Informed Consent Issue in Connecticut Resolved By State Chiropractic Board

By Stuart E. Hoffman, DC, FICA

ChiroSecure President

Stuart E. Hoffman, DC, FICA, is the president of ChiroSecure, the only malpractice insurance program endorsed and approved by the International Chiropractors Association. Dr. Hoffman is a highly experienced doctor of chiropractic and licensed insurance broker who knows the intricate details of daily practice and who can give you the best advice based on his unique knowledge of both the insurance world and the world of chiropractic. Dr. Hoffman can be reached at 1-866-802-4476 or visit www.chirosecure.com.

INTRODUCTION

In recent months, a high-profile debate on mandating specific terms for “informed consent” by doctors of chiropractic in Connecticut has been a very serious concern for many of us in the chiropractic profession. The roots of this debate go back to the activities of a small but heavily funded and well-organized clique of individuals and organizations with names like “Victims of Chiropractic Abuse” to use the media and also the public policy process to incorrectly frighten consumers into believing that chiropractic inherently puts people at risk for stroke. The impressive safety record of chiropractic, indeed the most impressive safety record of any health care profession, appears to mean very little to those organizations and individuals who have taken on the role of professional critics of our profession.

The Issue of Informed Consent

These blatantly anti-chiropractic organizations promoting the fear of stroke from upper cervical adjustments hit upon the informed consent issue as a means to showcase their issues. In four days of public hearings in January of this year before the Connecticut State Board of Chiropractic Examiners, they played it for all the publicity they could get, the facts again, taking a complete backseat to the fear factor they were promoting. The research and actuarial records, and the failure to make anything but a casual or coincidental link between stroke and chiropractic services, did not seem to deter these people at all.

At these four days of hearings, the state’s chiropractic organizations, the Connecticut Chiropractic Council and the Connecticut Chiropractic Association, with the support of a host of national organizations, offered a reasoned, research and fact –based defense of the safety record of chiropractic procedures, arguing that informed consent was already well-established in the state but that a specific warning of stroke as a possible outcome for cervical adjusting was simply not supported by the research record. On the other side, a long list of critics of chiropractic, including some well-known professional anti-chiropractic advocates such as Murray Katz, MD who was such a feature in similar discussions in Canada, and the “organizations” active on the stroke issue offered emotion, and accusations, but no facts to support their position.

Without any doubt, the highlight of the chiropractic presentations at these hearings was the testimony presented by respected researcher and epidemiologist J. David Cassidy, DC, PhD, Dr.Med.Sc., who testified as an expert witness and consultant to the International Chiropractors Association (ICA). Dr. Cassidy addressed key facts and issues on the basis of the existing science and research record, to which he has been a significant contributor on the issue before the Board. The objective of his testimony was to bring the discussion on an emotional issue back to the science and the objective research record.    Speaking in the context of the most recent research (Neck Pain Task Force Report of the Bone and Joint Decade 2000-2010, a United Nations & WHO sanctioned study), Dr. Cassidy stated in compelling and well-documented terms that “neck manipulation is safe and effective form of health care.” Despite several hours of aggressive cross-examination, Dr. Cassidy was able to keep the focus of the hearing on the scientific record and laid the foundations for the Board’s eventual fact-based decision.

CT State Board of Chiropractic Examiners Ruling

On June 11, 2010, the Connecticut State Board of Chiropractic Examiners issued their declaratory ruling on the issue of a mandated informed consent policy requiring a specific stroke Warning. In a well-reasoned, carefully worded statement, the Board concluded:

“The Board heard the testimony of persons who have suffered a stroke and who allege that joint mobilization, manipulation, or adjustment of the cervical spine was the cause of such stroke, experts, and lawmakers, and carefully reviewed the statistical and analytical data that was admitted into evidence at the hearing. After a careful and thorough review of all of the testimony and documentary evidence admitted at the hearing, the Board concludes that there is sufficient evidence to establish that a stroke or a cervical arterial dissection is not a risk or side effect of a joint mobilization, manipulation or adjustment of the cervical spine. Therefore, the Board finds that in securing informed consent from a patient a chiropractor is not required to address with each patient the risk and/or possibility of the occurrence of a stroke or cervical artery dissection as a side effect of a joint mobilization, manipulation or adjustment of the cervical spine.”

