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Coding the Right Way!
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Written by Kathy Mills Chang   
Sunday, 25 October 2009 00:00

Since 1983, Kathy Mills Chang has been providing chiropractors with hands-on training, advice and a broad range of solutions aimed to effectively assess and improve the financial performance of their practices. A well-known and sought-after speaker, Kathy Mills Chang has served in National and State level chiropractic organizations, sits on diverse boards and advisory councils related to the profession, and is frequently invited to address chiropractors in important conferences and seminars around the country.

In an interview with The American Chiropractor, Kathy Mills Chang shares some of her tips on coding the right way.


TAC: So how did you get involved in chiropractic?

KMC: In 1983, my brother, who owned an X-ray company, told me about a client of his looking for an insurance Chiropractic Assistant (CA). It was a high-volume, very straight practice in Phoenix. The doctor, his wife, and I managed to see well over 200 patient visits (PV’s) per day. I learned by hook or crook how to bill insurance. I also became a patient the same day I became an insurance CA. It wasn’t long before I learned firsthand how chiropractic care impacts patients. My lifelong asthma was virtually cured. My own health was transformed and my career began. I’ve always felt that I owe back the profession for the way my health was restored. That’s why, when I harp on doctors to do the right thing in coding and documentation, it’s because I really do have a higher purpose to help doctors achieve the respect and the financial rewards so richly deserved.



TAC: How did working in such a high volume practice starting out shape your development as a consultant?

KMC: I’ve been a worker bee for most of my career. Working in the offices I have gives me a great perspective on what does and doesn’t work. Only since 1999 have I been out of the day-to-day inner workings of a practice. That original high-volume practice and, later, managing one of the largest chiropractic group practices in the state of New York, taught me to rely on systems. As a consultant, I’ve watched practices adopt new procedures that work, only to see them fall out again. Without these systems, there’s no predictability; and, when a team member or doctor leaves a practice, we start over at zero. My KMC University Standard Operating Procedure is one of the most popular pieces of our curriculum and serves this purpose. Many of the systems I teach are those I developed just to make my life easier and, in my day, I was a master collector!


TAC: What is the #1 most frequent coding mistake that you encounter?

KMC: The biggest mistake I encounter is doctors’ simply coding based on what they think is right or their buddy down the road told them to do, rather than learning for themselves. There is a high percentage of doctors who don’t think they need to know what code is what, and why to use it. I recently testified on behalf of a client in a deposition with Allstate Insurance, and it was confirmed for me just how much doctors are expected to know. I was grilled extensively about this doctor’s knowledge of Evaluation and Management codes that were used, and why they might have selected the ones they did. Similarly, some doctors will choose to down code the Chiropractic Manipulative Treatment codes, from 98941, the 3-4 region code, to 98940, the 1-2 region code, just to "fly under the radar." This is not good practice. Your payer profile will reflect the aberrant pattern, whether too low or too high. The simple answer is, always code for exactly what you do.


TAC: How can someone go about fixing this type of a problem?

KMC: Be willing to be educated, or employ and rely on someone who is. Gone are the days of simplicity in coding and documentation. Attention to detail has never been more important. When doctors have an opportunity to attend a seminar on this topic, they should embrace the opportunity. Use team members to monitor and guide you in this area. Hospitals often employ coders to decipher notes and apply correct coding. Be in partnership with your team to ensure that your various services are described appropriately. For example, in the previous question, I mentioned that doctors often down code the 98941 to 98940. Medicare recently posted a clarification that, when a doctor is treating a full spine, but only 1-2 areas meet the definition of medical necessity, the correct coding is 98940-AT and then 98940-GA, indicating that they have notified the patient the additional spinal region is not covered, and have an advance beneficiary notice or ABN form signed to this effect. This clears up a lot of confusion that has existed for full spine adjusters who want to be more compliant.





TAC: By growing as a non-D.C., how do you think your appreciation for coding and compliance is different from that of D.C.’s?

KMC: It gives me global perspective, and I can be impartial. My experience of doctors of chiropractic is that they are passionate about the treatment, the need for the patients to receive the treatment, and the need to be reimbursed for that treatment. Sometimes, that sullies their viewpoint, out of frustration, and doesn’t allow for impartial logic. As a staff member for the American Chiropractic Association, I had the opportunity to serve the profession from that level, and participate in the AMA coding process and work with Centers for Medicare & Medicaid Services (CMS) on Medicare issues. I’m several levels removed from the actual patient experience, which allows me to trust the systems and the policy or law. There is often more than one way to solve a problem and, with this knowledge, it allows me to look for the twists and turns in the rules that will best serve a client. Likewise, by understanding what you can’t do, it opens up a world of possibility for what you CAN do. That gives me a unique perspective to advise clients on ways to keep a robust reimbursement department, while staying safely on the right side of the law.


