The Denneroll Orthotic: I Didn’t Believe It Till I Tried It!

Joseph Ferrantelli, DC
Private Practice New Port Richey, FL
CTO CBP® Seminars
CEO PostureCo.
INTRODUCTION
Since the introduction of the Denneroll, many doctors have confronted us at seminars believing that there is simply no way a “simple orthotic” could get some of the spinal changes we have been obtaining. Well at first, I did not ‘believe’ Dr. Harrison either! Why should I without proof, after all that is the CBP moto, “Don’t accept something for truth that for which there is a lack of confirming evidence.” Well, Dr. Harrison already had tested this unit in Australia and I saw his preliminary findings – which were quite impressive, but until you start having cases for yourself, it was still hard to believe. While we are working on studies on this and other home methods of rehab to publish, I would like to share 4 cases with you out of my own office. Three of the following were performed with the Denneroll orthotic ONLY as the choice of spinal traction.
While I did not set out to perform any “Denneroll Only Traction protocols”, three of these patients could not perform in office traction as will be explained, with the forth electing for both office rehab methods as well as home Denneroll orthotic use.
Patient Case #1
In the first case, we have a female that was involved in a frontal collision crash. The subjective complaints were the typical complaints seen with whiplash injuries, such as neck pain, sclerontonegous referral to lower neck and upper thoracic spine from facet joint injury, headaches, etc. In this case, the patient elected simply not to perform in office traction due to time constraints. In office care consisted of initial coarse of acute care diversified adjusting for 6 visits, then CBP Mirror Image drop table and instrument based adjustments and Exercises.
The patient having such a magnitude of kyphosis, was started as soon as possible with the Denneroll orthotic (on her 7th visit) starting 2x/day at 1 minute and building up to two sessions of 10 minutes, once in morning, and again once at night. Once this goal was achieved, after 2 weeks (4 weeks after injury), she was placed on 1 session of use per day working up to 20 minutes daily. Her initial x-ray was performed on 10/6/2009 then the next post was actually only 2 weeks later, this time on a Digital Motion X-Ray, dated 10/20/2009. DMX was chosen as she persisted with headaches and I wished to better view any evidence of ligamentous laxity. Notice in just 2 weeks of use, the cervical kyphosis is reduced! After 40 sessions of home use, and 36 visits total treatments, with her symptoms and outcome studies showing her nearing MMI, she was prescribed another follow up Digital motion x-ray. The changes were quite amazing as evidenced below in Figure 1.

PostureRay® Analysis from 10/6/2009 to 3/24/2009


Patient Case #2ab
On the next 2 cases, both patients, being friends which were involved in a low speed rear impact collision. Responding quite fast to acute care adjusting after10 visits, they were placed on Mirror Image protocols. However, at this initial re-exam, for both patients, their pain was down to 1/10 for complaints and neck disability scores, and SF36 scores, showing near resolution of any and all interference with activities of daily living, I had to promote them to a supportive care regiment. Remember, when treating injury cases, our job to return the patient to “pre-Injury” status, and both of these clients, knowing they had no other objective findings nor significant subjective complaints, I placed them on the supportive schedule of 1-2x/month with daily use of the Denneroll. I had to do some sort of home care, because I knew that their spines could not have been corrected with simple acute regiments of care.

Case 2a
In case 2a, the patient worked up to using the Denneroll for 20 minutes 1-2x/day, for a total of 40 total sessions along with Mirror Image Exercises. At the time of his final MMI examination and only a total in office treatments of 17 sessions, the outcome was quite amazing.

Figure 2a.

PostureRay® Analysis

Case 2b
In case 2b, the occupant was in the vehicle as discussed with case 2a. The difference here is that the patient had significant laxity distally, and was instructed to use the Denneroll mid cervical spine, not lower cervical spine. Unfortunately, the patent, finding this much more difficult, placed the orthotic in his low neck - unbeknownst to the treating doctor, ie. myself! Again, his results were posted after 15 total in office visits. He had approximately 40 sessions of home use working up to on average 20 minutes per day on the Denneroll unit. All outcome scores continued to show nearly resolution of any and all complaints. However, due to the lack of compliance on the part of patient 2b, placing the orthotic too low, he actually “over corrected” his spine, leading to a significant hyperlordosis. I have never encountered such a finding with any home traction device, but it makes sense given his injuries and laxity distally in his spine, and the patient, weighing approximately 265 lbs, using the home orthotic with a large skull, creates quite significant force.
The point here is simple, the Denneroll orthotic is not to be taken lightly, it is not a toy, rather a home clinical device, and as such will change the spine if used, and as evidenced positioning is quite important. Patient compliance and training is a priority, and we recommend follow up quiz’s for placement so the patient can demonstrate the proper positioning. Even though the patient demonstrated proper use and placement of the unit on several occasions prior to obtaining a unit for home use, he placed it too low – due to comfort, which had deleterious effects. Even though the patient is still asymptomatic with no positive findings, I elected AGAIN to stress the importance of placement yet to the patient, moving the unit to mid to upper neck, but only using 2-3x per week for 10 minutes, along with home distraction traction 3 days a week for 20 minutes in order remove some of the lordosis distally. He is scheduled to have another follow up x-ray to check his progress again in approximately 2 months.

Figure 2b.
PostureRay® X-Ray Analysis

SUMMARY
Given these cases, I (Dr. Joe F) now “believe” in the Denneroll orthotic as a viable addition to a patient’s home care, alongside other devices such as the Compression Extension Traction unit, and Circular Traction’s Cervical Remodeling Collar depending on their posture and cervical alignment - each, having specific applications to specific neck configurations.


For more information on the Denneroll Orthotic, please visit www.idealspine.com

cervical lordosis, Chiropractic BioPhysics, Denneroll Orthotic, Ferrantelli, rehabilitation, traction, Untitled

Low Back Pain Ad Campaign Ready to Go

Lisa Holmes, MBA, MHA

Lisa Holmes is president of Holmes & Co., an advertising agency headquartered in Salt Lake City and providing marketing communications services to health-care clients across the country.

INTRODUCTION

Millions of Americans suffer low back pain. It is among the most common work-related disabilities, resulting in lost productivity and cost of treatment amounting to scores of billions of dollars every year.

