2011: Core Traits of Wealthy Chiropractors

Vince Covino

Legacy Wealth Management Group

Boise, ID

vince@legacywealthmg.com

Vince Covino is a Chiropractic Wealth Advocate. He currently helps over 200 doctors in 37 states in creating meaningful financial abundance.

INTRODUCTION

All chiropractors live principle- based lives. The difference between wealthy and broke chiropractors is merely the nature of the principles they practice. Some principles will enslave, while others will set you free.

As I have observed my most successful clients I have noticed a singular trait in each of them: they consistently identify the limiting principles in their lives, and metamorphose each into its liberating counterpart.

The key to transformation is reflecting on current behaviors and identifying patterns in your life. And what about changing the way we see ourselves, the way we handle our money, the way we relate to other people, the way our marriages function, the way we raise our children, or the way we feel? There are multitudes of self-help books on the market full of programs, methods, and theories, but most of them seem to work in the same way as a typical diet: short term results that fade leaving you in a situation often worse than it was originally. Why is it so hard to change? Is it even possible to permanently change the way we manage our financial affairs?

NEUROADAPTATION

The brain works based on a principle called neuroadaptation. Neuroadaptation functions on patterns of behavior that become hard-wired into our brains over time. The same kinds of patterns of behavior, whether we notice them or not, take over other aspects of life as well: how we work, how we talk to patients or co-workers, how we relate to our spouses or respond to our children, even how we relax or process a new technique our coach is teaching us. The extreme side of having hardwired brains is that we develop routines or scripts that inculcate bad habits, negative emotions (such as fear, anxiety, or depression). We can encrypt into our brains routines that turn into seriously addictive behaviors which are ultimately self-destructive.

Principles and Practices

Review the following list and identify two principles where there is room for improvement in your personal or professional life. Once these are identified you are in the position to make a daily practice of transforming the principles on the left to the essential counterpart on the right.

1. Doubt to Inspiration
2. Fear to Faith
3. Contention to Collaboration
4. Ignorance to Enlightenment
5. Blame to Responsibility
6. Despair to Diligence
7. Illness to Wellness
8. Selfishness to Compassion
9. Estrangement to Intimacy
10. Entitlement to Gratitude
11. Shame to Humility
12. Deceit to Integrity
13. Arrogance to Confidence

Each principle can be targeted with specific practices which, when done consistently, have the ability to change the way the brain is hardwired (neuroadaptation).

Each practice has a corollary promise, a reinforcing drive to continue, which starts the moment the practice is initiated and grows with each successive trial.

Liberating principles and practices won’t eliminate sadness or guarantee a stress free life; nor will they bring immediate wealth Negative emotions have value and we are wired to experience them for a purpose. They are a function of the reactive (limbic) brain and will never disappear completely. However, when we practice these principles regularly, we become more resilient and better able to bear the financial, relational and other problems we face in life.

In the end, challenges that once seemed insurmountable become minor hurdles. It’s not that the challenges or struggles themselves have not changed, but our ability to bear them has increased. When this happens, escape strategies we once used to self-soothe are abandoned in favor of actions that empower us.

SUMMARY

Neuroscience has shown - just in the past decade - that the brain can change the way it is wired through consistent practice over at least two months. Similar to regular adjustments changing the curve in a spine, acting consistently is the unglamorous but essential practice of refinement that drives enduring progress. Strengthening positive qualities through practice fortifies the behaviors and their associated chemical responses in the prefrontal cortex so that the brain itself undergoes change. In turn, these habits can transform current ways of relating to the world into catalysts of growth and personal potential. In other words, you can change, not only for a moment, but forever.

As a chiropractor, you understand well the concept of identifying the root cause and then applying appropriate treatment such as mirror-image adjusting.

Email me at vince@legacywealthmg.com for 26 treatment practices that are specifically targeted to reverse your limiting principles into liberating principles. As you work on your core, you will find financial abundance begin to flow into your life.  

legacy wealth management

WHY SOME OF YOUR PATIENTS ARE NOT MAKING THEIR HEALTH A TOP PRIORITY.

Fred DiDomenico, DC

Practice Coach and Mentor

www.elitecoachingllc.com

INTRODUCTION

            Most doctors evaluate x-rays and make recommendations for a corrective care program at their report of findings (ROF). Why do some patients make their health a top priority, follow your recommendations; while other patients don’t at all? In my experience, I’ve found that one explanation for a patient’s lack of commitment can be a result of the classic approach of the “3 Questions” many management groups and doctors believe you have to answer in your ROF,

1.     What’s the problem?

2.     How long?

3.     How much?

THE PROBLEM

            One of the reasons some patients won’t commit to this old school communication principle is you want them to buy “YOUR IDEA.” Your recommendations are your idea for what YOU think they should do for THEIR condition. The problem begins with the very simple question: “What if they don’t like your idea?”

            It is common knowledge people buy with emotions and justify with fact. Answering the “3 Questions” in an ROF is just a presentation of facts. Patients can read a pamphlet and get these facts. True, they are the facts of their health. However, facts can be about as motivating to some as the note from the Surgeon General on the side of a cigarette carton. You know, the one they read warning them of cancer as they’re lighting their next smoke!

