CT Chiropractors "Say No" To Drugs

George B. Curry DC, DACS,FICA,LCP(hon)
Chairman CCC
ICA Northeast Regional Director
Private practice Windsor, CT 28 years

A recent Internet poll utilizing Survey Monkey ^TM, sponsored by the Connecticut Chiropractic Council revealed that 82.5% of the respondents indicated that they are against the expansion of Chiropractic in CT to allow prescription drugs, 8.8% were in favor and 8.6% were not sure. 

"The issue of practice scope expansion to include pharmaceuticals” has created a firestorm of controversy and I'm happy to see that the majority of our respondents want to keep Chiropractic a "drug-free profession" commented Dr. George Curry the CCC chairman of the board.

The sixteen question survey was sent to 300 licensed CT Chiropractors as part of the online poll.

FSCO Denounces ACC's Use of the Term "Chiropractic Medicine."

On February 24, 2011, Shane Walker, D.C., President of the Federation of Straight Chiropractors and Organizations (FSCO) sent the following letter to Frank Nicchi, DC, President of the Association of Chiropractic Colleges (ACC) and the other ACC Officers and Directors, as well as to the presidents
of all US chiropractic colleges.
Dear Dr. Nicci,
It has come to our attention that the Association of Chiropractic Colleges (ACC) has adopted and begun to promote the term "chiropractic medicine" within their programming.  Most notably, this term has appeared in announcement of an ACC program titled, "Integration of Chiropractic Medicine in the Workers' Compensation Industry."
As the ACC is presumably a representative affiliation of chiropractic colleges, we at the Federation of Straight Chiropractors and Organizations (FSCO) object to the ACC's utilization of terminology which has been flatly rejected by the majority of the chiropractic profession.  We note that there has been a covert movement by a small but vocal minority within the profession who have actively pursued the expansion of accepted chiropractic practice to include medical modalities and procedures associated with the promotion of the term, "chiropractic medicine."  It would appear that adoption by the ACC would serve as an attempt to infiltrate the academic community within the profession with expansive terminology that will increase the scope of chiropractic into an infringement on the practices of medicine by fiat.  We do not believe that the intent, purpose or direction of the ACC should be in the pursuit of expansion of scope.
The term "medicine" is not permissible in most, if not all states and jurisdictions as part of a chiropractic practice designation.  As the principles and tenets of chiropractic are antithetical to the practice of medicine, the term chiropractic medicine is an oxymoron and, at best, inappropriate and deceiving to the public.  The FSCO encourages the leadership of the ACC to act in proper accord with the majority in the chiropractic profession and not to serve as a vehicle for the dilution or destruction of the founding principles of our unique profession.

We will be in communication with the administrations of the ACC affiliated schools and seek to clarify their position in regard to this issue in the interest of professional conformity in the educational process.

The FSCO will remain vigilant in protecting and preserving chiropractic from all infringements so that it will be available for the benefit of this and future generations.
Respectfully submitted,

Shane Walker, D.C.,

President of the FSCO

Ligament Hysteresis, Creep, Recovery and Plastic Deformation

Don Meyer, DC

Private Practice Huntington Beach, CA

President Circular Traction Supply

CBP Instructor

INTRODUCTION

Structural/postural corrective based Chiropractors endeavor to return the abnormal spine back towards an accepted normal via the physiological process of ligamentous re-modeling. Ligamentous re-modeling is based on the fact that the resting length of a ligament can be altered by the application of a structurally specific traction or exercise. But how does this process really work?

In this article, I will discuss four main viscoelastic properties of spinal ligaments and their importance in the therapeutic rehabilitation of human spinal structure and global posture.

Visco-elastic Properties of Ligaments

The general response of ligaments to a traction load or a repetitive structural/postural corrective exercise is influenced by several phenomena which are time-dependent, such as hysteresis, creep, recovery and plastic deformation.

• Hysteresis

Ligamentous hysteresis is defined as the energy lost (as heat) within the tissue between loading and unloading. When the ligament is stimulated repetitively with constant peak load, hysteresis develops and the ligament length limits increase with each cycle. Thus the repetitive use of the same force produces greater and greater ligamentous deformation (creep). This is why postural/structural corrective exercises work and should always be done first, before the patient is adjusted or has any traction performed. The exercises “heat-up” the ligaments, increase their length and reduce their internal tension. This “sets-up” the spine to better receive any corrective spinal manipulation or traction. Also, if you can increase the peak load during the patients corrective exercise session you will increase tissue hysteresis. The use of a device such as the Pro-Lordotic Neck Exerciser™ provides 20-50 pounds of force into the lower, middle and/or upper anterior neck structures while the patient performs their corrective neck extension exercises. See Figure 1.

It is important the peak force be delivered into the region of the spine that most needs re-modeling. If the patient has a lower cervical kyphosis, that is the region that should receive most of the structural corrective exercise.

Figure 1. Pro-Lordotic Neck Exercise.

• Ligament Creep

Ligament creep is defined as the time dependent elongation of a ligament when subjected to a constant stress. Ligament creep is not linear in nature. Most of the ligament elongation occurs during the first 15-20 minutes of a traction load. This is why at least 10-20 minutes of structural corrective traction is usual recommended. But how long does is take the ligament to recover from the elongating force and return to its original length?

