Archive for March, 2013

Who needs a Paradigm Shift?

Thursday, March 21st, 2013

Paradigm shift is an often heard phrase in chiropractic motivational circles – and as a profession we have been waiting for the community to have the necessary paradigm shift to comprehend and gravitate towards our vitalistic healing services. But what if it is us that need the paradigm shift?

We beat up on the medical profession and quote the growing body of evidence of harm produced by pharmacy and surgery. We beat up on the common man as though he is too simple to understand that a spinal adjustment can release his inborn healing potential. But even if these two scenarios are true – can we change them? Can you make someone else have a paradigm shift? Will a research paper convert the medical profession to refer each and every inpatient to our rooms instead? Will a better spinal health care class transform the average Jo into a compliant, new patient referring machine? If we could just get our educational brochure to say what we really want it to say, then the world will finally notice us? Maybe a glossy TV advertising campaign will convert the masses…

If chiropractic is the answer that many of us think it is – and I’m not talking about curing cancer, turning HIV+ to HIV-, blind seeing, lame walking and deaf hearing: I’m talking about the ability of chiropractic adjustments to improve quality of life – regardless of the ailment. Haven’t we been around long enough for others to notice this is happening? Maybe not enough have seen what we see because:

1) It isn’t happening – maybe the clinical benefits from adjustments aren’t as big as we would hope?? Maybe only a small percentage of adjustments release innate intelligence – If so, is this a failing of chiropractic or of chiropractors? I am a huge fan of objective functional assessments and progress exams, but in my long involvement with professional development I have noticed that few in our profession truly share this obsession. Most want a tool that converts sceptics to long term practice members – few want to have their therapeutic effectiveness or lack thereof exposed and measured. I have to be honest that I have needed to make some significant shifts in the way I do things to find ways to more consistently and significantly improve function – and I am still looking for better ways.

2) It is happening but we don’t have the evidence to show anyone else. I am bamboozled by members of our profession that desire to limit our scope of practice to musculoskeletal pain on the basis that there isn’t any evidence to support any wider claims. I wonder how you can adjust large numbers of people and not see internal physiological improvements of some sort – surely at least one asthmatic, bed-wetter, parkinsonian, multiple sclerotic, migrainous, immune deficient would have returned to their office and thanked them for the help? Maybe not? But I think that this alludes to a wider challenge – how do we SEE the changes that our adjustments deliver? Can an Xray do it, CAT scan, MRI, blood test? My fantasy is that we will develop the skill and acumen to decipher which body function tests best measure the most important changes that occur in someone who receives regular chiropractic care. I’m a bit disappointed with our scientific and academic community that this hasn’t already been achieved: I don’t think the oswestry questionnaire is the answer…

3) It is happening, and we have the evidence, but we can’t get the message out. There’s a neuroscience to marketing – and I don’t think we use it – in fact to a degree we are forbidden to use it. I’ve never been fully able to find the words or images that convey the message that I want my surrounding community to perceive and comprehend. I’m still looking for the perfect imagery that encompasses a subluxation – and it is definitely not the one with two vertebrae pinching against each other and shrivelling the spinal nerve. And I scratch my head as to how McDonalds, Coca-Cola and other life threatening products succeed where I fail. But I do know that if you tell the wrong story then you will be misunderstood – I don’t think that anyone will expect improved quality and quantity of life from visiting a profession that promotes themselves as the spinal care experts.

Paradigm shifts birth from A-Ha moments: Someone looks at why and how they do things and all of a sudden sees a problem, but more than that, they envision a different way of thinking, being and doing: The thought that a circle could be turned into transport, electricity into light, sound transmitted along wires or through the air etc etc. So what is the paradigm shift awaiting chiropractic?

We have this concept that spinal dysfunction leads to nerve dysfunction. And regardless of our technique, practice management style, straight or narrow, type o or type m etc – the language of chiropractic tends to centre back to this one concept. And we claim that this is a vitalistic concept – it’s not – it is a mechanistic concept!

