The Unlikely Defender of the Subluxation: Interview with Gary Jacob, DC, LAc, MPH, DipMDT

jacobgaryalanGary Alan Jacob, DC, LAc, MPH, DipMDT completed his baccalaureate studies in Philosophy of Science. He graduated from Los Angeles College of Chiropractic in 1978 and the California Acupuncture College in 1981. He was the first DC and the 12th individual to receive the Diploma in Mechanical Diagnosis and Therapy in 1991 from the McKenzie Institute International. In 2003, he received a Master’s in Public Health in Community Health Education and Promotion from UCLA. He is an Elected Enrollee of the Johns Hopkins Delta Omega Honorary Public Health Society. Gary remains in private practice in Pacific Palisades, California. He teaches locally (at SCUHS and acupuncture colleges) and internationally about clinical reasoning, philosophy of chiropractic, biopsychosocial approaches, and the McKenzie Method  model. Dr. Jacob has authored several textbook chapters about the McKenzie approach. 
 
The American Chiroptactor (TAC): What are some of the services and products you provide to chiropractors?
Dr. Gary Alan Jacob (GJ): As an educator, I have attempted to serve the chiropractic profession by promoting the logic and ethics regarding rehab issues. It is my responsibility to make students aware of resources for products geared toward promoting self-efficacy. 
 
Most of the products I employ are produced and distributed by OPTP, a company that was chiropractic-friendly before it was fashionable, and one that has promoted important interdisciplinary links between chiropractic and other disciplines.
 
As an educator, I have attempted to promote critical clinical reasoning regarding chiropractic’s most unique attributes, including the following:
  1. That movement of the spine to end-range can have positive health outcomes.
  2. That movement of the spine to end-range in one direction may have a better response than movement to end-range in another direction.
  3. That movement of the spine to end-range in one direction may be deleterious and should be avoided until health is restored to the point of that direction being safe.
Of these three principles, most chiropractors employ the first two in practice, and although most might agree with the third, most do not employ it in practice, which results in adjustments that do not “hold.”
 
TAC: What are your goals in treating patients?
GJ: My goal in treating patients is to promote self-efficacy from the perspective that spinal complaints are of multifactorial origins. In addition to mechanical therapies, the promotion of positive health behaviors is important regarding diet, supplementation, exercise (aerobics, strengthening, relaxation exercises), etc.
 
TAC: How did you develop your treatment protocols?
GJ: After graduating from chiropractic college, I had manipulation skills but no clear way of knowing how to use them except for palpating for sticky joints. 
 
After seven years in practice, I stumbled on the McKenzie Method, an approach developed by a New Zealand physiotherapist that, for me, illuminated my understanding of the subluxation (McKenzie calls it a “derangement”). What the McKenzie Method provided for me was the symptom profile of the subluxation listing; it is my belief that chiropractic has been handicapped historically by ignoring the symptom pattern of the subluxation, i.e. how symptoms behave, in tandem, with mechanical findings. The McKenzie Method identifies patterns of those behaviors permitting a better understanding of which spinal movements should be pursued and which should be avoided in relation to positioning, exercise, or manual therapies. In addition to McKenzie, I have been influenced by others, such as Mulligan, Butler, and Laslett. 
 
My approach for the lower back pain of a 44-year-old would be as follows. After ruling out red flags, I make the assumption that complaints are due to spinal  derangement (subluxation) until proven otherwise. Should evidence for that be lacking, the next consideration would be the sacroiliac, tested via Laslett protocols  requiring three out of five reliable SI tests (iliac distraction, Gaenslen’s, thigh thrust, iliac compression, sacral thrust). Should that fail, the next consideration would be facetogenic pain, keeping in mind that Laslett demonstrated extension rotation pain to be 100% sensitive for facetogenic pain (i.e., if there is no pain with the test, you don’t have it!). My next consideration would be whether short tissue explained complaints, which would require a ROM loss consistent with the muscle believed to be short. Other explanations to be considered, if presenting phenomena cannot be explained as joint or short-muscle based, would be inflammation, clinical instability, nutritional, sensitized nervous system, psychological, etc. The approach I follow is shared by many rehab-oriented chiropractors and has best been formalized by Donald Murphy, DC, DACAN, initially known as  the Diagnosis-Based Clinical Decision Rule and currently called CRISPTM (Clinical Reasoning in Spine Pain).

TAC: What is the most common problem you see new or struggling chiropractors have in treating patients?
GJ: Aside from the economics of practice, the most common problems I see concern both conceptual and physical skills. When confronted with a clinical problem, there is no clear understanding of what to do or when to do it. The erroneous medical assumptions of spasm and inflammation have infected chiropractic thought precluding the willingness or ability to determine and correct subluxations. Curiously, the lack of ability of new graduates to adjust the spine by hand is commensurate with chiropractic institutions being less willing to use the word subluxation. Many new chiropractors lack the motivation, confidence  or ability to adjust the spine, resulting in a fear of moving the spine and the pursuit of non-movement passive therapies. New graduates can tell me more about contraindications for adjusting versus indication for adjusting.
 
TAC: What types of chiropractic techniques do you prefer?
GJ: Prior to attending LACC, I had a chiropractor in Manhattan who was a toggle-recoil HIO instructor for B.J. Palmer. When he heard I was to attend LACC, he went into mourning and then taught me toggle-recoil HIO to his satisfaction prior to my departing for Los Angeles. To that end, I have a MT-125 (MT Tables) toggle-recoil multidirectional headpiece stationary table with thoracic and lumbar drop pieces as well.
 
New graduates can tell me more about contraindications for adjusting versus indications for adjusting.[/pullquote]
Of all areas of the spine, it is my opinion that the upper cervical spine perhaps needs more manual assistance than other areas and I find upper cervical drop-piece adjusting to be well suited for that purpose. 
 
As a McKenzie chiropractor (McChiropractor?), I also employ the REPEX II table from Hill Laboratories, which permits continuous passive lumbar extension or flexion motions. 
 
I do not prescribe to any particular chiropractic “technique.” I am a hands-on, diversified adjustor guided by mechanical and symptomatic responses to loading as revealed by patient-generated positioning, movements, and exercises, as well as pre-manipulation mobilization testing. My approach is adjustment, not subluxation-based. The belief of having to determine exactly where the subluxation is so the force can be applied to exactly that spot  may not always be prudent  (research indicates that the cavitation does not always occur where the hand is applied). One can conceive, for whatever reason,of situations wherein a  a subluxation may be best corrected with the force/fulcrum applied above or below the subluxation level. The mechanical and symptomatic responses to the force applied are more relevant than determining where to apply force based on criteria that ignore those responses. 
 
TAC: What patients improve the most significantly with care?
GJ: The patient that improves most significantly with care is the patient for whom the appropriate education is provided. Education/exercise should be preferred to passive coping strategies that prolong the cost of care and reduce outcomes. The manner in which care is framed is very important. If benefit from exercise is explored before manual therapies, the sufferer realizes its efficacy, believes the DC feels it is important, and, therefore, is more likely to comply. If the DC rushes to rescue the patient with passive procedures and teaches exercise later, the outcome/compliance will not be as good.
 
The manner in which interventions are framed is also important. Benefit from an adjustment may be interpreted as meaning that the DC is the way, the truth, and the life, or a different interpretation may be forwarded for a better cognitive-behavioral effect. Benefit from an adjustment can also be diagnostic/educational by the following communication:
  • There was benefit from movement
  • There was benefit from aggressive movement to the end of range.
  • Your spine is, therefore, strong.
  • Your spine is not damaged; it is deconditioned.
  • It has a movement deficiency, especially concerning movements to end-range.
  • Exercises to end-range (similar to adjustments) can be developed to give you similar relief.
  • The avoidance of certain end-ranges will also benefit you.
  • You do not need to fear exercises at home, as the forces involved are less than the adjustment.
The role of chiropractic versus rehab
Chiropractic is the name of a profession, not a procedure or a technique. It is impossible to predict what any particular chiropractor defines his or her “chiropractic” as. Some distinguish what DCs do as “chiropractic” and “physio,” the former meaning adjustments and the latter meaning modalities and, less often, rehab exercise. 
 
It is my hope, (and I believe it is crucial for the survival of the chiropractic profession), that chiropractic will someday be indistinguishable from rehab, thus snuffing out critics of chiropractic that accuse us of promoting passive palliative procedures resulting in dependency and deconditioning.
 
I have referred to the “adjustment” as a diagnostic and educational tool for rehab. Of all the passive therapies, the adjustment has the best evidence-based support and is related to rehab, inasmuch as it is a movement therapy. 
 
Hopefully, chiropractic will have a future if it embraces the principles of rehab. Currently, the chiropractic profession is made of different tribes (techniques) having separate languages and approaches. The failure of the chiropractic profession to account for the symptom profile of the subluxation makes “magical” techniques attractive. It is a Tower of Babel that challenges the argument that the DC profession should be primary care.  
 
The role of chiropractic should be indistinguishable from the role of rehab. For me, it has been the marriage of the McKenzie Method with chiropractic that has permitted that to happen. 
 
The McKenzie Method takes a history regarding the effects of end range loadings and performs end-range loading exam procedures; based on that, an exercise program is developed involving the pursuit of certain end ranges and the avoidance of others. If complaints and mechanics recover, the sufferer was taught how to saddle up and ride innate themselves. If there is a partial response, greater forces in the same direction (i.e., an adjustment)  may be employed. 
 
Particular patients
The type of patient that sticks out in my mind the most is the patient that gets significant, albeit short-term relief from chiropractic adjustments, but has never been progressed to an adequate exercise program. The patient presents with a history of medications, injections, and modalities failing with the only significant (temporary) relief being realized with adjustments. 
 
The history of relief with adjustments is a history of relief with movements to end range . It is rare for me to encounter a patient who reports significant short-term relief from adjustments who cannot be liberated from dependence on adjustments if instructed how to perform end-range loading exercises in certain directions (like an adjustment), and if instructed about which movement directions to avoid (so the correction “holds”). 
 
After that, the patient would further benefit from being progressed to an adequate aerobic, strengthening, and relaxation exercise program. All too often, the only exercise given is “stretching” without any evidence of the ROM loss predicted by the muscle purported to be short.  
 
Please visit http://www.garyjacob.com to access educational materials written by Dr. Jacob or to contact him.
 

Some Perspective on Soft Tissue: Interview with Warren Hammer, DC

Dr. Warren Hammer has been in practice for 50 years. He graduated from Brooklyn College (BA) in 1955, Lincoln Chiropractic (DC) in 1960; Diplomate, American Board of Chiropractic Orthopedists in 1975; instructor in spinal biomechanics, NYCC; University of Bridgeport (Human Biology-Nutrition, MS) 1979. He is a consultant for Graston Technique©. He attended seminars at Gonstead Clinic (20 X), Cyriax, Nimmo technique, ART, Mulligan, Voyer, Fascial Manipulation®, and others. 
 
hammerwarrendcTAC: What made you become interested in soft tissue methods?
Dr. Warren Hammer (Dr. H): Early on, I realized that spinal and joint manipulation, while extremely important as a treatment modality, was only part of the picture regarding the treatment of musculoskeletal conditions. I wrote years ago about chiropractic tunnel vision regarding “subluxation” and spinal involvement. The spine is a passive structure, moved by muscles and supported by connective tissue. How can you neglect these areas? For me, the big realization about soft tissue began when I noticed that spinal and shoulder adjustments, plus some modalities such as ultrasound, were not the answer to the treatment of most shoulder problems. I might add that this also applies to most other areas of the body.
 
