How to Explain “SICKNESS” to Your Patients

:dropcap_open:L:dropcap_close:et’s cover an issue that many doctors often struggle with handling. You are doing your chiropractic “thing” and a patient suddenly says, “Dr. Bob, I couldn’t see you last week because I had the flu. I thought that if I was routinely adjusted, I wouldn’t get sick anymore.”
childSo how do you react? Do you panic or feel anxious? I am sure most of you have experienced this question in one form or another—and it made you suddenly feel a little uneasy. This is when you, a well-adjusted doctor with a university degree and tons of experience who has studied the art and science of chiropractic, start to babble defensively. Have I missed anything?
We all tell our patients that chiropractic will keep them well—that is the chiropractic wellness paradigm. Our care is hinged on the fact that what we will provide our patients with amazing health, and that’s the truth. 
However, sometimes the body has other ideas, and patients need to understand this. Let me explain with an example. When a child gets the flu, he or she experiences a runny nose, coughing, fever, swollen and glassy eyes, loss of appetite, lethargy, weakness, etc. Parents have been conditioned to believe that this means their child is really sick.
Yes! This is sickness at its best. But you need to look at this from a very different perspective: all of those symptoms have an amazing reason for being. They are not random. The nose runs to excrete the virus, for instance. The child may have diarrhea to excrete the bug further. Fever is the result of extra work produced by the body as defense mechanisms are brought in to fight the invading organism. The lacrimal glands produce continuous tears to cool down the cornea so its heat-sensitive protein makeup is not damaged, which is why the child looks glassy-eyed. There is no appetite because the body shuts down digestive cycles and shunts all energy to defense. 
All these activities are designed for one purpose only, and that is to restore health and remove the invading organism. That puts this whole “sickness thing” in a very different light. It means that all these things are not random symptoms that need to be treated.  
It does not mean that the child is sick. No, it means that the body is doing exactly what it was designed and programmed to do. This is not an example of “sickness.” This is an example of health! It is what should happen! Granted, it may not be pleasant—your child may not like it, but it is an expression of health.
So, when confronted with questions about “sickness,” remind your patients that there is an innate intelligence ruling their bodies. Ultimately, that innate force knows what is best for that body at that time. It also knows that all body systems need to be exercised regularly in order to function at optimum levels at all times—that is the expectation, isn’t it? Just like any other part of the body, the immune system also needs to be exercised. 
I personally feel we have a built-in “clock” which activates the immune system, temporarily lowers our immune guard and response, and we are then attacked by a bug of some sort. The response is a sudden activation of the immune system to fight off the invading organism. But what your patients need to understand is that this is not sickness. This is an expression of health—the body doing exactly what it is programmed to do. This is a good thing! 
Next time a patient gets “sick,” then you need to say, “Wonderful!”
At first the patient may look at you as if you’ve just lost all your marbles, but once you explain this process, he or she will understand what you mean and think that you are amazing—and you are! Your patient just needs to understand that having the occasional flu is a very important part of keeping healthy and that the body will not be at its best without it. 
So, relax and tell your patients the truth—they will totally get it! 

Dr. Ogi is a Practice Coach and teaches the Practice Evolution Program. He is an international lecturer, a pediatric and x-ray specialist, researcher and clinician. It was Dr. Ogi and Dr. Larry Webster who started the whole pediatric awareness and movement on the planet – when it comes to kids, he has no equal. He can be reached at [email protected] or


Organized Medicine Considers Chiropractic as a “First Line” Solution to the Opioid Epidemic