Just setting aside, for a moment, the discomfort of the condition, and the health-care provider’s responsibility to heal and alleviate suffering, low back pain is, to put it in the most crass of terms, a tremendous business opportunity.

Since most treatments for low back pain range from ineffective at worst to temporary at best, many sufferers are on the lookout for relief. They turn to pain relievers, mostly Non-Steroidal Anti-Inflammatory Drugs. NSAIDs sometimes provide temporary relief but, with continued use, often create problems with blood coagulation, kidney trouble, peptic ulcers, gastrointestinal bleeding, and other serious—even dangerous—side effects. Surgery can be even worse, with significant risk of hospital-caused disease, adverse effects from medication, and medical errors. Not to mention that surgery to cure low back pain is seldom effective, or only marginally so.

Which leaves the back pain patient few viable options.

Which is where you, the Doctor of Chiropractic, come in.

DISCUSSION

As you know—but most of the public does not—chiropractic can be effective in treating low back pain. A study of workers compensation claims in Florida, reported in the Journal of the American Chiropractic Association, showed back injuries initially treated by chiropractors rather than medical doctors had more positive results. A similar study in Oregon, reported in the Journal of Manipulative Physiological Therapy, showed chiropractic treatment got people back to work in a third the time of medical treatment. And the Journal of Occupational Medicine reported a Utah study that showed medical treatment cost ten times the amount of chiropractic treatment of low back pain. Other studies show similarly impressive results, including forty-five percent reduction of low back after eight to ten chiropractic visits.

Better still, treatment of low back pain using Chiropractic BioPhysics® techniques produces even more impressive results—one study showed pain reduction of seventy-five to eighty percent!

Well, enough of the introduction. Now, down to business.

Our marketing communications firm, in association with Dr. Deed Harrison and other chiropractic experts associated with CBP®, has created an advertising campaign targeted at the millions of low back pain sufferers, convincing them that help is available, and persuading them to contact their local CBP-trained Doctor of Chiropractic—you—for relief.

The cost of developing a similarly effective campaign on your own, assuming you have the expertise, would be prohibitive. But CBP makes this personalized material—print advertisements for magazine or newspaper or other publications, direct-mail postcards, and digital versions for online or e-mail distribution—available at a fraction of the actual cost. So you get professionally produced advertising at very affordable prices.

Back pain sufferers everywhere are crying out for relief. With this campaign, you can let them know you’re ready, willing, able, and available to answer the call.

Or, you can do nothing, and let prospective patients, and your practice, suffer in silence.

business, chiropractic BioPhysics

SUBLUXATION: End of Days or Wake Up Call?

Dr. Joe Betz, B.S., D.C

ICA Board Member,

PCCRP Board Member

Private Practice Boise, ID

Idaho Chiropractic Association Board Member

CBP Instructor

INTRODUCTION

It’s the year 2020 and you have received a letter from the state licensing board. You open the letter wondering what they want…another request for proof of CEs? Or maybe notification of additional regulations they recently passed to regulate your practice rights? But this isn’t it at all. You are being informed that you are practicing contrary to what has been described as the “ethical” practice of Chiropractic. You have never done anything you can think of as unethical, so why have you received this determination? You read on and find that you are being investigated for unethical practice because you 1) have brochures in your office educating patients about the relationship between the spine and health and others that claim you can help patients for non-musculoskeletal conditions, 2) took X-rays of a patient to assess the biomechanical alignment (subluxation) of a patients spine before initiating treatment, 3) adjusted a patients spine for any reason beyond low back pain, neck pain and headaches, and last but not least, 4) using the term subluxation on your website while not mocking it as an antiquated historical concept.

DISCUSSION

You probably are thinking that the above sounds impossible, irrational, paranoid… right? WRONG. To point out exactly how this scenario can happen, you can begin by looking at what is transpiring in Europe. The Education Committee of the General Chiropractic Council (GCC), the UK-wide statutory body with regulatory powers, recently gave the following advice to the GCC: ¹

1. “The chiropractic vertebral subluxation complex is taught only as an historical concept”; and

2. “There is no clinical research base to support the belief that it is the cause of disease or health concerns.”¹

The GCC has “AGREED to accept that advice and the Education Committee’s recommendation that the GCC should issue guidance on this matter.” ² In their “Guidance” letter on the matter, the GCC states, “The chiropractic vertebral subluxation complex is an historical concept but it remains a theoretical model. It is not supported by any clinical research evidence that would allow claims to be made that it is the cause of disease or health concerns.”²

This could arguably represent the end of the subluxation in Europe due to the recent actions of their licensing regulatory body, the GCC. Certainly the British Chiropractic Association (BCA) would stand up for Chiropractic in Europe… right? Unfortunately, in response to the GCC determination, the BCA stated, “The BCA reminds members of their obligations under the GCC Code of Practice and Standard of Proficiency. In ensuring compliance, they should refrain from making any reference to Vertebral Subluxation Complex in media to which their patients or the general public may have access.”³

The European Colleges are being advised not to teach subluxation, except as an outdated belief system that was held in the past and still held by the unscientific “fringe” of the profession. European Chiropractors are being told they should not teach the public about the benefits of Chiropractic beyond pain. Of course there are rational Chiropractors in Europe fighting this. It is my understanding that the MAJORITY of colleges and associations in Europe oppose these changes. Despite this majority opposition, this real “fringe’ element of the profession is making the decisions and calling the shots, ignoring the opinions of all others… sound familiar?

But this is in Europe and does not affect us here in the States… right? Well, you need to look no further than the CCGPP guidelines⁴ (REF) as another example of how one fringe element of the profession is working to redefine Chiropractic. CCGPP was commissioned and supported by COCSA (Congress of Chiropractic State Associations). They have taught the state boards through the National Board of Chiropractic Examiners (NBCE) that the guidelines can be used to go after over-utilizers.⁵

The CCGPP has also received support from Cleveland Chiropractic College and financial pledges companies such as Core Products ($10,000 donation). A systematic review which was published in the Journal of Manipulative and Physiological Therapeutics (JMPT)⁶ and soon thereafter referenced (adopted) by CCGPP⁷ states, “evidence from epidemiological studies does not support an association between sagittal spinal curves and health including spinal pain”.⁶ The CCGPP also adopted the Quebec “Red Flag Only Guidelines”⁸ that dictates that Chiropractors should not X-ray patients for subluxation assessment. In fact you should only take X-rays under certain parameters of pain conditions as described in “medical” guidelines.