TAC: How do chiropractors respond to your position on the role of chiropractic in health care?
Dr. H: Years ago, I used to receive threatening letters stating that I was not adhering to chiropractic “philosophy,”etc. It may sound like blasphemy to some, but I feel that the future of our profession depends on us departing from some of the original ideas of chiropractic. These ideas have been overemphasized and have slowed down our progress. Have we ever asked ourselves why we are treating the same percentage of the population that we did 50 years ago? In a recent volume of American Chiropractor, outgoing president of NUHS, Dr. James Winterstein was asked about the future of our profession. He stated that the new science called mechano-biology whereby mechanical input can affect human physiology down to the celluar and biomechanical level is very important for our profession. He stated that “when you work on the fascia, these fibrocytes communicate directly with one another, and they invest every organ in the human body.” “What we do biomechanically has an effect that goes far beyond the bones, joints, ligaments, and muscles.” “This has been the basis for the profession since the beginning.” I feel that what we do biomechanically, though, has to include much more than the spinal adjustment. 
 
TAC: What is it about fascia that chiropractors have been overlooking? 
Dr. H: Seems that in the US, except for the Rolfers (Structural Integrationists), up until recently almost everyone has been overlooking fascia. Except possibly in Europe where Fascial Manipulation® has been taught for the past 15 years. The most ubiquitous connective tissue in the body is the fascia. It has been defined as the connective tissue system that permeates the human body, forming a whole-body continuous three-dimensional matrix of structural support. It interpenetrates and surrounds all organs, muscles, bones, and nerve fibers. Every muscle fiber and every muscle belly is surrounded by fascia. It is extremely important because it transmits almost 40% of the force of a muscle contraction and possibly more important, the fascia is a sensory organ that communicates with the CNS. Muscle spindle cells that function to help regulate muscle function are in the fascia. If the fascia is densified and unable to slide over and within muscle, then the spindle cell cannot provide normal feedback to the CNS. There will be an incoordination of muscle function leading to eventual pain and malfunction, and the individual becomes an accident waiting to happen.

TAC: Do subluxations affect the fascia?
Dr. H: More likely, densified fascia affects the subluxation. Often after soft tissue treatment there are less spinal fixations palpated. Actually, an adjustment is a type of soft tissue treatment affecting the capsules, associated ligaments and muscles, and probably some local fascia. But due to the global distribution of fascia, the whole fascial system has to be considered along with the articular component.

TAC: Can you in a few words tell us about the Fascial Manipulation (FM) course?
Dr. H: I went to Italy for two separate weeks to learn the work and recently introduced it to the US with Antonio Stecco, MD. FM looks at the entire body from a global perspective based on an anatomical and neurophysiological understanding of the fascial system. Based on FM interpretation of the myofascial kinetic plane, for example, treatment of an old ankle fracture (fascial disruption) finally prevents the recurrent compensatory low back pain.

We must recognize the importance of our total structure and not get stuck on just treating its parts.[/pullquote]
TAC: Can you think of one change that a chiropractor can do to significantly impact his or her practice’s growth immediately?
Dr. H: Simple, get people well in a short period of time. Fill your “tool box” with as many healing tools as possible and apply them to the particular patient’s problem. I am not interested in gimmicks that create an immediate growth in practice. We are all in practice for the long haul and creating satisfied, referring patients has always been the key to growth for all types of doctors. I believe in a doctor having a healthy frustration, meaning that you can never be content until all of the patients you accept get well. Since this cannot really happen, allow your “healthy frustration” to continue to find out why you were not able to get them well.

TAC: Where do you see the future of chiropractic headed?
Dr. H: The future of chiropractic depends on how soon our colleges can teach the gestalt of healing. We must recognize the importance of our total structure and not get stuck on just treating its parts. The physical therapists seem to be developing this concept and are now graduating DPTs (doctors of physical therapy). They are teaching spinal and joint manipulation, and while they have not nearly reached our proficiency, they continue to stress a soft tissue paradigm. From what I see, however, they are still weak in the soft tissue arena, but to their credit, they are not stuck on original concepts. Frankly, I worry about our future.

TAC: Any final words for our readers?
Dr. H: The old adage that we should treat patients as we would want ourselves to be treated is truer than ever. I want my doctor to know everything possible about what he treats. I want my doctor to open his or her mind and never be satisfied with his or her state of knowledge. I want my doctor to be interested in getting me well as quickly as possible and not make me a lifelong contributor to his or her financial well-being.

Visit www.warrenhammer.com for more information.

Amazing Chiropractor Interview with Dr. Steven M. Horwitz, DC, CCSP, CSCS, CKTP: Sports Injury Practice with a Focus on Injury Prevention

Dr. Steven Horwitz is a graduate of Cornell University and the National College of Chiropractic. He is a certified Chiropractic Sports Physician, Strength and Conditioning Specialist, USA Weightlifting Club Coach, Kettlebell Instructor, USA Track and Field Level 1 Coach, and Sports Nutritionist. In 2010, Dr. Horwitz was named to Washingtonian’s list of top experts in sports medicine. In 2006, he was named to the Guide to America’s Top Chiropractors by the Consumer’s Research Council of America and in 1996 Dr. Horwitz received the Maryland Chiropractic Association’s Outstanding Achievement Award. He is a credentialed Active Release Techniques® practitioner (upper extremities, spine, lower extremities, nerve entrapments, Masters, and Ironman® Provider), certified Graston Technique provider, certified Kinesio Taping Practitioner (CKTP), certified Functional Movement Screen provider, and certified in Dry Needling by the Dry Needling Institute. Dr. Horwitz is Titleist Performance Institute certified.

 
tractiondevicesDr. Horwitz was selected by the United States Olympic Committee as the sole chiropractor on the sports medicine staff of the 1996 Olympic Team and in that same year was appointed by the Governor to the Maryland Advisory Council on Physical Fitness. He served as the Chairman from 2002 to 2004. Dr. Horwitz was elected as the Maryland State Director for the National Strength and Conditioning Association from 2004 – 2010.
 
After 26 years of chiropractic service, Dr. Steven Horwitz’s focus is on sports injury prevention with a special interest in young athletes. “Working with young athletes I see that coaches can offer specific sport-related skills. But every athlete, with the possible exception of swimmers, uses the same skill set: two or three steps forward, backward, to the left, to the right, stopping, jumping, landing, changing direction. I really enjoy working with young athletes to help them learn movement skills which will not only allow them to excel at their chosen sport, but to develop movement patterns and muscle memory which will serve them throughout their life.”
 
“A good analogy for the importance of proper athletic technique,” Dr. Horwitz goes on to explain, “is having your tires properly balanced on your car. Properly balanced tires allow the car to be driven faster, prevent uneven tire wear, permit the slowest rate of tread wear possible, and provide the greatest protection against blowout. The same goes for proper exercise technique and the human musculoskeletal system (bones, joints, muscles, ligaments and tendons).” 
 
TAC: What has really impacted your growth as a chiropractor and that of your practice? 
Dr. Steven Horwitz: My mentors, Dr. Jack Kahn and Dr. Charlie Miller, really shaped my career. They were amazing chiropractors! The Olympics certainly taught me how much athletes appreciate chiropractic care. Continuing to learn is critical. One cannot rest on one’s laurels if you want to succeed in this field. 
 
TAC: What inspired you to become a chiropractor?
SH: I consulted with my parents when I was in college about what to do with my life. They had a revolutionary idea—they went to the library and checked out a book of professions. I had always enjoyed fitness and health, but did not want to go to medical school. Not long after that conversation, I had a frustrating experience with an orthopedic surgeon when I injured my shoulder. The exam lasted two minutes and his treatment plan was aspirin. I thought there must be a better way. My father, wise and plugged in, recommended chiropractic care as a way for me to align my interests in sports with my desire to help people avoid the same kind of shallow and unhelpful clinical experience I had. 
 
I believe a holistic approach is the key to success for athletes young and old. “The function of protecting and developing health must rank even above that of restoring it when it is impaired,” said Hippocrates. This philosophy shapes my practice. Over the years I’ve worked with elite athletes, weekend athletes, and sometimes had the privilege of watching talented, young athletes develop their athletic careers. 
I believe a holistic approach is the key to success for athletes young and old.[/pullquote] 
A few years ago a patient of mine retired from playing professional soccer. She was a perfect example of the balanced tire analogy. We met as she was finishing her college career and I would see her once every few years. Very slowly, over years of  playing, her “tires became unbalanced.” The “wear and tear” progressed gradually. When she retired, she moved back to the area and sought me out because she was in pain. Her lumbar MRI showed two severe herniations at L4-5 and L5-S1. I had been reading about the “Traction on the Move” concept and thought it might make a difference for her. I purchased a Vertetrac for the clinic with her in mind. I started her off using it on a daily basis and afterward using it in combination with the treadmill after using cold laser and performing ART to the appropriate muscles. Over several sessions of care, she improved to the point of being able to coach soccer and live pain-free. She still uses the Vertetrac periodically for maintenance and preventive care while she continues coaching and staying active. I have a few special tools in my arsenal, and the Vertetrac is one I return to often.
 
You can contact Dr. Horwitz at: [email protected] Visit www.DrStevenHorwitz.com or call  214-531-7939
 
Dr. Horwitz refers to Meditrac Products in this conversation. Website : http://meditrac.co.il
 

Dr. Dick Versendaal: A Pioneer of Modern Chiropractic Wellness

Dr. Dick Versendaal is one of the last living doctors of chiropractic who studied under Dr. B.J. Palmer. Today, he still practices with the “big idea” in mind. 
 
versendaaldickIn a Q & A session with Dr. Ken Murkowski, Dr. Versendaal talks about his past and present.  Also revealed are some of the interesting beginnings of Contact Reflex Analysis® (CRA), as well as where Dr. Versendaal sees his influence as it relates to the Science, Philosophy and Art of chiropractic.  Join us in reviewing this inspiring history, for Dr. Versendaal’s 76th Birthday celebration.
 
Dr. Ken Murkowski (KM): Tell us about your memories of B.J. Palmer.
Dr. Versendaal (Dr. V):  Well, there are so many stories, but he demanded respect for himself and chiropractic, and he was strict about punctuality. If you were not in your seat 15 minutes before class, you were late and he locked the classroom doors.
 
KM: Dr. Versendaal, how did you come up with the concepts and principles of CRA?
Dr. V: Due to my own severe chronic stomach pain I, like so many other chiropractic patients, was desperate for a relief and cure. I sought out different techniques and DC experts. I was willing to try any chiropractic technique to relieve and cure my stomach pain. While attending a Dr. George Goodheart seminar, I was treated for my stomach dis-ease with reflexes in my mouth; these reflexes completely alleviated my problem forever. A chiropractic reflex miracle! I then hypothesized the body had to have other contact reflexes for other dis-eases and pains.
 
KM: Dr. Versendaal, exactly what does CRA stand for?
Dr. V: Today CRA®, Contact Reflex Analysis®, is an established protocol for testing the causes of VSC (dis-ease) and how they are affected by the structural (traumas), emotional (autosuggestion), chemical (toxins), and the VSC and its eight physical and eight chemical components. Of course, once comprehensive CRA testing is done by any DC who knows CRA then they must have the contact reflex adjustment. This, I refer to as the dynamic adjustment in class, for those practitioners licensed to do so today. Then we also do the VSC eight chemical components with the CRA  nutrition for wellness.

