Stroke… A Different Perspective

Stroke…  A Different Perspective

by John L. Stump D.C., Ph.D., Ed.D.


In May 1999, upon returning Sunday evening from one of his many trips, John Stump and his wife went out for dinner. Arriving home they decided to begin packing for the upcoming lecture he was scheduled to do in New Zealand. He glanced at the clock; it was five minutes before midnight when a strange feeling went to his right arm and a few seconds later his right leg went weak. He fell over on the bed; he tried to call for his wife but nothing would come out of his mouth but gibberish.

By the time they got him to the hospital, he was unconscious. They rushed him into the ER. “When I saw the doctor’s face, it didn’t look good. In the waiting room, he looked at me and said he would do all that he could, “but your husband has had a massive stroke and is hemorrhaging in the brain. We’re trying to get the blood pressure under control. I’ll get back to you when I can,” Diane Stump recalls.

“They confirmed my worst suspicion; he had suffered a stroke. But why? He’s not a smoker, or over weight, and has been an avid athlete all of his life…. What would cause this sudden brain attack? It was not until later that I realized the doctor on duty was trying to tell me there was not much hope. The ER physician told me he had called the neurosurgeon and the cardiologist but not to expect anyone very quickly. It was midnight Sunday.”


What Every Doctor of Chiropractic Needs to Know

What you have just read was an account pulled from the book A Stroke of Midnight. Alternative Concepts publishing, 2007. This book strives to enlighten not only chiropractors but also the general public about the epidemic of stroke in America.

Stroke is now the number two-killer in the west, behind heart disease, and replaces cancer. Every 43 seconds someone suffers a stroke. One out of three of those people is lucky and has only mild symptoms from the episode; yet a second dies and the third suffers permanent physical disability. Stroke is the number one cause of physical disability, at a cost of 6 billion dollars each year to the taxpayer. Disability accumulates year-after-year due to this ever-increasing condition. It is estimated by the World Health Organization that stroke will become our number one cause of death in the modernized world by 2020. The worst thing about these awful statistics is 80 percent of these strokes are preventable!

Today we find ourselves defending the profession and our procedures regarding stroke and stroke information. Let us turn the tables and issue statements from the profession supporting Stroke Awareness. We should not have to continually take a defensive posture about our position. Let us begin to show we are interested in the total health and wellness of each of our patients.


About Stroke

During a stroke, a blood vessel carrying oxygen and nutrients to the brain either burst or is blocked by a clot. This prevents brain cells from getting the blood (and oxygen) they need, and can result in a possible death. A stroke usually doesn’t just happen; it comes on gradually over a period of years. Signs and symptoms are seen well in advance of the incident, if you know what to look for.

This is why blood pressure should be checked at the time of an examination. If there is an increase in BP over a period of months or years, another risk factor should be noted. The main problem is the fact that, by the time the stroke signs and symptoms appear and present themselves, it is almost too late. Not too late to save the person’s life, but too late to use preventive health care methods like diet, exercise and lifestyle changes.

Our practice is very different from a medical practice. We are seeing patients more often and usually on a wellness basis first and an acute basis second. In as much, we keep better records of weight, cholesterol, blood pressure, neurological signs, arm numbness, tingling and differences in speech and articulation.

We are not asking the DC to become anything but a little more observant, especially with the over 40 patient. A few years ago it was felt that only the 60-year-old was at risk for a stroke; now the 40-year-olds have begun to suffer heart attacks and strokes. The American Heart Association (AHA) has recently issued advisories for all doctors to begin screening twenty-year-olds. (AHA, 2009)


Types of Strokes

Ischemic Stroke: This type accounts for about 83 percent of all cases. They occur as a result of an obstruction within a blood vessel supplying blood to the brain. The underlying condition for this type of obstruction is the development of fatty deposits lining the vessel walls.

Hemorrhagic Stroke: This type accounts for about 17 percent of stroke cases. It results from a weakened vessel that ruptures and bleeds into the tissue of the brain. The blood accumulates and compresses the surrounding brain tissue.

Transient Ischemic Attacks: (TIA’s) are minor or pre-strokes. In a TIA, conditions indicative of an ischemic stroke are present, and the typical stroke warning signs develop. However, the obstruction (blood clot) occurs for a short time and tends to resolve itself through normal mechanisms. Even though the symptoms disappear after a short time, TIA’s are strong indicators of a possible major stroke, and preventive steps should be taken immediately. (American Stroke Association. (


Teach a Preventive Lifestyle

Diet: Chiropractors know diet is probably the most important of all the lifestyle modifications patients have to make. Growing up in the South as we did, nearly everything was deep fried all the way to the tomatoes! Patients must avoid and limit fried foods that contribute to clogged vessels. Red meat is another red flag food, as well as sugar and junk food. We ask all of our patients to limit their consumption of processed foods from a can, bottle or box, due to the excessive amount of additives like sugar, salt and other chemicals. We are not asking you to change your practice; just be a little more aggressive in your advice on diet, exercise and lifestyle.

Physical Activity: We know not everyone can spend as much time in the gym as we would like, but daily physical activity is a must for overall good health. Make simple choices for more activity, take the stairs, park a little further away and walk an extra block or two, stop using remotes and begin being more physical. Everybody needs 30-45 minutes of daily physical activity—walking, bicycling, swimming, volleyball or golf—to keep the body, mind and spirit functioning properly.

Sleep and Rest: Just as they need physical activity, they also need rest and relaxation. Sleep depravation has become a big health issue within the last three decades. Sleep medications are a top pharmaceutical draw. A few years ago, it was a miniscule seller for the pharmaceutical industry. Tension, stress and fatigue are all by-products of lack of enough sleep. Today, sleep, rest and relaxation are being robbed by society’s demands. We recommend more activities like Tai Chi, Yoga, Qigong and Meditation each day, something that will both relax and refresh the mind and body. These can be done in a class or on an individual basis, depending on the patient. That’s why these ancient exercise and meditation systems are very old and still popular. Plus, they require no equipment and they can be done at anytime with no expense.


Let us point out one thing further. In February 2007, at an International Stroke Conference held in New Orleans, it was learned that the rate of strokes among middle-aged women has tripled in the last six years. Nearly 2 percent of women ages 35-54 reported a stroke in the most recent federal survey, from 1999 to 2005, while only 0.63 percent did in the previous survey, from 1988 to 1994.

Health officials think that women may be less attentive when it comes to acknowledging their own signs and symptoms. Women tend to ignore signs and symptoms in themselves, because they don’t want to upset their ability to take care of their family.

While statistics show women and men suffer strokes at about the same rate and time during their lives, this latest study gives us reason to believe the statistics are about to change toward the female suffering strokes at a younger age and at a faster rate.



We want to emphasize, chiropractors are in the prime position to recognize, teach and follow up with patients about the devastating effects of stroke. This was the primary reason why the book A Stroke of Midnight was written. Once John knew he was going to live and could write again, he decided everyone should be more aware of stroke and its consequences. It seems everyone knows about heart attacks but few know stroke is now the number two killer and will soon become number one. People must wake up and begin to change their habits and lifestyles. Chiropractors are “Wellness Oriented” and in prime position to help curb this tragic epidemic.

This is where the DC can project an entire new image of the profession as being on the cutting edge of the American “Stroke Awareness” movement.

Review of the Literature: Non – Operative Scoliosis Treatment

Review of the Literature: Non – Operative Scoliosis Treatment

by Marc J. Lamantia, D.C., and Gary A. Deutchman, D.C.


Without intervention, Adolescent Idiopathic Scoliosis (AIS) is a condition which is likely to progress between the time of detection and the time of skeletal maturity.1 This makes early detection, with the intent of early intervention of paramount importance to the success of a non-surgical treatment regiment.2 Unfortunately, the current medical standards recommend observation until a curvature has shown progression of five degrees or more, and the measurement exceeds thirty degrees. This leaves a very small window where brace treatment is suggested and, more importantly, lessens the patients’ chances of successful non-surgical treatment. Studies confirm, as the curvature increases, the likelihood of further progression increases as well.3 Therefore, the current standards are not congruent with the scientific observations reported in these studies. Early intervention should be coupled with early detection.


Progression and Protocols:

Nachemson, et al., 4 reported both girls and boys between the ages of ten and twelve, who had at least a thirty degree curvature at the time of detection, have the highest risk of progression before skeletal maturity, approaching 100%. If this is, in fact, accurate, recommendations of early screening and early intervention until the patient reaches skeletal maturity make the most sense. Unfortunately, the pediatric orthopedic community continues to recommend watchful waiting, often waiting until surgery is the only option.

It is my belief, from a clinical standpoint, following a comprehensive evaluation of vestibular function, movement analysis, gait evaluation and the like, patients can be trained to optimize postural muscle synergies through repetitive movement therapy and vestibular rehabilitation.

