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

Joseph Ferrantelli, DC

Private Practice New Port Richey, FL

CTO CBP^® Seminars

CEO PostureCo www.PostureCo.com

INTRODUCTION

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

AJCC Taken Offline Suddenly

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

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

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

• Good News—AJCC Back Online

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

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

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

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

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

• CBP Doctors Need to Get Listed Today!

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

  

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

• CBP Online now has Classifieds!

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

Chiropractic BioPhysics, PostureCo, PostureRay, PostureRay

Redefining Instrument Adjusting and Computerized Adjusting

Christopher J. Colloca, D.C.  

CEO and Founder of Neuromechanical Innovations

www.neuromechanical.com

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

INTRODUCTION

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

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

Table 1. Negative sentiments about chiropractic instrument adjusting

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

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

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

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

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

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

Table 2. Negative comments about computerized adjusting

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

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

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

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

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

Redefining Instrument Adjusting

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

Instrument Development

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

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

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

Technique Development

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

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

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

References

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

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

Impulse Adjusting Instrument

Denneroll Combined with Pope 2-Way Aids Patient Suffering from Chronic Whiplash Associated Disorders & Advanced S.A.D.D.

Joseph Ferrantelli, DC

Private Practice New Port Richey, FL

CTO CBP^® Seminars

CEO PostureCo.

Deed E. Harrison, DC   

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

INTRODUCTION

In this case report we present CBP Technique management of a patient with chronic whiplash associated disorders (WAD) and associated cervical spine kyphosis, flattening of the upper thoracic kyphosis, and moderate-severe spinal arthritis and disc disease (S.A.D.D.). The patient recently had over 50 visits with another chiropractor in the state of Florida which failed to improve his condition.

Case Report

In addition to the recent 50-plus Chiropractic treatments, the patient has had ‘regular’ chiropractic care for 10 years prior to his previous doctor. Furthermore, he was suggested surgery 10 years prior due to severe disc herniations, stenosis and instability of the cervical spine.

The patient’s most recent chiropractor recommended the use of an un-named at “home wedge” type of fulcrum-traction in the cervical spine for approximately 6 months; it is unknown how often and for how long the patient performed this or if it was indicated for the type of curvature and condition. Regardless, the patient still being symptomatic, found his way to the office of one of the current authors (Dr. Joe) where new cervical spine x-rays were obtained.

• Patient Complaints
• • Patient reported that his average pain per day was an 8/10 on a numerical rating scale.
  • Patient reported a limitation to his activities of daily living on a Neck Disability Index.

• Radiographic Findings

In the initial x-ray (Figure 1A), the patient has severe degenerative changes, along with significant instability upon flexion and extension radiographs. Additionally, the patient x-ray shows:

• A reversed cervical curve measuring +8.4° from C2-C7 posterior body lines,
• A straightening of the C7 posterior body line relative to vertical; indicating flattening of the upper thoracic kyphosis. See Figure 2.

Given the patient had such advanced S.A.D.D., and having no problem with treating in the office, he elected for an intensive 36 visit plan over the course of 9 weeks (35 total rehab sessions were performed).

Figure 2. C7-Body Tangent to Vertical. A line is drawn along the posterior body margin of the C7 vertebra (black line) and measured in flexion or extension relative to a vertical line originating either at the posterior inferior body of C7 or T1 (shown in Red from T1). In the Harrison Ideal Model, the ideal value of this angle = 21.5° of flexion relative to vertical.

If the value is ≤ 21.5° it indicates potential hypo-thoracic kyphosis of the upper thoracic region, T1-T4. If the value is ≥ ≤ 21.5°, then there is a potential hyper-thoracic kyphosis from T1-T4. A patient can’t have a normal cervical lordosis without a normal upper thoracic kyphosis!

• CBP Treatment Approach

In office treatment consisted of mirror image® adjusting setups to increase the upper thoracic flexion angle and increase the cervical lordosis(Figure 3). Given the mild retrolisthesis in the lower cervical spine and the flattening of the upper thoracic spine, no cervical extension exercises were given in this case as the treating clinician anticipated that this would flatten the upper thoracic kyphosis (T1-T4) even further. Additionally, Pope 2-way in office traction was performed with a lower neck front pull and an elevated back pull of approximately 45-60° above horizontal.