:dropcap_open:T:dropcap_close:he opioid problem in the United States is real and the prime culprit is prescription opioid pain relievers. Paulozzi, Jones, Mack, and Rudd, in The Centers for Disease Control and Prevention’s (CDC) publication, Morbidity and Mortality Weekly Report, on November 4, 2011, state: “In 2007, nearly 100 persons per day died of drug overdoses in the United States. The death rate of 11.8 per 100,000 population in 2007 was roughly three times the rate in 1991. Prescription drugs have accounted for most of the increase in those death rates since 1999. In 2009, 1.2 million emergency department (ED) visits (an increase of 98.4% since 2004) were related to misuse or abuse of pharmaceuticals, compared with 1.0 million ED visits related to use of illicit drugs such as heroin and cocaine. Prominent among these prescription drug-related deaths and ED visits are opioid pain relievers (OPR), also known as narcotic or opioid analgesics, a class of drugs that includes oxycodone, methadone, and hydrocodone, among others. OPR now account for more overdose deaths than heroin and cocaine combined.”
opioidepidemicPaulozzi et al. (2011) continued, “In 2008, drug overdoses in the United States caused 36,450 deaths. OPR were involved in 14,800 deaths (73.8%) of the 20,044 prescription drug overdose deaths. Death rates varied fivefold by state. States with lower death rates had lower rates of nonmedical use of OPR and OPR sales. During 1999-2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR all increased substantially . . . . The epidemic of overdoses of OPR has continued to worsen. Wide variation among states in the nonmedical use of OPR and overdose rates cannot be explained by underlying demographic differences in state populations but is related to wide variations in OPR prescribing . . . Health-care providers should only use OPRs in carefully screened and monitored patients when non-OPR treatments are insufficient to manage pain. Insurers and prescription drug monitoring programs can identify and take action to reduce both inappropriate and illegal prescribing. Third-party payers can limit reimbursement in ways that reduce inappropriate prescribing, discourage efforts to obtain OPR from multiple health-care providers, and improve clinical care. Changes in state laws that focus on the prescribing practices of health-care providers might reduce prescription drug abuse and overdoses while still allowing safe and effective pain treatment.” Organized medicine is now taking a hard look at this “epidemic type” issue and has reached to chiropractic for possible solutions.
In 2012, Dr. William Owens, a chiropractor from Buffalo, New York, was conferred as an adjunct associate clinical professor at the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Family Medical Practice. After working for five years to position himself within the institution, Dr. Owens began teaching the application of chiropractic (via chiropractic referrals) through clinical rotations to family medical residents as well as lecturing to the entire medical school body. As a result, he has been invited to participate in the research department to consider a formal study showing the benefits of family practitioners co-managing cases with chiropractors. Although much of the education surrounds chronic conditions and how chiropractic offers treatment options for acute and chronic musculoskeletal conditions and mobility issues as solutions for cardiac and diabetes, the primary reason for introducing chiropractic to these students is to offer chiropractic care as an acceptable and proven “first-line” choice of referral and possible solution to the opioid epidemic.
Cifuentes, Willets, and Wasiak (2011) reported in the Journal of Occupational and Environmental Medicine: “In work-related LBP [nonspecific low back pain], the use of health maintenance care provided by physical therapists or physician services was associated with a higher disability recurrence than in chiropractic services or no treatment” (p. 396). They went on to report, “In general . . . those cases treated by chiropractors consistently tended to have a lower proportion in each of the categories for severity proxy compared to the other groups; fewer used opiates and had surgery. In addition, people who were mostly treated by chiropractor had, on average, less expensive medical services and shorter initial periods of disability than cases treated by other providers” (Cifuentes et al., 2011, p. 396).
:dropcap_open:The outcomes showed that when chiropractic care was pursued, the cost of treatment was reduced by 28%, hospitalizations were reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including x-rays and MRIs, was reduced by 37%.:quoteleft_close:
DeBar et al. (2011) reported that, “. . . recent alarming increases in delivery of opioid treatment and surgical interventions for chronic pain — despite their high costs, potential adverse effects, and modest efficacy — suggests the need to evaluate real world outcomes associated with promising non-pharmacological/non-surgical CAM [complementary and alternative]treatments for CMP [chronic musculoskeletal pain], which are often well accepted by patients and increasingly used in the community” (p. 1). DeBar et al. rate chiropractic as one of the most promising, with the highest acceptance by physician groups and the best evidence to support its use.
A study by Legorreta (2004) compared more than 1.7 million insured patients looking for treatment for back pain. The outcomes showed that when chiropractic care was pursued, the cost of treatment was reduced by 28%, hospitalizations were reduced by 41%, back surgery was reduced by 32%, and the cost of medical imaging, including x-rays and MRIs, was reduced by 37%. Furthermore, 95% of the patients that received chiropractic care said they were satisfied with their treatment.
These types of studies have given medicine the insight to teach medical school students and family practice residents that chiropractic should be considered as a first-line alternative to opioid utilization. Dr. Owens has also been invited to be part of the process determining how state and federal grant money for research should be utilized in trying to find a solution for opioid issue with chiropractic as a primary solution. He has been able to create a partnership between  the State University of New York at Buffalo School of Medicine and Biomedical Sciences, Family Medical Practice and the University of Bridgeport College of Chiropractic in a joint research project around chiropractic utilization and opioid utilization.
While many groups and organizations within chiropractic are seeking scope changes to include limited prescriptive rights, it is because we offer a non-drug alternative that we are now considered as the solution to the problem that medicine created. In the past, this author looked at the numbers of possible chiropractors becoming primary care medical providers with the consideration that if we controlled the patients from the access point, we could get considerably more people under chiropractic care. However, with chiropractic being accepted and taught in medical schools as a solution, we now have a voice during the medical educational process and need to let medical doctors do what they are trained to do, albeit with one exception; chiropractic needs to be considered as the first-line referral for any spinal-related conditions and the effects thereof.
:quoteright_open:The question we need to ask as a profession is: are we to become part of the solution or part of the problem?:quoteright_close:
With chiropractic being the first-line referral, the doctor of chiropractic gets to educate and treat the patient in a non-drug environment while offering a real solution to both the opioid epidemic and the vast array of solutions to other issues that chiropractic offers. Now that a pilot program for chiropractic to teach medical students and family practice residents has been created and accepted within medical academia, other doctors of chiropractic are currently being trained to bring chiropractic to medical schools nationally. Over a relatively short amount of time, this program will be taught to the next generation of medical doctors and family practitioners, creating a significantly increased need for chiropractic nationally and a solution for the opioid epidemic.
With further research to bolster the studies already available, the concept of it being malpractice for a medical doctor to prescribe an opiate without first considering a course of chiropractic care is no longer deemed unattainable. If chiropractors are able to order prescriptive drugs, we may ultimately be prevented from inclusion in organized medicine’s solution for the opioid epidemic because we will be part of the problem rather than being uniquely positioned as part of the solution. The question we need to ask as a profession is: are we to become part of the solution or part of the problem?
  1. Paulozzi, L. J., Jones, C. M., Mack, K. A., & Rudd, R. A. (2011). Vital signs: Overdoses of prescription opioid pain relievers — United States — 1999-2008. Morbidity and Mortality Weekly Report (MMWR), 60(43). Retrieved from
  2. Cifuentes, M., Willets, J., & Wasiak, R. (2011). Health maintenance care in work-related low back pain and its association with disability recurrence. Journal of Occupational and Environmental Medicine, 53(4), 396-404
  3. DeBar, L. L., Elder, C., Ritenbaugh, C., Aickin, M., Deyo, R., Meenan, R., Dickerson, J., Webster, J.A., & Yarborough, B.J. (2011). Acupuncture and chiropractic care for chronic pain in an integrated health plan: a mixed methods study. BMC Complementary & Alternative Medicine, 11(118), 1-18.
  4. Legorreta, A.P. (2004). Comparative analysis of individuals with and without chiropractic coverage. Archives of Internal Medicine, 164(18), 1985-1992.

Why Don’t MDs Refer to Chiropractors?

:dropcap_open:T:dropcap_close:he coveted physician-referred patient is a source of pride for those chiropractors fortunate enough to receive one. The referrals may come in large numbers, proliferate and, if done properly, be self-sustaining.
mdandchiroHowever, reaching out to local physicians is something the average chiropractor thinks little about or even attempts. Fear prevents many chiropractors from trying something new and different; we enjoy our practice comfort zones. This is a colossal practice mistake. We find contentment with our technique of choice and do not hesitate to ask a current patient for a referral of a friend or a family member. We do this for one primary reason: we simply must in order to survive in practice. Secondly, we become quite good at requesting patient referrals, and most chiropractors in this country thrive primarily on them.
I often ask other chiropractors around the country: “Why don’t medical doctors refer patients to chiropractors?” There are several objections that at first seem reasonable but in reality could not be farther from the truth.
A common objection is that physicians “hate chiropractors.” This simply is not true. They dislike any specialist who makes them feel uneasy or in the dark about their patient. In turn, any specialist who acts roguishly and unconventionally without first consulting with the MD will see a cessation of referrals. Physicians must be kept informed.
Another objection is that MDs question our being “real” doctors. We produce charts to tout all of the hours of anatomy and physiology that we attend to in chiropractic schools and how they compare to our MD colleagues. The problem is that we show these charts to our patients and not the MDs. How are they to know? Are we expecting our patients to make a case for us? The truth is MDs do not think we are uneducated. We are licensed doctors, and they know and respect our ability to treat patients. They simply do not know what we actually do. All of the degrees and titles we acquire will never earn us an MD’s referral if we care for their patients in ways that they do not understand, or worse, that we fail to inform them about.
I have often heard that MDs will not refer to chiropractors because they think we will “cannibalize,” or steal, their patients from them. A primary care doctor may see over 100 different cases per week, or 400 per month. A conservative estimate is that 10% of those seen are musculoskeletal complaints, which is 40 patients. If the MD treats half of these patients, then there will be 20 patients that must be referred out for therapy. It is imperative that the MD not be worried that the specialist will cannibalize his patients. He sends to cardiologists, neurologists and endocrinologists on a daily basis. If he feels confident in what you do as a chiropractor, a musculoskeletal specialist, he will truly appreciate having an additional clinic to which he can send his patients. If chiropractic sees only 8-9% of the population, why would we not turn to where over 90% of the patients visit?
:quoteright_open:By nurturing your relationship with physicians today, you stand to enjoy a healthy supply of new patients for many years to come.:quoteright_close:
A physician’s referral is extremely strong. These patients tend to be more compliant and are eager to begin care. Once MDs refer a patient to you and trust is developed, they will stand by you and support the care you provide. We had a patient with a rotator cuff injury present to our office. Kinesiotape was used as part of the treatment. The patient developed a rash from the tape and related this to his physician. The MD responded, “Don’t worry, they are good, it will heal. Just keep up with the therapy.”

