Perspective


Adjusting, Manipulation, Pediatrics, Structural Correction, Subluxation Care and the Research: Critical Issues to Preserve Chiropractic
Perspective
Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.   
Tuesday, 19 July 2011 20:22

Where is the research to explain subluxation?

Where is the research to explain chiropractic? and...

scoliosis?

pediatric care?

asthma?

colic?

infertility?

otitis media?

etc....

 

spinegreenThe answer...IT DOESN'T EXIST! There is supportive research about chiropractic and musculoskeletal conditions and that is a very, very, very GOOD START!

When you do not have the supporting research, you leave yourself and the entire chiropractic profession exposed to negative legal sequella. The following (which was obtained from http://vertebralsubluxation. mccoypress.net) happened to the RMIT Chiropractic Paediatric Clinic in Australia in 2010, with the bulk of the information used against them coming directly from their Web site.

"A 'Request to shut down RMIT Chiropractic Paediatric Clinic for teaching disproven treatments that target pregnant women, babies, infants and children' has been filed with the Australian Minister for Health and Aging.  Ms. Loretta Marron, the author of this report, claims that the RMIT Chiropractic Paediatric clinic is 'teaching inappropriate, potentially dangerous, techniques that target pregnant women, babies, infants and children...[who] are particularly vulnerable groups, easily exploited by chiropractors.'”

Citing a lack of appropriate evidence for chiropractic treatment of these population groups, she requests that the RMIT clinic be shut down until further evidence can be produced.  Ms. Marron continues on with a request that other institutions, such as Murdoch and Macquarie, also be investigated for similar actions.

The author also suggests that a 're-education campaign be urgently initiated to provide information to both consumers and chiropractors as to what they can or cannot claim, based on the balance of evidence-based medicine.'  The basis of her claims refer to expert testimony such as that of Dr. Simon Singh and several medical doctors, and the United Kingdom General Chiropractic Council's May 2010 Guidance on the Vertebral Subluxation Complex.  Ms. Marron also cites claims on chiropractic practitioner websites and calls on the Council on Chiropractic Education Australia (CCEA) to reassess competency standards for chiropractors...".

While the article goes on to explain how unjust the claim and suit is, the fact is that there is a law suit against not just an individual or individual practice, but against an entire profession. This suit will be able to create precedent utilizing the courts to further define the scope of chiropractic within the reach of the courts and will be just the beginning.

It doesn't matter if you believe in adjusting, manipulation, subluxation care, structural care or adjunctive therapy. All of the above is chiropractic. You don't have to believe me; read the scope of practice for chiropractic in the entire 50 states of our country and you will find provisions for treating patients within those scopes that account for everything in the beginning of this paragraph.

The nonsense of abandoning the language of adjusting in order to give away what makes chiropractic unique is so self-serving. No one cares whether we "adjust" or "manipulate" them other than ourselves. It is inbreeding at its worst. On the other hand, if you do not teach and practice the correction of nerve interference using the adjustment/manipulation, you are creating a more sophisticated class of physical therapists or physician assistants, if you believe adding prescriptive rights is the solution in the absence of correcting the nerve interference at the spinal level.

Whether you are on the far left or far right of chiropractic, please stop shooting the rest of us in the feet. The public, the referral sources and the legislators really don't care what we call what we do; they only want the proof that what we do works. We have given them the rhetoric for 116 years with a smattering of scientific evidence to back it up. In Australia, for the issue to go away, all it would take is a peer reviewed scientific piece of literature to be put on the front cover of every newspaper with a headline that reads, "Chiropractic Works for Children." Quite a change of perspective and that slight change is the difference between being "king of the hill" and not having a hill.

Stop being defensive and fighting for what your individual dogmatic beliefs are and fight for chiropractic and all chiropractors because, no matter your beliefs, we are all chiropractors whether on the left, center or the middle. Support the only avenue to bringing all of chiropractic to where everyone wants it, via research. That is the only way chiropractic will survive. Today they are looking to take pediatric care away; next week, it could be scoliosis care and on and on until we have nothing left, but to be glorified physical therapists or extinct as a profession. The choice is yours.

 
Cobb Angle: Friend or Foe
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Perspective
Written by Clayton Stitzel, D.C.   
Monday, 25 April 2011 20:43

cobbangle

C
obb angle should not be the Gold Standard for radiographic evaluation of scoliosis. While Cobb angle has been the subject of numerous reliabilitystudies, there are several disadvantages to be noted. These disadvantages range from high inter-examiner variability to lack of validity. Cobb angle is oftentimes only as good as the film it is drawn upon. There are various alternative methods that involve measuring the Cobb angle, as well as its rotational component. Since chiropractors are particularly focused on obtaining radiographic evidence of treatment success, the profession at large should use radiographic analytical methods that provide more information on the presenting three-dimensional spine and spinal disorder.