These are the type of positions that typify the movement within the Chiropractic profession in North America to change the Chiropractic adjustment from a method that has been shown over the past 115 years to have positive effects for over 300 conditions,⁹ to a therapeutic procedure that may improve some types of pain, but only if successful in a few initial visits.

This can either serve as a wake-up call or you can continue to sit idly by practicing in your little apathetic bubble and let them finish what they have started. Make no mistake about it; we are at the eleventh hour. But, it is not too late for this to be stopped.

First, if you are a member of your state association (if you are not, join today) request that they immediately vote to decommission the CCGPP through COCSA. If you are a member of the ACA ask them why they have NEVER spoken out against it. If they don’t provide satisfactory answers, then perhaps you should consider becoming a member and connecting with the ICA, an association that is actively fighting against the CCGPP (Chiropractor as a glorified musculoskeletal therapist) movement and the concept of “Tiering” of the profession. You should contact the Presidents and CEO’s of the colleges and companies that financially support CCGPP and ask why they support restrictive positions such as 1) spine alignment has no impact on a patient’s health or pain, and 2) X-rays should not be taken by a Chiropractor for assessment of a patient’s spine unless they have certain parameters of pain.

SUMMARY

It is about time the vast majority of the profession speaks up and becomes vocal about what is going on. The extremes within our profession are working tirelessly to advance their agenda and bring into disrepute the practice styles of everyone else, see New Mexico’s efforts to “Tier” the profession as another example.

If every mainstream Chiropractor, such as yourself does not wake up and fight against this, it is my opinion that the 2020 licensing board scenario I opened with WILL become a reality in North America. In my estimation, there are between 50-100 individuals that are actively leading and organizing these movements, making these restrictive visions become a reality. Although their plans extend back decades, their work is now becoming a reality. It is obvious that there are tens of thousands of us practicing Chiropractors who sit in the middle who don’t agree with the direction these extremists are steering the profession.

We can make a difference, but not by complaining and whining on internet message boards or through email messages with pleas for “donations” to organizations you have never heard of before. There are organized associations, such as the ICA, that that have the infrastructure and knowledge to fight these actions, but need more funding to be able to effectively work to combat the activities of the motivated minorities. Stand up today and be heard!

Call the ICA now (800-423-4690). Become a member and join the fight. Our profession has been run by these radical academicians, researchers and policy makers long enough! This can be the end of days…or a wake-up call, it’s up to you!

References

1. Bulletin: Issue 32. General Chiropractic Council. Meeting of Council: 12 May 2010. http://tinyurl.com/2ebt46z

2. Guidance on claims made for the chiropractic vertebral subluxation complex. General Chiropractic Council. London, England. May 2010. http://tinyurl.com/322medc

3. BCA Statement on Vertebral Subluxation Complex. May 2010.

4. Council on Chiropractic Guidelines and Practice Parameters (CCGPP). http://www.ccgpp.org/

5. Best Practices Documents and Licensing Boards - A Quick Update. By Dr. David Taylor. http://tinyurl.com/2blzwlb

6. Christensen T, Hartvigsen J. Spinal curves and health: A systematic critical review of the epidemiological literature dealing with associations between sagittal spinal curves and health. J Manipulative Physiol Ther 2008;31:690-714.

7. CCGPP Diagnostic Imaging Report. 2009. http://www.ccgpp.org/diagnostic_imaging.pdf

8. Bussières AE, Peterson C, Taylor JA. Diagnostic imaging practice guidelines for musculoskeletal complaints in adults--an evidence-based approach. Part 1. Lower extremity disorders. J Manipulative Physiol Ther. 2007 Nov-Dec;30(9):684-717.

9. International Chiropractors Association. Best Practices and Practice Guidelines. 2009. www.icabestpractices.org

chiropractic BioPhysics, subluxation

Maximizing And Protecting Your Income: A Winning Combination

Tom Necela, DC, CPC, CPMA

Founder of The Strategic Chiropractor

Dr. Necela teaches chiropractors better billing, coding, documentation, collections and business strategies to improve their practice and work smarter, not harder. He can be contacted at www.StrategicDC.com.

Editor’s Note: Dr. Necela is one of the featured speakers at the upcoming 32^nd CBP Annual Conference on Sept 24-26^th, Scottsdale, AZ. See center page of this issue and www.idealspine.com for details.

INTRODUCTION

Most chiropractors would love to get paid better for what they do. If they are honest, most would also admit that they don’t necessarily want to work harder to increase that income! Similarly, few chiropractors intentionally engage in risky or questionable activities that put their assets at risk, regardless of the size of the potential gain.

If you can identify with these three statements, there is a winning combination available to you. In fact, it’s right under your nose! This combination will allow you to increase reimbursements without increasing your patient volume or working harder AND it will allow you to reduce your exposure to risks that could potentially rob you of your livelihood. It is an improvement which you can utilize every day of your career and an investment that can pay off for years to come, multiple times over.

In a recent article, health care consultant Keith Borglum plainly states one way doctors can do this: "The most cost-effective improvement is usually in improving your coding." Here's his reasoning why:

"An extraordinary number of physicians fail to stay current in their knowledge of coding, resulting in reduced reimbursement or delayed and denied claims. Many physicians purposefully under-code out of fear of penalties for up-coding or unbundling. Others leave their coding to support staff - an inappropriate approach virtually guaranteed to result in errors."

In my experience, his comments are right on the money. In chiropractic school, we were taught examination procedures so that we could accurately assess the patient's condition and create an appropriate plan of care. In many respects, our exams were also about protecting ourselves from malpractice resulting from potential hazards that could go undiagnosed.

But I have yet to meet a chiropractic graduate from any school who was taught how to properly document an exam for purposes of correct coding and billing. Unfortunately, the requirements are not necessarily the same. Upon learning what they are required to document to appropriately bill a certain level exam code, most DC’s are stunned because they are either way off the mark or they are performing many unnecessary tests that gain them nothing extra in the way of income or billable services.

