Ask the Advisor
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Written by Lisa Goldberg   
Friday, 21 August 2009 11:45

I am always trying to bring in new products and services to expand my practice, but it is difficult to know what will work and what will not.  What are some things that I should be aware of before bringing new products and services into my office that will help me understand my rate of return on my investment of time and money?

That’s a great question.
Interestingly enough, there was a similar question addressed in our advice column in the May issue of The American Chiropractor. First, it is important to determine if the products and services are reimbursable by third-parties, such as insurance carriers. If so, then what about the insurance carriers that YOU participate with? Once you have this information, the next step is to know the most commonly billed diagnosis of your patients, to see if the products and services are a good fit for your patient profile. The diagnosis of your patient will affect which products and services will be best, while the insurance reimbursement lets you know which of those products and services will be most profitable for you.

Keep in mind, when bringing a new product or service into your office, there are certain criteria that you have to look at, such as: the cost, amount of time to perform service, and any legal ramifications. You must check with CPT Coders and your Healthcare Attorney if you have any issues or concerns.


A lot of chiropractors have nutritional supplements in their office, but how can you be sure that you have chosen the right one? When was the last time you had your practice analyzed by an independent nutritional expert? There are nutritionists that will analyze your nutritional products at no or low cost and they will tell you which products work best for your patient demographic. The different types of products include weight loss, cartilage, antioxidants and energy drinks. It’s great to keep the products in the waiting room for the patients to sample. There is a unique energy drink that I have personally tried that has a liquid vitamin in it as well. There is a sugar free version of this energy drink that is great for diabetic patients as well as weight challenged patients.


Also, understand your patients’ needs. When was the last time you did a survey in your office to identify some of the needs and wants that your patients have? Assessments are very easy to develop, low cost, and provide great results. We provide these to our clients free of charge. Give us a call if you are interested.

Lisa Goldberg is the executive director of Physicians Choice Concierge (PCC), a company specializing in revenue enhancement. If you have a question you’d like Lisa to answer in an upcoming issue, email This e-mail address is being protected from spambots. You need JavaScript enabled to view it or call1-888-369-2224 for a personal consultation.

Patellofemoral Pain in a Fitness Walker
Written by Dr. John Danchik, D.C., C.C.S.P., F.I.C.C.   
Friday, 21 August 2009 11:32

History and Presenting Symptoms

A 38-year-old female reports the recent onset of pain at her left knee. She had started a fitness walking program in the past six months, and had gradually increased to two miles every day. She doesn’t recall any specific injury, and describes the pain as an aching soreness in her left knee that builds up during the day and, particularly, after walking. Advil is some help, but she doesn’t want to continue taking anti-inflammatory drugs. On a 100 mm Visual Analog Scale, she rates her left knee pain at about 55 mm.

 Exam Findings

Vitals. This fit-appearing woman stands 5’7" and weighs 152 lbs., which results in a BMI of 23 – she is not overweight. She has never smoked tobacco, and her blood pressure and pulse rate are in the normal ranges.

Posture and gait. Standing postural evaluation finds generally good alignment throughout her pelvis and spine. She has a mild left knee valgus and moderate calcaneal eversion and obvious hyperpronation on the left side. Measurement finds a standing Q-angle of 28° on the left and 23° on the right (20° is normal for women). Measurement of her navicular drop from seated to standing identifies a medial arch drop of 9 mm on the left and 4 mm on the right, with an asymmetry of 5 mm.

Chiropractic evaluation. Motion palpation identifies several mild limitations in spinal motion: the left SI joint, the lumbosacral junction, T11/12, and the cervicothoracic junction. There is no localized tenderness in these regions, and all spinal, hip, and knee ranges of motion are full and pain-free.  



Primary complaint. Orthopedic testing of the left knee finds no ligament instability, but the patellar grinding test produces pain upon contraction of the quadriceps with only moderate pressure. All knee ranges of motion are full and pain-free, bilaterally. Manual muscle testing finds no evidence of local muscle weakness.




No imaging of the knees or spine was performed.


Clinical Impression


Patellofemoral pain (previously chondromalacia patellae) on the left, associated with an elevated Q-angle and asymmetrical foot pronation. This is accompanied by sacroiliac and lumbosacral joint motion restrictions and compensatory lower thoracic and cervicothoracic fixations.

 Treatment Plan

Adjustments. Specific, corrective adjustments for the SI joints and the lumbar, thoracic, and cervical regions were provided as needed. Mobilization of the left knee into external rotation was performed to decrease the internal rotation associated with hyperpronation and her elevated Q-angle. Manipulation of the left navicular, cuboid, and calcaneal bones was also performed.