The patient returned to our office and related what the MD said in response to his now-healing reaction to the sports taping. The patient said, “Gosh, my doctor said you guys are the best and not to worry. He wasn’t concerned at all!” Clearly the MD thought our education and experience was enough to handle this incident. If we gain the trust of the MD, they will not be afraid that we will harm their patient, and furthermore, they will support us during those rare occasions we do.


The key to acquiring physician referrals is to build lasting, professional relationships. Just like any relationship we cherish in life, much care and attention must be given to our relationships with our local physicians. After all, we are all in it for the patient. View yourself as a fellow member of the healthcare team, and you will succeed. By nurturing your relationship with physicians today, you stand to enjoy a healthy supply of new patients for many years to come.

Dr. Joel Starr, D.C. is a co-director of a Multidiscipline clinic in Silver Spring Maryland.  He is also a consultant for Consultants of America and Endless MD Referrals.  For more information on medical doctor referrals, call (888) 972-0811.

New Software = New Improved Practice

:dropcap_open:T:dropcap_close:here are tons of reasons why chiropractors change the software in their office.  Most of the time, lack of service and software limitations trigger this important decision.  Often, the goal of changing chiropractic software is to eliminate a frustration over the software or the provider you deal with.  If you are thinking about changing your software for whatever reason, why don’t you use this opportunity to make an overall upgrade of your practice? In plain English, this means that while changing your management software you can make some very signifiant improvments to the efficiency and profitability of your office.  Here are only a few examples of what you can do.
Automate your waiting room
softwarenewAutomating your waiting room is the best-kept secret of chiropractic.  Doctors who do this automation are never going back to the old system.  Simply explained, let’s imagine your CA is sick today and cannot work at the front desk.  All patients have a Chiropractic Health Card and swipe in at an electronic sign-in device on their arrival at the clinic.  While being in the treatment room, the doctor activates the calling feature. Then, the magic goes on. The system will call the next patient and direct him to the next available treatment room.  Don’t worry, you will not hear a digital voice.  The doctor or the CA records every new patient’s name and the system will use these recordings to play in the speakers.  Every time a patient leaves a room after his treatment, the system will call the next one.  This will release your CA from overseeing this aspect of management and will give her plenty of free time to do much more profitable tasks.
Use Xray, thermo scan, posture image, etc. every visit
Many software programs have an imaging module to store and retrieve all images you may need to improve your patient’s care.  While adjusting your patient, you may press a key and instantly get all his x-rays, compare them, etc. If posture is important for you, you will see how your patient stands and how good or bad his posture is.  All images assisting your treatment will be available at your fingertips.
Activate automatic billing
While entering your SOAP notes, your new software will automatically post all the charges to the patient’s file.  Not only will the charges be posted but all transactions will be formatted and ready to be submitted to the insurance carriers. This will be done live, and you will not have to rely on any CA or other billing person to trigger all the charges.  The billing will always be accurate and maximized. Automatic billing from the treatment room is mistake-free and saves a lot of time for your staff.
Use an outside billing service
Using an outside billing service can be a tremendous help to your office.  Good insurance billing employees are hard to find and can be expensive.  You also have to pay for benefits, vacation and many other expenses.   Additionally, you need to evaluate your own time needed to manage these employees.  The chance is very high that you will save a lot of money by getting a professional and hassle-free billing system.  If you ever plan to use an outside billing service, then the choice of new management software becomes crucial.  Some of them are designed to be used by these external services, but others simply are not.  The best of the two worlds is to have your software company do your billing service as well.  This means one call can solve it all.
There are many other aspects of your practice you may improve.  Automation means improvement.  Changing software is definitely the right thing to think about and make it happen. Those improvements may go way beyond the software itself.  When shopping for new software, please ask questions about how it can help you improve your office.  You may be very surprised, as software providers may suggest things you have never thought of.
Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 18 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (  For comments or questions, please email to [email protected]

The Driving Force of Function: A Tonal Chiropractic Proposal

:dropcap_open:F:dropcap_close:or years chiropractors have stated collectively that structure equals function. The structure of the spinal column gives the chiropractor a standard by which to establish clinical guidelines for therapy. This presumes that there is a structural component to the spine that is perfectly adapted for the individual patient’s immediate and long-term needs that can be imposed by outside standards. Current chiropractic theories state that small asymmetries are pathological and ineffective and that they cause disease and decrease normal physiology of humans. These negative traits of small rotary asymmetries in the vertebrae, the classic chiropractic subluxation, would naturally decrease evolutionary fitness. But to state this is also to affirm that the small rotary asymmetries at the local level in the spine were not adapted for and selected against. These theories presuppose that the spine, after 400 million years of development, has not selected for species fitness and success as a biological line. How could these small asymmetries exist for 400 million years if they did not increase fitness?
drivingforceoffunctionBasic evolutionary fitness is the probability that the line of descent from an individual with a specific trait will not eventually die out. Perhaps those small rotations may be small adaptations to the many degrees of freedom, cultivated over 300,000 generations of vertebrate existence, allowed by the hominid spine. These small asymmetries may be pathological in the short term or long term, or these small asymmetries may be the best physiological adaptation for the individual to preserve resources in the short or long term.  Perhaps these asymmetries may contain both traits.
An understanding of proper function and the analysis of patients with small rotary asymmetries in the spine reveal that many of these patients have lived to a ripe old age and reproduced effectively. If this is documented fact, it leads one to deduce that small rotary asymmetries are at least not fatal to those individuals. To state that small asymmetries are always pathological would deny the fitness of 6.2 million years of human bipedalism, natural selection and generational adaptation. If these slight rotations were always a source of inefficiency and decreased evolutionary fitness, then the rotations would have been deselected for, and they would not have survived to the present.

