Chiropractors Don’t Apply

Eric Huntington, DC

Co-Owner Developer of the Chiropractic Business Academy

drhuntington@chirobizacademy.com

INTRODUCTION

            Keys to Practice Success:  It may seem inconceivable that the majority of practice owners don’t know what I am about to tell you.  But this is probably true, as evidenced by the condition of most clinics.  At best, some practice owners may know pieces of this data but don’t apply it.  However, with just a little study, you could use it to flourish and prosper in practice.

Defintion of “Hat”:  The use of the word “hat” in this article means “the job duties assigned to a position in an organization including what that post is supposed to accomplish”.

• ·      The Owner Hat:

            When I refer to the “owner hat”, I am clearly differentiating it from what most practice owners do on a daily basis.  An owner may wear OTHER hats, such as the doctor hat, the ROF hat (sales), the Insurance hat, or any other hat within the organization.

            But the true owner hat in a chiropractic practice encompasses things such as goal setting, determining plans of action, handling legal and compliance issues (at least overseeing them), managing key staff (not all the staff), and Public Relations (not marketing)—among other things.

            Goal Setting: The owner determines where the organization is going, short-term and long-term.  This is a crucial and should be done on a regular basis.  However, most owners wear this hat for only a few months prior to opening the clinic and then drop it for the rest of their career.

            Prior to things such as the internet and devices such as cell phones, the chiropractor of yesteryear operating a slow practice, probably used the agonizing hours between patients to dream up the future—and ways to get there.  Today, it’s easy to fill that time text messaging friends, or surfing the net.  It’s important to recognize that there is a big difference between wishing one had more money or a better practice and actually determining goals and figuring out the best strategy to achieve them.

            Unknown to most, there are very effective tools you can use to define exactly what you want to achieve.  The Chiropractic Business Academy helps chiropractors apply these tools daily.

• ·      Determine the Purpose(s)

            There could be many reasons why you want to achieve your goal(s), or maybe there is just one.  That’s up to you.  But the main driving force behind most activities in life is the purpose.  It’s the reasons one is going for the goal(s). 

            The purpose behind ANY activity is SO IMPORTANT, that some practice building gurus have packed huge conference rooms offering ONLY one thing—helping chiropractors find or establish a purpose to practice.  Despite the fact that focusing exclusively on purpose is rather narrow in scope for a “practice building” seminar it nonetheless can achieve dramatic results.

            It’s so powerful that purpose alone, with hardly the application of any other administrative skill, has built some very large chiropractic practices.  Albeit, these practices that operate on purpose alone may lack other important components leading to doctor burnout, overworked staff, and low fees, the fact remains that purpose is near the top of the list when it comes to the driving force behind success.

            Defining the purpose(s) of the organization and its activities as well as figuring out ways to invigorating the staff with that purpose is part of the owner hat.

            The Chiropractic Business Academy helps chiropractors to establish, reestablish or further define their purpose so as to help unleash the fire which drives practice and personal success.

• ·      Making a Plan

            Once you have your goals clearly defined, backed up by YOUR reason for achieving them, the next step is to figure out the plans needed to achieve the goal(s).

            You may find it easiest to break up the plans by area of the organization, such as a plan for the marketing, a plan for improving patient care, a plan for improving your report of findings, a plan for training your staff, etc.  The key is to determine the general concept of what you want to accomplish and put it into word--, such as “establish a marketing campaign to bring in 10 new patients per week”.

            In most cases, you would have several of these plans all which will coordinate to bring your practice from where it is today, to where you would like it to be at some specific point in the future.

            As a practice grows, the owner would need to constantly update these plans, and determine new plans to continue the practice toward its goals.  Plans need to change for many reasons.  Some plans are completed—brought all the way to full execution. Other plans need to be altered because new situations arise.  Still other plans need to be dropped all together based on new data.

            Establishing and reworking plans is an ongoing process, at least monthly.  Monitoring the steps taken to carry out these plans should be a daily and weekly activity of an owner.

            The Chiropractic Business Academy helps practice owners establish the exact plans needed to achieve the goals set by that doctor.  In fact, one of the first actions CBA does with a new client is to sit down and interview them to find out EXACTLY what that doctor wants to achieve.  From the data gathered in that interview, we help the client determine the plans needed to achieve the overall goals.  Then we work with that client to develop an exhaustive, in-sequence series of steps needed to carry out the plans.

• ·      Accountability:

            Most importantly, we speak to our clients every week by phone specifically helping them through each step of the plan, ensuring that they take all necessary steps to achieve their goals!  Every Week, one on one!

