomized Clinical Trial” by Farshci et al and was presented at the 85th Scientific Session of American Diabetes Associaiton in Chicago in 2025 and it’s a hot one, stand back   Remember the citations are in the show notes in this episode.   Citation Farshchi, M., Madjd, A., & Farshchi, H.R. (2025). Effects of Replacing Diet Beverages with Water on Sustained Weight Loss and Type 2 Diabetes Remission — An 18-Month Randomized Clinical Trial. Presented at the 85th Scientific Sessions of the American Diabetes Association, Chicago, IL. Abstract 586-P. Published in Diabetes, 74(Supplement 1).   Why They Did It About one in five Americans drinks a diet beverage every single day. And for a long time, the conventional wisdom was that diet sodas were a safe substitute for full-sugar drinks — especially for people trying to manage their weight or their blood sugar. After all, they’re calorie-free, right? Well, some emerging research started suggesting that diet beverages might be affecting the body differently than water, and that maybe the “free pass” thinking wasn’t as solid as we assumed. So these researchers set out to do something no one had done before in this specific population: a long-term, randomized clinical trial looking at what happens when women with type 2 diabetes actually replace their diet drinks with water — and track those results over 18 months. How They Did It They recruited 81 adult women with type 2 diabetes who also had either overweight or obesity — BMI between 27 and 35 — and who were all being managed with metformin. All of them regularly consumed diet beverages as part of their daily routine. The women were randomly split into two groups: one group was told to replace their diet drinks with water five times per week after lunch, and the other group simply continued drinking diet beverages as they normally would. The study included a 6-month active weight loss phase followed by a 12-month weight maintenance phase, for a total of 18 months of follow-up. Researchers tracked weight, BMI, fasting glucose, insulin, insulin resistance, postprandial glucose, and triglycerides. They used an intention-to-treat analysis, which means everyone who was randomized counted in the final results. What They Found The water group lost significantly more weight. At the end of 18 months, the water group had lost an average of 6.82 kilograms compared to 4.85 kilograms in the diet beverage group — a statistically significant difference. But the number that really jumps out? Diabetes remission. Ninety percent — 37 out of 41 women — in the water group achieved diabetes remission. In the diet beverage group, it was 45 percent — 18 out of 40. That is a massive, statistically significant difference. And it wasn’t just remission and weight. The water group also showed meaningful improvements in BMI, fasting plasma glucose, insulin levels, insulin resistance as measured by HOMA-IR, two-hour postprandial glucose, and serum triglycerides. Across the board, water won — and it wasn’t close. Wrap It Up The researchers concluded that sustained replacement of diet beverages with water after meals in women with type 2 diabetes may

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 [email protected]   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

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 [email protected] 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

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 [email protected] 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

  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 [email protected] 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 [email protected] 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

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 [email protected] 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

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 [email protected] 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

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 [email protected] 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

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 [email protected] 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

CF 378: Differences In Whiplash And Normal Neck Pain & Spinal Manipulative Therapy And Scoliosis Today we’re going to talk about Differences In Whiplash And Normal Neck Pain & SMT And Scoliosis 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 [email protected] 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 #378 Now if you missed last week’s episode, we talked about Neuroplastic Responses to Chiropractic Care & Screen Time and Depression. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Well what’s new this week? Still going through the sale process with the investment group you’ve heard me talk about in some of the past episodes. It’s a lot, ya know? Selling a percentage of your lifelong blood sweat and tears and your pride and joy isn’t something you go into lightly. But I think we’re closer than we’ve ever been.  They sent us a contract, our attorney pointed out his concerns, we sent those back to them, it took about 4 months but we got the contract back and are going through it to see what we can meet in the middle on. Once we firm that up, we should be good to go with the closing.  