Category: Other Articles

The Don’ts and Do’s of Building a Successful Personal Injury Practice through Lawyer Referrals

by Dr. Mark Studin DC, FASBE, DAAPM, DAAMLP

After a lawyer refused to accept my referral of a patient to him, I got my ego out of the way and started asking very difficult questions.

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Neck Pain Aggravated by Foot Imbalance

by Dr. John J. Danchik, D.C.

The patient is a 32-year-old mother of three active young children, who presents with chronic neck pain and fatigue. She reports a motor vehicle collision four months ago, during which she received a hyperflexion/hyperextension “whiplash” injury. While her acute neck stiffness has improved, she describes persistent aching in her lower neck, varying from 4.0–7.5/10. She also has frequent occipital headaches requiring the use of pain relievers, and she has not been sleeping well, awakening frequently. These ongoing symptoms have resulted in a progressive tiredness that makes caring for her family difficult.

Exam Findings

Vitals. This active woman weighs 136 lbs, which at 5’6’’ results in a BMI of 22—her weight is healthy. Her blood pressure and pulse rate are both at the lower end of normal range. She drinks a few glasses of wine each week, usually with meals. She reports that she has not smoked tobacco in about ten years. Posture and gait. Standing postural evaluation finds generally good alignment, with intact spinal curves, except for generalized cervical hypolordosis and anterior head translation. There is also a slight lateral tilt of her pelvis to the right, accompanied by right calcaneal eversion and a lower right medial arch. Dynamic treadmill gait evaluation finds hyperpronation of the right foot and ankle, with asymmetrical pelvic movements when walking at various speeds. Chiropractic evaluation. There is loss of regional cervical range of motion in all planes, but particularly in flexion, extension and right rotation. Motion palpation identifies several lower and upper cervical joint restrictions, with moderate tenderness and loss of end range mobility. Several compensatory fixations are noted in the lumbopelvic region. Neurological tests are negative, including sensory and reflex testing of the upper and lower extremities. Additional findings. Palpation of the right foot finds localized tenderness of the second, third and fourth metatarsal heads, with callus formation underneath. All foot and ankle joint ranges of motion are full and pain-free, bilaterally.

Imaging

A cervical X-ray series confirms the clinically-suspected hypolordosis with an anterior cervical gravity line. No contraindications to cervical manipulation are identified.

Chronic postural strain syndrome of the cervical spine, complicated by previous whiplash injury and asymmetrical pedal support. The right foot demonstrates loss of both the medial and anterior arches, with calcaneal eversion and hyperpronation during function. The asymmetry of the lower extremities affects her lumbopelvic region, adding to the postural strain.

Treatment Plan

Adjustments. Specific, corrective adjustments for the cervical and lumbopelvic regions were provided as needed. The right metatarsal heads were mobilized into an arched position, and the calcaneus and navicular bones were also adjusted. Support. A cervical support pillow was supplied, with instructions to spend as much time as possible in the supine position before (at least 30 minutes) and during sleep. This pillow was custom-fitted, based on four body measurements and a description of her mattress type. In addition, custom-made, flexible stabilizing orthotics designed to provide support for the calcaneus and the arches of the foot were provided. Rehabilitation. She was immediately started on a daily cervical posture corrective exercise – posterior translation against dynamic resistance. Marble pick-up and towel-scrunching exercises were also begun in an attempt to strengthen the intrinsic foot muscles.

Response to Care

She responded well to the spinal and foot adjustments, and reported a rapid decrease in her neck pain and headache symptoms. Once she received the cervical pillow and orthotic stabilizers, she reported feeling more energy and being much better rested. After five weeks of adjustments (10 visits), daily home exercises and using the cervical pillow and wearing the orthotics, she successfully completed her re-examination and was released to a self-directed maintenance program.

While many cases of neck pain and headache respond well to a local approach consisting of cervical adjustments and use of a cervical support pillow, some are more complex. This patient showed a commonly seen combination of a forward head posture with increased anterior foot stress and loss of the metatarsal and medial arches. In her case, this was primarily unilateral, resulting in a lower extremity asymmetry with lumbopelvic consequences.

Generate Healthier Patients with Laser Therapy

by Dr. Phil Harrington, D.C.