The original chiropractic theory of vertebral subluxation (functional anomalies) is incomplete and is as follows: The exertion of pressure on a spinal nerve produces pathology by interfering with the planned expression of Innate Intelligence. This statement is incomplete when we recognize that the vertebral column has been evolving for over 400 million years of vertebrate evolution to support the body and protect the central nervous system (CNS) in many millions of vertebrate species.
Traditional chiropractic—segmental and postural-technique classifications—evaluates abnormal function as a result of labeled abnormal structures. These labels are self-developed and described in isolation in the chiropractor’s practice or technique. Tonal chiropractic, a subset of chiropractic technique and theory, has attempted to respond to these inconsistencies by looking at the input side of structure. The abnormal structure can lead to abnormal function that continuously feeds the CNS with aberrant input. Or, the aberrant structure is the individual’s best attempt to adapt and save resources given the current immediate demands of the internal and external environment. Tonal chiropractic techniques explain that symptoms that we see in our clinics are a result of neuron-physiological partitioning. Since the CNS controls and regulates all physiological processes of the human body, optimizations must first occur at the microscopic cellular level in the nervous system. All of the changes can be explained by considering the process of energy efficiency of neural communication and neural processing. Energy, which is available ATP, is finite. It is reasonable to assume that the limiting factor for this energy resource/metabolic-efficiency-optimization process is the use of available ATP. Thus, to optimize neurological programs, the CNS will shunt and mobilize ATP to the areas of greatest physiological need in the CNS. Tonal chiropractic relies on observable biological standards.
History has proven, especially recently, that our scientific understanding of certain human physiological traits is not only incomplete but also at times plain wrong. The recent revolutions in the areas of CNS—neuroplasticity, the existence of widespread adult CNS stem cells and the “discovery” of the bidirectional communication of the CNS and the immune system—are areas of science that have changed 180 degrees from their original dogmas. This limitation of human understanding proves our generation’s descriptive limitation and the evaluation of normative function. But proper physiological function must be historical if human existence is a product of 400 million years of vertebrate adaptation and positive modifications.
Ruth Garrett Millikan, born in 1933, is a well-known American philosopher of biology, psychology and language, and she described the term “proper function” in the late 1980s.  Proper functions are the sorts of functions that biologists assign to the organs of animals and are the sorts of functions that human organs have. In the context of the philosophy of biology, the notion is introduced that proper functions are what things are for, whilst other functions of the design are not. Thus, it is possible to distinguish having the function X from merely functioning as X. Both of these linguistic distinctions can be used to mark a rough boundary for the term “proper functions.”
Function is any activity that can be produced by a structural entity. Proper functions differ from other functions in that they can explain the reason for a structure’s existence. The presence of the heart, for example, can be partially explained by its capacity to circulate blood and move oxygen into tissues. These functions provide an evolutionary and natural-selection explanation of the presence of the heart. But the presence of the heart cannot be explained by its ability to cause severe pain during a myocardial infarction event. The ability to cause pain is a function of the heart but is not its proper function; causing pain is pathological, but it does not lead to greater evolutionary fitness. The normative, or fitness, function could be said to be the heart’s proper function, but it would not be evaluative because, of course, normative definitions change with better understanding of biological functions. By definition, proper function is defined historically over evolution. For example, science used to understand that CNS glia cells were simple supportive structures; we now know that glia cells are the most important cells in the CNS for intercellular communication and neuroplasticity. Some glia cells are not supportive at all but are, in fact, adult stem cells. The proper functions of a trait are those with ancestral evolutionary fitness components. These functions of a trait are advantageous and are those selected over time. The effect is a positive adaptation. To explain a trait by alluding to its proper function is to explain it as the result of natural selection in the way with which we are all familiar.
:dropcap_open:In other words, how can we have patients who have these asymmetries and who are athletic superstars with large, socially stable families?:quoteleft_close:
When addressing the functions of the spine, one must specifically separate and define the proper functions and “foundational” functions. Proper spinal functions are functions that can best fit their place in the evolutionary fitness picture. The foundational functions of the spine must first fit in the overriding natural selection process. Function X or Y as described as a spinal function must first agree with evolutionary biology. If spinal function X or Y, though desirable, denies the natural selection process and evolutionary biology for all vertebrates, then the description of the observation must be incomplete.    The incomplete description of spinal function X or Y cannot be a proper function. Furthermore, if the function of the spine is to maintain perfect alignment with complete axial symmetry, but this “model spine” cannot be found in living or deceased humans—or in any vertebrates for that matter—and, moreover, perfect symmetry may not have evolutionary value, then perfect axial symmetry may not be a normative, or foundational function. 
There can be no statistical outliers to foundational function. If a few specimens with small rotary asymmetries are observable examples of maximum human performance and presumed evolutionary fitness—biological and athletic rock stars—then the principle of traditional chiropractic that small asymmetries lead to depressed function is visibly incomplete. Although perfect axial symmetry may exist theoretically as a spinal function, it does not supersede evolutionary drive and proper foundational function. The proper structure of the spine, as described by traditional chiropractic paradigms and colleges, cannot override examples of super normative function and faultless evolutionary fitness. If small rotary vertebral asymmetries have a deleterious effect on individual function and fitness, how can an individual have these asymmetries and have perfect adaptation traits and outstanding biological function? In other words, how can we have patients who have these asymmetries and who are athletic superstars with large, socially stable families?
So what is the proper function of the spinal column? Perhaps it is protection of the CNS and spinal cord, intersegmental flexibility that allows for great range of movement and mobility. Greater mobility adds to species fitness, or evolutionary survival ability. But again there must be an underlying principle that is true in every case when applied to all spinal functions. These functions of the spine are not the foundation function, which is, of course, evolutionary fitness. The first and primary proper function of any biological structure is energy efficiency. The proper functions must first and foremost satisfy the evolutionary fitness requirement before another function can be assessed.
Does your chiropractic technique evaluate in real time the patient’s proper physiological function that would increase evolutionary drive? High-priority physiological functions like breathing and circulation should be evaluated pre- and post-chiropractic intervention.  Can chiropractic or allopathic intervention be positive for the individual if it does not increase real physiological function despite its nociceptive effect? Increasing the body’s main physiological traits, e.g., breathing, circulation and heat regulation, should be our prime motivation for intervention. The body, after 6.2 million years of walking upright, will shift resources to maintain basic abilities. If we assist the body in prime physiological functions, the body’s innate ability developed over 400 million years will utilize the freed-up resources to improve fitness and heal local injuries and disease.
This brief article is designed to begin conversations within the chiropractic community as to what is the best physiological function to analyze in order to guide our adjusting techniques. Is it okay to have a chiropractic intervention (or an allopathic one, for sake of conversation) that may decrease pain but maintains or assists in degraded physiological function? Do we assess global physiological functions that biology and science have always proven affect every cell, such as breathing and circulation, or do we assess physiological functions on a small local level, such as segmental biomechanical function, muscle spasms and swelling, and presume they have global effects? The patient’s leg length may be even, but does that correspond to an immediate positive change in prime physiological functions like breathing, circulation, heat regulation, nutrient absorption,  CNS informational processing, energy efficiency or overall health? Is L5 right-rotated a pathological structural malposition, or is it the best adaptation that 400 million years of winning can produce to maintain efficiency and drive towards fuller expansion of our human potential? Do we evaluate physiological and pathological asymmetries? Is it always best to adjust that swollen, painful high spot, or is there a bigger game we should consider? Do we really trust that after 400 million years, the human body knows how to adapt efficiently in the short term? Or for those of other religious flavors, do we think we are divine junk?
Chiropractic is at a crossroads. For decades we have maintained that there is a perfect structure and that perfect structure leads to the best function. But that optimal structure has traditionally been a static definition, ignoring the basic principles of evolution through natural selection and energy-efficient adaptation. We have forced curves and aligned vertebrae when those apparent pathologies may be the best physiological choice at the time. It can be said that at the moment of birth, the nervous system begins to adapt to the gravity environment utilizing the structures available to it. Those structures are changed and modified over time as the efficient function drives the dynamic structures. Can chiropractic evolve at these crossroads to address those patients we have yet to reach out to? We should be reaching out to patients in wheelchairs or who are post-stroke or who have cerebral palsy, where perfect structure can never be attained. Do we pull our collective heads out of regional curves and aligned pedicles and embrace functional markers as the only objective finding that correlates to health? When the patient’s function outweighs the clinician’s biases, then chiropractic will have evolved to truly remove the interference, or inefficiency, from the patient’s nervous system. Using functional objective markers like breathing regulation, cardiovascular status, proprioceptive acuity and/or gait efficiency will dramatically change one’s practice and the clinical results.
Selected References:
  • Andre Ariew (Editor) (2002). Functions: New Essays in the Philosophy of Psychology and Biology
  • Bowler, Peter J. (2003). Evolution: The History of an Idea. University of California Press. ISBN 0-52023693-9.
  • Clary, Frederick. (2006). Functional Analysis Seminar Manual
  • Futuyma, Douglas J. (2005). Evolution. Sunderland, Massachusetts: Sinauer Associates, Inc. ISBN 0-87893-187-2.
  • David H. Peterson (Author), Thomas F. Bergmann (Author) (2002). Chiropractic Technique
Dr. Fred Clary, D.C., D.I.B.C.N. is the creator of the chiropractic technique, Functional Analysis. This technique focuses on detecting and correcting breathing inefficiencies as well as improving movement and gait patterns. He teaches the Clinical Neurology Diplomate for NWHSU. Dr. Clary holds world records in powerlifting. Contact him at: drfredclary[at]  or call  at 612-865-8430.

