Written by Frederick Carrick, D.C.
Friday, 29 February 2008 15:16
Frederick Robert Carrick, D.C., Ph.D., is the Distinguished Post Graduate Professor of Clinical Neurology at Logan University and is Parker College of Chiropractic’s Professor Emeritus of Neurology. He serves as the President of the American Chiropractic Association’s Council on Neurology and is the President of the American Board of Chiropractic Specialties of the American Chiropractic Association. Professor Carrick is a 1979 graduate of the Canadian Memorial Chiropractic College and received a Doctor of Philosophy degree specialty in Brain Based Learning from Walden University’s Faculty of Education. He is the recipient of a multitude of professional, governmental and societal awards and the subject of the Emmy Award Winning Public Broadcasting Service series, Waking up the Brain. Dr. Carrick was recently honored with a Life Time Achievement Award in Contemporary Scientific Paradigms from Life University. He holds board certification in a variety of disciplines central to the neurosciences and has enjoyed an international reputation as a clinician and educator for twenty-eight years.
In an interview with The American Chiropractor (TAC), Dr. Carrick expresses some of the innovations that he has pioneered through his work.
TAC: Dr. Carrick, please tell our readers about some of the services and research that the Carrick Institute has been doing?
Carrick: The F. R. Carrick Institute for Clinical Ergonomics, Rehabilitation, and Applied Neuroscience (C.E.R.A.N.) of Leeds Metropolitan University consists of a faculty of world class scientists and clinical researchers in Biomedical Engineering and Rehabilitation, Experimental Psychology and Adult and Developmental Neuropsychology, Ergonomics and Human Factors, Cognitive Neuroscience, Linguistics, Developmental Neuroscience and research in Physical Therapy and Occupational Therapy. The participants have produced numerous patents and developments as well as translational research in fundamental biomedical technologies, including applications of high temperature superconductivity, imaging science, brain pacemakers, apnea monitoring, laparoscopy, pain management systems, neural nets, treatments for decubitus ulcer, drug delivery systems, non-invasive anesthesia, acoustic body parts identification, acoustic correlation transform, miniaturized MRI, and neurochemical modulation by weak magnetic fields. The Institute is affiliated with Winthrop-University Hospital in Mineola, New York. A doctoral program in Rehabilitation Sciences and in Clinical Rehabilitation Neuropsychology is offered by the F. R. Carrick Institute through the Faculty of Health of Leeds Metropolitan University.
The Carrick Institute for Graduate Studies conducts Graduate School Programs in Neurology in five languages and maintains thirty extension facilities throughout the world. Our program qualifies individuals for a professional Master of Neuroscience degree as well as fulfilling the requirements for the Board Certification Examination in Neurology by the American Chiropractic Neurology Board (ACNB). The ACNB was the first certification agency in chiropractic to achieve full accreditation through the National Commission for Certification Agencies (NCCA) of the National Organization for Competency Assurance (NOCA).
Our research investigations have resulted in many publications in the indexed scientific literature by our faculty and learners. We also have participated in numerous international congresses specific to neurology and rehabilitation. This year, I have been a co-author on two major publications involving Posturographic Changes and Motor Learning.1,2
We are publishing in the mainstream medical journals due to the impact factor of our investigations that represent our approach to brain function without drugs or surgery. Our acceptance and participation in major scientific congresses with platform presentations of our research have assisted us in our responsibility of sharing and service to others.
TAC: We understand that the Carrick Institute is also involved in humanitarian efforts. Could you tell us a bit more about them?
Carrick: Yes, the F. R. Carrick Clinics at the Meru District Hospital have been established to assist in serving the health care needs of the citizenry of Meru, Kenya. These people live in extreme poverty and suffer from devastating illnesses and diseases. Medicines are expensive and scarce in this area and the applications of neurological applications by chiropractors can assist in the diagnosis and treatment of many disorders without drugs or surgery. Chiropractic neurologists volunteer their time and pay their own expenses to work in our clinics. Their talents and dedication enable us to help people who truly are in need.
As well as our volunteer staffing, the Carrick Institute has coordinated the shipment of $500,000 worth of medicines and supplies to be distributed at our clinics this year. Microscopes, mosquito nets and other supplies are shipped directly to the F. R. Carrick Clinics at the Meru District Hospital. Our chiropractic neurologists work in concert with other health care providers. While the treatment of disorders of humankind without drugs or surgery is an option in developed countries, it is often a necessity in areas of the world where medicines are not available. Our interdisciplinary approach to health care and the dedication to service, above self, of our learners have allowed us to learn more about diseases not typically seen in our country and promotes the development of applications in a patient based paradigm of care.
TAC: How is the use of concepts in Functional Neurology different from what your average chiropractor is doing on a day in day out basis?
Carrick: Functional Neurology promotes an ability to understand the nervous system at a specialist level that compliments the role of the chiropractor and other health professionals specific to the nervous system of humankind. When we refer to function, we embrace not only the pathology in a system but those areas that are intact. A Functional Neurologist is trained to serve as a specialist consultant in the field of neurology. His/her examinations need to be more detailed than the general practitioner, and the treatment parameters are often different with a greater emphasis on multi-modal environmental stimulations including light, sound, temperature and rehabilitation. We find that many general practitioner chiropractors elect to train in neurology to enhance their skills and service to their community without a desire to become Board Certified.
Certainly, we attract chiropractors from very diverse backgrounds such that a neurological approach to patient care can be utilized to measure the consequence of a therapy. A functional neurological approach to patient care can allow the practitioner to know if his/her applications are in the best interest of a patient or if there is a need to do something different. By attending to a therapeutic approach addressing maximizing human neurological potential, we tend to embrace a different concept from those practitioners who have a pathology based practice.
TAC: Is this approach only taught to chiropractors?
Carrick: Our institute trains a variety of health professionals in functional neurology. Our programs are based upon neurophysiological principles that are true to all disciplines. In some locations, our participants are mostly medical doctors, whereas in others they might be mostly chiropractors and, oftentimes, a blend. Our training is not discipline specific but more specific to the diagnosis and treatment of neurological conditions without drugs or surgery. These types of treatments are being actively embraced by the global community subsequent to the needs of our public and growing concerns over the utilization of pharmaceuticals. Our methods of examination are standard in neurology and our learners are also trained to identify those conditions that are not best treated in these manners. Ours is a realistic program of education that prepares our clinicians to recommend the best mode of treatment in a paradigm that is patient based. The acceptance of our work by peer reviewed scientific committees for presentation at specialty congresses demonstrates an increased receptiveness of a functional neurological approach in health care.
TAC: Can you tell us about chiropractors and medical doctors studying together with the Carrick Institute?
Carrick: Our Institute provides instruction in a variety of areas central to the function of the human nervous system. The breadth and depth of material is central to all professions, whereas the applications that we provide are those that do not use drugs or surgery. There is a great demand from the public for the types of applications we provide.
While we do not teach medical doctors to adjust joints, we surely teach them the need for referral to a qualified chiropractor for certain conditions and vice versa. We attract learners from all disciplines because of the expertise of our faculty in sharing material which applies to all health care providers. We have very talented instructors and our programs have become very popular. For example, our program in Functional Brain Anatomy serves the needs of all disciplines and our program in this knowledge area is attended by both medical doctors and chiropractors. Our chiropractic learners’ level of knowledge is most impressive and they are on par with learners from other disciplines. In fact, it is most impressive when you observe a chiropractic neurologist on research rounds in the brain lab; they make us very proud.
TAC: What is it that motivates your activities with the Carrick Institute?
Carrick: We are motivated primarily by our service to humankind. We are an educational institution and our programs exist only due to the demands and needs of our learners to serve others. We are the largest provider of graduate school education in neurology to chiropractors and serve the clinical educational needs of a present learner enrollment of approximately 4,000 individuals. We have a responsibility to them and their patients to facilitate their learning of a difficult knowledge area. We have learned how to teach and how to inspire a mastery of a specialty through our attention to the breadth and depth of the subject material and by our direction to an application based outcome.
TAC: What are some of the obstacles you have had to overcome to arrive where you are?
Carrick: Our greatest obstacles have been our ability to serve the demand for our programs. We continue to have a greater demand than we can serve. We pride ourselves in attracting faculty who are skilled clinicians and talented educators. We only accept faculty that have the ability to teach and are considered top in their field. As a consequence, we find our programs very popular but we are limited in the number of programs we can maintain. We are able to maintain thirty programs throughout the world but, unfortunately, cannot serve the demands of all communities for our educational programs. We do not offer faculty appointments to individuals who are not best suited to clinical instruction and leadership. We have maintained a superior sharing and education but continue to face the obstacle of saying no to groups of doctors who desire our program in their area.