Scoliosis is classically described in the literature as a curvature of the spine greater than 10 degrees on radiographic study. This measurement is taken using a Cobb angle, a measurement first illustrated decades ago in an effort to quantify scoliotic curvatures and the progression or correction thereof. Classically, the Cobb angle has been the gold standard for assessing spine curvatures, both in the sagittal and coronal planes. While this measurement has remained through the decades as the chief outcome assessment in scoliosis, this measurement has both a high degree of variability and virtually no validity. It provides no information on segmental or global spinal function, it gives little insight as to the risk of curve progression, it does not correlate to any subjective outcome, and it provides only two-dimensional information about a three-dimensional spine, hence failing to account for vertebral rotation. Since there are other newer methods to evaluate spine structure which have a higher degree of reliability, we will discuss our opinion in this article that the Cobb angle should be abandoned for scoliosis radiographic evaluation. 

Measurement Issues

Cobb angle has been the subject of numerous reliability studies. From an intra-examiner standpoint, a single practitioner's Cobb angle will vary anywhere from 2-5 degrees, depending upon whether the image is a plain-film radiograph, CT, or MRI study. The inter-examiner variability is unfortunately much higher, approximating 20 degrees or higher in some studies. Aside from the high degree of measurement variability, even the best Cobb angle measurement is only as good as the film it is drawn upon. Weinert demonstrated changes in anatomical measurements with only small incremental changes in patient positioning in radiographic practice models used in chiropractic colleges. In this study, ten degrees of rotation, for example, caused a six millimeter change in the width of the sacrum, as well as a six millimeter difference between the heights of the femur heads. One can predict the difficulty in repeating an X-ray of a scoliosis patient with a marked degree of pelvic rotation, which creates a significant amount of projectional distortion.

Classically, the Cobb angle has been the gold standard for assessing spine curvatures, both in the sagittal and coronal planes.

 Moreover, scoliosis radiographs are best taken with the central ray located at the level of scoliotic apical vertebra. This helps create a single point of origin from which to measure future comparative studies on full-spine 14"x36" radiographs. Since this method fails to account for issues such as pelvic positional changes on subsequent studies, a full-spine film lends to high variability, even when Cobb angle is drawn with 100% reliability. Another disadvantage of using the Cobb angle to evaluate scoliosis is its lack of validity. Many signs and symptoms of scoliosis, such as reduced pulmonary function, may be related more to the rotational displacement caused by scoliosis compared to any lateral bending component. Cobb angle, however, does not account for spine rotation, since it is purely a two-dimensional measurement. To accommodate for these pitfalls, additional forms of measurement have been created, such as the scoliometer, and Nash-Moe and Perdriolle measures of vertebral rotation. By contrast, surgeons report significant reductions in Cobb angle measurements following spinal arthrodesis. Despite these reported corrections, as many as 40% of these patients will be classified as permanently disabled as a result of the surgery, yet the Cobb angle is reduced. 

Conclusion

Scoliosis is a multi-dimensional disorder. Biomechanically, scoliosis is a three-dimensional deformity of the spine. However, the radiographic Cobb angle measurement only provides two-dimensional information. This, in and of itself, should make the measurement obsolete, given the availability of other published radiographic methods such as those outlined here. Use of a Cobb angle, especially on full-spine radiographs, assumes that the patient placement on a full-spine film is consistent from pre- to post-treatment studies. Since chiropractors are particularly focused on obtaining radiographic evidence of treatment success, the profession at large should use radiographic analytical methods that provide more information on the presenting three-dimensional spine.

 
Chiropractic Key in Electing the 46th President of the United States: A Vision for the Future
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Perspective
Written by Mark Studin, D.C., F.A.S.B.E.(C), D.A.A.P.M., D.A.A.P.L.M.   
Monday, 25 April 2011 20:20

sealpresidential

Press Release-November 8, 2016, Arlington, Virginia

The New York Times reported that the key states in getting President Elect XXXX voted into office were Ohio, Florida and California. When analyzing the key parties involved, the United States Chiropractic Association was instrumental in contributing $20,000,000 in the 11th hour; that was critical in funding the political ad-buys in those states in the few days just prior to the election. President Elect XXXX stated, "I am thankful that the United States Chiropractic Association shared the vision with our campaign and our administration looks forward to working together on getting many of our common healthcare initiatives passed in the years to come.”

The net result of the above scenario is that chiropractic would have the political clout to get appointed to committees that control research grants, create and change utilization guidelines, garner national influence on local and national senate, house and assembly elections and be in control of our own profession instead of organized medicine controlling us. While many of you read the above press release and laughed, the probability of that happening is high if a few key changes are made within the infrastructure of chiropractic.