KM: Dr. Versendaal, how did CRA  start? Where did the research funding come from?
Dr. V: Well, I must thank my mom. I was in practice about one year. I had to take my mother to a very famous MD (Dr. Northouse) in Grand Rapids, Michigan. I was sitting in his waiting room and a nurse summoned me to his private office. He said, “Young man, your mother says you are a specialist and you can fix anything. I am a world famous medical doctor, author, and teacher. I am now being forced into early retirement due to years of constant debilitating neck, shoulder, and arm pain. I have tried every known medical treatment and therapy and nothing has worked. I want to try chiropractic today!” The rest, as they say, is history. I did CRA testing and a dynamic adjustment on the doctor and recommended special nutrition. I left the doctor in the hands of “innate” and took my mom home.
Drs. D.D. and B.J. Palmer were light-years ahead![/pullquote] 
Two weeks later, I was again called to come to the doctor’s office. The doctor said, “I told you that if you helped me that I would help make you famous.” He opened his drawer and handed me the title to an antique car on display in a Grand Rapids museum. Its value was $15,000 in 1959. I later sold the car to a museum in North Carolina.
 
Dr. Northouse established a research foundation in hospitals covering three states (Tri-States Research) dealing with nutrition, the nervous system’s reflexes, and adjustments. We hired MDs and PhDs to do CRA  research with labs and tests. The CRA  research tied in blood tests and urinalysis samples just like B.J. did at the Palmer Clinic.
 
KM:  As one of the last chiropractic icons, where do you see yourself and CRA  in today’s chiropractic society?
Dr. V: Thank you. I never see myself as an “icon,” only as another chiropractor and teacher. We have to look at the entire chiropractic profession today. On the far left, we have DCs legally doing minor surgeries, injections, and wanting to distribute drugs. On the far right, we have DCs only adjusting one bone (HIO) by hand only. It is my belief that I am in the “middle” of all chiropractic and its philosophy, art, and science. CRA  is based on the vertebral subluxation complex (VSC) and its eight physical and eight chemical components, which stem from D.D.’s original teachings that VSC is caused by traumas (structure), autosuggestions (stress), toxins (chemical), and spinal subluxations (TATS). I will tell you that at CRA seminars, I have seen practitioners from the far left and the right who have embraced with CRA  principles, protocols, and teachings.
 
I welcome all practitioners today to “unite” under CRA  no matter what their individual chiropractic philosophy or technique tools are. I am giving all DCs and chiropractic another technique tool to add to their healing toolboxes thus increasing health and wellness in the world today with simple protocols!
 
KM: Do you think you have grown beyond chiropractic?
Dr. V: I believe it’s the exact opposite! I look at myself and CRA as being an evidence-based research teacher and sharing my knowledge based on TATS learned from D.D. and B.J. Palmer. CRA  is in the middle of the chiropractic road. Some of my former students have focused on one or more of the causes of VSC. Dr. Ulan, a former CRA board member and CRA practitioner is now a teacher focusing the majority of his teachings on the VSC chemical components of dis-ease. Two of my students are also focusing heavily on the chemical components of CRA  (Drs. Stuart White and John Dobbins). All three doctors learned the CRA  principles and protocols for wellness. I am happy to have been a teacher to them so they can teach also.
 
When I teach CRA , I reinforce the history of chiropractic in today’s wellness practitioner by utilizing D.D.’s triad of wellness as it applies to our philosophy, art, and science! This includes not only nutrition (toxins), but the structural (traumas) and emotional (autosuggestions) causing dis-ease. CRA  is one of the most holistic modern approaches to total “family wellness” today! CRA  raises the autoimmune systems and increases one’s immunity to dis-ease, especially inflammations in our environment today. 
 
KM: Do you view yourself as being light-years ahead of the current wellness movement?
Dr. V: Yes and no. Drs. D.D. and B.J. Palmer were light-years ahead! I don’t know if I am light-years ahead in the wellness movement. I view CRA  research for the last 56 years as the seed of chiropractic wellness care. I am exceptionally happy to see the modern chiropractic profession treating and teaching patients about wellness, and DCs dealing with the issues of traumas, autosuggestions, and toxins, along with the spinal VSC. The only place where I might be light-years ahead would be in the research and development of the 10 natural nutritional products and six essential oils (VerVita®) that we are using today in CRA  because of people’s chemical sensitivities especially with wheat, gluten, sugar, etc.
 
The reason we have it down to 10 nutritional products and six essential oils is because any practitioner today can learn and explain to the patient, the synergistic relationship of how VSC is affected by the triad. The research and development of these formulas is based on the interrelationship of body systems instead of the same old one vitamin deficiency syndrome.
 
versendaaldick2KM: Is CRA easy to learn and reproduce by young practitioners today?
Dr. V: Yes. Young, old, like any other chiropractic mainstream technique, the more you practice the technique principles and protocols, the more proficient you become in Contact Reflex Analysis® and contact reflex adjusting. How long does it take to learn to be perfect in the Gonstead, Thompson, diversified technique, or acupuncture? Remember the Vince Lombardi quote: “Practice doesn’t make perfect. Only perfect practice makes perfect.”
 
KM: Do you have one or two more memorable miracle success stories with CRA ?
Dr. V: For the record, every patient who is helped with CRA®  is a chiropractic success story. In my last 56 years, I estimate by seminar attendance records thousands of CRA  students have tested and taken care of tens of thousands of patients. They have heard the CRA  principles and protocols. One of the CRA  successes that is very dear to my heart is Dr. Bob Hoffman. This great man is one of my closest friends besides being a chiropractic teacher, management pioneer, entrepreneur, and speaker for The Master’s Circle.
 
KM: Do you see yourself retiring in the near future?
Dr. V: No, absolutely not. I believe you must walk your talk, and I do that. I am 76 years young. I celebrated my 76th birthday (in March) by teaching. I am just starting on some new research. I have great vitality, but more importantly, my passion  is for helping chiropractic, and people in life by teaching chiropractors CRA, so they can help their patients. My passion for teaching is only surpassed by my burning desire to help every sick person I meet through CRA, and to make the world a healthier place naturally…and spread the words of wellness.
 
Thank you, Dr. V, and Happy 76th Birthday from The American Chiropractor.
 

Leading Care through Innovation and Passion

Dr. Kevin Jardine graduated from Canadian Memorial Chiropractic College in 2002 and has been in practice for just over a decade. Dr. Jardine comes from a background in exercise science from the University of New Brunswick. 
 
jardine1Dr. Jardine is the co-creator of SpiderTech which has become a globally recognized brand delivering kinesiology taping products and education. On top of providing the professional health care market with an easier, more standardized approach to kinesiology taping, Dr. Jardine has brought the field of chiropractic to a world stage of credibility with the endless traveling and presenting he does for all health care professions.
 
Dr. Jardine has presented at dozens of chiropractic colleges and association events, as well as written numerous articles showing the world the broad diversity that chiropractic can offer. He has presented to such prestigious schools as UCLA, USC, Stanford, and Penn State, to name a few. 
 
Following his contribution in the building of SpiderTech, Dr. Jardine founded a Toronto-based multidisciplinary clinic called the Urban Athlete which has more than 20 different health care professionals all working together for the benefit of the patient. Dr. Jardine has treated some of the world’s greatest athletes as well as consulted with numerous professional sports teams.
 
As an avid sportsman, Dr. Jardine also contributes to the community by providing complementary services to less fortunate competitive athletes. Dr. Jardine has also volunteered his time to bring the sports chiropractic community together by acting as an advisor for the International Sports Chiropractic Association in its merger with the FICS organization.
 
TAC: Tell us more in-depth about the services and products you offer chiropractors, and how or why you offer them. 
KJ: In addition to creating SpiderTech, Dr. Jardine has developed additional innovation in the health care market by producing leading health and fitness products and mobile technology. Dr. Jardine’s company, Feeling Pretty Remarkable, provides targeted exercise programs to help people overcome and prevent some of the most common musculoskeletal injuries. Chiropractors benefit from using the products by learning more about the role of rehabilitation in patient care. In addition to the educational courses provided, practitioners can purchase DVDs and manuals to sell to patients as a simple way to extend the advantages of active care. 
For me, being a chiropractor is more than eliciting an audible click.[/pullquote] 
With a passion for education, Dr. Jardine also created a continuing education company called Collaborans with Dr. Nick Tsaggarelis, which provides both online and hands-on courses. Collaborans currently operates in 12 different countries and provides leading education around rehab, taping, and movement-based diagnostic skills. Collaborans also provides chiropractors with a platform to help develop their own products and educational ideas so that they can effectively share them with the whole chiropractic community. 
 
TAC: What are your goals in treating patients?
KJ: My goal in treating patients has always been about providing the best resources to help my patients reach their personal health potential. I take a “whole system” approach to patient care and I have always been a believer of the notion of patient empowerment and that physical activity is a fundamental pillar in someone’s approach to leading a healthy life.
 
TAC: How did you develop your treatment protocols?
KJ:  I have always considered myself a lifelong learner, and I have always been very curious about the human body. This has led me on a continuous path of learning and developing my skills. I realized a long time ago while on this journey that there is always something new to be learned. I enjoy collaborating with others and combining both the relevant research with practical experience to find innovative ways to help my patients.
 
TAC: What is the most common problem you see new or struggling chiropractors have in treating patients?
KJ: The most common problem I see chiropractors struggling with is the confidence in what they can help their patients with. For me, being a chiropractor is more than eliciting an audible click. It is about providing insight, context, and actions that patients can benefit from in order to live more fulfilling lives. Too often, I see practitioners focused on the technical side of what they do, or on how difficult it is to function in today’s troubled health-care system. Throughout history, there has never been a more important time to be a chiropractor. This profession puts you on the front lines of the battle of overcoming obesity and other non-communicable diseases that are sweeping the globe such as diabetes and heart disease.
 
lowbackspiderTAC: What type of chiropractic techniques do you prefer?
KJ: I am a diversified practitioner with a broad range of skills that I can draw upon to help my patients. I typically use a combination of soft tissue work, articular adjustments, and physical activity for most conditions I see. In addition to being a medical acupuncturist, I also use nutritional intervention to help promote recovery and health in my patients.
 
TAC: What patients improve the most significantly with care?
KJ: My patients are ones that understand that I am not going to just become a physical aspirin for them and do all the work. They understand they have a role to play, and it is a very important role. This helps me focus on working with patients who want to play an active role in their care rather than become a spectator.
 
TAC: How do you view the role of chiropractic, versus that of Rehab?
KJ: I feel the two go hand-in-hand and the greatest results are achieved when they are combined. I believe in order to provide complete chiropractic care, you need to provide patients with active exercises designed to help them get back to being able to take on the daily challenges without continually having to rely on your adjustments. I’ve actually created a whole brand around providing chiropractors with the tools necessary to learn about and implement active care within their practices. Feeling Pretty Remarkable was created because of a need to build the understanding of the role of exercise in clinical care for chiropractors. It provides clinicians with structured programs targeting the most common musculoskeletal injuries. Programs such as The Knee Program or The Low Back Program are offered as DVDs so chiropractors can continue to provide the best in care for patients while building the success of their practices.
 