            In contrast, when patients buy THEIR idea, their value for your program to get what they want changes significantly. Now, you no longer need to convince or “sell” them anything, especially your program. Your corrective care program becomes their idea to fix their health. Thus, the question really boils down to this: “How do you make it their idea?”

THE SOLUTION

            After you show them their x-rays and ask the patients’ questions requiring them to convince you they COMPLETELY understand their’ condition, you have them write their long term, 20-30 year health goals. Why such long term goals?

            These goals are long term to help them focus on the lifestyle of a healthy spine and posture. There is preliminary research establishing the relationship between poor posture to a shortened life span full, organ problems, and significant research showing an impact to overall health, performance and pain. The x-rays you are showing them in an ROF represent a life of poor health, the potential for disease as well as chronic, even debilitating pain, regardless of their present symptomotology. The program you are recommending is to correct their postural/spinal abnormality, followed by a lifestyle of home care and maintenance visits to maintain optimal spine and posture for LIFE! How many patients are actually going to follow this regime? If you haven’t created patients with this desire and healthy thinking you are selling them your idea. How about if we make this lifestyle their idea instead and inspire them to be completely EMOTIONALLY committed to their goals?

The Steps

First, we start by qualifying their goals and ensuring ourselves and them, their goals are truly long term. They MUST be 20-30 year, qualified goals.

            Next, we ask them, “How important are these goals to you?” Followed by, “Are they the MOST important goals to you?” If there is ANYTHING more important than these goals, that is why they WON’T pay you. You MUST find their #1 important priority. If they say their job is more important, that is why they won’t have time. If they say their job is more important, you say,

“I understand. Your career is very important. So please tell me, you just saw your x-rays and said that you have postural injuries that are making your body weak, your condition is associated with chronic pain and you have several health conditions that are getting worse as you get older. Correct?” They will agree.

“Would you be more successful in your career if you were battling disease and chronic pain, or would you be more successful if your body was strong, you had youthful energy and had no chronic pain?” They would agree.

“So what is REALLY the MOST important aspect of your life to reach your goals, your highest success in your career?” They would say their health. NOW you have placed their health in the top priority and they MUST fix their condition to reach their most important goal.

            Likewise, if they say their family is most important, you use a similar principle. You say, I understand your family is high on your priority list. Would you be a better father and husband if your postural injuries are to progress making your body weaker, sluggish and with a higher potential to create disease, or would you be a better father and husband if you were strong, healthy and had better energy for the rest of your life?” They will obviously agree to the later.

“So even in front of your family, what’s the MOST important aspect of your life for you to be the best provider, husband and father?” They will definitely say their health. If they do not put their health in front of their family, they won’t pay you because of the family vacation, bigger house, braces for their kids and a seemingly infinite number of other reasons.

            The next VERY important question to ask is, “Can you reach these goals (being a great father/husband/provider/successful in your career) and allow your condition to progress?” They MUST say “No,” and they will. Once they tell you their highest priorities in their life AND they tell you they will never reach that life and their posture and health is the barrier to stopping them, your program NOW is the answer to their problems that has a HUGE EMOTIONAL attachment. You now become the tool or coach that will help them get what THEY want.

This is similar to a person who wants to compete in the Iron Man Triathlon. They hire a coach training them to run through the tape in Hawaii. You are the coach that will help them run through the tape of their goals, THEIR desired life!

When it becomes their idea and they have a clear vision for the life they desire, they will pay you NOW, follow ALL of your recommendations including home care. They do this because you inspired them to be and reach for their best using spinal correction as the vehicle. Isn’t that our responsibility? You will also find their enthusiasm and happiness in your program will be so high, they will refer like never before so you can inspire more people. You are now living a fulfilled chiropractic life.

SUMMARY

This article has addressed one of the many coaching tools and communication systems you will learn at an Elite Coaching seminar and boot camp. If you are truly ready to reach levels of practice that are more fulfilling creating more committed relationships with your patients, call Dr. Fred DiDomenico at 253-851-8353 for a practice consultation. Elite is very committed to helping more doctors reach new levels of practice and learning spinal correction this year.

In fact, Elite will pay for a CBP® seminar of your choice and attendance at the Annual seminar if you join by Feb 28^th, 2011.

Join the movement with CBP® and Elite Coaching to strengthen full spine chiropractic corrective care for the betterment of the profession, as well as the overall health and consciousness of our populations and world.

Elite Coaching

At the 32nd Annual

The 32^nd CBP Annual conference was held at the historic Biltmore Resort/ Spa in Phoenix, AZ Sept 24-26. More than 70 chiropractors attended and many claimed that “this was one of the top conferences they’ve ever attended”.

2011 CBP Chiropractor of the Year

Each year CBP NonProfit, Inc. acknowledges outstanding Chiropractors in the community who selflessly donate their time and energy for the advancement of chiropractic in general and CBP Technique specifically.

This year the CBP Chiropractor of the Year was awarded to two separate Chiropractors:

• Dr. Donald W. Meyer, of Fountain Valley, CA, received the CBP Chiropractor of the year award. In the spring of this year, Dr. Meyer (on short notice) rekindled the CBP Elective course offered at Cleveland Chiropractic College in Los Angeles, CA. Dr. Littlefield, the former course instructor could not continue, so Dr. Meyer stepped in. Dr. Meyer sacrificed his mornings off of practice on a weekly basis in order to properly instruct the CBP Elective course.