At home he used the Denneroll orthotic in the lower cervical-upper thoracic region (Figure 4), working up to 2 sessions per day of 20 minutes on his ‘off days’ from Dr. Joe’s clinic, and 20 minutes in the morning on the days he treated at night in the office. A total of 40 Denneroll home sessions were performed along with 35 in office CBP procedures.

Figure 3. Mirror image adjustments were given in extension and NO posterior head translation to improve the lordosis. Also, a wedge shaped block is placed in the mid-thoracic spine in order to round-increase the mid-and upper thoracic kyphosis. The thrust is given P to A in the lower cervical spine. This corrective adjustment aims to improve the cervical lordosis while simultaneously increasing the upper thoracic kyphosis.

Case Outcome

Subjectively, the patient while not totally asymptomatic, had his average pain reduced to a 2-3/10 from 8-9/10 and he was able to return to more vigorous activities of daily living with less intense painful episodes.

The follow-up lateral cervical radiographic exam found:

• That the disc spaces at C5-C7 appear to be improved in height and alignment following treatment regimen;
• The cervical kyphosis is now a cervical lordosis measuring -12.5° of extension from C2-C7 (a 21° correction);
• The C7 posterior body angle relative to vertical is moving into a more normal flexion alignment.

SUMMARY

The patient obtained quite a dramatic correction in cervical lordosis (21°) considering the extent of S.A.D.D. and the short amount of treatment duration. We believe the successful results are attributable to the addition of the Denneroll orthotic use at home in combination with the in office Pope 2-way traction and proper mirror image adjusting setups. Further, this case suggests that good patient compliance can be readily achieved with CBP protocols provided in the clinic and at home.

cervical lordosis, Chiropractic BioPhysics, disc degeneration, kyphosis, PostureCo, PostureRay, PostureRay, subluxation, whiplash, x-ray digitization software, x-ray digitization software, x-ray digitization software

Foot Posture – Rockers, Pivots and Vaults

Stuart Currie DC,

Director of Research, Sole Supports.

www.solesupports.com

INTRODUCTION

The foot is the primary interface with the ground allowing smooth locomotion through space: a simple enough concept perhaps, but how is forward movement really accomplished? Through a complex system of pivots, vaults, and rockers, the foot absorbs force and enables movement – a truly brilliant design. One question that is often asked is does the foot push, pull, or act as a spring?

DISCUSSION

The following is a presentation of what we know about how downward directed forces are converted into sagittal plane forward momentum. Dananberg stated that the amount of sagittal plane motion of the foot required during gait is 500% that of the frontal and transverse planes the significance of which cannot be minimized¹. Dananberg’s article is considered a critical treatise on sagittal plane biomechanics as it applies to the foot. A summary of points made in the article is as follows:

• Working models of “muscle-less” walking machines have been constructed, tested and proven accurate.
• Bipedal gait is based inherently on the integration of gravity and momentum.
• The power for walking is predominantly by the swing leg, pulling the body over the standing limb.
• The stance limb is passive.
• Restrictions in this system (through a loss of range of motion) cause compensations.
• The magnitude of forces involved is sufficient to create deformity.
• Pathologic ligamentous laxity or neurologic absence of the muscle guarding response can contribute to an accommodation in which the body forms its own rocker deformity of the foot.
• Failure of one joint to move properly alters the motion of the entire structure.
• The power to propel the body forward is extrinsic to the foot.

From Kapandji, IA, The Physiology of the Joints, Vol.II, p.199

It becomes evident when evaluating these concepts, that the foot can function as a relatively passive rocker in the transmission of movement and that this rocker is affected directly by its posture. The three key contact points at the base of this vaulted posture are the first metatarsal head, the fifth metatarsal head, and the heel. It is this posture that defines the stabilized position of the foot that is so important in maintaining supination against body weight.

In her chapter on basic functions, Jacqueline Perry describes three rockers of the foot: the heel rocker, the ankle rocker and the forefoot rocker.² The heel rocker preserves forward momentum of the body as weight drops onto the leg by rolling forward. The ankle rocker is a fulcrum for continued propulsion as the tibia continues to advance and is dependent on the soleus muscle to allow forward progression of the tibia. As the heel rises and the center of pressure advances past the metatarsals, the forefoot rocker allows continued unimpeded forward progress as the phalanges extend on the metatarsal heads. During the stance phase, while the foot is on the ground there is also a pivot shift as weight transfers from the lateral aspect of the foot to the medial side just before toe-off. The overall function of the rocker system is to convert the momentum of the moving body at heel strike into an efficient forward roll.