TAC: Can you give an example, no names of course, of a patient that sticks out in your mind as having really benefitted from the care you delivered?
I have unfortunately seen, far too many times, patients in their sixties that are more physically deteriorated than my 96-year-old client.[/pullquote]
KJ:  I’m very fortunate to have worked on some of the world’s greatest athletes. I’ve worked on professional and Olympic athletes. I love the part of my job that involves reading the success stories of the people I have been able to help. And it doesn’t matter to me if they are someone’s grandmother or a world champion. The last couple of years have been great with being involved with a Tour de France-winning professional cycling team as well as the London Olympics. The case that stands out the most is my 96-year-old patient I see every month. There are two reasons that she stands out. One is because there are many times that I feel I am not able to do anything for her. This bothers me and I constantly ask if she feels that what I am doing is helping. Her reply is always “yes.” This teaches me that what I do is more than just the physical act of my technical skills. The other part that strikes a chord with me about working with her is that she is an example of what can happen if you take care of your body and take responsibility for your health. I have unfortunately seen, far too many times, patients in their sixties that are more physically deteriorated than my 96-year-old client. This breaks my heart to see people suffer knowing it didn’t need to be that way. This has fueled my passion to educate and inspire the habit of health in others.
 
TAC: Where do you see the future of Chiropractic and Rehab headed?
KJ: Chiropractic has a dangerous and challenging road ahead. What chiropractors have traditionally felt they have owned, the act of joint manipulation, is now being taught at leading physical therapy schools. And with the introduction of the Doctor of Physical Therapy programs, chiropractors will have an even more challenging time to differentiate the need for their services. In my opinion, chiropractors can make a mark for themselves as experts in health and physical activity. But this takes leadership with a vision for change and a profession that is willing to adapt for the times. Rehab and physical activity will become an even more important skill to have in the coming years and those who possess the tools that help their patients get better faster will lead the way to success.
 
TAC: Any final words for our readers?
KJ: Being a healthcare professional includes a commitment to continual learning, and having the intent to learn from the best suited for the job, not the cheapest. My call to action for you is to commit to leading others who are looking for your expertise and skills by first leading yourself. What is your health like? When is the last time you went for some preventative care? If you were your best client, what would you recommend as the first thing to do for building better, longer lasting health? Asking questions like this can be tough to swallow, but in today’s troubled healthcare system, I’ve often said “the best form of health care, is caring for your own health.”
 
You may contact Dr. Kevin Jardine at: [email protected]  or visit www.Collaborans.com

Structural Correction: Tim Maggs, DC Discusses the Most Ignored Demographic, The Student Athlete

Dr. Tim Maggs is the current Director of Sports Biomechanics at Christian Brothers Academy in Albany, New York.  He will provide his Structural Management® Program to their highly successful athletic department. This is the first time a chiropractor has had such an influential role in Christian Brothers Academy middle or high school athletic department.  Dr. Maggs is in his 35th year of practice and has always had a sports-based practice. He is a graduate of National College of Chiropractic and completed his undergraduate work at the State University of New York. In an interview with The American Chiropractor, Dr. Maggs explains what drives him in providing this type of care, as well as explaining what the Structurtal Management® Program involves.
 
maggs1TAC: Dr. Maggs, let’s start with a little about your background.
TM: My practice is filled with health-oriented, active people. We don’t get the acute, antalgic patient coming in. We’ve really done a great job of making our care part of people’s lifestyles. So, once they begin care with us, our goal is for them to go through enough care to “fix” their problems, then have them stay on at some frequency in an effort to “manage” their musculoskeletal systems throughout their lives.
 
TAC: When did you get interested in working with high school athletes?
TM: In 1979, immediately after graduating, I began working with the football team in my town. Twice a week I would go to their practices, and didn’t really know what to do with them, so I adjusted those athletes who would let me. I didn’t get paid, and I didn’t do too much of an exam on them. I don’t think I even got parental approval back then. But my goal was to work with athletes, and that’s what I did. Until the school doc got wind of what I was doing and asked the athletic director to ban me from the campus, which he did. So I’ve spent the last 34 years figuring out how to get back to working with high school athletes, but this time, through the front door. Eight years ago, we started our Concerned Parents of Young Athletes™ Program, a program designed strictly to raise the awareness of sports biomechanics in the middle and high school age group. My Structural Management® Program is a comprehensive biomechanical program we use on all of these athletes.
 
TAC: Why is it difficult to have access to high school athletes?
TM: There is an epidemic failure in the field of sports medicine to understand how to truly take care of athletes. The law of minimalism defines the care that high school athletes receive, and the medical model guides the practitioner. School districts defend this weak, reactive approach. The approach that I’m incorporating at CBA, and one that every school in the country needs, is a proactive, biomechanical model that looks at all athletes before injuries occur. It’s difficult to get access to high schools because the politics of health care, the egos of local orthopods who are in charge, and the ignorance of athletic directors and coaches keeps the system in the dark ages.
 
TAC: What are some of the negative experiences you had prior to finally getting this appointment?
TM: I’ve met with more athletic directors than I can count, boards of directors of school systems, even superintendents of school districts. I’ve met with coaches, parents, and athletes. The biggest disappointment is always that they don’t have my vision. It’s like 50 years ago, hoping someone would see every person having a phone/camera/computer/GPS/phone book/etc. in their pockets. No one could ever imagine what that would look like. So the amount of time and energy that I’ve exerted in this journey was absolutely necessary for me to get where I’m finally at today.

TAC: What does the title Director of Sports Biomechanics entail?
TM: This was a department the school and I had to create. No other school in the country, that I’m aware of, has a department for biomechanics. Many schools feel progressive if they have a bigger strength department. But, that in no way even comes close to what we’re offering at CBA. I worked four years in the strength department of the New York Giants, and I witnessed player after player that was injured, with no one ever knowing what their unique biomechanics looked like. New tires on a misaligned car is not the solution.
We provide Structural Fingerprint® exams to all athletes who wish to go through them, with a full report of findings to parents and athlete.[/pullquote] 
The product we offer is Structural Management®. The Structural Management® Program, a program that has taken me over 20 years to develop, is a comprehensive biomechanical program. It’s a program that truly enhances the value of chiropractic. As director of sports biomechanics, my biggest role is to educate parents, coaches, teachers, and students of the very existence of biomechanics and how our unique biomechanical makeups (Structural Fingerprint®) will dictate injuries, degeneration rate, and future disabilities. These people only know the medical model and reactive care. They follow the guidelines of the insurance industry, which is to only go to a doctor after you’re hurt. This is the reason the leading cost in health care today is musculoskeletal. My goal is to change that.

Secondly, all middle and high school athletes in this country must go through a pre-season exam in order to play their respective sport. This exam is a medical exam, checking eyes, ears, nose, and throat. No one ever looks at their biomechanics. Even though the musculoskeletal system is the system that becomes injured, and this is the system that is costing Americans more than any other category in health care. Biomechanical exams should be mandatory for all young athletes in this country.
 
So, as Director of Sports Biomechanics, we offer extensive education through our website, through the school’s website, through programs I give to parents, coaches, and athletes on a regular basis, and information provided in newsletters the school sends out. We provide Structural Fingerprint® exams to all athletes who wish to go through them, with a full report of findings to parents and athlete. We then recommend one of our treatment programs, two of which are one-year programs. We also provide same day, acute injury exams, with treatment provided immediately, if the parent chooses to accept our recommendation. Both of these exams are no charge for all CBA students, however, all treatment is paid for, either through insurance or out-of-pocket. Finally, we offer custom orthotics at a significantly reduced rate to all CBA students. Our program encourages custom orthotics for all athletes as the first proactive step in improving their overall biomechanics, so there is much education as to why custom orthotics are needed by all.
 
TAC: What is your vision for high school athletes around the country?
TM: My vision and my goal are for all middle and high school athletes to go through a comprehensive biomechanical exam (the Structural Fingerprint® exam) at the start of each sports season. Then, knowing that all athletes have unique biomechanical faults, imbalances, and distortion patterns, provide the services and products for correction. Chiropractic care is an integral component of “fixing” an athlete’s biomechanics, so when this paradigm is used, the need and value for chiropractic care goes up exponentially. We are the only profession that fixes biomechanics. Our program recommends and provides a higher quality of care for both kids with symptoms, as well as kids with no symptoms. My ultimate goal is for all young athletes to go through this exam, and provide high-quality visual evidence to parents so they understand why their kids need custom orthotics and advanced acute and corrective chiropractic and rehabilitative care.
 
TAC: In lectures and articles you’ve written, you say high school athletes are an ignored group. Why?
TM: No one pays any attention to them. The family doc only sees them when they get strep throat. The pharmaceutical industry has increased their involvement with this age group, with conditions like ADD and ADHD, as well as asthma, allergies, and other specific conditions. Surgeons have very little use for this age group, and chiropractic has never learned how to market to this age group. So, in essence, no one is educating or taking care of this age group.
 
Orthodontists have created the model that we need to follow. They look at the alignment of the teeth, and we (chiropractors) should be the ones who look at the alignment and organization of the neuromusculoskeletal system. No one has come close to providing this service, and my goal is to find docs who can embrace my vision to provide this program to the schools in their communities.
 
maggs2TAC: How can examining and treating middle and high school athletes help our healthcare costs?
TM: With musculoskeletal being a trillion dollar a year industry, we must change the model of care within that industry. The current model is a reactive, symptom-based medical model. I cannot understand why many in our profession want to compete in this model. We need to become a proactive, biomechanically based model that begins with the younger age group. Just as the orthodontist works with adolescents, so must we. If we can get this age group aware of musculoskeletal, and aware of their unique musculoskeletal structures (Structural Fingerprint®), then we can more easily motivate them to fix and manage their musculoskeletal systems over their lifetime. This will allow people to stay active longer in their lives, reducing the secondary degenerative disease costs that come with obesity, diabetes, heart disease, arthritis, and others.
 
TAC: Can you explain sports biomechanics?
TM: Sports biomechanics is merely looking at the athlete as an architectural structure. Those who have attended my seminars and have read my articles have been introduced to Crooked Man. This graphic explains the unique biomechanical imbalances that all of us have, regardless of whether there are symptoms or not. By identifying these imbalances on an exam, we can visually educate the patient, which helps to motivate them to take action. The motivation goes up when we inform the patient that musculoskeletal is the leading cause of disability in this country for people age 50 and over. We tell them they must do things differently if they don’t want to end up a statistic.
 
Sports biomechanics also creates a new methodology for caring for the athlete. Proper care can only occur when we know where we’re starting from, and provide the necessary care and education for that athlete over their lifetime.The evidence-based approach, encouraged by the insurance industry, is a major contributor to the overall problem. The goal with evidence-based practitioners is to provide an inadequate exam (no x-rays) and less treatment. This, to me, is the definition of incompetence as a healthcare provider. Any great leader, regardless of the issue at hand, has known that success comes with long-term vision, not short-term vision. We cannot concern ourselves only with immediate symptoms and costs. We must look at the correction of the cause, and we can do that if we focus on the biomechanical model of care.
 
TAC: What is a Structural Fingerprint® exam?
TM: This exam was developed after spending much time in the strength department of both the New York Giants and the Chicago Bulls. I watched how these two top strength coaches evaluated their players, and then redesigned my exam to be more biomechanically practical. Once I did this, it didn’t matter if the patient had symptoms or not. I now could take a 14-year-old boy who runs, has no symptoms, nor has he ever had symptoms, and get a quantifiable measurement of his biomechanics. Many of the norms we use come directly from my education at National College, as well as from Dr. Yochum’s book.
 
