OM DENNE EPISODE
Hey everybody, welcome to episode 390. I’m Dr. Jeff Williams and I’m your host for the Chiropractic Forward Podcast. This week we’ll cover Manual Therapy Plus Exercise & Multidisciplinary Rehab For Low Back Pain first though, 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!
WelcomeWelcome back, and thanks for joining me here on the Chiropractic Forward Podcast where we talk about issues related to health, chiropractic, evidence, manipulation, this profession, and the practical application of all of it. It’s a good one today, so stand back — we’ve got some good research to get into.
A Few Things To DoBefore we get rolling, here’s the usual list of things I’d love for you to do.
Go pick up my book on Amazon called The Remarkable Truth About Chiropractic; A Unique Journey Into The Research. It’s a quick, easy read and it’ll help you talk to your patients about the evidence behind what we do.
Go like and follow us on the Facebook page and if you want to be part of the conversation with other evidence-minded docs, jump into our Facebook group.
Please leave us a review on whatever platform you’re listening on. Honest reviews and subscribes are how this show gets in front of more chiropractors, so it really does make a difference.
And of course, head over to chiropracticforward.com for the show notes, the research links, and everything else we’ve got going on.
Last week, on episode 389, we covered PNF Stretching For Knee OA & A 50-Year Review Of Chiropractic Research. If you missed it, you can always go back and catch that one at chiropracticforward.com. You gotta keep up with the class.
Personal HappeningsWell, I want to start out by apologizing for it being so long since the last episode. I really do want to get back to doing the podcast more regularly. Maybe not every single week like I’ve done for seven or eight years, but at least every two or three weeks. It is something I still enjoy doing, but my time has become more and more limited in recent months.
I would say that part of that has to do with hiring a new associate and two new Nurse Practitioners, and working double time with marketing and planning ideas to get her as busy as possible as quickly as possible.
As if bringing on three new providers is not enough reason, I was also up to my neck in QME, studying and test taking for about six months. It was something I did not want to repeat twice, and the pass – fail rate for the QME test is about 50%, so I wanted to make sure that I only had to do it once. And as luck would have it, I passed the test.
So after getting my California chiropractic license and going through all of the study and prep, I am now a qualified medical evaluator in the California work comp system. What that means is I will be flying out to California from my home base in Amarillo, Texas, about once every four or five weeks to perform impairment rating exams on injured workers. Once I do an impairment rating and write a report, that goes to the disability evaluation unit, and they take my report and impairment rating, plus a lot of other factors, and combine it all in to determine the workers total disability rating, which will also determine how much they get in benefits and for how long and all of that good stuff.
So, as you can see, I’ve been really busy. On top of that, I’m firing my social media company because in the last two or three years of using them, while my YouTube channel has grown, that hasn’t turned into people coming into the office, which is the real reason for marketing, and here in 2026 I’m still not as busy as I was right before Covid hit. Now there are several factors that go into that, like relationships with PI attorneys coming and going, and the VA hiring their own providers and things like that, so it’s not all one factor, like COVID wrecked the practice and it’s just never recovered.
Still, I don’t like going backwards. I like to always move forward. And when I see other chiropractors doing paid ads everywhere and marketing like crazy, and I’m not doing any of that, and the company I’ve hired to market me is not doing any of that, then I think it’s time to make some changes. And in the day and age of AI, all of those things are well within hand if we’ve just got the time to do it. And that’s what I’ve been doing, trying to make better use of the very limited free time that I have.
I have AI walking me through building Facebook ads on my own. I’ve also been building an AI brain that holds all of my clinical information. It’s all HIPAA compliant. There’s no patient names or PHI in the brain, but as far as diagnosis, all of the certifications I’ve had, all of the learning, all of the education, all of it. I’ve built a brain that holds it all and can reference it all.
Think about it. We take courses or classes or go to conferences, and we’re lucky to just have three or four key takeaways. But what if you had a brain that you could load it all into and have access to at any point in the future, just by typing a simple question? That would be worth something, right? Well, that’s what I’ve been busy building. And I’m still building.
So, yeah, between traveling and working and all of this extra stuff on my plate, the podcast has been less frequent than planned. But I’m hoping to get back on it more regularly. And with that being said, let’s hop into the research.
Item #1The first one this week is called, “Effectiveness of adding manual therapy to exercise for pain and disability in chronic non-specific low back pain: A systematic review and meta-analysis.” by Dos Santos et al and was published in Musculoskeletal Science Practice in 2026 and that’s hotter that a jalapeno pizza Pedro!
The citation can be found in the show notes at chiropracticforward.com
Citation: Dos Santos ECS, Dos Santos AT, da Silva NA, Carneiro SR, Rampazo ÉP, Magalhães MO. Effectiveness of adding manual therapy to exercise for pain and disability in chronic non-specific low back pain: A systematic review and meta-analysis. Musculoskelet Sci Pract. 2026 Apr;82:103508. doi: 10.1016/j.msksp.2026.103508. Epub 2026 Jan 30.
Why They Did It
Manual therapy and therapeutic exercise are both recommended for chronic non-specific low back pain, but the additional benefit of combining the two is uncertain. The researchers set out to systematically review the effects of adding manual therapy to therapeutic exercise, compared to exercise alone, on pain intensity and functional disability in adults with chronic non-specific low back pain.
How They Did It
This was a systematic review and meta-analysis of randomized controlled trials.