TAC: So what exactly is KMC University?

KMC: Well, our mission is clear: We inspire chiropractors and their teams to realize certainty about the financial aspects of practice, including Medicare, documentation, coding, billing, and patient financial matters, and to achieve their rightful abundance of practice profitability. It’s the education arm of Kathy Mills Chang, Inc., and the way we deliver our financial department coaching curriculum. What makes it unique is that we can accommodate a doctor who needs a single, quick fix, by selling them a product or an hour of consulting time, without a long term commitment. In fact, one of our most popular products is our Straight A’s in Thirty Days. It’s a one month coaching program particular to only one topic, like coding, documentation, patient finances or setting proper fees. It’s a guided, one-month program, consisting of analysis, training, and personalized attention that is laser focused on a specific area. We are uniquely able to offer this at an outstandingly low fee, so it attracts a lot of doctors not interested in longer term commitments. We also offer our full curriculum when it’s needed and appropriate, and guide and train doctors with over 50 unique curriculum items from coding and documentation, to Medicare and patient finances. We do this with online training, consulting, and our very popular Hands On Lab, which is the two day training seminar we hold monthly.


TAC: Do you have any thoughts on how Healthcare Reform will impact chiropractic?

KMC: While our slice of the national health care pie is not the largest, we have dedicated patients who know the value of chiropractic care. I honestly can’t imagine a system that doesn’t include some kind of chiropractic coverage, not unlike Medicare. I’d hate to see all of our cash patients suddenly turn into Medicare patients, as I think most of the doctors I know would want to jump off a bridge. But we have a very strong American Chiropractic Association which has great inroads to the decision makers. The research is showing great outcomes for chiropractic, and cost effectiveness studies have been very favorable. It’s never been more important for our patients to get involved, and I love the new Chiro Voice available for them to express their opinions. I’m an old-timer who believes that our patients will find a way to get what they want, no matter what. It will force doctors to become better educators, clearer communicators, and superior health advocates.


TAC: What’s been your experience with exclusively cash practices versus exclusively insurance practices?

KMC: The concept of an exclusively cash practice is an interesting one. Because of the laws and rules pertaining to Medicare, even a doctor who is a cash practitioner must bill Medicare on behalf of those patients. So, billing and collections rules still have to be followed. That means there is almost no such thing as an exclusively cash practice. I’m an advocate of having a wonderful balance of cash and insurance, within the comfort zone of the doctor. The truth is that surveys have shown that about 70% of patients have some kind of insurance that will cover their chiropractic care. They expect to be able to use it. I’m not in favor of a practice that would turn those patients away, or have them bill on their own. Those practices that are exclusively insurance, or heavily imbedded in managed care, tend to be the more difficult ones to manage. Not only is there a great deal of work to do for billing and collections, but the patients could be more pain oriented, discontinuing care when they feel better. The most successful practices I’ve worked with have an adequate balance of cash and insurance patients, and ample educational processes that help insurance patients understand the benefits of continuing their care, while paying out of their pocket for wellness care.



TAC: Any final words for our readers?

KMC: Don’t underestimate the importance of accurate coding and documentation in the reimbursement process. We are lucky in our profession that we have such a small number of codes that apply to our services. It’s easy to master them and apply them for maximum benefit of your patients and your practice. Take the time and make the effort to be the best you can be in this area…the dividends that are paid back to you are tremendous.

kathy Mills ChangKathy Mills Chang can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call 1-888-820-7778

Products & Software To Help You Work with Insurance To Get Paid
Cover Stories
Written by TAC Staff   
Sunday, 25 October 2009 00:00

Oftentimes, the tools used will determine the possibility for success in accomplishing any task. Making the right decision with regard to the documentation software, record keeping and other products you use will have a tremendous impact on the heights that your clinic may be able to reach. Use this market review to get to know some of your options.