The exam includes a digital foot scan, foot exam, knee exam, joint mobility tests, trigger point testing, leg length testing, some orthopedic tests, center of gravity testing, and four standing x-rays, two of the neck and two of the low back.
 
TAC: What recommendations might you give from these exam findings?
TM: We’ve learned a lot over the years. The first thing you must address are any symptoms the patient may have, whether they be shin splints, Osgood-Schlatters, low back pain, etc. That’s what people primarily care for. Our office is set up to provide the absolute best acute injury care possible. We include cold laser therapy, kinesio taping, chiropractic care, nutritional supplements, percussion, and strict management of the patient through this phase. We also provide spinal decompression when indicated. Once the athlete is no longer acute, we then begin our corrective phase, which includes custom orthotics, the power plate, the Tri-Flex, and other specific rehab modalities. The key is, for most of these young athletes, our initial program will last one year. Many docs fail to admit that true biomechanical correction, like physical conditioning, takes this amount of time.
 
TAC: How do parents receive your requirement for x-rays as part of this exam, especially if the athlete is not symptomatic?
TM: In all my years, and we’ve now examined well over 700 kids in the past eight years, only one parent has requested to not x-ray his child. Ironically, he was a chiropractor. And ironically, his son, who suffered with a chronic hamstring injury, had an avulsion fracture of the ischial tuberosity, with major biomechanical faults. 
 
maggs3The standing x-ray, in my opinion, is the most important test when determining the biomechanics of a human being. To ever suggest that the x-ray only should be considered when you suspect pathology is both ignorant and destructive to the well-being of humanity. Looking at the athlete as an architectural structure, the x-ray provides the details of the corrective treatments needed for maximum improvement. Athletes need visual evidence to become motivated to take the action required, and there is no visual proof greater than the x-ray.
 
TAC: Give us an idea of what your office is like (space, modalities, staff, etc.).
TM: I work in 1200 square feet, with three treatment rooms, two decompression rooms, an exam/x-ray room, and a power plate room. I have three cold lasers, three vibercussors, an adjusting tool, and a digital foot scanner. Our waiting room has an alkaline water system for all patients to use as they desire. Many come with bottles at each visit and fill them for home use. We encourage this. We have a nutritionist come into our office once a month to consult one-on-one with five patients per month. This has dramatically increased our nutritional supplement sales. I have five support staff members who are the best any office could hope for.
 
TAC: What are your ultimate goals with your involvement with Christian Brothers Academy of Albany?
TM: My goal is for this approach to become the model used nationally for all docs interested in working with middle and high school athletes. I want to show those in charge at CBA that they are visionaries and leaders and that their decision to bring me in could dramatically help change the industry as we know it. At my seminars, when I ask who works with high schools, I’ve never come across a doc who works with them and gets paid for it. That’s a crime. Our profession should become the most important provider to this age group, and this age group can become the generation that did things differently in order to help fix our healthcare crisis.
 
I see every community in the country where a chiropractor is the most sought after provider taking full care of this critically valuable segment of our society. That’s my goal. It’s that simple.
 
Dr. Maggs travels the country teaching his Structural Management® Program. He’s also the author of a new book, Fixing the Healthcare Crisis: An affordable, proactive and sustainable plan we can hand down to our kids. Dr. Maggs can be reached at [email protected]
 

Changing Times: Interview with Gary Tarola, DC, DABCO

Dr. Tarola earned a BA degree from Marshall University, 1973 and was a Suma Cum Laude graduate of Palmer College of Chiropractic, 1976. He began private practice in Fogelsville, Lehigh Valley, Pa. in 1976. He obtained Diplomate status in Chiropractic Orthopedics in 1983. He was a post graduate faculty member of several chiropractic colleges. From the late 1980’s through 2005, he lectured extensively across the country on various orthopedic topics and case management protocols. 
 
tarolaDr. Tarola served as president and chairman of the board of the Pennsylvania Chiropractic Society (PCS). He received Chiropractor of the Year award from the PCS and Senatorial Proclamation of Accomplishments from the Pennsylvania State Senate.  
 
He was a consultant to the formulation of the Guidelines for Chiropractic Quality Assurance and Practice Parameters and the Council on Chiropractic Guidelines and Practice Parameters. Dr. Tarola has published numerous articles in peer reviewed journals and contributed to chapters in volumes two and three of the text, Principles and Practice of Chiropractic. 
 
In 2006, Dr. Tarola relocated his practice to the hospital campus of Lehigh Valley Health Network (LVHN), Allentown, PA.  His practice was acquired by Lehigh Valley Physician Group (LVPG), a division of LVHN in May 2012.  Twenty years ago, an idea such as this would have seemed outside the realm of possibility, however today, it appears as one of the potential future realities for  a chiropractor entering practice.  Read what Dr. Tarola had to say in this one on one with The American Chiropractor Magazine, when we discussed his story.
 
TAC: What kind of practice did you have? Was it a pain-based practice? Was it a wellness type clinic?
 
Tarola: My practice was and is a fairly typical chiropractic practice. We primarily see patients with back, neck and headache disorders. But we also treat patients with extremity disorders of all types. Both me and my associate have diplomats in Orthopedics and focus on orthopedic conditions. We have seven additional dedicated staff members. The practice sees over 300 patient visits per week with 50-60 new patients per month, most of which are medical referrals. All the staff was hired by LVPG and we still function as we did prior to acquisition. 
 
TAC: What kind of techniques would you use in your practice? Are there any specific or general types?
 
Tarola: We use fairly standard chiropractic techniques including various forms of high velocity adjusting and mobilization techniques, drop-table techniques, distraction therapy, pelvic-blocking and myofascial therapy including instrument assisted techniques, and of course exercise instruction. We do a limited amount of nutritional counseling. We use various modalities on a relatively limited basis, including ultrasound, electrical stimulation, and mechanical traction. Most importantly, we communicate with our patients to make sure they understand their condition, have reasonable expectations of recovery and a plan if they do not respond as expected. And we educate them on prevention and lifestyle measures. 
 
TAC: How did the health network approach you? And what was it about your clinic that made them interested in acquiring it as an asset?
 
Tarola: I’ve had very good relationships with the medical community in my area for over 25 years. Over the last 10 to 12 years, a prominent spine surgeon, tarola2pain management physician and I have been discussing the concept of a multi-specialty spine program. Because of the health network’s prominent role in serving our community, we decided a number of years ago that it would probably be best to initiate this program through the network.

The idea sat idle for a time and then six years ago it resurfaced and I was enticed to move onto the main hospital campus in preparation for the development of this spine program. I relocated there, but maintained an independent practice. I joined the hospital staff to create this multi-specialty spine program. Once again it was put on hold.
 
About two years ago, the health network formally accepted the concept of a spine center, decided to fund it, and we began meeting on a regular basis to develop the program. The team included select members of the neurosurgery practice, the pain-management practice, two physiatrists, me and my practice associates, and numerous administrators. We formulated a process, with evidence focused clinical pathways and algorithms, similar to other spine programs such as Texas Back Institute and Jordan Hospital. It was formalized and kicked off in February of this year. At that point, the health network asked me to consider joining. This concept was advocated by many of the medical providers and some administrators I’ve worked with over the years. That’s how those discussions began, in terms of melding my practice into the network. Then through negotiations we turned the concept into a reality.
 
TAC: It sounds like the relationship has been very cordial and professional?  Would you say that that’s been your experience, that they’ve valued your expertise?
 
Tarola: No question. My input to the spine program was equal to all others involved. Their approach to me and my practice during the negotiation and acquiring phases was the same and equal to their approach to any other medical practice that has come on board over the years. LVPG includes both primary and specialty practices. The network includes almost 1,000 beds at three hospitalsites, a Level I trauma center, a children’s hospital and numerous outpatient clinics. So it’s a very large and complex organization. But yes, they were professional and equitable.  
 
TAC: Great. What was it that you had done, or have done, throughout that helped you establish your credibility to the hospital? 

Tarola:Competency in clinical practice, making appropriate referrals and proper communication. It’s important for us as chiropractors to understand our strengths and weaknesses, and the strengths and weaknesses of all other providers that treat the same or similar conditions. All providers have certain things that they do well, certain patients that respond well to their care, and we all have limitations. 
 
TAC: Absolutely.
 
tarola3Tarola: It’s important to be able to communicate with all providers on their level, and with confidence. To make it known that you know what you can do and can’t do, you know what their potential is and what their limitations are, and you communicate that in a professional, matter of fact sort of way. They develop an element of respect, then trust and referrals start coming your way. I would say that’s largely how my reputation developed in my community. And then it spreads; it sort of snowballs. Providers talk to other providers.
 
There are a lot of medical providers that would like to refer patients to chiropractors; they just don’t know whom they can trust for their patients. Many of our patients are also patients of other medical providers, and discuss their experiences. If they get the perception that there was excess or prolonged treatment, inappropriate treatment and unwillingness to communicate, their view of that DC will be tainted.
 
TAC: How do you establish the limitations of chiropractic care or the care that you give to your patients? How do you demonstrate those limitations to someone that may question you? 
 
Tarola: Through education, scientific evidence and experience. Response to treatment becomes quite clear to those that pay attention to their own clinical outcomes. The history and physical examination usually provide enough information to determine if a patient is a candidate for the type of treatment we offer. Evidence tells us that if our treatment is going to be effective, we should see a reasonable response within a rather short period. Some studies indicate effectiveness can be predicted after the 1st or 2nd treatment. If our treatment is the best option, we suggest a short trial, 2 to 3 weeks, but also inform them of other viable options, and they decide. If the patient has clinical characteristics that suggest another provider or another form of treatment would be more effective under the circumstances, we inform the patient and initiate the referral. It is important however to know what forms of treatments are available to address the patients immediate needs, and which providers in your community are most proficient at providing those services.
 
Making appropriate referrals to the appropriate providers at the appropriate times builds a level of trust in those providers that you have the competence to know not only when and who you should treat, but when and whom they should treat. All providers prefer to see patients they will have success with. Referring only difficult cases or patients that have been therapeutically exhausted will not be appreciated or engender trust.
 
Our practice approaches become known to the people and providers in the community. We are not islands anymore. The patients we see also see other providers, primary care docs as well as specialists. These providers take histories, and patients will reveal their experience with their chiropractor. If they present a history that sounds questionable in terms of the condition the DC was treating, the amount or duration of treatment they received, the kinds of recommendations that were made, a reputation can develop. That kind of information sticks.
 
TAC: Dr. Tarola, do you send them there with a report, or would you communicate that with the physician that you’re referring them to via phone? Do you communicate at all with that doctor? Or just arrange the appointment?
 
Tarola: Early on in practice, I would always telephone them and follow up with a report confirming the information that I addressed on the telephone. I tarola4would discuss my assessment of the patient’s condition, treatment provided to that point if any and results of same, why I’m referring and for what, i.e.; evaluation only or evaluation and treatment, and what kind of treatment I felt was appropriate. For those who might want to position themselves similarly, I think you have to start out that way. It’s necessary to communicate as much as possible, make sure the communication is proper, appropriate, and that the terminology used is germane to all healthcare providers. Avoid using chiropractic jargon that no one else would understand. 