Although the highest risk of progression is clearly between the time of detection and skeletal maturity, a second significant progression has been reported to occur between skeletal maturity and a thirty year follow-up.5 In a longitudinal study, Weinstein, et al., (1981) followed one hundred and twenty patients over forty years. The authors reported a high likelihood of adult progression in those patients with thirty degree lumbar and thoracolumbar curvatures at the time of skeletal maturity. Thoracic curvatures of fifty degrees or more were also reported to have a high likelihood of progression during this same time frame. This is an important study because it highlights the necessity to treat lumbar curvatures which are thirty degrees or more, even when progression is not suspected. Although bracing alone has been the only accepted medical standard since 1951, as of 1984, there had not been any prospective or randomized clinically controlled studies to demonstrate its efficacy. In 1984, Miller, et al., demonstrated insignificant cant differences between bracing and observation in regards to the natural progression of AIS.6 Researchers such as Focalize, et al., (1991) and Goldberg, et al., (1993) corroborated these findings, and went as far as to recommend discontinuance of screening programs and challenged the usefulness of bracing at all.7,8 In a 1997 article printed in the Journal of Bone and Joint Surgery, a meta-analysis was performed to evaluate the efficacy of Non-Operative treatment of AIS. Nineteen studies were included in the analysis, with over 1900 participants. Although the findings clearly showed full time bracing (23 hours per day) did, in fact, significantly alter the natural progression of the disease, current trends continue towards reduced bracing hours and, in some cases, no recommendation of bracing at all.9 Furthermore, the type of brace being prescribed was also a signify cant variable. The Charleston brace was significantly less successful than the Milwaukee brace (64%), however the authors admit difficulties in comparing the cases due to reporting parameter and classifications amongst patient groups. In general, rigid bracing uses three point pressure systems to reduce the lateral deviation of the spine. More recently, the Spine or Brace has been gaining popularity among non-surgical providers (we have been providing Spine or in our offices for the past five years). Invented in 1992, the brace consists of a fabric bolero designed to help control rib cage positioning, four fabric elastic band and a pelvic belt. The brace is fitted to induce a corrective posture as first described by Dr. Christine Collaird. Depending upon curvature location, the brace is fitted accordingly. Spine or is the first dynamic elastic tension brace designed to provide neuromuscular rehabilitation through derotation of the rib cage in relation to the shoulder and Pelvic. belt. The brace is fitted to induce a corrective posture as first described by Dr. Christine Collaird.16 Depending upon curvature location, the brace is fitted accordingly. Spinecor is the first dynamic elastic tension brace designed to provide neuromuscular rehabilitation through de-rotation of the rib cage in relation to the shoulder and pelvic girdle. In a study published in the Journal of Pediatric Orthopedics, patients fitted with the Spinecor brace were monitored continuously for two years beyond the weaning period. Of the 172 participants with a definitive outcome, thirty-nine required surgery prior to skeletal maturity and twelve dropped out; fourteen patients were weaned out due to positive outcomes and stability prior to skeletal maturity. So the remaining one hundred and one patients observed had a 59.4% success rate, with an additional 10.6% who had progression of more than 6 degrees but did not require surgery. Of the 59.4% who achieved curvature reduction or stabilization, 95.7% maintained the corrections achieved two years prior. Five of the patients continued to improve despite being out of brace for two years. Interestingly, the authors report lumbar curvatures to respond most favorably (83.3%), then thoracolumbar curvatures (69.4%), thoracic (56.8%) and double curvatures of equal magnitudes being least favorable (42.8%). Furthermore, when initial curvatures measured between 25 and 29 degrees, the rate of success was 70.1% as compared to 50.2% success when the curvatures measured from 30-40 degrees. These findings are consistent with findings of others who report early detection and intervention as necessary for the most successful outcomes and are suggestive that Spinecor is more successful than any other brace when the patient begins treatment with curvatures measuring between 25 and 29 degrees.

In May 2007, Dr. Gary Deutchman and I presented the first study on the use of Spinecor in adults entitled, A retrospective study of twenty-three adults treated for scoliosis using the Spinecor Orthosis.10 Although adult treatment has been relegated to pain relief, it was our belief that neuromuscular rehabilitation would be a successful approach to reducing spinal deformities in adults as well as children. The patients were separated into three groups based on curvature location. The patients in the “thoracic” group (n = 20) had a mean average change of -5.27 degrees. This is considered by the Scoliosis Research Society to be a borderline significant reduction. The “thoracolumbar” group (n = 3) had a mean average change of -6.0 degrees, and the lumbar group (n = 15) had a mean average change of -4.40 degrees. A questionnaire survey revealed the adult group to be “extremely satisfied” and would recommend Spinecor to other adults. I should also add, due to the comorbid nature of scoliosis, chronic pain and degenerative joint disease, alterations were made to the brace configurations on a case by case basis. Many of the adults treated were fitted in an extension-type set-up (often used to treat kyphosis), irrespective of curvature location. After the patients were tolerant of brace wearing, we then switched many to a more conventional “Spinecor” set-up as described by Collaird. Although pain reduction was the most significant finding, this study highlighted the possibility of adult curvatures responding to non-surgical management. In my experience, adults with scoliosis are unaware that anything can be done to help them in regard to curvature or pain reduction. Of course, cosmesis is another consideration; improving posture and outward appearance is oftentimes the motivating factor for adults who seek treatment. Studies performed by Griffet, et al., indicated gibbosity reduction as a significant outcome of treatment with the Spinecor brace.11

Neuromuscular Influences in Idiopathic Cases:

Neuromuscular rehabilitation of the posture in both adults and children should include a thorough neurological evaluation of the vestibular system. Studies confirm the presence of vestibular disturbances in scoliosis patients12 which may not resolve without specific rehabilitation techniques. In an article published in the Scoliosis Journal 2007, I reported on my findings of vestibular dysfunction in a population of scoliosis patients.13 Vestibular dysfunction left untreated influences postural tone, in particular extensor musculature activity during dynamic balance. This includes ambulation as well as specific balancing tasks. Studies confirm abnormal activation of extensor musculature during walking in scoliosis patients.14 The authors of this particular study were concerned with post operative changes, but failed to explore possible non-surgical approaches to influencing muscle recruitment patterns. It is my belief, from a clinical standpoint, following a comprehensive evaluation of vestibular function, movement analysis, gait evaluation and the like, patients can be trained to optimize postural muscle synergies through repetitive movement therapy and vestibular rehabilitation. Although vestibular rehabilitation is well accepted, scoliosis care providers rarely offer evaluations and treatment along these lines. Interestingly, the adolescent population with vestibular pathology are often without symptoms, much in the same way they are typically without pain. On the other hand, the adult population often suffers from dizziness, imbalance, anxiety and vestibular headaches as a direct result of their vestibular disorder, and experience chronic pain syndromes as well. For those who embark on a course of postural rehabilitation for patients, whether it be working on sagital curve restoration or otherwise, its efficacy will be lessened in the presence of abnormal vestibulospinal function. Treatment of any movement disorder is most effective when vestibular function is robust, as would be the case in any population, adult or adolescent. To date, vestibular rehabilitation and, really, any rehabilitation of movement remains controversial in the United States.

1. Rowe D., Bernstein S., Riddick M., et al. A meta-Analysis of the Efficacy of Non-Operative Treatments for Idiopathic Scoliosis. J Bone Joint Surg 1997: 79-A; 664-74

2. Focarile, F.;Bonaldi, A.; Giarolo, M.;Ferrari, U.; Zilioli,E.; and Ottaviani, C.: Effectiveness of nonsurgical treatment for Idiopathic Scoliosis. Overview of Available Evidence. Spine 1991; 15:395-401

3. Weinstein, S., Zavala, D., Ponseti, I.; Idiopathic Scoliosis. Long-term follow up and prognosis in untreated patients. J. Bone and Joint Surg. June 1981: 63-A:702-712

4. Nachemson, A.,: Lonstein, J. E.; and Weinstein, S. L: Prevalence and Natural History Committee report. Rea dat the Annual Meeting of the Scoliosis Research Society, Denver Colorado, Sept 25, 1982

5. Weinstein, S., Zavala, D., Ponseti, I.; Idiopathic Scoliosis. Long-term follow up and prognosis in untreated patients. J. Bone and Joint Surg. June 1981: 63-A:702-712

6. Miller, J.; Nachemson, A.; Schultz A.: Effectiveness of braces in mild idiopathic scoliosis. Spine 1984; 9:632-635.

7. Focarile, F.;Bonaldi, A.; Giarolo, M.;Ferrari, U.; Zilioli,E.; and Ottaviani, C.: Effectiveness of nonsurgical treatment for Idiopathic Scoliosis. Overview of Available Evidence. Spine 1991; 15:395-401

8. Goldberg, C.;Dowling, F.; Fogarty, E.; and Moore, D.: School Scoliosis screening and the U.S. Preventive Services Task Force. An examination of Long-term results. Orthop. Trans. 1995-1996; 19:590-591

9. Rowe D., Bernstein S., Riddick M., A meta-Analysis of the Efficacy of Non-Operative Treatments for Idiopathic Scoliosis. et al. J Bone Joint Surg 1997: 79-A; 664-74

10. Deutchman, G.; Lamantia M.,; Indelacato J.; Raykhman M.: A Retrospective Study of twenty three adults treated for scoliosis using the Spinecor Orthosis. From 4th International Conference on Conservative Management of Spinal Deformities Boston, MA, USA. 13–16 May 2007.  Scoliosis 2007, 2(Suppl 1):S23doi:10.1186/1748-7161-2-S1-S23

11. Griffet et al. Relationship between gibbosity and cobb angle during treatment of idiopathic scoliosis with the spinecor brace. Eur Spine J (2000) 9:516-522

12. Manzoni D, Miele F.Dipartimento di Fisiologia e Biochimica.  Vestibular mechanisms involved in idiopathic scoliosis (Arch Ital Biol 2002 Jan;140(1):67-80 Universita di Pisa, Via S. Zeno 31, I-56127 Pisa, Italy)

13. Lamantia et al. A retrospective study of thirty six cases of vestibular hypofunction in adolescents with idiopathic scoliosis. Scoliosis Oct 2007. 2(suppl 1):s37.