TAC: How are the attitudes toward this approach from other professionals you work with?
Carrick: We train our learners to be skilled professionals who speak the same language as others specific to the nervous system. Consequentially, we attract a diverse population of professionals as learners and our graduates are able to participate in a team approach to health care. Our candidates do well in multi-disciplinary scenarios. For example, at a recent symposium in Amsterdam on coma and vegetative states, our chiropractic learners sat side by side with medical neurologists and neurosurgeons who are also our learners. The level of understanding and fluency in mutual disciplines promoted a superior sharing which has benefited our global patient population. I am very proud of all of them; they work together and understand the skills and abilities of each other and, more so, they become more than colleagues, they become a global family of neuromates. So, I would suggest that the attitudes of those exposed to our programs and to our graduates is wonderful. Chiropractors refer to our chiropractic neurologists as do other practitioners and our specialists also refer to the general chiropractor and to their medical counterparts. Our graduates are well trained and contemporary in their knowledge base.
TAC: Can you tell us about Board Certification in neurology for chiropractors?
Carrick: Board Certification in neurology for chiropractors is through the American Chiropractic Neurology Board (ACNB). This autonomous agency is recognized by the American Chiropractic Association as the sole authority for credentialing in neurology for the chiropractic profession. The ACNB is fully accredited by the National Commission for Certification Agencies (NCCA) of the National Organization for Competency Assurance (NOCA). Chiropractors who have completed our program of study are eligible to take the written and practical portions of the examination. The standards of Board Certification have been elevated to the level of NOCA/NCCA and are designed to protect the public and assure all stake holders of the quality of the certification process.
TAC: What kind of conditions would have the best likely outcome when being treated with some of the concepts you teach?
Carrick: Customarily conditions involving human posture and gait including disorders of movement, such as dystonia, seem to have superior outcomes with the drugless approaches we utilize. Falls are the greatest cause of accidental death in almost all age groups and our approaches to fall prevention appear to be superior to any other modality. Learning and behavioral disorders show promise as do a variety of pain syndromes. A Functional Neurological approach to neurological syndromes may have a varied outcome, such that the individuality of the patient has a great deal to do with the consequence of treatment. Two individuals with the same syndrome might not have the same results; however, a neurological approach will enable the practitioner to know if the patient is not progressing or is getting worse so that a change can be directed.
TAC: How is it that you would interpret the vertebral subluxation complex, based upon your research?
Carrick: My research is brain based and not specific to a vertebral subluxation complex. I can tell you, however, that angulation of joints is a consequence of brain activity. An individual who has suffered a stroke with an angulation of his arm and leg has that posturing because of his brain situation. Quite simply, the joint angulation did not result in the brain pathology of the infarct; it represents a state of the nervous system that already exists. It is a window or marker of a pathological process. I would suggest that angulation of joints in the spine is similar and might act as an observable marker that something is wrong in the nervous system. Applications that are specific to brain function can change the angulation of joints due to their effects on soft tissue tensions, just as they might change what is referred to as a vertebral subluxation complex. I measure extensor tone and activity in spinal, trunk and appendicular muscles and observe changes with environmental stimuli of a variety of modalities, including chiropractic adjustments. It would appear, from a brain based perspective, that the subluxation reflects a functional view of the nervous system and exists as a result of the soft tissue tensions produced by segmental and super segmental neurological integration similar to other joint angulations. It does not appear to be the cause of syndromes but the consequence.
TAC: Is there any diagnostic or therapeutic equipment that you would recommend to the average chiropractor?
Carrick: Absolutely. The CAPS force plate by Vestibular Technologies provides data that allows the clinician to predict the probability of a fall. It is a computerized force plate that measures human stability and sway and gives a statistical report that does not have to be interpreted by the doctor.
Falls are the greatest cause of accidental death and most fallers have no signs or symptoms before a fall. In fact up to 70 percent of the population is at risk of falling and might be helped by those individuals who can identify their pathology. We recommend that the chiropractor not charge for the test, even though there are CPT codes for the procedure. Our rationale is simple. This testing is necessary and is a public service. If the test is free, then people will get the testing and pathology will be identified. If people have to pay for a test, the probability increases that they will not have it done. With 70 percent of the population having pathology of stability, we find that people who are in need of care will customarily choose the provider who gave them the test. The treatment of pathology of human stance and stability is by a drugless non surgical approach and is in the armamenterium of the chiropractor.
Both the doctor and patient have an outcome measurement in the post tests which will indicate an improvement or worsening or even no change, so that they both can understand the direction and consequence of their care. Since neither I nor any of our faculty or the Institute accepts any royalties or commissions for recommending a modality, we feel comfortable in talking about it. We also have several registered studies utilizing the technology.
TAC: Are you personally teaching the seminars currently?
Carrick: I rarely teach anymore, spending the majority of my time involved with brain research, although I do present papers at a variety of scientific meetings throughout the year. I will be the instructor for our Alpine Neurology Symposium in Zermatt, Switzerland, this coming April. We couple neurology with a ski week and our symposium is specific to human posture and movement disorders. We have participants from around the world who have registered to participate and it is difficult to say no to such meetings.
TAC: What is the biggest opportunity you see in the chiropractic profession today?
Carrick: Chiropractors are uniquely positioned to serve a greater percentage of the population due to advances in clinical procedures and outcome measures. Our society is embracing a more intimate relationship with our environment and demands for a drugless approach to health care are exploding. Our patients are better educated than ever before and demand a superior knowledge base from their health care providers. Those doctors who increase their knowledge base and skill levels will enjoy an opportunity that will facilitate the service of their practice. The neurological consequences of chiropractic care demand a superior knowledge of clinical neurophysiological applications. Chiropractors might consider higher education as the biggest opportunity they have if that education is specific to their job. I can think of no opportunity superior to the chiropractor than an increase in their clinical knowledge of the nervous system and the applications that they might use to evoke change. . Managed care has affected both patient and provider satisfaction and many providers are forced to obtain the skills which allow them to escape the boundaries of such management. A large majority of our learners are able to establish a reasonable fee for service and establish practices that allow them to escape the bonds of third party relationships. The demand for a Functional Neurological approach to health care exceeds the number of our specialists and promotes an opportunity for those doctors who desire to raise their knowledge levels and abilities to a higher level.
TAC: Where do you see the future of chiropractic headed?
Carrick: The role of all health care providers is changing. Chiropractors utilize a patient based paradigm that demands a higher level of training for the health care professional. Chiropractors are being directed to additional training beyond the DC degree because of the public interest. We have seen an explosion in the number of chiropractors who enroll in our Graduate School Programs in Clinical Neurology and we understand our role and responsibility in our training. We train chiropractors that have many years of experience in practice and they become better doctors. We train debutante practitioners and they are able to enter practice at a superior level. The future is very bright for those chiropractors that continue their education and obtain a superior level of mastery of their profession. The chiropractic profession is based upon a neurological approach and I see that we have little choice but to embrace it; our future is bright.
TAC: Any final words for our readers?
Carrick: We have trained chiropractors who are skilled in a variety of techniques and philosophies. Ours is not a program of technique but a process by which the doctor might be able to do his/her job in a superior fashion, regardless of their techniques. We have trained the majority of the technique gurus in chiropractic and, at the end of day, we find that we have been able to promote a mélange of so many talented people. Chiropractors who speak the same language and can communicate within and beyond our profession have skills which are better and their role as part of a global health care team is ensured. I have been blessed to have been associated with so many talented people in my life and I am very proud to have played a part in their training; they have taught me much.
You may contact Dr. Carrick at Carrick Institute for Graduate Studies, 203-8941 Lake Drive, Cape Canaveral, Florida 32920. Phone 1-321-868-6464; Fax 1-321-868-6468; or visit www.carrickinstitute.org.
1. Carrick FR, Oggero E, Pagnacco G, Brock JB, Arikan T. Posturographic testing and motor learning predictability in gymnasts. Disabil Rehabil. 2007 Dec 30;29(24):1881-9. Epub 2007 Feb 9. PMID: 17852265
2. Carrick FR, Oggero E, Pagnacco G. Posturographic changes associated with music listening. J Altern Complement Med. 2007 Jun;13(5):519-26. PMID: 17604555 [PubMed - indexed for MEDLINE]
Written by Arthur Croft, D.C.