Product Name: ACOM Health Documentation and Practice Management Software
Price Range: You can own our software for a low monthly fee, no credit check required.
Best Feature Description: ACOM Health’s Documentation and Practice Management software solution integrates the clinical and management aspects of your office activities with a complete workflow system that turns tedious, manual obligations into simple automated tasks, establishing a seamless, paperless office environment to help you maximize collections and eliminate billing challenges by delivering exactly what payors need to see.
Contact Info: 1-866-286-5315, ext. 217



Product Name: ChiroTouch
Price Range: $10,000 to $15,000

Best Feature Description: ChiroTouch has developed its HIPAA-compliant total practice management system to drastically reduce the time it takes to perform tasks you are already doing! That gives you more time to see more clients—having a direct, measurable impact on practice profitability and quality of care.
Contact Info: 1-800-852-1771


E-Z-Bis-EHRE-Z Bis, Inc.
Product Name: E-Z BIS EHR
Price Range: $1795
Best Feature Description: E-Z BIS offers a complete electronic health record solution that gives doctors the ability to operate a paperless office, by recording histories, exam results, X-ray findings, care plans, daily treatment notes and all other pertinent patient health data. E-Z BIS also offers complete integration with billing, scheduling, collection and management features.
Contact Info: 1-800-445-7816



Eon-SystemsEon Systems
Product Name: Documentor™

Price Range: $2595
Best Feature Description: With a Tablet PC, Documentor™ is a giant leap beyond the "canned" note writers. It is designed to cut down your writing time and produce terrific notes, narratives and reports. Protect yourself in an insurance audit by having your notes say exactly what you want them to.
Contact Info: 1-800-955-6448



InPhase-Technology-GroupInPhase Technology Group
Product Name: InPhase Practice Management Software
Price Range: $2750 to 3500
Best Feature Description: InPhase makes your follow-up with carriers speedy, productive, and painless. Our Money Pit module tracks every unpaid claim and logs your progress. It even calculates carriers’ average response time. The Money Pit gives you all the information you will need to make that call and get your claims paid.
Contact Info: 1-800-490-3780.




Life-Systems-SoftwareLife Systems Software
Product Name: ChiroSuiteEHR; ChiroPadEMR & ChiroOffice
Price Range: $1495 to $7995
Best Feature Description: Integrated SOAP documentation and Office Management providing computerized paperless efficiency to increase income and patient visits, and reduce expenses. Features include SOAP notes generate billing; automatic diagnosis pointing; self auditing; electronic claims; electronic phone log; scheduling; missed appointment tracking; electronic sign out collection protection.
Contact Info: 1-800-543-3001, option 1



TGI-SolutionsTGI Solutions
Price range:  150/month – Subscription, Purchase starting at $1995
Product Name:  TGI- Autumn8
Best Feature Description:  Fully integrated office scheduling, billing, EMR, including patient self-check in.
Contact info:  1-800-645-4309



JTECH-MedicalJTECH Medical
Product Name: Eval Express Chiropractic Toolkit
Price Range: $7490
Best Feature Description: Eval Express Chiropractic Toolkit provides objective justification for treatment and rehabilitation, while showing the functional effects of subluxation to your patients. The Toolkit includes objective Range of Motion, muscle strength and pain evaluation and the exciting new Quick Screen module for patient marketing that eliminates the need for other screening products.
Contact Info: 1-800-985-8324



TyQ-CorporationTyQ Corporation
Product Name: Q-ROM Range of Motion Station
Price Range: $1995 to $4795; $95/mo. lease plan
Best Feature Description: The Q-ROM Station is a computerized and automated diagnostic system that quickly and accurately measures spinal ranges of motion. It uses 3D-Enhanced dual inclinometry along with an advanced graphical user interface to enable simple and fast measurements.
Contact Info: 1-770-880-7903



Future-HealthFuture Health
Price range:  $ 6,995.-
Product Name:  Documentation/HER/Scheduler
Best Feature Description:  Future Health’s documentation is fully integrated and includes a TRUE EHR and Scheduler. Easy, user-friendly and secure. FREE, unlimited training and support! Our customers rave about our complete, compliant and professional notes, customization, intuitive design and SPEED. Documentation also fully integrates with Future Health’s billing to expedite getting paid and patient education to increase your patient’s understanding.
Contact info:  1-888-434-7347






Practice-PerfectPractice Perfect
Product Name: MD/DC/PT Integration
Price Range: $1,000 to $1,500/month
Best Feature Description: Practice Perfect is the largest MD/DC, DC/PT Integration health care management and consulting firm in the country. Dr. Dahan has trained thousands of dedicated doctors to become the most achieved health care providers.
Contact Info: 1-800-598-6289


Price range:  $399.99
Product Name:  ECLIPSEtoOutlook (E2O)
Best Feature Description:  E2O synchronizes your ECLIPSE® patient schedule to your Microsoft Outlook calendar, allowing you to view your entire calendar in one place.
Contact info:  1-877-226-0314

Secrets of Marketing
Cover Stories
Written by TAC Staff   
Friday, 25 September 2009 09:06


Successful Marketing the "CLA WAY" by Patrick Gentempo Jr., D.C., CEO of Chiropractic Leadership Alliance.