An objective observer would think that this statement would put an end to the matter. This, regrettably, is not the case. The goal of the anti-chiropractic activists is not to deal with facts or real risks but to hurt the chiropractic profession. Sadly, we will have to continue to deal with the backwash of their campaign, since after the defeats in the legislature in Connecticut and at the hands of the Connecticut Board of Chiropractic Examiners, a class-action lawsuit against the chiropractic state associations in Connecticut has been filed by one of the “stroke” groups alleging harm because the members of those associations have not specifically been warning patients of a stroke risk. This is more of the same anti-competitive distortion, probably for the publicity it will generate because the facts do not support their allegations. Regardless of their destructive intent and deceitful ways and means they are employing, the chiropractic profession will need to come together to support our colleagues in Connecticut against this latest phase of harassment.

The Connecticut episode shows the degree to which informed consent has become the subject of growing attention as an element in risk management procedures, because the lack of it in malpractice cases has become a common and effective claim. It makes so much more sense to proactively deal with all of its dimensions ahead of any problems that it is to try and patch over or resolve issues with patients after the fact. Rather than look at the informed consent exercise as a burden, practitioners should look at the interaction with the patient on relative risk and informed consent as an opportunity to orient them to what they can expect from the adjustment process, especially if they are first-time patients. Such frank and open dialogue can only strengthen the doctor-patient relationship and enhance the positive nature of their chiropractic experience.

CONCLUSION

In today's litigation-happy (or many might argue litigation-crazy) society, even the best, most conscientious and responsible doctors of chiropractic, applying the highest standards and most established procedures and protocols, can still be named in a malpractice claim. When it comes to informed consent, a whole new dimension of malpractice reasoning comes into play, where patients and their attorneys regularly argue that if a patient was fully informed of all risks and possible negative outcomes, then they may have decided not to receive the care and would not, as a result, been injured. The proactive doctor of chiropractic will respond accordingly, with sound and well-researched forms and procedures, all consistently applied and included in the patient’s file. It pays to do the work and, consequently, minimize the risk.

And, as every doctor of chiropractic should know by now, a reliable malpractice insurance carrier is your best partner in protecting your practice and yourself from malpractice claims. In that process, ChiroSecure stands ready to serve and assist in making sure that you have the coverage you need, and in implementing risk management procedures that will provide the best possible firewall to jeopardy.

Shop around, compare and see what you find. Then, call ChiroSecuretoday and find out how you can have the best protection on the market, at highly competitive rates. The result will be both excellent coverage and peace of mind. You deserve both.

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References

[1] Hanumans v. Boyson, No. 2003AP1527, 2005 WL 1522624 (Wis. June 29, 2005).

[1] Matthies v. Mastromonaco, 160 N.J. 26, 37, 733 A.2d 456, 462 (1999).

[1] Schreiber v. Physicians Insurance Company of Wisconsin, 223 Wis.2d 417, 588 N.W.2d 26 (1999).

chiropractic BioPhysics, ChiroSecure

CBP NonProfit Research Update- CBP Research Team Member Passes from ALS

Dr. Burt Holland, Ph.D (1946-2010)

Burt Holland, a professor at Temple University, died of ALS (Lou Gehrig's disease) at home Monday evening, June 21st. He was 64. He is survived by his wife Margaret, his children Andrew, Ben, Irene, son-in law Jeremy, his sister Joan, his brother David, and 4 cats. Burt most likely inherited this disease from his grandmother, who died after the same progression of symptoms as his. He courageously fought the disease for nearly 3 years.

After receiving a Ph.D. in Statistics from N.C. State in 1969 at age 23, he served as a professor in the Department of Statistics in the Fox School of Business and Management for the next 39 years. He was department chairman during 1991-1996 and was an elected Fellow of the American Statistical Association. He taught a variety of graduate and undergraduate courses, and supervised doctoral dissertations, often helping his doctoral candidates secure employment upon graduation.

In 2006 Professor Holland created a new and innovative course entitled “Statistics in the News” for Temple University’s Quantitative Literacy Program. This course has become very popular, with at least 120
students registered each semester. Burt Holland's graduate textbook Statistical Analysis and Data Display, coauthored with Richard M. Heiberger, is a contemporary presentation of statistical methods that features extensive use of graphical displays for exploring data and for displaying the analysis.

Professor Holland's research covered several topics, particularly multiple comparison procedures, an area to which he made significant contributions. This research continued until a week before his death.