14. Hopf C, Scheidecker M, Steffan K, Bodem F, Eysel P. Orthopaedic Department, Lubinus Klinik Kiel, Germany Gait analysis in idiopathic scoliosis before and after surgery: a comparison of the pre- and postoperative muscle activation pattern. Eur Spine J. 1998;7(1):6-11

15. SPINECOR: a new therapeutic approach for idiopathic scoliosis. Coillard C, Leroux MA, Badeaux J, Rivard CH. Research Center, Sainte Justine Hospital, 3175 Côte Ste Catherine, Montreal, Canada.       Stud Health Technol Inform. 2002;88:215-7

Crash Course on Personal Injury Practice Success

Crash Course on Personal Injury Practice Success

Interview with Personal Injury Practitioner Dr. Tom Arnold



Dr. Tom Arnold is a december 1989 graduate of Texas Chiropractic College and moved to Albuquerque, New Mexico, and began practicing in early 1990.

In an interview with The American Chiropractor (TAC), Dr. Arnold explains what it is like to be a doctor with approximately 95 percent of his patients being
Personal Injury.

TAC: What inspired you to become a chiropractor? Do you have a specific story?

Arnold: Frankly, as a kid I started giving myself adjustments. It started with popping my knuckles, then my knees and then neck and back. I was always athletic and it helped me get through my sports, so I had a firsthand experience of the benefit it provided even though it was not administered by a chiropractor. As an adult, I started going to a chiropractor just to stay tuned up for sports and it made an enormous difference. After several years in the financial world as a stockbroker, I was burned out. And I quit. During the next year, I discovered a special God given gift in my hands and, with the encouragement of friends and family, I pursued that gift through chiropractic.


TAC: What type of patients do you generally treat or attract?

Arnold: Approximately 95 percent of my practice is Personal Injury. I concentrate on automobile collision injury cases and I enjoy caring for the injured. It offers me a challenge to use more of my clinical skills in ways that aren’t necessary when treating chronic pain patients. I can empathize with auto collision victims.


TAC: What was it about Personal Injury that led you to develop a clinic almost exclusively treating that condition?

Arnold: My interest in automobile injury cases developed in my last year of chiropractic school. During that time I married a young lady who had been injured in an automobile collision three years before we met. She was hit from behind and continued to deal with severe headaches, neck and upper back pain. She is a registered nurse and, at the time of the accident, she didn’t know anything about chiropractic and therefore pursued the medical model of treatment which was prescription medications and physical therapy. As she said, “It really didn’t help.” When we met, she was living on handfuls of ibuprofen just to get through the week. As I cared for her, her condition greatly improved. The sad news is that her problems never completely resolved and developed into a long-term chronic condition. I can say without reservation that her situation and experience deeply influenced me. I have made a life-long commitment to develop my clinical skills through post-doctoral training as much as I can to provide my patients a recovery experience intended to prevent or at least improve the chances that they will not suffer like my family has. I say “family” because, when one person suffers, it affects the whole family.


TAC: What did you do specifically that changed your practice in building a PI patient base?

Arnold: I started looking at the legal community in a completely different manner than I used to. I used to think of them as a “necessary evil” of the Personal Injury world and they looked at me as a “necessary evil” when they represented my patients, because my documentation was horrible. I have since come to realize that, in order to help my personal injury patients as much as I can, I must think outside of the box of just treating their injuries. I had to learn to objectively and effectively communicate my patient’s situation to his or her attorney. This now gives the attorney an articulate explanation to allow the truth to be the deciding factor in a trial or settlement. Since then, my relationships have flourished as I am now looked upon as an expert by the medical-legal community.


TAC: Are you required to testify, or do depositions frequently?

Arnold: Yes, I am asked to testify several times per year.


TAC: How important is your clinical knowledge when doing Personal Injury cases?

Arnold: This is the most important question you can ask. Your clinical knowledge is the most important component and that has little to do with your knowledge of adjusting the spine. If it wasn’t for my post-doctor training in spinal related subjects like disc pathology, neuropathology and crash dynamics, I wouldn’t be able to articulate or testify about my patients’ injuries from a factual base. That is especially true when being cross examined in a trial or deposition, because lawyers will come at you and the only way for the truth of case to prevail is to be clinically excellent.


TAC: What type of knowledge base and CE Courses do you feel are necessary to succeed in a PI Practice?

Arnold: Prior to my commitment to personal injury, I only took continuing education courses to keep current with my adjusting skills. Since making the decision to be the best of the best in the Personal Injury arena, I have taken courses in advanced imaging, neuro-diagnostics, crash dynamics and documentation, to be able to apply a broader understanding of the legal challenges that face the plaintiff attorneys who represent my patients. Clearly, establishing high-quality working relationships with the plaintiff attorney community is vital. To do so, I have to demonstrate that I speak their language by providing them a quality product in the form of reports and documentation on their clients’ conditions, especially if there are residual disabilities.


TAC: How is what you do now, after having practiced this way for a while, differ from when you started?

Arnold: Back then, I didn’t know that I didn’t know. But now I’m committed to keep growing in my knowledge to expand my practice. I realize it is a life-long journey.


TAC: Have your credentials affected your ability to work with the legal community and, if so, how?

Arnold: I have to admit that, for a long time, I was clueless about the importance of credentials. There’s no way to calculate what that has cost me in lost opportunities. Now that I have “seen the light,” so to speak, my curriculum vitae reflects the efforts that I have made over the years to elevate my standing in the Personal Injury arena, through my credentials vs. through rhetoric. As a result, I’m working with attorneys who otherwise would not have given me the time of day.


TAC: What kind of notes system do you use, and is there a reason?

Arnold: My daily patient progress notes are taken in a standard S.O.A.P. format. This format covers the requirements for proper documentation. The last thing I or any other doctor needs is an insurance audit that reveals substandard and inadequate documentation that leads to a demand for a refund to the insurance company. I can live without that nightmare.


TAC: What were the biggest mistakes you made that affected your PI practice?

Arnold: I don’t know that this was a mistake…more like a blessing in disguise; but, a few years ago, I was one of the early adopters in the field of nonsurgical spinal decompression. For over a year, I stopped taking PI cases and concentrated just on decompression. I began to miss the automobile injury cases and finally returned to my roots. In retrospect, it was good for me to get away from Personal Injury cases for awhile, because now I believe I have renewed energy and empathy for this unique segment of the patient market.


TAC: What type(s) of diagnostic testing procedures do you use and why?

Arnold: For functional diagnostic testing like computerized ranges of motion and computerized muscle strength tests, I am equipped to do them in my office. However, when the patient needs electro-diagnostic procedures like an Electromyography/Nerve Conduction Velocity study (EMG/NCV), Somatosensory Evoked Potential test (SSEP), brainstem auditory evoked response (BAER), Video Electronystagmography test (VENG) or visual evoked potential (VEP), I refer them to the appropriate specialist and treat in a team environment.

For structural diagnostic procedures, I have plain film X-ray in my office and refer out for magnetic resonance imaging (MRI), computed axial tomography (CT) scans and bone scans.

The short answer to why is simply to arrive at the most accurate diagnosis possible.


TAC: What has really impacted your growth as a chiropractor and that of your practice?

Arnold: I would have to give a well deserved round of applause to Dr. Mark Studin for sharing with me his vast wealth of knowledge and experience in dealing with the legal community and for encouraging me to strive to be, as he says, “the best of the best.” One of the not so obvious secrets I picked up from him was the importance of developing a strong “infrastructure” composed of the curriculum vitae, effective narrative report format, and medical-legal educational and communication system.


TAC: With your practice being Personal Injury, can you give our readers your advice about setting up and maintaining such a practice in today’s healthcare system?

Arnold: If you don’t have a strong empathy for the automobile collision victim, then don’t bother. I like this niche and I’m sure it is much different than a family practice. I like the specialization and the unique challenges of providing admissible documentary evidence and testimony to the legal community. Keeping up with the medical literature is a bit of a challenge because there is a constant flow of new research that validates these injuries and supports what we do to treat automobile injury patients.


TAC: What general advice would you give an established chiropractor whose PI practice might be struggling?

Arnold: It’s probably struggling because he or she has not established a solid infra-structure of credentials, narrative reports, and medical-legal educational and communication systems that lets the legal community know that he or she is the real deal. Like I did, there are programs in the chiropractic community that can guide you through the process so you do not have to “re-invent the wheel” and which will shorten the learning curve.

One thing I learned, simply advertising or marketing will not get you the Personal Injury practice you want; that will only be achieved by becoming the best at what you do through your knowledge and a solid infrastructure.


TAC: Any final words for our readers?

Arnold: Through this whole process of working effectively in the Personal Injury world, the biggest winners are more than just my patients. The legal community in my area now has a “new-found respect” for chiropractic because they realize that chiropractors have the same knowledge base as their medical counterparts. The end result is that chiropractic wins and that makes me proud!


You may contact Dr. Arnold at [email protected].