In a human in vivo study, following 20 minutes of deep flexion, a 25-minute rest period was required in order to achieve 50% recovery and a 50-minute rest period was required to achieve 70% recovery from the resulting creep.¹ Recent evidence demonstrate that both creep and tension-relaxation induced in 20-50 minutes of loading or stretching a ligament, respectively, demonstrated 40-60% recovery in the first hour of rest, whereas full recovery is a very slow process which may require 24-48 hours.¹ Also, hysteresis recovery following creep deformation was more prolonged and less complete in older subjects.² From these studies, we can see that performing corrective procedures on your patients (in-office) three times per week with 48 hours or more between sessions will not be very successful if the patient is not also performing some type of ligamentous rehabilitation at home on a daily basis. Having them re-stretch the soft tissues in-between the in-office therapy sessions with postural/structural corrective exercises and devices like the Pro-Lordotic Neck Exerciser™, the Cervical Remodeling Collar™ (Figure 2.) and/or a Denneroll™ (Figure 3.) are essential for a good structural corrective outcome.

Figure 2. Cervical Remodeling Collar.

Figure 3. Cervical Denneroll.

• Frequency or Time-History

Ligament behavior is also dependent on the frequency of load application and unloading or strain rate. Cyclic loading of a ligament with the same peak load, but at a higher frequency, results in larger creep development and longer time for the full recovery of the creep to occur.¹ So having your patient perform their corrective exercises in a slightly faster, but still controlled, manner is better than a slow methodical fashion.

• Temperature

Ligament length-tension (strain-stress) behavior is also temperature-dependent, exhibiting reduced capability and therefore increased deformation at higher temperatures.¹ The main point to understand from this statement is to not perform corrective procedures in a cold room or with a cold patient. It also re-iterates the importance of heating-up the tissues with exercise before other corrective procedures are performed.

Clinical Relevance

So a person could ask: How do you get the ligaments to stay elongated if they recover so quickly? This is accomplished by getting the ligament stretched out to a length that moves it out of its elastic capability and into its plastic (viscous) range. Plastic deformation of a ligament can occur all at once, such as in athletic injuries where an extremely large force is applied, or through what is called “repetitive overwhelm”. Repetitive overwhelm is when a sub-maximal physical stress is applied so often, that it causes a micro-failure of the ligamentous cross-links, resulting in permanent deformation of the ligament. The main factors that affect plastic deformation are the amount, duration and frequency of the applied force.³ In one reference involving the posterior cruciate ligament of the knee, it was found that “Slow stretching of the ligament results in elongation up to 30% before any plastic deformation”.⁴

CONCLUSION

Understanding ligament physiology is essential to achieving consistent positive changes in your patient’s posture and structure. This information presented above emphasizes the importance of giving the patient a “home rehab kit” that includes the Pro-Lordotic Neck Exerciser™ and some form of corrective home traction (Denneroll or Cervical Remodeling Collar).

I hope this information helps you improve your patient's corrective care and health outcomes.

References

1. Solomonow, M. Ligaments: A source of musculoskeletal disorders. Anatomy, physiology, pathophysiology review. Journal of Bodywork and Movement Therapies 2009 (13):136-154.

2. Twomey L, Taylor J. Flexion creep deformation and hysteresis in the lumbar vertebral column. Spine. 1982 Mar-Apr; 7(2):116-22.

3. Christensen, K. Plastic deformation and long-term support. Dynamic Chiropractic. December 15, 1999 (17).

Chow JCY. Advanced Arthroscopy. Springer-Verlag Publishing, New York, 2001: pg. 522.

Chiropractic United: “Bringing the Roots of Chiropractic Principle into Today’s Chiropractic Practice.”

Fred DiDomenico, DC

Practice Coach and Mentor

www.elitecoachingllc.com

&

Deed E. Harrison, DC

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

INTRODUCTION

Chiropractic was founded on the principle that the nervous system controls ALL functions of the body and spinal subluxations, individual of vertebrae out of place, impede nervous system function and can break down the body and cause disease. This is the TENET that early chiropractors risked their lives to teach. It was a segmental approach to full spine correction with B.J. Palmer leading the crusade using full spine pre and post x-rays.

Segmental Subluxation vs. Regional/Global Subluxation

After over a century of research and increased understanding of this TENET of a spinal subluxation, research now suggests that individual vertebrae do NOT readily subluxate as individual components---obviously there are exceptions to this statement (atlas laterality, retro's, spondy's, etc..). In contrast, when vertebra do displace, they subluxate within a displaced REGION of the spine or as groups of vertebra where one specific vertebra may have a greater displacement than the others.^1,2

This means a whole curve or sections of the spine is displaced and is generally understood using buckling theories from graduate level courses in mechanical engineering.^3-7 We now also know if one area of the spine displaces the WHOLE spine will adapt and displace to adapt to its environment, gravity. The REAL truth of spinal subluxation is REGIONS of the spine displace causing the brain to adapt the whole body structure to gravity displacing the rest of the spine to attempt to achieve balance. What does this mean? Thus, it is our perspective that nearly EVERY spinal problem is likely a FULL SPINE problem causing WHOLE spinal cord stress and strain weakening the WHOLE body? This statement is EXTENSIVELY documented in medical and chiropractic research, as well as supported in proven principles in engineering and laws of physics.