Marketing is a primary function for any successful business, whether it be a chiropractic


You may contact Dr. Patrick Gentempo at 1 International Blvd., #750, Mahwah, NJ 07495. Phone 1-201-252-3220, Executive Assistant Mike Thompson, Ext. 114, or visit  or

practice or a Fortune 500 company. Despite its importance, marketing is not well studied by most DC’s and is not a disciplined part of their business structure. I recently held a marketing boot camp for our high-achiever CLA clients. I was blown away with the ideas and creativity. They left with a budgeted, 12 month marketing plan with built in metrics that will assure their continued success. I want the.


same for you. In the brief space I have for this format, I will give you the best highlights I can. Let’s start with a couple of important premises.
Entire chapters can be written on the procedures for each of these. The purpose of my writing this short essay is to give highlights and context to the subject of marketing. Be bold. Be multi-dimensional. Be consistent. Stand out. Leverage all you’ve got to make it happen!

What´s ¨One¨ Idea? 


What I Learned from a New Jersey Boardwalk by Mark Mandell, D.C., M.B.A.


Dr. Mark Mandell is the President of The Vitality Depot, a national chiropractic supply company focusing on innovative equipment and extraordinary value. He is a popular lecturer on business growth and the author of Spark Your Sales. Reach him at 1-866-941-8867 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .  

It rained when I was out walking on a New Jersey boardwalk. As soon as it started to rain, I saw the boardwalk vendors bring out the umbrellas.

Some of the vendors placed signs outside that read "Umbrellas for Sale." These are pure entrepreneurs who were prepared to react to the rainy situation and make a simple profit by selling umbrellas for a few bucks each.

A whole other group of vendors opened up giant golf umbrellas and were running out to the people on the boardwalk, shielding them from the rain and escorting them into their shops. Some of the braver ones were even meeting prospects standing at the outer edges of other shops and walking them through the rain to their shop, while shielding them with umbrellas. In my mind, these were the true salespeople. These were the people who were not relying on signs, but using smiles, service and salesmanship to earn more business.

If it rained on your street, would you start selling umbrellas, use them as marketing tools or use them as sales tools?

Your business is what you make of it. Your success depends on your creativity and your gumption.

Your business is what you make of it. Your success depends on your creativity and your gumption.

Former Patients Are Where the Money Is by Daniel T. Drubin, CEO of Pro Practice Partners



Daniel T. Drubin is Co-Founder and Managing Partner of ProPractice Partners, LLC, a chiropractic management and marketing company and was previously President and founder of 4th Dimension Management Corporation, a company specializing in personalized business management and consulting, corporate motivational speaking and business development. Call 1-520-575-0207 or visit  for more information.

When Willie Sutton, the multiple bank robber, was finally apprehended, he was asked the following question. "Why do you keep robbing banks?"

His response was simple and to the point.... "Because that’s where they keep the money!"

Well, if you want to know where some of the money is in your practice, take a look at your inactive files. They are just filled with people that you have already had successful experiences with and many of them are just waiting for you to remind them that they are still part of your practice. And, while our marketing plan often contains events and activities that are outside of the office, these outside activities frequently come at the expense of some of the easiest things that we can do inside the office.

At ProPractice Partners, our statistical tracking indicates that, if you follow the four simple rules of former patient contact, for every ten people you reach, two to three will return to the practice.

As for what to say, keep it simple. I suggest, "(patient’s name), this is (doctor’s name), I just wanted to touch base and remind you that you are due for a check-up. When would be a good day to get you in?"


That's it. You will be astonished at how many patients will reactivate themselves as a result of this simple reminder.

Just do it and enjoy the results.


The 3 Elements to Ensure Success to Your Marketing Strategy by Dennis Nikitow, D.C., Founder of Certainty Practice Products and Seminars



Dr. Nikitow is one of the most sought after experts in the profession. He is the founder and developer of Certainty Practice Products and Seminars. Dr. Nikitow has been practicing for 29 years, and teaching for 20 years. For more information on Certainty Practice Products or The Certainty Seminar, call 1-800 544-3884 or visit

All marketing requires identifying a problem, providing a solution and establishing your solution as unique to that individual.

As a chiropractor, your ability to communicate chiropractic is the most important key to your success. Uniqueness is found in our philosophy and principles. When you know how to communicate our philosophy and principles as the solution to their problems, a profound repositioning occurs to people’s health care paradigm and they put you on their health care team for the entire family.

I have proved this in both internal and external marketing to build the largest most successful practices in the world for 25 years.

By incorporating the following three elements into every marketing strategy, you will insure its success. See table.