Wednesday, 30 January 2008 17:28
Dr. Croft is the Founding Director of the Spine Research Institute of San Diego. He has been actively engaged in whiplash research for the past twenty-five years and has co-authored a best-selling textbook on whiplash (Whiplash Injuries: the Cervical Acceleration/Deceleration Syndrome, 3rd edition, 2002) and temporomandibular joint disorders (Whiplash and Temporomandibular Disorders: an Interdisciplinary Approach to Case Management), along with several other books, textbook chapters, and over 320 professional papers. He was the original developer of the now widely used whiplash (WAD) grading system, as well as the widely adopted treatment guidelines. Dr. Croft wrote and produced the Emmy-nominated video Whiplash, and the most recent human subjects crash test DVD’s, Machine vs. Man I and II and is the only chiropractic physician to conduct ongoing, full scale human volunteer crash testing.
Dr. Croft is a biomechanist, a trauma epidemiologist, and chiropractic orthopaedist and lectures extensively in the United States and abroad. He serves on the editorial boards of several professional peer-reviewed chiropractic, medical, and engineering journals, including Spine, Archives of Physical Medicine and Rehabilitation, SAE, JMPT, DC Tracts, Journal of Musculoskeletal Pain, Chiropractic Technique, and is a senior editor of the Journal of Whiplash-Related Disorders. He has served as faculty of University of California, San Diego, Southern California University of Health Sciences, Western States Chiropractic College, and New York Chiropractic College. In addition to his own research, Dr. Croft has contributed to several research steering committees and has participated in RAND projects, including the cervical spine manipulation study, and has served as a grant reviewer for the Foundation for Chiropractic Education and Research and the National Institutes of Health. Dr. Croft is also a certified accident reconstructionist (NUTI). He currently serves as a panelist on the International Whiplash Task Force. Dr. Croft’s focus is public health and injury prevention and he is very close to receiving his PhD in epidemiology.
In an interview with The American Chiropractor (TAC), Dr. Croft shares some of the wisdom his studies have distilled.
TAC: Dr. Croft, please tell our readers a bit about some of the things you have been able to discover regarding whiplash through research.
Croft: Most of the discoveries concerning the whiplash phenomenon have come from the eight years of human subject crash testing we’ve done at the Spine Research Institute of San Diego. In many cases, our findings have been new and innovative and, in other cases, they have served to support or extend previous research or theory. We’ve found, for example, that occupant kinematics and biomechanics is much more complicated than previously thought and that smaller persons and larger persons have very different responses.1 A small female will experience two to four times the head linear acceleration as a larger male in the same crash. The male, however, will experience greater rearward bending.
We’ve compared frontal and rear impact collisions under identical crash conditions.2,3 We’ve tested the standard crash test dummy (HYBRID III) and the newer, biofidelic rear impact dummies (RID2 and BioRID II). In all cases, this was the first research to actually compare human and dummy responses on a validation platform under the same crash conditions.8,9
We’ve evaluated Saab’s antiwhiplash seat in a direct comparison to standard car seats. We’re the only group, to date, that has followed up with long-term surveillance of crash test volunteers using digital incliniometry, algometry, and multiple upright MRI with flexion and extension.
Unlike reports from some crash testing, we’ve documented injuries in about 30 percent of volunteers. We’ve also evaluated some standard accident reconstruction methodologies, such as the momentum/energy/restitution (MER) method and shown that it is not uniformly reliable.6 We’ve evaluated event data recorders (EDR)—the car’s black box that records acceleration during a crash—and compared it to a gold standard data from highly sophisticated and calibrated accelerometers. Its accuracy turns out to be nonlinear, falling off at lower crash speeds. We’ve shown that 45 percent of all chronic cervical spine pain is likely the result of motor vehicle crash injury.12 These are just some highlights of the many results and findings we’ve gained from crash testing. And then we’ve done some population-based studies10,11 and clinical studies as well.13
TAC: How do you feel the chiropractic profession is prepared to deal with CAD-type injuries?
Croft: To be frank, most chiropractors don’t have much formal training in whiplash traumatology because the curriculum in our schools doesn’t include it. I recognized this in my first year of practice and, while filling in the gaps in my knowledge, the idea of the whiplash textbook came to life. The first edition came out in 1988 and Whiplash Injuries: the Cervical Acceleration/Deceleration Syndrome is now in its third edition. The educational shortfall, of course, has also led to my seminar series and we provide chiropractic students with a large discount. The problem seems to be that the schools are under pressure to satisfy CCE core requirements on the one hand, and maintain their competitive edge on the other. Adding optional curriculum only extends the duration of the program and makes the school less competitive with other schools. So it is unlikely that students will get more than a lecture or two on whiplash in the future. That’s about all I got at Los Angeles Chiropractic College.
The problems of Personal Injury today are more convoluted than they were in the past. Insurers have made it progressively more challenging for doctors and lawyers over the past two decades, and physicians and lawyers have generally followed one of two paths: either they continue to do the same old thing year after year until they seemed to be swamped at every turn, or they attempt to keep pace with the rapidly evolving strategies. The first group eventually has given up, while the second group is actually able to pick up the slack from the first group. I remember that, in the early 1980’s, we just sent in our bills and we got paid. We wrote narrative reports in cases where there were lawsuits and they seemed to be sufficient, even though—speaking, at least, for myself—I had no idea what I was doing and would probably be mortified to read those reports now.
The world is much more sophisticated today. Not only has an entire new literature developed, but the insurance industry has developed a number of very successful tactics to defeat claims made against them.
TAC: Can you give us some examples of these new tactics?
Croft: Chief among them is the MIST defense. This arose out of an Allstate program which was devised by a large consulting firm in the 1990’s. It stands for minor injury, soft tissue. It’s been so successful for Allstate that most major auto insurers have followed suit in one way or another. The chief tactics are to "delay, deny, and defend."
The way it works is this: When a claim is made against the insurer and the property damage of the claimant’s vehicle is under $1000, the case is automatically "segmented" to the special investigative unit (SIU). This is the fraud investigative arm, so it is a serious issue and can later result in a complaint being filed with the state board of examiners and even trials in front of administrative law judges. The insurers consider this a "soft fraud," meaning that it is not an outright insurance fraud, but a situation in which medical charges and claimed injuries are excessive or overstated. The end result, however, is that the insurer will use this as a pretext to deny billing.
SIU investigators may call the patient and request an interview. They will ask what the doctor did on various appointments. Usually, patients can rarely verbalize their office visit in detail and usually answer, "I don’t remember." This will be interpreted to mean that nothing was done—more evidence of fraud.
If there is an attorney on the case, I would advise patients to refer these calls from investigators to the attorney. The most important take-home point from this is that we investigated the correlation between crash damage and three possible outcome parameters: (1) acute injury risk, (2) injury severity, and (3) long-term symptoms. In this meta-analysis of all medical and engineering literature going back to 1970, we found only four relevant studies and they did not support the notion that one could gauge any of these parameters from crash severity.5 This paper is available as a free download (go to www.medscimonit.com and search under author for "croft") and should be in the possession of every physician and attorney working within this arena, because it shows, once and for all, that this MIST segmentation policy is not scientifically or empirically based. Instead, it is an arbitrary, cost-saving device for the insurer which is deceptive and entirely bereft of an evidentiary foundation.
The reason it works so well is because low velocity crashes that produce minimal property damage do look trivial to most lay people who see only a photo of the car’s bumper, so the defense can effectively rely on the jurors’ intuition. We produced DVD’s of real crash test footage which more dramatically illustrate what happens in these MIST cases, but most jurors will never get to see these.
Ultimately, to be successful in PI today, DC’s need to have embraced the latest literature. They need to understand crash mechanics, occupant kinematics, and the numerous strategies applied in these cases. Otherwise, they—and their patients—will more likely fall prey to the more robust tactics employed by the defense.
But, let me be clear about one thing: In nearly every case, the defense case is almost entirely based on junk science, innuendo, reliance on faulty "common sense," and outright deception. If you know how to deal with it, it dissolves like smoke in the wind.
TAC: Do you have a particular stance with relation to videofluoroscopy?
Croft: I have been an advocate of videofluoroscopy (VF) since the early 1980’s. It can provide information about the spine that cannot be obtained by other methods. In demonstrating certain types of pathology, therefore, it is unique as a modality.
Having said that, the scant amount of research to date is disappointing. My colleagues and I did some research years ago4,7 but, as an orthopaedist, I felt that radiologists should be the ones to carry on with that kind of work. Oddly, though, radiologists, with some exceptions, have turned a blind eye to VF, and many appear to be outwardly hostile to it.
I think it is crucial that this profession develop a training and licensing infrastructure for VF. We should also develop a best practices guidelines with respect to indications for it, how it should be performed, and what it should cost. Currently, none of this infrastructure exists. It is also crucial that we invest in more research, beginning with the collection of normative data.
TAC: What is it about CAD that has captured your imagination and led to the vast database of information that you have been able to accumulate?