I would also always indicate if I intend to continue to follow the patient and manage the patient’s case during and/or after they see the patient. And there was almost never a problem with that, providing it was reasonable and appropriate for the patient.  I would never just transfer patients to medical providers unless I felt I had nothing further to offer. I would always make sure that they knew that I knew what the patient had, that I knew the treatment I could provide and how that would benefit the patient, and that I knew the treatment they could provide and how that would benefit the patient. Nowadays, although I still often communicate in this fashion, my relationship with most providers is such that a referral form is adequate.
 
TAC: During the first, 15 years, when you were doing a lot more of this, you were sharing research that you were acquiring with your medical providers on the benefits of chiropractic, as well as acknowledging the value that they represent. Would that be accurate?
 
Tarola: Yes, and still do. Any viable, valid research—on manipulation, or on something germane to their [medical providers] specialty—I forward new published articles or guidelines documents  that pertain to spinal surgery, different types of surgical procedures, surgical rates, pain-management, rehab and other data—whether the research is favorable or unfavorable to their specialty or to mine. It’s important to be objective. I would send a short cover letter and say, “I don’t know if you saw this. I thought it would be of interest to you,” and maybe add some of my own thoughts on the material. 
 
TAC: How, in your opinion, can your experience with your health network affiliation translate into national success for doctors of chiropractic?
 
Tarola: I certainly hope that it can serve as somewhat of a model for other chiropractors that have, or are developing these kinds of relationships. It would be my hope that this will be an impetus for other institutions to consider this type of integration. Chiropractic has evolved from a point of isolation 20 years ago and prior, to a point of acceptance, where a good percentage of the medical community and the general public understand the value of our services, and want to integrate these services. In my community, most of our orthopedic groups now have employed chiropractors. Now the largest healthcare organization in the Lehigh Valley has actually acquired a chiropractic practice, which as far as I know, is a national first. There are a number of chiropractors who are on staff or employed at various hospitals, but I am unaware of another one that has actually acquired a practice.
 
TAC: I haven’t heard of another, so I think you’re right on that. Now, do you see a change in the chiropractors you see coming out versus those chiropractors that may have been around for the last 40 years? How do you see chiropractors differently? 
 
Tarola: There is a definite shift to an evidence focused approach to practice. Our educational institutions are emphasizing it more and more. Third party payers are essentially requiring it for participation. And there is a plethora of evidence on the things we do most that can’t be ignored. 
 
TAC: On Pubmed, Google, Medline, the research journals...
 
Tarola: Everywhere. But I’m concerned that some of our higher institutions are still not training our students adequately enough to develop a scientific mindset. When I say scientific, that does not suggest that our practice be limited to published research. Evidence-based does not mean evidence-only. Much of what all providers do has limited supporting evidence. Evidence-based practice combines the integration of individual clinical expertise, provider experience and patient preferences with the best available evidence. 
 
TAC: Do you feel that chiropractic’s future is tied to integrative services such as this?
 
Tarola: Absolutely. It is becoming more and more difficult to survive as a solo practitioner or small group. Third-party payer and government policies and processes make it attractive to be part of a larger institution or group that has some negotiating power. And these institutions are recognizing that they have to offer all available services to stay competitive.
 
TAC: How would you suggest that other chiropractors position themselves to take advantage of or create these opportunities? You may have already covered this, but to sum it up.
 

Here again however, being integrated into a larger group or institution that has influence and negotiating power might help to mitigate the effect of these trends.

Tarola: Develop an expert knowledge base of and demonstrate competence in clinical practice. Study the pertinent literature. Understand our strengths and limitations and that of all other providers that treat the same patients we see. Practice professionally and ethically. Avoid incorporating questionable business processes and therapeutic procedures. Communicate in a logical, professional manner and do it as often as possible. Always look for opportunities where you can communicate with local providers and health care leaders.
 
TAC: With your current perspective, do you have any thoughts on the changing landscape of national healthcare? How that may affect chiropractors and their roles in patient management? Any perspective on that at all? 
 
Tarola: Even the hospital institutions don’t know how they will be affected by the new healthcare policies. If chiropractors are included in the process, we’ll have to adapt to the process. It’s pretty clear however, that the trend is more outside oversight. And this is occurring for all providers including hospitals. More and more therapeutic and diagnostic procedures require precertification. That trend is likely to continue. Limitations on treatment frequency, duration and methods will continue to be imposed. Here again however, being integrated into a larger group or institution that has influence and negotiating power might help to mitigate the effect of these trends.
 
Direct your comment or inquiries to : [email protected]
 

Chiropractic as Primary Care for the Spine: The Paradigm Has Changed – Interview with William Owens, DC, DAAMLP

Dr. William Owens has been in practice for 15 years in Buffalo, New York.  He has  a practice that focuses on the care and triage of the traumatically injured.  Early on in his career, Dr. Owens had the opportunity to help build two hospital-based chiropractic clinics: one of which allowed chiropractors to become credentialed as medical staff as opposed to allied health professionals, and the other being housed in the rehabilitation department at a level-one trauma center. He is  President of the American Academy of Medical Legal Professionals and the Director of the Academy of Chiropractic’s MD Referral Program, which among other things credentials doctors of chiropractic to present lectures approved for Category I AMA continuing medical education credit for medical providers.
 
owensdcIn an interview with Dr. Cory Littman, Dr. Owens shares some of the ways that he is helping medical doctors collaborate with chiropractic as a first line option for spinal related problems. Dr. Owens is creating the paradigm shift where the Primary Care Medical Physician coming out of Medical Residency has accepted chiropractic doctors as primary care for everything spine.
 
Dr. Cory Littman: You have started the first chiropractic elective in a medical residency program in the country.  This is not part of a complementary medicine or integrated medicine initiative; this is with regular family practice residents. Can you expand on this a little? 
Dr. Owens: Sure, the chiropractic elective is the first of its kind in the nation and is part of the elective rotation for the family practice residents at the State University of New York at Buffalo School of Medicine and Biomedical Sciences.  The residents, as part of their program, have the opportunity to shadow me in my practice during regular patient hours.
 
Dr. Cory Littman: How do you talk “chiropractic” with residents?
Dr. Owens: First, I want to mention that a chiropractor’s curriculum vitae (CV) is a very important part of building relationships.  This is your professional story and shows your level of expertise and credibility.  This is where the “rubber meets the road.”  The MD is most concerned with your ability to handle complex cases and not miss anything. They are not as interested in technique as your diagnosis skills, so when I start the conversation, we talk about the tough cases that I have managed.  I like to discuss disc herniation, central stenosis, claudication and post-surgical care.
 
When I have the Medical Resident in my office and there is an interesting case of ligamentous instability or a large central herniation, I sit and review the MRI with them. I always put myself in a position of teacher, but I also ask a ton of questions.  That is how I learn, too.  I try to learn as much about the medical-education model as possible. That only helps me to reach out to local treating MDs because now I know how they think. 
 
When the MD and I talk chiropractic, I split it into two very simple sections.  First, there is the simple biomechanical lesions side: we provide specific chiropractic adjustment to the area of fixation to break adhesions, increase white blood cell proliferation, reset the muscle spindle reflex and circulate synovial fluid.  I tell them those are generally the patients that we see the least.  I then discuss the patients that I may see for the rest of their lives for chronic pain management.  They understand pain, so that is where I start.  I discuss stimulation of the central nervous system and how we can modulate pain at that level without drugs or surgery.  I show them that these are patients not unlike those that they prescribe blood pressure medicine or diabetic medicine to for the rest of their lives.  We are not curing them; we are managing them.  The cool thing is they get to see firsthand the difference between a specific segmental chiropractic adjustment versus one that is generalized for maximum central nervous system stimulation.  
 

I discuss stimulation of the central nervous system and how we can modulate pain at that level without drugs or surgery.

Their eyes always seem to get larger with an aggressive adjustment, even more so when the patient stands up and says, “Oh, my God, thank you so much. I feel so much better!”  That creates a very visceral understanding in the medical resident about what we do.

Dr. Cory Littman: What is the most interesting thing a Medical Resident has said to you?
Dr. Owens:The most interesting thing came from the very first Medical Resident that I had in my office, and when I asked him why he was here, he said, “For a few reasons.  First,” he said, “I want to see your physical exam, and second I want to see how your patients react to your treatment.”  That was pretty profound to me because that represented the most fundamental aspects of the doctor/patient relationship.  All the bells and whistles we try to hold onto and all the fancy techniques we spend thousands of hours learning, and that was what he wanted to see. Interestingly enough, he said at that end of that first day, “Wow, that is a pretty in-depth examination, I never expected that you would have been that thorough.”   Regarding the doctor/patient relationship, he said, “I cannot believe how many of your patients said thank you, and many felt comfortable hugging you. I have never experienced that before. That is amazing.” 
 
Dr. Cory Littman: How do the Medical Residents see chiropractic fitting into their practices?
Dr. Owens: The residents have many concerns about managing chronic conditions. After all, they are the most time consuming, costly and difficult to manage in a primary care office. Those conditions are the big three: cardiovascular disease, diabetes and musculoskeletal conditions. The musculoskeletal patients essentially clog up the flow and disrupt their day.  Imagine the primary medical doctor walking into a treatment room to check on a blood-pressure reading, and the patient says to the primary doctor, “I hurt my back last night, and my right leg is giving out and numb.”  That is commonplace for us but throws a real monkey wrench into their day.  They are looking for qualified professionals to be able to be the portal of entry for those patients.
 
owensdc2Dr. Cory Littman: You mentioned something in one of our earlier conversations that I feel is important to bring up here. You said, “Nowhere in their training, medical school or residency are primary care medical doctors instructed to refer musculoskeletal conditions to physical therapy only.”  Can you expand on that for the readers?
Dr. Owens: Yes, that is a great point.  When I have conversations with the Medical Residents, I ask as many questions as possible to learn from them. Since musculoskeletal conditions are so common and have been such a burden on the healthcare system, I was interested to learn what they as primary care family physicians are taught to do when that patient walks into their office.   I was always under the impression that they were instructed to “send to physical therapy” first.  That turns out, at least in my experience, to not be true at all.  In most cases the Medical Resident asks the attending what to do.  My point is that they are being taught to, when needed, refer to the most qualified, conservative care provider.  That may be a physical therapist; it may be chiropractic or others.  How you position yourself and how you can help them relieve the burden is the important part. Providing them with research on chiropractic care is a very big step in this process.  I should also point out that the Medical Residents really see chiropractic as different than any other profession.  That is the reason in the past that they were reluctant to refer, and it is the reason when they are educated that they refer and refer often.
 
Dr. Cory Littman: Why are the Medical Residents so interested in research? 
Dr. Owens: Great question. Readers have to understand that published, peer-reviewed, indexed research is what protects patients from crazy and potentially dangerous treatments, directs the path of future discoveries and protects against malpractice claims.  In basic terms, if there is no research to show that a treatment is a standard part of the daily management of these conditions, the MD runs the risk of being sued should something go wrong. They will not refer for untested treatment, which in the past has really hurt chiropractic. Our academic institutions are publishing more and more research on the clinical and cost effectiveness of chiropractic. That is why we are enjoying more referrals from the medical community.  That is how we are gaining access to the 93-97% of the nation that has not experienced chiropractic care.  That is how chiropractic will thrive and secure our future. 
 