Insurance Management: A Third Party Billing Service May Be Your Solution

:dropcap_open:M:dropcap_close:anaging insurance is certainly one of the hardest tasks chiropractors have to perform in their office, and it is one of the reasons some chiropractors have decided to turn their office into a cash practice.  But turning your practice to an all cash practice is not an easy task.  It is difficult to convince your patients to pay cash when so many other chiropractors or health professionals in your area are managing insurance for them. Managing insurance requires a lot of skill and knowledge, and in order to get paid well and be able to comply with all the rules and regulations the billing staff needs to know and follow a lot of procedures. If you have a great billing employee working with you in your office, make sure you treat her (or him) well because they are hard to replace, believe me. But if you are not happy with your billing staff, or if your billing employee had to leave your office for some reason, a third party billing service may be your solution.  What is a third party billing service exactly?  Let’s see, step-by-step, how a third party billing service works.
What a third party billing service (TPBS) will do for you?
3rdpartybillingA third party billing service will be your billing staff and will work remotely through the internet.  They will send your claims to insurance carriers and will post all payments received in each patient file.  A good TPBS will follow up on unpaid claims, just as an on-site billing employee would do.  If you ever decide to use a TPBS, make sure they will follow up on unpaid claims, because not all of them do.  Make sure they do not write off claims without proper explanations and documentation. The service will give you access to all available insurance reports.  This way, you will be able to see exactly where your claims stand. They will also keep you informed about rules and procedure changes that insurance carriers put into effect.  Essentially, they will work as your insurance management expert.
What a TPBS will not do in your office?
A TPBS is not a chiropractic assistant. They will not give appointments to patients or educate your patients about the benefits of chiropractic care.  Also, a TPBS will not add or change any medical information in the system. Only the chiropractor is authorized to do that. They will not recommend any number of visits, or present or explain any kind of care plans to patients.  Remember, they are not on-site; they work remotely.
Advantages of using a TPBS
TPBS are insurance management experts.They manage insurance for hundreds or thousands of other clinics. They know all the ins and outs of insurance management. For this reason, a good TPBS will be very effective for you. Financially, using a TPBS may be very beneficial. Usually, you may expect to pay anywhere between 5 and 8 percent of paid claims for such a service. If you make the calculations, this is quite a cheap way to replace your billing staff. There will be no vacation, sick leave or any other benefits to pay. If you choose the right TPBS, it is very possible that this service gets paid by itself with a very efficient paid claim percentage. With all information provided by the TPBS, you will be kept on top of your insurance management. You will be kept informed constantly about claims paid, submitted or on hold.  You will be asked to update clinical information if required by the insurance company.  As soon as this is done, your TPBS will make sure to send the transaction with the next insurance submission. The process is well covered and easy to work with.  Some chiropractors are not very excited about managing employees, but operating a chiropractic office forces them to do so.  Giving the insurance management to a TBPS may be a relief for this often time-consuming task. This saved energy may be transferred to where it should be: patients and chiropractic care.
In chiropractic, just like any other profession, there is no magic solution for everything.  Using a third party billing service will not necessarily suit all chiropractors’ offices, but may certainly help a lot of them.
Claude Cote  is an expert in EHR systems, insurance billing and chiropractic clinic management for 22 years.  He has installed EHR system in 18 countries over 5 continents and nationwide in USA.  He is the President and Founder of Platinum System C.R. Corp (  For comments or questions, please email to [email protected]

Could It Be B12? A Question All Healthcare Providers Need to Ask Themselves: Interview with Sally Pacholok

coulditbeb12Could it be B12? An Epidemic of Misdiagnosis by Sally Pacholok and Jeffrey J. Stuart is one of the most important books I have read in a long time.  It is one that should be read by every doctor and health care professional regardless of specialty.  It will change and save lives as the information it contains dictates new standards of care. 
Sally Pacholok, R.N., and Jeffrey Stuart, D.O., have done an incredible job of assembling a wealth of information and have provided extensive scientific documentation to back up every assertion that they make.
As I read this book, I found it incredible and quite disturbing that most of this information has been available, but largely ignored for many decades.
This book left me with a hollow feeling in my gut, wondering how many patients I have seen over the years that had an undiagnosed B12 deficiency that I had missed.  I have vowed not to miss another.  Beyond that, I have pledged my support in helping Sally Pacholok and Dr. Stuart to raise awareness of what they correctly term an “epidemic of misdiagnosis.”
KOCH: Sally, I was not exaggerating when I said that this is one of the most important books I have read in decades. The effects of vitamin B12 deficiency have been badly underplayed and ignored in favor of more exotic, and more expensive-to-treat, diagnoses.
PACHOLOK:  You are right, Bill. It is very frustrating when intelligent, well-educated doctors choose to turn a blind eye, as if such an easily diagnosed and inexpensively treated condition were beneath them.
KOCH: It is hard for me to wrap my head around that kind of attitude. My take on it is that it makes it easy for any of us to be a hero for getting it right. The short- and long-term ramifications are enormous.