So that’s been going in the background for a long time. Like for a few years at one level or another but more seriously here in just the last year. Hopefully, that chapter is about closed so we can start looking at the next chapter.  Our Parker intern is doing great. She’s smart and very capable. All new DCs need as much adjusting time as they can get. I always think the Motion Palpation Institute is the best start anyone can get. Those folks are top tier. I’m personal friends with Dr. Mark King the President of MPI and with Dr. Lindsay Mumma, who is one of their instructors. I know the level of Doctors they have leading that and really respect them all and their organization.  I know them through our Mastermind and speaking of Mastermind, we’ll all be in New Orleans on October 22nd through that weekend. Really looking forward to being with my people and for the first time ever, we will have Dr. Kevin Christie’s East Group and West Group combined meeting.  My group is the East group and we’ve never met the folks from the West group so it’ll be a good time to build and expand the network. Good stuff and really looking forward to it.  Dr. Jay Greenstein will be there as well and it’s always a good time with Jay. He’s got the vibe down. Also, Dr. Tim Bertlesman of ChiroUp will be there as well. Put those guys on top of Kevin, Mark King, Lindsay Mumma, Ben Fergus, David Rudnick, Vanessa Wilczak, Curt Kippenburger, Anthony Houssain, Tiffany and Tyler Armstrong, and all of my other great friends…..well….it’s going to be solid. As you can imagine.  Lastly, as you know we purchased the Kinas Miracle Wave Radial Shockwave unit last month, attended the shockwave masterclass a week and a half ago out in Atlanta, and are off to the races.    Admittedly, we are behind some of our competitiors but I think with the knowledge base we get to draw from and the masterclass under our belt, we are well-positioned to catch up, differeniate from our competitors, and build this thing! If you need the Kinas hook-up, shoot me and email at [email protected] and I’ll get you in touch with the folks that can help you get started.  Item #1 The first one today is called, “Effects of High-Velocity Spinal Manipulation on Quality of Life, Pain and Spinal Curvature in Children with Idiopathic Scoliosis: A Systematic Review” by Piqueras-Toharias et al and published in children in 2024.  Remember, the citations can be found at chiropracticforward.com under this episode.  Piqueras-Toharias, M.; Ibáñez-Vera, A.J.; Peinado-Rubia, A.B.; Rodríguez-Almagro, D.; Lomas-Vega, R.; Sedeño-Vidal, A. Effects of High-Velocity Spinal Manipulation on Quality of Life, Pain and Spinal Curvature in Children with Idiopathic Scoliosis: A Systematic Review. Children 2024, 11, 1167. https://doi.org/10.3390/children11101167 Why They Did It Scoliosis is a condition that involves deformation of the spine in the coronal plane and commonly appears in childhood or adolescence, significantly limiting a person’s life.  The cause is multifactorial, and treatment aims to improve the spinal curvature, prevent major pathologies, and enhance aesthetics.  The objective of this review was to determine whether high-velocity low-amplitude (HVLA) spinal manipulation is more effective than other treatments for children with idiopathic scoliosis (IS). How They Did It The PubMed, Web of Science, Scopus and PEDro databases were searched for both clinical trials and cohort studies.  Methodological quality was assessed via the PEDro scale (for clinical trials) and the Newcastle–Ottawa scale (for observational studies).  The protocol of this systematic review was registered in PROSPERO (CRD42024532442). What They Found Five studies were selected for review. The results indicated moderate improvements in pain and the Cobb angle and limited improvements in quality of life Wrap It Up HVLA spinal manipulation does not seem to have significant effects on reducing spinal deformity in IS patients, nor does it significantly impact quality of life.  However, this therapy may have significant effects on reducing pain in these patients. Item #2 The last one this week is called, “Differences in the clinical presentation of chronic whiplash-associated disorders and nontraumatic neck pain: a systematic review and meta-analysis” by Junze et al and published in Pain in August 2025 and it’s a hot tamale hot tamale! Chen, Junzea; Farrell, Scott F.a; Huang, Wanyun Irenea; Cagnie, Barbarab; Murillo, Carlosb; Sterling, Michelea,*. Differences in the clinical presentation of chronic whiplash-associated disorders and nontraumatic neck pain: a systematic review and meta-analysis. PAIN 166(8):p 1738-1756, August 2025. | DOI: 10.1097/j.pain.0000000000003554 Why They Did It Health outcomes may be worse for individuals with whiplash-associated disorders (WAD) compared to nontraumatic neck pain (NTNP), and clinical characteristics may differ.  This systematic review examined evidence comparing WAD and NTNP in terms of pain, disability, psychological status, quality of life, measures of nociceptive processing, movement, sensorimotor, and muscle function. How They Did It Studies were identified through electronic database searches and included after screening against predefined eligibility criteria. Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CI) were calculated. Associations between MDs with demographics and study characteristics were explored using meta-regression. Certainty of evidence was assessed using Grades of Recommendation, Assessment, Development, and Evaluation. Sixty-one studies were eligible with 45 included in meta-analysis. What They Found Individuals with WAD reported  clinically relevant higher disability,  greater remote cold sensitivity,  lower quality of life,  greater depression,  greater local and  remote pressure sensitivity,  less cervical flexion and extension,  higher pain intensity, and  greater kinesiophobia.  No between-group differences were found for dizziness symptoms, stress, anxiety, balance, and local cold sensitivity.  Wrap It Up Certainty of evidence was mostly moderate.  Individuals with chronic WAD have a worse clinical presentation compared to those with chronic non-traumatic neck pain, which has implications for patient assessment and management. 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 treatment

CF 377: Neuroplastic Responses to Chiropractic Care & Screen Time And Depression Today we’re going to talk about Neuroplastic Responses to Chiropractic Care & Screen Time And Depression 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 12-er.  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 me and we’re 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 [email protected] 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 #377 Now if you missed last week’s episode, we talked about Acupuncture For Chronic Low Bac k And Spinal Manipulative Therapy for Acute Neck Pain Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I just recently returned from the Academy Of Shockwave Excellence Masterclass out in Atlanta, GA and now, I’m a master in Shockwave.  In case you are wondering, I started on this path and journey because of my Mastermind group that you always hear me talking about. Two of our members are instructors and masters in Shockwave. Dr. Ben Fergus in Evanston, IL and Dr. David Rudnick from Boynton Beach, FL.  These two guys are freaks on the. Shockwave and they BOTH use Kinas radial and focused shockwave units. So, I ordered Kinas, then attended the Masterclass, and now, I’m up and running and pissing some excellence.  If you are entertaining the thought of getting shockwave, I want you to send me an email at [email protected] and let’s talk about it. It is my understanding that this is the only group that has a materclass academy that really gets you and your staff trained. If you just get a manual from the manufacturer and don’t really get traning, then this is your group. I encourage you to get going on it. Send me an email and I’ll point you the right direction. [email protected] Item #1 Our first one is called “Role of Sleep and White Matter in the Link Between Screen Time and Depression in Childhood and Early Adolescence” by Santos et al published in JAMA Pediatrics on September 1, 2025 and it’s hotter than Angelina.  Remember, the citations can be found at chiropracticforward.com under this episode.  Lima Santos JP, Soehner AM, Biernesser CL, Ladouceur CD, Versace A. Role of Sleep and White Matter in the Link Between Screen Time and Depression in Childhood and Early Adolescence. JAMA Pediatr. 2025 Sep 1;179(9):1000-1008. doi: 10.1001/jamapediatrics.2025.1718. PMID: 40549406; PMCID: PMC12186512. Why They Did It To identify the association between screen time during late childhood and depressive symptoms in early adolescence, and to investigate whether these associations are mediated by sleep duration and white matter organization. How They Did It Prospective study was conducted from January 2024 to June 2024.  Data from the Adolescent Behavior Cognitive Development (ABCD) Study were used  Children and their parent/caregiver were recruited across 21 US cities.  Participants with no past/current psychiatric disorders were selected for analyses.  Outcomes included screen time assessed using a self-report questionnaire, sleep duration assessed using the Munich Chronotype Questionnaire, and depressive symptoms characterized using the Child Behavior Checklist.  Neurite orientation dispersion and density imaging and a tract profile approach were used to characterize the orientation dispersion index of 3 white matter tracts that are known to be implicated with depression: cingulum bundle, forceps minor, and uncinate fasciculus. Analyses included 976 participants What They Found Each additional hour of daily screen time at T1 (defined as aged 9-10 years old) was associated with a 0.12-point increase in Child Behavior Checklist depressive score at T2 (defined as aged 11-13 years old).  Shorter sleep duration and worse cingulum bundle organization at T2 mediated 36.4% of the association between more screen time and more depressive symptoms. Wrap It Up Results of this study show that more screen time in late childhood was associated with more depressive symptoms, potentially due to shorter sleep and worse white matter organization during early adolescence.  