Editor’s Note: Do you know an Amazing Chiropractor that you’d like TAC to highlight in our The Amazing Chiropractor series? Contact TAC’s editor Jaclyn Busch Touzard, by phone/fax at 1-305-716-9212 or email [email protected]. We want your inspiring story! Contact us today!

Evidence Based Wellness Care

Dr. James L. Chestnut has been studying human wellness for over 25 years. He has a Bachelor of Physical Education degree, a Master of Science degree in exercise physiology with a specialization in neurological adaptation, is a Doctor of Chiropractic from the Canadian Memorial Chiropractic College in Toronto, Canada, and holds a post-graduate Certification in Wellness.

Continue reading “Evidence Based Wellness Care”

Second Generation Chiropractor in the Trenches for Broad-Based Education Richard G. Brassard was appointed president of Texas Chiropractic College (TCC) in 2004, following several years of association with TCC as a member and chairman of the Board of Regents. He is a 1965 graduate of Palmer College of Chiropractic, following in the footsteps of his late father, Dr. Jerry Brassard. He is licensed to practice in both Texas and New Hampshire. Prior to his appointment as TCC president, Dr. Brassard maintained a private practice for 36 years in Beaumont, Texas.

Dr. Brassard is a past president of the American Chiropractic Association (ACA), serving in that capacity from September 2005 to September 2007, as well as a former president of the Texas Chiropractic Association (TCA) and the Texas Board of Chiropractic Examiners. Additionally, he is a diplomat of the National Board of Chiropractic Examiners, a Fellow of the International College of Chiropractic (honorary), and a fellow of the American College of Chiropractors (honorary).

In an interview with The American Chiropractor (TAC) magazine, Dr. Richard G. Brassard (Brassard) tells us about education based on science.

TAC: Dr. Brassard, could you tell our readers some of the exciting things that TCC has been experiencing?

Brassard: There is a lot of activity and excitement around campus these days. We completed the Southern Association of Colleges and Schools (SACS) reaffirmation of accreditation process just this past December after our Quality Enhancement Plan (QEP) had been accepted without recommendation, an achievement of which we are quite proud. We ran the pilot program for our Quality Enhancement Plan, which is titled “From Student to Clinician: Enhancing Clinical Reasoning Across the Curriculum,” the past two trimesters, and this spring have begun full implementation into our academic program.

As a part of the QEP implementation, and in conjunction with our faculty’s research on establishing a “blue print” of the TCC graduate of the future, we have been expanding the ranks of our faculty. We have welcomed many new members to our family, including Dr. Rahim Karim, our new Dean of Clinics. I have great expectations regarding his abilities to enhance the clinic experience for our students as well as to further strengthen our Hospital Rotation program.

I am also excited to welcome to the Texas Chiropractic College family Dr. Diane Resnick and Dr. Shari Wynd from Southern California University of Health Sciences, and Dr. Nancy Wills from the University of Texas Medical Branch in Galveston. In addition to their teaching duties, these professors will be leading and expanding research activities at the College.

TAC: So, could you tell us a bit of your background in chiropractic?

Brassard: I am very proud of my long affiliations and involvement with the national and state associations which lead, promote, and protect the chiropractic profession. It has been an honor for me to serve as the president of the American Chiropractic Association, the Texas Chiropractic Association and the Texas Board of Chiropractic Examiners. Prior to being named the president of TCC, I served on the Board of Regents, including a rotation as the Chairman. In 1991, I was honored when the TCA presented to me the Keeler Plaque as the Chiropractor of the Year for Texas.

I am a second-generation chiropractor. My late father, Dr. Jerry Brassard, offered me, and the chiropractic profession, tremendous guidance during his years in practice and through his many leadership positions with the ACA. While my brother, as a lawyer, did not join me in following in Dad’s footsteps, I do have two sisters-in-law who are chiropractors in Ohio. Do you have a thought on the healthcare reform debate taking place currently? 

Brassard: We have concerns with some possible outcomes of the health care debate; however, I’m very optimistic that there is an opportunity that we can pursue through this debate. Whether furthering friendships or further enhancing chiropractic within other aspects of the political spectrum, there are opportunities for chiropractic to capitalize on. I’m glad the conversations are taking place; it’s something we all need to keep a close watch on.

TAC: How do you view the relationship between chiropractic and the medical establishment?

Brassard: I think the relationship is continuing to grow and develop in positive ways. Now when our students graduate, they are often seeking positions in integrated practices that include medical doctors and physical therapists. Along those same lines, we are seeing MD’s looking for DC students with experience in our Hospital Rotation program. Those doctors are realizing, and embracing, the fact that having chiropractors on their teams (with the specialized care that trained DC’s bring to the table) can improve the lives of their patients.

This development is, in part, why we are always striving to enhance and expand our Rotation program. In September 2008, we entered into an agreement with the Rice University Athletics Department to help treat their NCAA Division I student athletes. Now in its second year, we have had many positive responses from the coaches and athletes there, and the experience attained by our students is tremendous. I want to thank the folks at Rice for choosing to work with us.

We have also just begun to work with a local alcohol and drug rehabilitation program. Although this program is still in its infancy, I truly believe that the chiropractic care offered by TCC student interns from our Moody Health Center will be a great benefit to these patients trying to better their lives.

TAC: What are the techniques taught to your students?

Brassard: We teach a variety of techniques without giving credence to one over another. We try to give our students a solid foundation in a variety of techniques so that, as they themselves grow in experience and confidence, they can then determine what may work best for them. Also, by giving them a broad-based foundation, I believe that our graduates will be better prepared to help their patients if a specific technique proves less effective.

When I was in practice myself, I would, on occasion, have a patient that didn’t respond to treatment, so I would send them to a practitioner of a technique that I didn’t use, but which I thought might work better for them. If the patient got well because of the other technique, that’s what was important—the patient got well. Other practitioners did the same and it always benefitted the patient.

As we learn to work together as a health care team, we also must work together as chiropractic professionals. Chiropractors and other medical practitioners must work well together. We don’t want to just integrate the practices of chiropractic and medicine; we want to integrate the further utilization of our colleagues as well.

TAC: What is the most unique aspect of being a student at Texas Chiropractic College? 

Brassard: I think the sense of family that develops here makes the TCC experience unique for students. Speaking personally, my door is always open to our students. I try to always be available to talk to them, share different techniques with them. When the Harris Administration building was being designed, the President’s Suite included an adjusting room which gets a lot of use by our interns and doctors. This open door policy is true for the faculty and staff at TCC. I gain great pleasure when I hear our students at commencement publicly laud so many members of our faculty and the support that they provided.

And while it may not be unique to TCC, we stress to our students the necessity of their involvement in the profession’s associations. It’s important for them to keep building the chiropractic profession through these organizations, whether on the local, state or national levels. I take great pride when I attend NCLC and see not just TCC students, but representatives from so many chiropractic colleges working together for the future of chiropractic.

TAC: Any thoughts on the overall importance of postgraduate education and what TCC’s department is up to?

Brassard: : Our postgraduate office is consistently trying to provide everything that chiropractors need to be successful, especially with the constantly changing laws and marketplace. They are constantly changing course offerings as needed and looking for new learning opportunities for our alumni and the professional community, including the addition of some webinars. The goal of our postgraduate office is not just to help DC’s maintain their licensure, but to provide the best opportunity for chiropractors to enhance their practices.

TAC: Any final thoughts or words for our readers?

Brassard: TCC is continually striving to provide a great chiropractic education for the sons and daughters of our alumni and many others, an education based solidly in the sciences. Also, many people may not realize that TCC has a large Board of Regents, with individuals from diverse professional backgrounds. This size and diversity provides us with a broad spectrum of advice and leadership from lawyers, MD’s, bankers, educators, etc., as well as other chiropractors.

I would encourage any prospective chiropractic student to visit our campus and see for themselves the great educational opportunities and challenges that await them each day in our classrooms, our student organizations, and our community. TCC really is the future of healthcare!


Visit for more information on TCC or call 1-281-487-1170.

Principles of a Sports Medicine Practice

In the fall of 1993, I was attending a Villanova versus Northeastern University football game. My son was a red shirt freshman wide out and me, a retired NFL veteran. We sat together as spectators, dissecting the game and the individual player performances. In events that would decide the game, the Villanova field goal kicker, Frank Venezia, missed two very makeable field goals. He pushed them off to the right and short. I told my son he missed them because he was locked up in his lumbar spine and could not rotate around the axis of rotation, the transverse plane. As a result, Villanova lost the game. following Monday, I was treating patients when my secretary paged me and asked if I could speak to Andy Talley. I recognized the name as the head football coach at Villanova. Seems my son went to the coach and relayed my thoughts on why Frank missed those field goals. Coach Talley asked if I could come down the next day and evaluate Frank and see if I could possibly correct the problem. I agreed to take the afternoon off the next day and drive the 87 miles to the University to see Frank. I did a basic chiropractic biomechanical exam, including the kinetic chain, and made the appropriate corrections. The next day Coach Talley called again. Seems Frank, in practice after my treatments, was pounding home 50 yarders. Coach Talley asked if I could come down again Thursday. I treated Frank again and then adjusted him before the Delaware game on the trainer’s table that Saturday. In the game against their arch rival Delaware, Frank kicked two 53 yard field goals to set a new school record. Villanova won the game. The following Monday, the Villanova trainer, Dan Unger, called and asked if I could, again, come down Tuesday. I agreed and rescheduled my afternoon patients. When I arrived at the training room there were eleven athletes, including two swimmers, with various conditions wishing to see me. Thus began a ten year relationship with some of the finest athletes, coaches, team doctors and trainers in sports. The following year,Villanova University put me on retainer and a fee for service plan that was quite generous. The schedule was demanding, trying to run a practice and still be at every game and two days a week in the training room. But, I hired an associate to help keep the ship afloat at home and, over the years, I was responsible for over 500 student athletes in 23 varsity, division 1 sports, some of whom went on to the Olympics, NBA, and NFL, including my son.