Two Questions for You to Consider

1. “With this knowledge, do you think B.J. Palmer would be treating patients the same way today as he did 50-70 years ago?”
2. “If the TRUTH of spinal function and subluxation is expanded today, do you think he would be correcting the spine and teaching the principle of chiropractic the same way?”

The answer to these questions is probably “NO!” If B.J. wouldn’t be doing the same thing decade after decade, then maybe today’s chiropractors should adapt their model, keeping the TRUTH of chiropractic principle alive today applied to the TRUTH of spinal function and dysfunction, subluxation, and how it relates to human health. Where do we find this TRUTH? This answer is www.chiropracticunited.com.

WWW.CHIROPRACTICUNITED.COM

Chiropractic United contains extensive and up-to-date research validating spinal function and subluxation and its affect on biomechanical function of the body, overall health, quality of life as well as life span. You may be SHOCKED to learn that with the history of medicine vs. chiropractic, many of the studies are MEDICAL research where these subluxation principles are validated. Yes, we are in the midst of a transformational evolution in the chiropractic profession. In fact, with all the intra-professional battles chiropractic creates, we ALL have the RESPONSIBILITY to know this information. Let’s begin with Chiropractors!

Purpose and Mission

The purpose and mission of www.chiropracticunited.com is to educate and unite subluxation-based chiropractors and arm them with the information and technical skill that will add power, credibility and TRUTH to the very principles that began this great profession.

Corrective care grounded Chiropractors need to teach their patients to know EVERY spinal problem is a FULL SPINE, OVERALL health problem in order to shift the consciousness of the general public toward spinal subluxation and health with consistency and predictability.

It is for these 2 intentions that CBP^® and Elite Coaching have come together to bring you systems to achieve these results in your practice; the research, clinical certainty achieving spinal correction from full and elevated patient commitment and retention living a chiropractic, optimal spine/optimal health lifestyle. These systems have been proven and will give you the ability to move your practice into today’s current model for the transformation of the profession now and into the future. If you are not keeping up with the times, you may be getting left behind.

In addition, tune in to www.ChiropracticUnited.com podcasts to hear Dr.’s Deed Harrison, Joe Ferrantelli and Fred DiDomenico interview the leading personalities in subluxation-based chiropractic, speak about philosophy, current issues in chiropractic politics, research and management tools that readily apply in your practice. It is the #1 and most downloaded podcast in the chiropractic profession today.

References

1. Harrison DE, Harrison DD, Troyanovich SJ. Three-Dimensional Spinal Coupling Mechanics. Part I: A Review of the Literature. J Manipulative Physiol Ther 1998;21(2): 101-113.
2. Harrison DE, Harrison DD, Troyanovich SJ. Three-Dimensional Spinal Coupling Mechanics. Part II: Implications for Chiropractic Theories and Practice. J Manipulative Physiol Ther 1998; 21(3): 177-86.
3. Gilmore R. Cartastrophe theory for scientists and engineers. New York, Dover Publoications, 1981.

4. Nightingale RW, Camacho DL, Armstrong, Robinette JJ, Myers BS. J Biomechanics 2000;33:191-197.

5. Nightingale RW, McElhaney JH, Richardson WJ, Myers BS. J Biomechanics 1996;29:307-318.

6. Nightingale et al. J Bone and Joint Surgery Am 1996;78-A:412-421.

1. Myers BS, Nightingale RW. J Crash Prevention and Injury Control 1999;1(1):67-82

Rehabilitation of Thoracic Hyper-Kyphosis: The Thoracic Denneroll

Deed E. Harrison, DC

President CBP Seminars, Inc.

Vice President CBP Non-Profit, Inc.

Chair PCCRP Guidelines

Editor—AJCC

&

Adrian Dennewald, DC

President / CEO Denneroll Industries

Private Practice of Chiropractic Sydney, Australia

INTRODUCTION

The thoracic spine as viewed from the side, should have a natural elliptical or ‘oval’-shaped curve; where slightly more curvature per segment occurs in the mid and upper thoracic segments.^1,2 Lifting injuries, falls, poor posture, de-conditioned supporting muscles of the trunk and lower extremity, and poor ergonomics all may contribute to abnormal increased thoracic kyphosis (hyper-kyphosis). Figures 1-4 depict abnormal types of thoracic kyphosis and the proposed elliptical shape that should be present (Figure 5.)

In the past decade, research into the detrimental effects of thoracic hyper-kyphosis on patient populations has become quite prolific.^3-14 In fact, studies have identified that hyper-kyphosis places a person at greater risk of adverse nerve, ligament, and muscle function. Ultimately, abnormal thoracic hyper-kyphosis has been found to contribute to a number of health related disorders including: lower self image, depression, lack of motivation, increased potential for back pain, injuries-falls, vertebral fracture, deformity progression, and even shortened life span.^3-14

While there has been increased awareness of and studies on proposed effective treatments for thoracic hyper-kyphosis, these studies are based on small case series and trials with few reporting long-term results.⁶ Of the proposed interventions for rehabilitation of thoracic hyper-kyphosis, only spinal extension based exercise programs and spinal corrective orthoses have been found to have a corrective effect aimed at reducing curve magnitude. ^6,15

THORACIC DENNEROLL

Due to the paucity of existing methods to effectively improve thoracic hyper-kyphosis and the general lack of a simple but effective home-based corrective orthotic, my colleague (Adrian Dennewald, DC) and I, sought to develop such a spinal orthotic. The idea was to design a unique spinal orthotic to be used with the patient in a supine position where lying over the apex of such device would provide a tolerable but effective stretch that assists in the correction of abnormal thoracic hyper-kyphosis (Figures 6-8 below).