Croft: That’s simple. This is a huge public health problem today in all parts of the world. Every year, in the U.S., three million people are injured this way. Of these, about half will be left with permanent residua and half a million will become disabled to some degree. It has an annual comprehensive cost (i.e., the total cost including lost wages, medical, legal, etc.) of $43 billion, which is about what we spend on diabetes. But, unlike diabetes, whiplash injuries are largely preventable, without resorting to expensive lifelong interventions and dramatic lifestyle changes.
We are interested in ways to (1) prevent crashes, (2) improve crashworthiness to reduce injuries in collisions that are unavoidable, and (3) make treatment more efficacious. All of these are exciting vistas and all of them are being actively and aggressively researched right now. This is, in fact, one of the fastest growing areas of investigation in both medicine and engineering and I am involved in both fields, so "captured" is a very apt term. But I can certainly say that I love my work.
TAC: Are you currently seeing patients?
Croft: I see patients in consultation. In some cases, I simply review records and render reports. I do a lot of international work in this manner. In other cases, patients come to California to see me for an examination. They come mostly from the U.S.
I serve as an expert in cases large and small. I think my input is unique, because I can provide an opinion not only as a physician, but also as an epidemiologist, crash test researcher, and biomechanist. Wearing all of these hats means I can provide a sort of polymath opinion for the price of a single expert, while simultaneously obviating the problems of internal disagreement among multiple experts!
TAC: What is the most common problem you see among chiropractors today?
Croft: A lack of cohesion and a failure to understand that the old "separate but equal" philosophy is no longer viable. Most chiropractors don’t seem to recognize that we won’t be able to legislatively insulate ourselves from extinction. Many have been falsely buoyed by the Wilke’s case. This merely changed the game plan of chiropractic’s enemies. The erosion of our influence and scope is evident in many states, including California. With a stroke of his pen, long-time chiropractic friend and now Governor Arnold Schwarzenegger sharply limited our place in the workers’ compensation system.
The healthcare world now demands verification and validation. We have not been very responsive in that context. Nor have we been effective in policing our own ranks. Meanwhile, PT’s have been more active in research and now have doctorate (DPT) level programs. They will be looking to have autonomy and to practice manipulation and, if the insurers see them as being more tractable than DC’s have been, watch for a change in reimbursement practices that will favor DPT’s. And the profession won’t be able to sue its way out.
We are also seeing changes in the use of non-physicians—a change also driven by insurers’ profit goals. In many cases now, when patients have surgery, the assistant surgeon is a physician’s assistant (PA) rather than a surgeon. Will there be a corollary in chiropractic?
TAC: What is the biggest problem or challenge you see in the chiropractic profession today?
Croft: The biggest challenge is to face the research/validation/cohesion problem mentioned earlier. If the members of this profession would donate just $100 per year to a research fund, we could really accomplish something big. Little science shops like mine have always—with some exceptions—been self-funded. We simply don’t have the budget for really big projects. But that’s what the profession desperately needs.
TAC: Do you have any recommended marketing strategies that chiropractors can do to attract new patients and/or to keep current patients?
Croft: Yes. We developed a program called Auto Safety Facts that is designed to provide physicians with the tools to go out to their communities and educate the public in critically important safety issues like head restraint geometry, seat belts, airbags, child protection systems, etc. It is not about chiropractic—it is about safety. Of course, it is also useful in the clinic. Our doctors have had surprisingly good success with it. And, best of all, they are probably actually saving lives and preventing serious injuries in the process. This is the kind of positive PR the profession really needs.
You may contact Dr. Croft at
, www.srisd.com or by calling the Spine Research Institute of San Diego at 1-619-423-9867.
1. Croft A, Freeman M. The Neck Injury Criterion (NIC): future considerations. 44th Annual Proceedings of the Association for the Advancement of Automotive Medicine. Chicago, IL, 2000:519-21.
2. Croft A, Haneline M, Freeman M. Differential Occupant Kinematics and Forces Between Frontal and Rear Automobile Impacts at Low Speed: Evidence for a Differential Injury Risk. International Research Council on the Biomechanics of Impact (IRCOBI), International Conference, Munich, German, September 18-20 2002:365-6.
3. Croft A, Haneline M, Freeman M. Low speed frontal crashes and low speed rear crashes: is there a differential risk for injury? . 46th Annual Proceedings of the Association for the Advancement of Automotive Medicine. Tempe, AZ., 2002:79-91.
4. Croft A, Young D. Videofluoroscopy: a sampling of chiropractic radiologist’s opinions. Topics Diagn Radiology Adv Imag 1994;2:4-10.
5. Croft AC, Freeman MD. Correlating crash severity with injury risk, injury severity, and long-term symptoms in low velocity motor vehicle collisions. Med Sci Monit 2005;11:RA316-21.
6. Croft AC, Haneline MT, Freeman MD. Automobile crash reconstruction in low speed rear impact crashes utilizing a momentum, energy, and restitution (MER) method. International Congress on Whiplash-Associated Disorders. Berne, Switzerland, 2001:28.
7. Croft AC, Krage JS, Pate D, et al. Videofluoroscopy of cervical spine trauma-an interinterpreter reliability study. J Manip Physio Ther 1994;17:20-4.
8. Croft AC, Philippens MMGM. The RID2 biofidelic rear impact dummy: A pilot study using human subjects in low speed rear impact full scale crash tests. Accid Anal Prev 2007;39:340-6.
9. Croft AC, Philippens MMGM. The RID2 biofidelic rear impact dummy: a validation study using human subject in low speed rear impact full scale crash tests. Neck injury criteria (NIC). 2006 SAE World Congress. Detroit, MI: SAE, 2006.
10.Freeman M, Croft A, Centeno C. Fatal head injury cases in a rural Oregon county. . Proceedings of the 19th World Congress of the International Traffic Medicine Association. Budapest, Hungary, 2003.
11. Freeman MD, Croft AC, Nicodemus CN, et al. Significant spinal injury resulting from low-level accelerations: a case series of roller coaster injuries. Arch Phys Med Rehabil 2005;86:2126-30.
12.Freeman MD, Croft AC, Rossignol AM, et al. Chronic neck pain and whiplash: a case-control study of the relationship between acute whiplash injuries and chronic neck pain. Pain Res Manag 2006;11:79-83.
13.Freeman MD, Sapir D, Boutselis A, et al. Whiplash injury and occult vertebral fracture: a case series of bone SPECT imaging of patients with persisting spine pain following a motor vehicle crash. Cervical Spine Research Society 29th Annual Meeting. Monterey, California, 2001.
Written by Jeffrey Slocum, D.C.
Saturday, 08 December 2007 17:13
Dr. Slocum graduated from Logan College of Chiropractic in April 1993. He has been the owner of his practice for over fourteen years. Dr. Slocum is a fourth generation chiropractor and has focused on developing a family wellness based practice that uses state of the art technology and focuses extensively on staff development. Dr. Slocum has been named Mid-coast Maine’s #1 Chiropractor for 9 consecutive years. Through his commitment to alliance development and community outreach, he has served as an advisor to many of the largest employers in Maine and has become a well known speaker for the Maine Municipal Association and Maine Department of Education.
He and his partner, Dr. Rok Morin, have created the most advanced community outreach and marketing program in chiropractic. Their Learning Curves Program helps its members develop civic, social, and health care leadership through time tested and proven methods of building relationships, creating more value for chiropractic and more trust in their message.
Dr. Slocum was honored in 2004 as Masters Circle Chiropractor of the year, and Dr. Morin was named the Associate Doctor of the Year by The Masters Circle in 2006.
In an interview with The American Chiropractor (TAC), Dr. Slocum demonstrates his passion for chiropractic and humanity.
TAC: Tell us about the services you offer chiropractors and how or why they are offered.
Slocum: Dr. Morin and I began Learning Curves out of our passion for the advancement of chiropractic and the vision of civic, social, and health care leadership in a chiropractic model. The Learning Curves program is a multi-tier community outreach and marketing program that has a primary focus of helping its members develop leadership skills, clarify their core practice values, and market their practices in powerful ways to serve more people. Our Advanced Citizenry training model helps individual chiropractors understand the seven characteristics of effective leadership. It is the goal of the Learning Curves team to provide its members all of the tools and resources they need to effectively build their identity as the most valuable and trusted contributor to the overall health and wellbeing of the individuals in their communities.
TAC: How do you feel chiropractors should work with medical doctors, surgery, and vaccination?