IF we are vitalistic then we need to practice with model, theory and technique that are also vitalistic. Let me illustrate what I believe was a paradigm shift in my own chiropractic world. We say that a Subluxation is a mechanical lesion which can interfere with the transmission of something in the nervous system (Let’s not argue today about whether that something is intelligence, mental impulse, action potentials, neuropeptides, type c fibres, proprioceptors – Whatever). What if the mechanical lesion is not the cause – what if it is merely a symptom of what’s really going on? It’s not a huge paradigm shift in terms of language but what if a Subluxation is a neurological lesion first and foremost? What we see and intervene against is a manifestation of this disturbed neurological state. Hence our intervention does not necessarily have to be mechanical as is required by the former model – but it does need to be “neurological”.

How else can we describe the variation in adjustment vectors, forces and contact points all having similar therapeutic outcomes: Without regressing to the placebo copout that is. Many have tried to win the argument of which technique is best on biomechanical grounds, but maybe that misses the active ingredient? How often have we seen in the nutritional product world where they try to extract the active ingredient only to find that they have lost something magic in the process?

Stop for a moment and allow your mind to stretch around the idea that the Subluxation is a neurological pattern – an altered state of frequency that may manifest with tightening muscles, reducing range of motion, and amended flow of neuropetides – but the underlying state is at least electrical and perhaps more accurately energetic. When you read this, do you have this internal mental tension attempting to bring it back to the fact there must be a mechanical explanation – if you do then you are not ready for the paradigm shift quite yet.

I’ve been teaching vitalistic, neurological, tonal chiropractic for roughly eight years now and I have observed the furrowing of the chiropractic brow when I present the idea that we can forget the mechanical component of the Subluxation altogether and still be a Chiropractor: DD Palmer predicted that we would find better ways of doing things. But I often have Chiropractors approach me during the refreshment breaks asking “you’re not really serious are you”?

Let me put it another way – we have a public image problem, and a professional image problem. The public has trouble comprehending how a “bone out of place” can produce anything but a sore back bone. And the other health care professions doubt that spinal dysfunction can cause anything but mechanical back pain. And we have to go through this long-winded process of trying to explain spinal anatomy to connect the dots between a vertebra and the immune system, or an organ or even the brain.

What if you just skip the vertebra part of the explanation? If you talk in terms of nervous system only you will observe some different A-Ha experiences occurring in your practice members. As soon as you mention a bone or a muscle their minds will get stuck there and they won’t hear anything else you say. If you hear this statement– “so it’s just a muscle” or “so something is out” – then the chance of new communication has ended.

Here is a challenge for the next two weeks in practice: Do not mention a single bone or muscle. Make all of your conversations about nerves. It’s not easy for most chiropractors and the temptation to take the easy path will be strong. Don’t talk about pinched nerves – that’s a mechanistic concept. Use words like tone, tune, tension, frequency, vibration, electricity, energy, balance, harmony, spinal cord, spinal nerves.

Use illustrations like guitars and pianos being tuned, electricity flowing through the body, fuse-boxes with blown fuses, switchboards with switches in the off position, radios or televisions tuned to the wrong frequency/channel or with volume switches turned up or down too far. Talk about the nervous system and how it controls and regulates every cell in everybody – but avoid the need to then talk about spinal bones – instead talk about the flow of information around the body and how there can be blockages – and how your specialty is to locate and reduce those blockages.

Here’s what you may discover – your practice members stop asking you about whether this will help their sore neck or back, instead they will ask about the internal functions that need help. You see – they innately know that the nervous system controls and regulates every cell in every body. And they innately know that the spinal bones don’t control and regulate every cell in every body. Heresy you say? Paradigm shift I say…

Now give yourself permission to attend a Torque Release Technique Seminar to complete the shift to a vitalistic and neurological adjusting system – one that DD himself aspired to. Check the details of the next TRT Seminar at this link: www.torquerelease.com.au/Torque-Release-Discount.htm

Yours for better health and better chiropractic
Dr Nick Hodgson, 2005 Victorian Chiropractor of the Year

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Every Case a Case Study

Thursday, March 14th, 2013

Some time ago I set myself a goal to write up case studies based on the positive results that have I seen in my practice. Like every Chiropractor I get excited when I hear of life changing turnarounds in a wide range of health complaints. And not always because that person first consulted me with “Condition X” – they may come to me with the garden variety neck and back ailments. But then weeks later the person shares their story of healing and improved quality of life since starting to see me.