Burt's interests included both domestic (he took pride in having set foot in all 50 states and visiting a plethora of baseball parks) and international travel. He was also an avid tennis player and Philadelphia sports fan, and had a keen interest in classical music.

A memorial service will take place at the Diamond Club of Temple University. Please email bellapeggy@gmail.com for the date and time. The Holland family would appreciate donations to the ALS Association, 321 Norristown Rd, Ambler, PA 19002.

chiropractic BioPhysics, Research

Active Cervical/Thoracic Exercise Rehabilitation with Pro-Lordotic Traction

Don Meyer, DC

Private Practice Huntington Beach, CA

President Circular Traction Supply

CBP Instructor

INTRODUCTION

It is usually more difficult to re-establish a lordosis in patients that present with a kyphotic cervical curvature and advanced degenerative joint disease (DJD). These patients usually complain of chronic cervical pain, muscle rigidity and restricted motion. Long term relief for these patients is generally not possible without some form of effective structural and soft tissue rehabilitation.

In this article I would like to present a case study of this type of difficult patient and an inventive solution I have found to help facilitate structural correction and soft tissue rehabilitation of these cases.

CASE STUDY

A 53 year old woman came to my office for evaluation and treatment of constant slight neck and upper back pain. On a 0-10 numeric pain scale, she rated her average pain as a two and her worst pain as a four. She also had constant tightness of her upper thoracic region. Her Neck Pain and Disability Index (Vernon-Mior) questionnaire revealed an eight percent restriction of her activities of daily living (ADL). The pain interfered with her reading and caused a mild disturbance of her sleep (1-2 hours sleepless). The use of a heating pad and 25 years of previous Chiropractic care provided her with only temporary relief.

On examination, her range of cervical motion demonstrated an eight percent impairment of normal motion, primarily restricting her lateral flexion and rotation. Her postural evaluation revealed a mild flattening of her upper thoracic kyphosis, mild forward head posture and a right lateral translation of her head on thorax with an associated left high shoulder. The AP and lateral radiographs were analyzed with Posture Ray™ digitalization and denoted a 20.2 mm anterior head translation with a 15 degree mid to lower cervical kyphosis (See Figure 1). The AP view showed 18 mm of right head translation.

Figure 1. Patient initial lateral Cervical X-Ray #1 (analyzed by the PostureRay® system).

A treatment program of progressive resistance (head halter and tubing) neck ROM exercises with mirror-image left head translations, mirror-image diversified spinal manipulation, standing left head/neck translation traction and seated and supine cervical 2-way axial extension (Pope) traction was initiated.

After one month of treatment (16 visits), and again after two months of treatment (16 more visits) the patient was re-evaluated. The patient stated that she was now pain free with no restrictions of her ADL, but her ranges of motion and post lateral and AP cervical x-rays were basically un-changed. Due to the lack of objective change, the seated and supine 2- way axial extension traction was stopped and supine, motorized 2-way compression extension traction was added to her treatment program for 12 additional visits. Even though this is not the ideal traction for her lateral neck/upper thoracic structure/ posture, I was desperate to get some objective change for this patient.

Re-evaluation again demonstrated no objective improvement, so the patient was released to monthly maintenance care. Some return of subjective pain was observed once the frequency of treatment was reduced. After five months of maintenance care, the patient also started getting symptoms of radicular left hand paraesthia with increased physical stress.

For the past two years I have been working on developing an inexpensive, motion-based home 2-way cervical traction device. At this point in time, I had been testing a new device design on myself. I was experiencing daily upper cervical pain and headaches after having whiplashed my neck while side-posture adjusting a very large patient. Spinal adjustments and various forms of physical therapy only provided temporary symptomatic relief. I developed eight different active exercises that I could perform with the device. After daily 5-10 minute application of these exercises for two weeks, not only had all my chronic neck and head pain subsided, but my lateral cervical curvature was also improved. So I asked my patient if she would like to try the device herself. She was instructed to stop use of the device if her pain or radicular left hand symptoms increased.

I termed the new lordotic exercise device: “the Pro-Lordoic Neck Exerciser™ (Figure 2)”. This device was modified after the CBP posterior neck traction strap exercise taught by Dr. Deed Harrison in CBP Cervical Rehab Seminars for the past several years (Dr. Deed taught this exercise to increase the upper thoracic kyphosis and load the lower cervical spine forward in Type 2-3 neck curves in the Cervical Rehab Text Chapter 6).¹ I modified this, CBP neck traction strap by adding resistance tubing and padded grip handles on each side. The patient used the device, which for one month and returned for another re-evaluation. The patient’s first comment to me was “I don’t really care if my neck curve is getting any better or not. I feel and can move my head and neck so much better since starting to use this device that I do not want to stop.”