The main features of this Denneroll Thoracic Orthotic as seen in Figure 9 include:

· Contoured thoracic elliptical shape based on the CBP evidence based Elliptical model.^1,2 This shape provides stability and effective passive forces specific to the thoracic spine.

· The denneroll’s fulcrum peak located at the top of the orthotic creates localized 2-4 segment extension specificity at the proximity of the fulcrum peak.

· The width is designed to allow stability whilst not impacting the scapula.

· Tolerable and impactful spinal extension moment-bending- and slightly compressible peak for patient tolerance with a firm base for support so the unit will not collapse or tilt to maximize the effects.

· Note that changing the apex of the thoracic spine segmental contact with the peak of the thoracic denneroll allows customized fit to the individual patient’s needs and their spinal abnormality.

· Ultra light weight, extremely portable, effective, and user friendly.

· Cost effective!

Figure 9. Thoracic denneroll sitting centered on top of the thoracic support block. The taper of the denneroll and design was cut from the CBP evidence based thoracic kyphosis elliptical model.^1,2

The Recommended Types of Patient Cases and Spine Presentation for Denneroll Orthotic Application:

· Hyper-kyphosis with or without posterior thoracic translation relative to the pelvis;

· Allows for specificity in correcting an increased lower, mid, or upper thoracic kyphosis;

· Anterior head posture greater than 25mm (approximately);

· Rounded-protracted shoulder girdle and scapular region. The size of the denneroll allows for support while simultaneously being narrow enough to allow the scapula to retract over the unit;

· The addition of different sizes of the support block under the thoracic denneroll allow correction of internal flexion-extension of the ribcage while simultaneously reducing kyphosis.

DENNEROLL PLACEMENT

There are three primary types of thoracic corrective setups appropriate for thoracic denneroll application:

1. Lower thoracic,

2. Mid-Thoracic, and

3. Upper-Thoracic..

However, in each of these three spinal placement categories there exists the possible need for both a translation component of the whole ribcage as well as a mild flexion-extension component of the top of the curve relative to the bottom of the curve. Review Figures 1-4 for identifying that the thoracic kyphosis can exist with the top of the ribcage 'flexed' relative to the bottom of the ribcage; alternatively, it can exist with the top of the ribcage extended relative to the bottom of the ribcage. See Figures 10-13 below for detailed setup alterations using various sizes of translation support blocks underneath the thoracic denneroll.

Only a radiographic and postural analysis can determine which denneroll placement is right for the individual patient. The denneroll device should only be used on a firm surface such as the floor, or a bench so that an effective stretch can be applied to the thoracic tissues.

Figure 10. Thoracic denneroll turned around so the peak contacts the lower thoracic spine (T10) while the tapered end supports the mid thoracic region. This setup is for hyper-kyphosis in the T9-T12 region with upper thoracic flexion relative to the lower.

Figure 11. Thoracic denneroll placed in the mid thoracic spine (T6-T7). This setup is for mid-thoracic hyper-kyphosis with T1-anterior to T12—or upper thoracic flexion relative to the lowers.

Figure 12. Thoracic denneroll sitting centered on top of the small 20mm block in the Thoracic Support Block System. This setup assist correction of mild posterior thoracic translation postures with upper thoracic kyphosis and anterior head translation.

Figure 13. Thoracic denneroll sitting centered on top of the Thoracic Support Block. This setup assist correction of moderate-severe posterior thoracic translation postures with upper thoracic hyper-kyphosis and anterior head translation. This is for deformities where the T1 vertebra is posterior to T12.

SUMMARY

In future articles, my colleagues and I will report on selective case studies where the effectiveness of the thoracic denneroll is shown in properly selected and managed patient cases. Also, formal clinical trials into the effect of the denneroll on hyper-kyphosis and patient outcomes is planned; these results will be reported as they are completed.

References

1. Harrison DE, Janik TJ, Harrison DD, Cailliet R, Harmon S. Can the Thoracic Kyphosis be Modeled with a Simple Geometric Shape? The Results of Circular and Elliptical Modeling in 80 Asymptomatic Subjects. J Spinal Disord Tech 2002; 15(3): 213-220.
2. Harrison DD, Harrison DE, Janik TJ, Cailliet R, Haas JW. Do Alterations in Vertebral and Disc Dimensions Affect an Elliptical Model of the Thoracic Kyphosis? Spine 2003;463-469.

3. Katzman WB, et al. Age-related hyperkyphosis, independent of spinal osteoporosis, is associated with impaired mobility in older community-dwelling women. Osteo Int 2011 Jan;22(1):85-90.

4. Katzman WB, et al. Increasing kyphosis predicts worsening mobility in older community-dwelling women: a prospective cohort study. J Am Geriatr Soc. 2011 Jan;59(1):96-100.

5. Kasukawa Y, et al. Relationships between falls, spinal curvature, spinal mobility and back extensor strength in elderly people. J Bone Miner Metab 2010;28(1):82-7.