Since that time, I have been involved with the University of Maryland, the Pan American weight lifting competition, local high schools, and various athletes, including Steffi Graff. These athletes have come to learn that they perform better, are less susceptible to injury and heal faster from injury when their body is free from factors that inhibit motion, inhibit normal blood flow, and allow for normal proprioceptive input.

I want to focus on some foundational principles and how chiropractic addresses them from a performance enhancement, injury prevention, and therapeutic stand point.

Two of those principles simply stated are:

1. The body moves in circular planes.
2. Sports are linear.

This seemingly contradictory principle is one key to our understanding of sports performance and injury prevention. The process of taking circular motion to create linear velocity involves the progressive engagement of the entire kinetic chain and sequential firing of the muscles in a coordinated pattern.

Let us look at a few examples; a baseball pitcher or a football quarterback in the performance of their respective activity must involve the progressive engagement of the kinetic chain in circular planes to affect the velocity of the ball in the linear plane. If there is a motion deficit at any level from the talus in the push off phase, the lumbar spine in the rotary flexion/extension phase, the glenohumeral and scapular interaction in the respective planes of motion, the velocity will be compromised and, as the athlete tries to compensate, injury will occur and performance will decline.

The golfer must create club head speed to cause the ball to go in a linear direction. This involves the various joints, especially the low back, to take circular motion to create linear velocity. If he is unable to rotate around the transverse axis in the pelvis, he cannot achieve the necessary elements of his sport to the maximum degree. He then compensates by swinging harder, causing form breaks, poor performance, and possibly injury. Studies show that low back and pelvic adjustments improve the range of motion in all planes. Does it make sense that a chiropractor could be a great asset in this sport? Tiger Woods thinks so, as does Johnny Damon, the great Yankee hitter, who convinced the World Champions to put a chiropractor on staff.

Consider the swimmer. Statistics tell us that 77% of swimmers will develop shoulder pain, usually rotator cuff or entrapment syndromes. But it is unilateral. If it were simply an overuse injury, it would be bilaterally, since swimmers use both arms equally. I found in my experience treating Villanova swimmers for shoulder injuries that most had a loss of motion in their low backs and segmental dysfunction in the lumbar spine, thus preventing the lumbar spine from laterally flexing and the latissiums dorsi from elongating. This, in turn, prevents the scapula from rotating in the frontal plane due to the attachment of the latissimus dorsi muscle on the inferior angle of the scapula and the subsequent overreaching at the glenohumeral joint, causing micro trauma in the rotator cuff tendons.  While this is elementary to a chiropractor, our medical counterparts choose only to look at the inflamed tendon and intervene at that level, whereas the chiropractor will clean up the motion deficits in the kinetic chain, recommend repetitive motion exercises to restore normal muscle and joint function, thus eliminating the cause of the injury and rehabilitating the injured tendon.5

Let’s now look at a third principle. All soft tissue injuries are caused by exceeding the tensile strength of the tissue.1,2 Consider, however, the intrinsic factors, primarily joint dysfunction, that predisposes the athlete to exceeding the tensile strength of the tissue. When a joint does not move or moves improperly, the connective tissue traversing that joint shortens, weakens and becomes dysfunctional, both in the support of the joint and the dynamic function of the joint.4 Studies have shown that improper proprioceptive afferents into the central nervous system (CNS) further disrupts coordinated motion patterns in the extremities. Chiropractic adjustments have been shown to normalize joint motion, activate mechanoreceptors which impact the CNS in coordinated movements and restore normal joint stability, including the soft tissue traversing the joint. This, coupled with rehabilitation exercises to restore tensile strength and joint neurology, proprioceptive afferents, goes a long way in the prevention of overload injuries when detected before excessive stress occurs and enhancing the therapy post injury.3 Remember, all therapy speeds up, slows down or modifies the natural healing process. In the acute phase, we want to slow down the inflammatory process; in the healing phase, we want to speed up the process; and in the rehabilitation, we want to modify the process. Apart from motion, joints and soft tissues heal improperly and normal function is lost.4 Statistically, an improperly rehabilitated ankle sprain has an 80% chance of causing an injury farther up in the kinetic chain, most commonly the groin.6,7

To have a successful sports medicine practice at any level, from the child athlete to the professional, to the weekend warrior, knowledge of the basic biomechanical factors of sports performance and pathophysiology are essential. Beyond that, especially at the high school or club sport level where you may be required to do sideline or on the field evaluations, an advanced  knowledge of things like concussions, when to transport, and play-no-play decisions require the chiropractor to get training beyond our basic chiropractic education. Dealing with the female athlete and the child athlete requires one to have unique insight into the different problems presented by these population groups. Finally, a thorough understanding of the role of exercise and resistance training, as it relates to performance and injury prevention, is a real asset to any chiropractor wanting to develop a sports medicine practice.

The chiropractic profession has come a long way since Drs. Leonard Schroeder, James Ransom, Bill Womer and others started the Council on Sports Injuries. We owe a great debt to those pioneers. Now it is our great opportunity to move the profession into the forefront of the sports medicine world. Along with this opportunity, we must realize an even greater responsibility to represent our profession with the utmost integrity and professionalism.


Dr. Jack Dolbin is a 1977 Graduate of the National College of Chiropractic. He did his undergraduate work at Wake Forest University, where he was an All ACC running back and leading scorer on the track team.  He started 67 consecutive games at wide receiver for the NFL Denver Broncos between 1975 and 1980, including Super Bowl XII, where he was the leading Bronco receiver. He was named most valuable player in 5 NFL games. Dr. Dolbin is the owner of Pottsville Sports and Rehabilitation Center, a multi discipline practice, employing chiropractors, physical therapists, and exercise physiologists. He served on the staff of Villanova University sports medicine team from 1993 until 2003. Call 1-570-622-7291 for more information.


Principles of a Sports Medicine Practice—by Jack Dolbin, D.C. (pg. 18-19)
1. Leadbetter, MD. Clinics in Sports Med 1995; 14(2):353-410
2. Kibler, MD. Clinics in Sports Med 1995; 14(2): 447-457
3. Seaman, DC, MS Top Clin Chiro 1997;4(1) March vi-viii
4. Nelson, DC. Top Clin Chiro 1994;1:20-29
5. Herring, MD. Med & Science in Sports and Exercise 1990; 22(4) 453-456
6. Weisel, MD. Backlete 1997; 12 (5): 57
7. Kibler, MD. Sports Induced Inflammation 1990; 759-769
Advances in Sports Chiropractic from the Olympic Athlete to the Weekend Warrior—Class IV Deep Tissue Laser Therapy
by Phillip Santiago, D.C. and Julie L. Scarano, D.C. (pg. 22)
1. Steinlechner C, Dyson M, Laser therapy 1993; 5 (2): 65-74
2. Friedman, H., et al.  J Photochem Photobiol B Biol 1991: 11 87 – 95.
Recognizing Drug Induced Nutrient Depletion in Chiropractic Practice
by James B. LaValle, R.Ph., M.S., N.D., C.C.N. (pg. 26-27)
6.  Gau JT, Heh V, Acharya U, Yang YX, Kao TC. Uses of proton pump inhibitors and serum potassium levels. Pharmacoepidemiol Drug Saf. 2009 Sep;18(9):865-71.
7.  De Groote D, d’Hauterive SP, Pintiaux A, Balteau B, Gerday C, Claesen J, Foidart JM. Effects of oral contraception with ethinylestradiol and drospirenone on oxidative stress in women 18-35 years old. 1: Contraception. 2009 Aug;80(2):187-93. Epub 2009 Apr 22.
8.  Pincemail J, Vanbelle S, Gaspard U, Collette G, Haleng J, Cheramy-Bien JP, Charlier C, Chapelle JP, Giet D, Albert A, Limet R, Defraigne JO. Effect of different contraceptive methods on the oxidative stress status in women aged 40 48 years from the ELAN study in the province of Liege, Belgium. Hum Reprod. 2007 Aug;22(8):2335-43. Epub 2007 Jun 20.

Instrument Adjusting Panel

• Activator Adjusting Instrument • Impac’s Pro-ArthoStim
• Neuromechanical Innovations’ Impulse® and Impulse iQ® • Sense Technology’s PulStar

So many great adjusting instruments out there, but who’s got the time to figure out which one is right for them, right? Well, as always, we here at The American Chiropractor Magazine know exactly what you are looking for. We went ahead and contacted the marketing department of four of the most popular adjusting instruments in the Chiropractic Profession. We asked each of them one simple question, that each were happy to answer, although a little upset in the space constraint that we gave them, as each was happy to talk for pages on the topic: What is the one factor that differentiates the instrument you represent from the others in the market? Please read what each of them had to say.