Well you might say I have opened a can of worms because the reality of “writing up” has been daunting: A clear history, examination findings and having some sort of outcome measure in place so that after those weeks of adjustments you can say for real that signs and symptoms have diminished – the objective before and after as opposed to the testimonial. And then there is the challenge of writing up an introduction and discussion of the condition in question – requires literature research and time.

So retrospectively I began to dig out files of my fondest case memories and quickly discovered that I did not have much more to go on than a testimonial. Child was a bed wetter – now they aren’t, teenager had reduced asthma medications and number and severity of attacks but no actual numbers to go along with those subjective observations, person who attended for low back pain and was then able to become pregnant after being adjusted (why didn’t they tell me they were infertile when they presented?), a parent stating that their child’s ADHD had significantly improved but now I have the challenge of finding out of their academic and social performance has improved – where to start?

I had been haunted by the words of an “old-timer” chiropractor at a Dynamic Growth Congress years before. He asserted that you “never ask your patients how they are – you tell them!” How do you do that? Now I know that we get to know our practice member’s bodies and that we can to a degree sense where they are at – but that intuition wasn’t quite enough for me – I wanted tools to measure where someone was in their functional journey. I’ve never been a dedicated user of Xrays and biomechanical lines and would always prefer non-invasive technologies so I began searching. The first purchase I made somewhere in the mid-nineties was software to analyse posture (www.torquerelease.com.au/Posture-Pro-Software.htm) and to come up with some objective calculations – cool tool and patients love the before and after pictures – a win-win. Back then this type of software cost thousands. This was in the days when computers were like old-age pensioners – took half the morning to warm up, and then didn’t do much after lunch. And we had to buy excessively expensive cameras that had a removable floppy disc – remember what those were? I envy today’s chiropractors who can pick up the latest version of this software for less than a grand, and download and install it on their high-speed notebook, and already have the camera that connects wirelessly.

Next I took out a five-year lease to get my hands on an Insight Subluxation Station (www.subluxation.net.au) and discovered that surface EMG, thermography and inclinometry were awesome tools for me to see if I was making the physiological changes that I hoped my adjustments produced. Boy was this confronting as I was forced along a pathway of finding better ways to deliver better adjustments and advice. I think we Chiropractors have had it too easy for too long because the only quality assurance that we have had to answer to is customer satisfaction. I remember one of my associate Chiropractors who was notorious for bypassing initial and progress exams, who when confronted stated that he didn’t see the point in using the measurements when they didn’t change! I guess my conclusion had been different as my revelation was that maybe I had to find the best ways for making positive changes – After all if a spine isn’t better aligned, more flexible and surrounded by less muscle tension after a series of adjustments, then what has been the actual benefit of those adjustments?

My next revelation was that I needed better outcome measures in my practice for a range of health concerns: If someone consults me and they suffer with migraines then I need to be able to demonstrate that the improvements in the sEMG, posture, thermography and range of motion are matched by measurable improvements in the regularity and severity of the signs and symptoms of migraine – sounds simple – just visit outcomemeasures.? to download the free tools I hoped? Not! My fantasy was a file of severity questionnaires that could be accessed depending on the name of the presenting dis-ease. So I contacted the academics and was told that such standardized and validated tools did exist. Next step was to find them… Still looking! Here’s the problem – they all have different completion and rating systems, most aren’t free or at least accessible, and regardless of whether they are scientifically validated few have been designed by chiropractors, for chiropractic – what is the point of a headache questionnaire that lacks a question about neck pain or dysfunction, or a low back questionnaire that fails to note any associated gastrointestinal or genitourinary signs? Since this time I have been gradually authoring my own range of health questionnaires – as I encountered a different health syndrome in practice, I would spend hours researching and then listing the “top twenty” associated signs and symptoms which would then be pasted into my template – each having exactly the same rating and format (www.torquerelease.com.au/Health-Questionnaires.htm) . Now these aren’t validated research tools but I love them for the power that they offer in terms of being able to take a subjective snapshot in time.