Figure 2. Pro-Lordoic Neck Exerciser™. This device was modified after the cervical neck strap used and taught for this exercise by Dr. Deed Harrison in the CBP Cervical Rehab Seminars for the past several years. Resistance straps and padded handles were added to the posterior traction neck strap.

The patient’s range of motion impairment had decreased from eight to five percent, her persistent 15 degree kyphosis had reduced to 10 degrees and her forward head posture of 20.2 mm was now 17.3 mm. (See Figure 3).

Figure 3. Patient initial lateral Cervical X-Ray #2 (analyzed by the PostureRay® system).

CONCLUSION

This case is a good example of why it is so important to achieve objective functional and structural improvement with your patient care if you expect the patient to receive any long-term benefit from your treatments. Even after 46 in-office exercise sessions (with head halter and tubing resistance), this patient shown only mild functional improvement, no structural improvement and no lasting relief from her chronic condition. It was only through the application of daily home Pro-Lordotic™ traction exercises that a positive outcome was achieved. I have since seen this occur in numerous other cases.

References

1. Harrison DE, Harrson DD, Haas JW. CBP Structural Rehabilitation of the Cervical Spine. Evanston, WY: Harrison CBP Seminars, Inc., 2002, ISBN 0-9721314-0-X. Chapter 6.

Chiropractic BioPhysics, traction

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 BioPhysics® College Course Updates

Cindy Boyd, DC Life Chiropractic College West

CBP^® at Life Chiropractic College West (LCCW) is in full swing! Currently CBP is taught in two parts. CBP Technique I is core curriculum with an average of 30 students per quarter and Advanced CBP II is an elective with 10 students on average. I am finishing up my first year of teaching both classes and am starting to get a grasp on all of the changes that have occurred over the last year, including the responsibility of running a busy CBP practice in Alameda, CA while implementing new and exciting things related to my classes at LCCW.

As a graduate of LCCW and a previous CBP club president, it brings me great joy to witness the evolution of the technique in the Chiropractic College setting. Many of us worked tirelessly for many years to make this all possible. Not only is CBP core at this point, but it is readily accepted by the students and clinic staff. Students have the ability to practice CBP with ease in the clinic setting due to fabulous clinic directors, and the new traction and adjusting equipment that has been donated over the past year. Since the 2009 CBP Annual in Scottsdale Arizona, the school has received many generous donations including: All new CBP teaching materials for the classroom, new CBP posters for the clinic, Denneroll™ home traction devices, PostureRay®, 4 Impulse^® Instruments, IMPAC^® brand adjusting tools, and a new Pope traction unit. Dr. Deed has donated the Denneroll home traction device to EVERY student in my class, and I have been able to give students class notes on CD’s similar to the CBP seminar notes. Class lectures are taught with new and improved Power Point presentations which are closely aligned with CBP seminar standards.

Over the next year, I will continue to improve the class and work with Dr. Kerri Duggins to improve the systems in the school clinic for CBP Technique applications. I hope you all will continue to support CBP Non-profit and donate to Life Chiropractic College West in the name of CBP.

Don Meyer, DC Cleveland Los Angeles

My first class has only five students this semester (May 2010); but the students have great enthusiasm for Chiropractic BioPhysics (CBP) technique. The students have been learning about the Harrison Spinal Model, how to read and list posture, and marking/measuring x-rays. They have also been improving each other’s abnormal posture with Mirror Image® Drop Table Adjusting in the Lab portion. I have been told that the students are enjoying the opportunity to learn CBP.

Jean-Guy Daigneault, DC UQTR

This past March I received a phone call from Dr. Deed Harrison to see if I would be interested in teaching a basic CBP course at the University of Trois-Riviere in Quebec , Canada. Without hesitation, my answer was yes. I thought it would be a privilege to help further advance the basic knowledge of Chiropractic BioPhysics in the French speaking province of Quebec. The course was given thru the Chiropractic technique department. There were 20 students that registered for the class and it was very well received. The class was a seven credit hour basic introductory course. I covered postural analysis, mirror image adjusting as well as mirror image exercises. We also covered the Harrison spinal model and an introduction to cervical traction. Now, I’m very excited to announce that the college would like me to return for another semester CBP Technique course! This time around we are expecting greater interest with approximately fifty students to register.