Currently, we have 2 national organizations and 50+ state and splinter organizations where everyone does their own thing. Can you imagine our country with 2 presidents, 2 governing bodies and then 50+ independent organizations in every state, each with completely different sets of rules? We wouldn't be a country; we would be a feudal region with everyone fighting for their inch of turf. In spite of COCSA (Congress of Chiropractic State Organizations ) and other similar organizations who are critically needed because of the splintering within our profession, what I just described is the state of chiropractic, where every organization has to fight for its piece.

When we discuss unity, an issue currently affecting many states, the conversation becomes about eliminating competing entities at the state level. That is a critical step towards the survival of chiropractic. I know the circumstances personally, as 21 years ago I was instrumental in creating a competing organization in New York, a very poor decision in hindsight. However, I am not discussing the survival of chiropractic, I am discussing getting chiropractic to flourish. Survival is easy; you do what you need to do to live at any cost regardless of the pain and you take the quickest avenue to ensure your continued existence.

In order to flourish, chiropractic must take the bold step to unify. As an example, we need to look no further than the American Physical Therapy Association (APTA), made up of 74,000 members strong and influential enough to help shape national and state policy. Chiropractic roughly has the same numbers, 74,000 chiropractors nationally. The national structure would be simplified to 1 organization in the United States, no different than the federal government; 1 executive branch with 50 chapters, one for each state (no state organizations).

In order to flourish, chiropractic must take the bold step to unify.

NOTE: Your practice philosophy has nothing to do with state or national organizations. They are POLITICAL ENTITIES to support our ability to practice and nothing more!

In October 2010, at the New York Chiropractic Council's state convention, unity was a central topic. We discussed joining 2 state organizations and as a model examined what recently occurred in Michigan. The state of Michigan, with 2 state chiropractic organizations, was in disarray. Only 32% of the DC's were members of either organization. After a merger, that number jumped to 54% of DC's as members, with many members getting involved in various fundraising activities called the "Century, Ambassadors and Presidents Clubs." Averaging each of these clubs equates to an additional $499 per member. A brilliant maneuver that resulted in the organization having enough funds to purchase its building 2 blocks from the state capitol and, in its first year, having a surplus of over $1,200,000.

If we take the same formula as a conservative approach, using the "fundraising averages" in Michigan and the current membership fees of the American Chiropractic Association, this would equate to a $54,737,800 annual national budget if 65% of chiropractors nationally joined. If each state was given a budget of $400,000 annually (with many activities centralized, that number becomes workable, pro-rated based upon the # of DC's per state), that would leave the national organization an operating fund of $34,737,800 annually.

Electing a president is not a "pie-in-the-sky." It is within our reach and the time has long passed for the profession to take this issue seriously. Will this be an easy task? No...but neither was putting a man on the moon, gaining our independence from England or abolishing slavery.

 
Practice Statistics and the MD Report of Findings
Perspective
Written by William J. Owens, D.C., D.A.A.M.L.P.   
Friday, 11 March 2011 09:25

prescription

T
he chiropractic profession has been blessed to offer drugless and non-surgical based care to millions and millions of people.  People continue to benefit from our patient centered approach and communication skills.  The stark reality, though, is that these millions and millions of patients only amount to 7% of the total population being under care.  Why is that?  Since the inception of modern practice management, one important number has been discussed over and over again and that is the Patient Visit Average or PVA.  Everyone should know what it is but, if you do not, it is determined by taking the total  number of new patients per year and dividing them into the total number of patient visits for the same year.  That gives you the number of visits that the average patient is receiving in your office.  Doctors of chiropractic have been focused on this number, as they should be; however, it only allows us to evaluate one aspect of practice building, and that is internal marketing.chartowensmarch

The addition of another number to our arsenal will help to reflect the community effect of our practices and our success at external marketing efforts. In order to do that, we simply need to add another statistic to the analysis.  This is called the Unique Patient Visit or UPV.  This means exactly what it says…how many individual patients (regardless of treatment frequency) are in our offices on a weekly basis?   This gives us a different look at the practice and shows us how well we are doing at finding NEW patients.  When we look at internal marketing, we know that it centers on patient education and the Patient Report of Findings.  The Patient Report of Findings is a critical part of chiropractic practice and is the most important method used to increase PVA.  I have had the pleasure of helping to build two hospital based chiropractic clinics and have daily referrals into my private office from the medical community.  Over the years it has become apparent that MD's do not refer, because they are uneducated and fear licensure repercussions, if a patient were to be handled improperly.  It is easier to educate a single MD that sees thousands of patients, than it is to try to educate the non-chiropractic patient population as a whole.  How we accomplish this is through the Medical Doctor Report of Findings.  Once this happens on a large scale, we will go from 7% to 95% of the population under care.