Slocum: Simple: Understand what chiropractic means to you, develop a rock solid foundation for your professional beliefs, and have the courage to tell the truth without fear of being different. I have found, consistently, when we share our message with non-chiropractic health professionals with certainty, congruency, and confidence, we find that it is more often met with interest and acceptance than it is with disinterest or indifference. When we approach other providers with the goal of finding ways to work together and we highlight our common goals of better patient outcomes, only pure unadulterated ignorance can interfere with a positive outcome and, more often than not, we don’t run into that level of bias.
TAC: One of the components of your program is the Learning Curves curriculum to educate children. Why do you think that is important?
Slocum: We developed our curriculum because we understand that, for chiropractic to move forward and establish a leadership position in health care, we need to change some of the ways we share our message and when we share it. We started by looking for a model that has been successful for other health care systems and we realized that the most highly advanced and accepted health and wellness model on the planet was the dental hygiene model. When you look at the development of the dental hygiene model, you start to see that it has happened in a relatively short period of time. In the period of roughly five decades, the dental association has created a generational wellness model that is accepted by all to be an essential part of a healthy lifestyle. They did this through early education and continual reinforcement in the classroom. Dentists became role models and mentors to children, and that relationship and the value system that it created was carried through life and became the value system we now share with our children every night before bed. Our research shows that, between the ages of seven and eleven, children are capable of learning causal relationships and relate lifestyle behaviors with health outcomes. At this age, they are still more interested in personal wellbeing than they are in social wellbeing or acceptance. We know that, if we take this lesson from the dental association and use it to shape the health paradigm of the next generation, we can create a powerful and lasting paradigm shift where spinal hygiene and the role of chiropractic will be seen as a valuable and necessary part of a healthy lifestyle for future generations.
TAC: What are the attitudes toward you from other professionals you work with?
Slocum: I think the biggest attitude issue we have facing our profession is the issue we have with ourselves. I feel that we have a values issue within chiropractic. We have become a profession that lacks fusion and is fractured. Individual chiropractors need to start with themselves. It is only when we, as individuals, start to take professional responsibility seriously and become more courageous and disciplined with our message, that we will be able to serve with more compassion those that are suffering with the silent dread of chronic subluxation. We need to commit to working tirelessly to create a more just and fair health care delivery and reimbursement system, and start to respect the honor and privilege that comes with the degree of Doctor of Chiropractic. As we do that individually and that becomes the standard for our profession, we will begin to move forward with a greater sense of self respect and be able to declare with pride and dignity that chiropractic is healthy and well. I believe that everything that needs to be done is already there; we just need to focus on our purpose and avoid getting stuck in the process. Just like the body needs no help, just no interference, the same can be true for chiropractic. As a profession, we could be incredibly powerful and it is my dream that the hard work of the pioneers of chiropractic will be honored by the commitment and dedication of today’s chiropractors and that, through that commitment to the greater good of our profession, we will have something very powerful to share with tomorrow’s chiropractors.
TAC: What is the most common problem you see among chiropractors today?
Slocum: The lack of a clearly defined purpose. When we are unsure of our professional values, it is impossible to stay on purpose. The foundation of the work we do with our Learning Curves members is to help them define their professional values and understand how those values contribute to their purpose. Without a clearly defined purpose based on a firm foundation of values, our vision becomes narrow and our actions or procedures become meaningless. This lack of foundational stability is what leads to the frustration that most chiropractors feel at some point in their careers.
TAC: What is the biggest opportunity you see in the chiropractic profession today?
Slocum: We now have the ability to support what we do with great technology. Technology and the ability to evaluate and assess subluxation in objective and reproducible ways create more certainty in practice and more certainty in the power of chiropractic. This expanded level of certainty gives us the power to share our message with more courage and discipline to more people more often. We have more credible technologies that are supported by reproducible trials that demonstrate the effects of subluxation than ever before. We have the ability to support our principles with real science and that will only help to build our professional self esteem.
TAC: Can you think of one change that a chiropractor can do to significantly impact his/her practice’s growth immediately?
Slocum: Call us to find out how we can help them clarify their values, define their purposes, and use our tools and resources to demonstrate their value as civic, social, and health care leaders for their community. Our members not only attract a lot of new patients, but their patient-visit averages go up, their case averages increase, and their referrals and retention rates go up. Our Learning Curves members understand that, through community outreach and education, they attract educated and engaged new patients that are not just shopping for health care; they have already bought the relationship.
TAC: Do you have any recommended marketing strategies that chiropractors can do to attract new patients and/or keep current patients?
Slocum: Commit to becoming more valuable to your community. Building relationships based on trust and contribution is the key to increasing your social capital. When you become more valuable to your community, your community becomes more valuable to you.
TAC: Where do you see the future of chiropractic headed?
Slocum: I see a very bright future for chiropractic. I believe that we are moving out of the adolescent phase of our professional development and on to adulthood. From about 1895-1960, our profession was in its infancy and the growth of chiropractic was marked with incredible hope and expectation. Our pioneers showed incredible commitment, perseverance, and bravery. We learned, adapted, took some lumps and bruises, but we did so with confidence in our principles. From 1960 to today, we have been in an adolescent stage where we have been awkward, uncertain, fearful, and selfish.
I believe that the end of our adolescent phase is here and there is a growing sense of individual and collective strength that is welling up in our profession. I believe that, as we start to become more mature and we see the strength that comes with responsibility, courage, and discipline, we will become a profession that will enter an adult phase marked with a redefined sense of professional values, self discovery, growth and fulfillment. I think the best way to sum up the state of chiropractic going forward is the declaration from my friend and mentor Bob Hoffman. His declaration is, "There has never been a better time to be a chiropractor," and I couldn’t agree more.
TAC: Any final words for our readers?
Slocum: To be your best, you must do what the best do: You must find a coach that serves your personal and professional growth goals. I believe that every chiropractor and his or her entire team needs to work continuously on values clarification, develop a clear purpose, and have a boundless vision. At the very least, find a mentor or a role model and become a sponge; absorb all you can from the people you trust and look up to. I have found coaching with The Masters Circle to be extremely helpful to me personally and professionally. I have spent the better part of the last three years in and around the many excellent coaching companies available today and I have realized that there is always something new to learn and always a new perspective that can help you overcome obstacles and discover your genius.
For more information, contact Dr. Slocum at 1-800-613-2528 or
Written by Gerard Clum, D.C.
Thursday, 08 November 2007 16:33
Dr. Gerard W. Clum, the profession’s most senior chiropractic college president in the world, received his Doctor of Chiropractic degree from Palmer College of Chiropractic in 1973. He was a member of the Palmer faculty and practiced in Davenport, Iowa, in 1974 before becoming a member of the founding faculty of Life Chiropractic College in Marietta, Georgia, in January 1975.
In 1981, Dr. Clum was asked to serve as the president of Life Chiropractic College West, a position he holds to this day. Over the course of the past thirty-four years, Dr. Clum has served on the board of directors or as an officer of the Association of Chiropractic Colleges, the Council on Chiropractic Education, the International Chiropractors Association, the World Federation of Chiropractic and the Foundation for Chiropractic Progress. Currently he serves as the president of the World Federation of Chiropractic and as a member of the board and executive committee of the Foundation for Chiropractic Progress.
TAC: Dr. Clum, tell us some of the exciting events that Life West is currently experiencing
Clum: As a part of the silver anniversary celebrations of Life Chiropractic College West in 2006, the College completed a comprehensive assessment of what was accomplished over the past quarter century as well as a plan for what we wanted to see happen at the College as we move into our second quarter century. We did identify several areas on which to focus our attention for the near future. These were not necessarily areas where we felt the College was underperforming; rather they were areas where we felt the timing was right for greater emphasis within the College. The areas have come to be known on campus as the four T’s—Tradition, Technique, Technology and Tomorrow.
Life Chiropractic College West has been a pioneer in the chiropractic profesion with respect to the implementation of digital imaging.
Life Chiropractic College West would never have come into existence had it not been for the efforts and vision of Dr. Sid Williams. The "Tradition" we speak of includes the central concepts of the Life Movement, that is, Lasting Purpose—to love, to give, to serve and to do out of our abundance. The "feel" of our campus is very important to us and we also know that that feel is created by the people who occupy and enliven the campus. The College has had a long history of being on the cutting edge of technique instruction and application. We have recently re-energized our Technique Department with a revision in our required curriculum as well as our elective curriculum. Earlier this year, the College made offerings in Activator, Blair, Chiropractic Biophysics, Knee Chest Upper Cervical and NUCCA required courses in addition to our existing technique curriculum. Further, we have designed advanced courses in each subject area that are available on an elective basis.
The Technology side of the campus covers everything from admissions to alumni and everything in between! Also, earlier this year, Life West became one of the first institutions in the nation to implement Datatel Corporation’s Version 18. This may not seem important to you but, when you are a student and you need to know your grade, this technology is a godsend!
