The Fundamental

B.J. Palmer had a saying in the famous Palmer Clinic, “That fundamentally this clinic is to see how little we can do at how few places, how rarely and quickly it can be done to accomplish the greatest change in the shortest space of time and to know what to do and why we do it before doing it and to assure changes have been made.”
So you say practice is tough, the economy is down, the media is making things worse, patients are not referring, and patients are not staying or paying.
Reread the above quote. Say what you will about B.J. Palmer. For his time, he was one of the wealthiest successful men in the United States. What are the fundamentals of your clinic? Surely, not some ROF script or consultation script? Surely, the fundamentals are not some new Gizmo or Gadget to bill patients with? Just what are your fundamentals and do your patients know? Read the first line in B.J.’s statement, “How little we can do at how few places.” Do you really do that?
Are you trying to correct a lifelong decayed and damaged spine in 6-12 Medicare visits? Or are you determining from the very first visit with a patient What, When and How often the spine needs adjusting. Look at the next line “How rarely and quickly it can be done.” Are you using some cookbook, management company approved frequency of visits just so you don’t have to think about what the next step for your patient is at each visit? Are you in a rush to get them in, then get them out? Or are you really checking the body indications of how well your patient is holding their adjustments.
There are so may outside influences to a patients’ health and subluxation condition, their emotions, their jobs, diet, exercise, stress levels and a million other outside influences. Do you even try to take any of these into consideration? Do you help the patients learn to adapt?
The next line is what every one of your patients should know about you and your clinic. “To accomplish the greatest change in the shortest space of time.” Do you want to cut the crap about having to see the chiropractor forever? Well, if you understand this line and show it to your patients, it explains itself. I am not speaking of short changing a patient care program, but being realistic about really getting patients through their care as fast as possible.
Finally, the last line... which is a problem with most chiropractors, especially those taught in colleges where chiropractic is no longer taught or spoken of. Namely, “and to know what to do and why we are doing it before doing it.”
The last line defines the death and birth of Chiropractic. Given 100 chiropractors from various backgrounds, what do you think their answers would be to the last statement? What do to? Let’s see physical therapy, then this therapy or that, maybe I’ll crack this area of the spine or that. Maybe I’ll send them to their M.D. for tests first, and then I’ll do something like a hair analysis or detox their feet.
“What to do”, indeed! “Why we do it” is a great question, a question on every patient’s mind. “Why?” So, why adjust? Can your patients answer why they get adjusted, coherently? “Before doing it” At your initial consultation and examination, your patients should be leaving your office day one with a good idea that they have subluxations. That these tests prove the presence of one or more components of a subluxation complex and they should be asking you lots of questions as you walk them to the door. Questions that you will answer at the ROF based upon the very first paragraph of this article.
DO YOU WANT THE PRACTICE OF YOUR DREAMS? Do you want a practice that evolves into a lifetime of serving others for the greater good? And yes, you will be wealthy! But first, give your practice and your patients the fundamentals.

Till next time…

Three Biggest Mistakes Most Doctors Make in their Practice

Many CBP® and spinal rehabilitative oriented doctors have good practices, but struggle to achieve a level of practice that will fulfill your desires for your patients, for your families as well as for yourself.

The challenge is most doctors utilize traditional practice management and communication systems and apply these principles to a spinal rehabilitative technique that funnel you into making crucial mistakes sabotaging your pure intentions. These mistakes will create a barrier to your practice growth and success that will feel like you are constantly pushing a boulder uphill. With these repetitive mistakes, if you stop pushing, the proverbial boulder will roll back over you down the hill again, only for you to begin pushing it back uphill again. Identifying and eliminating these crucial mistakes will help you get the boulder uphill with the greatest of ease and help you keep it on top of the mountain to attain and maintain the results you have been struggling to achieve. I have had years of experience coaching doctors in spinal rehabilitative systems to overcome these barriers to growth with systems of communication and management that have PROVEN to be successful.

1. “Stop Selling Your Care.”
Selling your care describes what you are doing when you feel as though you are attempting to convince your patients why they should follow your recommendations. They may have an objection, most commonly time and money, and with every objection or reason they give you, “I want to think about it,” “…get a second opinion,” or “......just want to use what my insurance covers.,” you are trying to return with a logical answer that should surely CONVINCE them to change their mind. This is frustrating, stressful and almost degrading as we may feel we are jumping through hoops of fire to get them to commit to care because we KNOW we can help them. “We know how to fix this,” “I have shown them I know what I am talking about,” “I am trying to make this affordable,” “What else can I say so they just get it?” Have you said these words or something like these words? They should be BEGGING us to take them as a patient into our clinic, yet here we are selling AGAIN! This is very unfulfilling. It’s even worse. It can sometimes feel degrading.

TELLING patients,
1. What’s causing their condition?
2. How long it will take to correct.
3. What the cost will be
at your ROF is called consulting. Consulting is telling people what to do. Unfortunately, this is what traditional management programs have taught us and is the least effective communication technique of persuasion. Influence is about LISTENING.
Coaching is helping people find their own conclusions and answers within themselves. Our job is to COACH our patients to find their OWN emotional reason to commit to care.
People buy with emotion and justify with fact. Each person has his/her own individual emotional reason to engage in a potentially grueling spinal rehabilitative program to change his/her health for the rest of one’s life. How do you “coach” patients?
You coach patients by asking them questions. Once you briefly explain their condition, you ask them to tell you what their impression is.

A. What do they FEEL about the cause of their problem right NOW?
B. What is the MOST important aspect of their health they would like to change (not their pain)? Why?
C. Do they like the direction their health is going? Get them to reject the position they are in now.
D. What are your health goals for the next 30 years? Qualify their goals.
E. How emotionally attached to these goals are you?
F. What are you willing to do to reach these goals?
G. Can you reach these goals while this condition is progressing inside your body?
H. What do they want to do about it and WHY?

When you can turn your statements into these questions, they will have told you THEY want to change the direction of their life and stated to you THEIR reason for their motivation. People will sell themselves if you give them a chance. Influence is about LISTENING and ASKING questions. If you ask the right questions, they will convince THEMSELVES. Your job is to teach them about their condition and help them get honest about the direction they want to take their life. Once they have established they want to change their life, ask them what is their emotional motivation to follow through with a program. Have them put it in writing and SIGN it. Next, remind them of their goals every 30 days.

STOP MAKING STATEMENTS, SELLING YOUR CARE AND START ASKING THE RIGHT QUESTIONS!!

2. “Accepting Patients BEFORE They are Qualified for Their Commitment to Care.”
The majority of the time, we are very excited to accept and process new patients. We may get excited to the point where we make the CRUCIAL MISTAKE of thinking the worse their problem, the more they will commit. It doesn’t take long in practice to realize this is NOT the truth. Just because you have given the patient great facts and information regarding their condition, it is still not a requisite for their commitment to care.
In fact, the more you attempt to “pull” patients into care by telling them how much you can help them, the more they will resist your intention and “pull” back away from you. Human behavior can be quite predictable. People resist force. If you are attempting to convince them, let them know you can help them too soon, are overly confident with your results before you have taken the necessary tests to determine your clinical outcomes with their condition, you are placing yourself in the group of doctors who have made other promises and have not delivered the clinical results.
The reality is you can ONLY help patients who commit to your FULL recommendations and strictly adhere to the program of care for MONTHS. We know you can fix their spine, but you can only fix their spine if they are completely committed and follow through with your care, so NEVER accept patients until they are COMPLETELY qualified.
Remember, time is one of the most common objections. Recommend-ations are time. NEVER give time (recommendations) until they have passed the qualification questions. NEVER give money (financial agreement) until they are qualified on time FIRST. If you have not interviewed the patients through the proper qualification process, BEFORE you give them time and money, there is a much higher probability they will reject your recommendations (time) and your finances (money).
Patients will usually tell you what they think you want to hear even when they have no intention of committing to your recommendations or the money. There are systems to help them become honest with their intentions so they tell you what they are THINKING instead of what they are SAYING. These systems will help you directly handle their objections and allow them to make a larger, more qualified commitment to their health. Once you have qualified their intentions and “WHY” they are committed to care, follow with time and money.
When their commitment to care is dependent on “IF” they want to afford it, you have already lost them as soon as their pain is gone. Accept them for care ONLY when they have absolutely CONVINCED you they have the right intentions to achieve phenomenal results and commitment to follow through with your recommendations. Now the money commitment is very easy and they will pay you far beyond what their insurance will cover.