            This is in addition to the monthly three- day workshops, chiropractic staff training programs, weekly webinars, our training center which is open 362 days per year, and over 30 courses we offer for practice owners and staff.

            We are so sure our program will increase your bottom line that we make that guarantee in our client service agreement.

            Call my office today to schedule a free consultation to learn the exact system we have used to help thousands of chiropractors over the last 15 years!

888-989-0855

            Put on your owner hat and make the needed changes today to create a better future!

CBP® NonProfit, Inc. Research Update

Check Out Our Research Reference List Online at: http://www.chiropracticbiophysics.tv/cbp-research/ 

Paul A. Oakley, M.Sc., DC

CBP Research & Instructor

Private Practice New Market, Ontario, Canada

            Chiropractic Biophysics Non-profit, Inc. is a 501(c)(3) nonprofit corporation dedicated to the advancement of chiropractic principles through scientific research. Dr. Don Harrison (deceased) and his second wife Dr. Deanne LJ Harrison (deceased) founded CBP research foundation in 1982; it was registered as CBP Non-Profit, Inc. in 1989 by Dr. Sang Harrison (Don’s 3rd and final life’s love). Through this organization Dr. Don and colleagues have published 140 peer-reviewed spine and Chiropractic research publications. Further, CBP Non-Profit, Inc. has funded many scholarships as well as donated chiropractic equipment to many chiropractic colleges; always trying to support chiropractic advancement and education. Dr. Don Harrison was the acting president of CBP Non-Profit, Inc. since 1982. Currently, Dr. Deed Harrison (Don’s son) is the President of CBP Non-Profit, Inc.

            Results of our studies have been published in prestigious research journals and presented at respected conferences around the world. Your (Chiropractic donations) support enables us to continue important research and gives you a voice in the course our studies take. Join today, either as a regular member or member of the President’s Circle. The result will be better chiropractic techniques, stronger chiropractic practices, and healthier chiropractic patients.

CBP® research consists of studies on a variety of CBP® technique related topics including:

1. Spine modeling studies evaluating ideal and average human alignment variables,
2. Spine biomechanics studies analyzing loads, stress, and strains,
3. Posture modeling studies,
4. Reliability of measurements and evaluation of patients (x-ray, posture),
5. Validity of the measurements and evaluation of patients,
6. Randomized trials evaluating technique outcomes
7. Non-randomized trials evaluating technique outcomes,
8. Case series studies evaluating technique outcomes,
9. Case studies evaluating technique outcomes,
10. Literature reviews and professional commentaries.

Foot Posture and Foot Orthoses -- The Lost Connection? Part I of II.

Dr. Ed Glaser, DPM

Dr. Glaser is the President and developer of Sole Supports orthotics.

INTRODUCTION

            Chiropractors rely on the study of human form and posture to determine deviations from normal and apply appropriate corrections to the underlying structure.  It is commonly accepted that departures from correct form, posture or structure, either through acute trauma or insidious degradation, affect function.  Muscles exert their pull and force more efficiently across joints and the human body is better able to counteract the effects of gravity and the ergonomics of our sedentary lifestyles, when the ideal postural balances are maintained.  This concept is illustrated by studies of the cervical spine which have demonstrated that changes in joint position and moment arms affects the moment generating capacities of muscles (1), and that posture has an effect of motion coupling(2).  There is a conservation of energy and an efficiency of function essential to the biomechanical workings of the human body. 

            When considering these concepts within the scope of current popular foot orthosis intervention strategies, the question arises as to why these concepts have not been applied to the foot to any significant degree.  Although clinicians may consider these concepts in their clinical evaluation, it seems that these ideas have lost traction when it comes to foot orthosis design and correctional model.  In many common models, emphasis is less on correcting foot posture that may have deteriorated and more about shifting tissue stresses and forces.  Although shifting tissue stresses may provide pain relief, it may be too narrowly focused and not provide the most complete preventative solution to the problem. 

 

DISCUSSION

            The Podiatric concept of basing a foot orthosis around the tenet of subtalar neutral has been called into question.  Investigations have demonstrated the lack of correlation of rear foot motion during gait to a valid measure of subtalar joint neutral position during weight bearing (3;4).  This underscores the fact that when considering orthotic intervention to affect dynamic function, the subtalar joint neutral position cannot be relied on to predict the corrected position.  In addition, the ability and degree to which a custom orthosis can even control rearfoot motion is debatable.  Davis et al showed that there are few differences between a custom and a semi-custom device in the ability to control the rearfoot (5) and that foot orthotic devices do not produce significant change in rearfoot-tibial coupling (6). 