1. Kado DM. The rehabilitation of hyperkyphotic posture in the elderly. Eur J Phys Rehabil Med 2009;45(4):583-593.
2. Peetcharaporn M, et al. The relationship between thoracic hyperkyphosis and the Scoliosis Research Society outcomes instrument. Spine. 2007 Sep 15;32(20):2226-31.
3. Kado DM, et al. Hyperkyphotic posture and risk of injurious falls in older persons: the Rancho Bernardo Study. J Gerontol A Biol Sci Med Sci 2007;62(6):652-657.
4. Huang MH, et al. Hyperkyphotic posture and risk of future osteoporotic fractures: the Rancho Bernardo study. J Bone Miner Res 2006;21(3):419-423.
5. Kado DM, et al. Hyperkyphotic posture and poor physical functional ability in older community-dwelling men and women: the Rancho Bernardo study. J Gerontol A Biol Sci Med Sci 2005;60(5):633-637.
6. Mika A, et al. Differences in thoracic kyphosis and in back muscle strength in women with bone loss due to osteoporosis. Spine 2005;30(2):241-246.
7. Miyakoshi N, et al. Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporosis Int 2003;14(12):1007-1012.
8. Keller TS, Colloca CJ, Harrison DE, Harrison DD, Janik TJ. Prediction of Osteoporotic Spinal Deformity. Spine 2003; 28(5): 455-462.
9. Kado DM, et al. Hyperkyphosis predicts mortality independent of vertebral osteoporosis in older women. Ann Intern Med. 2009 May 19; 150(10): 681–687.
10. Katzman WB. Changes in Flexed Posture, Musculoskeletal Impairments, and Physical Performance After Group Exercise in Community-Dwelling Older Women. Arch Phys Med Rehabil 2007;88:192

The Works Not Done!

Randall Hammett, DC

INTRODUCTION

At a recent family gathering at my home, some nephews and nieces were playing around the house, one of them brought me a paper--I wish you could have seen it. It was written by an 11 year old girl. On the top of the paper, it read Medical Form, then first name, last name, reason: it said my thought is that I can’t talk because I have a cold. Time in and time out, doctors recommended medicine for head and neck aches is Advil. Then it said healthy or not healthy and next to it said okay.

The Prescription

Now I wish I could’ve shown you this 2x4 piece of paper because it was written out like a prescription. This 11-year-old's mother and father are not doctors, and when I asked her what this was about, she said that this is what doctors do when you have a cold, they write down which route to follow with your name. Then, they give you some pills that make you feel better and this is how it looks when it is written out and given to you!

The Real Fight

You see with all the battling from within and without of chiropractic a lot of us begin to lose sight of what BJ Palmer DC said so many years ago. That we are all born into a medical medicine bottle and we all learn from seeing what others do and how they react when it comes to healthcare. The mission of chiropractic is much more than removing subluxation; although that is a major job. The real fight with the chiropractic profession and the world is to educate our public on what they thought they have been educated on. The powers of the control of media, the public idea and what healthcare is, this is now stronger than the one BJ Palmer lived in.

Even with our own profession there are those who think that we need to prescribe drugs to help the body heal itself. I know for me it is getting harder and harder after 30 years of private practice to continually try to reeducate patients about the truth and facts of health and what they can do to sustain it. But, it is a fight worth fighting for, even if you have just saved one life, extended one life, and prevented future disease and systems from affects of drugs and surgery. Then you can call yourself a chiropractic excavation point.

The Danger

All the therapies, medication, and surgeries in the world do not get people well. If you really want to help someone in your community and the world you have to go about it in a different way. In my 30 years of practice I’ve seen the chiropractic profession become more conservative over time, more leery of examining boards, attorneys and the public opinion. The chiropractic profession has spent the last 50 years trying to make itself respectable in the eyes of the medical community and the public. This is an admirable goal, but is fraught with danger.

The danger is losing the identity of chiropractic and the promise that it holds to help the sick and the dying world. If history teaches us anything, it is the radicals, the dreamers and the ones who step outside the box and into the parameters of chiropractic that will tell the world what we really do and how we do it. If this profession is to survive and to thrive it must become united, it must have a basic understanding and agreement of what chiropractic is and is not. It must be written into law and enforced by legislative bodies to hold the chiropractic profession accountable for its own rules. There always will be those within the profession that will do odd things, especially in times of financial or economic chaos.

SUMMARY

The chiropractic profession has survived by telling the truth about healthcare, by working outside of the medical mainstream of third-party insurance interference, and unethical chiropractors whose review from insurance companies only allows eight visits to correct a retro lordotic cervical spine. It is a balance that you must tread each day, but understand in the end it is your patient that holds you accountable and not the insurance industry, the medical profession and not even your peers. It is your patients and their understanding of what you do and why you do it, what’s in it for them and this ultimately, controls their destiny and that of our profession.

So, the next adjustment you perform, the next life that you enhance or that you save may very well be your own, and that of your profession. Till next time.

Motivation or Business Systems?

Vince Covino

Legacy Consulting

Boise, ID

vince@SuccedwithLegacy.com

Mr. Vince Covino is a Chiropractic Consultant with Legacy Consulting, they currently work with 200 doctors in 37 states creating personal and financial success. Note: Investment advisory services provided by Prospera Financial Services, Inc. an SEC registered investment advisor.