Dr. Cory Littman: What do you have on the horizon?
Dr. Owens:  I’ve been invited to lecture to the second-year medical student in December on the chiropractic perspective on the management of chronic spine pain.  I will be there with a physiatrist and an MD that practices acupuncture.  The point that I made prior to be being invited to speak was that I would like to address the concerns and questions the Medical Residents have on conservative spine care while they are in still medical school.  It seems that it would be much more effective for these concepts to be introduced early on in their education as opposed to six months before board certification.   We need to shed some more light on the fact that musculoskeletal conditions are often the number-one reason a person will see their family doctor, and what they are doing with those patients now is clearly not as effective as it could or should be with chiropractic as a first-line referrer.  There are plenty of places to get drugs and surgery but only one place to have a provider with the education and skill to handle any conservative spine care case.   We are different, and that is our strength if presented in a truthful and educationally centered manner.

I will tell you that I did review my statistics over the last six months, and 90% of my new patients have never been examined or treated by a doctor of chiropractic.

 
Dr. Cory Littman: Looking into your crystal ball and based on your experience, how do you see chiropractic and medicine working together into the future?
Dr. Owens: In my experience, the Medical Residents that I work with have a genuine curiosity about chiropractic that certainly starts out as skepticism.  Their understanding about chiropractic as both a science and an art is based on me teaching and them learning.  I focus on current scientific terminology, current research and case studies; that is the only way.  I envision every chiropractor presenting continuing medical education to the MDs in their community to share our successes and create an open dialogue.  I think it is critical that chiropractors be willing to learn from the MDs in their communities as well.  A relationship is a two-way street, and everyone loves to teach.  Allow the MD to teach you some things, and you will be surprised how quickly you can build a relationship.
 
Dr. Cory Littman: How has this affected your practice?
Dr. Owens: This has had a profound effect on me as a doctor, as a chiropractor and as a part of a larger and expanding healthcare community.  I will tell you that I did review my statistics over the last six months, and 90% of my new patients have never been examined or treated by a doctor of chiropractic. My compliance is as good as it gets because their MD told them to see me, and I am spreading chiropractic outcomes to the medical community. That is important because many DCs are not as successful as they could be because they are all competing for the now 4.12% of the population that is looking for a chiropractor.  I want to clarify, though, chiropractors do not have to start a chiropractic elective to enjoy referrals; all they have to do is reach out and build relationships with the local medical community.  Teach and be open to being taught; it is that simple.

William J. Owens, DC, DAAMLP, runs the first chiropractic elective rotation for primary care medical providers at the State University of New York at Buffalo, School of Medicine and Biomedical Sciences.

Dr. Cory Littman is a 1997 graduate of National College of Chiropractic.(National University of Health Sciences). He is currently chairman of the medical documentation committee of the American Academy of Medical Legal Professionals. He maintains a private practice in Lockport, NY  where he focuses on treating families and traumatically injured patients. He can be reached at dr.corylittma[at]gmail.com

Interview with Jeff Rockwell, DC of Manual Neuroscience Methods®

Dr. Jeff Rockwell, DC is a chiropractor, bodyworker and somatic educator, with a passionate interest in the neuroscience of manual therapy.  A pioneer in the use of instrumentation in neuromuscular therapy, Rockwell has been a popular teacher on the seminar circuit for the past twenty years. Professor of Clinical Sciences at Parker University for many years, he is the author and producer of numerous manuals, books, and DVDs on neuromuscular therapy and somatic education, and he is a member of the Continuing Education faculty for Parker University. Dr. Rockwell can be reached at www.manualneuroscience.com, touchinghealth[at]aol.com or 831-713-8885.
 
manualneurosciencemethodsKOCH:  Jeff, I must tell you that I have been studying your DVDs and am very impressed with your work.  The ease, with which you present your material and your knowledge of the details of the anatomy of the entire musculoskeletal system, makes it very easy and enjoyable to watch, understand and apply.
 
ROCKWELL:  Thanks, Bill, . I love and live this stuff.  I am always studying, learning, refining and changing what I do as new information and scientific data comes along.
 
KOCH:  That is the essence of being a professional. It is the reason that we say that we are “in practice.”  We are never a finished product.  If we are not evolving, learning and improving, we are static, stagnant and intellectually dying.
 
ROCKWELL:  I totally agree. We are living in an incredible time. Information is coming at us so fast that it is challenging to keep up.  It is very exciting!
 
KOCH:  It certainly is.  One of the things that I find so exciting, as well as rewarding, is that every new scientific finding validates our vitalistic philosophy.  It is like a beautiful jigsaw puzzle that is taking shape. Science is finally able to give us the technical reasons for what we have instinctively known for decades.
 
ROCKWELL: Yes, the great thing is that so much is applicable to our everyday care of our patients. It has allowed me to refine my technique by taking advantage of the latest research, especially in neuroscience.

KOCH: Very interesting, I have always said that chiropractic is not about bones and muscles; it is about the brain and nervous system.  If it is not about that, it is a lot ado about nothing. Chiropractic is all about neurology, if you are doing it right.
 
So please tell me about the neurological aspects of what you do because it looks like soft-tissue work.
 
ROCKWELL:  I  know it does, but looks can be deceiving.  It isn’t about soft tissue.  It is all about the nervous system and the understanding of how and why it works the way it does.  That has given us a whole new insight into how best to access it and work with it more effectively than ever before.
 
KOCH: Okay, you have my attention. So how does what appears to be treating soft tissue take on neurological implications?
 
ROCKWELL: This really is exciting stuff because it brings together some of what we already know academically but positions it where it makes functional sense.
 
Here is what I am talking about: When we were in chiropractic school, we studied embryology. We learned that the brain and nervous system developed from the ectoderm layer of germinal tissue. We also learned that the skin was also of ectodermal origin. Right?
 
KOCH: Absolutely, I always found that curious.  What is the significance?
 
ROCKWELL: The implications are huge, Bill.  Neuroscience is making discoveries that are dramatically expanding our understanding of how the nervous system works and carries energy and information to every cell of the body. 

KOCH: We have known for a long time that the nervous system experiences and records everything holographically throughout the entire body.  Is this what you are talking about?
 
ROCKWELL:  Exactly!  And I will talk about that in a minute, but I don’t want to get ahead of myself. Let’s talk about the skin.  It is not an accident that it is ectodermal, like the nervous system.  The skin is, in fact, an extension or an end organ of the brain.
 
KOCH:  I see, just like the olfactory bulb, optic nerves and eyes are extensions of the brain stem.
 
ROCKWELL: You got it.  It is the same thing.  Now, think about this:  There are six yards of mechanoreceptors under every square inch of skin.
 
KOCH: That’s impressive. Talk about a tight network.  No wonder the skin is so sensitive.
 
ROCKWELL: You can think of the skin as the most accessible part of the nervous system.  We know that the largest population of mechanoceptors lies just below the surface of the skin in the superficial fascia.
 
KOCH:  I am glad you mentioned that.  I found your discussion of the fascia particularly interesting when I was studying your instructional DVDs.  I would really like to hear more about it.  I will just tell you that when you spoke of the fascia as being a semiconductor with a crystalline nature, you really got my attention, because I  know that it would not only make it capable of conducting energy, but also capable of generating a piezo electric charge when subjected to deformation.
 
ROCKWELL: Okay Bill, since you obviously understand the importance of this, let me take it further.
 
I recently attended the Fascia Research Conference.  It only meets every three years, each time in a different country. This time it was in Vancouver; the previous one was in Amsterdam.
 
KOCH: I’ve never even heard of this group. Were there many chiropractors there?
 
ROCKWELL: No, chiropractic was not well represented. It’s really too bad because they presented some really great information that is very relevant to us.
 
KOCH: Great, tell me about it.
 
ROCKWELL: I am going to give you a trail of breadcrumbs to follow. You are going to love this, Bill, because it explains so much.
 
You will recall that in school when we learned about proprioceptors, the only ones they spoke about were the Pacinian, Ruffini and Meisner’s corpuscles.  Later, we began hearing terms like mechanoreceptor and nociceptor, right?

KOCH: Sure, nociceptors being the ones registering pain and mechanoreceptors noting mechanical changes in tissues or joints.
 
ROCKWELL: Yes, that’s how we have thought of it–up until now.  The latest thinking is that nociceptors are in reality more like danger receptors.  They not only register pain, but they even alert us to potential danger, such as an unpleasant person or even a situation that doesn’t seem to be “quite right.”
 
KOCH: I see what you mean: like an indefinable thing that causes the hair on the back of your neck to stand up; that intuitive sense that is more quantum than triggered by one of the six senses.
 
ROCKWELL: Right, something that you know but can’t quite put your finger on why or how you do [know]. Wild, isn’t it?
 
KOCH: Yeah. At the risk of sounding like I’m stuck in the 1970s: “Far out!”
 
ROCKWELL: I want to tell you more about the mechanoreceptors and, specifically, the nociceptors. Stimulation of the mechanoreceptors affects neuroplastic changes in the brain.  Now here is the really interesting part.  At the Fascia Research Conference, we learned that high-velocity thrusts, as in the P-A thrust of the typical adjustment, affect the higher centers of the brain, causing neuroplastic changes that last only 20 seconds.  However, very light tangential forces cause positive neuroplastic changes in the brain that last 20 minutes.
 
KOCH: So light forces create more positive, long-lasting changes in the brain than do heavier ones.  That sure is counterintuitive.
 
ROCKWELL: The way it works is that the Ruffini corpuscles are slow to respond but continue to buzz and stimulate the brain for about 20 minutes, as opposed to the Pacinian corpuscles that only fire for 20 seconds.  It is naturally easier to piggyback on 20 minutes than 20 seconds of brain imprinting.
 
KOCH: What you are saying is that the mechanoreceptors do not like strong compressive forces but are most responsive to tangential forces.  Would that be as you show in your DVDs when you use the Therapy Edge™ attachment on a VibraCussor®?
 
ROCKWELL: That is exactly what I am doing. That’s why Ed Miller at Impac, Inc. designed that attachment.

KOCH: I have a Therapy Edge™, but when I first got it, I was not crazy about it. That is because I didn’t understand how to use it.  I started getting used to it only after watching how you use it.  Now that I understand the neurophysiology behind it, I have to keep reminding myself to go lightly.  It just requires a little retraining for an old full-contact chiropractor like me.
 
ROCKWELL: I like to explain it this way, Bill, we have all learned to speak to the body in “mesoderm-ese.”  That is, we have been used to working on muscle and skeletal structures, which come from the mesoderm layer of embryonic tissue.

Now we find that in many instances, the body would rather be spoken to in “ectoderm-ese.”  It’s like another language that the brain understands better and is more responsive to.  It makes sense because the tissues we are working on are of ectodermal origin.
 
KOCH: This might be a silly comparison, but if you speak to a child in a soft voice, you will most likely get a better response than if you constantly yell at him.
 
ROCKWELL: I don’t think it’s silly at all.  I think it’s a good comparison.  It is all about imprinting the brain. 
 
KOCH: Jeff, what you are talking about is a new paradigm in neurology.
 
ROCKWELL: It certainly is a new paradigm: A different understanding of how the nervous system works. Think about this.  Nerves under pressure or tensile stress become hypoxic.  Pain isn’t just reporting on that stress, it is a cry for movement to get the microcirculation of blood around the nerves going.
 
KOCH:  I can’t argue with that logic. It is the nerves’ way of saying that they are starving and gasping for breath.
 