            Measurements of the rearfoot to forefoot relationships in the static position have been the foundation for a clinical rationale.  Investigations into the assumptions behind these measurements have shown that the goniometric measurement of the forefoot to rearfoot relationship is unreliable regardless of clinical experience (7).  In addition, one study revealed that when comparing groups of doctors casting for foot orthotics  (inexperienced, experienced and “expert”) there is a 16.5 degree variation in the measurement of frontal plane forefoot to rearfoot angulation across the groups(8).  This relationship is the major determinant of arch height. When considering the degrees involved in the strategy of posting the rearfoot (i.e 4-10 degrees) this variability casts doubt on the practicality of rearfoot control with a posted orthosis.  Foot type analyses that involve primarily frontal plane static measures may have less to offer than more dynamic and robust analyses.  Clinical measures of static foot structure that have included subtalar range of motion and calcaneal eversion and inversion, have been shown to have poor interrater reliability(9) .  Moreover, these rearfoot measurements are poor predictors of dynamic rearfoot motion (10). 

            To review, if these static measurements are unreliable, and unrelated to the function of the patient’s foot in motion, then any skepticism on the part of the clinician regarding these types of foot posture measurements, is warranted.  However, abandoning the concept of foot posture altogether because the rearfoot measurements don’t correlate, does not help with the great incongruity that exists - we generally accept the concept of an ideal architecture to the rest of the human body, so why should this not apply to the foot?

SUMMARY

            In contrast to the clinical murkiness of the measurements discussed above, we do know that there are statistical differences in the biomechanical function between the planus and rectus foot. (11;11).  It is thought that changes in foot structure affect dynamic function (12) and foot morphology has been implicated in a variety of lower extremity overuse injuries (13;14).  A pronated foot posture is thought to be a factor in various pathologic conditions of the foot; for example the excessively pronated foot has been cited as a cause of limited dorsiflexion at the first metatarsophalangeal joint during gait (15;16).  Munteanu et al also postulated that people with pronated feet are more likely to exhibit limitation of dorsiflexion at the first MPJ during gait, and found that orthoses focusing on the forefoot to rearfoot relationship (Blake-style inverted) did not significantly change the range of motion (17). Could this be due to the focus of this type of intervention on subtalar rotation, rather than on restoring proper orientation or posture to the entire foot?

            Since the days of Merton Root, single axis position (subtalar “neutral position”) has been the goal of orthotic intervention.  It is clear the relationship of these measurements to the improvement of the human gait cycle is questionable. Part II of this article (January 2013, AJCC) will advance these topics presented herein.

Reference

10.  McPoil TG, Cornwall MW. The relationship between static lower extremity measurements and rearfoot motion during walking. J Orthop Sports Phys Ther 1996; 24(5):309-314.

11.  Song J, Hillstrom HJ, Secord D, Levitt J. Foot type biomechanics. comparison of planus and rectus foot types. J Am Podiatr Med Assoc 1996; 86(1):16-23.

12.  Cavanagh PR, Morag E, Boulton AJ, Young MJ, Deffner KT, Pammer SE. The relationship of static foot structure to dynamic foot function. J Biomech 1997; 30(3):243-250.

13.  Krivickas LS. Anatomical factors associated with overuse sports injuries. Sports Med 1997; 24(2):132-146.

14.  Yates B, White S. The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. Am J Sports Med 2004; 32(3):772-780.

15.  Roukis TS, Scherer PR, Anderson CF. Position of the first ray and motion of the first metatarsophalangeal joint. J Am Podiatr Med Assoc 1996; 86(11):538-546.

16.  Harradine PD, Bevan LS. The effect of rearfoot eversion on maximal hallux dorsiflexion. A preliminary study. J Am Podiatr Med Assoc 2000; 90(8):390-393.

17.  Munteanu SE, Bassed AD. Effect of foot posture and inverted foot orthoses on hallux dorsiflexion. J Am Podiatr Med Assoc 2006; 96(1):32-37.