As a result, most chiropractors fall into one of the two camps mentioned above. Conservative chiropractors tend to under-code or under-bill, thus denying themselves reimbursement for procedures they actually performed. More aggressive chiropractors tend to over-bill or up-code in ways that may not necessarily match up with coding or documentation requirements.

The worst news is that these same trends do not only apply to exam coding, but to all billable services we perform in our office. In this respect, most chiropractors can reliably improve income by making sure they are being paid for what they are already doing. Because most chiropractors lack proper training in this department, they are literally robbing themselves of potential income because they don’t know what they don’t know!

By learning proper billing, coding or documentation strategies, you have a fantastic return on your investment that allows you to both increase income AND save money. Here’s why:

The cost of attending a seminar such as the upcoming CBP Annual (hint, hint!) could easily uncover at least one item that you could help you improve your billable services. Even if that one item resulted in a $25 increase for a service or procedure you performed just a few times a week, it could add up to a $5,000 increase over the course of a year – better than a 12:1 ROI! Previous seminar attendees have confessed to me that one coding strategy I gave them would equal a $25,000 increase for their practice that year – how’s that for a ROI?!

In the wake of insurance audits, denials and payment delays, utilizing proper billing, coding and documentation can save you money and help protect your biggest asset – your practice! By helping you avoid post-payment demands, fines, legal costs to defend yourself, trouble with your state board and by helping you save the time it takes to jump through all the hoops to get yourself paid, doing things right the first time goes a long way towards keeping you out of trouble and protecting your money.

CONCLUSION

Regardless of what technique you use, what school you went to, and how big or small your practice, the reality is the same: looking outside your practice to increase your income potential makes little sense when you are already leaving plenty of income on the table through poor billing, coding or documentation procedures.

Sure, you can work harder and try to make up for it in volume by seeing more patients. But why not work smarter and make sure that you are getting maximum reimbursements from the patients you already have? In the process, you can slow down a little and make sure you are doing everything correctly so that you also protect your income from exposure to audits, delays and denials.

Finally, if you’re ambitious and willing to learn new strategies, you can do all of the above simultaneously and improve your practice exponentially!

chiropractic BioPhysics, chiropractic coding

Anti-Inflammatory Nutrition: Topical Applications

Dr. Lynn Toohey, Ph.D, Nutrition

Colorado State University in Ft. Collins, CO

Research Consultant NutriWest

INTRODUCTION

There are a lot of nutrients that are billed with characteristics that address certain elements of inflammatory pathways. The natural cox-2 inhibitors, for instance, that affect the prostaglandin cascade of inflammation, include rosemary¹, curcumin², beta-sitosterol³, spirulina⁴, quercetin⁵, boswellia⁶, ginger⁷, and fish oil⁸, to name a few. But what about topical nutrition?

Proteolytic Enzymes

First, let’s take a look at proteolytic enzymes. These enzymes work on a different pathway from cox-2 inhibition. These enzymes dissolve proteinaceous debris that accumulates after injury, when proteins leak out of permeable blood vessels and initiate an inflammatory response.

Anthony Chicoke describes the action of the enzymes in his book… “The process of any inflammation is governed by numerous enzymes, especially the body’s own proteolytic enzymes. They eliminate the inflammatory debris and initiate the restitution. This process can be supported and accelerated by the use of supplemental proteolytic enzymes…With enzyme therapy, pain stops quickly and the duration of inflammation is rapidly diminished”⁹.

Scientific evidence exists for the systemic application of proteolytic enzymes¹⁰, but what about topical application of the enzymes? Actually, evidence supports this as well, and it appears that enzymes can efficiently cross the skin and be effective.

Evidence for Topical Enzymes:

Bromelain is a proteolytic enzyme extracted from pineapples, papain is a proteolytic enzyme from papaya, and pancreatic proteolytic enzymes (pancreatin, animal source) include trypsin, chymotrypsin and pancrelipase.

Bromelain has proven efficacy in cosmeceutical products¹¹, as well as papain and trypsin¹², and synergy has been suggested among the enzymes¹³. In a review of nutrients that are used on the skin, Leslie S. Baumann, MD, (Division of Cosmetic Dermatology, University of Miami School of Medicine), emphasized bromelain and other ingredients that are used topically for “dermatologic benefits”¹⁴.

Other Topical Nutrients:

• Arnica

Arnica is a popular ingredient that has been used both internally (homeopathic) and externally as a topical application. Positive results of three randomized double-blind studies have been published with homeopathic arnica¹⁵.

“Preparations of Arnica montana are widely used for the topical treatment of inflammatory diseases. The anti-inflammatory activity is mainly attributed to their sesquiterpene lactones (helenalin & dihydrohelenalin)”, which have demonstrated transdermal penetration¹⁶.

In a randomized, double-blind study of 204 patients to ascertain differences in pain relief and hand function after 21 days' treatment, “Results confirm that this preparation of arnica (topical) is not inferior to ibuprofen when treating osteoarthritis of the hands”¹⁷. Additionally, in a multi-center trial conducted on 26 men and 53 women, it was discovered that, “Topical application of arnica montana gel for 6 weeks was a safe, well-tolerated, and effective treatment of mild to moderate OA of the knee”¹⁸.

One double-blind, randomized placebo-controlled trial found a significant reduction in pain after 2 weeks in the group treated with homeopathic and topical arnica, when they studied 37 patients undergoing carpal-tunnel surgery¹⁹.

• Topical Lavendar

Lavendar has a long history of topical application and is included in a wide variety of skin care products; in fact, “Several species of lavender have been used for therapeutic, cosmetic, and commercial purposes for thousands of years. Lavender blossoms were used by ancient Greeks and Romans to scent bath water, to prevent infections at communal baths, to bathe and soothe wounds, such as bites, burns (including sunburns), lacerations, and to treat acne, psoriasis, fungal conditions, and herpes”²⁰.

Modern research on lavender supports some of the historical dermatologic applications of the herb. In women who had recently gave birth, reduced pain was experienced after lavender oil was utilized in baths²¹. And in a randomized, double-blind, controlled trial, lavender oil was one of the essential oils massaged into the scalp with resulting moderate success for alopecia areata (hair loss)²².

• Topical Aloe Vera

One journal reported that “There are numerous natural ingredients that have been demonstrated to possess anti-inflammatory properties that make formulations containing these ingredients attractive treatment options”, and they included topical aloe vera in this category²³.

