Posts Tagged ‘Adjusting’

EFFECTS OF CHIROPRACTIC ADJUSTMENTS ON CD4 COUNTS OF HIV POSITIVE PATIENTS

Monday, December 15th, 2008

The researchers sought to demonstrate that upper cervical specific adjustments would have a positive effect on the physiology, serology and immunology of HIV positive individuals.

Tests were performed on the patients by an independent medical center. The CD4 counts in the regular group were dramatically increased over the counts of the control group. A 48% increase in CD4 cells was demonstrated over the six month duration of the study for the adjusted group.

This paper analyses the efficacy of upper cervical chiropractic care for HIV positive patients.

A small randomised, controlled clinical trial was carried out on two patient groups, each with 5 patients. The regular adjusted group was given upper cervical adjustments to the atlas using the Laney instrument, and for the control group a placebo adjustment was carried out by placing the stylus on the patients’ mastoid process with the instrument emitting no force.

The results are quite remarkable. In summary, the control group experienced a 7.96% decrease in CD4 cell levels and the adjusted group experienced a 48% increase in CD4 cell levels. It would be desirable to carry out follow up studies with far larger groups in an attempt to establish both a link between the nervous system, immune system and upper cervical region.

Click On This Link To Read More About This Research At Upper Cervical Spine…

Super Healthy Tip…

I have seen a diverse number of research papers and case studies over the years which consistently illustrate improvements in immune function when chiropractic adjustments are received. My fairly black and white brain looks at it this way – chiropractic adjustments kick start the immune system. In my own practice if someone rings to cancel their appointment because they’ve “got the flu” – we try to insist that they keep their appointment – and repeatedly we have seen much quicker recoveries in the people who keep their appointments, than the ones who we are still ringing two weeks later to see if they are up to an appointment yet.

But how can this be – someone adjusting your spinal column – improving your immunity?

Consider the following:

  1. Your spinal column houses your central nervous system
  2. Direct nerve connections to immune system tissues have now been isolated
  3. Many of the chemicals of communication found in rich deposits in the spinal cord, have receptor sites on many of the types of white blood cells – so even without direct nerve connections there must be a chemical communication process between the two systems
  4. The key to a healthy immune response is dependent on the recognition and reaction to invading microbes – not only do the white blood cells that encounter a microbe need to know about it – they need to tell all the other white blood cells too – this needs a fully functional communication network – we know this as the nervous system
  5. Malfunction in the spinal column could interfere with this communication network, and correction of this malfunction would therefore restore the network

GUIDELINES FOR CLINICAL GUIDELINES?

Sunday, November 2nd, 2008

There seems to be a progressively increasing number of practice guidelines appearing on the horizon for Chiropractors. If enough of these are generated could it get to the point that depending on whom a Chiropractor is dealing with, they will need to behave and practice in a chameleon-like fashion – what’s good for one patient, may be very different to what is good for another – depending on which guideline oversees that person’s situation?

Some of these guidelines appear to be less like best practice guidelines and more like agenda-based guidelines.

Most recently the Chiropractors Registration Board of Victoria has crossed over a boundary not previously entered into, and that is into the arena of clinical practice guidelines (http://www.chiroreg.vic.gov.au/comment.php). This is being justified on the basis that they act to protect the public against unethical chiropractice – but once reviewed against the standard of everyday chiropractic one might ask who will protect the chiropractor from the public and other third parties?

And if many established and widespread chiropractic practices such as X-raying for biomechanical assessment, use of physiological assessments such as surface EMG, adjusting children and newborns, caring for people with non-musculoskeletal conditions, maintenance and even wellness adjustments are guidelined as fringe, questionable and even unacceptable behaviours, then will future chiropractic practice resemble the service that so many chiropractors have offered to their communities for over 100 years?

Most of these guidelines are presented under the umbrella of “evidence-based practice”: Evidence-based clinical practice is defined as “The conscientious, explicit, and judicious use of the current best evidence in making decisions about the care of individual patients… (it) is not restricted to randomized trials and meta-analyses. It involves tracking down the best external evidence with which to answer our clinical questions.” (Sackett DL. Editorial. Evidence Based Medicine. Spine 1998.)