Life Chiropractic College West has been a pioneer in the chiropractic profession with respect to the implementation of digital imaging. The fact is, we were the first to see the power of this technology and to take action to see that it was brought to the hands of our faculty and students. That doesn’t mean the first in the United States; that means the first in chiropractic in the world!
Digital imaging offers nothing but advantages. The College has been functioning in this environment for over five years and we have yet to come up with a disadvantage—unless you really like the smell of a darkroom! The utility, the efficiency, the radiation reduction capacity and the sheer simplicity of digital imaging make it an absolute no-brainer.
Our next step is almost as exciting as the movement into digital imaging, in general. Since the inception of digital imaging technology on campus, we have stored our images on a campus-based server. Recently, we completed plans to convert from a server-based storage of images to a web-based storage of images. In the web-based storage environment, images from the College’s Health Center will be available, with the appropriate documentation, on any computer with Internet access. Before the dawn of 2008, our images will be available online anywhere in the world!
As we move up the imaging food chain, the College’s next resource is the availability of a state-of-the-art weight-bearing MRI facility on our campus. The College enjoys the availability of a Fonar Upright MRI through a collaboration with True MRI, Inc., of Bellflower, California. This technology is available for use by our interns in the College’s Health Center and by our Research Department. In addition, our senior students have the option of choosing a rotation working in the MRI center on campus.
Tomorrow—an important concept to consider for all the obvious reasons—that is where we will be living and, the more we understand and appreciate about the trends affecting health, health care and health funding, the better off we will be. This focus on tomorrow has fueled the College’s activities for years and we are dedicated to making sure this continues to be our viewpoint over time.
In 1994 Dr. Gerry Clum spoke with then-House Majority Leader Richard Gephardt about chiropractic in national health care reform.
TAC: What is your involvement with the Foundation for Chiropractic Progress, and what plans do they have in store for the future?
Clum: It has been my pleasure to serve for several years as a member of the board of directors of the Foundation for Chiropractic Progress. I have also had the opportunity to represent the Foundation as its spokesperson in various settings.
The Foundation for Chiropractic Progress is, today, the longest consistently functioning effort on behalf of the profession to help improve the public’s understanding of us and what we do. The Foundation has one primary purpose—to seek positive press for and about the chiropractic profession. As such, our focus has been on the single most important asset of the profession: the results that chiropractors see everyday over their adjusting tables.
A dogged adherence to this focus is what has allowed the Foundation to avoid the problems that befell many of the preceding efforts. Maintaining that focus is also what has caused the profession, those businesses that support our profession, and our patients to rally behind the Foundation.
The agenda for the Foundation is simple: develop and implement the most cost-effective and most consumer-responsive strategies to bring positive press for and about the profession to the world.
TAC: So, now that the WFC has had such a successful seminar in Portugal, could you describe some of the plans they have for the future?
Clum: The World Federation of Chiropractic’s Congress was held in Vilamoura, Portugal, in May 2007. It was a magnificent location for the largest gathering of chiropractors on the European continent!
The goals of WFC remain today as they were twenty years ago at its founding—to provide a worldwide forum for the exchange of ideas, information, strategies and data that will help to support the growth of the chiropractic profession around the globe. Twenty years ago the member nations of the WFC included several dozen associations; today, over ninety national associations from every region of the world are represented at the Assembly of the WFC.
The most important accomplishments of the WFC, from my perspective, are related to the activities with the World Health Organization (WHO). Beginning with the recognition by WHO as a non-governmental organization (NGO) entered into relations with the agency to the publication of the WHO guidelines on the Basic Safety and Training related to the practice of Chiropractic, the track record of the WFC has been a source of great pride for all involved.
The WHO doesn’t make a big difference to health care policy and practice in the United States and Canada. But, in much of the world, when the WHO speaks, it sounds much like the voice of God! For the profession to be represented in this environment is essential to the global expansion of the profession. I am honored to have played a part in the organization that has gained such recognition.
World Spine Day-October 2006 Dr. Clum was honored by a resolution from the California State legislature, presented by Assemblyman Johan Klehs, recognizing his 25 years as president of Life Chiropractic College West.
TAC: What are some of the difficulties students have voiced as they traverse through the program at Life West?
Clum: The most obvious and tangible difficulty for students is the challenge of funding their education. The most important difficulty for students is the effect of outdated, irrational and archaic requirements from state boards and other regulatory bodies that limit the creativity and inventiveness of their institutions to offer their curricula.
Chiropractic colleges are still encumbered by the old model of educational hours that says a butt in the seat for a given number of hours will produce quality and capacity in the student. It was dumb when it was developed and it is even dumber today.
In California, for example, students must complete a given number of hours of "syphilology," but not a word about AIDS. Another example—when we know that the lecture format is the least effective form of education, we still require X number of hours in a seat listening to faculty members lecture to qualify for a degree. Those precious hours could be invested in Internet-based instruction, research and learning that would increase knowledge and retention geometrically; but that kind of thinking isn’t allowed! We ask students to be professional and then we deal with them as they haven’t been dealt with since junior high school—it is crazy making!
TAC: Have you brainstormed methods to address those problems they do have; and what may they be?
Clum: As far as the funding question is concerned, I don’t have an answer. But I can illustrate the gap between our world and others. The money an institution invests in the education of its students is classified by the bean counters as "educational and general expenditures". In chiropractic colleges across the country, on average, a student pays about 85 cents for $1.00’s worth of education. That is, tuition pays 85 percent of the educational and general expenditures of our programs. By comparison, Stanford University’s School of Medicine is one of the most expensive medical schools in the country. At Stanford, their tuition represents 5 percent of the educational and general expenditures of the program. In this setting, the student gets $1.00’s worth of education for 5 cents.
As far as the curricular problems related to my previous rant—the answer lies with the state boards. They need to set a requirement that persons presenting for licensure be graduates of institutions or programs accredited by the Commission on Accreditation of the Council on Chiropractic Education and/or a similar or successor organization and get out of the micromanagement of the programs and institutions.
TAC: After graduation, does Life West offer assistance to students to help support them in their growth?
Clum: Our alumni have access to the resources, human and otherwise, of the College to assist and support them as they go into practice. That being said, very few will take advantage of what the College has to offer down the road—until they get into a problem! Regardless, it is our pleasure to help them then as well as at any other time.
Our Alumni and Office maintain regular contact through typical alumni publications and we host two events per year—Spring for Life in May and Homecoming in October, where we offer our alumni, as well as our students, a broad array of topics and speakers.
TAC: What are some of the reasons a student would attend Life West?
Clum: Now this is a nice softball over the center of the plate! Thank you!! Let me approach this in Letterman style with a top ten list:
Ten: A modern, state-of-the-art campus with possibly the highest level of technology available in chiropractic education worldwide.
Nine: No snow, no tornados, no hurricanes, no dust storms, no sandstorms, no locusts
Eight: A dedicated faculty and administration, who are or are among the most experienced in chiropractic education worldwide.
Seven: San Francisco.
Six: A solid and proven curricular approach that prepares the student for National Boards as well as for clinical success within the curriculum and then on into practice.
Five: An average summer temperature in the highs 70’s and an average winter temperature in the low 50’s.
Four: The opportunity to study with access to the most sophisticated imaging technology available in chiropractic education worldwide
Three: The most senior chiropractic college leadership at the president or dean level in the profession worldwide
Two: To be able to finish class on Friday and, within one hour, be in Muir Woods, Napa Valley or on Fisherman’s Wharf in the greatest city in the world!
One: The opportunity to study chiropractic in an environment that values the heart as much as it does the intellect, functioning under the concept of loving for the sake of loving, giving for the sake of giving, serving for the sake of serving and doing for the sake of doing out of one’s personal abundance.
TAC: Do you have any recommended marketing strategies that chiropractors can do to attract new patients and/or to keep current patients?
Clum: Understand baby-boomers. Learn what they think, how they think, what they want and tailor your message to meet their needs. They are the largest most potent economic force in our country and their health care utilization pattern is coming into full bloom.
As one of my mentors, L. Joe Stucky, D.C., of Eau Claire, Wisconsin, taught me thirty-some years ago: "Tell them what you can do for them, produce the goods you tell them about and do it at a price they can afford." That strategy has worked for Dr. Stucky as he has applied this strategy for the past fifty years. The approach has proven to be timeless!
TAC: Where do you see the future of chiropractic headed?