ROCKWELL: This is why we all have a type of reflex behavior known as pandiculation.  You know it as the urge to stretch and yawn.  It is another way in which the body causes us to move instinctively.
 
KOCH: That makes sense.  We see that in our pets.  Dogs and cats stretch and yawn all the time.  It is an instinctive activity that keeps these naturally active predatory animals strong and supple in a much more sedentary lifestyle than they would have in the wild.  It is also why the practice of yoga is so beneficial to us.
 
ROCKWELL:  Speaking of blood flow, we all know that the cerebellum modulates muscular coordination, but we recently learned that it controls the distribution of blood to all of the organs of the body.
 
KOCH: Wow! That is huge.  It explains why even a mild level of cerebellar ataxia is so devastating to the whole body. 
 
I have seen a number of cerebellar ataxias through the years and have had good results with them.  I currently have two young women in my practice who have Fredrick’s ataxia, a genetic form that is only passed on if both parents have the gene.  
 
Both have benefited greatly by chiropractic.  While there is no cure, I have been able to slow the progressive deterioration that people with it normally experience.  It also explains why I have been successful in improving the circulation to their extremities. I’ll bet that I will do even better when I speak to their bodies in “ectoderm-ese”.
 
ROCKWELL: Bill, you obviously get all of this, so I am sure you will agree with another paradigm shift.
 
It is for us to move away from being an operator to an inter-actor.  An operator, in the way a surgeon operates on a patient, is purely allopathic.  It is something that the patient submits to in faith.  When we work with our patients as an inter-actor, it is a joint, cooperative effort.
 
KOCH:  I agree with that.  It is symbiotic and much better aligned to our vitalistic approach to healthcare.
 
ROCKWELL: That’s it, Bill.  I believe that it is the direction we need to go as a profession.
 
KOCH:  There is no doubt in my mind that you are correct.  It is the right message for our time.  Healthcare as we have known it is changing as we speak.  Now more than ever it is important for people to be proactive and informed in order not to be victimized by the medical industrial complex which is already rationing care based on cost effectiveness, not patient needs.
 
Those of us who practice interactively with our patients will be well positioned to be the natural choice in healthcare for those who are sophisticated and smart enough to seek our services.
 
ROCKWELL: Amen to that.  We are on the same page.
 
KOCH: Thanks Jeff.  I really enjoyed this conversation and certainly learned a lot.
 
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 http://DrWilliamHKoch.com and Chiropractic the Superior Alternative and the newly published Conversations with Chiropractic Technique Masters (available at Amazon.com).  He may be contacted at outislandd[at]hotmail.com.

Defining Food Enzyme Nutrition: An Interview with Howard Loomis, DC

Howard F. Loomis, Jr., DC has been the leader in the clinical application of plant enzymes and is the person responsible for bringing food enzyme nutrition to the forefront of the health care field.  After graduating from Logan Chiropractic College in 1967, he entered practice in Missouri and practiced there for 26 years. 
 
loomisenzymeIn 1980, he was introduced to the work of Dr. Edward Howell, M.D. and his Food Enzyme Concept in his books, Enzymes for Health and Longevity and Enzyme Nutrition. It changed the entire focus of Dr. Loomis’ practice. 
 
In 1985, after years of work on the clinical application of plant enzymes, Dr. Loomis founded 21st Century Nutrition (now known as the Loomis Institute™ of Enzyme Nutrition) for the sole purpose of educating other health professionals on the use of plant enzymes. 
 
He has lectured extensively at various chiropractic colleges as well as chiropractic state associations. He currently writes columns in several recognized chiropractic journals and other publications. 
 
Dr. Loomis practiced continuously until the end of 1993, when he sold his practice, retired, and moved to Madison, Wisconsin to develop his own enzyme supplement company, Enzyme Formulations, Inc. 
 
In 2002, the Loomis Institute™ was approved by the State of Wisconsin as an educational institution, a relationship that continues today. 
 
In 2007 he joined with his alma mater to create the 72-hour Internal Health Specialist Certification Program for the Logan College Postgraduate Department. This program is open to chiropractors as well as chiropractic students who have reached their 7th trimester. Thousands of health care practitioners around the world rely on the education and products developed by Dr. Loomis for their clinical success and fulfillment.
 
TAC:  What kind of products and services do you offer chiropractors?
Dr. Loomis: The Loomis Institute teaches chiropractors an objective and scientifically valid system of physical examination for determining nutritional need, as well as the best information available about food enzymes and how to use them in practice. 

Enzyme Formulations, Inc. offers food enzyme and herbal supplements based on specific individual patient need, not on a one-size-fits-all concept.  

TAC: Tell us more in depth about the services and products you offer chiropractors and how or why you offer them.
Dr. Loomis: Because of the success we enjoy as a company, we are able to provide unprecedented clinical support to the practitioners who attend our seminars, free of charge. This has always been something I would have found helpful when I was in practice, and I am happy to be able to offer it now. For example, if a chiropractor has a question about how to use a product or what to recommend with a specific set of clinical results (24-hour urinalysis, case history, and/or physical exam findings), they have access to an experienced chiropractor on staff who will guide them through the process of recommending a specific plan for that individual patient. 
 
TAC: Are chiropractors the only professionals that use your methods for their patients?
Dr. Loomis: No. While the Logan Internal Health Specialist Certification Program is offered specifically for chiropractors to utilize their unique education, the Loomis Institute seminars train many different modalities of health professionals in the use of food enzymes.
 
TAC: How many practitioners have learned the  Loomis System?
Dr. Loomis: Over 1000 health care professionals have learned the Loomis System and are successfully incorporating it into their practices.
 
TAC: How did you get interested in enzyme therapy and the effect enzymes have on the body?
Dr. Loomis:My interest was in understanding why, when there is no history of injury, some people develop back problems and others do not. Was there a nutritional component? I could never find the clinical parameters that would allow me to say “this person needs calcium, this one needs magnesium, that one needs calcium  AND magnesium, or that one needs better protein digestion.” At the time, I was convinced there was no objective means of using nutritional supplements. It seemed would be a nutritional component because the body’s ability to digest and assimilate protein (and consequently improve its ability to carry calcium and other nutrients to the tissues) is very important. It has been my experience that most people who have symptoms of musculoskeletal dysfunction, such as osteoporosis, herniated discs, bursitis, leg cramps, and many more problems, do not readily digest protein. However, by 1979 I had given up trying to apply the objective measurements of physical examination, blood and urine testing to the practice of nutritional supplements, having failed to find consistent results.

 
loomisenzyme2In 1980, I was fortunate to be introduced to the work of Edward Howell, M.D. and his “Food Enzyme Concept.” After reading his two books, Enzymes for Health and Longevity and Enzyme Nutrition, I was convinced that he had found the missing link for providing consistent results in clinical nutrition.
 
Dr. Howell had graduated from the University of Illinois medical school in 1919, the year before the first vitamin was discovered. After graduation he practiced at the Lindlahr Institute in Chicago, which was the Mayo Clinic of his day. They specialized in the treatment of chronic degenerative disease using a system of fasting and raw food diets. This was in a time period prior to the discovery of insulin, and diabetes was the major degenerative disease. Cancer was not as readily diagnosed as it is today, and diabetes was the number one killer.
 
Dr. Howell was impressed with the results obtained with raw foods and fasting and he struggled to find an explanation. He became convinced that there had to be something else in food besides protein, carbohydrates, fat, vitamins and minerals. This led to his eventual fascination with the enzymes found normally in food and the role they played in pre-digestion before stomach acid can be produced.

In the early 1980s I made trips to Ft. Myers, Florida and spent time with Dr. Howell in his home. He allowed me access to his accumulated notes, including his extensive bibliography for Enzymes for Health and Longevity. He was very gracious in sharing his time and information with me and he completely changed my attitude about nutrition and the importance of enzymes. Gaining permission to copy many of his accumulated notes and bibliography was incredibly valuable since they were destroyed when he died in the late 1980s.
 
 
TAC: What type(s) of diagnostic testing procedures do you use and why?
Dr. Loomis: We utilize a Case History and review of systems physical examination with chiropractic postural and spinal evaluations, coupled with range of motion tests. When needed, we order blood tests and 24-hour urinalysis testing. We place emphasis on determining the causes of a patient’s symptoms and the stress responsible for them. Using this procedure is time-honored in the healing arts and stands up to legal as well as scientific scrutiny. It also makes it possible to develop a specific, science-based plan for each patient.
 
TAC: How has the evolving understanding of stress points affected current approaches to teaching this type of therapy?
Dr. Loomis: In our seminars, we ask the class, “Who in this class considers themselves to be average?” Of course we never get a positive response. My point is this: nutrition is often practiced as is pharmacology, using a bell curve to determine what and how much of a particular supplement the average person needs instead of treating each body individually. The Loomis System uses palpation of muscle contraction (stress points) to determine when visceral dysfunction is responsible for a patient’s symptoms and is causing and perpetuating structural misalignments and subluxations. In other words, once the cause is known, the treatment becomes obvious.
 
The beauty of the stress points is that they are objective. They are either positive or not. Paired with the 24-hour urinalysis and our case history form, a very clear, individualized plan of treatment is evident. Chiropractors do not need to guess anymore when it comes to nutrition.

TAC: What types of conditions/patients respond best to this approach to care?
Dr. Loomis: Those who respond best are those whom I call the “walking wounded.” People who have not been diagnosed with a disease, but still suffer with unresolved symptoms. These people are desperate for help, and they are so grateful when someone finds the cause of their symptoms. Their quality of life improves dramatically.
 
TAC: It’s been said by some experts that one can get all the nutritional products they need from eating a balanced diet. What do you say when someone tells you this?
Dr. Loomis: That is true only if you can digest that well-balanced diet. And who decides what the best diet for your specific needs is? Does one size truly fit all? I have noticed that no one in the healing arts specializes in restoring normal digestive function and, if it fails, what compensates for inadequate digestion? Only the immune system. That is why this work fits so perfectly within the chiropractic paradigm for health restoration and maintenance!
 
The reality is that naturally occurring food enzymes are removed from much of our food supply, and taking digestive enzymes replaces the enzymes that belong in the food to begin with. I do not advocate taking multiple supplements. In fact, in our seminars we focus on improving the diet first, then making sure that diet is properly digested. If these two factors are working well, then multiple supplements are not necessary. 
 
loomisenzyme3TAC:  What type of chiropractor/chiropractic practice fits best with this paradigm?
Dr. Loomis: Because of their educational perspective and unique training in palpation and adjusting, all chiropractors are well-prepared for this type of analytical approach. We do not offer a specific chiropractic technique. This nutritional system is a perfect adjunct to any type of chiropractic office.
 
TAC: How do you see nutritional supplementation changing in the future? 
Dr. Loomis: The answer to that question lies with the pharmaceutical industry. They and the Food and Drug Administration will determine that. However, I have always believed that eventually food enzymes and improved digestion will surface as the key nutritional component.
 
One thing is certain, food enzymes will not go away and they cannot be patented. That is why I have endeavored to bring this work into the mainstream chiropractic education and place our profession at the forefront of health maintenance.
 
TAC: Where do you see the future of chiropractic headed?
Dr. Loomis: Hopefully the profession will find its way and fulfill its promise as it was envisioned by D. D. Palmer.
 
TAC: Any final words for our readers?
Dr. Loomis: Illegitimatis Non Carborundum.
 
You may contact Dr. Loomis at [email protected] or 1-800-662-2630.