However it appears that some guideline developers twist the definition of “best” – disqualifying research and publication, or evidence, which isn’t the “best” – that is, if it isn’t a randomised, placebo-controlled, longitudinal, multi-centred, independently peer reviewed, published in a journal which the expert panel subscribes to, then it ain’t “best” and therefore it doesn’t exist…

In fact “best evidence” means the best level of evidence that we can find and what it tells us… If we don’t have the gold standard evidence, then do we have silver, bronze and even minor placing evidence to review and interpret? It is no secret that not only is chiropractic not very amenable to controlled study for a plethora of reasons, but the bulk of our evidence exists in the realm of longitudinal outcome studies, case series, and case studies. If this is the “best evidence” what does it tell us – there can be no denying that they tell us that a massive diversity of health complaints present in chiropractors’ offices, and that positive changes seem to happen?

We can’t say that if 100 “Syndrome A” sufferers present to chiropractic offices tomorrow, what percentage of these people will receive some degree of improvement let alone a complete resolution. But based on the evidence wouldn’t it be fair to say that if a “Syndrome A” sufferer presents to your office tomorrow, that it would be rational to initiate a course of treatment with clear goals and terms for review? How does that seem inferior or unacceptable to any other health care profession’s plan of action? Even after the gold standard research measures that 45% of patients receive an average of 35% improvement, what can we guarantee Mrs Jones on Monday morning? A course of care with clear goals and terms for review…

“Well it might mean that they aren’t receiving necessary medical intervention and maybe they have some terminal condition and detection will be delayed by this unproven approach!” Welcome to the life of a health care consumer trying to deal with a “primary care practitioner” – maybe the medications that the MD would prescribe as an “alternative” to our care would be ineffective or even damaging; may mask or delay the identification of other pathology; and maybe it could take months and even years to get a correct diagnosis in the medical system anyway? Sound familiar?

The chiropractic profession is not alone in the struggle to produce relevant and applicable guidelines which guide best practice, as opposed to restricting practice. “The National Health and Medical Research Council (NHMRC – an Australian Government body) has statutory responsibilities to raise the standard of individual and public health throughout Australia and to foster the development of consistent health standards. As part of this role, the NHMRC encourages the development of evidence-based guidelines by expert bodies.” (NHMRC standards and procedures for externally developed guidelines, updated September 2007)

Is a health care profession’s registration board an example of such an “expert body”? A quick read of the profiles of members of the board suggests that there is not much representation of the chiropractic profession’s academic and scientific community. So has the board received significant funding to employ the services of such experts? Who would know – no names or qualifications of any contributors or peer review panel members are listed in any of the guidelines. The guideline which covers the issue of paediatric care is an exception: It gives thanks to a Medical Paediatrician and an American Chiropractor who also holds Medical Degree, who is a self proclaimed “Quackbuster” who deals with healthcare consumer protection, and is therefore about quackery, health fraud, chiropractic, and other forms of so-Called “Alternative” Medicine (“sCAM”): Is this our desired expert body?

“It is now widely recognised that guidelines should be based, where possible, on the systematic identification and synthesis of the best available scientific evidence. The NHMRC requirements for developing clinical practice guidelines are rigorous so as to ensure that this standard is upheld. As such, guidelines with NHMRC approval are recognised in Australia and internationally as representing best practice in health and medical knowledge and practice.”

I’ll leave it to the educated reader to review the current proposed guidelines based on the following information:

Key principles for developing guidelines:

The nine key principles are:

1. The guideline development and evaluation process should focus on outcomes: This statement shouldn’t be glossed over as it seems that some of the worst examples of guidelines are more interested in practice than outcomes.

2. The guidelines should be based on the best available evidence and include a statement concerning the strength of recommendations. Evidence can be graded according to its level, quality, relevance and strength; (Ideally, recommendations would be based on the highest level of evidence. However, it has been acknowledged that the levels of evidence used by the NHMRC for intervention studies are restrictive for guideline developers, especially where the areas of study do not lend themselves to randomised controlled trials. It is proposed that this issue will be addressed when the toolkit publications are reviewed.)

It is tradition when presenting scientific evidence, to cite the source of your evidence. The proposed guidelines of the Registration Board list no references, and request for such evidence is refused on the grounds of “intellectual property”. Does this mean that there is no evidence? Is it only some “expert’s” opinion? Or are there too many pages of citations to fit in the publication? Who would know?

3. The method used to synthesise the available evidence should be the strongest applicable;

4. The process of guideline development should be multidisciplinary and include consumers early in the development process. Involving a range of generalist and specialist clinicians, allied health professionals and experts in methodology and consumers has the potential to improve quality and continuity of care and assists in ensuring that the guidelines will be adopted;

The board’s approach is to implement this step as late as possible, input only being sort after the guidelines have been drafted; and if past guidelines are representative, additional input will only lead to minor amendments at best.