Support. Custom-made, flexible stabilizing orthotics were supplied, with a pronation correction added on the left. Two pairs of stabilizing orthotics were ordered, one designed specifically for her walking shoes and the other for her job-related dress shoes. She reported that she quickly became used to them in her walking shoes, and she had no difficulty in adapting to the stabilizing orthotics in her work shoes.

Rehabilitation. She was encouraged to continue her two-mile daily walks at a comfortable and relaxing pace. As she got used to her stabilizing orthotics, she was permitted to gradually increase her tempo and distance. Simple isometric quadriceps strengthening exercises were demonstrated and asked to be performed on a daily basis.


Response to Care

The spinal and knee adjustments were well-tolerated, and she reported a rapid decrease in symptoms. Once she began wearing her orthotics regularly, she noted a substantial decrease in knee irritation during and after walking. After eight weeks, she had built up to walking three miles every day, with no return of her left knee pain. At that point, she was released to a self-directed maintenance program.



Because of a wider pelvis, women naturally have higher Q-angles at the knee. When they are physically active (especially with a regular walking or running program), this frequently results in patellofemoral pain. This condition was previously called chondromalacia patellae, but is now known to be a biomechanical "tracking" disorder of the kneecap in the femoral groove. Conservative treatment that addresses any biomechanical asymmetries is very effective. This usually entails a combination of chiropractic adjustments and flexible orthotic support combined with quadriceps strengthening exercises.  

Dr.-John-J.-DanchikDr. John J. Danchik, the seventh inductee to the ACA Sports Hall of Fame, is a clinical professor at Tufts University Medical School and formerly chaired the U.S. Olympic Committee’s Chiropractic Selection Program. Dr. Danchik lectures on current trends in sports chiropractic and rehabilitation.


Is Your Little Leaguer Pitching Too Much?
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Written by Dr. Kirk A. Lee, D.C., C.C.S.P.   
Saturday, 25 July 2009 17:02

Shoulder injuries are common in sports. The category of rotator cuff injuries has numerous names ranging from painful arc syndrome, bursitis of the shoulder, or rotator cuff tears, to just name a few—all usually present with decreased range of motion and pain in the shoulder area.

There are three groups of people who are most vulnerable to these types of shoulder injuries: athletes younger than 25, the "weekend warrior" athletes that are 25 to 40 years of age, and workers over the age of 40. It is rare before the ages of 10 to 11 years.


Pitches Curves

The most common mechanism of injury is overhead stress from participating in swimming, tennis, or throwing, all of which involve overhead mechanisms. Continuous repetitive stresses can lead to inflammation, necrosis and calcification of involved soft tissue and bone structure.

On postural examination, we may notice one shoulder to be lower than the other and/or the patient may hold the shoulder complex in a protected or guarded posture. Ranges of motion may note an aberrant movement instead of a smooth rhythmic motion. Noticing apprehension in facial expression during flexion, extension, abduction, adduction, internal and external rotation can all clue us into possible rotator cuff injuries that may identify structural or neurological problems.

Having an understanding of some simple tests can also help us identify underlying causes. If pain is at the beginning or end of a range of motion, it could indicate an impingement syndrome. You could perform an Apley scratch test, which externally rotates and abducts the shoulder. Dislocation of the glenohumeral joint can be identified by pain on the apprehension test. The drop-arm test could be an indicator for a possible rotator cuff tear. Yergason test, for biceps tendon instability or tendonitis, is performed by having the patient flex the elbow against resistance while the examiner rotates the humerus externally.

Treatment would include chiropractic manipulative therapy to reduce resulting subluxation complexes of the spine and possible extremities, rehabilitation to help strengthen a weakened shoulder musculature or laxity of the joint, or use of stretching exercises for conditions that are more in line with a repetitive stress that results in tightness of the capsule and supporting musculature. A side note with rehabilitation: Be careful not to overload the joint too quickly and make sure proper patterns of movement are employed. Remember to also include both eccentric as well as concentric strengthening.

A very important and commonly overlooked aspect of rehabilitation is making sure proper technique is used. Whether the sport is swimming, tennis or pitching, improper technique can add additional stresses on the joints, resulting in injury. In sports like baseball, also keep in mind that Little League Baseball has incorporated rules that went into effect starting with the 2008 season that limit the amount of pitches a pitcher is allowed to throw in a given contest. These rules also include required days of rest which are based on the amount of pitches that the pitcher throws in a given contest. The following are the requirements established by Little League Baseball.