In a randomized, double-blind, placebo-controlled trial, it was concluded that a topical aloe vera gel was a safe and effective treatment for patients with lichen planus²⁴.

CONCLUSION

Many nutrients, including peppermint oil, described as having a “strong analgesic effect on neuropathic pain”²⁵, and all of the topicals mentioned above, are excellent possibilities for anti-inflammatory topical nutrition. Combining several of them together adds synergy and optimizes the benefit of all.

References

1. Sotelo-Felix JI, et al. J Ethnopharmacol. 2002 Jul;81(2):145-54.

2. Hong J. Carcinogenesis. 2004 Apr 8 Int J Immunopharmacol. 1992, 14:1363.

3. Awad AB et al. Prostaglandins Leukot Essent Fatty Acids. 2004 Jun;70(6):511-20.

4. Reddy et al. Biochem Biophys Res Commun. 2003 May 2;304(2):385-92.

5. Carcinogenesis, 2000, May. Vol. 21, No. 5, 959-963.

6. Integr Cancer Ther. 2002 Mar;1(1):7-37

7. Kim, MK et al. Exp Gerontol. 2010 Jun;45(6):419-26.

8. Oxley, A et al. Br J Nutr. 2010 Mar;103(6):851-61.

9. Cichoke, Anthony MA DC. Enzymes & Enzyme Therapy. Keats Publ. LA, Ca. 2000 pp 138-139.

10. Kamenicek V, et al. Acta Chir Orthop Traumatol Cech 2001;68(1):45-9).

11. LS. MD. Dermatol Ther. 2007 Sep-Oct;20(5):330-42. Review.

12. Glenn J. Managing a Traumatic Wound in a Ger. Patient. 52(4): Apr 1 2006.

13. Ito C, et al. Nippon Yakurigaku Zasshi 1979 Apr 20;75(3):227-37.

14. Baumann, ibid.

15. Brinkhaus B, et al. Complement Ther Med . 2006 Dec;14(4):237-46.

16. Wagner S, & Merfort I. J Pharm Biomed Anal. 2007 Jan 4;43(1):32-8.

17. Widrig R., et al. Rheumatol Int. 2007 Apr;27(6):585-91.

18. Knuesel O, et al. Adv Ther. 2002 Sep-Oct;19(5):209-18.

19. Jeffrey SL, Belcher HJ. Altern Ther Health Med. 2002 Mar-Apr;8(2):66-8.

20. Baumann, ibid.

21. Cornwell S, Dale A. Mod Midwife 1995: 5: 31–33.

22. Hay IC, Jamieson M, Ormerod AD. Arch Dermatol 1998: 134: 1349–1352.

23. Wu, J. Anti-inflammatory ingredients. J Drugs Dermatol. 2008 Jul;7(7 Suppl):s13-6.

24. Rajar UD, et al. Efficacy of aloe vera gel in the treatment of vulval lichen planus. J Coll Physicians Surg Pak. 2008 Oct;18(10):612-4.

25. Davies SJ, et al. A novel treatment of postherpetic neuralgia using peppermint oil. Clin J Pain. 2002 May-Jun;18(3):200-2.

chiropractic BioPhysics, Omega, Research

The Relationship of Foot Posture to Pelvic Position

Stuart Currie, DC

Director of Research, Sole Supports.

www.solesupports.com

INTRODUCTION

It seems obvious that the foot’s alignment or posture can have an effect on the kinetic chain and influence proximal structures, from the tibia to the femur to the pelvis and low back. What exactly do we know about this relationship, and what are the clinical findings to look for when evaluating patients?

A previous article discussed the relationship of back pain to foot alignment and what evidence exists for the treatment of back pain with foot orthotics; this discussion will focus on what the literature can tell us about specific alignment changes in the pelvis that can occur due to altered foot position. The pelvis is situated in the center of the body, and connects the movement of the lower limbs to the segmental motion of the spine. It is a functional link, through which loads are transferred in a proximal and distal manner. Although suggested often, until recently, its position and movement as related to foot posture was mostly hypothesized.

We now know that both bilateral and unilateral calcaneal eversion (part of pronation) can cause pelvic anteversion in the standing position¹. Recommendations from this study included that excessive pronation be considered when evaluating pelvic misalignment. Another study has shown that pelvic alignment is influenced by foot alignment with an anterior tilt of the pelvis being induced by wedging the feet into pronation². Using motion analysis this study also illustrated the link between foot and pelvis, showing that changes in calcaneal alignment (pronation) produce resultant shank and thigh internal rotations.

When considering any study using measurements of static pelvic position it is important to remember that the results (unless otherwise accounted for in the study design) are a reflection of the immediate effects, and not a prolonged adaptive effect. As we know, every human body is unique and can adapt in different ways to the same perturbation. In addition to temporal considerations, the distinction between static measurements and dynamic function is an important one, for it is easy to forget that the static evaluation is a snapshot at one point in time. How is the snapshot related to the gait cycle and at what point is the observation made? A caveat to pelvic evaluation is that research in foot and gait analysis reveals the lack of correlation between static measurements and dynamic function³; therefore, it would be unwise to assume postural measures of the spine and pelvis in the standing position present superior insight. In other words, static alignment is suggestive but does not reveal how the pelvis, hip, knee, ankle, and foot respond to ground reaction force and body weight⁴.

Figure 1. – Asymmetrical pronation of the right foot can result in internal rotation of the tibia, internal rotation of the femur, and anteversion of the pelvis.

If we know that an anterior pelvic tilt can be caused by pronation the logical question is, can it be reversed? This has been demonstrated in a study that showed increasing the arch height (through the use of low-dye taping) resulted in effects that were seen throughout the kinetic chain. In addition to changes in lower limb muscle activity and motion, an increase in total excursion of the pelvis was seen due to a more posterior tilted pelvic position⁵. Interestingly, even after removal of the tape and a subsequent lowering of the arch, the pelvis maintained a more posterior tilted position during 10 minutes of walking. It is this type of finding with sustained effects even after the intervention is removed, that leads to a discussion of how the neuromuscular system controls the way we move and learns to maintain a preferred posture.