That’s also why it is best to employ a medical paediatrician and an overseas chiropractor to produce a guideline on chiropractic care for children in Victoria. Perhaps the Australian chiropractic paediatric specialists that abound and the university academia that are responsible for the undergraduate paediatric curriculum were out to lunch when the document was written?

5. Guidelines should be flexible and adaptable to varying local conditions;

6. Guidelines should consider resources and should incorporate an economic appraisal, which may assist in choosing between alternative treatments;

7. Guidelines are developed for dissemination and implementation with regard to their target audiences. Their dissemination should ensure that practitioners and consumers become aware of them and use them;

In the case of the guidelines being discussed here you can download them from the web-site – otherwise you can get someone else to download them from the web-site for you.

8. The implementation and impact of the guidelines should be evaluated; and

9. Guidelines should be updated regularly.

I look forward to the dissemination of the steps and process for implementation of steps 3 and 5 to 9 with our newest guidelines – don’t hold your breath.

So, if the Registration Board’s attempt to offer guidelines is severely flawed where can we turn?

Guidelines have been produced which would more likely live up to the standards of the NHRMC. The Council on Chiropractic Practice Clinical Practice Guideline (“CCP”) is currently undergoing its’ second revision. Following publication of the CCP Guidelines the document was submitted to the National Guideline Clearinghouse for consideration for inclusion. The NGC is sponsored by the U.S. Agency for Health Care Research and Quality and is in partnership with the American Medical Association and the American Association of Health Plans.

Its mission is as follows: “The NGC mission is to provide physicians, nurses, and other health professionals, health care providers, health plans, integrated delivery systems, purchasers and others an accessible mechanism for obtaining objective, detailed information on clinical practice guidelines and to further their dissemination, implementation and use.” In other words the US equivalency of the NHRMC.

The AHRQ contracts with ECRI, a nonprofit health services research agency, to perform the technical work for the NGC. ECRI is an international nonprofit health services research agency and a Collaborating Center of the World Health Organization.

In November of 1998, following review by ECRI, the CCP Guidelines were accepted for inclusion within the National Guideline Clearinghouse.

The CCP has developed practice guidelines for vertebral subluxation with the active participation of field doctors, consultants, seminar leaders, and technique experts. In addition, the Council has utilized the services of interdisciplinary experts in the Agency for Health Care Policy and Research (AHCPR), guidelines development, research design, literature review, law, clinical assessment, chiropractic education, and clinical chiropractic.

The Council additionally included consumer representatives at every stage of the process and had individuals participating from several major chiropractic political and research organizations, chiropractic colleges and several other major peer groups. The participants in the guidelines development process undertaken by the CCP and their areas of expertise are clearly disclosed.

The Guidelines offer ratings of practices based on the following system:

Established: Accepted as appropriate for use in chiropractic practice for the indications and applications stated.

Investigational: Further study is warranted. Evidence is equivocal, or insufficient to justify a rating of “established.”

Inappropriate: Insufficient favorable evidence exists to support the use of this procedure in chiropractic practice.

Categories of Evidence underpinning each rating are presented as:

E: Expert opinion based on clinical experience, basic science rationale, and/or individual case studies. Where appropriate, this category includes legal opinions.

L: Literature support in the form of reliability and validity studies, observational studies, “pre-post” studies, and/or multiple case studies. Where appropriate, this category includes case law.

C: Controlled studies including randomized and non-randomized clinical trials of acceptable quality.

To download the full version and updates of the CCP guidelines go to http://www.worldchiropracticalliance.org/

WHY ATTEND TORQUE RELEASE TECHNIQUE TRAINING?

Wednesday, February 6th, 2008

There are SO many chiropractic programs and techniques available to Chiropractors nowadays – Alphabet Soup you might say. For this reason it is imperative that each DC choose programs which are going to give them real value for their money. Nobody wants to attend a program which gives them one take-home strategy which they will use on one patient a week; or worse still leave the class and never implement a single aspect of the training. Below is my list of reasons to attend Torque Release Technique based on feedback from previous graduates of what changes the most in a DC’s life after attending a TRT program…

1) Better results with the majority of your patients – so many programs tell you that they are going to help you get better results with those “problem patients”. Isn’t it perplexing how we forget about the 80% that are getting good results and focus our minds on that 10% that isn’t responding: And we’ll spend big dollars attending a program that will help us get better results with the people who provide us with a small proportion of our income!! What if you could attend a program that will convert your good results to great results – imagine what will happen when 80% of your practice is getting better results?