It’s important that, when caring for your patients (especially those under the age of 18), you take time to explain their need to rehab and rest. Both rehab and rest are vitally important to the recovery from a shoulder injury and prevention for future injuries.

Kirk_LeeA 1980 graduate of Palmer College of Chiropractic, Dr. Kirk Lee is a member of the Palmer College of Chiropractic Post Graduate Faculty and Parker College of Chiropractic Post Graduate Faculty. He has lectured nationwide on sports injuries and the adolescent athlete, and currently practices in Albion, Michigan

News of the Profession
Written by TAC Staff   
Tuesday, 21 July 2009 15:41

Chiropractic in Military Medicine

Chiropractic services are offered at several United States military bases and veterans healthcare locations. An article in the June 2009 issue of the journal Military Medicine discusses, in an effort to increase awareness and improve interdisciplinary collaboration, when to refer patients for chiropractic care. The article titled "Chiropractic in US military and veterans’ health care" by Drs. Bart Green, Claire Johnson, and Anthony Lisi provides a brief overview of chiropractic services and helps to inform readers and health care providers who may be unfamiliar with how chiropractic services are utilized within the Department of Defense and Department of Veterans Affairs (VA) healthcare environments. Also published in this issue of Military Medicine is the article titled: "A cross-sectional analysis of clinical outcomes following chiropractic care in veterans with and without post-traumatic stress disorder" authored by Drs. Andrew Dunn, Steven Passmore, Jeanmarie Burke and New York Chiropractic College student David Chicoine. Military Medicine is the official journal of the Association of Military Surgeons of the United States.

Source; the journal of Military Medicine.


Missouri State Chiropractic Association Legislative Report

HB 577, with the MSCA’s 50% Rule attached, was the last bill of the 2009 session to be truly agreed and finally passed

One very good bill that was passed was HB 577. It started its journey through the legislative process as a 15-page bill dealing with captive insurance companies, but picked up several amendments along the way. Two good amendments that were added were the language strengthening the prompt pay statute in Missouri and the language pushed by the MSCA prohibiting insurance carriers from charging a co-pay amount to chiropractic patients that exceeds 50% of the actual cost of the service provided (50% rule). Unfortunately, the prompt pay language was stripped off in conference along with most of the other amendments.

With the help of Senators Jim Lembke and Scott Rupp, and Representative Brian Yates, we successfully fought to keep our 50% rule in the bill; and, at 5:37 on Friday, HB 577 was the last bill of the 2009 session to be truly agreed and finally passed and sent to the governor. This is a major victory for chiropractic in Missouri. It will help keep your patients coming to you for their care, and it will keep money in their pockets. For more information on the 2009 Legislative Session, search the Missouri Government website, www.moga.mo.gov


Erickson Honored as Minnesota’s Chiropractor of the Year

Dr. Kent Erickson was recognized as the "Chiropractor of the Year" for 2009 by the Minnesota Chiropractic Association (MCA) during their recent Convention and Annual Meeting in Brainerd, MN.

Honored for his outstanding service to the profession, Dr. Erickson has been a member and champion of the MCA for nearly 30 years. During his tenure with the association, he has lead the organization’s legislative efforts by serving as chairperson of the legislative and political action committees.

In addition to volunteering his time and resources to the MCA, Dr. Erickson has also served on the Minnesota Board of Chiropractic Examiners, whose primary focus is protection of the public. "Dr. Erickson has clearly dedicated his life to improving public health and the chiropractic profession," explained Dr. Christopher Jo, MCA President.

Erickson received his Doctor of Chiropractic degree from Northwestern Health Sciences University, located in Bloomington, MN, where he is currently serving as Chairman of the Board of Trustees. Since 1983, Dr. Erickson has practiced at Brookdale Health located in Brooklyn Center, MN.

Pi Kappa Chi (PKX) Reunion, October 2009

Pi Kappa Chi (PKX) Chiropractic Fraternity, with Student Chapters at Palmer College (Davenport), Logan College, and Texas Chiropractic College is holding a reunion at the New Jersey Shore this October 15, 16, 17, 18, 2009. Founded in 1961 by students of Palmer College of Chiropractic, PKX students soon rose to prominence in the student hierarchy (student clinic help, assistant instructors; gold coats, blue coats, red coats). Upon graduation PKX doctors assumed prominent positions and furthered the profession.

Over 3000 Fraternal Alumni practice around the world. Many will be heading to the Ocean Place Resort to hear PKX speakers and enjoy the memories and Brotherhood. For information, contact This e-mail address is being protected from spambots. You need JavaScript enabled to view it , call 1-718-981-9755 or visit www.PKXreunion.com.