Sub-occipital Headache

Dan Murphy, DC

Private Practice of Chiropractic;
Diplomate American Board of Chiropractic Orthopedist;
Faculty Life Chiropractic College West;
Vice President ICA 2003-2009;

ICA Chiropractor of the Year 2009

INTRODUCTION

            All headaches synapse in the Trigeminocervical Nucleus (1):

            The 4 suboccipital muscles are innervated by the posterior primary rami of the C1 nerve root (1):

 

            Three of the suboccipital muscles are directly and firmly attached to the spinal dura mater (2, 3, 4, 5, 6):

• ·      Rectus Capitis Posterior Major (C2 spinous process to the occiput)
• ·      Rectus Capitis Posterior Minor (posterior arch C1 to the occiput)
• ·      Obliquus Capitis Inferior (C2 spinous process to the transverse process of C1)

DISCUSSION

The apparent function of the attachment of the suboccipital muscles is to prevent the cervical spine Dura Mater from being mechanically irritated, injured or inflamed during spinal motions.

The cervical spinal Dura Mater is innervated with pain afferents (nociceptors) from the upper cervical spine nerve roots.

Upper cervical spine nerve root nociceptors synapse in the Trigeminocervical nucleus, and are therefore capable of initiating an electrical signal in the brain interpreted as being headache.

Mechanical dysfunctions of the upper cervical spine may compromise the ability of the suboccipital muscles to protect the Dura Mater from motion related stress, irritation, injury, and inflammation.

Whiplash extension injuries occur quickly, so that the suboccipital muscles do not have enough time to contract and pull the spinal Dura Mater to safety, resulting in injury and headache.

In chronic whiplash patients, injured suboccipital muscles may undergo atrophy and fatty infiltration, further compromising the ability of these muscles to protect the dura mater from irritation and inflammation during routine motions, resulting in headache (7).

DISCUSSION

Chronic upper neck postural stress and distortions that invoke contraction of the suboccipital muscles may cause chronic stress on the spinal dura mater, resulting in headache. This is particularly important in postural techniques, such as Chiropractic Biophysics.

Mechanical dysfunctions of the upper cervical spine may also irritate/inflame the spinal cord and its blood supply because the Dura Mater is attached to the vascular Pia Mater that surrounds the spinal cord (8).

There is biological plausibility for upper cervical spinal manipulation, occiput-atlas-axis chiropractic alignment, postural improvement, and suboccipital muscle myotherapy to be utilized in the cervicogenic headache patient.

References

1. Bogduk N; Anatomy and Physiology of Headache; Biomedicine and Pharmacotherapy; 1995, Vol. 49, No. 10, 435-445.
2. Hack G, Koritzer R, Robinson W, Hallgren R, Greenman P; Anatomic Relation Between the Rectus Capitis Posterior Minor and the Dura Matter; Spine; December 1, 1995; Vol. 20; No. 23; pp. 2484-2486.
3. Rutten HP, Szpak K, van Mameren H, Ten Holter J, deJong J; Letters: comment on Anatomic Relation Between the Rectus Capitis Posterior Minor and the Dura Matter; Spine, April 15, 1997; Vol. 22; No. 8; pp. 924-926.
4. Alix ME, Bates DK; A proposed etiology of cervicogenic headache: the neurophysiologic basis and anatomic relationship between the dura mater and the rectus posterior capitis minor muscle; Journal of Manipulative and Physiological Therapeutics; October 1999. Vol. 22; No. 8; pp. 534-539.
5. Nash L, Nicholson H, Lee ASJ, Johnson GM, Zhang M; Configuration of the Connective Tissue in the Posterior Atlanto-Occipital Interspace; Spine; Volume 30(12) June 15, 2005 pp. 1359-1366
6. Scal F, Marsili ES, Pontell ME; Anatomical Connection Between the Rectus Capitis Posterior Major and the Dura Mater; Spine; December 1, 2011; Vol. 36; No. 25, pp. E1612–E1614.
7. Hallgren RC, Greenman PE, Rechtien JJ; Atrophy of suboccipital muscles in patients with chronic pain: a pilot study; Journal of the American Osteopathic Association; 1994 Dec;94(12):1032-8.
8. White AA, Panjabi M; Clinical Biomechanics of the Spine; Second edition; Lippincott; Phildelphia; 1990.

CBP ® Online Gets a Facelift & New Doctor Referral Directory

 

            You asked for it, we did it. Recently, the Chiropractic BioPhysics' (CBP) website (www.idealspine.com) received a professional makeover. According to Dr. Deed Harrison, President / CEO of CBP, "Dr. Joe Ferrantelli and I knew the CBP website was in a sad state of affairs. Simply put, we did not keep up with the technology for web development in the past several years and the result was that our website's functionality and look did not match our internal image and new marketing identity. Thus, I consulted and hired a professional web design team, whose custom chiropractic web design offerings were outstanding. I hired MyChiroPractice™ (www.mychiropractice.com); the owners, Ardavan and Kevin Javid, created an outstanding new look, feel, and function for CBP online complete with new content and features."