The anterior pelvis is important to the chiropractic evaluation for well agreed upon reasons. In addition to other problems, the anterior pelvis with its resultant superior to inferior movement of the symphysis pubis, can result in secondary dysfunction from imbalances of the adductors and lower abdominals⁶. A comprehensive evaluation of pelvic and foot posture may include the following observations. With the patient standing, a side-to-side visual comparison of the patient’s feet (bunions, hammer toes etc.) provides clues as to differential function. Observe genu valgus, genu varus, the rearfoot angle, arch height, and hallux dorsiflexion. Heel walk and toe walk illustrate the function of the dorsiflexors and plantarflexors. With the patient seated and their legs hanging, tibial torsion and varum can be evaluated. In the supine position, foot segmental motion, forefoot flexibility, ankle plantar flexion and dorsiflexion can be evaluated. Hip and knee flexion provide information about the shock absorbing capability of the patient. Limitations in hip extension and internal/external rotation can be observed prone, which all provide information as to the cause of pelvic dysfunction. While an exhaustive discussion of the various normal ranges of motion and specific consequences is beyond the scope of this article, much information can be gleaned from simple comparisons right to left.

When evaluating the pelvis for alteration as a result of lower extremity postural change, it is helpful to consider the other causes of pelvic dysfunction that may be present. In addition to spinal changes, muscular dysfunction can cause pelvic gait errors. In the sagittal plane anterior pelvic tilt can be a result of weak hip extensors or hip flexion contracture. In the coronal plane contralateral hip abductor weakness, a short ipsilateral limb, or calf muscle weakness are just some of the causes of pelvic drop⁷

Therefore, something as simple as the assumed and documented pelvic anterior tilt as a result of pronation (asymmetric or bilateral) might not be so simple at all. The position of the pelvis is affected by factors such as acetabular orientation, soft tissue flexibility, muscular imbalances, and limb length, and all must be considered together when evaluating pelvic findings.

Reference List

(1) Pinto RZ. Man Ther 2008 December;13(6):513-9.

(2) Khamis S. Gait Posture 2007 January;25(1):127-34.

(3) McPoil TG. J Orthop Sports Phys Ther 1996 November;24(5):309-14.

(4) Lun V. Br J Sports Med 2004 October;38(5):576-80.

(5) Franettovich M. J Foot Ankle Res 2010;3:5.

(6) Geraci MC. Phys Med Rehabil Clin N Am 2005 August;16(3):711-47.

(7) Perry J. Gait Analysis: Normal and Pathologic Function. Thorofare: SLACK Inc.; 1992.

chiropractic BioPhysics, Research, Shoe Lift, SoleSupports

Omega-3 Fatty Acids for Neuropathic 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

Pain is an electrical signal interpreted by one’s brain. Neuropathic pain is a chronic pain state that usually (but not always) is caused by some sort of tissue trauma. In neuropathic pain, the nerve fibers themselves are often damaged, dysfunctional or injured. These damaged nerve fibers send incorrect electrical signals to the brain’s pain centers.

Inflammation alters the threshold of the pain receptors and nerve fibers. Consequently, it is easier for pain nerves that are inflamed to generate the electrical signal that the brain interprets as pain.

Omega-3 fatty acids, especially the molecule eicosapentaenoic acid (EPA) found in fish oil, has powerful anti-inflammatory influences through several different mechanisms, including the reduction of pro-inflammatory cytokines. Omega-3 fatty acid supplementation has been shown to reduce the chronic pain associated with degenerative spinal disease (Maroon).

Earlier this year (2010), researchers from the University of Toronto, Canada, published a case series of patients suffering from neuropathic pain syndromes, who were treated with high doses of omega-3 fatty acids from fish oil (Ko). The abstract from this study makes the following points:

Objective-- The aim of this case series study was to investigate and report on patients with neuropathic pain who responded to treatment with omega-3 fatty acids.

Methods-- Five patients with different underlying diagnoses including cervical radiculopathy, thoracic outlet syndrome, fibromyalgia, carpal tunnel syndrome, and burn injury were treated with high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA + DHA).

Outcome measures were obtained pre-treatment and post-treatment. These included validated surveys (short-form McGill Pain questionnaire, DN4 neuropathic pain scale, Pain Detect Questionnaire), objective clinical tools (Jamar grip strength, Lafayette dynamometry, tender point algometry) and EMG Nerve Conduction studies.

Results-- These patients had clinically significant pain reduction, improved function as documented with both subjective and objective outcome measures up to as much as 19 months after treatment initiation.

No serious adverse effects were reported.

Conclusions-- This first-ever reported case series suggests that omega-3 fatty acids may be of benefit in the management of patients with neuropathic pain.

Figure 1.

DISCUSSION From Dr. Murphy

In my review of this article, I found these to be the Key Points:

1. The benefits of omega-3 fatty acid supplementation are well documented in the literature for the prevention and management of a wide variety of health conditions including: Inflammatory joint pain, Chronic spinal pain, Autoimmune disease, Cardiovascular disease, Depression, Fibromyalgia syndrome.

1. The probable mechanism for the benefit of omega-3 supplementation in the treatment of inflammatory pain is through the suppression of the pro-inflammatory eicosanoids (Prostaglandin E2 [PGE2], Leukotriene B4 [LTB4]).
2. This is the first study to assess the use of omega-3 supplements in the treatment of neuropathic pain. Neuropathic pain can exist in the absence of pro-inflammatory eicosanoids. Rather, neuropathic pain is linked to pro-inflammatory cytokines (proteins made by immune system cells).

4. These authors present 5 case studies on chronic neuropathic pain patients with excellent results. The patients were treated with high oral doses of omega 3 fish oil (varying from 2400-7200 mg/day of EPA + DHA).

a. Results were excellent both subjectively and objectively for all five, which included: Cervical radiculopathy, Thoracic outlet syndrome, Fibromyalgia, Carpal tunnel syndrome, Burn injury.