Activator Adjusting Instrument Methods International has been providing chiropractic care, resources and training since 1967. Established on the principles of clinical research, the company’s major contribution to chiropractic care is the discovery and development of the Activator Method Chiropractic Technique and the associated Activator Adjusting Instrument. Activator Methods was co-founded by Arlan W. Fuhr, DC, who serves as the company’s CEO. Activator Methods International; 2950 N. 7th Street, Suite 200; Phoenix, AZ 85014; 1-800-598-0224;


Activator Methods: Over the past four decades, the Activator Method has grown to become the world’s number one instrument adjusting technique for chiropractors. The mainstay of this gentle, low-force technique is the Activator Adjusting Instrument, which is supported by extensive research, provides unparalleled reliability and produces positive results for patients.

Why is the Activator Adjusting Instrument the superior option for chiropractors worldwide? Unlike other chiropractic adjusting instruments, the patented design and engineering of the Activator has been proven effective through clinical trials, as evidenced in numerous published papers.

The Activator Adjusting Instrument is made of quality, sturdy materials, including stainless steel, and is covered by a one-year warranty, the best in the industry. And Activator Methods also provides product liability coverage for doctors who use the Activator Adjusting Instrument.

The Activator Adjusting Instrument is available in several models, to suit the varying needs of every chiropractor. The Activator II is ideal for the newer doctor who is recently trained on the Activator Method. This instrument is constructed of stainless steel exclusively and has variable settings, ranging in force from 11 pounds for pediatric care to 28 pounds for adults. The Activator II is available in both regular grip and EZ grip models for ergonomic comfort.

The Activator IV, developed for the more advanced chiropractic physician, is constructed of lightweight materials with special ergonomic handles. The range-of-force settings offer great flexibility, with 16 pounds to 38 pounds of thrust. The Activator IV’s ratchet setting also ensures exact force from each setting. The most unique feature of this instrument is its five pound preload capability that automatically tells you when to stop pressing on the patient before an adjustment.

Regardless of which Activator Adjusting Instrument chiropractic physicians choose, they can rest assured that they will be using a highly-developed instrument and one that will, no doubt, bring much needed relief to patients.

For more information about the Activator Adjusting Instrument, visit


Impac’s Pro-ArthoStim Inc. began producing high quality instruments for the chiropractic profession in 1982. Their product line has continued to expand and evolve over the last 27 years. Their ArthroStim® and VibraCussor® instruments are currently used in many thousands of private clinics worldwide and they are an integral component of many somatic techniques. Impac Inc. designs and manufactures all of their instruments onsite, in the USA. This enables them to provide rigorous quality control and helps to ensure availability of the instruments. They are able to provide custom manufacturing services to enhance a specific technique approach and to facilitate research. Call 1-800-569-8624 or visit


Impac: Some would answer that because the Pro-ArthroStim has a number of patents, and some pending, that this alone makes it unique. Among the many innovations of the Pro-ArthroStim, one of the favorite ones that doctors appreciate is the Pro-ArthroStim’s intuitive “tactile sense thrusting technology”. This technology is designed to mimic a “hands-on” feel and action that most practitioners are accustomed to. It allows the doctor to sense changes in tissue and muscle tone directly through the instrument. The Pro-ArthroStim’s design also permits a practitioner to change the amount of thrusting force that is produced—without stopping to reset knobs, switches or software settings. For example, the thrusting force can be increased or decreased simply by changing the amount of set-up/pre-load pressure that is applied—like manual adjusting.

The Pro-ArthroStim’s unmatched adaptability permits a practitioner to remain in control of the adjusting process-as opposed to being overruled by a machine or computer.* A practitioner can instantly customize the thrust dynamics to meet the needs of each individual patient. Most importantly, the ability to readily control the thrust dynamics allows a practitioner to transfer clinical skills they have accumulated from prior hands-on experience and apply them via the Pro-ArthroStim instrument.

The Pro-ArthroStim instrument generates a spring-cushioned recoiling thrust—rather than a “hammer-anvil” type thrust, which is used by other adjusting instruments. The Pro-ArthroStim also comes with a full cushion grip handle and an exclusive “comfort-trigger” feature. These features minimize the amount of force transferred back into the practitioner’s hands. When combined with the instrument’s ergonomic design, these features make the Pro-ArthroStim the most comfortable multiple thrusting instrument in the market place. Additionally, the Pro-ArthroStim offers the widest selection of tips in the industry. The wide variety of tips enables practitioners to apply the Pro-ArthroStim instrument in a broad range of protocols.

The Pro-ArthroStim instrument also comes with an extended 4 year warranty and a quarter-year long, money-back satisfaction guarantee. IMPAC is able to back-up the Pro- ArthroStim instrument with an unparalleled performance guarantee as a result of refining and manufacturing the instrument for more than 27 years.

*Other adjusting instruments limit a practitioner’s ability to freely determine the pre-load pressure and/or the thrusting force. Some instruments restrict a practitioner to just 2 or 3 force settings.

For more information, visit

Neuromechanical Innovations’ Impulse® and Impulse iQ® Innovations is a research-based medical device manufacturer of the patented, FDA registered, and UL listed, Impulse® family of chiropractic adjusting instruments, in use in over 5,000 chiropractic offices in every state in the USA and over 40 countries around the world. Neuromechanical provides educational training in Impulse Adjusting Technique® at more than 25 seminars each year in most major US cities and international hubs.

Contact: David Chubb, Director of Marketing, Neuromechanical Innovations, 101 S. Roosevelt Ave. Chandler, AZ 85226 USA, Tel. 1-480-785-8448, Fax. 1-480-785-3916, [email protected],


Neuromechnical Innovations: “In God we trust, all others, bring data,” is a fitting and illustrious quote from physicist and quality improvement pioneer W. Edwards Deming. Simply stated, the differentiating factor that makes the Impulse® and Impulse iQ® Adjusting Instruments so unique can be answered with one word: Research. Both Impulse® devices were prospectively born out of research to create the most efficient and effective chiropractic adjusting instruments in the industry.

To improve upon the traditional spring-loaded activation devices, the waveform of the Impulse Adjusting Instrument® was optimized to emulate the half-sine wave of a manual thrust—but 100x faster—producing more bone movement with less force (JMPT, 2005, 2006). Impulse® was then shown to produce a wider range of forces for clinicians to choose from and more vertebral motion during an adjustment in a follow-up study (JMPT, 2006). The multiple-thrust feature of Impulse® was also found to increase mobility by 25% over single thrusts (Chiropractic & Osteopathy, 2006). These features along with single and dual stylus’ and preload indication, with the affordable cost of Impulse® ($789) are responsible for its exponential growth in the chiropractic industry to 5,000 offices in the USA and over 40 countries around the world.

In studying how vertebrae moved, a gold-standard biomechanical assessment of actually placing steel pins into the spinous processes to measure spine motion was conducted, along with measuring neurophysiologic responses of adjustments. After tuning in what speeds, frequencies, and forces provided the most effective adjustments, a motion sensor was added to Impulse® which is connected to a computer microprocessor inside the instrument allowing spinal motions to be measured non-invasively. Impulse iQ® was born. We validated this technology to the gold-standard and published it in the August 15, 2009 issue of the orthopaedic journal, Spine. The Auto-Sense® technology of Impulse iQ® enables the adjustment to be tuned to the natural frequency of the individual segment in each patient while providing the clinician with biomechanical feedback about the body’s response to the treatment. As motion improves during the adjustment, the iQ’s Auto-Sense® technology recalibrates the adjustment frequency in real time to keep up with the patients new motion pattern and thrusting stops when motion has been maximized. This patented technology is a truly distinguishing feature from any other adjusting instrument available at any price point.

Neuromechanical Innovations is the first and only manufacturer or distributor of chiropractic adjusting instruments to receive the prestigious UL-Listing mark for the Impulse® family of adjusting instruments and is among few in the chiropractic industry with such designation.

For more information, visit

Find references online at


Sense Technology’s PulStar goal of Sense Technology and everyone associated with the Company is to provide instrumentation that will enable clinicians to provide patients with the most efficient and effective therapy possible while maximizing the number of patients that can be treated by the clinician. Sense Technology originated the computerized adjusting system known as the FRAS (Function Recording and Analysis System) and currently markets the latest state-of-the-art spinal analysis and adjustment system, the PulStar. Published research documents the reliability and efficiency of this affordable system. For more information on Pulstar call 800-628-9416 or visit


Sense Technology: When the PulStar adjusting head with automatic pre-load impulse mechanism (US Pat #4,841,955-1989) was introduced, it changed instrument adjusting forever. For the first time, the chiropractor could apply a measured and repeatable adjusting impulse to the patient. Although copied by others, this mechanism has been refined over the years and now automatically matches the force setting chosen for the adjustment.

In 1993, the precision controlled impulse was extended to analysis of the patient’s spine with Computerized Fixation Imaging™ a graphical pre- and post-adjustment display (US Pat # 5,662,122). This computerized system enables the control of analysis and adjustment through the computer screen or from the adjusting head and allows the patient and physician to see the results of the adjustment in real time. The full spine display ensures that problems between each area of the spine are dealt with effectively and the graphical record can be printed out for the patient and used to:


• document each patient visit

• obtain reimbursement

• enhance patient referrals


The PulStar has more rates and force levels available for adjusting and analyzing than any other system. The force of the impulse is settable from 5 pounds to 35 pounds. The rate of impulse application automatically adjusts to the severity of the spinal fixation during adjustment or can be set from 2 to 20 Hz at all force levels and to 90 Hz in the sweep mode.