These elements will impact people to take action and never fail you in any marketing strategy you do. I incorporate these on the radio, at screenings and talks, in print ads and even in one on one encounters.



As long as you learn to communicate them with certainty, you will be perceived as having a unique solution to their problems, and your practice will continue to grow and thrive.



Focus on All Marketing Aspects, Not Just One! by Lisa Goldberg, CEO of Allcare Consultants


Lisa Goldberg is the executive director of Physicians Choice Concierge (PCC), a company specializing in revenue enhancement. If you have a question, email This e-mail address is being protected from spambots. You need JavaScript enabled to view it  or call 1-888-369-2224.

What some people fall short of knowing is that your practice is a business; therefore, it should operate like one. The marketing approach that most businesses focus on first is outbound marketing, which includes advertising and promotions, sales, and public relations. Too often, a business jumps right into getting the "word" out before they even decide what the "word" is. It is very important, especially in today’s economy, to focus on your company’s inbound or internal marketing first, which consists of understanding your market and knowing how your products and services will meet the needs of that market, along with proper pricing and value proposition, customer service and customer satisfaction. Time and time again, businesses end up pushing products and services onto people who really do not want or need the products or services at all. With effective inbound or internal marketing, outbound marketing will be much more efficient and uncomplicated.

Keep in mind that marketing consists of a wide range of activities that involves your business meeting the needs of your customers, while getting appropriate value in return. It is not only about advertising and pushing sales through. Nine of ten customers will tell their friends about a bad experience they have had with your company, which creates a ripple effect of negativity on your potential customers. Patient surveys are a good way of getting feedback on your performance. Marketing with regard to customer satisfaction and customer service is crucial, so remember to focus on the customers that you already have and keep them happy! Referral-based marketing can lead to an influx of business. It is important to know your referral sources and to thank them, whether it is a patient referring a patient or a physician referring a physician or patient. Also, consider your future and be strategic. You may know what your patients need now, but do you know what they may need six months from now? Will they still be your patients at that point in time? Keep those happy customers coming back time and time again and focus on all marketing, not just one aspect.


Creating Practice Growth through Sophisticated Simplicity by Shawn Veltman

The biggest secret for successful marketing is to forget about new patients. Not forever,


Shawn Veltman is a practice growth expert operating out of Hamilton, Ontario, and the founder of SV&A Chiropractic Consulting. He has helped practices in Canada, and the U.S., develop systems to bring back patients, retain existing patients, and run their practices more effectively. For more information about SV&A Chiropractic, visit  

of course, but for the next six months or so.

In that time, take a long hard look at all the things you’re doing right and wrong between the time somebody calls your office for an assessment, and the time they have their final visit.

Look at EVERYTHING in your practice with fresh eyes—with the eyes of a brand new patient, who doesn’t know ANYTHING about chiropractic.

Then figure out how to make the experience better and more meaningful for that patient.

Look at things that are extremely important (Are you communicating your findings to them in a way that they can easily understand?), and seemingly trivial (Did the person at the front desk make eye contact, smile, and make them feel comfortable when they walked in the door?).

Look at the conversations you have with new patients. Are you sure you’re fully addressing all their questions, worries and concerns (especially the unspoken ones)? Remember, most patients won’t necessarily tell you if they have any reservations— they’ll just never come back.

Looking inward and working in these areas ensures a better and more meaningful experience for all your patients, which translates into happier, healthier patients who will stay longer, refer more, and, in general, contribute to a better practice for everybody.



Fitness and Chiropractic A Critical Niche for Your Practice and the Chiropractic Profession
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Written by Dr. Eric Plasker, D.C.   
Friday, 25 September 2009 08:54

The fitness and nutrition industries are poised to take a leadership role in health care. They have all the research that demonstrates their role in achieving optimum health and prevention of sickness and disease. These elements of a healthy lifestyle are being sought after by the public who are trying to decipher between the good and the bad, the real and the snake oil, and they are searching for a trusting voice. If you want your practice to thrive, it is critical that your practice brand itself toward delivering relevant information regarding these important lifestyle components without giving up your chiropractic identity, and that you learn how to work with the fitness industry.

Phillip and Jackie Mills, M.D., are passionate about the health of the planet.

When you establish a brand for your practice, consider your overall vision. Do you want to be strictly a pain based practice, insurance based practice, or an office that creates patients that stay with you for life? Do you want a revolving door of relief care and inactive files or do you want to be their doctor primary health care provider? If you are a pain clinic, and you brand yourself that way, no matter how hard you try you will have tremendous difficulty getting patients to understand why they should continue on with their care after they feel better. Your brand will establish your identity and determine the type of patients you attract, as well as your ability to attract supportive companies and organizations who want to co-brand with you.