• ·      The New Doctor Referral Directory

            In addition to the new CBP website design, MyChiroPractice created the new CBP Doctor / Patient referral directory. While this directory is still being developed, several of the features are currently live. CBP Chiropractors need to check their listings for accuracy to assist the process of debugging the content database. The criteria for listing on this new directory are as follows:

• ·      Only chiropractors who have attended a CBP seminar in the previous 5 years will be listed on this directory; thus any Chiropractor not attending a CBP seminar since 2007 will not be listed;
• ·     
• ·     

            A quick list of functionality options for the new directory at www.chiropracticbiophysics.tv/directory/ is shown in the figure. And here's the pointed description of how to use the database:

            Currently, new features are being developed daily and a list of items still to come include:

• ·     
• ·     

            Future content updates for www.idealspine.com will be ongoing. However, one the largest updates will occur, hopefully, by the time your reading this article: the new CBP product store for doctors will debut. Check www.idealspine.biz for this update.

Special Issue on Spinal Manipulation to Appear in the Journal of Electromyography and Kinesiology

Christopher J. Colloca, D.C.

CEO and Founder of Neuromechanical Innovations

            At the invitation of Moshe Solomonow, PhD, MD (Hon), Editor of The Journal of Electromyography and Kinesiology, three prominent individuals in the forefront of spinal manipulation research were selected to serve as Guest Editors for a Special Issue on Spinal Manipulation appearing in the October 2012 issue of the Journal. 

Guest Editors, Chris Colloca, DC, Joel Pickar, DC, PhD, and Malik Slosberg, DC, MSc were invited to compile related papers from the worldwide spinal manipulation field.  Dr. Colloca is a Graduate Student in the PhD Kinesiology Program at Arizona State University and is also the CEO and Founder of the medical device company, Neuromechanical Innovations that manufactures the Impulse Adjusting Instruments.  Dr. Pickar is a renowned neurophysiology researcher and Professor from the Palmer Center for Chiropractic Research who has received numerous Federal Grants for his work.  Dr. Slosberg is a noted postgraduate chiropractic lecturer from Life College of Chiropractic West.  Together, they formulated an outline for paper submissions based upon the following topics: The Basis for Spinal Manipulation; Epidemiology; Clinical Research; Kinesiological Research, and Neurophysiological Research.

Through their our own personal contacts within the research community and keyword searches of the Pubmed database using ‘spinal manipulation’ together with relevant categorical terms researchers and research groups who had published on these topics were identified.   Original and review paper submissions from thirty-one individuals representing twenty-five institutions who were identified as lead researchers or department heads and who were considered authorities within a given topic on spinal manipulation. Consistent with the professional diversity of spinal manipulation research, scientists with backgrounds in chiropractic, osteopathy, physical therapy, manipulative physiotherapy, and rehabilitative medicine were sought. In addition to these professional associations, submissions were sought from individuals within the disciplines of anatomy, biomechanics, biomedical sciences, education, epidemiology, engineering, kinesiology, medicine, neurology, and public health. Eighteen paper submissions were received. Manuscripts went through the Journal’s peer-review process ultimately yielding seventeen papers included in the special issue.

When asked about how this Special Issue came to be, Dr. Colloca said, “I first met Professor Solomonow at the International Society for the Study of the Lumbar Spine (ISSLS) conference in 1999 in Kona, Hawaii.  He won the Volvo award that year in Spinal Biomechanics for his work in ligamentomuscular reflexes, so I made it a point to reach out to him and introduce myself.  Over the years at conferences, I had the opportunity to chat with him and we published a paper in the JEK in 2008.  Ultimately invited him to speak at our International Spine Research (INSPIRE) Foundation symposium that we hold in Phoenix each year.  Dr. Solomonow spoke to our group twice and got to see first-hand the chiropractic research that our group was conducting.  The idea for a special issue on chiropractic research stemmed from these discussions.  Dr. Solomonow knew well of Dr. Pickar’s excellent work in neurophysiology and he felt Joel would be an perfect candidate to assist in reviewing the many papers as a Guest Editor for this issue.  Dr. Slosberg had also reached out to Professor Solomonow to discuss some research projects that he had an interest in and in seeing how well read Malik was made a natural fit for him to participate.  Dr. Solomonow will travel to Phoenix on October 27-28, 2012 for our 10^th INSPIRE Conference where together we will debut the Special Issue where full issue reprints will be distributed to attendees.  We are very fortunate to have this opportunity to showcase spinal manipulation research in such a prestigious international publication forum.”