Nowadays I am in a newer practice and while designing my new systems I spent numerous hours (internet) searching for the best outcome tools out there: They had to be affordable, simple to use, and easy for the practice member to comprehend. After much shopping I combined Posture Pro, with digital photographic range of motion analysis software, Heart Rate Variability (www.torquerelease.com.au/emWave.htm) , along with the Torque Release Technique Indicators of Subluxation Scoring System that I had developed, and my Health Outcomes Questionnaires. Now I present my practice members with what I call their Spinal Functional Age (SFA) and Self-Perceived Health Age (SPHA).

The next barrier was in getting humans to follow the plan. I realised that my chances of producing legitimate case studies retrospectively were small. I needed to have a prospective plan: When Master Bedwetter, or Miss Asthma, or Mr Parkinsons or Mrs Multiple Sclerosis arrives at my rooms then I need the procedures in place so that I have sufficient pre-examination findings. Next challenge is to achieve sufficient compliance with care that will result in the types of positive changes we aspire to. And step three is to conduct a progress examination that supplies the “evidence” that I crave which is going to look good in ink.

What I am trying to say here is that my initial urge to write up a simple case study that is of some value to the evidence-base has actually sent me on a path of research and development that I like to think is making me a better Chiropractor.

Have you ever watched an episode of Geoffrey Robertson’s Hypothetical? This famous legal shark draws together a diverse cross section of “experts” and then forces them through a hypothetical case scenario that pushes the ethical, moral and human boundaries. Entertaining and usually enlightening viewing. To a point I believe it is valuable to apply this principle in our practice development pathway.

So, how does MY hypothetical influence YOUR life in practice? Ask yourself these questions:

1) Is your initial intake process thorough and objective enough that you could present clear evidence of what it is you are setting out to change for that person?

2) Do you have objective measurement tools to demonstrate how much this person’s functional status needs to change and whether you will have been able to initiate a change in their health concern?

3) Do you conduct a progress or review exam to measure whether you are achieving your shared goals?

4) Have you had the guts to put your technique to the objective litmus test across your entire practice population and not just your favourite miracle cases?

5) Do you have enough evidence to contribute a Case Study for the advancement of the Chiropractic Evidence Base?

When I present the stats from my own practice I show the average functional changes that occur and share the journey I have had to follow to ensure that I consistently generate significant objective improvements. At one seminar a Chiropractor pulled me aside during a refreshment break, and with a concerned look on his face stated that the changes I had documented were not very BIG. “Oh really” I said “how big are the changes that you are seeing?” “Well I don’t know” he said “but I know that they would be better than yours”. I almost envy his delusions of grandeur, but the reality is if you don’t know for sure, then you don’t know! My own research based on the functional tools that I currently prefer, suggest that one adjustment reduces someone’s functional age by one year. I personally think that is very significant – name any other healing method that can make someone one year younger in one visit?

To find out more about the next Torque Release Technique Seminar visit: www.torquerelease.com.au/Torque-Release-Discount.htm

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The Secret to Building the Practice of Your Dreams

Monday, March 4th, 2013

Could you sum up all the secrets to success in practice and perhaps even life in two words? I think I can… And I am going to tell you on this page, without the need for you to subscribe to my free e-report, or register to a cheap tele-seminar, or commit to twelve months of direct debited coaching: Instead you are going to receive 100% free, unconditional wisdom!

Here is the first word – but before I tell you I’d like to introduce you to my life changing program: Just kidding – The word is “Relationships”. Everything you do in life and the outcomes of your thoughts, beliefs and behaviours comes down to this one complex biochemistry term.