Co-branding becomes a very powerful and cost effective way to leverage your brand with companies and organizations that can help you grow. We see co-brands everywhere, including FedexKinkos, Delta and American Express, Apple and ATT, and even in your practice. If you use Foot Levelers products, you are co-branding with Foot Levelers and they are doing the same with you to help more patients. You may be doing the same with nutritional products, professional memberships and the chiropractic college you graduated from. Co-branding brings credibility and invites the customers affiliated with your co-brands to be more receptive to your practice.


One of the strongest brands in the fitness industry is Les Mills. Founded in 1968 by Les and Colleen Mills in New Zealand out of their passion for fitness, Les Mills now provides fitness classes in over 12,000 fitness centers around the world, certifies instructors and has become the global group fitness leader. Currently owned and run by Les’ son Phillip and his wife, Jackie Mills, MD, Les Mills exercises more than five million people per week. Phillip and Dr. Jackie, who co-authored the book Fighting Globesity, are passionate about their business and truly care about the health of our planet. The unique focus of Les Mills is that they provide innovative, creative fitness classes and they do this for their co-brands, the gyms that they work with in the United States, Canada, and worldwide. They work together with the owners of these facilities to keep this department on the cutting edge of fitness and fun for their members. It is very common that, when people travel and are looking for a good workout, they go to to find a gym with classes that they know they will love. This is the power of the brand and demonstrates the value of their co-brand with the gym, and they maintain their unique focus in every location. The Family Practice and several other companies co-branded with Les Mills on a Stress Less America campaign, that was designed to de-stress America, while also directing lots of people to Les MIlls for a work-out as well as to the chiropractors who participated. It was very successful and landed me on several news programs around the country.

Our expertise in chiropractic relates to the spine and nerve system. We know that we can influence the health of the entire body through the spine and not only provide rapid relief, but we can also provide a lifetime of health through our knowledge about the body, our philosophy, and keeping the spine and nerve system healthy as an important component of a healthy lifestyle. Too many chiropractors, in their attempt to sell the healthy lifestyle, lose their identity, become unclear of their business model, and dilute their brand in the process. This is not necessary and can be solved through the power of co-branding.




I have had the opportunity to work with Gold’s Gyms around the country by speaking at their Gold’s Gym Challenge, their international convention, and being appointed to their Gold’s Gym Fitness Institute. The gym provides the endurance and strength training, while the chiropractors take care of the structure, the spine and nerve system. There are quite a few Gold’s Gyms that have chiropractors working inside their facilities, with the goal of enhancing the Endurance, Strength and Structure, or what I call the ESS principles.


If you want to build a relationship with gyms and the fitness industry, you have to brand yourself in such a way that makes your relationship with them relevant, and you have to consistently provide cutting edge information and content for their members in the area of lifestyle. When you do this, they will more seriously consider working with you.


Being successful working with the fitness industry in your area requires a branding for your practice that is lifestyle oriented and recognizes the need for everyone working together, doing their part to help people live healthier lives.


If your only focus is on making their customers new patients and getting a series of quick hits from them, they will drop you like a hot potato and you will be giving chiropractic a bad name. You will not only ruin the relationship for yourself, but you will ruin the relationship for chiropractors everywhere. If you play your cards right, by providing their clients with great information and by becoming a fantastic referral source to them, you will build a relationship that can last a lifetime and that is also very profitable for your practice. The quality of your relationship will be based on what you are willing to give.


Fitness companies love chiropractic. Associations and companies love working with chiropractors who bring quality lifestyle information to their members or employees. As an example, many of the doctors who co-brand with The 100 Year Lifestyle are finding this to be true. Dr. Peter Huber, in California, capitalized on this co-brand to become a featured speaker for the American Heart Association. Dr. Sonny Gotro, in North Carolina, used this co-brand to implement The 100 Year Lifestyle wellness program in his town, which includes fitness, nutrition, and chiropractic. Chiropractic is such an important element of living a healthy lifestyle and, if you brand yourself this way, fitness companies and leading organizations in your town will seek you out and become great allies in helping you improve the health of your community and give you an important strategic positioning for your practice.


Fitness is going to become a core element of health care reform. The cost of obesity and unhealthy lifestyles is bankrupting our system and the change will happen very rapidly, with you or without you. Chiropractors have been teaching this health and wellness lifestyle for decades. The world is finally listening but, if you do not strategically brand and position your practice properly, this wave will pass you by. If you have already positioned yourself this way and your practice is not thriving, it is important to bring your message up to speed and your delivery system into the present.