Additionally, Dr. Meyer has maintained a full-time CBP based practice since 1982. He has developed numerous ambulatory, vibratory and motorized dynamic postural/structural corrective devices in his career. He also introduced a new design and protocols for posture corrective body-weighting. Dr. Meyer is a co-author of the CBP Lumbar Rehab Textbook.

• Dr. Jean-Guy Daigneault, of Lansing MI, was the second recipient of the CBP Chiropractor of the year award. Dr. Daigneault graciously agreed to teach the CBP Elective Course beginning in 2010 at the University of Quebec at Three Rivers, Canada. Three times each Semester, Dr. Daigneault had to fly from Michigan to Montreal, Quebec, Canada and then make the long drive to the University. Due to the length of the flight and the time away from his private practice, he would not have been able to teach the CBP course had it not been for his wife, Dr. Denise Rassel, who saw both their patients while Dr. Jean-Guy was away.

Dr. Jean-Guy has been a long-time CBP Chiropractor and is Advanced Certified in the technique.

CBP AT CHIROPRACTIC COLLEGES

            Chiropractic BioPhysics Technique is now offered at seven Chiropractic Colleges around the globe including:

1. Life Chiropractic College West, Hayward, CA—Both core curricula and as an active elective;
2. Life Chiropractic College Marietta, GA—As an active elective;
3. Cleveland Chiropractic College Los Angeles, CA—As an active elective;
4. Palmer West Chiropractic College—As an inactive elective currently;
5. Cleveland Chiropractic College Kansas City—As an inactive elective;
6. University of Quebec at Three Rivers, Canada—As an active elective;
7. RMIT in Melbourne, Australia—As an active elective.

Chiropractic BioPhysics

Chiropractic Research to be Presented at the 2011 APHA Annual Meeting

Michael Schneider, DC, PhD

Assistant Professor

School of Health & Rehabilitation Sciences

Pittsburgh, PA 15260

Mjs5@pitt.edu

The Chiropractic Health Care Section of the American Public Health Association (APHA-CHC) invites abstracts for presentation at the 2011 Annual Meeting to be held in Washington, DC, October 29 – November 2, 2011.

Topics related to this year's theme, "Healthy Communities Promote Healthy Minds & Bodies", and in all areas related to chiropractic health care will receive high priority.       

The abstract is limited to 250 words. The submission deadline is February 8, 2011. Abstracts must be submitted electronically through the APHA website: http://apha.confex.com/apha/139am/oasys.epl.

If you have any questions, please contact Michael Schneider, DC, PhD (2011 Program Chair, APHA- CHC).

Research

Does Practice Purpose Match Research?

Len Siskin, DC

Promote Chiropractic,

Co-Chair ICA Best Practices

INTRODUCTION

Just this morning my wife and I were surfing the Internet before the sun came up and read a statement made by a ‘principled’ chiropractor. He said that chiropractors who don't adjust on the first visit and ask the patient to wait until visit number two to review findings are lying to the patient and setting the patient up to build anxiety so the chiropractor can ask them for a year’s commitment and a large advance check. While I guess this might be true some of the time, I know in our office the reason we ask the patient to wait to be adjusted until the second visit in most cases is because our experience has been that the patient's who we've adjusted on the first visit in the past are more likely to become confused.

Patients don’t know whether the treatment was supposed to completely fix them despite our best efforts at communicating chiropractic and our expectations. Research demonstrates that patients have about a 56% chance of worsening from the first adjustment; albeit temporarily.¹ Using research to justify treatment has been considered by some chiropractors to be a form of manipulation of information for the health of the chiropractor’s wallet.

By the same token selecting which research should be taken seriously by groups writing particular chiropractic guidelines or by the insurance industry may be accused of the same motive. Incidentally, treatments in our office are typically paid for on each visit and not in advance.

Whenever I speak with chiropractors about what the research says I always tell them it's important to understand each research paper on an individual basis and that it's important to understand the methods section about how the research was conducted to guide the reader about the quality of the research they're looking at. Just because a study shows something doesn't mean it's true but when 10 studies show the same thing it’s much more likely to be true. By the same token if one extremely well done high quality study has very meticulous procedures it may be the equivalent of many more simple studies in drawing conclusions which should be believable.

In our office we actually use a combination of what the research supports and a set of values as a map by which to judge whether our recommendations to patients are ethical, sound, scientific, and in the best interest of the patient. We then gage what the patient wants according to their own health values which may be different than ours.

We believe patient care comes first which involves building collaborative relationships with our patients through compassion and empathy and the celebration of any health success related to their care in our office. We believe it's far too common for people to be treated in a cold manner in clinical settings. As chiropractors, we have a golden opportunity to connect with our patients and to learn what benefit they would like in their health. In doing this, patient's come to understand the Dr. does not actually fix the patient and it is actually the patient's body that does the healing. We use research to show examples of this and to communicate the human body is a self-healing organism using a little scientific backing. In this way we are able to hold the patient accountable for their choices and for the actions they participate in which ultimately result in their health outcome. Part of our job is to understand what they want at any given time and what they need in line with their own stated personal goals.