Unlike systems that feature only one position, the PulStar adjustment can be made in the prone, sitting and standing positions and enhanced through positional adjusting where preloading the body is achieved with no stress on the chiropractor. The PulStar’s quiet adjustment is produced through a true impulse rather than an impact. Unique to the PulStar is the computer voice prompt at each phase of analysis and treatment allowing the chiropractor to focus on the patient rather than the computer screen.

The PulStar also includes a networked patient database which allows the chiropractor to access any patient file from any PulStar. Initial patient entry into the database is made at a front desk computer and effortlessly accessed from any adjusting station. The database contains patient demographics as well as parameters of adjustment including vertebrae adjusted, force setting and number of impulses used on each patient visit. The database interfaces with multiple independently developed documentation and billing systems giving the doctor more flexibility in their choice of EHR systems.

All-in-all, the PulStar represents a unique advance in instrument adjusting that is constantly being improved by a dedicated team of engineering and scientific professionals as well as many, many members of the chiropractic profession.

For more information, visit

The State of the Chiropractic Profession

As The American Chiropractor celebrates its 30 Year Anniversary, our panel of leaders look back on just how far the chiropractic profession has come and what lies ahead.



Dr. Louis Sportelli
President of NCMIC

 Dr. Sportelli has served in many capacities throughout his 47-year career in chiropractic. He is currently serving as President of NCMIC Group Inc., which provides malpractice insurance and financial services to doctors of chiropractic. Another area of interest has been patient education, and he has written a book, Introduction to Chiropractic™, which is widely used by doctors of chiropractic across the world and is now in its 12th edition.



TAC: The past thirty years have been controversial for chiropractic. What would you say have been the milestones that have occurred and how have they impacted chiropractic?

There have been several that have happened in the past 30 years. A few years earlier than 1979, the most significant achievement occurred and that was the recognition of CCE by the United States Department of Education. That single event changed the entire educational process for the profession, established one standard, provided loans for prospective students and removed a stigma from the profession that chiropractic education was inferior. Following that event, the long awaited success of the Wilk v AMA litigation, which essentially provided information from the legal discovery process which enabled the profession to fully understand the events of the past and pave the way for future advancement based on the AMA conspiracy. Then, the starting of the World Federation of Chiropractic (WFC) in 1988, the AHCPR recognition of spinal manipulation and the most current accomplishment with the publication of the proceedings of the Bone and Joint Decade–Neck Pain Task Force, which was the most comprehensive research consortium ever assembled from around the world. The significance of that research and scientific collaboration has yet to be fully realized. These events have continued and will continue to change the public, private and professional view of chiropractic.

TAC: What is the most pressing issue of the moment for the profession?

Without question, The Health Care Reform, and whether or not chiropractic will be included and in what fashion. This new health care model will change the direction of chiropractic availability for decades. This issue is far more difficult to expound upon because no one knows precisely where the debate will take us and upon what the reform will focus. Without a doubt, however, the health care debate will provide the most significant challenge to the profession ever.


Dr. James Winterstein
President of National University Health Sciences

 Dr. James Winterstein is a 1968 graduate of National University of Health Sciences. He completed his residency in diagnostic imaging in 1970 and became a diplomate of the American Chiropractic Board of Radiology in May of 1970. Dr. Winterstein has been a member of the Board of Directors of the Federation of Illinois Independent Colleges and Universities for the past 18 years and also serves as a board member for Alternative Medicine Integrated Inc.



TAC: What would you say was the largest missed opportunity for Chiropractic?

During the past 30 years, the chiropractic profession, which prior to 1970, saw itself and practiced as a diagnostically, therapeutically conservative primary care profession, had the opportunity to demonstrate its potential as a source of conservative primary care providers–the necessity for which has become very clear in the past several years, as the deficiency of primary care providers becomes ever more evident. Unfortunately, the chiropractic profession chose to restrict itself almost completely to musculoskeletal disorders, primarily because of reimbursement opportunities provided by the insurance industry during the 80’s and 90’s. It sold its true value for the sake of increased income. As this took place, the third party payer industry took note through its actuaries and, gradually but consistently, contained and further restrained the chiropractic profession, by virtue of its own profile of practice to limited musculoskeletal therapeutics. The missed opportunity has resulted in a boxed in profession and, except for some small future opportunities, it might well never recover from this error of professional judgment.

TAC: What, in your opinion, was the most significant event that unfolded in the past 30 years?

The most significant event to have unfolded in the past 30 years was the development of the Journal of Manipulative and Physiological Therapeutics, which, until recently, was the only peer reviewed and fully indexed scientific journal of the profession. Prior to this, the development of educational accreditation by the Council of Chiropractic Education as a true watershed event. Also of true significance for the profession has been the development and federal funding of basic and clinical research at a high level of scientific attainment. These three accomplishments, which actually cover the period from 1974 to the present, are, in my estimation of greatest significance to the development and recognition of the chiropractic profession.


Dr. Joseph Brimhall
President of Western States Chiropractic College

 Joseph Brimhall, D.C., President of Western States Chiropractic College in Portland, Oregon, since 2003, was in private practice for twenty-two years. He has extensive experience in regulation, professional testing, chiropractic accreditation (national and international), and regional accreditation. Dr. Brimhall was CCE President, CCE-COA Chairman, and is President-Elect of CCEI.



TAC: What has been the single biggest deterrent to unity within the profession?

The question, itself, reveals the restraint—the perception that the profession lacks unity may actually be the principal dilemma. Second to that quandary is the illusory notion that somehow “unity” is a necessary or desirable attribute for the profession.

The chiropractic profession is unified where it counts, with recognized educational requirements, dependable evaluation processes, professional licensure and regulation in jurisdictions around the world, and strong ethical values. Yes, we disagree about practice scope and philosophy and techniques and many other things. We have a variable mixture of attitudes and a broad dissimilarity of professional philosophies. Is that a bad thing, or is the diversity of thought a strength?

My view is that the range and assortment of clinical and philosophical approaches is an asset—that we benefit from having multiple views and opinions, because it forces us to persistently assess and evaluate our direction and our values. I’m not talking about those that use the profession for unethical purposes—we need to continue to weed those elements out in order to protect our patients and our professional integrity. However, I believe that honest disagreements provide grist for the mill in advancing the profession. Otherwise, we become a profession of homogenous zombies that are unable to make new discoveries or adapt to changing environments.

Our disagreements need to continue as great debates. As changes occur and health care evolves, we can discover our direction and our identity only through open dialogue, mindful deliberation, and decisive action.

It is not the lack of unity that binds us; it is the failure to engage. A critical majority of the profession is willing to simply sit on the side-line and observe, too lazy or too afraid to take a stand and work for the greater good. If we expect the profession to develop and thrive, we need to be willing to ask the difficult questions, to fight for what we believe in, and to grapple with our differences until we find accord. This is a continuous and necessary pattern. If we expect to grow, the process must repeat itself over and over. There is no easy path to success, and advancement of the profession cannot be accomplished by spectators.


Dr. Gerry Clum
President of Life Chiropractic College West

 Gerard W. Clum, D.C., is president of Life Chiropractic College West in Hayward, California, and is the most senior chiropractic college president in the world today. He will begin his 30th year as president of Life West in January 2010. He has served in the leadership of the ICA, ACC, WFC and the Foundation for Chiropractic Progress.



TAC: What is the Most Pressing Issue of the Moment for the Profession?

Perspective. We are in a moment of great fluidity in our culture. Further, we are in a moment where the focus of this fluidity has the potential to greatly impact our circumstances.

I am not naïve. I understand there is a great deal at stake in the current discussions regarding health reform. But I also understand that this focus on health reform has brought conversations forward that would have been hard for us to imagine months ago. When the President of the United States predicates a dialogue about health care reform with the premise that we do NOT have a health care system, we have a sickness care system, something we have longed for has arrived. When policy makers and pundits alike agree that health care reform will not reform health, something we have longed for has arrived. When the great “answer” for health reform is not big pharma, but clean living, something we have longed for has arrived.

If we can gain a perspective on how the thinking of large and powerful portions of society is aligning with our viewpoints and understandings, we can begin to further appreciate how the firmament is being prepared for a transition that will be far more welcoming to our practices than we ever dreamed possible.

Joseph Campbell was fond of remarking that, to change a culture, one must first change the metaphor of the culture. The metaphors of health and health care have changed and the culture is changing accordingly. The culture wants and needs a new model of health care—and we are in remarkable alignment with what they are seeking.

Our task today is to gain a broader view of our world and its directions and express our views in language and metaphors that are consistent and synchronous with their view, so that we may be more easily heard and more fully appreciated for our contribution. We are on target. We do not need to change our path. Rather, we need to appreciate the alignment of the hearts and minds of our society with our thoughts and practices. Dr. Sid Williams often quoted Columbus’ log, “Today, we sailed due West, because it was our course.” Stay the course, but do so in the language and with the cultural understandings of the day.


Dr. Scott Haldeman
Chairman of the Research Council of the World Federation
of Chiropractic.

hadelmanScott Haldeman, D.C., M.D., Ph.D., is a Clinical Professor of the Department of Neurology, UC, Irvine; Adjunct Professor of the Department of Epidemiology, UCLA; and Past President of the North American Spine Society and the American Back Society. He is chairman of the Research Council of the World Federation of Chiropractic. He has published over 185 articles or book chapters and has authored or edited 7 books.