INTRODUCTION

The majority of chiropractors have at one time or another attended a chiropractic seminar, but have never attended business seminars that are frequently held for dentists or physicians. At these events, no one is preaching to fill more cavities, nor will you hear anyone ranting on the need to perform more root canals. Instead you would hear detailed advice on how to develop an efficient and effective business model by thinking and acting like a business owner. The sad irony is that most chiropractors would benefit more by attending business “boot camp” than just another traditional trade seminar.

If you have been to the variety of chiropractic conventions like I have, you've probably witnessed (at least once) a parade of overly-enthusiastic motivational coaches. The rally cry of such presentations is that you simply need to see more patients. Ostensibly saving more lives which requires putting in longer hours, in essence, work harder and you might make more money. In the end these “rocky moments” can be very inspirational, but the inspiration eventually tends to wane and soon dies out when faced with the rigors of the day leaving you to reflect, wondering why things haven’t improved the way the presenter passionately described.

Work Smarter not Harder

The fact is that working harder does not always equal better results. For example, you could put all the electricity you want to a lamp with a burned out bulb and not get any light. If the system itself is impaired, it may in fact take more and more energy to get the same results, or may even lead to diminished results. You have heard the old adage “work smarter not harder”, but what does that really mean? It’s a fact of life that unskilled labor generates less capital for the organization than skilled labor. Why is the person on the line paid less than the person running the organization? It’s not because she is expending anymore energy, it is because she knows how to use the energy proficiently in a systematized way, so that all the effort put into work at the end of the day actually creates the desired outcome. Granted this is basic, but when a system (or office) is poorly organized, more labor has to be invested and more energy consumed just to sustain it. The outcome in this scenario is frequently organizational inefficiency and decline.

Motivation vs. Business Systems

Not recognizing the need for office systems, many chiropractors find themselves perpetually trying to motivate their staff. As you well know, this effort is seldom effective and short lived at best. The obvious solution therefore, is to hire motivated staff, easier said than done I realize. Hiring self-motivated people into an office that has structure, accountability and measurement (key performance indicators) is the foundation for any successful practice. A motivated staff is then taught to work on recognizing duty prioritization within the workflow of your practice. These focused efforts allow staff to be effective in their roles and is in it-self a motivator as they see themselves accomplishing tasks on a daily basis. Real inspiration and motivation then result; both are essential to vibrant practice.

They know that empowering themselves to do better business, taking care of themselves and their families, actually frees them to not only offer the best service to their patients, but to do more good for the wellness of their communities.

SUMMARY

Chiropractors can take a page from dentists, doctors and other professionals that embrace solid practice management techniques. Health comes from strength, and strength comes from empowerment of knowledge. The smarter you organize your practice business systems, the more effective you and your office will be in helping the people in your community. Most Chiropractors I know are not “all about the money”, but remember, that profit does matter.

How Much Money Should You Make?

Eric Huntington, DC

Co-Owner Developer of the Chiropractic Business Academy

drhuntington@chirobizacademy.com

INTRODUCTION

How much money should a chiropractor earn? I get asked this question fairly often and in speaking to chiropractors from all over N. America, I realized that there are some basic misunderstandings which can lead chiropractors into confusion on this topic.

The answer sorts out fairly easily once you realize that it is vital to further clarify the question. A “chiropractor” is, of course, someone who has a DC degree—and we probably can assume that if the chiropractor refers to him as a chiropractor, that they have some involvement with the profession. For the purpose of this discussion, that eliminates those people who have a DC degree but work in a completely different field.

DISCUSSION

Within the field of chiropractic, there are those who work outside of private practice, but inside the profession. This would include chiropractic college staff, researchers, and those that own or are employed by companies that supplement chiropractic practice—such as insurance carriers, consulting companies, and chiropractic supply companies. The income of these doctors can vary widely, depending on their position and relative success at what they do. This group comprises a relatively small percentage of chiropractors and so the rest of this article will focus on those chiropractors that are associated with private practice.

The typical categories that most of us consider regarding chiropractors in private practice are “owners” and “associate doctors”. There is naturally a significant divide in the income of owners versus associates for the simple fact that an owner carries the typical risks and responsibilities inherent to running a business. In the end, everyone else can jump ship, except the owner. It’s simply the concept of risk versus reward which drives the income difference.

Amongst owners of chiropractic clinics, there is a very wide range of incomes. This is because some chiropractors choose to wear all (or almost all) the hats in a clinic whereas others delegate duties to staff.

The Chiropractic Executive works on his practice(s) and not in his practice(s). His time is spent developing and improving the clinic(s) which allows for greater expansion and greater income. He is very skilled in administration and the handling of people. For these reasons, the Chiropractic Executive is generally the highest paid of all DCs.

The owner who works in his clinic and has an associate, is often the next highest paid of all chiropractors. This is because there are so many other income generating hats in a chiropractic clinic which need to be worn effectively in order for the clinic to be very profitable. By having an associate, the owner can concentrate on these other key income generating actions such as marketing or report of findings. Those that are able to pass the treating doctor hat and help their associate become successful can be greatly rewarded with time and money.

The next highest income earner is generally the owner chiropractor who wears the doctor hat in the clinic. This is the most common scenario in our profession. Because treating patients is very time consuming, it limits the owner’s ability to grow his income beyond a certain point. This problem has led chiropractors to all sorts of odd solutions—such as doing everything themselves, only accepting cash, unusual insurance billing strategies, limiting patient services to the very minimum, or whatever other time or money saving solution can be imagined. These solutions in and of themselves may not be wrong, but when they are only done because the owner doctor can’t figure out a better solution, they can becomes problematic.

