Posts Tagged ‘Evolve’

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…

Practice Tip - ASKING FOR REFERRALS

Monday, October 29th, 2007

I can remember paying good money to attend a practice management seminar that promised me I’d be able to see more people, charge more for my services, work less hours, convert everyone to lifetime care, and attract hundreds of new patients. The crux of the seminar was rehearsing, memorising and then regurgitating powerful “scripts” which if said in the correct manner, guaranteed that everyone would do anything you told them to do. I must say they did work well, but here’s the glitch: When you’ve been in practice for a little while, and you start to see the same people over an extended period of time; and you also see their family members, and friends and colleagues, and reactivated patients; and if your CAs and associates are also using those same power scripts - eventually you are all going to be “found out”. You see this technique is based on “Disney” systems - BUT; how many times have you visited Disneyland? Once, maybe twice, to go to the bits that you missed the first time? And guess what - you only have to listen to the script once! If YOU are going to be a wellness DC with people seeing you 12 or more times a year, for many years, then you’d better have something different to say… Here’s the best way to develop dialogue processes that evolve and adapt to where you practice members are at…

Ask better questions!

Here’s a really simple strategy that doesn’t take long; builds rapport, intimacy and relationship; and produces numerous opportunities for generating referrals: Get to know the practice member’s family, friends and colleagues by asking a simple series of questions… My CA even knows their Dog’s name/s!

It goes something like this:

Q: “What does your husband/wife/partner do for a living?” A: ……..

Q: “Wow, does he/she enjoy that?” A: ………

Q: “Has your husband/wife/partner seen a chiropractor before?” A: ……..

This is where the brief conversation can take a number of turns, but regardless of the answer, your questions should search for a reason for you to recommend that they bring their partner in to be checked to see if you can help.

On subsequent visits I’ll take some brief moments to get to know their kids, and then their friends, and then their colleagues…

I know this sounds really simple, but I have got to tell you that the conversations are much more interesting than listening to the sound of your own voice saying the same thing over and over again?

Click Here To Find Out About Chiropractic Coaching…

PROVE IT!

Monday, September 17th, 2007

Gill and I have just gone through a major change in our practice and personal lives. After 18 years of owning and practising in the one location, we have handed over ownership to another chiropractor. So it feels like an appropriate time to reflect and to share some experiences, and some insight into the challenges and potential of our great profession.

It was an emotionally charged time as we started to tell our patients and practice members that we were going to be moving on and that we were going to be handing over their care to a new chiropractor. And there were three groups whose reactions really impacted me: The first group was those old faithful regular clients who had been seeing me for 15 to 18 years. Some reminded me that they had seen me in my first weeks of practice. A couple of people even reminded me that they’d seen me in the first days of my practice. And they reminded me how young and “green” I was; and many thanked me for how much I had grown up and evolved in that time.

Now, this raises an interesting question: why would someone see a chiropractor consistently, and regularly over a period of 18 years? I can guarantee you that it wasn’t because I signed them up with an 18 year prepayment plan. But instead, they must have some conscious value for the benefits that they receive from their adjustments. And they have enormous experience in terms of how chiropractic has helped them – beyond the relief of an acute low back episode

The second group that probably affected me the most was a group of 18 to 22-year-old’s, who when I told them that I was going to be moving on, and that they were about to be under the care of another chiropractor; they looked at me with sorrow and surprise and even disappointment. And most of them said to me, “what am I supposed to do, you have been my only chiropractor for my entire life. You have kept me healthy for all these years?” - Many of them since birth. And it reminded me of how much children intuitively love chiropractic care when they have a good experience. You don’t need to educate or intellectually explain the benefits of chiropractic to a child who experiences them. It’s like a seven-year-old boy said to me once, “I love getting adjusted, you recharge my batteries”.

The third group that probably surprised me a little was a significant group of people who’d only been seeing me for weeks, perhaps months, maybe a year or two: In the bigger scheme of an eighteen year old practice, not a long time. But they too were shocked and disappointed that I was going to be moving on. I guess every chiropractor has patients like this: People who’d been to every other doctor and had all sorts of medical tests and been to other alternative practitioners. And then they stumbled upon you and the healing magic started to occur. And I realised that this group associated their healing with ME and perhaps not so much CHIROPRACTIC. They also place an enormous amount of value on our adjustments. The next part of their journey, being under a new chiropractor, will be to discover that their healing comes from chiropractic, not from Nick Hodgson.

So here is the big question: Do you underestimate the value of the benefits from YOUR chiropractic to the health and wellbeing of your patients and your community? Are you aware of the changes that are happening in the lives of your practice members?