Published by Elsevier, The Journal of Electromyography and Kinesiology is the primary source for outstanding original articles on the study of muscle contraction and human motion through combined mechanical and electrical detection techniques. As the official publication of The International Society of Electrophysiology and Kinesiology, the journal is dedicated to publishing the best work in all areas of electromyography and kinesiology, including: control of movement, muscle fatigue, muscle and nerve properties, joint biomechanics, electrical stimulation, motion analysis, sports and exercise, measures of human performance, and rehabilitation.

            To order a copy of the Special Issue on Spinal Manipulation, contact Elsevier at http://webshop.elsevier.com. For more information on the 10^th INSPIRE Conference in Phoenix October 27-28, 2012 visit www.helpinspire.org or call toll-free 888-294-4750.

October 2012 AJCC issue PDF now online!

The latest American Journal of Clinical Chiropractic is now online as interactive PDF.  Download now.

American Journal of Clinical Chiropractic

Download the full print version of July 2012 AJCC

Lumbar Spine Ergonomics Part 2: The 5 Key Contemporary Concepts

Paul A. Oakley, M.Sc., DC

CBP Research & Instructor

Private Practice New Market, Ontario, Canada

VIEW PRINT VERSION

INTRODUCTION

     Last issue we discussed the essential reasons for the understanding of contemporary ergonomics concepts and their potential contradictory effects on patient care – good ergonomic practices will aid in patient response to care - poor ergonomic practices will undeniably compromise patient outcomes. We have discussed the first two concepts, and now continue with concept 3 of 5.

3) Optimal Spinal Loading: Not too Much, Not too Little

     A common ergonomic misconception is that recommendations should be directed at minimizing tissue loading, however, this is not true.¹ For example, not typically considered stressful to the spine, sleeping for more than 8 hours at a time may indeed stress the spine.¹ This is due to the fact that the discs swell by imbibing fluid over night,² and since the discs function to transmit force, (rather than absorb force which is the function of the vertebral bodies)³ the column is subjected to increased stiffness and is at greater injury risk in the early morning.⁴ The fact is too much loading or too little loading is potentially injurious.  For this reason, “the challenge is to develop a wise break strategy to facilitate optimal tissue adaptation.”¹

Since most spinal injury occurs as an accumulation of micro-trauma as opposed to an isolated acute traumatic event,^5,6  regular ‘micro-breaks’ are recommended. This allows a continuously varying demand and subsequent migration of load on the low back tissues.¹ Standing up to answer the telephone while performing seated work is a good way to aid in varying the posture throughout the day.  Any posture adopted for prolonged periods may fatigue the tissues used to maintain that position.  When standing for long periods one can alternate the placement of a foot on top a footrest to reduce tension in the psoas and lumbar spine.⁷ See Figure 1.   

 

     The idea of an ideal sitting posture is a farce. This is because it would only be ideal for about 10 minutes¹ as sitting creeps the posterior ligamentous tissues (20 minutes of continuous sitting requires over 30 minutes of non-seated recovery time to regain the normal protective spine stiffness⁸). The ideal sitting posture is a variable one.^9,10  McGill (2002)¹ suggests three recommendations for prolonged sitting: 1) Use an ergonomic chair properly (i.e. vary the adjustable features regularly within sensible ranges); 2) Get out of the chair (i.e. rest breaks should involve opposite activities – Mirror Image Postures); 3) Perform an exercise routine during the workday (i.e. not first thing in the morning; not exercises that exert excessive spinal loads).

4. Reduce the Reaction Moment

The ‘reaction moment’ is the rotational force your body must generate to successfully perform a sagittal lift - the weight of the load (and upper limbs) would cause your torso to fall forward unless the back extensors offset this gravity-induced moment to allow the maintenance of an upright lift. The extensor activity within the low back causes compression of the spinal mechanism.¹¹ Excessive compression within the low back is detrimental especially during prolonged, or repeated tasks. Excessive loading of the low back due to reaction moments can occur during any activity where there is a demand for the body to resist a force that is a distance from the spine.

Reducing the reaction moment is the key to reduce spinal compression. This is accomplished by carrying the load closer to the body and/or reducing the weight of the load lifted. See Figure 2.