Do not allow yourself to be blindsided by how quickly things are changing in the world of health care and in the mind of the consumer. Our culture is going to begin making health a primary value. Be the Lifestyle Leader in your community and blend fitness and chiropractic to keep the people in your town as healthy as possible.

Dr.-Eric-Plasker-D.CDr. Eric Plasker is the founder of The Family Practice, a marketing and training company for chiropractors, and the author of the international best selling book, The 100 Year Lifestyle, and the creator of The 100 Year Lifestyle Certification Program. He can be reached at 1-866-532-3327 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it . For a free audio download to help you build your practice, visit

Herniated Discs and Conservative Treatments
User Rating: / 1
Cover Stories
Written by Jay Kennedy, DC Michael Schneider, DC., PH.D David Seaman, D.C.   
Friday, 21 August 2009 13:59




Dr.-Jay-KennedyDr. Kennedy is a graduate of Palmer College and has been in both private and MD/DC practices in Berlin, PA, for over 23 years. He is a leading authority in North America on decompression and rehabilitation procedures and has successfully treated tens of thousands of patients. He has pioneered decompression therapy technique since 1993. Dr. Kennedy is also a renowned product designer and holds multiple patents. Dr. Kennedy is a frequent guest lecturer at leading chiropractic colleges and decompression therapy certification seminars throughout the US. For more information email This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

Decompression, a.k.a. traction therapy, as a primary treatment modality for herniated lumbar and cervical discs is well known in physical therapy (PT) and chiropractic. Over 50% of PT’s report using traction therapy as a primary treatment for herniated discs, especially conditions showing nerve tension signs. I believe up to 15% of DC’s now utilize decompression with 70% using Flexion/Distraction, primarily to affect disc and nerve conditions. Cervical traction is far more prevalent than lumbar traction, in both PT & DC practice, according to a recent survey by Hartte et al. However, both cervical and lumbar traction therapy tend, at least in the PT world, to be directed toward nerve encroachment syndrome (A condition with few other safe and utilitarian options).

Interestingly, lumbar traction has been completely usurped by disc decompression, even though they are one and the same. It is not far fetched to suggest advertising and marketing slogans are the primary differences. Decompression is the potential disc related outcome achieved during axial traction. The prime contingency being that the disc must be intact and hydrostatic (pressurized fluid). When axial tension is applied, a centripetal effect can enhance osmotic renewal. Movement of fluid and nutrients can expedite healing in many cases. This is typically referred to as molecular solute transport and the hydrophilic property of the proteoglycan molecules affords the nucleus its pressure deformation and resiliency characteristics. Keep in mind, decompression isn’t ‘table dependent’, it is an inherent action of axial elongation applied to an intact (hydrostatic) disc.

The primary clinical question is; why Decompression does not always work and why, if so theoretically valuable does it so rarely demonstrate dramatic efficacy in controlled trials? (see Cochrane collaboration; traction review 2006) That remains one of the most puzzling questions for those of us regularly using traction and convinced of its efficacy.

Traction (axial tension) apparently affords 3 potential outcomes:

1. Decompression...if the above mentioned criteria of disc patency hold true.

2. Stretch...creating pain modulation via mechanoreceptor/nociceptor pain gate mechanisms.

3. Directional preference...a range-of-motion that tends to centralize referral pain based on a potential migration or stress-shielding effect of the disc.

These actions-of-traction allow a theoretical answer to why a clinical outcome is attained from treatment. However, we don’t as of yet have the ability to know with certainty what is actually causing the pain and how traction is affecting it specifically. It remains largely theoretical and its benefits largely empirical. My experience through 15 years of clinical use and study of traction tells me it does offer improvement, often dramatically, in disc herniation conditions, with or without nerve involvement. I believe, it will become a primary treatment modality in chiropractic and is fast approaching a tipping-point acceptance.





Dr.-Michael-SchneiderDr. Michael Schneider has been a practicing chiropractor for 27 years. He has a PhD in rehabilitation science from the University of Pittsburgh where he presently is an Assistant Professor in the School of Health and Rehabilitation Sciences. Dr. Schneider has obtained a five-year Federal grant from the National Institutes of Health to conduct chiropractic research on low back pain

Rehabilitation involves the use of therapeutic exercises and activities to stabilize the spine. The evidence based approach to rehabilitation of herniated discs has two basic components:

1. Directional preference exercises to directly affect the disc

2. Stabilization exercises to improve function in the muscles around the disc

Direct treatment of the disc requires that the chiropractor pay careful attention to how various movements affect the patient’s lumbar and leg symptoms. McKenzie was the first to describe the centralization phenomenon, in which repeated movements cause a receding of leg symptoms proximally toward the spine. Old time chiropractors used the term "retracing" to describe the same observation of pain leaving the foot and slowly retracing back to the spine. When a particular movement causes centralization of symptoms, this is called a directional preference, and is thought to be mechanically causing movement of the herniated nucleus pulposis back toward the center of the disc. When the disc has herniated posteriorly, often repeated extension movements will drive the nuclear material anteriorly and reduce the sciatic symptoms. In patients with a lateral shift or antalgia, repeated lateral bending movements into the same side of pain will cause centralization. This concept was called "closing the open wedge" by some old time chiropractors.