TAC: What are the challenges that face the chiropractic profession in the 21st century, in the next decade, and beyond? How could the growth and progress of chiropractic be advanced or stymied during this time period?

The past 20 years has seen a marked increase in the amount of research into the epidemiology, diagnosis, and treatment of disorders associated with the spine, especially back and neck pain. The therapeutic benefit of spinal manipulation for back and neck pain is no longer seriously questioned and there are growing research efforts to look into the impact of this treatment approach on other conditions.

The research support for spinal manipulation has resulted in the situation where chiropractors are generally accepted as valuable members of the health care team. The acceptance of chiropractic has resulted in a debate within the profession concerning the future role it wishes to play within this team. The potential future roles for chiropractors include 1) a limited practice to that of a skilled practitioner of spinal manipulation; 2) a wellness/holistic clinician focusing on preventative health care therapies; or 3) the primary spine care clinician.

Recent publication of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders and a special issue of The Spine Journal on Evidence Informed Management of Chronic Low Back Pain emphasized the fact that many of the treatments that have been demonstrated to be effective in the management of back and neck pain, such as exercise, education, mobilization, manipulation and NSAID’s, are neither high tech nor expensive and could easily be offered by chiropractors.

The position that offers the greatest opportunity for chiropractors is that of primary spine care clinician. This position assumes that the chiropractor will become the most knowledgeable clinician in the field. A decision to strive for this role in the health care system will require a change in the culture of the profession. Practicing chiropractors will be expected to attend the major chiropractic research meetings, such as the World Federation of Chiropractic and the RAC conferences. They will have to participate in greater numbers in the inter-professional spine research meetings, such as the North American Spine Society Congress. They will also be required to subscribe to and read the major spine journals in order to achieve the knowledge necessary to become the authority on the spine. Chiropractic colleges will have to change the curriculum to train students to accept this role. Graduate continuing education programs will have to include a strong scientific component.

It is not yet clear whether individual chiropractors, the colleges or the state and national associations have made the decision as to which of these roles would serve the profession the best. It will be very interesting to see what role the chiropractic profession will decide to assume in this very exciting evolution of health care.


David Chapman-Smith, LL.B, F.I.C.C.
Secretary-General of the World Federation of Chiropractic

 Mr. Chapman-Smith, a Toronto attorney, is Secretary-General of the World Federation of Chiropractic and editor/publisher of The Chiropractic Report. His introduction to chiropractic was as legal counsel for the New Zealand Chiropractors’ Association before the famous New Zealand Commission of Inquiry into Chiropractic in 1977/78.



TAC: If you could have your wish to change the profession, what would be the thing you would change?

Nothing fundamental to the profession should change–such as its philosophy of health and its central focus on skilled assessment and treatment, by hand, of subluxation/dysfunction in the spine and the neuromusculoskeletal system.

The profession that so many of us admire, and to which I have devoted my last 30 years, will have lost its way, if new generations of chiropractors are not skilled and confident in joint adjustment–spine, pelvis and extremities.

Two of the major issues for the profession today, related to each other, are its relative isolation within health care and the lack of public funding for education, research and practice that it needs and deserves. On isolation, a chiropractic friend of mine who holds qualifications in both chiropractic and medicine is an executive in a large Canadian health services corporation. This employs many MD’s, DC’s, PT’s and others. It seeks contracts with large employers, insurers and others for the health plans it offers. He sees much more of the health care world as it actually is than you or me. His conclusion, after watching all the above professions at work with NMS patients, and seeing which services are most in demand and how they are priced–”chiropractic is the best kept secret in the world. DC’s offer such a superior service but nobody knows.”

What would I change in the profession? It would be something key to bring about more rapid knowledge, acceptance and, therefore, use, funding and support of chiropractic services within mainstream healthcare. I would like to see all chiropractic students having at least part of their clinical training in a multidisciplinary setting that includes medical services and, ideally, medical students.

This is already happening in many chiropractic schools internationally. In Denmark, chiropractic students complete most of their clinical training in a major spine care hospital. In Mexico, all graduates complete a first clinical year in state hospitals.

In the US, eleven chiropractic colleges now have some students doing rotations in VA and DOD hospitals, but this exposure to broader clinical training and other professions and healthcare students should be available for all.

This will strengthen clinical training. However, my point here is that it will continuously educate others influential in health care about chiropractic—and this will lead to the greatly increased community acceptance and funding that the profession and its patients need and deserve.


Dr. Vernon Temple
President of the National Board of Chiropractic Examiners

 Dr. Vernon R. Temple is the president of the National Board of Chiropractic Examiners. A 1977 graduate of Palmer College of Chiropractic, he is past president of the Vermont Board of Chiropractic and past chair of the Federation of Chiropractic Licensing Boards. Dr. Temple is a diplomate of the American Board of Chiropractic Orthopedists.He continues to practice in Bellows Falls, Vermont.



TAC: If you had one piece of advice for new graduates starting into practice in 2010, what would it be?

The most important piece of advice I can provide to the new practitioner is to develop a Patient-Centered (PC) practice. This means that the full intent of doctor and staff regarding all patient contact is always to be focused on the best interest of the patient.

Some of the key areas where the practitioner can incorporate PC include:

1. Patient Education


Patients come into your office with the same four basic questions: “What’s wrong with me?” “Can you help?” “How long will it take?” “How much will it cost?”

To meet patient’s needs, the doctor will completely answer these questions; but, to truly have a PC practice, the doctor should also educate the patient about their role as a partner in their health care. The PC doctor ensures patients understand how chiropractic will relieve their current condition and contribute to long-term health.

2. Patient Services


As the new practitioner develops office procedures, both the doctor and staff must put patients’ needs first. From the initial phone call, to the first time a patient comes in to fill out forms, to the initial consultation, to the report of findings, through the final staff encounter, all processes must be convenient for the patient and must make the patient feel cared for.

3. Empathy


Having a doctor and staff who demonstrate a sincere and genuine passion for the patient’s well being will build a lifelong successful practice. Empathy for the patient’s suffering gives the patients confidence that their health is in the hands of caring people. Not only will these patients return, but they will refer their family, friends and loved ones to receive that quality of care.

4. Financial arrangements


Payment for services will always be a consideration, but should never take priority over patient needs. A PC practice dictates that patient contact and care always remain in the best interest of the patient. Ensure that all financial arrangements are based upon the needs of the patient and then billed appropriately. The fruits of an ethical practice are a waiting room full of patients appreciative of a doctor they know is working in their best interest.

5. Continuing Education for the Doctor and Staff


Doctors of Chiropractic should always continue to learn, to expand their knowledge, to continue to invest their time in order to enhance their abilities to meet their patients needs. Ongoing staff training regarding procedures and patient interactions represents another avenue to meet the goals of a PC practice.

If all doctors incorporate the philosophy of patient-centered care, they will be rewarded with a comfortable living, an enjoyable career and, most important of all, the satisfaction of helping thousands of patients in their community live healthier lives.


Dr. William Morgan
Champion for Chiropractic Integration

 Dr. William Morgan, a champion for chiropractic integration, has been credentialed in four hospitals, including Bethesda and Walter Reed. He is the resident chiropractic consultant to the government clinics that care for our nation’s leaders in Washington, D.C., and is on faculty of three chiropractic colleges and one medical school.



TAC: Where do you see the next great challenge to face chiropractic?

Cultural Relevance. Contrary to what other futurists may predict, I do not see chiropractic’s next big challenge to be attacks on our market share by competing professions or insurance companies, nor do I see it as exclusion from Congress’ health care bill. I do, however, see chiropractic’s next big challenge to be more fundamental: the loss of cultural relevance. Cultural relevance is maintained by being embedded in the popular culture; to speak the same language, to understand the culture, and to have a position in the culture that is valued. In the current congressional healthcare debate, no adversary is seeking to confine us, because we aren’t even mentioned. Have we lost our impact on the debate? Is society becoming indifferent towards chiropractic? If these are indicators of a trend, chiropractic will gradually ebb. The danger of this type of challenge is in its insidious nature, slowly eroding our niche; so slowly, that it is hardly recognized.

The vertebral subluxation is neither the cause nor the solution to our problems. Certainly, I can use this term when engaged in discussions in chiropractic circles, or I can speak with more standardized neurological/biomechanical terminology when engaged with medical specialists. To most of our culture, whose goals are pain relief and health, the word subluxation is simply jargon. To establish our relevance, we need to move past jargon, beyond practice management schemes, past intra-professional disagreements, and emerge with a higher degree of professionalism and maturity.

If chiropractic attains cultural relevance (some would say cultural authority), then our other concerns should take care of themselves. With relevance, chiropractic will be in demand and, whether or not we are included in government health care plans or covered by insurance, will not matter. Patients will seek us regardless of coverage or competition. Think of dentists or optometrists. Whether covered by third party payers or not, our culture will continue to utilize dentistry and optometry. These professions have cultural relevance.

What will it take to attain strategic cultural relevance? We need to align our profession with the needs of the culture. We need to develop a realistic sense of self-awareness and, instead of trying to bring the culture around to our way of thinking, we need to listen to the culture, learn what the culture values, strive to fill a niche that is valued by the culture, and communicate to the culture in the predominant forums of the day.

Coding the Right Way!

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 [email protected] or call 1-888-820-7778