 

Fig. 2: Reduction of ‘reaction moment’ and therefore muscle work is accomplished by bending the arm to decrease distance of arm segments and load from spinal axis.

     A third method of reducing a reaction moment is to direct the transmissible vector through the low back. The ‘transmissible vector’ is likened to the former concept only applied to tasks such as pushing and pulling. It should be known that there is no specific muscle that has the primary function of producing torso torque, it is performed by co-contraction of all the torso muscles resulting in substantial spinal loads.¹ Thus, when performing tasks such as pushing and pulling on objects such as doors and vacuums, the pull/push should be directed so that it is in line with the low back.

5) Maintain Spine Stability

     McGill was the first to capture a ‘live’ segmental spinal buckling while viewing the spine of a power lifter during a lift.¹² This buckling is possible when either there were high forces in the global muscles and low forces in segmental muscles or when there are low forces in all muscles.¹³ This mechanism explains how one can injure themselves by performing ‘negligible’ lift such as picking up a pencil.⁵

     As expressed by McGill, “stiffness creates stability,” and symmetrical stiffness offers greater stability.¹ Thus, a slight abdominal co-contraction (5-10% max. vol. contraction) will ‘brace’ or stabilize the spine prior to a lift. This will prevent any tissue from bearing a surprise load.¹⁴ Spinal stability is also maintained by adopting symmetric postures, avoiding twisting action, and flexion postures. Symmetrical trunk postures also ensure greater available strength,¹⁵ enabling one to perform activities easier in symmetric postures.

     Lastly, the lumbar lordosis is essential in maintaining spinal stiffness – keeping it dynamically (lifting) and having it statically (standing) – any chiropractic treatment neglecting the correction of lumbar lordosis is missing a key ingredient for their patient’s back stability and health.

Conclusion

     It has been suggested that the “mechanics of the spine are not well understood by those who examine and treat these structures.”¹⁶ The Chiropractic BioPhysics® lumbar rehabilitation protocol has its unique niche in remolding the spinal posture and thus succeeding where most other LBP treatments fail including other chiropractic techniques. Both the neutral static posture and the dynamic postures performed throughout the day have significant implications for spinal health and response to treatment. The performance of a lumbar rehabilitation without regard for the dynamic activities performed throughout the day may render patient care fruitless. Always consider the Five Key Concepts to Lumbar Spine Ergonomics:

1. Maintain the Neutral Lumbar Curve

2. Appropriate Timing of Spinal Loads

3. Optimal Spinal Loading: Not too Much, Not too Little

4. Reduce the Reaction Moment

5. Maintain Spine Stability

References

1.McGill SM. Low back disorders: Evidence-based prevention and rehabilitation. Champaign, IL: Human Kinetics, 2002.

2.Urban JPG, McMullin JF. Swelling pressure of the lumbar intervertebral discs: Influence of age, spinal level, composition, and degeneration.  Spine 1988;13:179-187.

3.Ruch WJ. Atlas of common subluxations of the human spine and pelvis. New York: CRC Press, 1997.

4.Adams MA, Dolan P, Hutton WC. Diurnal variations in the stresses on the lumbar spine.  Spine 1987;12:130-137.

5.McGill S. The biomechanics of low back injury: implications on current practice in industry and the clinic.  Journal of Biomechanics 1997;30:465-475.

6.Kumar S. Cumulative load as a risk factor for back pain.  Spine 1990;15:1311-1316.

7.White III AA, Panjabi MM. Clinical biomechanics of the spine.  2 ed. New York: Lippincott Williams & Wilkins, 1990.

8.McGill SM, Brown S. Creep response of the lumbar spine to prolonged full flexion.  Clinical Biomechanics 1992;7:43-46.

9.Eklund J. Biomechanical aspects of work seating. In: Kumar S, ed. Biomechanics in Ergonomics. Philadelphia: Taylor & Francis, 1999:325-334.

10.  Pynt J, Higgs J, Mackey M. Seeking the optimal posture of the seated lumbar spine.  Physiotherapy Theory & Practice 2001;17:5-21.

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Attracting a New Generation of Quality Patients

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Nona Djavid, DC

Private Practice Newport Beach, CA

MyChiroPractice, Inc.

CBP Certified Practitioner

Dr. Nona Djavid operates a private practice in Newport Beach, CA. A graduate of University of California at Berkeley in the field of Molecular and Cellular Biology with an emphasis in Neurology, Dr. Djavid earned her Doctorate of Chiropractic Degree from Life Chiropractic College West. She also earned post Doctorate certifications in Neurology and Chiropractic Biophysics. Dr. Djavid is the founder of WOW – Women of Wellness group – an organization that empowers female health care professionals to build healthy caring relationships through education and integrated health and wellness services.