The first tier associate income is generally the doctor who not only treats the patients but also manages the clinic. This is often a satellite location or small operation. This associate usually takes on all the typical responsibilities of running an office, outside of finance and future planning. I see this arrangement more often, but not exclusively, in personal injury or work comp practices. Often, the owner has the relationships with lawyers and simply needs someone else to run each of several locations. The extra income enjoyed by this associate is earned from the managerial responsibilities—and maybe the fact that he has to deal with the typical hassles of some personal injury or work comp cases.

The next level for associate doctors is the “practice builder”. This is the associate who is able to not only treat the patients, but also to generate a flow of new patients into the practice that supports the day to day volume of the clinic. This can be highly desirable to the owner, but also can be highly unstable as this type of associate often decides to leave an open his own clinic.

The next category of associate pay is the doctor who is responsible for patient treatment only. Someone else handles all other aspects of the practice. This is the dream job for most chiropractors, since the vast majority of us go to school because we want to take care of people--and for the typical doctor, that means hands-on care.

The key factor in determining your future is to decide what you want to have. This means everything from how you spend your days, to how much money you make, to the amount of responsibility for others you’d like to shoulder. Deciding what you want to have now, and in the future is the first step.

Next, you’d have to decide what actions you would need to do in order to obtain whatever it is that you’d like to have. This would mean determining the actual activities, when done would eventually lead to those things you want to have. For example, if you want to have several clinics, then you will need to do the actions necessary to achieve it. Most likely, being pinned down at the adjusting table is not the actions that will lead to owning several clinics, as an example.

Lastly, you should choose which of the chiropractor hats described above that you need to be in order to do what you need to do the necessary actions, so you can achieve what you want to have.

For example, if you decide you want to have a million dollars a year of income and go on vacation for one week every month, then you probably can’t be an associate or be the owner of your practice and also treat all the patients.

However, if what you want to have is lots of patients to treat daily, a good income that allows you to support a family, and a place to go to work every day, then you can probably be an owner or associate who treats all the patients.

What you want is exactly right because it’s right for you! The only mistake you can make is wanting to have something, but not doing what you need to do, or being what you need to be, in order to get what you want. Get that all sorted out and you’ll do just fine.

SUMMARY

Every day at the Chiropractic Business Academy, we help doctors sort this out and get them on the path to achieving their goals. In fact, the material in this article is from one of the courses we teach to our clients.

If you’d like more information on these concepts, or help of any kind with your practice, call-- we are here to help you!

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

888-989-0855 or online at www.ChiroBizAcademy.com

Transforming Your Patient’s Perspective From Pain to Posture into Organs and Overall Health on Day #1 PREDICTIBLY!

Fred DiDomenico, DC

Practice Coach and Mentor

www.elitecoachingllc.com

INTRODUCTION

As spinal corrective doctors we become so focused on correcting spinal structure and restoring curves we can forget what matters most to the patient, the progressive, even rapid degeneration of their health from a weakened posture. Our responsibility is NOT to correct their spine. Our responsibility is to teach them how a strong spinal structure and optimal curves leads to an optimally functioning body with the system to attain health for life! This purpose is NOT related to pain or how they “feel,” which is very temporary. Correcting their spinal structure is merely the first step in this process. Many patients quit during their program or when they complete corrective care because you may have not created a long term vision for them past spinal correction. We can transform their perception of spinal function as the foundation of the core strength and health of their body along with the desire to have optimal health for life immediately on Day #1, PREDICTIBLY!

The 4 Step Consultation originating in Elite Coaching IS that immediate shift from pain into posture and organs. DO this and you will see amazing transformations in your patients.

• Step #1: Finding Organ Problems.

After you address their pain area, you also say, “Postural distortions also weaken the nerves to organs in that area causing…..” Give 3 health problems for each organ related to that area of the body. Repeat this statement with each organ as you move through the body. If they ask why you are asking about organ problems when they may believe they are there for pain, you respond from the scripts in the Pre-Consultation (not covered in this article), “Remember, when one area of the spine shifts from its normal position it weakens the rest of the structure of your spine and distorts your overall posture. Did you know many causes of back pain DIDN’T originate in your low back? If your problem began in another area of your spine would that be important for me to know where it began for me to get directly to the cause of your problem?” This will bring them into agreement. You may add, “Did you know that many postural distortions don’t cause any pain, so we are using organ problems to discover where your posture and nervous system may be weak.” This will transform their perspective toward the cause of their problem. These facts are truth when you learn postural coupling patterns in CBP.

Reframe the organ symptoms

Reframing is changing the meaning of each health condition, especially since ALL patients minimize their conditions. For example, if they say, “I had allergies as a kid and now they are gone.” Your reframe may be, “It may be your cervical spine never developed normally as a child weakening your immune system, if you had allergies. Many back problems are a result of long standing neck problems regardless if you had neck pain. Now your whole spine may be weakening since you are now having low back pain.” This is also an opportunity to get a referral. You can say, “I see on your forms you have a child. Do they have allergies? It may be they are developing the same spinal problems as you. We can check them on your next visit.” You can build your practice with your systems getting many referrals.