I know there was a time in my practice life where I underestimated the value of what I did. And I remember sitting in a packed theatre at a Dynamic Growth Congress on the Gold Coast, on a Friday night. And one particular speaker was sharing a case story of someone that he cared for over a long period of time. This patient was in a wheelchair as a result of previous injuries, and as the story unfolded, we saw photos of this guy, looking sickly and drawn, in his wheelchair; through to a time when he was no longer in his chair; and then he was holding a newborn baby; his own son in his arms: Both events that should not have happened – but for a chiropractic miracle. And I can remember sitting in my chair, feeling really tense, and then I broke into a cold sweat, and then tears started to well up in my eyes. And later that night, I was tossing and turning in bed, trying to get sleep, and I realised that there was a deep burning question building up inside of me; and it sounded something like this: “Nick, where are your miracles, where are the miracles in your practice?”

Now you might be thinking that when I got back to practice on Monday morning, that there was a guy in a wheelchair, or a deaf or a blind person, waiting to see me, who had a miraculous healing after I adjusted them, and that from that day on I produced miracles of my own. No, my outcomes didn’t change: But instead what happened was my awareness changed. And over the next few weeks and months I started to notice changes and miracles that had already been occurring in my own patients – I just had never taken the time to notice. And as a result I developed a deeper appreciation for the changes that occur as a result of my adjustments. So, let me ask you again: Do you underestimate the value of YOUR chiropractic care?

How do you start to identify and become more aware of the changes that are happening in your practice? In the past, the main way we used to help ourselves to become aware of our miracles was through the patient testimonial. When we had a patient who had a dramatic response to our treatment, we would get them to write a short story about their experiences. And after a while we would have a collection of a range of these testimonials. But what about all the other patients in your practice? How do you know what changes they are experiencing under your healing hands?

Now is one of the best times to be a chiropractor, because we have so many fantastic tools and technologies to measure and demonstrate what happens as a result of an adjustment: We can use health questionnaires to record someone’s state, at any given time. Anything from a neck disability, or low back pain questionnaire; through to specific health problem questionnaires, like asthma or ADHD or any named illness for which I guarantee you can find the questionnaire that matches the ailment; through to health and wellness, and quality of life questionnaires.

And there are also numerous functional assessment technologies, which can measure almost any aspect of your patient’s physiology. From taking digital photographs, and then using software to analyse their postural alignment; Or digital radiographs, where we can store the images on our computer and draw angles and measurements and calculations to be compared later; Through to surface EMG, paraspinal thermography, and pain algometry, and flexibility inclinometry; and now even heart rate variability, brain EEG, skin conductivity, and bio feedback assessments: You name the thing you want to measure, and the technology probably exists to demonstrate the changes.

So what are the benefits to the average chiropractor of utilising these technologies? The first and most obvious reason is that it helps to identify the miracles that you might otherwise miss. Often people don’t tell you about some of the less predictable changes that have happened in their lives until you see the changes in their physiology, and then they’ll say, “oh so that’s why I’m sleeping better, or playing better golf, or feeling happier?” And like me you’ve probably noticed that sometimes people have short memories. Those people who, when you first met them were in a terrible state, and were struggling to do even daily activities. And after a period of being under your care life is now going pretty well. But then, they say to you, “why do I need to keep coming? I’m not sure whether I’m getting any value out of my adjustments?” And you think “what are you talking about, don’t you remember how bad you were? Can’t you see how much you have improved?” So the benefits of using outcome tools is that you have a “snapshot” in time of what they were like back then, and you can show them and remind them as to how far they have come, and how much value they do receive from chiropractic.

So which tools should you be using in your practice? Here’s a really big question that you need to be asking yourself: What do you claim to change? What changes do you expect to see in your patients when you adjust them? A useful bit of homework to do is to take a blank sheet of paper and down one side list what are the major changes that you focus on that indicate that your chiropractic is working? And come up with a short-list of what are the most important functional improvements that you expect. Is it an improvement in posture, a change in a cervical curve angle, a reduction of muscle tension, improved flexibility, less pain and daily dysfunction, or an increased state of well-being and quality of life? Then, next to each of those listed changes, you need to identify the tool that you can use to prove that you change what you claim to change.

I’ve noticed that this can be really, really challenging for many chiropractors. And there seems to be only two possible reasons why a chiropractor would resist utilising these tools: The first is that they perceive these technologies as being expensive or time-consuming: In fact most technologies are now more than affordable and cost effective than ever before, and can usually more than pay for themselves via the extra revenue they generate: Some can be delegated to staff members who are usually more than enthusiastic to get more involved in the clinical and healing process.