1. No serious adverse effects were reported from taking high oral doses of omega-3 fish oil (varying from 2400-7200 mg/day of EPA + DHA).
2. Patients taking Coumadin (or other blood thinners) should slowly begin to take omega-3s while monitoring clotting times.
3. Because of the blood thinning effects of omega-3s, patients should stop taking them 2 weeks prior to surgery, dental work, or invasive procedures such as a colonoscopy.
4. Patients taking omega-3s should have their blood analyzed for the arachidonic acid (omega-6) (AA) / eicosapentaenoic acid (omega-3) (EPA) ratio. (AA/EPA)
5. “An optimal [AA/EPA] ratio for cardiovascular health is 1.5/1 to 3/1.”
6. The lab analysis of [AA/EPA] is especially important if the patient is taking more than 7,500 mg of EPA + DHA per day.
7. “An AA/EPA ratio of 0.5/1 is associated with an increased risk for hemorrhagic stroke.”
8. Fish oils should be purified.
9. “A recommended conservative dose is 2,700 mg of EPA + DHA. However, a more aggressive approach for more severe pain can be up to 7,500 mg of EPA + DHA. This will require serum laboratory tests to monitor AA/EPA ratio.”
10. “Patients should clearly be instructed to take only omega-3 and not omega-3 to omega-6 to omega-9 products. The omega-6 fatty acids are pro-inflammatory and the use of such products will not help in relieving pain.”
11. Pain patients must also reduce their intake of arachidonic acid (omega-6) (AA), which is commonly found in red meat and fried foods.
12. The conversion of alpha linolenic acid (ALA) (plant omega-3) to the anti-inflammatory EPA omega-3 is enhanced with adequate levels of vitamin B6, magnesium, and zinc.
13. The conversion of alpha linolenic acid (ALA) (plant omega-3) to the anti-inflammatory EPA omega-3 is impaired by trans fats and caffeine.
14. “To conclude, the use of omega-3 fatty acid supplements for the treatment of neuropathic pain shows promise, on the basis of these case studies.”

References

1. Maroon JC, Bost JW; Omega-3 Fatty acids (fish oil) as an anti-inflammatory: an alternative to nonsteroidal anti-inflammatory drugs for discogenic pain; Surgical Neurology; 65 (April 2006) 326– 331.

2. Ko GD, Nowacki NB, Arseneau L, Eitel M, Hum A; Omega-3 Fatty Acids for Neuropathic Pain: Case Series The Clinical Journal of Pain; February 2010, Vol. 26, No, 2, pp 168-172.

chiropractic BioPhysics, Dan Murphy, DC, Omega

EMRs, Electronic Billing? The sky is falling, the sky is falling! Extra, Extra Help

R.J. Hammett, DC

INTRODUCTION

The government says EMR’s by 2014, state boards and associations are setting up committees and groups to study the solutions for the coming EMR catastrophe.

EMR software vendors are advertising like crazy, why? Their software is the one to buy, and you better buy it now before its mandatory. Ok, I’ve listened and looked; I’ve even tried a few EMR systems. So what are the facts?

1. There is no standardization of EMR for chiropractic or medicine. In Britain a $20 billion dollar program for EMR’s is 5 years behind schedule and heavily over budgeted.

2. The majority of EMR software cannot communicate with other EMR software.

3. As of June 2008, only 4% of medical physicians really use EMR’s in hospitals or private setting on a regular basis.

4. Error reporting on EMR’s is high with regards to quality studies.

5. A JAMIA research paper of 2006 concluded that “the promise of improved care quality and cost control has prompted a call for universal EMR adaption by 2014.” The EMR products now available are unlikely to achieve full diffusion in a critical market segment within the time frame being targeted by policy makers, it may reach the target by 2024!!

6. According to NYT, Doctors annually reap about 11% savings from EMR’s, the rest goes to insurance companies (again). The doctors bear all the costs, and others reap most of the benefits.

7. The capacity to manipulate electronic records is a risk management nightmare!!

8. Doctors become distracted by the computer program, lessening their ability to focus on their patients (the TV in the room syndrome).

9. Privacy and security issues; according to JAVELIN strategy and research; 275,000 incidences of medical information theft occurred last year, with 260 million medical data breaches since 2005 (so much for HIPPA).

10. The American public has been surveyed several times and overwhelmingly (74%) do not trust the security of electronic records.

DISCUSSION

So, what are you to do? With EMR systems costing $10,000-$20,000 and with the above in mind, what’s the answer?

Unfortunately there is no clear cut route for the private practitioner. While it is sure that clinics like Mayo, Harvard in Cleveland can benefit for large main-framed based EMR’s, does this fit the small time solo Chiropractor?

I hate to say it, but its wait and see time. Yes, get involved with your board and association (Are you listening Minnesota?) before anyone mandates and unproven system for note taking that isn’t ready yet.

Will EMR’s happen? Yes, is now the time… Absolutely not!

Technology and policy has not caught up yet, when it does, then do it! But until they do the things you know, that works every time… ADJUST!

Til next time. RJH

chiropractic BioPhysics, EMR

How to Make Money$ In Chiropractic Practice

Eric Huntington, DC

Co-Owner Developer of the Chiropractic Business Academy

OVERVIEW

In this article, I am going to share with you some secrets to making more money. Fact is, these secrets are things I’ve observed and they act like facts or natural laws-- but are not well known to people in general. I guess that is why making money remains to be a sort of mystery to most people. And that is probably also why most people seem to have a problem making enough money.

First thing to establish is relatively obvious. Money, itself, is worthless (unless it is made out of a valuable resource such as gold or silver). Even so, it does represent something valuable—and that is why people want it. They want what it represents, they don’t want piles of otherwise useless paper or metal.

WHAT IS MONEY?

Well, for the purposes of this very short article on a large subject, we can say that money is energy. It represents energy. At least it should represent energy. It should represent the energy created by someone’s production of a valuable product or service.

On occasion, a counterfeiter, a government, a central bank, or another kind of thief just prints or steals money and puts it into use when it does not represent any real production. That ruins money and the economy. But that kind of criminal viewpoint is NOT what we are referring too.

We are referring to the fact that money, properly used, represents the energy of creation and allows for exchange between individuals.

HOW TO ATTRACT MONEY?

Well, there do need to be a lot of things in place in order for this to happen in the frame of reference that we are discussing here—a chiropractic office. However, it comes down to a very simple idea which you can implement immediately.

Consider this question--where do you put your money? To figure this out, you have to get beyond the simple answers like, “toward my bills” or “I give it to my spouse” or whatever. Maybe an easier question is, “What do you buy?”