Life University Executive VP First Chiropractor Named ACE Fellow

Brian McAulay, D.C., Ph.D., executive vice president, recently completed a six-month fellowship with the American Council on Education (ACE), the nation’s premier higher education leadership development program. McAulay is the first chiropractic college administrator to be selected in the group’s 45-year history. ACE Fellows are matched with a college or university and its president for a six- to twelve-month placement of intense, on-site mentorship and special projects. McAulay completed his fellowship at Georgia College and State University in Milledgeville, GA. Fellows are also expected to travel throughout their tenure to learn from other institutions’ presidents and senior staff. McAulay met with more than 60 university presidents and toured 50 campuses, including several institutions in India.

For more information, go to www.life.edu.

Small Businesses Keeping Up With Online Presence
Written by Dr. Richard E. Busch, III, D.C.   
Saturday, 23 May 2009 16:37

SBOThe world of marketing is changing. It is not the same as five years ago, ten years ago, or even one year ago. Because of this, it is imperative for us to begin to look at all of our marketing efforts and avenues, and make changes accordingly. Change should be made not only in the way we target potential patients, but how we continually market to those potential patients.

Researching health information is the third most popular online activity with the senior group, right behind emails and other online searches.

Consumers with internet access, more than 60 percent of the time, are doing their research about local companies and services online. People are consumers. Yet small business owners behave entirely differently when they are using the internet as a business owner in comparison to when they are using the internet as a consumer. This is an important point, because only 45 percent of small businesses have a website and, if they have a website, very little money is spent to target and drive potential patients to their website, even though websites provide accessibility of information 24 hours a day, 7 days a week, and 365 days a year. Any business with a website is constantly connected.

According to research in 2008, the largest increase in internet use has been in age groups between 70 and 75, known as the "silent generation," and they are seeking online information about health conditions and treatment. They are driven to the internet, for health information, just as frequently as Generation Y, ages 18-32. Researching health information is the third most popular online activity with the senior group, right behind emails and other online searches. However, Generation X, 33-44 years of age, is the most active group to look for health information online and is the generation most likely to do their banking and get their news online.1

Keeping this in mind, as we begin to see this change in the population, it is important for us to remember that we are small-business operators. Although my clinic, Busch Chiropractic Pain Center, has had a website for the last twelve years and Freedom Awaits: Total Practice Freedom has had a website for almost three years, until recently I did not act on the realization that I wasn’t using the website to its full potential.

Websites achieve many goals: internet presence, no matter how simple, is exposure that creates a certain forum, which informs people about yourself and the services you provide. They can provide interaction between the potential patient and your office, collection of data and list building for future communication, image building and the ability to have a superior presence.

Remember that, if those that search, which is a large percentage, find it hard to locate a business, then the searcher will likely contact a similar business with the strongest online presence, even though they may provide an inferior service or product.

Internet marketing includes the website, emails, blogs, and e-newsletters for communication tools and can be done cost-effectively, although this has to be paired with ongoing television, radio or newspaper advertising to drive potential patients to your website.

Researching health information is the third most popular online activity with the senior group, right behind emails and other online searches. 

Social networking sites like MySpace, Facebook and Twitter are an inexpensive way to create increased traffic to a website. Though I have previously not employed networking sites, it is apparent that these sites are here to stay and can be used as a marketing benefit.

Don’t look back—look forward. It is vital to remove the barriers and any other obstructions that will keep potential clients from finding you. Not being on the internet is not an option. It is imperative for small businesses to have an internet presence, as search engines are now used more than yellow pages and the newspaper, for locating local companies. The use of the internet increases at high speed, old news is an hour ago. All this will seem elementary as to what the future predications may hold: dolls with personality and sensory input chips, money replaced by smart media, patients staying at home with healthcare being provided via teleconferencing and self-certification for prescriptions using electronic diagnostics.2 None of these may happen exactly; yet changes are continually flooding the technology and are almost here.

Just think of it as an internet tsunami, flooded by internet loving patients.

Dr. RicDr.Rick E. Busch IIIhard E. Busch III, is the founder of the Busch Chiropractic Pain Center, www.buschchiropractic.com and co-founder of the cash practice/decompression consulting rm Freedom Awaits, www.freedomawaits.com, and can be reached at 1-888-471-4090 est.Dr. Busch is a nationally recognized chiropractor and author of the upcoming book, Surgery not Included: Freedom from Chronic Neck and Back, which will be released in early spring 2009. www.surgerynotincluded.com.


1. Center for Media Research: February 11, 09, Seismic Shift of Internet

Age Mass

2. Imagining the Internet: Prediction Surveys



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