These findings emphasize the importance of promoting healthy habits and balancing screen time with adequate sleep. Item #2 Our last one today is called, “Neuroplastic Responses to Chiropractic Care: Broad Impacts on Pain, Mood, Sleep, and Quality of Life” by Haavik et al and published in Brain Science in 2024.  Haavik, H.; Niazi, I.K.; Amjad, I.; Kumari, N.; Ghani, U.; Ashfaque, M.; Rashid, U.; Navid, M.S.; Kamavuako, E.N.; Pujari, A.N.; et al. Neuroplastic Responses to Chiropractic Care: Broad Impacts on Pain, Mood, Sleep, and Quality of Life. Brain Sci. 2024, 14, 1124. https://doi.org/10.3390/brainsci14111124 What This Study Found: Chiropractic Care and Brain Changes This 2025 research paper looked at how chiropractic care (spinal adjustments) affects the brain, particularly focusing on people with chronic lower back pain. Here’s what they discovered, explained simply: The Main Question: The researchers wanted to understand how chiropractic care works in the brain. They knew it helped people feel better, but they wanted to see what was actually changing in the brain itself. What They Did: The study recruited 122 participants with chronic low back pain and gave them chiropractic care approximately three times per week for four week.s They used brain scans (EEG), measured nerve responses, tracked sleep with Fitbit devices, and asked people about their quality of life. The Big Discovery: The researchers found that chiropractic care changed how a specific brain network called the “Default Mode Network” (DMN) functions. Think of the DMN as the part of your brain that’s active when you’re daydreaming, thinking about yourself, or reflecting on your life. Chronic problems, such as chronic musculoskeletal pain, as well as common chronic disorders such as anxiety and depression have been found to have clear deficits in access, engagement and disengagement of the DMN Why This Matters: It is thought that when suffering is ongoing long-term the feelings of pain may become part of one’s internal self-story, and, similarly, ongoing worry can develop into anxiety and ongoing sadness can become depression. In other words, chronic pain can literally become part of your identity. What Improved: After four weeks of chiropractic care, participants showed: Significantly improved overall quality of life with significant improvements in the domains of anxiety, depression, fatigue, pain intensity and pain interference  Better sleep quality (more light sleep) Changes in brain activity suggesting better pain processing Improved connections between different brain regions The Bottom Line: The current findings provide compelling evidence for why chiropractic care, that includes the HVLA adjustments directed towards subluxated segments, can impact not only chronic pain symptoms, but also influence anxiety and depression symptoms.  The study suggests that chiropractic adjustments don’t just help with pain directly—they actually change how your brain processes sensory information and how you think about yourself and your pain, which can break the cycle of chronic pain becoming part of your identity. This research helps explain why some people with chronic pain find relief through chiropractic care and why that relief extends beyond just physical symptoms to include mental health improvements.   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 & disa

CF 376: Acupuncture For Chronic Low Back & Spinal Manipulative Therapy For Acute Neck Pain Today we’re going to talk about Acupuncture For Chronic Low Back & Spinal Manipulative Therapy For Acute Neck Pain 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 12-er.  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 me and we’re learning together.  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 #376. Can you believe I’ve done 376 episodes of this podcast?/ That’s weird to think. Doing 376 reps of anything is a lot. Much less something like this. I’m in the 8th year of doing this. Weird.  Now if you missed last week’s episode, we talked about Neural Mobilization & Cannabis And Heart Attacks And Strokes.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. As part of the Kinas Shockwave purchase, a staff member and I are headed to Atlanta this weekend for the shockwave masterclass where we will learn master level shockwave. Or at least that is what the name implies! Which is awesome because I get to learn from one of my fellow Mastermind members and friends, Dr. David Rudnick out of Boynton Beach, FL which is basically Boca Raton. David is the man and I’m looking forward to learning from him. He and Dr. Ben Fergus from Evanston, Illinois (Chicago) are the Shockwave masters and both are in my Mastermind. Which is incredibly handy.  I’ve said it before but it stands repeating that any time you can get into a room where you are not the smartest or most capable, that is a room you desperately want to be in. That is definitely the case with my Mastermind group.  Now, let’s talk about business. It’s coming back and coming back strong. We just had to get out of Summer and the travel season that comes with the Summer. Getting everyone back on a schedule has made all the difference in the world.  