2) Absolute certainty that you are adjusting the subluxation which most needs to be adjusted, at that moment in time, with the correct vectors and contacts – by contrast most other systems give you a list of possible subluxations, and then you either adjust all of them or make some subjective decision as to which ones you will adjust on that visit – and then there’s a bunch of systems that place no value or priority on what needs to be adjusted (if it pops then it must have needed it) – near enough is not good enough.

3) Increased retention – Because most other systems are linear and mechanistic they don’t adapt to the change that is happening: They see patient plateau at some point in the care program – plateau is the biggest enemy of retention – TRT is non-linear and vitalistic – in other words; the adjustments adapt and evolve as the patient’s nervous system goes through plastic changes – this means that patients keep getting significant changes after each adjustment – and excited patients stay and they refer.

4) Very quick analysis system that helps to cut down the number of adjustments needed each visit while still giving the best results – It IS possible to give someone a high quality adjustment in less than 2 minutes.

5) Less physical strain on the DC’s body – many DCs are paying a personal price physically and mentally due to how hard they are working to give their patients great adjustments – TRT is very easy physically and very orderly mentally – you get to the end of the day with energy still left over for your family and interests.

6) Every DC who has ever implemented TRT to some degree has increased their practice volume, while often reducing their working hours – TRT is very helpful for DCs wanting to practice high volume.

7) It is the first analysis and adjustment system to be totally neurologically based: The indicators we use are neurological indicators, the analysis system we utilise is neurological, and the Integrator adjustment is a neurological intervention.

8) It is the only system that breaks Chiropractic out of a mechanistic model: Most systems talk about the nervous system in terms of the outcomes, but then regress into biomechanical speak, assessment and intervention – “I’m a wellness Chiropractor and I straighten spines” – NOT! – a straight spine does not guarantee wellness – only improved neurological function guarantees wellness.

9) It is the only system that offers a completely vitalistic application of our vitalistic philosophy – totally congruent with the 33 principles and yet current with quantum science: Mechanism is not a subset of vitalism; it is a subset of reductionism. Vitalism requires a respect for the life, spirit, energy and intelligence of human existence – does your “treatment” release human potential, or does it impose your belief of what angle a cervical curve should be?

10) Increased understanding of the emotional component of subluxation – how emotions contributes to subluxation – how subluxation impacts on the emotional component of the nervous system – and most DCs see bigger changes in patients emotional states when they use TRT.

11) Totally congruent with WELLNESS practice – many DCs say they are wellness DCs, but basically have a practice full of people who come for regular check-ups – a wellness practice can only be measured by improved state of wellbeing in the clients, not by how often someone gets adjusted – TRT DCs find that their practice members go through major shifts in their state of wellbeing.

12) The level of satisfaction with the Integrator is much higher than with most other instruments – most DCs use their instrument as an alternative to manual adjusting – when all else fails or when they feel it is not safe to adjust manually. The opposite happens when DCs use Integrators – they are usually shocked to find that they actually get better changes and feel their adjustments “hold” better when using an Integrator. And those recurring subluxations that used to be back again every visit suddenly seem to clear and no longer recur.

13) They discover a massive demographic of new patients who would never see a “bone cruncher” but love the low-force approach – Like it or not – the manual adjustment has been the vehicle with which most DCs have produced great health changes in their customers. But at the same time the manual adjustment suffers from a very poor public relations history: From comedy shows, to fanatical and very vocal cynics, to a large segment of the general populace – there is a huge number of people who question “cracking backs” as being of little therapeutic value, and of much unnecessary risk. When you use a low-force adjusting approach – you enter a new game – and you find a whole new marketplace.

14) Enjoyment, fulfilment, passion and excitement seem to happen in DCs lives. It amazes me how many DCs are actually struggling in practice emotionally – and are in a state of disappointment, boredom or burnout. We get so many phone calls and emails a few months after a TRT program with amazing stories of renewed practices, revived enthusiasm, and unexpected but well-deserved rewards

CAN YOU SEE WHAT YOU ARE DOING?

Saturday, November 10th, 2007

Many aspects of chiropractic practice have evolved - there have been so many modern developments from within our profession, and from complementary professions - many of which make daily practice simpler, more efficient, more effective, more objective, and even more profitable… Whether we talk about the computerisation and even automation of our front desks, technological advancements in our investigative tools, online education and marketing tools, new and diverse technique systems, in-house entertainment and educational multimedia, online and electronic banking options, and I could go on…

But at the same time could it be that as we utilise more and more technologies, and become more dependent on machines to make decisions and record memories for us - That our own innate and intuitive recording, analysing and comparative skills may be withering and vanishing?