Sagittal restrictions cause blockages in forward motion. These restrictions can include ankle and meta-tarso-phalangeal joint limitations, both of which can be addressed with manual therapy techniques and manipulation.

The various arches of the foot, medial longitudinal, lateral and transverse provide selective planar stability to the foot. As a whole, they can be considered a plantar vault. Any one of these arches is only a 2D slice of the 3D architecture of the foot. The stability of the vault and rockers is related to the degree of re-supination the foot can achieve. The rockers of the foot can be made or broken by foot posture – i.e. a well formed plantar vault. If a proper plantar vault is not present in a pathologic foot it is benefitted by an orthosis that is casted in a corrected position providing a spring mechanism for gait that the foot did not have otherwise. A study investigating the effects of an orthotic designed to support the plantar vault in a specific corrected position has shown that these foot orthoses can increase the economy of gait.³

For the clinician it is important to realize that in order to see sagittal plane compensations properly, you must evaluate your patients from the side during walking. Restrictions in flexion and extension at the knee, hip and foot can only be visualized from the side. This is important because Dananberg also showed these blockages in hip extension and toe dorsi-flexion (hallux limitus) are also causative factors in chronic low back pain.⁴

It is generally accepted in the realm of orthopedics that joint loads are affected by posture, position and motion. It is therefore logical to assume these concepts are at work in the foot, and the morphology that is observed can have a profound effect on the transmission of forces through the body during gait.

Reference List

1. Dananberg HJ. J Am Podiatr Med Assoc 2000 January;90(1):47-50.
2. Perry J. Gait Analysis: Normal and Pathologic Function. Thorofare: SLACK Inc.; 1992.
3. Trotter LC, Pierrynowski MR. J Am Podiatr Med Assoc 2008 November;98(6):429-35.
4. Dananberg HJ. J Am Podiatr Med Assoc 1993 August;83(8):433-41.

SoleSupports

Chronic Upper Thoracic Hyper-Flexion and Headaches

Don Meyer, DC

Private Practice Huntington Beach, CA

President Circular Traction Supply

CBP Instructor

INTRODUCTION

It is sometimes difficult to differentiate between a simple forward head posture problem and an upper thoracic hyper-flexion subluxation problem. Their symptoms and appearance can be very similar, but their corrective treatment is quite different. In this article, I will present a case study that illustrates the differences between these two conditions.

Case Study

A 23 year old male presents with chronic severe headaches that he has suffered with (2-3 times per week) for the last 2-3 years. He rates the headaches as a 7-10 level on a 0-10 numeric pain scale. He also denotes having occasional left upper thoracic/neck pain that he rates as a 4-7 level.

The patient’s initial cervical ROM exam demonstrates a restriction of flexion, rotation and lateral flexion (3% whole person impairment). His postural exam shows a general forward head carriage on lateral inspection. His AP head/thoracic posture is relatively normal. His initial lateral cervical x-ray analyses was preformed with the Posture Ray™ digitizing program and denoted 28.3 mm C2-C7 anterior translation and a 33.1% loss of normal lordosis (see x-ray #1). He has a positive foraminal compression test bilaterally in the upper cervical region indicating a chronic upper cervical facet joint inflammation.

The patient was started on a rehabilitative treatment program to strengthen the deep anterior neck flexors and reduce the Forward Head Posture (FHP). This consisted of posture corrective head weighting and ambulatory use of the Cervical Remodeling Collar™ (10-15 minutes each). Diversified spinal manipulation was also preformed. After 14 treatments the patient was re-evaluated.

The patient’s pain levels and frequency had now decreased. His new cervical ROM exam reveals grossly improved rotation and flexion, but only a mild improvement of lateral flexion. His new lateral x-ray showed only a mild improvement of the FHP to 27.4 mm and a moderate improvement of the lower cervical lordosis.

Because of the persistent FHP, the patient’s lateral cervico-thoracic posture was re-evaluated with the patient and on the new lateral x-ray. On closer inspection, it was determined that this patient’s upper thoracic spine was fixated in a state of hyper-flexion. To confirm this on the radiograph, lines are drawn on the back of the body of C7 and vertically up from the posterior inferior body corner of C7. The angle these two lines create should be approximately 22-24° in the normal upper thoracic spine. A much larger angle is indicative of an upper thoracic hyperkyphosis and a much lower angle indicates a straightened upper thoracic spine. This patient’s C7 to vertical angle was increased to 37°, confirming the upper thoracic hyperkyphosis.