The general answer is that you usually buy what you are INTERESTED in buying. Right?

So, if you want someone to buy your product or service, what must they be? Well, of course, they must be INTERESTED in your product or service to whatever degree is required for them to purchase it. The degree of interest will vary from person to person, but you’ll know when you’ve crossed that threshold because the person will have purchased something from you.

But there is another undercut we are going for here. Before you become INTERESTED in something, what must that something get from you? Think about this for a second, if you didn’t know that your favorite type of car existed, would you be interested in it? Of course not--you wouldn’t know about it. So what does your favorite car have of yours?

It has your ATTENTION. And, if it’s your favorite car, it has quite a bit of your attention. And, if you own that car, it got enough of your attention that you gave away your money in exchange for it—didn’t you?

So, the way to make money is to get the ATTENTION of and maintain the INTEREST of others. The way to make lots of money is to get lots of ATTENTION and maintain a lot of INTEREST from lots of other people.

HOW TO APPLY THESE CONCEPTS?

So, the real value of these concepts, is in their application. Here are some real ways to apply these principles.

1) You and your staff should maintain a very high interest in your products and services. You can do this by continuing to learn more about the services you deliver, and teaching that to your staff and patients. Spend a few minutes at each office meeting teaching your staff something about chiropractic.

No matter how difficult things may be on a particular day, week, month or year, stay very interested in what you deliver to your patients—and let that interest shine through to those you interact with on a daily basis.

When presenting your recommendations, don’t let your interest drop just because the person you are talking to is getting a bit grumpy over paying for your service. Just stay interested in what you deliver and keep communicating to them in a very interested manner.

Always maintain a very high interest in your practice and your services.

2) Market the Heck Out of Your Practice and Your Services! The only way to get interest from others is to let them know about it--internally and externally. My company has consulted thousands of chiropractors. With this experience, it is obvious to us that practices that do consistent marketing are larger than those that don’t. Practices that place a lot of emphasis on marketing make a lot more money than others that don’t.

Why?... Because the practices that are marketing themselves are getting lots of ATTENTION and INTEREST from people in their community.

GUARANTEE YOU’LL MAKE MORE MONEY

If you’d like to have a larger practice, or earn more money, or have more time off from work, then call The Chiropractic Business Academy and ask us how we can help you achieve your goals.

888-989-0855

Most of our clients are in the top 5% of chiropractic income earners- many in the top 1%. We are one of the only companies that can show you how to phase out of any area of practice. Many of our clients have multiple offices but don’t “work” in any of them

We know our systems work, so we guarantee that you’ll make more money after training with us. We give that guarantee to you in writing.

For a Free CD which includes some marketing basics see the ad below! See many of our clients testimonial videos on our website: www.Chirobizacademy.com

chiropractic BioPhysics, Chiropractic Business Academy

How to Hear What Your Patients Are NOT Saying and Why They DON'T Commit to Care;

Fred DiDomenico, DC

Practice Coach and Mentor

Founder—Elite Coaching

Every doctor has experienced patient telling you what they think you want to hear when they truly have no intention of committing to care. Oh, they tell you they are completely committed as they are planning their exit strategy in their mind. Your problem is you believed their words. Even when you KNOW they are not honestly giving you their commitment. The challenge is you may not know how to handle their objection. Why? Because they are not telling you what their objection is. You must be able to “hear” what they are NOT saying. You must hear the “thought behind the thought.”

The thought behind the thought is what they are thinking when they are telling you something contrary. How do you hear what they are NOT saying? Over 90% of communication is nonverbal. In fact, when influencing patients to accept your recommendations and commit to a spinal corrective program, 7% of the influence you create is related to your words, 38% is related to your tone and 55% is related to your body language. If you believe you are going to talk someone into care, not only will you be less successful, you feel as though you are selling, one the most frustrating interactions with patients. Patients are actually watching the way you move and your tone to decide whether or not they will commit to care. Do you ever feel no matter what you say a patient just doesn’t “get” what you are talking about? This feeling is because they are not listening to your words.

People buy with emotion and justify with fact. It is more important how they “FEEL” about what you say than the facts of what you say. To the contrary, you will know how they feel and “hear” the thought behind their thought by watching their body language and listening to their tone. You may actually “see” the thoughts they are not saying. A patient will tell you what they think you want to hear and their true intention and thoughts are revealed in their body language. One example is when a person is thinking something opposite to what they are saying they will unconsciously shake their head “No.” They are saying their health is their top priority as they shake their head “No.” Their body is essentially telling you they don’t believe what they are saying. Anytime a person’s body language does NOT match their words there is a contradiction between thought and words and a potential objection in their thoughts you have not handled. It is THAT objection, the thought behind the thought, that is the barrier to your recommendations or financial.

Another very simple example is when a patient leans back in their chair or steps back after your last statement. This is a disagreeing posture. Other body language objections are facial expressions, eye movements, changes in breathing patterns and more. If you watch the way patients move to what you are saying, their objection will be revealed in their body, the thought behind the thought. If you are too busy making statements and convincing them to accept your care, selling, rather than watching their response and asking a question when you notice body movement inconsistencies, you will be fighting objections and ultimately accept a non committed patient, one that leaves when their pain is gone. Even worse they have no value for your care and reject your recommendations or financial and leave your office.

To the contrary, if you are not consciously aware of how YOU are moving when you are speaking, you may be making recommendations in your words and denying them with your body. Many doctors have no conscious awareness of how you move when you talk NOT realizing your body is talking them out of your words. When your body language does not match your words you are breaking trust and there is inconsistency in your message. This may be part of the reason some of your patients are not committing. You are talking them into your program with your words and OUT of your program with your body.

The Elite Coaching systems teach you how to accelerate patient’s learning process as well as create maximum influence with words, tone and intentional body language to ensure the highest probability of patient trust, confidence and commitment. Ask about our communication boot camps and seminars to master influence inspiring patients to accept and follow through with your care to create a fulfilling and purpose driven spinal rehab practice.

Dr. Fred DiDomenico, founder of Elite Coaching, the leading and most unique coaching group specific for spinal rehab practices. For and questions regarding boot camps, seminars or coaching please contact Dr. Fred personally at 253-851-8353.

chiropractic BioPhysics, Elite , Nerve Root Function