Once directional preference exercises have helped to reduce the disc herniation and symptoms are centralizing, the next step is to stabilize the spine with rehabilitative exercises. Patients should first be taught the postural cat-horse exercise in order to be able to sense their "neutral position", which is the normal lumbar lordosis. Next, patients should learn how to tighten their abdominal muscles as if someone were to punch them in the stomach. This reflexive tightening of the abdominals is known as an abdominal brace, and immediately stiffens all of the muscles surrounding the spine. Finally, McGill talks about the "big three" exercises for spinal stabilization which consists of training these key muscle groups:

a) Partial crunches: Activates the rectus abdominis without flexion of the spine

b) Side bridge: Activates the oblique abdominals without rotation of the trunk

c) "Dog Pointer": Activates the erector spinae muscles without hyperextension

Most patients with herniated discs need to be careful not to aggravate their condition with exercises that are beyond their ability. This mistake is made in many physical therapy clinics who take a "no pain – no gain" attitude. McGill has shown that most disc patients do not require intensive strength training to stabilize their spines, with his research showing that only a 5-10% improvement in muscular strength is needed to greatly improve spine stability. Chiropractors can easily incorporate these directional preference and stabilization exercises into their practices without expensive equipment, and help many disc patients to improve.



Dr.-David-SeamanDr. Seaman is an Adjunct Associate Professor at Palmer College of Chiropractic Florida, has a part-time practice in Ormond Beach, and is the Clinical Education Director for Anabolic Laboratories. He has written numerous articles on the treatment options for chronic pain patients, with a focus on nutritional management. He can be reached at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

For many years, we have known that the presence of disc herniation does not equate with the presence or severity of back/leg pain.1 It is also known that, substantial disc degeneration associated with a grade II spondylolisthesis can be pain-free.2 Thus, the first treatment technique should be to reassure the patient that disc degeneration, internal disruption, and herniation are common and often remain painless throughout one’s life. Reassurance, as a treatment, is important because we know that there can be a negative effect on outcomes when patients view images of their degenerated spine.3 The second treatment technique involves the realization that no treatment technique fits all patients and so there is no specific technique that is responsible for reducing herniations. Interestingly, if a patient does not have progressive neurologic changes and they can withstand the pain of discopathy, most herniated discs will resorb on their own within two to twelve months.4

In terms of managing patients with herniated discs, the goal should be to reduce the pain to a tolerable level, while the natural resorption process occurs. In addition to traction, manual procedures, and rehabilitative exercises, both dietary and nutritional supplementation may be helpful. While there is no specific "nutrition" technique for discs, it is important to realize that the pain process with herniated discs is no different than any other pain. Foods known to reduce inflammation in general include omega-3 fish, vegetables, fruit, and nuts. Lean meats and skinless chicken are also acceptable. Tubers such as potatoes are also anti-inflammatory, so long as they are consumed with the aforementioned low glycemic index/load foods. Foods that are less anti-inflammatory are whole grains, legumes and dairy. And foods that are overtly pro-inflammatory are refined grains, grain/flour products, sugar-rich foods, deep fried foods, trans fat-containing foods, and dressings/foods that contain omega-6 fatty acids from oils derived from corn, safflower, sunflower, cottonseed, peanuts, and soybeans. Ensuring adequate digestive function is also an important consideration. Bearing down during a bowel movement increases intrathecal pressure and can dramatically increase back and leg pain in those with disc herniations. In addition to eating anti-inflammatory foods, supplemental fiber such as psyllium husks can dramatically improve bowel habits. Meals should be spiced with ginger, turmeric, oregano, and other spices, and/or these can be taken as supplements. Not well known is that these spices have anti-inflammatory actions that are similar to NSAIDs. Three key supplements that can influence inflammatory and nociceptive processes include magnesium, vitamin D, and EPA/DHA, which are omega-3 fatty acids from fish oil.

These nutritional recommendations are known to reduce levels of inflammatory mediators in humans, and so should be considered in all of our pain patients.


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