The CRCollar™ and head weighting was discontinued and the patient was started on motorized axial extension traction as shown in

Figure 1. This traction targets the lower cervical/upper thoracic spinal regions and provides passive intermittent extension traction at a rate of 13 times per minute

.

The patient performed 10 more treatments of this new traction (10-12 minutes) and continued manual manipulation of the thoracic and cervical regions. The patient’s symptoms continued to decrease in frequency and severity throughout this last phase of his treatment. On his final re-evaluation not only did this patient’s lateral flexion ROM notably improved, but his FHP was reduced to only 11.6 mm and his cervical lordosis was completely restored (see x-ray #2).

CONCLUSION

The typical patient with moderate FHP will usually have an extension fixation of the upper cervical spine (restricted flexion). Performing posterior head translation traction (CRCollar™) will induce flexion into the upper cervical spine and along with muscle rebalancing (head weighting) will nicely correct this aberrant condition. But as this case demonstrates, it is possible that the FHP can be secondary to an upper thoracic flexion fixation which usually shows itself as restricted cervical lateral flexion. Upper thoracic extension traction must be performed to correct the FHP in these patients.

Chiropractic BioPhysics

Prescription Drug Spending in USA Double

• “Over the last 10 years, the percentage of Americans who took at least one prescription drug in the past month increased from 44% to 48%. The use of two or more drugs increased from 25% to 31%. The use of five or more drugs increased from 6% to 11%.
• In 2007–2008, 1 out of every 5 children and 9 out of 10 older Americans reported using at least one prescription drug in the past month.
• The most commonly used types of drugs included: asthma medicines for children, central nervous system stimulants for adolescents, antidepressants for middle-aged adults, and cholesterol lowering drugs for older Americans.”¹

Furthermore, spending on prescription drugs in the U.S. totaled more than $234.1 billion in 2008 and this figure is more than double the amount spent in 1999.¹

Key Take Home Points

Research demonstrates that conservative chiropractic interventions may help offset one of the primary cost drivers in the current healthcare system: drugs. For example, a 2004 study by Sarnat and Winterstein⁴ conducted on nearly 22,000 patients over a four year period, demonstrated the following cost reduction when care was directed by a doctor of chiropractic:

1. 1. 51.8% reduction in pharmaceutical costs!
2. Assuming a simple extrapolation, a 51.8% reduction in prescription drug expenditure would have saved the US Health Care system over $121 BILLION in the last decade had Chiropractors directed patient care or at least were a major part of it.
3. Instead of 1/5 children being on prescription drugs in the US, perhaps parents should consider Chiropractic care as the first line of care. See Dr. Len Siskin’s article in this issue.
4. Perhaps the increase in prescription drug use in the USA is one of the driving forces behind the CCE’s recent attempt to change the course of the Chiropractic profession towards the use of drugs (see Dr. Joe Betz’ article in this issue). Chiropractors—THE PROFESSION—need to promptly steer CCE back to our roots and livelihood and away from the use of drugs and surgery as the first line of defense of Chiropractic patient care.

References

1. Gu Q, Dillon CF, Burt VL. Prescription Drug Use Continues to Increase: U.S. Prescription Drug Data for 2007–2008 NCHS Data Brief, No. 42, September 2010 US.
2. http://www.usatoday.com/yourlife/health/healthcare/2010-09-04-prescription-drugs_N.htm
3. http://www.cdc.gov/nchs/data/databriefs/db42.htm
4. Sarnat R, Winterstein J. Clinical and Cost Outcomes Of An Integrative Medicine IPA. Journal of Manipulative and Physiological Therapeutics 2004; 27: 336-347.

Untitled

Life Chiropractic College West (LCCW) Highest in Alumni Satisfaction

“Life Chiropractic College West alumni continue for the third year in a row to honor their alma mater in an independent survey administered and tabulated annually by New York Chiropractic College (NYCC).”

Analysis of the survey data demonstrated that LCCW ranked #1. Respondents were chiropractors who graduated three, five, and seven years ago. A questionnaire was administered to each Alumni covering 17 different issues regarding the quality of Chiropractic education and satisfaction with the profession. LCCW alumni ranked highest of all the participating colleges in the key areas of "satisfaction being a chiropractor" and with the "overall value of your education."

Additionally, LCCW alumni ranked among the highest levels of "feelings of success," of being "prepared to effectively use techniques and treatments," and of being "prepared to manage patient care."