Another thing is that we recently had a local chiro suffer a stroke. From what I hear, he is able and capable, but unable to speak or communicate efficiently or effectively. So at 72, he’s had to call it quits and retire.  While unfortunate and terrible, it means that many of his patients have somehow found their way here to our clinic. So we had a big number of new patients last week and continuing into this week and most of them are from that clinic.  So, it’s been a plus for our clinic for sure but nothing to celebrate. This chiro was an excellent person and, from all indicators, a great chiro whose patients really loved.  Now the challenge here is that we need to figure out how to blend with these new ones. Imagine going to a brand new chiro when you’ve been going to the same one for years and years. That’s a difficult thing.  So, it’s clear I’m different so I have to make sure I explain at length why they might hear something different from me vs. their old chiro without bashing their old chiro. It’s OK to say something like, “‘While I agree with Dr. So and so on this, I can tell you that just in the last few years, research has started suggesting this on this issue over here.” Or something similar. So they know you’re on top of your crapola but you’re not trashing the other or throwing them under the bus.  That’s important. They need to know you’re sensitive to them having to come see you and they need to know that you really appreciate them being here and you’d like for them to become a part of your practice.  I also tell them what Clinical Compass tells us on their treatment schedule but, remember, they’ve been going to the chiro a long time. They have their schedule and their routine. So you can commonly hear me say, “Clinical Compass suggests starting at twice per week for a month but you’ve been going for a while and you know what works for you so use me how you would like and I’ll see you on your next visit.” Pretty simple but delicate too  That’s the dance we’ve been doing lately. OK, here is this week’s research.  Item #1 Our first one this week is called, “Acupuncture for Chronic Low Back Pain in Older Adults: A Randomized Clinical Trial” by DeBar et al and published in JAMA Open on September 12, 2025. Hell yeah it’s hot! Remember, the citations can be found at chiropracticforward.com under this episode.  DeBar LL, Wellman RD, Justice M, et al. Acupuncture for Chronic Low Back Pain in Older Adults: A Randomized Clinical Trial. JAMA Netw Open. 2025;8(9):e2531348. doi:10.1001/jamanetworkopen.2025.31348 Why They Did It To determine the effectiveness of standard acupuncture (SA) or standard acupuncture plus maintenance (enhanced acupuncture [EA]) to improve CLBP-related disability relative to usual medical care (UMC) at 3, 6, and 12 months after randomization. How They Did It This multisite, 3-arm, parallel-group randomized clinical trial of older adults with CLBP collected data from 4 US health care systems in 3 geographic areas and compared SA and enhanced acupuncture treatment with UMC only.  Both standard acupuncture, which was 8-15 treatment sessions over 12 weeks plus UMC,  and enhanced acupuncture, whiich was standard acupuncture plus 4-6 maintenance sessions during the next 12 weeks, were provided  Participants were randomized to the 3 groups. The primary outcome was CLBP-related disability measured by a baseline-to-6-month change in the Roland-Morris Disability Questionnaire (RMDQ) score.  What They Found The trial identified 800 individuals who were randomized to 3 groups  At 6 months, RMDQ change scores were significantly better in both the SA and EA groups compared with the UMC only group  SA and EA change scores did not differ significantly from one another.  Benefits were still present at 12 months.  Pain intensity exhibited a relative benefit of EA over SA at 6 months, and both acupuncture groups had significant improvement over UMC.  Wrap It Up The findings of this randomized clinical trial of older adults with CLBP suggest that acupuncture needling provided greater improvements in back pain–related disability at 6 months and at 12 months compared with UMC alone.  Item #2 Our second one today is called, “Efficacy and safety of spinal manipulative therapy in the management of acute neck pain: a systematic review and meta‐analysis” by Diao et al and published in BMC on May 1, 2025 and that’s a steamy plate of goodness.  Diao Y, Liu Y, Pan J, Chen J, Pan J, Liao M, Liu H, Liao L. Efficacy and safety of spinal manipulative therapy in the management of acute neck pain: a systematic review and meta-analysis. Syst Rev. 2025 May 1;14(1):97. doi: 10.1186/s13643-025-02855-7. PMID: 40312450; PMCID: PMC12044948. Why They Did It This study aims to comprehensively evaluate the efficacy and safety of SMT in the treatment of acute neck pain. How They Did It A thorough search was conducted in PubMed, Embase, Web of Science, PEDro, and Cochrane Library databases, covering all studies from inception to March 20, 2023.  Mean differences (MD) with 95% confidence intervals (CIs) were calculated to assess outcomes such as pain intensity, cervical range of motion, and disability.  The PEDro Scale and the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach were utilized to evaluate the methodological quality and strength of evidence. What They Found Eight randomized controlled trials (RCTs) with 965 patients were included.  Their PEDro scores ranged from 4-9.  Forest plot analysis showed SMT was better than the control in reducing pain and improving cervical range of motion in all measured aspects.  It also significantly reduced disability scores.  No serious adverse events were reported. Wrap It Up The evidence supports the use of SMT as an effective and safe intervention for reducing pain, improving cervical range of motion, and decreasing disability in patients with acute neck pain.  These findings provide valuable insights for clinical practitioners and highlight the potential of SMT as a viable therapeutic option in managing acute neck pain.   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 movem