Our office is fun. In our experience this is completely different than most clinical settings which can be cold and impersonal. Since healing takes time and often working with the patient requires repetition in order to see changes and results, the patient's meet their goals better when they actually want to come to the office. Without fun, any activity becomes difficult. Having fun in an appropriate manner makes the patient experience in our office more rewarding for us as well as for the patient and makes it unique and special within our current healthcare environment.

In our office we use research, our training, and clinical experience to inform and educate to facilitate patient learning about their own health and help them understand their power in maintaining and sustaining health and improving life. We don't jam concepts down the throats of our patients and we don't have a generic topic each day that everybody has to listen to. On every interaction with each different individual we learn about their concerns then educate and inform based on what is interesting to them at that exact moment.

Our office is professional and staffs in our office are encouraged not to complain or react negatively in an emotional way nor judge people's lifestyles or their own personal values or play favorites among patients.

We embrace traits of responsibility, accuracy and efficiency in working with our patients as well as with staff and other professionals and the general community.

When deciding how to behave inside and outside the office, all of us consider the above points as well as what we know about what chiropractic research and education shows. We use these values and the information as a roadmap to clear the path and highlight the direction that we should move in both with business and in patient care. We do this in alignment with both our clinical as well as our healthcare business values. The beautiful thing about all of this is it simply requires honesty. Sometimes it's difficult to differentiate the impulse to do something which sounds good at the time, from confidently moving forward with an agenda that is concretely in line with our office values and our mission to help our community.

The best practices guidelines of the international chiropractors Association along with the PCCRP x-ray guidelines² now serve as part of our roadmap for how to behave with patient's and how to move forward in educating patients about their health and their care with integrity in a fun, educational and professional manner. This helps us utilize responsibility, accuracy, and efficiency to the best of our ability to pull it off every day.

Any time a patient asks what kind of research exists on a particular named medical condition, all I have to do is open up the best practices guidelines book on my desk and point it out to them. I can do the same when asked by another professional whether there's any information behind statements I might make about chiropractic or how the human body works.

I strongly encourage anyone who has not yet received a copy of these guidelines to go to the ICA's website at www.CHIROPRACTIC.org and pick up a copy. The money you spend in purchasing these guidelines will be used to distribute them to schools, chiropractic associations, and those who influence lawmaking and policy development so that they may understand the importance and the greatness of chiropractic.

Finally, if you are interested in what has held more current influence in some of the content here I have listed some of my resources^3-6

REFERENCES

1.     www.ICABestPractices.org; www.Chiropractic.org

2.     www.PCCRP.org

3.     The Anatomy of Peace: Resolving the Heart of Conflict, The Arbinger Institute; may 1, 2008: ISBN-10: 1576755843

4.     Switch: How to Change Things When Change Is Hard by Chip Heath and Dan Heath; 2/16/2010; ISBN-10: 0385528752

5.     Delivering Happiness: A Path to Profits, Passion, and Purpose by Tony Hsieh; 6/7/2010; ISBN-10: 0446563048

6.     http://www.chiropracticementoring.com/

ICA Best Practices Chiropractic Guidelines

25+ New Patients from Valentine’s Day

Eric Huntington, DC

Co-Owner Developer of the Chiropractic Business Academy

drhuntington@chirobizacademy.com

Why am I Giving this Away?

For a business to prosper it must charge for its services. So, why is it sometimes beneficial to give away something valuable to a potential client or patient? Well, it allows that prospect to experience something your company has to offer with little or no risk. Also, once you’ve helped someone, it seems to make it easier for them to accept help from you again. You can’t give away your entire service, but it can, and should be something valuable.

What can you offer?

How would you like to have each of your patients give a gift certificate for a service in your office to their local friends, family and co-workers? And better yet, also give you those names and phone numbers with permission to call each person and invite them into your office for that introductory service?

If you understand the value of a referred patient, then like most doctors, you’d love to have the above scenario occur. Well, here is how you can do it…

A FREE Gift To You!

I would like you to have the CBA Valentine’s Day Promotion which you can use to get new patients into your office. Since I only have one page to convey to you exactly how to do this promotion, I’ve created a video available to you on-line so that you can learn every detail—the link is at the end of this article.

THE VALENTINE’S DAY PROMOTION

There are three parts to this promotion—Internal, In-Actives, and External. The promotion is often started two full weeks prior to the week of Valentine’s Day.

• INTERNAL:

This part of the promo is done by purchasing a variety of Valentine’s Day cards for your patients to use to send to friends, family and co-workers. Create a display with an example of each card. Your patients will choose which card they want sent to each person on their list. Your office is supplying the cards, the postage and a gift certificate for a service at your office. The gift certificate should have a value on it of whatever service you are giving away. You’ll see an example of this on the video link below. Many doctors choose to provide a certificate for a massage and consultation, as an example.

Your front desk will promote this to patients each time they come into the office. The positioning is that this is a Valentine’s Day gift to the patient-- the doctor is providing cards, postage and gift certificates to all of the patients local friends, family and co-workers.

You’ll need to collect the names, addresses and phone numbers of all the people that will be sent cards from your office. You will be calling on these leads to schedule appointments a few days after the cards go out.

You can have forms that patients can bring home to record all the people they want cards to go to. Some patients will just bring their address book or a list of work employee contacts to fill out the cards and envelopes in your office. NO CARDS GO HOME. It is best to give patients the option of filling out the cards there in your office or just providing you the contact data to fill out for the patient as an added service.