Abe Cardwell, DC Life Chiropractic College Marrietta, GA

Here at Life in GA, we are offering the Introduction to CBP class as an elective for upper class students, 10th quarter and above. The class is continuously filled to capacity; around 50 students each quarter. I am considering adding another lab section in order to open the class up to greater numbers. My hopeful objective is to have an Intro to CBP added into the core curriculum, much earlier in the curriculum, with an advanced class added as an elective; similar to how Life West CBP courses are offered.

If CBP can be added to the core curriculum, the technique will be included in the clinical experience, as well. At present, the young student docs cannot practice CBP in the clinic. They are somewhat frustrated in this regard, as you can imagine. There is a curriculum review taking place this year, and I am hopeful we will be added to core curriculum as part of this process. The students and many faculty are very supportive of the new data, and very grateful for the good work CBP has done to help us be better Chiropractors. I feel it is just a matter of time, patience, good communication, and open mindedness. All in all, things are going very well here.

Chiropractic BioPhysics

Postural Alignment & Health Disorders: A Scientific Connection?

Deed E. Harrison, DC

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

Editor’s Note: Dr. Deed will be presenting a comprehensive, contemporary review of this topic at the upcoming 32^nd CBP Annual Conference on Sept 24-26^th, Scottsdale, AZ. See center page and www.idealspine.com for details.

INTRODUCTION
Posture has probably been one of the longest studied aspects of Humans. The correlation of posture and health has driven us to study our posture since at least the time of Hippocrates.1 Since Hippocrates’ time, many have attempted to categorize man into constitutional posture types.1-3

Even in present times, the criteria for normal and abnormal posture continue to be ill defined without clearly defined and agreed upon categories and measures. Before any possible consequences of abnormal posture can be addressed, normal posture must be defined and precise measurement methods developed.

DISCUSSION

• Ideal Upright Postural Alignment:

Herein, we use the definition of ‘Ideal Posture Alignment’. Ideal Posture is really a matter of simple engineering. The human body is designed such that the centers of mass of the head, ribcage, and pelvis should be perfectly centered and balanced on each other. From the front, the spine is perfectly aligned with gravity. But the spine, when viewed from the side, contains three curves to properly balance the weight of the body and allow free movement. Figure 1 depicts the proposed Ideal Posture Alignment. Note that we will ignore the ideal spinal curvatures that give rise to optimal postural alignment for the purposes of this short presentation.

• Abnormal Postures as Rotations and Translations:

Now that we have an Idealized Posture Alignment as an origin, we can now look at categories of abnormal postural displacements. In 1974, Panjabi, White, and Brand4 presented a right-handed central orthogonal (Cartesian) coordinate system where local systems (i.e. body joints or segments) may be used to define human body joint and segment static positions or relative motions from the central system. My father (Dr. Donald Harrison) originally (in 1982) implemented this system to define human body posture as rotations and translations of the head, thoracic cage, and pelvis as 12 simple movements in 6 degrees of freedom.5-7

A center of origin to describe the global orientation of the major body masses was defined as right-handed Cartesian coordinate systems describing the origin of the head movements from T2, the thoracic cage from S2, and the pelvis from the mid-talus centered between the feet and in some movements from the femur heads. The single posture component rotations and translations of the head, thorax, and pelvis are shown in Figures 2 and 3.

While there are only 36 possible single movements of the head, thorax, and pelvis shown in Figures 2 and 3, complexity of this system of description is inherent. There can be singles, doubles, triples, quadruples, quintuples, and sextuples of rotations and translations for the head, thoracic cage, or pelvis.
Using just the head, there are 6 degrees of freedom (Rx, Ry, Rz, Tx, Ty, Tz) and three possible choices for direction ( -, 0, +) for a total number of permutations of 36 = 729. In other words, there are 729 unique postural displacement combinations for the head relative to the ribcage; 728 of these would be abnormal postural displacements and 1 would be the ideal alignment position shown in Figure 1.