INTRODUCTION

            Years ago personal referrals and yellow page ads helped market and build businesses from the ground up.  Small towns were littered with mom and pop shops, and business owners spent lazy afternoons walking up and down Main Street drumming up business with just a simple handshake and business cards.

            Fast forward to today’s rapidly changing business landscape, and a new generation of technologically, web, and brand savvy patients who rely heavily on their FaceBook® friends for referrals, check the reputation of a health care provider on Yelp®, or Google® their way through dozens of listing for chiropractors, instantly trusting or discrediting them based on how each of their websites, logos, online reviews, or social media pages look like.

            Right or wrong, image and social media standing is taking the front seat to credibility, reputation, or experience.

            To stay competitive and visible, chiropractors have to start stepping outside the box, and give their future patients an image and presence that will make a statement. The first step would be to leave behind their homemade / cookie cutter logos and websites, and being open to change.  Don’t get me wrong, I strongly believe one shouldn’t judge a book by its cover, but this new generation doesn’t even have time to crack open the book; an iPad® maybe.

How Do Quality Patients Choose a Chiropractor?

            It’s very simple; aside from referrals, potential new patients let their subconscious decide.  To understand this concept, you must put yourself in the shoes of a potential patient, and see the world through their eyes.

            Let’s pretend you are looking to find a new dentist, because the referral from your wife happened to be on vacation. So you take to Google, and a minute later you are presented with a list of 20 dentists near your home. 

            As you click through to each dentist’s listings, you make certain conscious observations about them.  You notice how fast or slow their website loads, how gimmicky or professional their web pages read, how attractive, old, or experienced the staff looks, or how depressing or modern their office feels. You may take a moment to read a couple of lines of text, but if the information is hard to find or decipher, you quickly click the back button.

            For most people today, visual elements take precedence over the content of the website. The grumpy looking dentist with the outdated website could be the best oral surgeon in town, but chances are you passed him up because his website didn’t give you the impression of value, trust, or reliability.  Instead you will remember the clean powder blue website with the round yellow logo in the corner – and in your opinion whoever this website belongs to, is the front runner in your search for a dentist.  That’s your subconscious deciding.

Give People What They Want

            As one of the founding partners of MyChiroPractice™, we have made it a mission to research and pinpoint what quality new patients look for when choosing a chiropractor, then designing a memorable brand and engaging online presence that resonates with them.

            In a recent 100 person focus group study we conducted, 84% of participants said that TRUST supersedes experience and price when choosing a chiropractor online.  So how can you portray trust through a website that looks cookie-cutter, outdated, and overwhelming with useless information?  You can’t.

            In other words, if you want to continue running a successful practice and attract quality patients, you have to come to grips with one simple (and difficult) concept; it doesn’t matter what you think looks nice, it’s important what your potential patients find attractive and engaging.

Three Things You Can Do Today to Evaluate Your Image

            The first step in evaluating your website is to see if it is patient friendly.  Take a look at your home page and see if it follows the 30/70 rule – whereas there is 30% text to 70% imagery.  Why is this important?  Besides the mere fact that consumers today don’t have the time or patience to read text-heavy content on a website, larger imagery can have much more of a psychological impact than its textual counterpart.  By consolidating your paragraphs into a few short blurbs, you are opening the page to large rotating photos / banners, and presenting the patient all the relevant information they need on the home page, without a need to scroll.

            The second step in evaluating your website is to ask yourself “does my website stand out from the competition?”  To answer this question you must be 100% open to looking at it from a non-bias perspective.  If your website looks eerily similar to most other chiropractic website out there – for the exception of some color changes or your logo – chances are potential quality new patients have picked up on that too, and will make certain assumptions about the quality of your practice.

            Finally, does your website look cluttered, with an overwhelming number of tabs / buttons?  Research shows that custom-designed websites with smaller page counts and intuitive navigation not only attract the attention of quality new patients, but portray a much higher value and quality of care.  As a matter of fact, a recent focus group study conducted by MyChiroPractice™ revealed that 77% of potential patients leave a “cluttered” website within 2.2 seconds of arriving there.

SUMMARY

            Whether we like it or not, the world is moving at a very fast pace.  The sooner your chiropractic practice engages and attracts the new generation of patients, the sooner you can serve your community.