And the second “excuse” appears to be a degree of fear of exposure. “What if I don’t change what I claim to change?” And I guess that are only two possibilities to this scenario: either chiropractic doesn’t work or YOUR chiropractic doesn’t work! But this perception is best resolved by putting the outcome tools to work – You either discover that your chiropractic is working; it’s not working as well as you would like (in which case you can modify your management plans and procedures); or it isn’t working (in which case you will need to discover a way that does work): Any of these three possibilities leads to improved quality in your products and service to your community – a win-win situation for everyone.

It is now the 21st century, and if you are practising in the same manner as you were in the 1990s, then you are not a 21st century chiropractor. Assessment and treatment technologies have evolved greatly in the last decade, including the chiropractic adjustment – there are new ways of adjusting which are gentler and faster, which work as well as, and perhaps even better than the “old” stuff. And there is no doubt that the chiropractic profession needs to redesign its packaging IF it wants to be seen as the leaders of the wellness revolution, as opposed to just another provider of drug-free back treatment.

What will happen if our profession doesn’t embrace the technologies and opportunities of the 21st century? There’s a saying, “put up or shut up”: Show your evidence and be listened to and respected, or stay silent and have your ways of life dictated to by others. I know there was a period in my practice life when I was waiting for the definitive study that proved that chiropractic did what I thought it did – improved state of wellbeing, maximized health and optimised human performance. And that once this paper was published in a legitimate scientific journal, the rest of the world would sit up and listen to us. It’s been eighteen years, and I am still waiting! And the profession is 112 years old, and we are all still waiting. That’s not to say that
there haven’t been some good papers – but the “breakthrough” has not occurred.

Here’s what I have discovered to be a fact: The evidence that chiropractic works exists inside the four walls of each and every chiropractor’s office – they are just not using the tools to prove it – they are waiting silently for someone else to present the evidence – maybe someone really famous and trendy who will receive a chiropractic miracle and do a testimonial on national TV, and then everyone will want to get adjusted??

Imagine if every DC used outcome tools in their practice, and that as a result they had enough evidence in their practice to publish just one case study in their career: That would mean that the Australian chiropractic profession would contribute 2,500 case studies to the evidence base. And the US contingent could produce tens of thousands of case studies. Case studies are a legitimate means of scientific endeavour, and the registration boards can’t silence you from sharing this information with the world.

But here’s what happens if you stay silent, and have no evidence to “put up” – third parties start to dictate to you the terms and conditions of your practice life… When the chiropractic profession shuts up, we wake up one morning and discover that our patients cannot share their success stories with the outside world; we wake up and discover we can no longer use the title Dr. What wake-up call will it take to make you put up your proof? Waking up to discover that it is now illegal for you to care for children; waking up to discover that you can no longer adjust necks because some other profession thinks it’s not safe; that you must discharge your practice members once their symptoms subside; or that if their symptoms haven’t subsided after four weeks that you must refer them to another profession anyway?

Maybe we shut up because we lack certainty? THE BEST solution to a lack of certainty is EVIDENCE: Evidence that what you do makes a difference in the world – and the most convincing way to collect the evidence is through the use of relevant outcome tools to measure what it is that you claim to change. You see, nowadays I have complete certainty that MY chiropractic works exactly as I thought it did; it improves state of wellbeing, maximizes health and optimises human performance – I know this because I have used the tools to measure what I claim to change, and they change!

Please join me in the 21st century…

FLAWS OF A MANUAL CHIROPRACTIC ADJUSTMENT

Friday, June 8th, 2007

DD Palmer was the first practitioner to deliver a correctional thrust to the spinal column in an attempt to restore nerve function. DD must have been aware of the shortcomings of the manual adjustment as he very clearly stated that future generations of his profession would find better ways of delivering the goods. But for many decades it has become taboo to discuss the limitations and flaws of our wonderful healing art. Thankfully there are some pioneering practitioners exploring new means of facilitating neurological change.

But first let’s do some serious soul searching…

1) Difficulty isolating a segment

We’ve all been guilty of this one – your intention is to adjust C2, but when you set up and deliver your dynamic thrust, you may or may not feel the cavitation at one of the C2 articulations; can you ever be truly sure that the joint that you wanted to move – moved? And then there are those extra “pops”. I remember being adjusted by an “old-timer-chiro” years ago: He insisted on adjusting me so I could experience a “real adjustment”. I guess he was intending to adjust my upper cervical spine, because they were the first joints that I felt separate. But then his thrust continued and I felt numerous more joints move further down my neck and what felt like my upper thoracic spine. Apparently the soreness and stiffness that I experienced for the next two weeks was an essential and needed healing process? Now I know that most of us are much more specific than this life-crunching experience; but let’s be really honest – we don’t truly know whether we hit our target on each and every adjustment.