PACHOLOK: As you know, my husband and I work in the emergency room of a busy hospital. Amazingly, diagnosing B12 deficiency is not considered to be appropriate for ER doctors and nurses. Yet how can you not, when we see the same patients appear over and over again with injuries from one fall after another simply because of weakness, balance problems, leg and back pains or glove and stocking numbness of hands and feet. Many walk with a slow, foot-slapping gait because they can’t tell when the bottoms of their feet are touching the floor. In addition, B12 deficiency can cause visual disturbances, dizziness, vertigo or postural hypotension.  These problems dramatically increase the risk of falls, and falls in turn can lead to broken bones, hospital stays and often an end to an independent life for many seniors.
KOCH: What I find equally amazing is the mental and emotional manifestations of B12 deficiency. You cite so many cases of elderly people who have been diagnosed with Alzheimer’s disease or senile dementia yet have regained their mental faculties after the deficiency was recognized and treated.
:quoteright_open:Yes. I believe that untreated patients who are suffering from an undiagnosed deficiency of B12 will eventually develop disorders of the nervous system.:quoteright_close: 
Likewise, there are many people of all ages suffering from severe anxiety, depression and a host of other neuro-emotional disorders, who become hooked on dangerous psychotropic drugs when the underlying problem is vitamin B12 deficiency.
PACHOLOK: Yes. I believe that untreated patients who are suffering from an undiagnosed deficiency of B12 will eventually develop disorders of the nervous system.

KOCH: Sally, all of the information and the cases you present in your book are absolutely relevant to the day-to-day practice of chiropractic. That is why I felt the urgency to call my colleagues’ attention to it.
Every chiropractor needs to be aware of the far-reaching neurological consequence of B12 deficiency and how it can masquerade as multiple sclerosis, Parkinson’s and other dreaded neurological disorders.
PACHOLOK: It is frightening to think of how many people are suffering and dying because this simple diagnosis is never even considered.
KOCH: One of the most important points you make in your book is the urgent need for revision of what should be considered normal serum B12 levels. When serum B12 is tested, the labs and doctors use a “range of normal” scale which current data shows to be obsolete. 
Please tell our readers what the currently accepted serum B12 range is, and how it needs to be revised to correctly reflect levels appropriate for optimal health.
PACHOLOK: That is where the reform must first take place. Laboratories and doctors must be made aware that the serum values of vitamin B12 that have been thought to be normal or acceptable are, in fact, marginal or woefully inadequate for optimal health.

The current guidelines for serum vitamin B12 suggest 271-870 pg/ml as the normal range and less than 200 pg/ml as deficient. We advocate treatment in all symptomatic patients with serum B12 below 450 pg/ml. At this time, we believe normal serum B12 levels should be greater than 550 pg/ml. For brain and nervous system health and prevention of disease in older adults, serum B12 should be maintained near or above 1,000 pg/ml.
KOCH: Sally, you and Dr. Stuart have done a masterful job of covering all aspects of the subject of B12 deficiency. You have made it so easy to access the information you present through the many appendices you provide. You have referenced all of your information and backed up every statement you make so clearly that anyone can feel secure in quoting you. 
Congratulations on providing an important work that will undoubtedly serve millions of people.

Dr. Bill Koch is a 1967 Cum Laude graduate of Palmer. After 30 years of practice in The Hamptons, NY, he retired and moved to Abaco, Bahamas, where he and his wife Kiana travel by boat to provide Chiropractic care to the residents of the remote out islands.  Dr. Koch, author of the book Chiropractic the Superior Alternative,writes a blog: Mentoring Young Chiropractors and is working on three new books: ChiroPractice Made Perfect,  The Out Island Chiropractor and Conversations with the Chiropractic Technique Masters.  He may be contacted at [email protected].

Seeing Is Believing

Leaders See The Future
One quality that all leaders have in common is that they have a clear and exciting vision for the future. This is something that only a leader can have. Only a leader can think about the future and plan for it each day. Do you have goals for your practice? Do you have a plan to execute your goals? A goal without a plan is nothing more than a wish. Are you wishing for your practice to grow, or are you working it? How can we help you this week? How do you see your future? Is it the practice of your dreams? Or, are you stuck in a rut? What you see is what you believe. If you see your practice overflowing with new patients it will happen, but you must see it first.
visionfutureA Clear Vision
Excellent doctors take the time to think through and develop a clear picture of where they want their practice to be in one, three and five years. The great doctors, the profession’s leaders, have the ability to communicate this vision in such a way that others “buy in” and eventually see the vision as belonging to them. Your staff and your patients must share in your vision. President Obama has a health plan (not to be political), do you? Whether you like his plan or not is not the question. Do you have a plan? My plan is for every American to receive chiropractic care. Imagine every person you speak with, look at, or engage in business with is a potential patient. Now you can help me execute my vision of a less subluxated society.
“If you see the invisible, you can do the impossible.”
How We Motivate Patients 
It is the vision of the future possibilities, of what can be, that arouses emotion and motivates people to give their best. The most powerful vision is always qualitative, aimed at and described in terms of values and mission, rather than quantitative, described in terms of money. Of course, money is important, but the decision and commitment to “be the best in the business” is far more exciting. 
To encourage others, to instill confidence in them, to help them to perform at their best requires first of all that you lead by example. Being a doctor is a 24/7 job. Whether you realize it or not you are now committed to changing lives, to healing, to helping others. Once a doctor, always a doctor. 24/7. No matter what time of day, or where you are, you are a doctor. People expect, actually demand, that you lead by example. “If you want to lead the band, you have to face the music.” My father taught me this early on; there is a responsibility to leadership, but the rewards are great.
Prepare For Greatness
A recent study examined the qualities that companies look for in promoting young managers toward senior executive positions, especially the position of Chief Executive Officer. The study concluded that there were two important qualities required for great success in leadership. The first is the ability to put together a team and function as a good team player. Since all work is ultimately done by teams, and the manager’s output is the output of the team, the ability to select team members, set objectives, delegate responsibility and, finally, get the job done, was central to success in management.
You are the CEO of your life, of your office; you must lead your staff, your team. If your staff does not follow your lead, then why would any patient? If you have members on your team, in your staff, that don’t believe in you, then it is time for you to move on and get teammates that believe in their captain, that share in your vision. At Concierge Coaches, I am the CEO of my life, which stands for CHIEF EMPOWERING OFFICER; my goal is to empower my clients to be the best doctors they can possibly be. Your goal is to empower the patients, by being the best doctor you can possibly be. Patients want to be proud of their doctor. They want to go to the best. They want a doctor to lead by example.
When your patients are proud of you, believe in you, they will refer to you. How many referrals have you had in the last month? If your answer is low, you must work harder to be better. If you are going to be, be the best. Why just be a human being? Be a human doing!
Always Maintain Your Composure
Another key quality required for success was found to be the ability to function well under pressure, and especially in a crisis. To me this is germane to being a great doctor. Keeping your cool in a crisis means to practice patience and self-control under difficult or disappointing circumstances. How you handle your patients in acute and chronic pain is observed by your staff. How you handle office adversity can determine your future success. Some days are tougher than others.  How do you respond when the office is slow, no money comes in the mail, your staff call in sick? It is these moments that you must expect and during which you must act with respect and dignity. It is these moments that help define your future. 
Dr. Eric S. Kaplan, is a two time # 1 Best Selling Author, his latest book The 5 Minute Motivator,, his resume includes former President COO of a NASAQ traded public company, which included Nutrisystem, Currently he is CEO of Concierge Coaches, Inc., www., a comprehensive coaching firm with a successful, documented history of assisting doctors create profitable practices nationwide, providing over 30 New Patient marketing Programs. Teaching doctors nationally how to develop a successful business in the health care industry of today. Dr. Kaplan is the best selling author of Dying to be Young, and Lifestyle of the Fit and Famous and Co-developer and President of Discforce and Palm Beach Massage Centers,, the next Generation Chiropractic Practices, massage and Spinal decompression. For more information coaching or spinal decompression, call 1-888.990 9660.