Need more reasons to attend Life Chiropractic College West? Call 800-788-4476 and ask for the Admissions office.

AJCC Editors Note: My wife and I are both graduates of LCCW and valued our education and time there. Furthermore, LCCW is the only Chiropractic College to offer CBP Technique as a core curricula course that each student sits in their first year; additionally, it is the only Chiropractic College to permit CBP Technique protocols and procedures to be practiced in the last year of out-patient clinic.

Second Class Doctor

R.J. Hammett, DC

Do you have this syndrome? Do you consider yourself a second class doctor as compared to a medical physician, a dentist, or a podiatrist? Do you feel less when a patient talks about their medical care? If you have even a slight disregard of chiropractic, you have a second class doctor mental state… Don’t!

While it is true that medical life saving care is wonderful, it is not a Health profession. It is a profession based upon many scientific inaccuracies, many money oriented individuals, and power hungry ego’s whose last thought is health of the patients. Recently, I had the opportunity to first hand witness several consultations with a stroke patient. I witnessed a Neurologist, Speech Pathologist, General Practioner, Physical Therapist, an O.T. and a parade of other consultants with this stroke patient. They not knowing who I was (only a chiropractor) went on with their normal business of patient care. Curiously, they all started and ended the same. Mr. Patient, you have had a slight stroke we don’t know why, we are going to do more test, prescribe some medications and then we’ll see what happens. All of these professionals had almost the same “pat” statements, approaches and answers. Watching the patient in total bewilderment was heart breaking for me. Nowhere was an action plan, a solid course of care explanation or recommendation to this patient.

What needed to be done? Just we’ll see. For those of you secretly aspiring to gain the respect as a medical physician has or mimic them by wearing scrubs to your clinic while walking around with a stethoscope around their neck. Wake up!! Chiropractic is so much more then this side show of health care called medicine. You want to ape the M.D. and P.T.? Why?

Medical care cannot hold a candles flame to the power of a correctly preformed spinal adjustment, that’s right an adjustment, not a manipulation. If you think I’m ranting and raving, go spend some serious time with these “real” doctors, really learn what it is really all about. To end this, I say “quit trying” to be an accepted member of the medical community, this is not chiropractic, be different, show the world that your spinal adjustment is more powerful than any drug, or any surgery, and quit being afraid.

Insufficient Evidence for Pediatric Chiropractic!

Len Siskin, DC

Promote Chiropractic,

Co-Chair ICA Best Practices

INTRODUCTION

Communication and honest reporting of scientific observations are the goal of healthcare research. In a recent overview of systematic reviews of randomized clinical control trials (RCT) using complimentary and alternative medicine (CAM) treatments, Katherine Hunt and Edzard Ernst of Peninsula Medical School in the UK point out that chiropractors, among other CAM professionals, have nearly failed to show RCT’s supporting claims of helping children¹. I would like to thank Dr. Matthew McCoy for bringing this to paper to our attention². The authors reinforce that they were simply using literature searches to overview existing reviews and did not actually read the original research papers themselves. They noted the failure of CAM professions, including chiropractic to produce adequate numbers of these types of reviews which are common in mainstream medicine. Be careful.

I am a practicing chiropractor and at first I became defensive when reading this paper. I was prepared to discuss the limitations of RCT’s in guiding clinical practice and the masses of research omitted by these authors. When I thought for a moment I realized the world of evidence based medicine values these types of evaluations so much they might not be so interested to know the volumes of research that exist. They are looking for a certain type of research performed by each healthcare profession and in the absence of reviews on chiropractic RCT’s they conclude that chiropractic care is ineffective for things chiropractors claim they can help in the pediatric population.

When looking at the numbers, 99 articles were located covering reviews of RCT’s spanning CAM professions of acupuncture/acupressure, Alexander technique, Aromatherapy, Bach Flower remedies, chiropractic, craniosacral therapy, herbal medicine, homeopathy, hypnotherapy/hypnosis, massage, naturopathy, osteopathy, spiritual healing, Tai chi, traditional Chinese medicine, and yoga. Twenty of these articles were included in this overview of which 4 appear to be chiropractic.