3. “Don’t Have Your Recommendations NOT Match Your Financial.”
One of the BIGGEST mistakes many doctors make in a spinal rehabilitative practice is giving recommendations for a corrective program and giving a financial payment option to pay in smaller incremental visits or “as you go.”
People tend to ACT according to how they PAY. Their commitment level is most commonly to the money. No matter what recommendations you make, when their balance comes to zero, especially if that happens to occur multiple times during the course of their care, there are many great opportunities for the patient to quit. The result is you MUST keep giving them more reasons for them to make their next visit. This is a practice KILLER. Many practices using this payment system tend to have lower PVA’s (patient visit averages). There are practices that may be exceptional, but this result is very common.
This is a killer because as your patient volume grows, the more convincing you must do with EVERY patient for them to come their next visit past their pain and pay more money. This translates to much more demands for energy and the more fatigued you are at the end of the day from talking people into continuing care.
The key to growing your practice is to have the ability to increase your volume without working harder. If more success equals more work, you and your staff will not sustain your new volume and your practice will drop to its previous level of volume. Have you ever noticed your practice grows then drops to its original level again and the new level is too hard to sustain? This is a problem with your systems, and many times, it may be the frequency of payments being made and too many people clogging the flow at the front desk making too frequent payments. A guaranteed way to discover if your financial arrangements are affecting your patient retention is to calculate your PVA.
Your PVA is calculated by taking the number of office visits per week divided by your new patients per week. If you have a PVA of 30 or less and your patients pay more frequently than their whole recommendations, you are most likely suffering from this problem. Evaluate your payment options along with your PVA and you may find some interesting answers.

We will cover how to avoid these common mistakes at our Denver seminar Feb. 7th/8th, 2009.

Restricting Chiropractic Care To 6 To 12 Visits is Unsupportable

Recently, ASHN, CCGPP, and other health insurance companies have cut patients’ benefits in the 6-12 visit range. The claim is that RCTs (Randomized Clinical Trials) indicate the benefits of chiropractic occur in this range. We at the ICA decided to check on this claim.

We performed two time consuming searches, separated into Low Back pain RCTs with manipulation and neck pain, headaches, and upper back pain with manipulation. We categorized these into number of visits, number of procedures performed, pain scale scores pre-and post, and who provided the care. DCs provided the care in only approximately 25 percent of these published studies and almost always extra procedures were provided to the subjects.

The average number of visits determined as pre-research designs was approximately eight visits. However, the average improvement in VAS scales was only between 40-45 percent. Thus, manipulation did not result in pain resolution in these eight visits. Using a linear extrapolation, one arrives at approximately 20 visits to completely resolve UN-complicated pain syndromes. However, this omits the examinations and follow-up visits need to document and diagnose these cases. Thus, about 25 visits are necessary to document, diagnose, and resolve un-complicated spine (axial) pain. These ideas are inside the ICA’s Best Practices? Practice Guidelines document.

However, when we tried to get these published in JMPT and JCCA, we were rejected. Subsequently, the head and neck paper came out in JVSR and the low back pain paper is in review at JVSR. The conclusions of these two papers go against the politics at these journals where these papers were rejected. While the practicing DC needs these to support longer terms of care, the reviewers at these journals have other agendas.

Segments, Posture, and Allergic Diseases - Article Review -Relationship Between Vertebral Deformities And Allergic Diseases

The Internet Journal of Orthopedic Surgery
2004; Volume 2; Number 1
Yasuhiko Takeda and Shouji Arai

FROM ABSTRACT
Background:
A research verification between visceral disease and immune dysfunction from sympathetic segmental disturbances secondary to vertebral deformities has been put forward by chiropractic and various fields' medical practitioners.
We report on the positive results of a controlled study using vertebral correction treatment to reduce vertebral misalignments in patients with atopic dermatitis and bronchial asthma. We also discuss possible mechanisms for the relationship between visceral and immune dysfunction and vertebral deformities.

Methods:
We divided 360 atopic dermatitis patients into six groups in the treatment frequency to compare a treatment effect. We investigated the existence of the diurnal secretion quantity change of adrenal cortex hormone to judge the present condition of the adrenal cortex functions of 1,699 atopic dermatitis patients and bronchial asthma patients. We investigated the spinal condition of 1,028 atopic dermatitis patients and bronchial asthma patients to consider the relationship between the allergic disease and the spinal misalignments. We implemented Takeda Method to 906 bronchial asthma patients and 1,827 atopic dermatitis patients and chased the treatment effect.

Results:
Among 120 atopic dermatitis patients who received spinal correction treatments every day, 106 [88%] showed improvement in skin itching and 86 [72%] showed improvement in skin condition.
Among 240 atopic dermatitis patients who did not receive spinal correction treatments every day, we could not obtain a sure treatment effect.
As a result of the questioning about the diurnal quantity change of adrenal cortex hormone secretion to 1,699 patients, the adrenal cortex function of these patients may be in the decline condition. We obtained over 70% improvement in allergic symptoms by Takeda's Method.
We found that vertebral misalignment is a common and characteristic finding in patients with atopic dermatitis and bronchial asthma.

Conclusion:
According to the results of this study chronic nerve compression secondary to vertebral deformity in the thoracic region had a significant effect on the immune function of atopic dermatitis and bronchial asthma patients.
The adrenal cortex functions of these allergy patients may be in the chronic decline condition with this chronic nerve compression. A sure treatment effect cannot be obtained without considering the nature and the function of the autonomic nerves.

KEY POINTS FROM DAN MURPHY
1) Chiropractors and other medical practitioners have presented evidence that there is a relationship between vertebral deformities and sympathetic segmental disturbances secondary to visceral disease and immune dysfunction.
2) These authors report on the positive results of a controlled study of the correction of vertebral misalignments in patients with atopic dermatitis and bronchial asthma.
3) These authors claim there is a relationship between visceral and immune dysfunction and chronic vertebral misalignments.
4) Correction of spinal misalignments improved the itching symptoms of chronic atopic dermatitis patients by 88%.
5) Correction of spinal misalignments improved the skin appearance of chronic atopic dermatitis patients by 72%.
6) These improvements were only observed in patients that were treated daily for 3 – 6 months.
7) Among atopic dermatitis patients who did not receive spinal correction treatments every day, there was no treatment improvement.
8) Allergy symptoms improved in over 70% of patients who received spinal misalignment treatment.
9) “Vertebral misalignment is a common and characteristic finding in patients with atopic dermatitis and bronchial asthma.”
10) “According to the results of this study chronic nerve compression secondary to vertebral deformity in the thoracic region had a significant effect on the immune function of atopic dermatitis and bronchial asthma patients.”
11) “The adrenal cortex functions of these allergy patients may be in the chronic decline condition with this chronic nerve compression.”
12) Patients with allergic diseases, atopic dermatitis and bronchial asthma, hay fever, etc., have a high ratio of “chronic vertebral misalignments.” [Important]
13) Chronic allergy symptoms improve with the reduction of chronic vertebral misalignment.
14) “As it was surmised that allergies, such as very severe atopic dermatitis and bronchial asthma, have a strong connection to severe chronic vertebral misalignment.”
15) “The muscular system that supports and maintains the spine was in noticeably poor condition in atopic dermatitis and bronchial asthma patients alike.”
16) The chronic vertebral misalignment causes:
A)) “Chronic narrowing of the intervertebral foramina.”
B)) “Chronic neurotripsy.” [nerve rubbing]
C)) The “reciprocal innervation between the brain and the organs is continually and severely impacted.”
17) “Because of the chronic neurotripsy, caused by the intervertebral narrowing of the foramina due to changes in the 8th to the 10th thoracic vertebra in a forward and downward direction, the immune function related to innervation of organs, such as the adrenal glands and the adrenal cortex, is chronically and severely impaired.” [Very Important]
18) The “continuation of this chronic and severe condition” results in a high probability that the following chronic conditions are present:
A)) “The presence of chronic and various reciprocal innervation disorders between the brain and the adrenal glands.”
B)) “The presence of chronic hormone secretion dysfunctions of the adrenal glands based on the reciprocal innervation between the brain and the adrenal glands.”
C)) “The presence of a chronic dysfunction of the adrenal glands and adrenal cortex themselves caused by blood circulation dysfunction in the adrenal glands.”
D)) Altered cytokine production.
E)) Increased inflammation.