CF 375: Neural Mobilization & Cannabis And Heart Attacks And Strokes Today we’re going to talk about Neural Mobilization & Cannabis And Heart Attacks And Strokes 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, 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 [email protected] If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast on wherever you listen to it  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #375 Now if you missed last week’s episode, we talked about Non-surgical Disc Treatment & Cognitive Functional Therapy.  Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. Well, now that school’s back in and people are getting back on a schedule, I am starting to see patients returning. Which is quite a relief. I was starting to wonder if I pissed on the mayor’s dog or something and made the whole town mad at me. It’s been slow all summer long and that’s no fun.  While this week is still slower than I like to see, the new patients are well on the rise. I think I have 18 new patients this week and that’s A-OK with me.  Especially when you factor in that we have what is called the Tri-State Fair going on here. It’s a week long thing and people will literally take out small loans to take their family to this thing. Which is something we don’t really understand but, yeah, it’s a real thing.  The fair typically slows us down but this year, we’re on the rise while the fair is happening and that’s even better news.  Our intern from Parker is doign great. She’s really smart, very professional, and seems to be learning a ton. She asks great questions and seems pretty happy with her experience. Which is great. We don’t get a ton of interns here in Amarillo so it’s nice to have an extra set of hands around the clinic. Especially and extra set of hands that we enjoy having around. She’s been great.  Still getting goign with the launch of Shockwave here in the clinic. Still introducing it to our patients and so far, they love it. As an old college football player myself, I’m using it as well. Both shoulders and low back to start with. Once I get them in shape, we’ll move to the knees and a hammy. Hey if you pay for something, you might as well be engaging in some healthcare too. That’s just another tip from your Ol’ Uncle Jeffro.  Before we get to the research I’ll leave you with this. Go Cowboys! Item #1 The first on etoday is called, “Neural mobilisation effects in nerve function and nerve structure of patients with peripheral neuropathic pain: A systematic review with meta-analysis”’ by Bittencourt et al and published in PLOS One on November 8, 2024 and it’s a lil bit smoky.  Remember, the citations can be found at chiropracticforward.com under this episode.  Neural mobilisation effects in nerve function and nerve structure of patients with peripheral neuropathic pain: A systematic review with meta-analysis Juliana Valentim Bittencourt , Leticia Amaral Corrêa, Maria Alice Mainenti Pagnez, Jéssica Pinto Martins do Rio, Gustavo Felicio Telles, Stephanie Mathieson, Leandro Alberto Calazans Nogueira Published: November 8, 2024 https://doi.org/10.1371/journal.pone.0313025   Why They Did It To assess the effects of neural mobilisation on nerve function and nerve structure of patients with peripheral neuropathic pain. How They Did It A systematic review with meta-analysis was conducted.  Eligibility criteria included controlled trials or quasi-experimental studies comparing neural mobilisation versus sham, active or inactive control in adults with peripheral neuropathic pain.  Primary outcomes were the change in peripheral nerve cross-sectional area.  Secondary outcomes included nerve echogenicity, nerve excursion and nerve conduction.  What They Found Eleven randomised controlled trials and four quasi-experimental studies (total sample = 722 participants) were included.  Thirteen studies included participants with carpal tunnel syndrome.  Two studies examined the cross-sectional area, revealing improvements (i.e., a reduction) in the cross-sectional area after the neural mobilisation.  Neural mobilisation improved motor and sensory conduction velocity in short-term, compared to control.  Neural mobilisation did not alter distal motor or sensory latency. Wrap It Up Neural mobilisation seems to improve the cross-sectional area and sensory conduction velocity.  Neural mobilisation was superior to control in improving motor conduction velocity in patients with peripheral neuropathic pain with moderate quality evidence.  