• IN-ACTIVES:

For your in-active files, you simply send them each a Valentine’s Day card with the gift certificate enclosed. For this portion of the promo, you can buy pre-printed cards that have a message and even the offer inside the card. If this is the case, you can decide whether or not you include a gift certificate. Make sure to include the certificate if the card itself does not state the offer.

It is very important to call on your in-actives, just as you will be calling on the new leads that you get. When you call, in addition to doing the mailing, you’ll find that your percentage of responses goes up dramatically—sometimes 3-5x. It is best to designate specific times to make these calls. Best is to designate specific personnel to do the calling. Many doctors have found it very workable to designate a specific staff member to be in charge of the promotion to make sure it is a big hit!

• EXTERNAL:

The direct to public aspect of this promotion is done by having your marketing staff go out in the community and give out the gift certificates in the community. In exchange for the gift certificate, your staff member gets the name and phone number of the person.

The best place to give out these certificates is anywhere there are people that are likely to live or work local to your office.

If you decide to use massage as part of this promotion, you can offer a half hour massage and consultation, for instance. Of course, be sure to check with your state board to ensure that whatever you offer is legal in your state. If you don’t have a massage therapist on staff at your office and don’t want to do the massage yourself, you can purchase an inexpensive hydro-massage bed which works just fine for this and other promotions.

This promotion can be so easy to do, and so effective, that our clients often get thousands of leads in a few weeks. For some doctors this promotion results in hundreds of new patients in February, March April and May.

This is an overview of the promotion that has literally increased some offices by as much as 50-100 patient visits in a matter of months.

To see a video on this promotion with more details on how to put it into action, check out this link.

www.chirobizacademy.com/valentine

This promotion is one of over 100 marketing actions we have covered at our seminars this year. Call my office and find out how we can help you grow your practice:

888-989-0855

The Chiropractic Business Academy teaches workable, time-tested business principles and chiropractic marketing strategies. If you are good at delivering high quality chiropractic service but want to see more patients or have more time off with a staff driven practice, then we can definitely help you!

CALL US NOW 888-989-0855

Chiropractic Business Academy

Radiologic Evaluation of Chronic Neck Pain

  

Dan Murphy, DC—

Private Practice of Chiropractic;

Diplomate American Board of Chiropractic Orthopedist;

Faculty Life Chiropractic College West;

Vice President ICA 2003-2009;

ICA Chiropractor of the Year 2009

INTRODUCTION

The October 15, 2010 issue of the journal American Family Physician, published an article summarizing the American College of Radiology Appropriateness Criteria for chronic neck pain. Key concepts from the abstract of this article include:

• Imaging plays an important role in evaluating patients with chronic neck pain.

• Five radiographic views (anteroposterior, lateral, open-mouth, and both oblique views) are recommended for all patients with chronic neck pain with or without a history of trauma.

• Magnetic resonance imaging should be performed in patients with chronic neurologic signs or symptoms, regardless of radiographic findings.

• Patients with normal radiographic findings and no neurologic signs or symptoms, or patients with radiographic evidence of spondylosis and no neurologic findings, need no further imaging studies.

KEY CONCEPT:

1) The American College of Radiology Appropriateness Criteria has produced the optimal imaging study for every clinical scenario.)

2) This study considers two etiologies of chronic neck pain:

a. Posttraumatic: includes gross injuries and whiplash syndrome.

b. Degenerative: includes spondylosis, degenerative disk disease, and acute disk herniation; degeneration may also be secondary to previous injury.

3) Spondylosis is radiologically diagnosed when osteophytes, disk space narrowing, or facet disease are present.

4) There is “little correlation between the presence of cervical spondylosis or degenerative disk disease and the severity or duration of symptoms.”

5) “Although spondylosis and disk disease increase with age and are usually asymptomatic, whiplash can accelerate these processes and lead to symptoms.”

6) A long-term (minimum 10 year follow-up) study in 2009 demonstrated that progressive degenerative changes on MRI are not associated with clinical symptoms, and “the authors concluded that there is no statistically significant association between MRI findings and changes in clinical symptoms.” [Important, see Key Points, below]

7) MRI is useful in documenting disk herniations, canal encroachment by osteophytes, tumor, infection, fractures, and posttraumatic ligament ruptures of the lower cervical column.

8) “Although MRI does not always detect the cause of chronic neck pain, particularly at the craniocervical junction, it is the preferred method for making most diagnoses.”

9) Guidelines from the American College of Radiology Appropriateness Criteria for the evaluation of patients with chronic neck pain (regardless of the etiology) include the following:

a. A five-view radiographic examination (i.e., antero-posterior, lateral, open-mouth, and both oblique views) should initially be performed in patients of any age with chronic neck pain with or without a history of remote trauma, with a history of malignancy, or with a history of neck surgery in the remote past.

b. Patients with chronic neck pain and normal radiographic findings, and no neurologic signs or symptoms need no further imaging.

c. Patients with chronic neck pain and normal radiographic findings, and neurologic signs or symptoms should undergo MRI.

d. Patients with chronic neck pain and whiplash-associated disorders should “undergo MRI to evaluate for disk herniations, spur encroachment of the vertebral canal, or ligament abnormalities of the lower cervical region.”