They included adults aged 18 to 65 with chronic non-specific low back pain lasting twelve weeks or longer.
The interventions combined joint-based manual therapy — spinal mobilization and/or manipulation — with therapeutic exercise that involved stretching, strengthening, motor control, and endurance training.
The main outcomes were pain intensity and functional disability at short-, medium-, and long-term follow-up.
What They Found
Five trials with a total of 260 participants were included.
Low-quality evidence indicated no significant short-term pain reduction with manual therapy plus exercise versus exercise alone.
However, moderate-to-low-certainty evidence showed greater improvement in disability with the combined therapy at both short-term and long-term follow-up.
Wrap It Up
The authors concluded that adding manual therapy to therapeutic exercise does not appear to provide a substantial additional short-term improvement in pain intensity compared to exercise alone, but it did produce significant benefits for functional disability in both the short and long term.
And that’s the part I want you to hang onto.
Disability — how well a person can actually function and live their life — is what matters to the patient sitting in front of you.
This is one more piece of evidence supporting the conservative, hands-on, movement-based approach that we do every single day, and it’s a reminder that manual therapy and exercise together are a powerful combination for getting people back to their lives.
Item #2The second one today is called, ‘Effectiveness of Multidisciplinary Rehabilitation in Chronic Low Back Pain: A Pragmatic Study With a Waiting List Control Group’ by Van W ingerden et al and published in European Journal of Pain in 2026 and it’s hot like an August Texas Tin Roof people.
Citation: van Wingerden JP, van Opstal T. Effectiveness of Multidisciplinary Rehabilitation in Chronic Low Back Pain: A Pragmatic Study With a Waiting List Control Group. Eur J Pain. 2026 Jan;30(1):e70209. doi: 10.1002/ejp.70209.
Why They Did It
Small-scale care providers often run into a wall when they try to demonstrate that their treatments work through randomized controlled trials, simply because RCTs are so expensive and organizationally demanding. So this group wanted to examine whether they could evaluate a multidisciplinary treatment for chronic low back pain using a waiting list as the control group instead — a more realistic option for a smaller clinic.
How They Did It
Out of 344 chronic pain patients referred to a Dutch outpatient rehabilitation clinic, 123 received treatment while 88 were placed on a waiting list.
Their main effect measures were pain on a visual analogue scale, daily limitations on the Quebec Back Pain Disability Scale, and fear of motion on the Tampa Scale for Kinesiophobia.
Data were collected at the start of treatment, at eight weeks, and at three months for follow-up — or after another eight weeks for the waitlist patients who received treatment after their waiting period.
What They Found
The intervention group showed significant, persistent improvement in pain, in daily limitations, and in fear of motion.
Then 51 of the subjects from the waiting list went on to receive treatment, and their results were similar to those of the original intervention group.
On top of that, dysfunctional pain-coping strategies diminished during therapy.
Wrap It Up
The bottom line is that multidisciplinary rehabilitation was clearly more effective than simply being parked on a waiting list — even when those waitlisted folks were receiving other treatments while they cooled their jets.
The authors also made the point that small-scale, high-quality effect studies using a waiting list control have real scientific potential.
For those of us in conservative care, there are two takeaways here.
First, active, multidisciplinary rehab beats doing nothing or just waiting around, and that lines up with everything we preach about getting people moving. Hurt doesn’t mean harm. If you wait to feel better to move, you’re in trouble, homie.
And second, you don’t have to be a giant research institution to produce meaningful evidence — smaller clinics can and should be contributing to the body of research that supports what we do.
Closing RemarksSo there you have it. Two papers this week, both pointing in the same direction: keep people active, combine smart hands-on care with exercise, and don’t leave them sitting on a waiting list.
That’s conservative care, and that’s our corner of the world.
Alright, that’s it. Keep on keepin’ on. Keep changing our profession from your corner of the world. 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.
The StoreHead to the store at chiropracticforward.com for evidence-informed brochures and posters to help educate your patients and your community.
Purchase Dr. Williams’s book, a perfect educational tool and chiropractic research reference for the daily practitioner, from the Amazon store TODAY!
The MessageI want you to know with absolute certainty that when Chiropractic is at its best, you can’t beat the risk versus reward profile when it comes to non-complicated musculoskeletal complaints. Chiropractic care, when it’s at its best, tends to be safe, more cost-effective, and at least as effective — if not more so — than a lot of the other options out there. And when patients get good, evidence-based chiropractic care first, a lot of them never have to go down the road of unnecessary imaging, dependency-forming medications, spinal injections, or surgeries. Going to a evidence-based chiropractor first is the right move.
ContactSend us an email at dr dot williams at chiropracticforward.com. Feedback and constructive criticism is a blessing, and so are subscribes and excellent reviews. It really does make a big difference.
ConnectWe can’t wait to connect with you again next week. From the Chiropractic Forward Podcast flight deck, this is Dr. Jeff Williams saying upward, onward, and forward.
Social Media Linksfacebook.com/chiropracticforward/
About the AuthorDr. Jeff Williams — Fellow of the International Academy of Neuromusculoskeletal Medicine (FIANM) and Board Certified Diplomate of the American Board of Forensic Professionals (DABFP) — Chiropractor in Amarillo, TX, Chiropractic Advocate, Author, Entrepreneur, Educator, Businessman, Marketer, and Healthcare Blogger & Vlogger.
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