Distal motor or sensory latency presented similar results compared to other interventions.  Our findings should be interpreted cautiously since most studies included patients with carpal tunnel syndrome.   Item #2 Here we go….Ol Uncle Jeffo is being uncool again and trying to tell people what to do with their recreational drug habits. I’m not trying to tell you what to do. I’m not your real mom.  But if you’re going to do it, at least know the real risks and not what your bud dealer Ernie told you about the safety.  Yes, I know alcohol is worse and all the other pro-weed arguments. I get it. We actually tried outlawing alcohol in the 30’s because it’s so bad. I get it. But just because alcohol is legal does not mean weed is good, safe, and smart for legalization. Why make two things legal when you don’t have to? Keep it for medical use without abusing the term and disrespecting those that actually need it for medical use. Hell yeah, Francis. But don’t legalize it. It’s ridiculous.  With my total uncoolness now being on full display, the last one today is an online article called, “Cannabis use raises risk of heart attack and stroke more than cocaine, other drugs, major review suggests Marijuana users may face twice the risk of cardiovascular death, research finds” by Angelica Stabile with Fox News and posted June 19, 2025 and aye carumba!!! Es muy caliente!! https://www.foxnews.com/health/cannabis-use-raises-risk-heart-attack-stroke-more-than-cocaine-other-drugs-major-review-suggests Here it is summarized in a nutshell: A major new study has found some concerning links between marijuana (cannabis) use and heart problems. Here’s what the research shows in simple terms: The Big Study: French researchers looked data from over 400 million patients across 24 different studies to see how cannabis affects heart health. It was a “meta-analysis,” so it’s no small thing. The Scary Numbers: The study found cannabis users had a 29% higher chance of heart attacks, 20% higher risk of strokes, and twice the risk of dying from heart problems The risks were especially high for people who used cannabis at least once a week. More Dangerous Than Expected:  Surprisingly, one study found cannabis was a bigger predictor of heart attacks than other illegal drugs like cocaine and opioids This challenges what many people assume about cannabis being “safer.” Young People at Risk:  The dangers weren’t just for older adults either. Several studies found higher risks for younger people, including those aged 15-22 and 18-36 Women appeared to face higher risks than men. Why This Matters:  As more states legalize marijuana and more people (including seniors) use it, doctors are seeing more emergency room visits related to cannabis.  A medical expert compared marijuana’s effects on the heart and lungs to cigarette smoking. The Bottom Line:  While medical marijuana can help some patients with serious conditions, this research suggests regular cannabis use carries real heart risks that many people don’t realize.  The researchers say doctors should ask all heart patients about cannabis use, just like they ask about smoking or drinking. 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!

CF 374: Non-surgical Disc Treatment & Cognitive Functional Therapy Today we’re going to talk about Non-surgical Disc Treatment & Cognitive Functional Therapy 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, 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 [email protected] If you haven’t yet I have a few things you should do.  Go to Amazon and check our my book called The Remarkable Truth About Chiropractic: A Unique Journey Into The Research. It’s excellent resource for you and is categorized into sections so the information is easy to find and written in a way that is easy to understand for everyone. It’s on Amazon. That’s the Remarkable Truth About Chiropractic by Jeff Williams.  Like our Chiropractic Forward Facebook page,  Join our private Chiropractic Forward Facebook group, and then  Review our podcast on wherever you listen to it  Last thing real quick, we also have an evidence-based brochure and poster store at chiropracticforward.com You have found yourself smack dab in the middle of Episode #374 Now if you missed last week’s episode, we talked about Vertebral Artery Dissection Recognized and Referred By Chiropractor. Make sure you don’t miss that info. Keep up with the class.  On the personal end of things….. I got back from Florida Keys annd am doing everything I can do to catch up. I’m nowhere near being caught up so I hope you’ll understand that I’m keeping it short this week.  Our new intern is on board and getting settled in and says she’s learning fast so that’s good. We’ll have her doing the exams by next week I believe. If you have a great intern training program, send it my way at [email protected]. I’d love to see it. I have one. But I’m open to all suggestions.  We are up and running with the new shockwave machine. While it’s going well early on, we have an obstacle we didn’t expect. The entire Eastern half of the country can get shockwave covered through the VA system.  