Imaging: The Future of Musculoskeletal Care
FEATURE
INTERVIEW
Interview with Tim Maggs, DC
The American Chiropractor
The chiropractic profession is caught in an identity crisis in this broken and complicated healthcare system. While many of the schools and national organizations want to align themselves with the medical community’s approach to musculoskeletal care, some want to lead those interested chiropractors into a biomechanical model of care—one that is not just based on symptoms. This approach would concern itself more with the many underlying biomechanical faults that all people have yet no profession to date has claimed responsibility to identify or fix. These biomechanical faults are the underlying cause to most musculoskeletal injuries and the accelerated premature degenerative changes from which most Americans suffer. Chiropractic would gain massive market share if they’d commit to having higher ideals rather than following the medical model of care, which is purely symptom-based.
Dr. Maggs, a graduate of National College of Chiropractic in 1978, has been in private practice for 41 years. He is the developer of The Structural Management Program, The Structural Fingerprint Exam, and The Concerned Parents of Young Athletes Program. This year Dr. Maggs became the first chiropractor to become sole owner of a professional sports team. Dr. Maggs purchased the Albany Patroons basketball team. Many former players and coaches moved from the Patroons to the NBA, with Phil Jackson winning his first professional championship in 1983 as head coach of the Albany Patroons. Dr. Maggs states that the Patroons will be the first professional sports team that will be 100% under the care and guidelines of his Structural Management Program.
In an interview with The American Chiropractor (TAC) Dr. Tim Maggs (TM) comments on why X-rays can be so important in evaluation, as well as what he sees as an important opportunity for the profession going forward.
TAC: Tim, your patient exam begins with an X-ray of your patients. Can you tell me why you insist on taking X-rays?
TM: It really begins with the goals you have as a provider and the goals your patients have.
Many chiropractors have fallen into the medical model role, working only to alleviate symptoms. My goals are much higher. Every human has biomechanical faults, and they can be detected with today’s technology of digital X-ray, MRI (when needed), and the digital laser foot scan. After our Structural Fingerprint Exam, which includes the above testing, we have a blueprint of the patient, even the 12-year-old soccer player who has never been injured. Unlevel femoral heads, an increased sacral base angle, an anterior Ferguson’s center of gravity line, collapsed arches of the feet, etc. are all invaluable details to begin proactive care. This proactive care includes orthotics, lifts when needed, laser therapy, chiropractic adjustments, spinal decompression, nutrition, and more. We’re working to preserve the human structure and enhance the quality of life using today’s technology, not just looking to alleviate pain. You must have X-rays to achieve that.
TAC: Does your approach differ from what is being taught in school today with regards to the usage of X-rays?
TM: I don’t get involved with the schools directly, but I teach many recent graduates who tell me the schools discourage the use of X-rays. To me, this is absurd, especially since many of these kids graduate with huge debt. We are chiropractors who work with the musculoskeletal system (that houses the nervous system), and there is so much valuable information on the X-ray that you can’t know without it. This is similar to asking the medical profession to minimize the use of blood and urine tests. The last thing this world needs is another pain-relieving healthcare provider who has no idea why the patient is in pain.
TAC: Why do you think there has been a shift in the way chiropractors have thought of X-rays?
TM: I think our leadership is coming at it from a position of weakness. They feel that if they fall in and mirror the medical model, this will help our profession politically. The medics will like us and refer to us more, the politicians will see us as very similarly to the accepted medical machine that society is so aware of, and it’s not too risky because we’re not suggesting a test that the medics don’t use. I approach this differently. The medical model is the cause of this crisis because they never know the underlying condition, and therefore the underlying condition is never addressed. The opioid crisis is a by-product of this approach. We need to rewrite the entire care system for musculoskeletal, and it begins with a thorough biomechanical examination, including four standing X-rays, which doesn’t currently exist in our society. The medics don’t know how to read the biomechanics on an X-ray, so it’s understandable why they say X-rays aren’t needed. We should come at this from a position of strength, tell society the medics are the wrong doctors, and that our new model is the model of the future.
TAC: Do you think it is harming our professional identity?