F)) Altered production of IgE.

G)) Altered activation of mast cells.

H)) Altered activation of helper T2-cells and eosinophils.

[Recall, Th2 {Thymus helper-2} responses produce IgE {immunoglobulin E} which attach to mast cells causing degranulation {the membrane falls apart} of the mast cell membrane, dumping chemicals {like histamine} that cause atopic disorders {atopic dermatitis, bronchial asthma, etc.}].
19) Atopic dermatitis and bronchial asthma patients are often medically treated with corticosteroids, antihistamines, and immunosuppressants, which can actually aggravate their symptoms in the long run.
20) “It can be said that the fundamental treatment of these diseases [atopic dermatitis and bronchial asthma] is the improvement of the chronic narrowing of the intervertebral foramina secondary to vertebral distortion.” [Important]
21) The patient must “improve the muscles supporting the vertebral column and to engage in sufficient sleep and rest, active stress reduction, and nutrition to improve basic physical strength (immunity and resistance) for the recovery from the disease.”
22) The method of correction of the chronic vertebral misalignments and improvements in the chronic narrowing of the intervertebral foramina used in this study were developed at the University of Tokai (Tokyo, Japan), Graduate School of Engineering, Department of Human Engineering. It involved both segmental and postural corrections.
23) “Regarding the frequency and duration of the treatment to correct changes in the vertebrae caused by vertebral misalignment, it is noted that the results of comparative studies on atopic dermatitis and bronchial asthma patients showed that daily corrective treatment for three to six months of the course of treatment had the best improvement effect.” [Very Important] “It was necessary to give daily stimulation for at least three to six months to the autonomic nerves indirectly to obtain sure treatment effect.”
24) “X-ray of the patient’s thoracic vertebrae showed that intervertebral foramina between the 8th and 10the vertebrae were much narrower than those between the other vertebrae.” Also, the curvature of the spine was flattened.
25) “In all the patients, there was disappearance of the posterior curve of the spine that peaks at the 7th thoracic vertebrae. The slight shift in thoracic vertebrae 8th to 10th causes narrowing of the vertebral foramina conduit for nerves related to adrenal cortex function.”
26) “The changes in the vertebrae caused by the vertebral misalignment are present from the 7th or 8th thoracic vertebra to the 10th thoracic vertebra.”
27) The vertebral misalignment described in this paper were:
Bronchial asthma T2 – T4
Atopic dermatitis T8 – T10
At both spinal regions, the vertebrae were tipped forward (a flexion malposition), compressing the anterior portion of the disc, allowing the spinous process to become more horizontal. The narrowing of the IVF was not initially caused by disc narrowing, but rather by the superior articular process of the flexed vertebrae moving into the IVF. [Important]
28) This study “confirmed that over 98% of allergy patients had the vertebral misalignment.”
29) The chronic vertebral misalignments were found only in the thoracic vertebra region that corresponded to the innervation of the adrenal glands (T8-T10).
30) These authors believed that the improved symptoms with the correction of the vertebral misalignments were due to altered function of the autonomic sympathetic nerves. “On the occasion of correction of vertebral misalignment, we must consider the nature and the functions of the autonomous nerves.” [Very Important]
31) “As a result of this multi-faceted study investigation, we re-confirmed that these vertebral deformities and the allergic diseases linked together strongly.”
32) “Based on the test results, we can state that the only treatment that can demonstrate fundamental effects on allergies such as atopic dermatitis, bronchial asthma, and pollinosis will have the potential to treat spinal curvature disappearance. In other words, we can state that a treatment that cannot fundamentally treat spinal problems cannot fundamentally improve conditions such as atopic dermatitis, bronchial asthma, pollinosis, and allergic coryza.”
33) “There is a high possibility that allergic disease relates to the innervation of organs that relate to the immune function which are affected by changes in the vertebrae caused by the chronic vertebral misalignment.”
34) “There is an expectation of alleviation, and prevention of development of symptoms by correcting the changes in the vertebrae caused by chronic vertebral misalignment, which is common in allergic disease patients.”

Another CBP® NP Research Paper Accepted at JEK

For several years now, CBP® Nonprofit has been funding Dr. Chris Colloca’s team of researchers working on sheep in Australia. Several papers are generated from this research each year. Recently the 9th CBP® NP sponsored study was accepted at JEK from this research. The other studies in review from this research are:

1. Colloca CJ, Keller TS, Moore RJ, Gunzburg R, Harrison DE. Effects of disc degeneration on neurophysiological responses during dorsoventral mechanical excitation of the ovine lumbar spine. Journal of Electromyography and Kinesiology 2008;18(5):829-37.

2. Colloca CJ, Keller TS, Moore RJ, Harrison DE, Gunzburg R. Validation of a Non-Invasive Dynamic Spinal Stiffness Assessment Methodology in an Animal Model of Intervertebral Disc Degeneration. In review.

3. Gunzburg R, Szpalski M, Callary SA, Colloca CJ, Kosmopoulos, V, Harrison DE, Moore RJ. Effect of a novel interspinous implant on lumbar spinal range of motion. In review.

4. Colloca CJ, Cunliffe C, Pinnock MH, Kim YK, Hinrichs R. Force-Time Profile Characterization of the McTimoney Toggle-Torque-Recoil Technique. In review

Will You Help Me?

I have had considerable success each year in practice, although that is not to say it has always been easy. Nonetheless, I have consistently found myself confronted with “good” problems (need more space, need more staff, lots of doctors applying for jobs, etc), rather than bad ones (not enough patients, poor patient outcomes, need money, etc). At the same time, many of my friends and colleagues tell me that they are struggling with “bad” problems.
I consider my desire to help others as one of the foundational components to my success and happiness in practice. This fact alone is probably not unique. I would guess that many chiropractors attribute their success and happiness to a desire to help others—particularly their patients. And I certainly share that desire to help my patients. However, I actually attribute much of my happiness and practice success to my desire to help other chiropractors and the chiropractic profession. I have found that when I put my attention on helping the profession, things go very easy for me in practice.
I think that almost every chiropractor would do something to assist another chiropractor or our profession if they felt that they could do so. In talking to other chiropractors, I have found that the one most common barrier to doing something for another chiropractor or our profession is that they feel consumed with their own problems, especially in practice—leaving them with no time to worry about another’s.
So what can you do about that? Well, my successful action has been to solve the problems of other chiropractors and our profession. I know it probably seems counter-intuitive, but it works. Each time I have decided to help another chiropractor, or to take on a project for the Maryland Chiropractic Association, or the ICA, or a research project, or anything else along the line of expanding chiropractic, I have had an immediate return on my investment with regards to more happiness and prosperity in my practice and in my life.
That brings us to this article and its title, “Will You Help Me?” As my next project to help another in our profession, I have decided to begin sharing my successful actions with the profession through articles such as this one. I have decided to break this article into two components, ‘Theory’ and ‘Practical’—since my interest in getting something done exceeds my interest in merely entertaining you with my article.

THEORY (Webster’s Collegiate Dictionary defines ‘Theory’ as “the general or abstract principles of a body of fact, a science, or an art.”)

The Theory behind this idea is that if you decide to help the profession by helping another chiropractor or contributing to some project or solving some problem facing the profession, you will be happier and find more success in practice. I can’t say that I know this is universally true, but it wouldn’t be a bad thing to agree with, right?
If you agree, then here is what we can do about it. Keep in mind that if you don’t like the practical that I have given you, then choose some other activity. Regardless of what it is you do for your practical, if it helps the profession, it’ll help you personally. But also keep in mind that the magnitude of the return you’ll get will be somewhat in accordance with what you do to contribute to the profession.

PRACTICAL (Webster’s Collegiate Dictionary defines ‘Practical’ as that which is “designed to supplement theoretical training by experience.”)
Here is where the rubber meets the road, where we separate the men from the boys—or whatever other analogy you want to use to describe the fact that this is the point where it can, and often does fall apart. We all probably can remember chiropractic students who knew (theory) about everything but couldn’t apply (practical) themselves one bit. And if you’re that student, well, that’s okay because you can start bringing an end to that problem now by doing this practical.
You may find this very easy or it may be difficult for you. If it does seem like too much, then just take on whatever part of this you can comfortably do now. Then once you get that part done, do another, if you so feel inclined. If my practical is way too easy for you, or you’ve already done it all, then make up your own practical that would be right for you. Either way, if everyone reading this article does something to help the profession, then 2009 is going to be great for all of us!