There is an alternative means of adjusting which guarantees that you will impact exactly the joint/nerve you intend – one that delivers its impulse exactly where you place it…

2) Inability to deliver specific frequency

The thing that first got me excited about chiropractic was the suggestion that spinal adjustments might improve neurological performance. I was studying a Bachelor of Science at the time and had no trouble with the concept of the supremacy of the central nervous system over all other body systems – this understanding is not peculiar to the chiropractic profession. But let’s have a moment of awakening – the thought that the delivery of a correctional force vector to the spine to change nerve activity appears quite peculiar to many other members of the scientific and general community.

The ONLY way that an adjustment could change nerve function is if it can change nerve frequency.

Can you deliver exactly the right frequency needed to correct aberrant nerve activity due to Subluxation with your hands? Thankfully, technology exists that can deliver specific vibrational frequency…

3) Speed/acceleration variable

The best manual adjusters are fast. The faster you are the less the mass you have to use. This is a simple physics formula: Force = Mass times Acceleration. Increase the speed and you increase the impact of your adjustment without increasing the body weight that is needed. “Small” chiropractors can adjust just as well as “big” chiropractors – if they have speed on their side.

Imagine if you could adjust with an impulse that is finished in 1/10,000 of a second? You would hardly need any mass whatsoever to produce the same physiological changes – such a tool exists today…

4) Increased Mass

Higher speed reduces the mass you have to use. Low speed with high mass meets with more tissue resistance, reflex muscle guarding, patient discomfort and fear, and increased pressure against supporting soft and hard tissues. In other words, increased likelihood of developing clients that don’t like you and that are sore after you adjust them. If you can make this one shift alone in your adjusting proficiency, then you will dramatically increase your patient satisfaction and clinical outcomes.

Why not remove your dependence on mass altogether by using an instrument that is so fast that mass is almost irrelevant?…

5) Reliance on cavitation as THE outcome

I can still remember my early days in practice. I inherited a few patients who showed up sporadically to get their “back put back in”. I don’t know whether they had been taught that cavitation was evidence that the bone had returned to its rightful place, or whether they had made their own conclusions due to their previous DCs gleeful comments when a good “pop” was produced. Anyway, some of them would refuse to leave the practice until they were satisfied that an adequate noise had emanated from their spinal column. Praise God, I know longer have any of these kind of clients in my rooms. Most of my practice members seem to intuitively as well as intellectually get it that there are many more signs and symptoms that their adjustments are delivering health improving benefits, than just the production of “spinal farts”.

If you can rehabilitate yourself from the false belief that cavitation is any kind of sign of a neurological response then you are ready to evolve to the use of newer adjusting methodologies…

6) Poor inter-examiner reproducibility

I’ve had a lot of locum and associate DCs grace my practice rooms over the last eighteen years, and the variance in client satisfaction, and obvious variability in touch, technique and practices has been astounding. No two DCs are the same, and no two chiropractic experiences are consistent it would seem. Contrast this to my current situation – I have been fortunate over the last three years to employ locums who use the same system, method and adjusting technology that I use every day. Most recently one of my clients commented, “it was like you were there, even though you were in Marysville!”

I’ve got to tell you that it makes leaving your highly valued business and long-term clients in the hands of someone else VERY easy, when you can rely on the fact that what you do and what they do is so reproducible. Wouldn’t you like that same degree of confidence and security?…

7) Move joints into para-physiological range

Real Estate Agents speak of the golden rule of investing in property – “Position, position, position”. In terms of effective manual adjusting perhaps we can steal and adapt this concept to – “Positioning, positioning, positioning”? Previously when tutoring associate DCs to deliver precise neck adjustments I always found that if you get their patient positioning right then “all else followed”. We all know that to get a joint to cavitate we must get the joint into its para-physiological zone – don’t get there and it won’t move without extra force and excursion in our thrust; go too far and woops we’re talking sore clients.