e. If MRI is contraindicated (e.g., in patients with a cardiac pacemaker or severe claustrophobia), CT myelography with multi-planar reconstruction is recommended.

f. “Patients with radiologic evidence of cervical spondylosis or a previous trauma without neurologic signs or symptoms need no further imaging.”

g. “Patients with radiographic evidence of cervical spondylosis or previous trauma and neurologic signs and symptoms should undergo MRI. If MRI is contraindicated, CT myelography is recommended.”

h. “Patients with radiographic evidence of bone or disk margin destruction should undergo MRI. If an epidural abscess is suspected, the examination should be performed with intravenous contrast media. CT is indicated only if MRI cannot be performed.”

i. “Facet injections and arthrography are useful for patients with multilevel disease diagnosed by any imaging modality to identify the specific disk level that is producing symptoms.”

j. “Diskography is not recommended in patients with chronic neck pain.”

KEY POINTS FROM DAN MURPHY:

1) All chronic neck pain patients, with or without a history of trauma, should have 5 radiographic views (antero-posterior, lateral, open-mouth, and both oblique views).

2) All chronic neck pain patients with neurologic signs or symptoms should have an MRI, regardless of radiographic findings.

3) It is inappropriate to ascribe a whiplash-injured patient’s chronic neck symptoms to pre-accident degenerative disease (spondylosis).

4) Depending upon the circumstances, if one did not follow these Guidelines from the American College of Radiology Appropriateness Criteria for the evaluation of patients with chronic neck pain, it is possible that one might be accused of practicing below the standard.

5) On the other hand, if an insurance company, reviewer, or examining board claimed that radiographs were not indicated in a chronic neck pain patient, one could use this study to argue for their necessity.

6) Additionally, I would suggest that all acute traumatic neck pain patients have x-rays to rule-out fracture. I also suggest that all acute traumatic and chronic neck pain patients have maximum flexion-extension x-rays to evaluate for segmental instability.

REFERENCES

1. Daffner RH. Radiologic Evaluation of Chronic Neck Pain; American Family Physician; October 15, 2010; Vol. 82, No. 8, pp. 959-964.

Research

Chiropractic Adjustments Found to Improve Creative Thinking

   A recent study reported in the Chiropractic Journal of Australia has found that chiropractic adjustments may enhance creativity and divergent thinking. Ten subjects between 10 and 62 years of age were assessed for spinal subluxation and adjusted using Applied Kinesiology and ‘Diversified’ techniques. The majority of subjects received both cervical and thoracic adjustments; but some also received cranial, jaw, upper extremity, and lumbar adjustments as well.

            The main outcome measure was performance on the ‘alternate uses test’ both before and immediately following one treatment session. The majority of the subjects were found to have enhanced scores on the post-administered test indicating a short-term improvement in creativity.

            Mechanisms for the improved cognition identified in this pilot project remain speculative but a number of possibilities exist including: reduced anxiety and emotional stressors, enhanced blood flow to specific regions of the brain with mild ischemia (so called ischemic penumbra), etc.

This line of research would seem to be sorely needed in the chiropractic profession today with many in the ranks standing on the verge of throwing in the towel or conceding that the adjustment is only good for transient improvements in a few pain syndromes. Historically in chiropractic, subluxation was thought to be linked to interference with the nervous system’s ability to function—Creativity of the mind would seem to be a primary component ‘of the nervous system’s functional capacity’.

Future studies will need to test this study’s findings with more rigorous methods including control groups matched for age, occupation, social class (and other variables), draw upon larger samples and include longevity of the results.

References

1)    Masarsky CS, Todres-Masarsky M. Effect of a single chiropractic adjustment on divergent thinking and creative output: a pilot study, Part 1. Chiropr J Aust 2010;40:57-62.

chiropractic and creative thinking

CBP Online Update: We Got Googled! But AJCC is Back Online

Joseph Ferrantelli, DC

Private Practice New Port Richey, FL

CTO CBP^® Seminars

CEO PostureCo www.PostureCo.com

INTRODUCTION

It seems that in the world where search and online data rules our lives, we forget how entangled and dependent on technology we have become until it is suddenly taken away. In August, CBP (Deed and I) received hundreds of emails from concerned doctors when trying to find the American Journal of Clinical Chiropractic (AJCC) online – which was suddenly taken offline, so I thought I would explain the unfortunate turn of events and the good that has come out of it.

AJCC Taken Offline Suddenly

In early August of this year, our blog hosted on Google’s own Blogger system, was suddenly, without warning, removed from the internet. Now at first I thought this was a simple glitch, but then I soon found out it was a permanent action by the most powerful force online – Google! This was frustrating for us, as we had another recent debacle with Google two years ago, when we were suddenly “de-listed” from all search results where idealspine or chiropractic biophysics was to be listed by a Google search. This was very problematic for us as our “Chiropractic friends” over at Quackwatch (chiro-base) suddenly were thrust into #1 position when one searched for Chiropractic Biophysics!

How frustrating, again, to have another problem with CBP online resources. This time, it seemed that our AJCC blog, was rising very fast in the rankings and that Google’s “new algorithm” put in place to avoid “spam” had actually, and perhaps inappropriately, flagged our blog as “spam”. How could this be I wondered? On the AJCC Blog, we simply repost everything that you are reading now and the AJCC has a 20 year history as a Chiropractic news journal. We don’t ask anyone to join our site, nor send this out into people’s in boxes without their consent and our articles are all professionally written and not online elsewhere. Thus, in my opinion, we should not have met Google’s criteria for a Spam blog.