Unhealthy Doctors Are Poor Role Models for Patients

:dropcap_open:I:dropcap_close:t seems that today’s doctors, from all specialties, are doing a poorer job of representation when it comes to health and well-being. You see it everywhere now – doctors that are obese themselves are consulting with patients on how to lose weight. Some doctors even smoke, yet will have patients dying of lung cancer that they deliver care for. The problem is not at all limited to chiropractic physicians. Ask yourself this: Would you trust a doctor who doesn’t him or herself display the image of health? Would you be more likely to trust a doctor who does?
obesedoctorIt is human nature for one to have more confidence in a dental practice where the dentist has flawless teeth, or in a salon where the hairstylist has a chic hair-do. The same is true of doctors who maintain a healthy weight, which may help explain why those who are overweight are less likely to raise the topic of weight loss to their patients.
In a study consisting of five hundred primary care physicians around the United States, researchers at the Johns Hopkins Bloomberg School of Public Health and the Johns Hopkins University School of Medicine found that a doctor’s own body weight influenced how he or she cared for patients with weight problems. Overweight or obese doctors were less likely to discuss weight loss with overweight patients: only 18% of the overweight physicians discussed losing weight with their patients, while 30% of healthy-weight physicians did.
Additionally, the researchers found that 93% of the doctors were diagnosing obesity in their patients only if they believed their own weight was equal to or less than the weight of their patients; only 7% of the physicians who believed their weight exceeded that of their patients actually diagnosed obesity.
In the study, when overweight or obese doctors did address obesity, they were more likely than the healthy-weight physicians to prescribe anti-obesity medications (26% vs. 18%), as opposed to recommending healthy lifestyle changes such as diet and exercise. This finding likely reflects a lack of confidence in these approaches to weight loss, either due to the physician’s own personal experiences or as a consequence of their subconscious concern that such advice would be viewed as less reliable to patients coming from someone who wasn’t of a healthier weight. 
Compared with overweight doctors, the physicians of normal body weight were more confident in their ability to offer advice on diet and exercise to their heavier patients, and 72% believed that they should be models of healthy weight for their patients. Only 56% of the overweight or obese doctors believed that their own weight was viewed as a reflection of any kind for their patients.
These results represent one of several other challenges in the war against obesity – doctors are notoriously bad at taking care of themselves and consequently many are poor role models for their patients – but the study also signals an opportunity for significant improvement in weight management with patients. “If we improve physician well-being, and improve their lifestyles toward weight loss or weight maintenance, that can go a long way toward influencing the care they provide their patients,” says Sara Bleich, an assistant professor of health policy at Johns Hopkins Bloomberg School of Public Health.
Doctors who successfully lose weight, eat well, and exercise regularly may be more likely to share their own personal experiences with patients, increasing the likelihood that their patients will then follow their advice. With healthier physicians, we could help pave the path for the general population to live more healthfully.
Dr. Corey Mote is a chiropractic physician, professional natural bodybuilder, exercise physiologist, columnist for various fitness magazines nationally and internationally, regular contributor to various healthcare profession magazines and journals, as well as a consultant for a United Kingdom-based vocational fitness program known as U-Phorm. For more information on Dr. Mote, visit his site at, or email him at [email protected].

Subluxation Vs. Disc Herniation: A New Paradigm for Chiropractic

:dropcap_open:A:dropcap_close:lmost every Doctor of Chiropractic that has been in practice for 8-10 yrs. or more has experienced the chagrin of treating a patient for a subluxation and afterwards having them discontinue care, only to find out later that the patient was doing very well after a surgical disc operation.  After experiencing 1 or 2 of these embarrassing scenarios, we may come to realize that there may be more information involving a subluxation than meets our chiropractic eyes.
subluxvsdischerniation4This embarrassment of missed diagnosis should never happen to a Doctor of Chiropractic. A DC should and can be in a position of being CORRECT in his/her diagnosis, before a patient has an operation for a herniated disc. If a DC is not correct, not only does he/she lose credibility with their patient, but their reputation is harmed. Imagine, if nearly all DCs have one or two of these missed diagnoses periodically, our entire profession loses credibility on a large scale. 
One of the many definitions of chiropractic that has stood the test of time states that “Chiropractic is the art, science, and philosophy of locating and correcting nerve interference, without the use of drugs or surgery.” Notice that it does not say what is causing the nerve interference, nor does it say what is used to correct the nerve interference or how it is to be corrected. This allows the chiropractic profession to have great latitude in describing what we do, but that does not excuse us from making an incorrect diagnosis.  
In order to understand how to correct spinal pain we MUST have a correct hypothesis of what is causing the nerve interference. Many hypotheses appeared in the chiropractic profession, the most popular of which has been the subluxation (or bone out of place) theory. This idea was accepted broadly by nearly the entire profession. Not so by medical surgeons. It is only common sense to them that when a chiropractor works on a patient and proclaims that the cause of the patient’s pain is a SUBLUXATION, and a surgeon operates and resolves the patient’s pain by removing the disc bulge, WE LOSE CREDIBILITY.  
However, the DCs continue the drumbeat to remove subluxations that they analyze to be displaced, a missed diagnosis. 
After the subluxation theory 60 years ago, along came Nimmo’s pressure theory.  Then came the “fixation theory” that theorized that “fixations” were the cause of the nerve interference.  Kinesiology then came into being proposing that imbalance of the muscular systems caused much of the nerve interference. Also there were reflex techniques, full spine techniques, cranial-sacral techniques, and many others. All had some success, but they had obscure, vague, ambiguous, and even conflicting hypotheses of what the actual mechanism was that caused the nerve interference or pain. And when it came time for a report of findings, it was difficult, to say the least, to convey understandable causation to the patient. In light of all the new information that has been revealed in the present-day healing world, the profession may need to come to grips and accept a new paradigm in order to make progress and grow.
Some of these theories appeared in chiropractic simultaneously, and resulted in much confusion in the profession. Chiropractic must come to the realization that, along with slight subluxation, herniated discs play a major role in compressing the SNR to cause spinal pain. 
A subluxation, which is defined as a vertebral displacement less than a luxation, can occur when extreme motion takes place in the spine that is beyond a motor unit’s normal physiological range of movement. And if this movement is in forward flexion of the spine, the increase in pressure will be concentrated on the front of the discs’ nucleus pulposis (NP). If this pressure is great enough it can suddenly thrust the NP posteriorly, breaking through many of the internal annular rings of the annulous fibrosis which then could bulge the outer rings of the disc into the intervertebral foramina (IVF) space and exert pressure on the spinal nerve root (SNR). (The majority of disc herniations are internal in nature, similar to a bulge on an auto tire or an inquinal hernia, where the outer skin still contains the internal ruptured parts).
We now have a subluxation and a herniation of a disc occurring at the same moment. Not all subluxations and disc herniations occur this way, some disc herniations can occur