Clum: Health care and health care delivery, as we know it, is about to implode under the burdens of the day. One of the main contributors to this load will be the aging baby-boomers. At the present time, 10,000 Americans turn sixty every day of the year and they will continue to do so for the greater part of the next two decades. Their consumption of health resources, as they age from relatively healthy forty-something’s to aging sixty-something’s, will devastate health care as we know it.
The profession should focus as much attention and as many resources as possible on making the case for the cost replacement value of chiropractic care. We have always been viewed as a cost center in health care; we need to reshape that thinking into viewing us as a cost reducer in health care. Our care costs, that is a fact; but our care replaces care that costs more. That is the economic case to be made.
We have made the case for the value of spinal care. An illustration of our tremendous success in making that case can be seen in the number of different providers who now want to do what has traditionally been our service. We can be angry about their invading our territory, or we can take a page from the playbook of Apple and we can come up with the chiropractic IPod.
We need to stratify the profession and let the public know that we are not one generic, monolithic thing known as spinal adjusting or spinal manipulation, etc. We need to add texture and taste to what we offer in the world of the adjustive arts. Medicine and the consumer see everything we do as one thing, done one way. That is like saying there is only one type of orchestra and it can play a piece of music only one way! For years we have shied away from noting the differences in our ranks; we have viewed this as divisive, which it can be if it is approached in the wrong way. Rather, we need to celebrate the diversity of what we have to offer clinically, acknowledge that many others are attempting to jump on the bandwagon of adjustive care and point out we have been at it for over a century; we have refined it, cataloged it and learned to apply varying forms of it in varying clinical situations. We need to make our care, with all of its forms and variations, IPod cool!
Dr. Clum(center) presided over the 2007 World Federation of Chiropractic assembly meeting held in Vilamoura, Portugal, in May. Also shown at the opening session are David Chapman-Smith (WFC Secretary General), Stathis Papadopolous, D.C. (WFC 1° Vice President) and Dennis Richards, D.C. (WFC Secretary-Treasurer)
TAC: Any final words for our readers?
Clum: Dr. Williams taught me in the very early days of my career to "keep the faith, turn the crank and testify." To some who did not understand his counsel, this was a religious incantation; but this came through to me to mean have confidence in what you do, how you do it and the good that can come from it, then work hard, every day, day-in and day-out, and tell the story of chiropractic and the magnificent healing capacity of the human being. In gratitude to Dr. Williams, my request to all is to "keep the faith, turn the crank and testify!"
You may contact Dr. Clum at Life Chiropractic College West, 25001 Industrial Boulevard, Hayward, California 94545, by calling 1-510-780-4500 or by e-mailing
Written by Dr. Joel Dekanich, D.C.
Monday, 08 October 2007 12:02
“...when everyone is on board, amazing results become the norm”
Dr. Joel Dekanich is a 1994 graduate of Palmer College of Chiropractic in Davenport, Iowa, who practices in Vail, CO.
Beginning his practice as a sole practitioner in 1995, following a year long fellowship with extremity expert Mitch Mally, DC, Dekanich became a certified strength and conditioning specialist in 2002, certified Chiropractic Sports Physician in 2003, Emergency Medical Technician in 2005 and received his diplomate of the American Chiropractic Board of Sports Physicians in 2006.
Since graduation Dr. Dekanich has always believed chiropractic should be a primary discipline in conjunction with allied health providers. For the past ten years and unconventional at the time, he teamed with a physical therapist to run the rehabilitation and strengthening department of the office. "It’s simple and sensible," stated Dekanich, "that my area of expertise is specific adjustments to both the spine and the extremities and the physical therapist’s expertise is in treatment and specifically rehabilitation of an acute or chronic injury." "Also, like most chiropractors I don’t have 30-45 minutes to spend with a patient in rehab."
Dr. Dekanich finishes first at Ironman Wisconsin (2002) Dr. DekaniCh’s wife, Elizabeth
"Dr. Mark Pitcher and myself in Vail outside the athlete treatment tent."
"That started what is now a multidiscipline group comprised of 3 DC’s, 3 MD’s, 3 PT’s, 1 PhD in clinical psychology, numerous massage therapists, and an acupuncturist in 3 locations throughout the Vail Valley. Our mission statement is simple: To provide the residents and visitors of the Vail Valley exceptional integrative, multidisciplinary treatment for problems ranging from acute and chronic issues to comprehensive wellness care.
"There is constant dialog on patients’ being co-treated to make certain our protocols are in concert and in the best interest of the patient. In acute and subacute phases, many patients will see the DC, the PT and the soft tissue therapist and there never is a duplication of services. We each focus on providing the best our particular aspect has to offer, whether individually or in cooperation with one another. It’s miraculous that, when everyone is on board, amazing results become the norm. However, one of the biggest challenges we face is making sure we are more than the sum of our parts. That is why there is constant dialog and grand rounds on the patients’ progress.
"During much of our acute and subacute protocols, we are planting seeds with the patient on the importance of prevention and ‘protecting their investment’ when active care has finished. Following discharge of the patient, our goal is to have the patient appreciate prevention and wellness and to get them into one of our cash plans that offers different levels of services and products that focus on prevention. This includes monthly adjustments, sessions with the physical therapist to review exercises and workout goals, anti-inflammatory diet and supplement counseling, massages, guided imagery techniques to qi cong, acupuncture or sessions with the psychologist. With our Eagle office located directly in a gym, patients find it easy to use both the gym facility and our clinic. We are trying to get them to literally be one in the same and promote personal responsibility with an independent gym program.
"Chiropractors help thousands of people who are in pain everyday. One of our first goals with chronic myofascial pain syndrome is to help the patient recognize that they do, indeed, have chronic pain. Many patients are unaware that they are in a chronic cycle and, of course, it has much to do with being subluxated, eating pro-inflammatory foods, lack of exercise, poor coping strategies and psychological challenges. With so many concurrent causes, it only makes sense to offer concurrent treatments options. Our pain management program offers an eight-week program that is one-on-one and has incremental levels ranging from specific psychological techniques, meditation and qi cong, chiropractic, physical therapy, guided imagery and medication, if need be."
#1 golf instructor, David Leadbetter (right) and Dr. Dekanich.
In an interview with The American Chiropractor (TAC), Dr. Joel Dekanish shares some of the secrets to his success.
Joel Dekanich, D.C. Profile
• Married: "I have been married for six years to my wife Elizabeth and we have three children Kate (4), Thomas (2) and Joseph (6 months)."
• Recreation and Leisure: A few years ago I tried triathlon and completed my first Ironman in 2002. Since then, what little time I have left (when I am not working or being a father/husband) is spent running and training for various races. My leisure time is spent with my incredible family or on the golf course and playing guitar.
• Professional Affiliations: Colorado Chiropractic Association, American Chiropractic Association, National Strength & Conditioning Association, Delta Sigma Chi Fraternity, The American Chiropractic Board of Sports Physicians and Breakthrough Coaching
• Seminar Attendance: The annual American Chiropractic Sports Symposium, quarterly Breakthrough Coaching seminars and an occasional lecture to an orthopedic group or grade school.
• Vacations: "Not with three kids under five."
• Clinic: Vail Integrative Medical Group
• Office Hours: 8-6 M-F and Sat. 8-12
• Techniques: Full spine with emphasis on Gonstead, Pettibon and CBP, decompression therapy and extremity adjusting.
• Staff: The team at Vail Integrative Medical Group consists of: Drs. Joel Dekanich, DC, EMT, DACBSP, CSCS; Mark Pitcher, DC, MSc; and John Steffens, DC; Bradley Gibson, MD, board certified neurology; Scott Brandt, MD; and Ken Allan, MD, interventional pain management; Dave and Miki Blanchard, MPT physical therapy; and Michelle Laasi, PhD, clinical psychology.
Dr. Dekanich is a Diplomate of the American Chiropractic Board of Sports Physicians. He is an Emergency Medical Technician and a Certified Strength & Conditioning Specialist.
Dr. Pitcher also holds a Masters of Science in Exercise Physiology. He has been a university lecturer for Human Factors and Occupational Ergonomics at Memorial University of Newfoundland.
Dr. Steffens is a recent graduate of Logan College of Chiropractic who specializes in applied kinesiology along with patient education and prevention. He has over 200 hours of post graduate education in Applied Kinesiology.
Dr. Gibson is a board certified neurologist and was one of the early pioneers to bring MRI into Colorado.
Drs. Brandt and Allan are both board certified anesthesiologists who are fellowship trained in pain management and are Diplomats of the American Board of Pain Medicine.
Dave and Miki Blanchard both earned their Master’s Degrees in Physical Therapy. They both have extensive outpatient orthopedic experience and, additionally, Dave is a specialist in Sports Injury and a certified Pilates instructor. Miki specializes in pain management and neurological rehabilitation
Dr Laasi is a published psychologist with over 12 years of clinical experience with expertise in pain management.