THE ASSIGNMENT
Remember, you can do one, more than one or add your own. Just keep in mind the reward ratio mentioned above!

1) Go online at www.ICABESTPRACTICES.ORG and complete the survey for these new chiropractic practice guidelines. Your input is needed to make these guidelines the best they can be. It could take as little as 30 minutes to read the summaries of the chapters. However, the more thorough you are with your review, the more valuable your feedback may be.
2) Call a chiropractor and schedule lunch with him/her. Make this call to someone that you wouldn’t ordinarily call. Maybe it is someone you can help in some way. It could be a chiropractor who is having personal or practice problems or it could be a ‘competitor’ in your area you’ve never really spoken to. If you think that there is no help that you could bring to another chiropractor, just realize that by getting to know another chiropractor a little better, you will actually help the chiropractic profession become more of a group—and that would be very helpful to everyone!
3) Join a chiropractic association. Decide where your membership is best invested. If you are currently a member, well done on that! If you are a member of your state association, but not a national/international association (or visa versa), then take that step and join. It is vital that our associations have as much support as possible. If you’re not sure which to join, find out what the different associations have done for the profession—look at the facts, then make a decision to join the ones that best supports chiropractic.
4) Call your state association and find out how you can help. Most associations are running off of too few memberships and off the work of even fewer volunteers. You can create a huge impact with just a small amount of time. You may be able to come to their next meeting or maybe there is a project that is being done that you can help with. Don’t be surprised if you don’t get a huge welcoming response as most association volunteers and staff can see over the heaping pile of work they are trying to do. They may also be in shock that some has called them to offer help. No association has 100 percent membership or too much money, so there are at least two projects that can be done—and there are many, many more, I can assure you.

Thanks in advance for your help. I’d love to hear your wins. You can email me at doctorhuntington@hotmail.com.

INTRODUCTION

Studies have shown that the pattern of spinal injury in children is related to age and also the mechanism of injury. “While traffic-related incidents are a leading cause of injury across all age groups and account for approximately one third of all spinal trauma and half of serious injuries, emphasis on fall prevention is needed for younger children. Older children, particularly boys, are sustaining spinal trauma in sporting and recreational activities.1”
The cervical spine was the most frequently injured region, with thoracic and lumbar spine injuries becoming more common with age. The upper cervical spine was more commonly seriously injured in young children, and the lower cervical spine was involved more often in older children. The frequency of minor soft tissue neck injuries increased substantially above the age of eight.1
Numerous biomechanical factors increase the chance for cervical injury in children. Two of the main ones are:
• The diminished development and strength of various spinal musculoskeletal components.2 Children’s spines are weaker and more flexible than adults, allowing more joint impingement during traumatic impacts.
• The more unfavorable head diameter to neck diameter ratio, as compared to adults.2 Children have larger, heavier heads in relation to their bodies than adults.
I would like to present a case study involving the structural and functional rehabilitation of a soft tissue neck injury in a 12 year old boy. In contrast to what the insurance industry thinks, these are not self-limiting disorders in many cases and need proper treatment management and documentation.

CASE STUDY
A 12 year old boy presented for evaluation after a neck injury that occurred earlier in the day. His mother stated that “he was rolling around on the ground and somehow twisted the left side of his neck.” He described having constant severe, dull left-sided neck/upper back pain for the last 5-6 hours that was increased to a sharp pain with any motion of the head or neck. He rated his neck pain on the initial examination day as a seven to nine on a 0-10 point Numerical Pain Scale. He rated his average neck pain as a seven and his worst neck pain as a nine on the Numerical Pain Scale. He has never had a neck injury like this before.
A pain questionnaire should also have been administered, but my usual (Vernon-Mior) Neck Pain and Disability Index form is not really applicable to children. A much better choice to establish how a child’s pain is affecting their eight domains of health (physical functioning, role limitations due to physical health (role-physical), bodily pain, general health perceptions, vitality, social functioning, role limitations due to emotional problems (role-emotional) and mental health) is the SF-10™ for Children. This is a new short form that contains items adapted from the CHQ™. With just 10 items (questions), the SF-10™ for Children can be easily integrated and administered and is particularly applicable to large-scale child population surveys. This questionnaire can be found on the Outcome Assessment CD Rom and can be purchased at CBP® seminars or off the www.idealspine.com web-site.
On this young boy’s initial physical exam, he had severely restricted cervical extension (33 degrees), lateral flexion (rt. 34/lt. 18 degrees), and mildly restricted left rotation (70 degrees). This resulted in an eight percent whole body impairment (AMA guidelines). Increased pain was elicited on the foraminal compression test bilaterally, especially on the left with no radiation of pain into the upper extremities, indicating a facet joint inflammation most pronounced on the left.
The initial postural exam demonstrated a mild forward head posture. The initial lateral radiograph revealed a military cervical spine with 17 millimeters of forward head translation and a reduced C-1 angle of 9-1/2 degrees (See X-ray #1). The AP view showed minimal displacement of the cervical spine from mid-line and was generally unremarkable as was the AP posture.






Treatment was started on the initial visit due to the patient’s severe pain levels. During the first two treatments, the young boy received vaseo-pneumatic interferential electric muscle stimulation to improve circulation, diffuse metabolite toxins, decrease inflammation/pain and stimulate healing. No cervical manipulation was performed due to the acute inflammation and soft tissue damage. On the third visit, the patient’s pain levels had decreased to a three to four on the 0-10 pain scale so gentle diversified manipulation was introduced as well as low level, supine motorized cervical extension compression traction to restore the normal lordosis and reduce the forward head posture (See Picture #1).


The motorized traction was applied for two minutes for the first treatment and slowly increased to 12 minutes sessions over the next six treatments. The traction was gradually increased to a 15 pound low pull/27 pound high pull intensity. Due to the absence of any notable postural aberrations, no mirror-image exercise was applied.
After 15 treatments (13 with traction), the patient was re-evaluated and a new lateral cervical x-ray was taken. His new range of motion revealed notable improvement of extension, lateral flexion and rotation to normal values, resulting in a zero percent whole body impairment. The foraminal compression test was now negative and his forward head posture visually appeared reduced.


The new lateral cervical x-ray showed a restoration of the cervical lordosis to 31 degrees. A common mistake that many clinicians make is to try to induce an adult’s 40 degree cervical lordosis to a child’s neck. Children have a reduced cervical lordosis compared to an adult. Table #1 denotes the normal amount of lordosis that children of different ages should have.3 A reduction of the forward head posture to 11 millimeters and an improvement of the C-1 angle to 19 degrees were also observed (See X-ray #2).




In spite of the nice structural and functional (ROM) improvement, the young patient still reported having daily morning neck pain that he rated at a two level on the 0-10 point Numeric Pain Scale. Because of the soft tissue fibrosis of repair that occurs in children as well as adults, residual pain can often be present even after structural rehabilitation has been accomplished if no Mirror-Image® or range of motion exercise has been performed. Realizing this, full range of motion, progressive resistance exercise was initiated with this young boy using a head halter and Medi-Cordz™ surgical tubing for the progressive resistance. After just five additional treatments that included continued diversified spinal manipulation and the progressive resistance exercises of bilateral rotations and lateral flexions, this young boy was pain free and released.
CONCLUSION
Post-traumatic chiropractic care of the pediatric patient is often questioned by the insurance company as not likely to be reasonable or necessary. Proper documentation of your young patient’s structural and functional deficits as well as how their pain is affecting their overall physical and emotional health are a necessity in the modern health care arena, if the doctor expects to be paid for his care.
Involved in the treatment of this case was a new type of motorized, intermittent cervical extension traction that combines the benefits of functional and structural soft tissue rehabilitation. By constantly varying the traction force, my new CTBox™ provides a dynamic variation on preexisting corrective spinal traction application and, because of its increased patient comfort level, can be utilized sooner in the patient’s rehabilitation then static applications of extension traction. To my knowledge, this is the first motorized, intermittent extension traction device to receive FDA approval for resale to Doctors of Chiropractic.