Invest time and energy into healthy relationships in any domain of life and you will achieve success in that area. Ignore, abuse or neglect this facet of life and I guarantee that any success will be short-lived, hollow and most likely lonely.

Now I am not just talking about human relationships here – this principle can be applied to EVERYTHING!

Let’s break this down first – to a microscopic level. Would your DNA, RNA and enzymes function if the relationships between the C, N, O & H are incoherent? You could have a soup of the individual atoms, or even nucleotides, but unless the relationships between the components are aligned then organic chaos will prevail.

On a human level health and wellbeing depends upon healthy relationships between every single cell. To understand this in technical terms one should spend time researching the topics of Tensegrity (see tensegrity-and-chiropractic/) and Neural Holography (see holographic-brain-model-and-chiropractic/) . As chiropractors we have simplified this down to the model that the central nervous system controls and regulates every cell in every body. To claim this requires greater understanding beyond action potentials and perhaps our pioneers were closest to the truth when coining the term “mental impulse”.

Now I know some vocal contemporary chiropractic academics dismiss the mental impulse as nonsense, but these same authors fail to supply a modus operandi for chiropractic beyond pain transmission and a shallow hypothesis that stimulating proprioceptors inhibits C fibres, and that’s that. This may be an accurate small picture, but as always there is a bigger picture – and an even bigger idea.

Within a family, relationship is pivotal –when relationships break down, families decay. And we could continue to illustrate the vitality of relationships within groups, organisations, cultures and populations. Let’s face it crime and war are the most pathological manifestations of relationship breakdown.

Which brings us to the second foundational word for success in all things = “Communication”. Relationships only work when communication flows. Relationships are like the structure and communication the function. Why would RNA be so important to human existence? Because it communicates the message stored in DNA. Why do we dare to claim that the nervous system is the most important system of the body? Because it is the means of communication in the human body – afferent and efferent. Relationships within a family are only sustained by communication. Why do entertainers get paid such ridiculous wages? Because they are perceived to be the masters of communication…

Now let’s bring this into the realms of chiropractic practice.

At our most prehistoric level we propose the importance of the relationship between adjacent vertebrae, and how the disruption of these relationships leads to at least pain and perhaps also bodily dysfunction. And the relationship between adjacent vertebrae hinges upon communication – Biofeedback between neighbours that enables coordinated alignment and movement.

Many use Xrays to analyse and demonstrate these relationships between neighbouring bones, but a more instantaneous and non-invasive assessment tool is postural analysis. The downside of postural analysis is that if you lack technology to measure and record postural relationships your assessment will be too subjective to mean much: But when in ownership of technology that objectively illustrates the breakdown in postural relationships a chiropractor possesses a tool that can be meaningful to his clinical decision making, a practice member’s comprehension of need for care and progress under care, and has the added bonus of being able to demonstrate clinical necessity and efficacy to a third party (see Posture-Pro-Software.htm) .

Posture is the most global expression of relationship and communication in a person – why would someone carry their head which weighs as much as a bowling ball more than two inches in front of their shoulders when this uses more energy and creates more stress on all the supporting structures? Because of breakdown in relationship between the head and the torso, and an obvious disconnect in communication about where that person’s head is located in space. Why would someone carry their head too far forwards – because they don’t know it is there!

Healthy relationships between human cells, tissues and organs depend on this same dance between relationship and communication. And chiropractic knows better than every other healing profession that this all flows up and down via the central nervous system. Jay holder describes chiropractic as “communication through touch”. When we are analysing someone’s spinal and neural state we are asking the person’s body pertinent questions – “where do you want to be adjusted and how?” That is if you have ownership of a technique that teaches you these questions – if not then you must be imposing some external recipe of when and how to adjust.

And then your adjustment needs to be healing communication – “a correctional vector with intent” – are you adjusting each person in the way that their body is giving permission to be adjusted, or are you imposing your will on the baddest, stiffest, crookedest bone or joints? (See Torque-Release-Discount.htm) I hope that you possess the technical skills that give you clear communication from a person’s spinal column about where the vertebral relationships have become disconnected and the best approach to communicate the need for adjustment to that person’s nervous system.