I assumed the West part of the US was the same but it is not. Much to my chagrin. The East is served by Optum Server. The West is served by Tri-West. You’d think it’d all be Federal and uniform. Yeah, no. It’s not.  So, we put on our big boy pants and knock it out the hard way. Cash pay patients. But it’s going OK.  That’s all I have today. Between the Ukranian refugee girl being stabbed and murdered on the train in Charlotte and Charlie Kirk being shot and killed today…….I’m just not feeling it. I’m sure I’m not the only one.  2025 has been a tough one. For me nand for lots and lots of my friends. Just crazy.  I’ll be back next week with more time and more ability to form a great thought process for you. Or, at least, a normal for your Ol’ Uncle Jeff anyway.  Item #1 Our first one today is called, “Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review” by Melhat et al published in Jorunal of Clinical Medicine in February 2024. Sizzlin’ hot! Remember, the citations can be found at chiropracticforward.com under this episode.  El Melhat, A.M.; Youssef, A.S.A.; Zebdawi, M.R.; Hafez, M.A.; Khalil, L.H.; Harrison, D.E. Non-Surgical Approaches to the Management of Lumbar Disc Herniation Associated with Radiculopathy: A Narrative Review. J. Clin. Med. 2024, 13, 974. https://doi.org/10.3390/jcm13040974 Why They Did It Lumbar disc herniation associated with radiculopathy (LDHR) is among the most frequent causes of spine-related disorders.  This condition is triggered by irritation of the nerve root caused by a herniated disc.  Many non-surgical and surgical approaches are available for managing this prevalent disorder.  Non-surgical treatment approaches are considered the preferred initial management methods as they are proven to be efficient in reducing both pain and disability in the absence of any red flags.  The objective of this article is to introduce advanced and new treatment techniques, supplementing existing knowledge on various conservative treatments. It provides a comprehensive overview of the current therapeutic landscape, thereby suggesting pathways for future research to fill the gaps in knowledge.  How They Did It Extensive exploration of recent clinical research, focusing on various non-surgical approaches for LDHR.  By exploring the effectiveness and patient-related outcomes of various conservative approaches, including physical therapy modalities and alternative therapies, therapists gain valuable insights that can inform clinical decision-making, ultimately contributing to enhanced patient care and improved outcomes in the treatment of LDHR. What They Found Specific to our detailed review, we identified the following interventions to yield moderate evidence (Level B) of effectiveness for the conservative treatment of LDHR: patient education and self-management, McKenzie method, mobilization and manipulation, exercise therapy, traction (short-term outcomes), neural mobilization, and epidural injections.  Two interventions were identified to have weak evidence of effectiveness (Level C): traction for long-term outcomes and dry needling.  Three interventions were identified to have conflicting or no evidence (Level D) of effectiveness: electro-diagnostic-based management, laser and ultrasound, and electrotherapy. Item #2 The last one this week is called, “Effectiveness of cognitive functional therapy for chronic spinal pain: a systematic review with meta-analysis” by Marelli et al and published in Pain Medicine in May of 2025 and it’s a hottie too! Michele Marelli, Matteo Cioeta, Leonardo Pellicciari, Fabio Rossi, Stefania Guida, Silvia Bargeri, Effectiveness of cognitive functional therapy for chronic spinal pain: a systematic review with meta-analysis, Pain Medicine, Volume 26, Issue 5, May 2025, Pages 248–260, https://doi.org/10.1093/pm/pnaf002 Why They Did It To assess the effectiveness of cognitive functional therapy (CFT) in reducing disability and pain compared to other interventions in chronic spinal pain patients. How They Did It Five databases were queried to October 2023 for retrieving randomized controlled trials (RCTs), including patients with chronic spinal pain and administering cognitive functional therapy.  Primary outcomes were disability and pain. Secondary outcomes included psychological factors, quality of life, patient satisfaction, and adverse events.  Two independent reviewers performed study selection, data extraction, risk of bias assessment  What They Found Compared to other conservative interventions, cognitive functional therapy may reduce disability and pain at short-term follow-up with probable to possible clinical relevance in CLBP and with low and very low evidence certainty, respectively.  Similar results, with larger effect sizes, were observed for cognitive functional therapy compared to any unstructured or unsupervised minimal care treatments.  Efficacy persisted in longer-term follow-ups, except for comparison with other conservative interventions. The study showed positive results for cognitive functional therapy. Evidence certainty was low to very low. Wrap It Up Cognitive functional therapy may offer clinically relevant benefits for CLBP, although the evidence remains mainly of low to very low certainty.  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 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 chir