REFERENCES
1. Bilston LE, Brown J. Pediatric spinal injury type and severity are age and mechanism dependent. Spine 2007; 32:2339-2347.
2. Murphy DJ. Pediatric Chiropractic. Ed: Anrig C, Plaugher G. Williams and Williams, 1998.
3. Harrison DE, Harrison DD, Haas JW. CBP® Structural Rehabilitation of the Cervical Spine. Harrison CBP® Seminars, Inc. 2002. Ch. 3, Table 1, p 63. (Further referenced to a Spine 1996 published study by Kasai et al.)

The Changing Face of Malpractice Risk

With nearly one trillion dollars being spent on health care services each year in the United States alone, you can bet that any industry remotely related to health issues is going to aggressively be working to get their share of this financial mother load. This can be said many times over for the nation’s health care malpractice industry. As practitioners, our concept of “malpractice” is largely anchored in the idea of practice mistakes that cause injury. This, of course, where it should be. In the increasingly competitive and cynical health marketplace, however, this is clearly no longer the case.
In recent years, new risks and issues have emerged that require the responsible doctor of chiropractic to take a careful look at their practice environment, procedures and protections, and regularly review and update both their operations and their malpractice coverage. Life in practice, if it ever was, is not simple anymore.
There are plenty of new and alarming developments that every chiropractic practitioner should be aware of in their risk management efforts. Here are a few of the top issues that ChiroSecure, ICA’s only approved malpractice program, invite you to consider:

New Definitions and Norms in Malpractice: As noted above, our idea of malpractice is centered on injury. In the current environment, the parameters of risk have been greatly extended and the latest trends include litigation for what you failed or declined to do in terms of your care, or what you missed diagnostically, even though such a diagnostic responsibility might be far outside your professional scope. Like the smoker with cancer who sues the tobacco company or the obese individual who sues the fast food establishment, the concept of malpractice liability, supported by an aggressive legal industry, is being redefined, most importantly in the minds of consumers.

The Aggressive Malpractice Law Firm: Just a glance at the websites of a few law firms that advertise that they are “malpractice specialists” gives you a window into the new effort and resources that the legal industry is putting into malpractice claims development. Such websites feature a wide and sometimes outrageous list of incitements and inducements to potential clients, noting that their firms have a host of undercover operatives, batteries of clinical experts in every field to help evaluate your chances of a successful claim, and bold statements that malpractice is not just about injury, but about missed diagnoses, timely care and providers’ charges. Some even invite what can only be characterized as harassment suits by encouraging potential clients to come in on a contingency basis even if they think their claim might be shaky, because most claims are settled out of court anyway and they might get something.

Managed Care Interference: Doctors who work within managed care plans frequently find themselves and their patients confronted with care limitations that fall far below the minimum clinical needs of even uncomplicated cases. In these situations, the doctor runs the risk of being tagged or even dropped by the managed care organization if the care parameters are exceeded, regardless of the reason, and being exposed to added risk by limiting care that they know is indicated, but exceeds the limits of the plan. This grossly unfair equation is compounded by the fact that if any patient denied care under the participating doctor’s management, it is the doctor’s problem and the managed care plan is nowhere to be found.
HIPAA: New regulations such as the privacy requirements of the HIPAA law expose doctors to a new range of risks that simply did not exist before. While the record of HIPAA violations and prosecutions is still very small, it is clear that aggressive attorneys working with clients looking for a problem with YOUR care, have another field in which to search, and in which even seemingly innocent matters might be seized upon and thrown back at you in a complaint or lawsuit.

Even with these new issues facing the chiropractic profession, there is certainly no reason to despair. Careful attention to clinical procedures, personal boundaries for both you and your staff, responsible record keeping and good malpractice coverage mean that you can enjoy a stable, prosperous and enjoyable practice. Knowing that your malpractice carrier stands behind you, having their risk management and consultation resources available when you have questions and knowing that they are in for the long haul mean that you do not have to shift into a totally defensive practice mode, looking over your shoulder every 2 minutes for potential risks. ChiroSecure is there to serve your needs, and is the only major chiropractic liability program administered by a licensed doctor of chiropractic. For more information contact ChiroSecure by calling toll-free 866-802-4476, or visit us on the Internet at www.ChiroSecure.com.

Remembering a Chiropractic Legend, Dr. William M. Harris CBP® Non-profit Meets Harris Foundation Matching Grant

By Christopher Colloca, D.C.

When I learned that Dr. Bill Harris had taken a fall at the age of 90, I knew things weren’t good. He had fractured his neck and was in a rigid collar while healing. In speaking with his family and secretary, I learned of the seriousness of his injuries. He had just approved a $25,000 matching challenge grant from his Foundation for our 2008 research. Weeks later, with his family by his side, he quietly passed away in Roswell, Georgia on Sunday, November 9, 2008.

William M. Harris, D.C. is known in the chiropractic profession as its greatest philanthropist. He gained this reputation by donating over $11 million to chiropractic education and research throughout his illustrious career. This was strictly by design. His influence in the profession began when he started his first successful practice in 1940. He began by influencing many of his family members and patients to become chiropractors as well, and pioneered chiropractic in the State of Georgia.

From Humble Beginnings

Dr. Harris was born and raised on a 2,000-acre family cotton farm in Opelika, Alabama. As a child, he witnessed father cured of a serious illness by a chiropractor, prompting his desire to enter the profession. His family gathered together $500 from their cotton farm to pay for Harris' tuition at Palmer College of Chiropractic. His family sent a small amount of money to him each month and Dr. Harris worked nights and weekends to make ends meet. In the midst of the Great Depression, Dr. Harris’ father died. He returned home to help run the family farm, and later finished his chiropractic education in Davenport. After graduation, he proudly paid his family back for the funds they provided him.

In the 1950's, Dr. B. J. Palmer, the president of the Palmer College and developer of the chiropractic profession, personally came to the dedication ceremony of Dr. Harris’ new clinic in Albany, GA. Throughout the years, Dr. Harris opened several very successful chiropractic practices throughout the State of Georgia. Others were eager to learn the secrets to his success. Dr. Harris began a practice management consulting business, coaching others to strive for success through his consulting, seminars, and trainings.

A Foundation for Giving

With his business acumen, work ethic, and wise investing, Dr. Harris began to amass wealth. He was a personal friend of Napolean Hill, and a fan of his book, “Think and Grow Rich.” In 1978, Dr. Harris chartered the Foundation for the Advancement of Chiropractic Education (F.A.C.E.), later renamed the William M. Harris Family Foundation, to begin in earnest to give back to the chiropractic profession. In honor of his generous donations, several chiropractic colleges have named buildings after him. His last great venture in chiropractic philanthropy was in Marietta, GA. When the Life University lost its accreditation and was facing serious financial troubles, Dr. Harris stepped up and gave the necessary collateral to hold the school from insolvency until it could be re-staffed and gain back its accreditation. The move saved Life which is now again thriving. Life University President, Dr. Guy Riekeman, had the following comments about Dr. Harris:

“Beyond all his tangible contributions, this fine man, who was both kindly and determined, has left us a legacy of the spirit. For so many decades, he has exemplified chiropractic’s commitment to humanity. In my mind, he will always stand as an icon representing the best of what we in this profession stand for and can rise to become. He was a great friend to me and I will truly miss him, as will so many others.”

A Personal Reflection

My friend, Dr. Terry Peterson and I traveled to Marietta, GA to attend Dr. Harris’ memorial service held at Life University. Dr. Riekeman began the ceremony and invited the attendees to don the red caps that were distributed upon arrival. A sea of red caps rightfully honored this great man. Several chiropractic college presidents and members of the Harris Family Foundation spoke at the service to honor his memory. Stories were told of the great man that Dr. Harris was and what he stood for. The congruent message of Dr. Harris’ work ethic, and desire to empower others through his matching challenge grants shined through from each of them. Following his death and during my trip to Atlanta, I reflected on my memories of this great man.