TM: I’m not sure we have an identity. We are too diversified. It’s like a Secret Santa Party. You have no idea what you’re going to get when you enter an office. So the answer is absolutely yes, it is hurting our profession. We’re the same as the medics, but we’re not as societally accepted yet on a grand scale. And no one clearly understands what our profession’s mission is. We don’t even understand what our mission is.
TAC: Do you explain your X-ray findings describing subluxations?
TM: Never. The subluxation concept is outdated and not part of society’s vocabulary. “Abnormal loading” is the correct terminology today. Chiropractic doesn’t even have a system for detecting subluxations. Ten chiropractors examining the same patient would have 10 different listings. And we’re hoping the public will understand? Subluxations are more of a concept, not an objective finding. We need the public to understand what we do and what their problem is, and “abnormal loading” is always part of their condition.
TAC: Can you give an example?
TM: I use technology today—digital X-ray, digital foot scans, MRIs, etc.—to show patients biomechanical imbalances and areas vulnerable to injury, breakdown, and premature degeneration. They understand it so quickly. They can see it, they feel the pains in their bodies, and it’s usually the first time anyone has made any sense to them as to why they have this condition.
TAC: You have a practice in a high school. Do you see the effects of chiropractic more demonstrable with children or adults?
TM: Well, youth heals quicker. But, more importantly, I think performing our biomechanical exam on middle and high school athletes will prove more beneficial to society as we’re able to get these kids on a more proactive course for preserving their musculoskeletal systems, something our profession should be spearheading instead of fighting for higher Medicare reimbursements in Washington.
TAC: Can you provide an example?
TM: I have literally thousands of examples because I have a massive database of digital scans of the feet with standing biomechanical X-rays of middle and high school athletes. Every one of them have biomechanical faults that can be helped prior to injuries and definitely prior to degenerative changes. For our profession to compete with others on the relief of pain is truly going after the low-hanging fruit. I would never want that to be my reputation.
TAC: How do orthotics play into your overall treatment paradigm?
TM: When we scan a patient’s feet, the scanner will portray an optimal scan of the feet. If the patient’s scan doesn’t look identical to the optimal scan, I recommend orthotics because the collapse of the feet will only get worse as time goes on. This means the biomechanical faults the patient has will also worsen over time. It all starts at the foundation of the body—the feet. They must be “fixed” to hope for maximum benefits from our treatments.
TAC: Do you ever get concerned that you’re missing soft tissue findings on X-rays?
TM: No, because I probably order more MRIs than any chiropractor in the country. If there’s even a remote possibility of a soft tissue involvement or a disc or meniscus involvement, I have a great relationship with our MRI facility, and we have a great out-of-pocket program for patients who don’t have insurance or whose insurance won’t cover the cost. Again, as the title of the article states, imaging is the future of musculoskeletal.
TAC: Is this approach that you use for patients in pain or for performance enhancement? Do you have data that demonstrates this?
TM: My approach is for the reduction of injury potential and the preservation of the human structure. This includes quality of life as one is growing older with the reduction of healthcare costs due to musculoskeletal preservation. My second book, Fixing the Healthcare Crisis, tells how we need to fix musculoskeletal to fix the crisis. Once a patient loses the ability to move freely, all other degenerative diseases can only increase (i.e., heart disease, diabetes, etc.) We’re after quality of life for our patients.
TAC: What do you see as the biggest risk for the chiropractic profession going forward?
TM: In my opinion, I think we need to unify our protocols any way that we can. The diversity is keeping us from growing. I’ve recommended making my biomechanical exam the standardized exam for the profession because it would unify the information we all get on each and every patient. It would also elevate our status above all other professions because no other profession can do this biomechanical exam due to their limited scopes of practice. Once the exam, scan, and X-rays are done, each chiropractor could use their techniques, their physical therapy, and their nutrition to care for the patient. Standardizing the exam would make a major advancement for our profession.
Thank you for your time.
Dr. Maggs can be contacted at drtimmaggs@cpoya. com or 518-393-6566. More information can be found at structuralmanagement.com.