In their critical review aimed at assessing the effectiveness and safety of CAM for infants, children, and adolescents, the authors looked only at reviews of RCT’s to maximize reliability and validity of the review. Admittedly this excludes all other forms of evidence which is a problem when RCT’s are not available. The authors observe only one of three total RCT’s for colic using chiropractic was performed reasonably and showed no significant improvement with chiropractic treatment. This does not take into account the information in the ICA’s Best practices database which shows only 2 (not 3 because the third RCT reviewed has not yet been incorporated to the database) RCT’s and than 20 additional papers on colic and chiropractic where all papers showed improvement with chiropractic care and no adverse effects were noted.

It should be mentioned that because 19 of the 20 additional studies were case reports here a system of rating traits of the case report mathematically shows the data equivalent to .6 RCT value per paper on average and the total quality score is equivalent to about 12 RCT’s. Unfortunately for both our profession and for the understanding society has about chiropractic, the tendency in healthcare science is to ignore the lower profile and often more clinically representative research but in CAM professions, there has notoriously been little no funding with little emphasis for higher quality research so the lower quality research represents the vast majority of what exists for us to communicate the benefits of what we do to the scientific world.

The authors suggest claims about chiropractic helping otitis media are baseless as they were unable to find any reviews on this topic of RCT’s. Fifteen level III and IV studies were found in the ICA Best practices research database equivalent in point scores to nearly 10 RCT studies. Fourteen of the 15 papers showed positive treatment outcomes and one paper was inconclusive. No adverse effects were noted in any paper.

As for nocturnal enuresis, the authors found insufficient RCT reviews to suggest chiropractic can help. The ICA Best practices database shows 9 papers published on chiropractic helping this condition equivalent to 6 RCT’s in quality points where all papers showed positive outcomes and no adverse effects.

The truth of the matter is the Best Practices Database of the ICA shows about 290 papers on chiropractic treatment in children where all but 2 show positive outcomes and none show adverse effects. Many dozens of named medical conditions were shown to improve in these papers because of chiropractic care. The authors of the overview paper discussed here make the statement, “Our analyses do not reveal consistent evidence to suggest that CAM is effective for pediatric conditions.”

When I want to eat Chinese food in New York City I would not go to Little Italy even though it is across the street from Chinatown. If I want Chinese food I should cross the street to Chinatown! If I were looking for Chinese restaurants in Little Italy I might conclude that New York City is void of Chinese restaurants. Dr. McCoy recently urged chiropractors to subscribe to peer reviewed chiropractic journals to show that chiropractors are conscientious about the research in our profession and to prove to the world we care. Furthermore, he urged chiropractors and chiropractic organizations to publish more research. The discussed overview of reviews of CAM RCT’s written by professionals in mainstream medicine sadly conclude what this author found to be negative about the entire CAM industry. Without good quality chiropractic research and a vehicle to communicate and publicize that research our profession will continue to be represented in this negative light.

Problematically, insurance companies, guideline developers, and ‘other reviewers’ are likely to use papers like the Hunt and Ernst¹ one which misrepresent our existing research and to some extent vilify CAM to deny payment for care. Consumers will be left with the personal financial responsibility without the real information behind what we do. If you are reading this and want to defend what you do a good step would be to go online to www.chiropractic.org and purchase a copy of the very readable ICA Best Practices Guidelines and also a copy of the ICA’s Practicing Chiropractors Committee on Radiology Protocols (PCCRP) Guidelines if you take chiropractic x-rays. The monies spent to purchase these materials go to educating accrediting bodies, law firms, state boards, malpractice insurance companies, etc.

These two ICA based Chiropractic practice guidelines also help defend chiropractors in lawsuits. The information in these resources will prove vital to any chiropractor writing a report to a patient, other professional or third party payer. Support our great profession and protect your practice by purchasing these materials and subscribe to a scientific journal! Join organizations within our profession who support your philosophy of chiropractic and be very careful when discounting what role research will play in your future ability to help the people who honor you with their trust and health status.