Now look at the person from a wider view and if you can comprehend the definition of Subluxation as a “separation from wholeness” – then you will start to see how breakdown in the relationships within the Cranio-Spinal-Meningeal-Functional-Unit results in interference with communication within the central nervous system which will include disorders in pain, emotion, coordination and regulation. And suddenly the intent of each adjustment you deliver takes on wider and deeper implications for the individual and the community that surrounds them.

Then the other side of the formula are the human relationships and communication that either build or shrink your practice numbers. The only problem that I have with scripts in practice management is that they are usually uni-directional and that reeks of relationship deficiency and communication minimisation: The only scripts I endorse are questions – relationship builders and communication initiators. Take a look at your own scripts and see if there is some way that you can rephrase them as questions.

I can sense some of you cringing at this point – “if I ask my practice member’s a question I don’t have time to stand around waiting to hear the answer.” Here is my advice to you – be very good at hiring great team members – team members who will compensate for your own inability to build deeper relationships, and nurture meaningful communication! Sounds harsh but could be the best advice I could ever give to you?

Now what are the symptoms in your practice that you need some adjustments to your relationships and communication?

1) Insufficient new patients – The Universe will supply you as many new patients as you have the capacity to develop relationships and communication pathways with. If you want more new patients, before you invest huge amounts of money into a marketing campaign, investigate how you can increase your capacity to initiate a relationship and effectively communicate with a larger patient base.

2) Poor patient retention – If people are dropping out of care prematurely then it is time to investigate your ability to maintain ongoing relationships and to keep communication pathways open. As soon as a practice member smells any degree of disinterest or misunderstanding between you, they will leave. The skills of developing a lasting clinical relationship are not the same as those needed to maintain a long lasting romantic relationship so don’t make the mistake of thinking that I am suggesting you have to become everybody’s best friend.

3) Poor team morale or high staff turnover – If your staff aren’t especially happy to be at work, or they leave for something better not long after you have finished training them then you may need to work to build better relationships and communication within your team.

I understand that this piece may be sounding hypothetical or at least metaphorical but I hope that you can contemplate the applicability and simplicity of these two concepts – Relationship and Communication. And if you are willing to invest some time to brainstorm this in your own life circles I believe you will find a holistic way of prioritising your energies. For example – your technique – take a look and review of your “treatment” system is improving relationships and communication in your practice members’ bodies? And do you have the means to determine that you are achieving this? And are your team members aligned in their procedures to maximise relationship and communication within your office? And when you finally leave your office are you investing adequate time and energy into all the other key relationships in your own body and community?

Here are some concepts to explore…

  • So what is the role of an initial consultation = to build a relationship.
  • What is the role of an initial examination = to determine the relationship and communication status in that individual’s biology.
  • What is the role of the report of findings = to communicate your perception of the state of their body’s relationships and communication, and express how you believe you can help them improve these.
  • What is the role of your care = to improve the person’s spinal relationships and communication via their central nervous system.
  • What is the role of an office CA = to support and enhance the human relationship and communication within the office and to facilitate the practice member’s compliance with the agreed program of care.
  • What is the role of a technical CA = to support and enhance the human and clinical relationship and communication within the treatment room/s and to facilitate the practice member’s participation with the agreed program of care.
  • What is the role of a progress exam = to review the level of success of the agreed plan, to celebrate positive progress and in the case of null or negative progress to amend the understanding of the relationships and communication.
  • What is the role of an office educational process = to maximise communication, deepen relationships and to encourage and facilitate the best possible program of care.
  • What is the role of an office procedural manual = to clearly communicate the methods utilised to perfect the development of win-win relationships between team members and towards practice members.

When I teach a Torque Release Technique Program one of my intents is to improve each clinician’s ability and intuition to perceive the state of relationship and communication within each practice member’s nervous system –I like to think of it a conscious intuition… Find out more about the next TRT program at www.torquerelease.com.au/Torque-Release-Discount.htm

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