I tried repeatedly, but unsuccessfully, to contact someone within Google; I finally realized it was hopeless. Thus, I simply had to find a new host for the AJCC and painstakingly rebuild the last several years of blogs that I have maintained for CBP’s AJCC. Over 300 pages were gone, and I had to start nearly from scratch. Sure, I have the original articles backed up – but it is not that simple - all of the “Search Engine Optimization” that went into the blog, and all the referral links back from various sites, are now gone!

• Good News—AJCC Back Online

The new address for our AJCC online is www.chiropractic-biophysics.com. On this new site you will find the last few years of AJCC articles; now completely searchable. You can also get to the AJCC online by going to our main page at www.idealspine.com where you will readily find a link for the AJCC.

You can help us too! Simply link to our AJCC online and browse it frequently. By doing so, the AJCC site will again rise in the searches, thus allowing our consumers, i.e. doctors and patients to find accurate information on Chiropractic BioPhysics Technique updates and Chiropractic in general.

• CBP Patient-Doctor Referral and Education site, www.CBPpatient.com Now Getting Thousands of Hits per Month!

Our patient referral site has begun to grow with traffic reaching thousands of hits per month! Our site has now catapulted to #3 on Google, behind our main site idealspine.com, and unfortunately – Quackwatch is still #2.

As many of you have noted, our new site is easy to search and the content is specific to CBP Technique but also has great Chiropractic content. All articles online are fully referenced, and your patients can now find CBP trained doctors quickly and easily search a zip code, with a radius of 10, 20, 50 or 100 miles to find the most qualified CBP doctor in their area. All certified CBP doctors will be ranked at the top, then by alphabetical order followed by the non-certified CBP doctors.

• CBP Doctors Need to Get Listed Today!

It is important to note that not all CBP doctors are actively listed on our patient referral site (www.CBPpatient.com). For the 2-years, CBP has charged a small fee ($10 per month) to have an active listing on the referral directory. If you would like to start building your practice through qualified CBP seeking patients, I suggest you enroll in the program by calling 800-346-5146 or email drdeed@idealspine.com. Your content is quickly and easily managed by yourself, allowing you control of your own content. Once you are online, you can request a “CBP Trained” logo for your own website that you can link back to our site. Please note to be listed online you must also attend at least 1 seminar every 2 years.

  

CBP Trained Seal. This is the CBP logo-seal that we send to our CBP doctors listed online. We require that you place this on the home page of your website and link back to www.CBPpatient.com health disorders. You can use this on your business cards and other promotional materials if ;you like.

• CBP Online now has Classifieds!

CBP Classifieds have been revamped in order to allow image uploads and to be fully managed by you the user. For the last few years, we have been bombarded by requests for online classifieds. While we did always have these listings, only a few doctors and students knew about them. Further, you, the user, were not in control of your content, and had to email us every time you wished to change or update a listing. Now, you can manage your own “CBP specific” classified by going to our main site and following the links to our all new classifieds section. With this new system, we will have classifieds for doctors and students both looking for employment, for selling their used equipment, and their practices. To get started with your FREE classified listing, just browse to our online system linked on our front page at www.idealspine.com.

Chiropractic BioPhysics, PostureCo, PostureRay, PostureRay

Redefining Instrument Adjusting and Computerized Adjusting

Christopher J. Colloca, D.C.  

CEO and Founder of Neuromechanical Innovations

www.neuromechanical.com

Dr. Colloca is the CEO and Founder of Neuromechanical Innovations, a UL Listed and ISO 13485 medical device manufacturer of the patented Impulse® family of adjusting instruments currently in use in over 6,000 chiropractic offices in 42 countries around the world.

INTRODUCTION

Instrument adjusting is by far the fastest growing technique specialty in the chiropractic industry. The last National Board of Chiropractic Examiners survey reported that over 70% of chiropractors utilize instrument adjusting in their practice as one of an average five techniques they incorporate. But what comes to mind when you think of Instrument adjusting? Do you think of an esoteric chiropractic analysis that you couldn’t imagine yourself doing? Or, maybe you have visions of high priced computerized adjusting systems with no research to back them up? In a recent survey that we conducted, we identified these sentiments as primary concerns among chiropractors who hadn’t incorporated instrument adjusting in their practice. What would you change about Instrument adjusting for the betterment of your practice and the profession? That is exactly the question that I asked myself when developing the Impulse® family of adjusting instruments and Impulse Adjusting Technique®.

Having taught Instrument Adjusting to thousands of chiropractors throughout the US and around the world, I think I’ve fielded most every question on the subject. Unfortunately, instrument adjusting has historically been associated with esoteric chiropractic analyses within technique systems. Unquestionably, chiropractors have a right to be turned off by some of the instrument adjusting techniques. Some common negative feelings about instrument adjusting that we identified in our survey are listed below in Table 1.

Table 1. Negative sentiments about chiropractic instrument adjusting

1.     “I don’t think the instrument can move the vertebra like I can manually.”

2.     “Patients don’t feel the immediate result after an adjustment like they do with manual adjusting.”