Laser therapy is a progressive service that will en-hance clinical outcomes, increase patient satisfaction and expand your market share. This article will outline six reasons why you should implement laser therapy in your practice.

1. Treat More Conditions

Laser therapy’s primary mechanism of action is biostimulatory. By enhancing cellular output of adenosine triphosphate^1,2 (ATP), injured tissues heal more rapidly and with better quality.³ As Dr. Rick Harris of Mabank, Texas, says, “Laser therapy lets me treat more conditions on so many more people. Soft tissue injuries are now a much larger part of my practice.”

2. Treat More Patients

Approximately 10% of the population currently visits a chiropractor. Patients who are “chiro-phobic” react favorably to laser therapy, because you are simply shining light on them. Once they are in your clinic, you can tell them the Chiropractic Story. And, even if they choose not to get adjusted, at least you have helped them, and not someone else down the street. “I have more patients presenting with a much wider range of conditions for laser treatment,” says Dr. Ben Acree of Fort Dodge, Iowa.

3. Increased Clinical Results

Laser therapy is an excellent adjunct to all chiropractic services. When used in combination with adjustment, decompression, or soft tissue work, many chiropractors have witnessed improved clinical results. Therapy lasers accelerate tissue repair and growth,^4,5 improve nerve function,⁶ and reduce inflammation⁷ and scar tissue formation.⁸ Dr. Harris adds, “I’m getting results with laser therapy that I couldn’t even dream of with any of the other modalities I’ve utilized.” And Dr. J. R. Kille of Springfield, Missouri, adds, “I have had dramatic results with post knee replacement therapy in as little as three laser treatments.”

4. Added Revenue Stream

You can incorporate laser therapy into your practice by having the doctor perform the treatment, having a trained chiropractic assistant administer the laser prior to the patient’s seeing the doctor, or to have a “stand-alone” laser therapy center—a clinic within a clinic. Laser therapy is a new stream of revenue in your clinic that adds new patient visits and value to existing patient visits. “A laser is an expensive piece of equipment for sure. But it started covering the cost of the system after only one month of use, so it is definitely a worthwhile investment,” says Dr. Kille.

5. Increased Patient Compliance

Patients being treated with laser therapy will usually improve faster than without and, if they can feel a difference quickly, they will be more likely to return for care, as well as refer family and friends. Dr. Kille says, “My newspaper ads bring in new patients because laser is the latest technology, but they keep coming in because it works.”

6. Stay on the Cutting Edge and Avoid Burnout

Since they have been cleared for use in the US for less than ten years, therapy lasers are cutting edge technology. Progressive chiropractors appeal to educated patients. Through increased patient flow and improved clinical outcomes, adding laser therapy to your practice can also help you avoid burnout. Dr. Harris says, “I think that the best part of laser therapy is the ability to get results on my chronic and difficult patients. It is so much more fun at work now.” Another chiropractor added, “The laser has given me an excitement about helping people that I haven’t felt since discovering chiropractic itself!”

We can complain about how the world is treating us, or we can change the way we treat the world. Adding laser therapy to your practice can give numerous benefits to you and your patients. “The single most beneficial move I have ever made for my patients in 24 years of practice was implementing laser therapy,” says Dr. Dan Knapp of Sarasota, Florida.

Retain Health Under Extreme Exercise Duress How to Handle Extreme Athletes in a Family Practice

by Dr. L. Jon Porman, D.C., C.C.S.P., R.T.P

An extreme athlete performs mostly maneuvers the general public would never even dream of attempting. His sport requires that he possess phenomenal skills, courage, strength, endurance and perseverance. The extreme athletes I am talking about are Mixed Martial Arts (MMA) fighters, like the ones in the ever-popular Ultimate Fighting Championship (UFC).

The UFC fighter can get kicked, punched, body slammed, tackled and even choked unconscious. These “warriors” do share common injuries with most other sports however, with the majority of injuries categorized as strains and sprains. They are highly skilled performers that are many years in the making because the event is so diverse and the backgrounds of the competitors are so varied.¹

The fighter has to be strong, agile, explosive, enduring and mentally tough. But to attain these skills, he must go through extensive training and competition that is brutally tough each and every day, even though most have “regular” jobs they report to daily. Their daily training is based on wrestling, boxing and other combat sports.