Wouldn’t it be good if we could find a way of adjusting which didn’t require resting on that knife’s edge? A way of adjusting that could be performed with a joint in its neutral, totally relaxed position? That “way” already exists and patients will love you and enter into very deep states of relaxation when you adjust with this method…

8) “Bone-crunching”

“Bone-crunching” has made chiropractic famous – It has also made Chiropractic infamous: There is a large segment of the population who will never go to a chiropractor that “crunches bones”. And I know that there isn’t a single chiropractor on the planet that thinks they are a bone cruncher – but if you manually adjust, producing audible popping sounds, then good luck trying to convince the skeptics that what you do is not bone crunching. These skeptics will however visit a chiropractor who uses a low force methodology: I know this to be true because 50% of my new clients nowadays, have never been to a chiropractor, and all of them tell me the same story; “I swore I would never go to a chiro but then someone told me that you helped them without crunching their bones, so I figured I would give it a go”

There’s lots more of this untapped new patient market place awaiting you too…

9) Less specificity of vectors

Imagine if there were some tests you could perform that would differentiate exactly what correctional vectors were needed to provide the most effective adjustment – wouldn’t that be great? They exist and are very quick and simple to perform. However, is there any point knowing within a few degrees these vectors required, if you then cannot deliver those vectors with your adjustment. Unfortunately with a manual adjustment there are some basic flaws which preclude exact correctional vectors.

It requires an instrument which has true reproducibility to be able to deliver precise vectors. Unfortunately most instruments on the market require the practitioner to fire the instrument, and research has shown that this can vary the reproducibility of the thrust by as much as 300%. There is however one instrument which has pre-loading with pressure sensitive firing, so that every adjustment varies minimally from the last…

10) Iatrogenic risks – disc, Fx, vascular

We all know that what we deliver is amazingly safe, especially when compared to the statistics from other more “conventional” healing practices. Nevertheless there are some published risks especially associated with manual adjusting: Most of the risks appear to be proportionate to the amount of mass delivered during the adjustment, and the positioning of and thrusting upon patient’s joints into “para-physiological” ranges.
Exacerbation of disc prolapse is one such documented risk – I would hope that every DC exercises a great degree of caution and a certain amount of hesitancy when faced with a patient showing classic signs of disc protrusion; and I would hazard a guess that a significant number of DCs have erred on the side of too much force on at least one occasion.

I’ve seen two cases of cracked ribs in my practice in 18 years of practice – one was produced by a locum DC who adjusted an elderly female client’s thoracic spine in the prone position producing a loud crack, and instant pain which took 6 weeks to resolve and much “TLC” to appease. The second happened to me when I was setting up for a prone thoracic adjustment on a seemingly healthy mid 30’s male – we both heard the weird cracking noise – and then I was astonished when he announced that he should have told me that he had cracked that same rib several times and he sincerely apologised for not warning me!? I suspect that any other form of fracture supposedly attributed to chiropractic would be due to some un-diagnosable pre-existing weakness in the bony architecture.

The issue of vascular complications due to neck adjustment is controversial: It is clear that the estimates of the relative risk are at best imaginary and seemingly always overestimated. I have seen other statistics which claim that chiropractic reduces the risk of stroke in an adjusted population! The obvious fact is that nearly every DC will never see this in their practice. Let’s say that the risk of stroke from cervical “manipulation” was 1 in 1 million. In my estimate this means that there are 20 people in the whole of Australia who shouldn’t have their neck adjusted manually. My secret prayer has been that not one of this tiny group lives anywhere near my rooms, and that if they do, they intuitively know to go and see a Physio instead of me…

It would seem that every chiropractic cynic has a story of someone who was crippled by a chiropractor; one loud-mouthed critic I was confronted by once even claimed that “a nurse had told him that there was a whole ward full of chiro-cripples at a well-known Melbourne hospital”. We all know that this is absolute nonsense, but this does demonstrate a common fear of our “therapy” – safety – there are chiropractic techniques available right now which minimise risk and maximise safety…

11) One segment at a time – no “Double Ended Contact Assist”

To understand this concept fully you need to attend Torque Release Technique training. The concept of Lovett Brother Reactors is not a new one in chiropractic, but it is an ignored concept in many manual models. I wonder if this is due to the fact that you cannot manually adjust two segments at the same time? Most DCs if they possess a protocol to determine if an adjustment has held (you’ll learn this at TRT too) will keep adjusting the same segment until it submits. Deeper understanding of the neurological coupling known as Lovett Brothers provides the answer to this scenario though; and if the DC also possesses a protocol to simultaneously correct the two coupled segments at the same time then these persistent subluxations can be coerced into correction in a very quick and gentle manner.

The shortcomings discussed here have all been carefully solved through the research and development of Torque Release Technique and you will learn numerous strategies to evolve beyond these flaws as well as how to adjust with the purpose-built Integrator Instrument…