• Measurement of Ideal and Abnormal Posture Alignment:

Previous investigations into postural analysis systems have suffered from an incomplete analysis, including use of only one examiner, small sample sizes, and measurement of only one region of the body, or a limited number of degrees of freedom of postural displacements.
Recently, CBP researchers developed a new computerized system (PosturePrint®), to measure head, rib cage, and pelvic postures as rotations and translations in three-dimensions (3-D) in upright stance. In three separate validity studies,8-10 the PosturePrint system was found to be sufficiently accurate in measuring head, thoracic cage, and pelvic postures in five degrees of freedom (vertical translations were not assessed) on inanimate subjects: errors ≤ 3mm and 3°. Further, intra and inter-examiner reliability of the process required for the PosturePrint computer systems’ analysis of upright human posture was evaluated; the PosturePrint measurements were found to have good to excellent examiner reliability.11
The use of the PosturePrint system allows detailed postural measurements to be used clinically to gauge an individual’s response to intervention and/or for research purposes assessing correlations between postural alignment and health disorders. Figure 4 depicts the AP Postural Alignment using the PosturePrint system and the consequent displacements measured: Left pelvic translation, Left thoracic translation, Left thoracic bending, and Right Head translation are the significant findings.

• Postural Deformity, Pain, Disability & Health:

The cause-effect relationship between postural deformity-abnormality and health disorders has been the subject of numerous investigations and review articles and it has advocates on both sides of the debate. A comprehensive review of this information is behind the scope of the current short presentation. However, recent high quality case control investigations have found interesting and significant differences between condition groups vs. control groups and significant correlations between abnormal posture alignment and a number of health disorders including:

• Abnormal thoraco-lumbar alignment and back and neck pain in children and adolescents;12,13
• Hyper-kyphosis-round back and health perceptions and function in adolescents;14,15
• Hyper-kyphosis and rigid anterior head translation and functional impairments in seniors;16
• Hyper-kyphosis and early mortality in seniors;17
• Abnormal cervical spine postures in women with chronic pelvic pain;18
• Abnormal forward head posture and neck pain, headaches, disability, range of motion, respiratory muscle function, and carpal tunnel syndrome.19-23

At the upcoming 32nd CBP Annual conference in Sept, I will be presenting a comprehensive and contemporary review of this type of information from the scientific literature. However, scientific studies aside, ask yourself or others this question: Which one of the four persons in Figure 4 visually appears to be in good health and which one of the four persons would you say has poor health?
Your eyes (and mind), may in fact be pointing you to answer for the questions regarding the scientific connection between good posture and good health and poor posture and poor health. In the end, how do you wish to age with respect to gravity may be the only question that need be answered.

SUMMARY
This short paper has presented a fundamental yet rigorous model of ideal posture and consequent abnormal posture alignments as components of rotations and translations after Dr. Don Harrison. The use of this posture model has many advantages over previously ill-defined postural ideologies. It is simple to implement into the clinical or research settings and easy to record and communicate between professionals.

References
See AJCC Online at www.idealspine.com for the detailed list of references accompanying this article.

• Goff CW. J Bone Jt Surg Am 1952;34:115.
• Beck A, Killus J. Aerospace Medicine 1973;44:1277-1281.
• During J, et al. Toward standards for posture. Spine 1985;10:83-87.
• Panjabi MM, White III AA, Brand RA. A note on defining body parts configurations. Journal of Biomechanics 1974;7:385-387.
• Harrison DD. CBPâ Technique: The Physics of Spinal Correction. National Library of Medicine #WE 725 4318C, 1982-97.
• Harrison DD. Spinal Biomechanics: A Chiropractic Perspective. National Library of Medicine #WE 725 4318C, 1982-97.
• Harrison DD, Janik TJ, Harrison GR, Troyanovich SJ, Harrison DE, Harrison SO. Chiropractic Biophysics Technique: A Linear Algebra Approach to Posture in Chiropractic. J Manipulative Physiol Ther 1996;19(8):525-535.

1. Harrison DE, Janik TJ, Cailliet R, Harrison DD, Normand MC, Perron DL, Ferrantelli JR. Validation of an algorithm to estimate 3-D rotations and translations of the rib cage in upright posture from three 2-D digital images. Eur Spine J 2007; 16(2):213-218.
2. Janik TJ, Harrison DE, Cailliet R, Harrison DD, Normand MC, Perron DL. Validation of an algorithm to estimate 3-D rotations and translations of the head in upright posture from three 2-D images. J Manipulative Physiol Ther 2007;30(2):124-129.
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Chiropractic BioPhysics, chiropractic research, subluxation, Posture