Dr. Harris stopped by our Atlanta Neuromechanical seminar last year. I invited him to give us a short talk and he gave us all an inspiring lecture spur of the moment, off the cuff. When I introduced him, I spoke of his accomplishments and his incredible philanthropy including the support of our research. I mistakenly said, “Dr. Harris has given over $5 million back to chiropractic.” From the front of the room, he looked at me a bit bewildered and whispered in my ear, “It was Ten.” I was just off by five million. I quickly corrected the error to the amusement of the audience. How embarrassing! At the age of 89, he had the seminar crowd standing and sitting and at full attention for his short talk. We had lunch together that day and he told me of how proud he was of our research and what our team had built — a new Instrument Adjusting technique to advance chiropractic, and a following of respected instructors and thousands of DC’s. Dr. Harris loved numbers.

I was first introduced to Dr. Harris in the mid 1990's when I was doing research with the National institute of Chiropractic Research (NICR). He had given us several matching grants each year ranging from $50,000 to over $100,000 that we were successful in raising matching funds from the profession. When I resigned from the NICR Board in 2001, I was without any funding to continue my chiropractic research. When he heard of this, Dr. Harris called me and offered his encouragement and advice to help me continue on the research track. He offered a generous matching grant that year such that he would match dollar for dollar what we were able to raise for our research. Dr. Don Harrison offered CBP Non-profit, Inc. to earmark contributions to this effort.

Each year for the past 8 years, we have been fortunate to receive word from Dr. Harris' Foundation that the matching grant challenge was on. Each year, we have met the challenge with selfless donations from chiropractors through our fundraising at our Neuromechanical/CBP® seminars. These challenge grants have been the catalyst funding source responsible for basic science and clinical research that we have done which has been presented at numerous chiropractic, orthopaedic, and other scientific conferences around the world. To this extent, scientific publications have been accomplished in chiropractic journals like the JMPT, and Chiropractic and Osteopathy, as well as medical and scientific journals like Spine, European Spine Journal, Clinical Biomechanics, the Journal of Biomechanics, and the Journal of Electromyography and Kinesiology.

$25,000 Challenge Matching Grant Met for 2008

Earlier this year, we were notified to confirm our 2008 Challenge to raise $25,000 in matching funds from Dr. Harris' Foundation. We issued the challenge to the CBP® Non-profit membership and to the profession to meet the challenge. In an overwhelming show of support, we received over $49,000 in CBP® Non-profit donations in the campaign, doubling the amount required to secure the additional $25,000 from the William M. Harris Family Foundation. It was an incredible feeling to witness this kind of support. I would like to extend a sincere thank you to all of those who donated to last year’s research.

Dr. Harris' legacy is more than his tremendous success in business and in his profession, the buildings that bestow his name, or the millions of dollars that he gave back to his profession. His legacy is the very spirit of hard work and giving out of abundance that he so often taught others. He will be sorely missed and never forgotten.

Dr. Colloca is the CEO and Founder of Neuromechanical Innovations, a research-based medical device manufacturer and postgraduate education company serving the chiropractic profession since 2000. Based in Chandler, Arizona, the Neuromechanical Campus houses a 15,000 sq. ft. corporate headquarters, manufacturing and training facility where its patented products, the Impulse® and Impulse iQ® Adjusting Instruments are manufactured. The Impulse® family of adjusting instruments are in over five thousand chiropractic offices in all fifty U.S. states and over thirty countries around the world. Dr. Colloca holds postgraduate faculty appointments in a number of chiropractic colleges and has lectured extensively throughout the United States, and around the world on five Continents. A distinguished scientist, his original research has been presented at numerous international scientific conferences and published in several biomedical and professional journals. He is a reviewer for the Journal of Biomechanics, Spine, and European Spine Journal, among others.

CBP® Becomes an Elective at UQTR

By Louise Marcotte
Martin Normand, PhD, DC, Director of the Chiropractic Program at the University of Quebec a Trois Rivieres, announced that CBP® is an Elective course starting January 2009. The instructor for the CBP® Elective course is Montreal Chiropractor Dr. Louise Marcotte. This makes the 7th Chiropractic College where CBP® is taught. The others are Life-West, Life University, Cleveland Los Angeles, Cleveland Kansas City, Palmer-West, and RMIT in Australia.

PostureRay®: Now With Added Scoliosis Functionality

Scoliosis has been traditionally defined as a lateral curvature of the spine greater than 10° using the Cobb methods of analysis. Scoliosis plagues not only children but the adult population as well. According to authors such as Weinstein et al, adolescent idiopathic scoliosis (AIS) affects 1-3 percent of children in the at-risk population of those aged 10-16 years.2 Concerning adult scoliosis, Schwab et al.1, concluded a prevalence rate of up to 68% in the population with an average age of 70.5 years. The National Scoliosis Foundation website estimates that in the United States, scoliosis affects 2-3% of the population or approximately 6 million people. In a recent publication, Wong et al.3 state, “Early detection by comprehensive screening programs enables early institution of conservative treatment, with the aim of reducing the number of patients with curves reaching a magnitude that requires surgical treatment.” While it is not the purpose of this article to detail the natural history or the various types of scoliosis, it is our purpose to call attention to the fact that doctors often do not adequately measure, monitor, and possibly treat such deformities when indicated. We believe that the only valid measure for doctors to detect early onset of scoliosis is not external, but rather with x-rays. As such, chiropractors should take their rightful place in being part of the solution for conservative treatment and management of scoliosis cases when surgery is not indicated.
Traditional marking of x-rays by hand is very time consuming for the busy clinician. Fortunately, you now have an easy tool to use which not only measures these displacements, but at the same time educates and monitors scoliosis patients: PostureRay®. Since measuring a scoliosis is different from traditional Chiropractic Biophysics® line analysis due to excess vertebral rotation, the Risser-Ferguson analysis has been incorporated as PostureRay’s primary method. In addition, we also incorporated the traditional 4-line Cobb method of analysis. While the Cobb method is less valid, as it only measures the end points of the curve, most health care providers including orthopedists, rely on this method by default as a method for gauging the magnitude for a scoliotic deformity. In fact, this method is almost exclusively used in reporting research data. Because of this, we had PostureRay® programmed to digitize both systems of analysis in order to better aid chiropractors in documenting their patient’s scoliosis and communicate findings to other health care providers such as orthopedic spine surgeons.
As with any patient care, scoliosis is no different. You must first educate the patient on the magnitude of their problem. Below in figure 1 is an example of the patient report for the AP thoracic view. On this report, you will find very friendly patient oriented text descriptions of their findings, and again, like in the other x-ray views, there is room for you to make custom notes to your patient.



In figure 2, the Impression report can be seen. In this view, you will see that PostureRay superimposes the actual line drawing method on the x-ray itself. Furthermore, PostureRay® can quantify and qualify the patient regardless if they have one or two curves in their thoracic region.





As chiropractors, we now have the tools to more easily measure, track and create evidence-based treatment plans for patients. Using tools such as PostureRay® saves time and creates unlimited marketing potential with referring medical doctors, particularly opening doors with orthopedic spine surgeons.
If you are interested in learning more about PostureRay® and how it can help you better document and treat your patients, please go to www.postureco.com or email sales@postureco.com.

Reference List
1. Schwab F, Dubey A, Gamez L et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 2005;30:1082-5.
2. Weinstein SL, Dolan LA, Cheng JC et al. Adolescent idiopathic scoliosis. Lancet 2008;371:1527-37.
3. Wong HK, Hui JH, Rajan U et al. Idiopathic scoliosis in Singapore schoolchildren: a prevalence study 15 years into the screening program. Spine 2005;30:1188-96.

Joseph R. Ferrantelli, D.C. graduated with honors from Florida State University in 1995 with a B.S. in Biological Sciences and earned his Doctor of Chiropractic (D.C.) degree from Life University School of Chiropractic, graduating Magna Cum Laude in March 1999. Dr. Ferrantelli is a distinguished Fellow of Clinical Biomechanics of Posture and a Certified Instructor for CBP® Seminars. Dr. Ferrantelli was named the “CBP® Chiropractor of the Year” by CBP®Seminars in 2002. Additionally, he has co-authored manuscripts published in top journals such as Spine, European Spine Journal, and JMPT. Dr. Ferrantelli is the webmaster for CBP® OnLine, www.idealspine. com and currently is in private practice in New Port Richey, FL.

Dr. Denise Perron has a Bachelors Degree in Biology and received her DC degree from Palmer Chiropractic College in the middle 1980s. She ran a high volume practice in Montreal, Quebec, Canada from 1986 to 2001. Her interest is in posture digitizers, and she has been working in that field since 2001. She is currently a consultant for business organizations and Chiropractors in Canada, USA, and Japan.