The above chart will show you what I do on a daily basis in my office and how this part of building relationships in the medical community works.  The Stage column represents the time frame that these items are introduced to the MD.  The easiest way to imagine it is Stage 1 is the “first date” information, which is introductory research and clinical competence information, Stage 2 is when you have been co-treating patients for awhile and you will be showing the MD that your expertise is evolving and the research is getting more in-depth, and, finally, Stage 3 is where the MD is under care and you are now talking “real” chiropractic, including Subluxation complex and central nervous system concepts

The MD Report of Findings is a process that is done with every patient’s MD in your area.  The key is to start with a few MD's and build from there.  This easy concept, when properly implemented, has been generating 5-7 new patient referrals per week and, the fascinating point is, approximately 75% have never been to a chiropractor!

owens_pic
Dr. Owens has been working  extensively with the medical and legal communities in his practice areas for the last 14 years.  The MD Report of Findings is a foundational component of the MD Relationship Program at www.teachchiros.com. Dr. Owens uses these systems in his practice on a daily basis and continually updates and critiques their effectiveness.  He can be contacted at This e-mail address is being protected from spambots. You need JavaScript enabled to view it  for more information.

 
Hope
Perspective
Written by Tom Owen III   
Monday, 21 February 2011 17:09

hope

W
e were greatly saddened to hear of a chiropractor that we knew who recently took his own life. Unfortunately it has not been an uncommon occurrence within the chiropractic profession. It obviously troubles us to hear these stories and makes us ponder what kind of hopelessness drives someone to do this. This most recent loss struck us especially hard because we had a personal relationship with this doctor. We asked ourselves all the “what if” questions and agonized over whether there was something, anything, we could have done to prevent this.

This doctor would have appeared to have a fulfilling life. He had a wife and five children (and one on the way). We wondered if this unfortunate act had something to do with money (as a lack thereof) as a result of our country’s recession, but that didn’t appear to be the case. This doctor had a very stable practice. The fact is, we may never know for sure what could drive someone to take their own life, but it served as a wake up call for us to remember one of the most powerful principles in life.

The principle we are referring to is that “HOPE is Essential”. Hope is defined as the feeling that what is wanted can be had or that events will turn out for the best. Hope is that factor that ignites the inner man or your spirit for that which is good and promising.

Observing someone who has lost hope is one of the saddest sights to see. It is like a dog that has been beaten so much that the beatings have actually destroyed the dog’s spirit. Even when someone shows the dog kindness or love, it will cower in fear. It seems to always expect the same cruelty from everyone, no matter what type of gentleness they show. The same goes for the person who has lost all hope. They give up and resign themselves to expect the worst. While they may not physically cower as they go through their days, mentally and emotionally they resist hope, and resist those who try to give it, even those closest to them who try to reach out to them in love. When hope is lost, events like our recent loss become more common. Hope is essential to our well being.

As a chiropractor, you may encounter many in your office that have experienced hopelessness due to debilitating pain that no one seems to be able to cure. Remember, the most powerful thing you can give to your patients is HOPE. Chiropractors have been able to restore lost mobility and stop chronic pain when other health providers have given them no hope. We never know what someone is going through in life, especially a patient in pain.

Remember, the most powerful thing you can give to your patients is HOPE.

While we have a lot to offer our patients, often hope is overlooked. However, it is one of the essential factors that we must learn to give to our patients. In many cases, hope for a better future fuels the importance of the actual service that is being rendered. This can be true in many arenas, but especially in a chiropractic office. Stop to think about that for a second. In most cases, the chiropractor was not their first choice in provided health care. In fact, in many cases, a prospective patient is considering chiropractic as their last option before “giving up”. In other words, they are beginning to believe they will just have to live with it, because they are losing hope of the issue’s ever being resolved. Hope can motivate a person to take one more step. Hope can move us forward, even when the obstacles that block our path seem impossible to overcome.

Giving a patient hope can be the motivating factor that drives them to their next visit. It is not slick marketing, chiropractic education, or free hot chocolate in the waiting room that motivates your patients to become lifetime patients of chiropractic. It is the giving to them of hope that their condition will improve while, simultaneously, treating them with the miracle of chiropractic that will keep them on the right course of treatment. Let’s be careful to feed our patients hope, not demands and requirements. HOPE is ESSENTIAL in a doctor/patient relationship. Make it a point to give others (not just patients) HOPE everyday. You never know how powerful a little dose of hope can be in someone’s life. Make a conscious effort to share it with your patients THIS WEEK!

by Tom Owen III, and Todd Osborne, D.C.


Dr. Todd Osborne, a 1989 graduate of Palmer College, ran a successful high volume multiple doctor practice, and is currently Vice President of AMC, Inc., as well as an author and lecturer. Visit www.amcfamily.com or call (877) AMC-7117 for more information.

 
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