TAC: What inspired you to become a chiropractor? Do you have a specific story?
Dekanich: Yes, I had a lower back sprain in the seventh grade from gym class. First, our family MD prescribed three days rest flat on my back and, when that did not help, I spent one week in the hospital in traction. I saw my mom’s chiropractor as a result and, after that, I never looked back. It was pretty much then that I knew I had found my profession.
The Vail Integrative Medical Staff
TAC: What type of patients do you generally treat or attract?
Dekanich: Practicing in Vail, we see a lot of sports and musculoskeletal injuries. It is an extremely active area and pretty much everyone is an avid sports and recreation junkie. In addition, we see pretty much your garden-variety spine and extremity conditions, many of them chronic.
Also, due to the large tourist population in both winter and summer, we frequently see people for one or two visits while they’re passing through town. Our attempt is to emulate whatever technique their DC back home uses to have the most beneficial result. It is gratifying knowing that we have "saved" hundreds of vacations in Vail for travelers from all over the world.
We also seem to attract chronic and acute disc cases. It is convenient being associated with a neurologist and pain MD’s who can order medication faster (if the patient wants and needs it) than trying to get into their GP’s a few days later. Patients are frequently amazed at their options at our offices.
Lastly, I truly enjoy adjusting infants for ear infections and reflux issues.
TAC: What are your specialties and can you tell us more about them?
Dekanich: I am a diplomate with the American Chiropractic Board of Sports Physicians so, therefore, my specialty is in sports and related injuries. We provide care for some of the top professional athletes in the country and enjoy working in the field at events such as the Honda Pro Snowboard Session, Gravity Games and The Dew Action Sports Tour, to name a few.
I also feel comfortable in managing a case from start to finish and referring to an appropriate allied provider if I feel their collaborative treatment may be beneficial or the logical next step. This can run from referring to another DC, to physical therapy or interventional pain management such as ESI’s. It is simply a higher level of service when a team is working together on a case.
TAC: Which techniques do you use and why?
Dekanich: Full spine with a Gonstead and Pettibon/CBP interest. My extremity work combines proprietary techniques learned from interning and teaching with Dr. Mitch Mally, along with other "pearls" I learned along the way.
TAC: What type(s) of diagnostic testing procedures do you use and why?
Dekanich: When indicated, I order advanced imaging or testing on any patient who is not responding to care. These are mostly MRI scans and EMG’s. It’s important to get the correct diagnosis before treatment is initiated. Again, it’s great working with a neurologist across the hallway.
TAC: What has really impacted your growth as a chiropractor and that of your practice?
Dekanich: Creating a multi-specialty office changes the way you look at treating a patient. You go from having one tool in the tool belt to having a belt with many tools. Patients appreciate the convenience and we achieve remarkable results by working collaboratively. Our statistics indicate the faster we discharge a patient, the more new patients come in. Patients love the "one stop shop" concept, especially when they see results. Yes, we still (and always will) embrace supportive care.
| Dr. Joel Dekanich Toolkit
|To give you a clear idea of what an amazing chiropractor uses to run his practice, we’ve asked Dr. Dekanich to share with us some specific products & equipment that he uses to reach his practice’s goal of bringing health into their community.
• Believe it or not but I am still using (and love) my Thuli table I left school with in 1994. I can’t even recall how many times it’s been reupholstered but it still is my favorite adjusting table. We also have a Cox flexion/distraction and a VaD decompression table along with numerous hydraulic high/low tables.
• EMG, ray and fluoroscopy.
• Bennett high frequency.
• Pilates reformer, phys balls, wobble boards, foam rollers and low tech banding/tubing.
• We carry an array of different nutraceuticals and use primarily Anabolic Laboratories and Metagenics. For acute injury, we recommend natural muscle relaxers such as Ultra Cal-M and Myocalm to anti-inflammatories such as Zymain, Inflavinoid and Kaprex and similar bioflavonoids. Following the guidance of Dr. David Seaman, we promote the anti inflammatory diet and suggest supplementing EPA/DHA, CoQ 10, Magnesium, and a daily multivitamin. This is why I am a big fan of the CORE 5 from Anabolic Labs.
• Medisoft and Write Pad.
OTHER COMPANIES I LOVE:
• Breakthrough Coaching (see ad on pg. 8) for consistently delivering first class products and services. They, like our practitioners believe in consistent, never-ending improvement. I also love the fact that BTC invites outside lecturers like Jack Canfield and Brian Tracy who are masters at quality of life challenges (regardless of your field). BTC truly promotes chiropractic while promoting balance in all areas of life.
TAC: What marketing strategies do you use to attract new patients and to keep current patients?
Dekanich: We are thankful to have consistent new patients. The best marketing strategy focuses on following a yearly marketing calendar that implements both monthly external and internal projects. Look for "base hits" with marketing and not always "home runs" and always track your statistics. Stop being emotional about the results and confront the brutal facts if something is either working or not. If you are not achieving a 3 or 4:1 ratio on your marketing efforts, stop what you’re doing and change course. Lastly, look for pull marketing as opposed to push marketing.
TAC: With your practice being multidisciplinary, can you tell our readers your advice about setting up and maintaining such a practice in today’s healthcare system?
Dekanich: Every state has a different set of legislature or governing rules in operating a multidiscipline practice. Refer to an attorney who is well-versed in your particular state law on how to operate it legally. Some attorneys will claim they can set up your practice correctly, but make sure it follows the letter of the law in your state. You want to avoid any Stark Law issues and always keep your records and billing clean. Always bill what you do and do what you bill. Multidiscipline offices have a greater susceptibility to egregious billing and other pitfalls, so don’t go there.
One other large challenge is keeping all the providers on board with the vision of the practice. It is sometimes challenging to bring multiple providers with clearly different treatment strategies and philosophies into the collaborative treatment. Only hire team players. You have to check your ego at the door and be the best possible provider in your specialty, but also have enough flexibility to see when something is working or not.
TAC: What advice would you give a new chiropractor just starting out?
Dekanich: First, make sure you want to live in an area before you invest blood, sweat and tears into establishing a practice. It makes no sense to build something great and not enjoy where you live.
Second, never stop trying to improve and learn, as we should all be students for life. Consider joining a consulting group. The systems for effective management, practice building and profitability have already been time tested and proven so why recreate the wheel? It’s also nice to have a one-on-one coach for accountability and to keep you on track.
Lastly, do whatever it takes to surround yourself with a staff that is positive. I am blessed to have such an amazing group of colleagues (and friends) who are possibility thinkers and are dedicated to the vision of our concept. We all put the clinic first.
TAC: What general advice would you give an established chiropractor whose practice might be struggling?
Dekanich: Get back to the basics. Chiropractic works! If you are not getting results, you are doing something wrong. There are so many people who need specific chiropractic and never get it. If your results are average, reinvest some time and money into a technique to learn, master and enjoy. Perhaps, find one specialty that you would like to become the local expert in. That might be pediatrics, neurology or disc cases. Find something you enjoy treating and stick with it and master it. Stop trying to be all things to all people. That’s a tall order and almost always leads to failure and burnout.
Write down exactly what it is you want and then implement Jack Canfield’s "Rule of Five." That is, do five things everyday that push you to your goal (which you have to have to even know where you are trying to get). Be clear on your vision and your expectations. You’ll be surprised that you will start attracting the things and people you want in your life.
Lastly, stop being territorial. Chiropractors are generally poor referrers within our own profession. Perhaps the technique you’re using is not appropriate on a particular case or an allied colleague may have a more effective solution. The only competition is the vast amount of suffering people who don’t know what to do.
TAC: Where do you see the future of chiropractic headed?
Dekanich: How much space is available? With history as my guide, we are often our worst enemy. We can’t agree on much and we're divided. That hurts us at both the state and national levels. Our memberships should be higher at both levels as well. Get involved, as it protects your right to practice and earn a just remuneration for your education and expertise. The turf wars will likely get more arduous with the obvious foes and, until more significant and valid research along with substantial funding validates the efficacy, we’ll stay where we are, treating twelve percent of the population.
I love being a chiropractor working amongst "the other guys." They respect me and our profession (more than you might appreciate) and that is what keeps me coming to work everyday.
You may contact Dr. Dekanich at
or 1-970-926-4600 x111 or visit www.vailhealth.com.
Editor’s Note: Are you an Amazing Chiropractor that you’d like TAC to highlight in our The Amazing Chiropractor series? Contact TAC’s Managing Director Dr. Joseph Busch by phone/fax at 1-305-399-3917 or email
. We want your inspiring story! Contact us today!
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