Michigan Association of Chiropractors Unanimously Approve ICA’s Best Practices and Practice Guidelines

By Joseph Betz, D.C.

In an effort to update existing ICA clinical practice guidelines while also defending practicing chiropractors from discrimination from insurance companies and rogue state boards, the ICA developed a committee to gather, read, evaluate and rate every single clinical chiropractic paper that has ever been written. This has resulted in the production of the ICA’s Best Practices and Practice Guidelines (ICA-BPPG) document. Over 1400 articles were individually reviewed and rated, resulting in support for chiropractic’s effectiveness for over 300 different health care conditions using a variety of chiropractic methods, including subluxation correction. BPPG Committee members met many times across the country to achieve this feat. The document has been available for public review since 04/27/2008 at www.icabestpractices.org.
The purposes of this ICA-BPPG document are to (1) locate and rate all levels of evidence for Chiropractic Care of a variety of health conditions, and (2) assist the practicing Chiropractor in making sound, fundamental, clinical decisions when providing Chiropractic Care in clinical practice. The BPPG Committee recommends that all state chiropractic associations form a committee to review the document and consider it for approval. Questions on the appropriate steps to perform this review can be directed to the author of this article. In the wake of recent chiropractic guideline development, it has become apparent that many mainstream state chiropractic associations have rejected these past efforts. However, the ICA-BPPG has shown that by gathering all levels of evidence from the case report to the randomized clinical trial, mainstream chiropractic associations will support the final product.
The Michigan Association of Chiropractors (MAC) was created from a Joint Venture Agreement and Plan of Consolidation by and between the Michigan Chiropractic Society and the Michigan Chiropractic Association Board of Directors several years ago. This unified chiropractic association has shown other states that chiropractors, speaking with one voice within the state, have a powerful voice. The MAC currently has approximately 75% membership. To our knowledge, this is a higher percentage of membership than any other state association. We contacted Dr. Donald M. Reno, Vice-President of the MAC, to ask him several questions about the recent approval of the ICA's Best Practices and Practice Guidelines.

AJCC: We at the AJCC understand that your state chiropractic association recently reviewed the ICA’s Best Practices and Practice Guidelines (ICA-BPPG) that has recently been made available for review. What was the determination of your assessment?

Dr. Reno: The ICA Best Practices and Practice Guidelines received an unanimous approval of the Board of Directors of the Michigan Association of Chiropractors. Our association determined that the quality of the document was based on a foundation of excellent evidence based studies. The ICA-BPPG committee is also comprised of the finest practitioners and researchers within our profession and this helped to solidify the unanimous vote.

AJCC: The review and adoption of practice guidelines has been met with skepticism, so what kind of score did the ICA-BPPG document receive in your association’s review?

Dr. Reno: The MAC rated the document a 10 on a scale from 1 to 10. With that being said, the ICA-BPPG got the highest rating possible. The review committee was comprised of doctors who belong to the various national organizations. We believe that this indicates that skepticism dissolves when quality research is approved by an association that is unified.

AJCC: Having reviewed this document and adopting its content to help protect your chiropractors in your home state, would you make the recommendation that other state associations independently review the guideline and consider adopting it? Why or why not?

Dr. Reno: We definitely suggest that each state review this document. As a matter of fact, if another state association wished to discuss our findings, we would welcome that opportunity.

The ICA-BPPG is currently available for review by individual chiropractors, state associations, chiropractic colleges, etc. By supporting/adopting the findings of this guideline, you hold a significant advantage over individuals and groups who fail to do so. The ICA-BPPG is by far the most comprehensive document ever produced in the chiropractic profession today. The authors and committee members worked tirelessly, without compensation, to produce a thorough document that will defend the rights of all chiropractors to care for patients without undue discrimination by the insurance companies and state boards when all we are doing is practicing, ethically within our scope of practice and up to the standard of care as recognized repeatedly by judicial system in the U.S. Often this discrimination against chiropractors comes from groups outside our profession, but often times these problems originate and are perpetuated from within.
There is a misconception that there is not evidence to support what chiropractors do in their offices, other than treating acute (and now chronic) low back pain and neck pain. This is not accurate. The problem is that past groups have chosen to ignore 85% of the chiropractic evidence by limiting their review of the literature to randomized clinical trials. This error was corrected by the ICA-BPPG Committee when we designed the methodology for the literature review. Simply stated, as the United States Department of Health and Human Services has outlined, there are 4 levels of evidence, and Expert Opinion is not one of them. The ICA-BPPG relied upon ALL of the evidence to develop its document, not merely a selective 15% of it.
The Chairs and Executive Committee Members of the ICA-BPPG document have taken great strides to include every clinical paper that has been written on chiropractic care. We did not produce a document that has its greatest finding merely support of Spinal Manipulative Therapy for Chronic low back pain. The ICA-BPPG will be used to defend chiropractors who manage a variety of health care conditions, using a vast array of clinical applications, including but not limited to subluxation correction. As the Michigan Association of Chiropractors, an organization whose unparalleled success lies in its diversity and unity, has discovered this document appeals to the majority not the minority fringes at either end of the profession!

Special thanks are extended to Dr. Don Reno for taking the time to answer our questions on behalf of the MAC. The MAC can be reached for comments and questions at info@chiromi.com. Questions or comments for the author can be directed to drjoebetz@gmail.com. The document, in its entirety, is available for review and comment at www.icabestpractices.org.

Dr. Joseph Betz has his practice in a state-of-the art spine rehabilitation center called Chiropractic BioPhysics of Idaho. He was born and raised in Erie, Pennsylvania and graduated from Cathedral Preparatory high school. He went on to earn his undergraduate degree in Biological Sciences from the University of Pittsburgh in Pittsburgh, Pennsylvania. After performing medical research for two years, Dr. Betz and his wife, Shelly, moved to Atlanta, Georgia, where Dr. Betz earned his Doctor of Chiropractic degree. After graduating with honors in 2001, Dr. Betz spent 8 months practicing with Dr. Deed Harrison, DC, learning Chiropractic BioPhysics®. In his time at this chiropractic clinic and research center, Dr. Betz co-authored several spinal biomechanics and chiropractic research papers, making him one of the youngest chiropractic researchers in the world. In addition, he is currently writing a chiropractic textbook on the management of scoliosis. He was one of the first officially certified Chiropractic BioPhysics® practitioners in the world.

What Does Our Chiropractic Research Really Say?

Would you or your practice have better piece of mind if one of the computers in your office had a summary of every original chiropractic research article conducted since the beginning of time? Mine does. Of course this would not be so worth while if the data-bank was not easily searchable by technique, health condition, and more. The fact that I can print a bibliography on any searches I do and can choose whether to include a summary of each individual research paper found in my search helps as well. A nice fringe benefit of being involved with the ICA’s Best Practices and Practice Guidelines (BPPG) project (www.IcaBestPractices.org) is the fact that the database our group compiled sits on a computer in my office for quick reference anytime.
One day, this database should be available online where it can be used by any ICA member the same way I can use it right now in my own office. Just for fun, I would like to overview selections from Chapter’s 10 and 11 of the ICA BPPG document here to elaborate some of the 339 or so named health conditions published chiropractic research has shown chiropractic has been helpful for. For those of you wondering how much of this information is based on symptom outcomes and how much is based on subluxation correction, I would ask the individual authors of the individual research studies their intent. From reading through, most research has been conducted with the focus and intent of correcting subluxation. Because of the chasm in our profession between those who embrace the correction of subluxation and those who refute it as clinically trivial, I would emphasize the information here is based on outcomes from the chiropractic procedures used regardless of the chiropractic clinicians intent. In other words, the research shows chiropractic works.