3.     “Those instrument guys use whacky tests and look for leg lengths to change telling them where to adjust.”

4.     “There’s a new instrument adjusting guru teaching people that they adjust away emotional problems stemming from childhood by tapping on the skull. He even teaches chiropractors to adjust themselves.”

5.     “I like using the instrument, but it hurts my hands and wrists!”

The sentiments seemed to grow even stronger when speaking of so-called computerized adjusting. Some felt that they have been harassed by salesmen trying to land the big sale, and others who actually did buy had felt swindled. Some negative connotations associated with computerized adjusting that we identified are listed in Table 2.

Table 2. Negative comments about computerized adjusting

1.     “It is cost prohibitive. They sell these things for $25,000 - $80,000!”

2.     “I bought it and I still can’t explain what the device measures. Even the owner of the company can’t explain what it does.”

3.     “There is no research validation for computerized adjusting.”

4.     “The ‘analysis’ they teach in their assessment is not enough pressure to measure through the fat and muscle of the patient, let alone the spine’s stiffness.”

5.     “There is no way they can locate the same vertebra for their pre-post analysis.”

Redefining Instrument Adjusting

Surveys are powerful tools to identify customer’s feelings and consumer confidence. As a instrument adjusting manufacturer, of course we wanted to overcome each of these objections to restore consumer confidence and instrument adjusting utilization. Interestingly ten years ago, we began overcoming these very objectives in developing the Impulse Adjusting Instrument®, computerized adjusting (Impulse iQ®), and Impulse Adjusting Technique®. My aim was to redefine instrument adjusting and computerized adjusting in the minds and practices of chiropractors. We needed to create reliable and valid research-based adjusting instruments to combine with a logical chiropractic analysis to take the mysticism (whacky stuff) associated with instrument adjusting. Table 3 provides our response to the concerns that chiropractors had with instrument adjusting.

Instrument Development

Simply stated, instrument adjusting can be broken down into two components – the instrument itself, and the chiropractic analysis used to identify where and when to adjust with the instrument. First, we had to begin to answer the basic science questions of instrument adjusting. What forces should we use to adjust different regions of the body? How much preload should be applied? What frequency should the multiple-impulse thrusts be delivered? Using both human subjects and animal models, we measured these variables and published our results in scientific journals.

Table 3. Response to negative sentiments about chiropractic instrument adjusting
Negative Sentiment	Impulse® Response
1.     “I don’t think the instrument can move the vertebra like I can manually.”	Research clearly demonstrates equivocal inter-segmental motion responses with impulsive chiropractic adjustments to manual thrusts.
2.     “Immediate results?”	Because of the faster speed, tuned frequency, and larger force magnitude of the Impulse® devices, patients report more immediate results than with other spring loaded activation devices.
3.     “Whacky Tests”	IAT does not incorporate any leg checks, isolation tests, or other esoteric tests
4.     “Esoteric adjustments and adjusting yourself”	I don’t cut my own hair and I don’t advocate adjusting yourself.
5.     “The Instrument hurts my hands and wrists!”	Impulse doesn’t have a spring activation system that slams back into your wrist and hand. Impulse® uses microchip technology to control the force of the adjustments.

To perform the necessary biomechanical studies to answer these questions, we implanted stainless steel pins into the spinous processes to which we attached 3-D accelerometers. With this experimental setup, we were able to precisely quantify the spinal motion responses during chiropractic adjustments as well as differences in motion among those with disc degeneration, hyperactive muscle activity, and ligament injury. Through this research we validated our computerized adjusting protocols in a non-invasive method to measure dynamic spinal stiffness. We published our findings in the journal, Spine. To this extent, the Impulse Adjusting Instrument^® was prospectively developed out of this research. Table 4 provides our answers to the concerns posed by chiropractors with respect to computerized adjusting.

Technique Development

After the instruments were invented, Impulse Adjusting Technique® (IAT) was developed. IAT was developed with an aim to incorporate logical and validated objective assessments into a technique analysis that was fast and easy to perform. We embraced the Centers for Medicare (CMS) Services mandated P.A.R.T. analysis in our own technique to keep chiropractors in compliance and increase their reimbursements at the same time. Easy to implement and combine into your current technique system, IAT is taught in most major US Cities and international hubs (see www.impulseseminars.com).

Table 4. Answers to computerized adjusting concerns
Concern	The Impulse iQ® Approach
1.     Cost	Affordable pricing at a fraction of the cost of others
2.     Difficult to Explain	The patented auto-sense technology® of Impulse iQ® monitors spinal motion and its frequency during the treatment.
3.     Validation	Validation studies have been published in numerous scientific journals
4.     Analysis	Stiffness measured during the actual adjustment; Accepted PART assessment utilized
5.     Test-Re-Test Reliability	No pre-post analysis vs. adjustment modes used. Instead, Stiffness is measured in real-time during the adjustmen.

We hope to have addressed the most common concerns that chiropractors have about instrument adjusting and in the decades to come will continue to improve computerized adjusting technology with the Impulse® family of adjusting instruments. To learn more about the Impulse system and for free educational downloads visit www.neuromechanical.com.

References

1. Complete references for this article can be found online at www.neuromechanical.com or

http://www.chiropractic-biophysics.com/

Impulse Adjusting Instrument