How seriously and consciously do you control what you are seeing and absorbing in your mind’s eye, as you are working on each and every practice member, on each and every visit? This was named INTENT by our pioneers.

While you are leaning over and assessing your patients: Are you thinking about what you are going to have for lunch, reviewing your golf swing, planning your next holiday, worrying about your debts, or even rewinding the last patient who was complaining that you hadn’t fixed them yet?

Make a commitment to include the following steps as you examine and treat each person…

1) Become One: When you enter into someone’s field of intelligence (their personal space), you are being allowed into a very privileged place - AND you also enter into a dimension where you can gather enormous perceptions about the state of mind and body of that person - IF you are willing to perceive and observe them! The way to take this to its full potential is to comprehend that when you enter into this “zone” you and your patient become one. Have you ever started to feel angry, sad, frustrated, or agitated while adjusting someone - guess what - it might not be you feeling it - it may be them. See if you can develop this skill of knowing more about your clients than they know about themselves…

2) Visualise: As a Chiropractor, you are extremely blessed, because you have done some of the most comprehensive anatomical, physiological, biomechanical, neurological and even pathological studies possible. As you examine and adjust each person, develop “XRay Vision”: Visualise the structures and functions that you are examining and adjusting as you perform each procedure. Makes the job much more interesting and fascinating. Your diagnostic and technical skills will improve in a quantum leap if you integrate this one skill…

3) See Whole: This transports your visualisation skills to the next dimension: Making the jump from observation, to influence! See the fixated joints start to move again; visualise a person’s alignment being restored; feel the surge of nerve flow and energy transmission; envision cells, tissues, organs and beings becoming whole and vital once again…

When we teach Torque Release Technique we equip you with a comprehensive range of indicators which you use in your ongoing evaluations of your patients’ state of wellbeing, and degree and location of Subluxation. These build and strengthen your intuitive and innate abilities to perceive and differentiate what condition someone is in, AND where and how they need to be adjusted.

When you put this all together you achieve what is probably best described as TOTAL CERTAINTY.

Click Here To Find Out More About TRT Training…

Are You Relieving Your Patients’ Emotional Pains And Strains?

Sunday, October 7th, 2007

Are You Relieving Your Patients’ Emotional Pains And Strains?

Whether or not we all agree on the theory that Subluxation is the cause of ALL illness - most DCs agree that there are three primary causes of Subluxation - Physical, Chemical and Mental.

At our TRT programs I ask the participants to rank these factors, and we always get 100% agreement - Emotional factors are by far the most common cause of Subluxation. So how does this revelation impact your every day clinical conversation and your adjusting procedures? Let me put this another way - what system/s do you have in place in your practice to identify and correct the emotional component which is causing most of your practice members, the majority of their problems?

What happens in your practice when someone is responding slower than you would expect, they keep exacerbating their condition, or you keep identifying the same recurring subluxations?

Here’s what it sounds like in most chiropractic offices: “Well Fred, what did you do on the weekend - did you do any gardening or lifting? Tell me about your office chair at work. How many hours do you spend in front of the computer? Are you doing some exercises? What position do you sleep in? Tell me more about that car accident you had 55 years ago.”

Notice something missing? Where were the questions to identify the emotional cause, let alone the second most common cause of subluxation - chemical? Physical, physical, physical…

Do you want to be a wellness chiropractor and not a back doctor? Then you need to connect with your practice members on an emotional level. This has got nothing to do with counseling or psychology, and it’s definitely not about finding new referrals for the Beyond Blue program. But it is about providing your customers with a more holistic service…

Next time you find yourself in the above scenario, stop yourself before you blow the opportunity for a learning moment, and try this instead…

“So Fred, why do you think that your body is having trouble getting better as fast as YOU would like?” Fred’s usual answer will be “well I d’know, your the doctor?”

“Have I told you that there are actually three causes of subluxation? There’s the obvious one, the physical stuff that happens to you and that you do to yourself. Then there’s chemical stuff; you know, all the toxic stuff that we eat and drink, and all the poisons that exist around us in our homes and in the environment, like allergies. Then the one you might not have thought of before, is the mind - this is actually the most common and the most severe cause of subluxation. Fred, can you think of any mental or emotional stuff in your life that might be creating stress inside your body?” Now don’t drop the ball, stay silent until Fred comes up with some ideas… Then adjust him as per usual.

Like I said, this doesn’t have to lead to a psychotherapy or hypnotherapy program; just the therapeutic power of the identification and connection of HIS emotional stuff with his subluxation will astound you….

Click Here To Find Out More About Chiropractic Coaching…