without a subluxation, i.e. a subject can jump down from a 10 ft. wall and herniate a disc, and a  person could have a subluxation without enough force to cause disc herniation.  
However, there is strong evidence that many disc herniations are associated with a subluxation. The frequency of which could be very high. Could this be one of the most prevalent causes of spinal pain? If we conclude that a bulged disc is in fact causing pressure on an SNR, shouldn’t we as DCs include this in our diagnoses? If we conclude that a bulged disc is in fact causing pressure on an SNR, shouldn’t we as DCs include this in our diagnoses?
So, it’s not SUBLUXATION VS. DISC HERNIATION – it’s subluxation WITH disc herniation. This is a change in the chiropractic philosophy as to the cause of nerve interference that, if adopted, could give real relevance to our profession. Why should we adopt this change? The answer is, of course, that there is OVERWHELMING clinical evidence that in most cases of SPINAL PAIN, it is the bulge of the disc that presses or squeezes the SNR, and not the bone pinching the SNR. 
A Hypothesis of Disc Pain Causation by Clinical Evidence
Here are some examples of strong clinical evidence that a high percentage of spinal pain is caused by subluxation/disc herniation. 
1. MRIs have proven that there are frequent, multiple disc bulges in most spines. Even though some of them may not be symptomatic, they can become so as people do repetitious bending while doing normal daily activities. Multiple spinal flexions may gradually increase the size of these dormant bulges.  They can then begin to touch the SNR, becoming symptomatic. 
2. Most histories of patients demonstrating back pain occur when the subject is in a forward bent position, i.e. lifting a box over other articles in the trunk of a car, bending over to pick up a heavy item, picking up a pencil off the floor, bending over doing toe touches, or as simple an action as lifting the corner of a bed mattress to tuck in sheets. It’s easy to visualize what is happening within the spinal disc. 
3. Thinking about all the above activities that may cause back pain, the idea of the disc placing pressure on the SNR reasonably begins to dovetail to the subluxation/disc protrusion scenario. (Bending first, nucleus pulposis of disc suddenly slipping backward, second = sudden cause of back pain). Of course, it doesn’t always occur suddenly, the disc NP may slip backwards gradually. 
4. People that stand constantly in their job have a high incidence of low back and leg pain because discs tend to flatten with many hours of weight bearing. This can cause circular peripheral bulging of the disc and place pressure on the SNR.
5. For the same reason overweight individuals experience frequent disc, back and leg pain. 
6. Lumbar spinal decompression by expensive machines is adding strong evidence to the credibility of disc herniation, claiming results up to 80%. If subluxation was the ONLY major cause of back pain, I doubt if decompression results could be so effective, for they do not claim to replace the subluxated bones. However, decompression could tend to draw in or suck in the disc bulge or protrusion.

:dropcap_open:Chiropractic first, medicine second, and surgery last.:quoteleft_close:

7. Very much credit must be given to Dr. James Cox for his persistent teaching of the herniated disc theory over 30 years ago.  I believe he was the first DC that instituted traction or distraction to correct bulged or herniated discs. Moreover, he invented a chiropractic table and taught seminars on how to correct these problems. His work is great evidence that validates that the majority of spinal pain is caused by disc pressure on spinal nerve roots.  
8. Long Term Cryotherapy (LTCT) is very effective in reducing disc pain because it tends to contract the disc, and the tissues surrounding the swollen disc, relieving pressure on the SNR. If the source of the spinal pain was subluxation alone, cryotherapy could not contract the hard substance of the offending bone to produce the relief that LTCT consistently does. 
9. There are medical pain clinics springing up in various areas of the nation who advertise aggressively their minimal surgical technique to shrink the NP by laser surgery. They claim nearly 95% results. If the disc was not the offending cause, would they even get close to that % if only the subluxation existed?  They are so confident of their results that some of them don’t even accept insurance.  Cash only.  Cost to the patient?  10 to 20 thousand. 
10. Could this be why the chiropractic general adjustment works so well? When adjusting bilaterally down the entire length of the spine we often hear many audible releases. Could those releases be small protrusions being replaced (anteriorly) toward their normal positions? 
However, chiropractors need not worry, because our treatment is less costly and will one day become the treatment of choice.

For we can correct a large percent of subluxations/herniations a lot more reasonably and with far better outcomes than any other  method.  That doesn’t mean we can correct all disc protrusions, but most of them, in almost all areas of the spine. Therefore, it would be reasonable for people to try chiropractic first, medicine second, and surgery last, in that order to rid themselves of musculo-skeletal pain.
We all can do the job, but chiropractic can and should be tried first for 3 major reasons:
1. We can reduce multiple protrusions during each patient’s treatment, saving the patient untold amounts of future health care costs.  No other health profession can do this.
2. Even though repeated treatments may be needed, because discs can re-bulge with time, chiropractic is the lowest cost of all disc reduction methods. 
3. Since we can reduce the majority of disc herniations, then the few that won’t respond to chiropractic can be referred to other more costly and risky methods (decompression, laser, drugs, orthoscopic surgery, bone fusion, or the newest attempts of disc replacement). However, the most reasonable route to improvement is firstly the low-cost chiropractic way. 
In Conclusion:
Therefore, when disc involvement is detected by physical exams, MRIs, CT scans, etc., our diagnosis must include disc bulge, protrusion, or herniation along with subluxation. Whenever the profession adopts this finding, progress can be made with insurance acceptance, and with other healing professions. When the occasional patient isn’t responding well, the DC, having diagnosed the patient with subluxation/herniation, can refer them to the next level of appropriate treatment. He/she will have been credited with a correct diagnosis and will look good in the eyes of his/her patients, medical doctors, and surgeons. Subsequently, the chiropractic profession will gain in stature.
When this truth is fully accepted by chiropractic, the public, and other healing professions, then and only then will people use “Chiropractic first, medicine second, and surgery last.” Whoever created that phraseology was “right on target”.
Can you envision it?  If everyone used Chiropractic FIRST, there literally wouldn’t be enough DCs to take care of the people. This may be a long way off, but it could happen in our future. 
The TRUTH of a correct hypothesis shall set us free.

John W. Fiore, DC, attended Purdue University, majoring in Chemistry, Physics, and Biology graduating from Lincoln College in 1954.  Practiced together with his brother for 40 years and invented the “Back-Huggar” in 1968, and the “Neck-Huggar” in 1982, and founded Bodyline Comfort Systems in 1968.  Served five years as secretary of Florida Chiropractic Association.  Author of “Discaltic Aberrations of the Spine”  (Disc Theory of Chiropractic) published in the 1974 Edition of the Journal of Clinical Chiropractic.