So, when one of these athletes walks through your door, you need to have prepared an arsenal of skills. You need to be able to unlock fixated joints, break up long-standing scar tissue, speed healing of strained muscles and sprained ligaments, improve lymphatic drainage, as well as working on their (subconsciously driven) limiting beliefs. If you don’t, they will go elsewhere to someone that does, because they depend on the ability to train. Without training, this athlete will quickly lose strength, endurance, explosiveness and his confidence.

That is why we utilize so many diverse technologies in the treatment of these modern day “gladiators.” We will only touch on a few of these treatment protocols in this article. The most common acute injuries sustained are strains and sprains from the daily training regime they endure. We routinely utilize Super-Pulsed lasers to treat pain, inflammation, swelling and/or bruising associated with their training sessions and competition.²

Laser therapy reduces the excitability of the nerve cells by an interruption of the fast pain fibers with a concomitant resultant reduction in pain, inflammation, swelling and bruising. Laser has also shown to accelerate the repair of nerves and improve function in both the central nervous system (CNS) and peripheral nerves after injury.³

We employ Super-Pulsed lasers because we found them to be the most effective treatment for the medium and even deep soft tissue structures within the body (3-5cm)^4,5 and allow shorter treatment times than traditional lasers. With multiple frequencies, depth penetration and additional modalities in this unit it is the ideal treatment for these warriors. The Super-Pulsed Infrared Laser (905nm) unit also has Pulsed Broadband Non-Coherent Infrared Laser (875nm), Pulsed Red Non-Coherent Light (660nm), Static Magnetic Field (35mt) and E-Stim with technology that detects tissue inflammation. This unit is our dependable daily workhorse because of the reliable results we have achieved in treating injuries.^6,7

To improve neurological firing, we utilize work developed by Dr. Allan Austin from Canada. He has been using proprioceptive distortion protocols to modulate (facilitate and/or inhibit) athletes movement patterns for many years. Estonia has used him with their Olympic athletes for several Olympics now. It is a brain-based multimodal treatment system designed to integrate correct neurological communication between the brain and body.⁸

We have treated fighters using this neurological approach and achieve strength gains, for example, of 50+ lbs in their bench press after their first visit. We have also increased a Straight Leg Raising (SLR) test from 40* to 90* again after only a few treatments, if the tightness is due to neurological overfacilitation. Not to mention, an athlete that had continuous low back pain for 6 yrs and without ever treating his lower back, we permanently shut off the pain signals.

Common Sense for Outdoor Activities

by Dr. Kirk A. Lee, D.C.

During the warmer months, our interest turns to outdoor activities. For those of you who practice in states where you commonly see the changing of the seasons, we also see a change in the patients who come to our office. Both new patients and established patients will commonly exacerbate or reaggrevate a new or existing neuromusculoskeletal condition from gardening, starting a running program, or golfing, just to name a few activities. Let’s look at some things that benefit our patients from an informational point of view. We will focus on proper use of safety helmets, hydration and use of sunblock or sunscreens.

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Seminar Circuit

PALMER HOMECOMING

TAC Goes to the Palmer Homecoming Palmer Chiropractic College, Davenport, I

by Palmer Chiropractic College (PCC)

Nearly 1,500 attendees—alumni, their guests, students, prospective students, faculty and staff—enjoyed Palmer Homecoming 2009 on the Davenport Campus, Aug. 13-15. Alumni attendees earned up to 23 hours of continuing education credits, and there were special tracks for students and chiropractic office staff. A program packed with great presentations featured world renowned keynote speakers Bob Harper, fitness trainer on NBC’s The Biggest Loser, NCMIC Group Inc. President Louis Sportelli, D.C., and best-selling author and Wall Street Journal columnist Jeffrey Zaslow.

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But My Consultant Told Me It Was OK

by Ron Short, D.C., MCS-P

How many times have you heard of the case where a doctor hired a consultant and was told to implement a marketing plan?  The plan worked  and the doctor got lots of new patients until an inspector from the OIG looked at his ad and fined him for inducement of beneficiaries in a Federal Health Care Plan.  

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