Another example of reframing is when you discover a patient complains of fatigue for the last 3 years. You also discover they were in a car accident 4 years ago. You say, “You injured your spine in the accident and your metabolism and energy has been progressively weakening since that time.” When they agree they are admitting more problems than they expected. With every organ problem you can reframe to show the correlation between posture and their overall health. When you have completed this step their focus will shift toward their health rather than their pain.

• Step #2: Review symptoms

In this step, connect the health problems to the spine and speak in a tone that sounds like an extensive grocery list of health problems using the language of the reframes from Step #1. For example, “You came in with back pain and we discovered the nerves in your low back are weakening your bladder because you’re having recurrent bladder infections. You damaged your spine and posture in your neck in that accident 4 years ago because you’re experiencing fatigue and a weakened immune system with recurrent colds and flus.” Listing the health problems and clarifying the effect of their spine on their health will create an immediate shift in their thinking. Do this for ALL the health conditions.

• Step #3: Impression

The list of health problems in Steps #1 & 2 are like pieces to a puzzle. When you put all the pieces of the puzzle together they make a picture, your overall impression of their health. You must give a FULL spine/OVERALL health impression and they MUST agree with your impression. You may say something like, “You injured your neck in that accident 4 years ago and you now have organ problems related to ALL areas of your spine. It looks like you’ve weakened your WHOLE spine and now your overall health is breaking down.” You can say, “You originally came in with back pain and we discovered you have pain in every area of your spine and 15 different health problems at 35 years of age. That’s the health profile of someone at least 10 years older than you. How do you feel about that?” They will say something like, “I know, I feel like an old woman sometimes.”

When they agree with your impression you have just shifted their perspective from pain into posture and organs. They now become more concerned with their health rather than their pain.

• Step #4: Get them to a “Yes.”

You want to bring them into agreement for the next step, the exam. You may have offered them a complimentary consultation and they now have to pay for the exam and x-rays. Either way, getting them to say “yes” to the next step begins to release their barriers and objections. When they give you permission they will become more willing and open to listening. This step consists of one sentence, “Do you want to find out what’s causing this?” This is a crucial “yes.”

Master this 4 Step Consultation and you will see incredible changes in the perspectives, commitment and follow through with your patients who will pay you for something MUCH bigger than back pain, their overall health. This is the principle Chiropractic was founded on. The general public just hasn’t been taught. Now there is a system that can teach your patients the truth of spinal correction and health.

You can receive training on the Day #1 procedures and this 4 Step Consultation to master these perspective shifts in your communication systems at Elite Coaching boot camps, www.chiropracticunited.com, Quarterly seminars and more. Please visit www.elitecoachingllc.com or call Dr. Fred DiDomenico personally at 253-851-8353 to answer any questions. Your patients’ health is waiting.

At the 33nd CBP® Annual

 

September 23-25, 2011 in Phoenix, AZ

The 33^rd CBP Annual conference will be held at the historic Biltmore Resort/ Spa in Phoenix, AZ Sept 23-25, 2011. We are anticipating a great attendance this year and will ensure that this event will be “one of the finest conferences you’ve ever attended”. Here's a highlight of what will take place at this year's event:

• Several Outstanding Presenters & Topics
  • Dr. Deed Harrison, DC--Review the latest spine research that impacts corrective Chiropractic practices. CBP Technique case studies and new CBP Non-Profit research updates.
  • Dr. Chintan Desai, MD Radiologist-- 2 hours of Radiology CE Hours for CA and other states. Advances in X-Ray & MRI Technology to Better Determine Cervical Spine Injury: The Perspective of a Neuro-Radiologist Working with Corrective Care Chiropractors.
  • Dr. Billy DeMoss, DC-- Chiropractic principles meets Chiropractic science and art.
  • Dr. Sandy Haas, DC-- The model of the future is here: corrective chiropractic health and wellness practices incorporating spinal rehabilitation, nutrition, physical-functional rehabilitation, and more.
  • Dr. Joe Ferrantelli, DC-- Advances in technology that improves efficiency-accuracy of subluxation analysis. Get your I-pads ready!
  • Dr. Stu Currie, DC--Update on foot biomechanics, disorders, and identifying the need for custom foot orthotics.
• 3rd Annual CBP Golf Event

The 3rd annual CBP Golf event will be held Friday the 23rd at the Biltmore from 7:30am-Noon. Email Dr. Deed if attending (drdeed@idealspine.com). The scores will be tallied and the winner will be honored with a custom plaque. Each player will receive a sleeve of custom CBP Logo balls.

• Best Chiropractic T-Shirt Contest

New for this year will be the best Chiropractic T-shirt contest. Conference attendees enter by being present and wearing their chosen Chiropractic relevant T-shirt Friday night at the wine social hour from 6pm-7pm. Best T-shirt voted on by a panel will receive a complimentary gift valued at over $500.

• Catered Lunch, Social Hour, and Breakfast

As always, all attendees will be welcome at our wine social hour Friday evening from 6pm-7:30pm in the Biltmore lawn courtyard. A hosted lunch will be provided Saturday afternoon for all guests. And new for this year, a hosted breakfast will be offered on Saturday morning from 7:30am-8:30am.

• The 2011 CBP Chiropractor and Chiropractic Researcher of the Year Will be Announced

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

We hope to see you there.