References

1. Hunt, Katherine; Ernst, Edzard. The evidence base for complimentary medicine in children: a critical overview of systematic reviews; ADC Online July 6, 2010; 10.1136/adc.2009.179036 BMJ Publishing Group
2. McCoy, Matthew Ernst Slams Chiropractic for Children; http://researchupdate.mccoypress.net/2010/07/29/dont-just-sit-there.aspx

Chiropractic BioPhysics, ICA Best Practices Chiropractic Guidelines

From Success to Significance: A Vision for a Significant Chiropractic Career

Yurij Chewpa, DC

Practice Coach & Mentor

Co-Founder Warrior Coaching

Co-founder Chiropractors with Compassion

www.warriorcoaching.org

www.chiropractorswithcompassion.org

INTRODUCTION

If you took the time to hang out at most chiropractic seminars and conferences, and listened to the conversations in the hallways and restaurants of the hotel for long enough, you would come away with one common, two-part definition of success in practice: patient volume and practice income. Inherently, there is nothing wrong with volume and income as long as they are a byproduct of devoted service, or an indicator for the level of service the doctor is bringing to the community. However, most often the volume and income are the end point. They are not merely the indicator, they are the goal. There is likely a lot of cover up about the actual intent of the practice. There will be a nice mission statement on the wall stating that the mission is to save lives and change the world. Everybody on the staff is scripted to say the right things.

Unfortunately, you cannot fool the patients for long. They will quickly see through the charade. It doesn't take long to figure out that it's all about the Doctor and not about them. They will stop referring and they will stop coming in for care. This, of course, will sabotage the volume and income goals of the practice. This is the first failed practice scenario: missed goals, and chronically low volume and collections, will lead to mounting financial pressure and the doctor's dissatisfaction with practice.

But let's say that the doctor practices in a larger urban center, he has a good marketing program in place and he can continue to find enough new patients who don't yet know his true motives. He can continue to build his volume and income by attracting more new patients. This is where the second problem scenario kicks in. If it's just about the volume and income, the practice quickly becomes too difficult and too much work to maintain. Both scenarios, not enough volume and too little income, and too much volume and lots of income, both done for the wrong reason and with the wrong motive, lead to the same problem: a tired, frustrated and burned out doctor that is looking for an exit strategy. Whether driving the same old Pinto from college or a new Mercedes with DC plates, he just wants out.

DISCUSSION

How can you avoid this trap? In my 25 years of practice, and 10 years of coaching experience, I have come to the conclusion that there is only one solution, and that is to change the doctor's vision. To achieve significance, the doctor's vision needs to change from volume and income (leading to early retirement and an unfulfilled life) to one of service to the sick and lost in the community.

Doctor, it cannot be about making as much as you can in as short a time as possible so you can eventually stop practice and go do what you really love to do. If you really love something else, then go do that now, and you will be successful at it. Otherwise, decide that you are going to serve the people as a chiropractor for as long as you can remember their names and have the strength to accurately move the bone. If you make this decision, you will have more love, joy and peace in your life than you could ever imagine.

Changing Your Vision

Here are some of the benefits that you will experience if you change your vision for your chiropractic career to that of service to others over the long run:

• You will lessen the short-term pressure on your life. This will allow you to keep your priorities straight, which is putting family before practice and God before family.
• Patients will recognize that you are there to serve them. If you make them your number one priority they will thank you by following through on your recommendations.
• Your patients will stay long enough to get the results that they came for. This will exponentially raise the level of their experience in your practice and will increase your personal satisfaction in practice.
• Your patients will refer their family members. You will be able to serve families in a lifetime wellness model.
• Your patients will refer their friends. You will finally have that referral practice of which you always dreamed.
• Your patients will pay you a fair fee for your adjustments. You will be able to eliminate the insurance companies before they eliminate you, and have a cash practice.
• You will attract a great team, because people want to work for an organization that has a purpose beyond the bottom line. They, too, want to make a difference in people's lives.
• You will have much less stress, because a referral practice is much less stressful then a marketing practice.
• You will remain significant and become more and more valuable as you get older because of your experience and expertise.
• You will achieve much higher service goals, because we always underestimate how much we can get done in the long term and overestimate how much we can do in the short term.
• You don't have to worry about financing your retirement, because when your friends are retiring and dying you will be entering into the most productive and profitable years of your career.

SUMMARY

As you progress in your career during the decades ahead, you will be able to attract, train and mentor young doctors to work alongside you. This will allow you to focus on the things in practice that you really love to do and delegate everything else.

1. When you go to sleep at night, you will have peace.
2. You will have the resources, both human and monetary, to take time away from the practice to renew and rejuvenate your life.
3. Your practice will carry on after you are gone, and your life will leave a legacy of service for future generations to model.

The above are just a few of the benefits of changing your vision. I could keep going but I think you get the point. Only you can decide which way you want to go. A shift in vision sounds simple but it will not be easy. It will require a willingness to change as well as stepping into fear, but in my opinion it's the most important thing that you could do. The stakes are high - your life depends on it!

warrior coaching