Curious for Some Search Results…
Search 1: Searching on, “Gonstead,” which I believe is the second most utilized chiropractic technique (diversified is the first), I found the average number of treatment visits was 29 over 20 weeks of care. Conditions in these papers shown to improve are as follows: Bell's Palsy, TMJ, Low Back Pain, Myasthenia Gravis, Bone Fracture, Headache - Migraine, Enuresis - Nocturnal, Occulomotor Palsy, Colitis, Vertigo, Otitis Media, Attention Deficit Hyperactivity Disorder, Dejerine-Sottas Disease, Asthma, Erb's Palsy, Scoliosis, General Chronic Degenerative Diseases, Infertility, Hot Flashes, Headache - Tension , Encopresis, Hypertension, Colic, Occupational Stress Syndrome, Whiplash, Anxiety, Nursing - Trouble Breast Feeding, And High Blood Pressure. One scoliosis paper did not show improvement, but others did. All other listed conditions showed improvement.
Search 2: Since I mentioned it I then searched on, “Diversified,” and found the average number of treatment visits shown was 20 over 18 weeks. Is 20 visits a magic number? Remember, this is research and many studies only treated once before re-evaluating so these studies skew the number of visits to the low end. 15% of the papers looked at only showed one or two treatments for the sake of maintaining research controls. 30% of these papers showed treatment visits between a low of 40 and a high of 250 to achieve their clinical results. One percent of studies did not show positive outcomes (this means 99% showed positive outcomes at low consumer cost) and 24% of these studies never mentioned how many visits were seen at all. The average number of weeks treated here was 18 but when excluding studies where only one or two or three treatments were applied, the average changes quickly to 26 weeks of treatment. Remember, the visit numbers commonly are for research to show measurable improvement and not resolution of the problem.
Conditions shown in this search to improve are as follows: ADHD, Allergies - Hay Fever, Angina Pectoris, Ankle Inversion Sprain, Ankle Pain, Ankle Sprain, Ankylosing Spondylitis, Anxiety, Aphasia - Acquired Verbal, Arnold-Chiari Malformation, Asthma, Auditory Neuropathy, Developmental Delay, Autism, Back Pain, Bladder Infection, Breathing - Difficulty, Capsular Fibrosis, Cardiac Arrhythmia, Carpal Tunnel Syndrome, Chest Pain, Child-Bed Fever, Colic, Constipation, COPD, Cough, Cranial Plagiocephaly, Deafness, Diffuse Idiopathic Skeletal Hyperostosis (DISH), Disc Degeneration, Disc Disease, Disc Herniation, Doule Crush Syndrome, Dysarthria - Cervical, Dysmenorrhea, Eczema - Acute Ectopic, Elbow Pain, Encopresis, Enuresis, Eustachian Tube Blockage, Eye Pain, Failed Back Surgery, Femoral Nerve Entrapment, Foot Pain, Gastroesophegeal Reflux Disease, Hallux Rigidus, Hamstring Strain, Headache, Headache - Cervicogenic And Vertigo, Headache - Migraine, Headaches - Cluster, Hearing Loss, Hiccups, Hip Pain, Hot Flashes, Hypertinsion, Hypertonia & Hyperreflexia, Immune Status, Infertility, Insomnia, Intercostal Neuralgia, Irritable Bowel Syndrome, Klippel Feil Syndrome, Knee Pain, Lateral Epicondylitis, Lateral-Flexion Asymmetry, Low Back Pain, Menopause Symptoms, Menstrual, Meralgia Paresthetica, Metabolic Disorders, Metatarsalgia - Primary, Motion Asymmetry - Cervical, Musculoskeletal Pain, Myasthenia Gravis, Myofascial Pain Syndrome, Neck Pain, Nursing - Difficulty, Nursing - Dysfunctional, Nursing - Hypolactation, Ochronotic Arthropathy, Otitis Media, Pain, Paralysis, Paralysis - Infantile, Paralysis - Left Arm, Patellofemoral Pain Syndrome, Pelvic Pain, Plagiocephaly - Non-Stenotic Deformational, Plantar Fasciitis, PMS, Pneumonia, Pregnancy, Pregnancy - Low Back Pain, Premature Ventricular Contractions, Radiculopathy - Cervical, Reiter's Syndrome, Rett Syndrome, Rotator Cuff Tear, Sacroiliac Syndrome, Sciatica, Scoliosis, Scoliosis - Mechanical, Shoulder Injury, Shoulder Pain, Shoulder Pain - Chronic, Shoulder-Hand-Syndrome, Sinusitis, Spasmodic Dysphonia, Spinal Cord Encroachment, Swimmer's Shoulder, Thoracic Disc Herniation, Thoracic Nerve Root Injury, Tight Muscle, TMJ, TMJ Pain, Torticollis - Congenital, Torticollis - Congenital Muscular, Transient Syncope, Tremour - Intention, Ulnar Neuropraxia, Urinary Incontinence, Uveitis, Vertigo.
Incidentally, a whopping 1.6% of diversified research studies failed to show improvement in the things being measured.
Search 3: How about, “Headaches?” I show approximately 138 research studies where headaches were looked at and 3 (2%) showed no significant improvement. Of these three studies not showing improvement, one showed an exacerbation of symptoms after the first adjustment, the second discovered the patient had renal cell carcinoma and the third showed headache as related to sleep apnea and did not report on whether the headache changed during treatment. Subjects of these studies were seen an average of 39 visits in 22 weeks.
Headache related conditions in these papers shown to improve are as follows: Asthma, Colitis, Constipation, Difficulty Walking, Disc Rupture, Dysmenorrhea - Primary , Eye Pain, Fracture - Lamina, Fracture - Pelvic, Gangrene, Headache, Headache - Cervicogenic, Headache - Cervicogenic And Vertigo, Headache - Migraine, Headache - Occipital, Headache - Tension, Headaches - Cluster, Headaches - Suboccipital, Hemiparesis, Hyperflexion-Hyperextension Syndromes, Hypertension, Indigestion, Infection - Acute, Infertility, Klippel Feil Syndrome, Leg Pain, Mid Back Pain, Neck Pain, Nervous Breakdown, Numbness In The Upper Extremities, Pinched Nerve, PMS, Polyuria, Purulent Discharge, Radicular - Arm, Sinusitis, Sprained Shoulder, T4 Syndrome, Tic Doloreux, Tinnitus, TMJ, Unexpected Weight Loss, Uterine Cramps, Vertigo, Visual Defect - Monocular, Visual Field - Narrowed, Visual Perception Deficit, Whiplash, Wrist Pain.
Incidentally, 15 of these studies were randomized clinical control trials (Level I Evidence) which are considered to be the gold standard of clinical research.
Chapter 11 of the BPPG document on treatment frequency and duration states, “It has been estimated that, among studies providing a break down on direct costs, the largest proportion of direct medical costs for LBP was spent on physical therapy (17%) and inpatient services (17%), followed by pharmacy (13%) and primary care (13%).”1 While only 3% was reported for Chiropractic Workers Compensation costs in the USA,1 Dagenais et al2 reported an average of 5% from studies in Australia, Sweden, United Kingdom, USA, and Korea. This data is very misleading because these authors stated… that, “Chiropractic,” included Osteopathy costs. Since Osteopathy has a bigger percentage of the health care pie world-wide than does Chiropractic, it is likely, based on this data, Chiropractic represents less than 2% in industrial nations.… “It is a known fact that costs of CAM (Complimentary and Alternative Medicine - Chiropractic) utilization are less than that for standard medical care.3 Thus, to reduce Workers Compensation budgets, it becomes apparent that standard Medical Care and Physical Therapy also need to be audited and guidelines developed to reduce costs within these two areas, not merely in Chiropractic.”
What might lawmakers and insurance companies or even your patients do if some of this information were to become more readily available? All indicators point to chiropractic as a safer, more natural and less costly way to help people. In this environment of evidence based practice, one major problem is only few know what the evidence actually shows. Even still, few understand how to accurately represent the evidence.
This ICA Best Practices and Practice Guidelines is not so much an ICA document as it is a chiropractic document. There is no spin on what research exists as the document shows simply the original clinical chiropractic research that does exist without filter or bias. At that point, the data starts speaking for itself. As a closing note, I want you to know the document is easy to read and not too long (there are many pages of references). It is available for professional review and reference in its draft form at www.IcaBestPractices.org. Please give it a look and then fill out our online survey for practicing chiropractors.

1. Guo HR, Tanaka S, Halperin WE, Cameron LL. Back pain prevalence in US industry and estimates of lost work days. Am J Public Health 1999;89:1029-35.
2. Dagenais S, Caro J, Haldeman S. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J 2008; 8:8-20.
3. Lind BK, Lafferty WE, Tyree PT, Sherman KJ, Deyo RA, Cherkin DC. The role of alternative medicine providers for the outpatient treatment of injured patients with back pain. Spine 2005;30(12):1454-59.