Posts Tagged ‘Heart Rate Variability’


Monday, September 12th, 2011

There are a lot of modalities available to complementary health care professionals nowadays, and many claim significant benefits and often share testimonials of miraculous results. Whenever I check out a new technique the first question I ask is “how does it work?” The answer needs to follow some kind of logical and plausible physiological principles before I even ask the second question; “is there any research?” I have to be honest that I struggle with web-sites and marketing materials that are full of claims and stories, but lacking in rationale and evidence. Auriculotherapy is one method that has continued to impress and excite me, and for this reason it is one of the primary modalities that I offer in my own practice. This is the third in a regular update of recent research.

First let’s summarise the most recent findings:

1) Satisfaction in a wellness clinic: This study involved feedback from health professionals being given access to wellness services including Auriculotherapy once a week in the workplace. Most participants agreed or strongly agreed they felt more relaxed after sessions (97.9%), less stress (94.5%), more energy (84.3%), and less pain (78.8%). Ninety-seven percent (97%) would recommend it to a co-worker. Among surveys completed after five or more visits, more than half (59%-85%) strongly agreed experiencing increased compassion with patients, better sleep, improved mood, and more ease in relations with co-workers. Perceived benefits were sustained and enhanced by number of visits.

2) Effects on autonomic function in healthy individuals: The results of this study using non-invasive assessment methods showed a significant decrease in heart rate, a significant increase in heart rate variability total, and marked (but statistically insignificant) decrease in pulse wave velocity. This translates to signs of decreased stress physiology internally.

3) Chronic low back pain: This pilot study found that Auriculotherapy was safe and demonstrated additional clinical benefits when combined with exercise for people with chronic low back pain. This supports my own observation that the best treatment for low back pain is a combination of passive and active treatment.

4) Effect on inflammatory reactions: This study using animals showed that Auriculotherapy can increase serum Tumour Necrosis Factor and Interleukin-6, and down-regulate pulmonary NF-kappa B p 65 expression suggesting a cholinergic anti-inflammatory mechanism. This suggests a neurological pathway for antiinflammatory effects of Auriculotherapy which makes sense since Auriculotherapy is a neurological intervention!

5) Treatment of migraine attacks: This study compared using a reflex point well documented to relieve migraine (group A) versus a point unlikely to have a therapeutic effect (group B). During treatment, there was a highly significant trend in the reduction of symptoms in group A, whereas no significance was observed in group B. Symptoms were significantly lower in group A than in group B at 10, 30, 60 and 120 min after treatment. This study suggests that the therapeutic specificity of auricular points exists and is linked to the somatotopic representation of our body on the ear.

6) Analgesia and sedative effects during abdominal gynecological operation and effects on postoperative recovery of body function: This showed sedative, analgesic and function-regulating effects from Auriculotherapy. Anxiety was less, lower-doses of anaesthesia were required, breathing response was improved after the operation, and higher levels of serum beta-endorphin were found when Auriculotherapy was added. Anything that potentially improves surgical outcomes sounds like a really good thing to me!

7) Improving postural stability: Balance performance was measured on a force platform before and after Auriculotherapy. Main balance parameters pointed to an average short-term improvement of about 15% 1 hour after treatment and 5-10% after an interval of 3 days. However, a few participants showed a better than 30% improvement with the same parameters. The explanation tentatively put forward to account for the results was that Auriculotherapy reduces nociceptive interference and thus improves postural control.

8) Treating headache, trigeminal neuralgia and retro-auricular pain in facial palsy: In this study Auriculotherapy treatment showed pain alleviation in headache, trigeminal neuralgia, and retro-auricular pain levels. The researchers noted that treatment number should be no less than 10 sessions.

9) Preoperative anxiety treatment: Preoperative anxiety has become more frequent in preoperative patients and can bring negative impact on operation outcomes. The study concluded that Auriculotherapy was significantly effective in decreasing anxiety in preoperative patients.

Sounds like some good reasons to check out Auriculotherapy training to me… Go to to find out more…

Now for the abstracts:

1) Employee use and perceived benefit of a complementary and alternative medicine wellness clinic at a major military hospital: evaluation of a pilot program.

J Altern Complement Med. 2011 Sep;17(9):809-15. 2011 Aug 11. Duncan AD, Liechty JM, Miller C, Chinoy G, Ricciardi R.

Abstract Objectives: The objectives of this study were to examine the feasibility of a weekly on-site complementary and alternative medicine (CAM) wellness clinic for staff at a military hospital, and to describe employees’ perceptions of program effectiveness. Setting: The study setting was the Restore & Renew Wellness Clinic at a United States Department of Defense hospital. Subjects: The subjects were hospital nurses, physicians, clinicians, support staff, and administrators. Interventions: The walk-in wellness clinic was open 8:00am – 2:00pm 1 day a week. Participants selected one or more modalities each visit: ear acupuncture, clinical acupressure, and Zero Balancing. Outcome measures: A self-report survey was done after each clinic visit to evaluate clinic features and perceived impact on stress-related symptoms, compassion for patients, sleep, and workplace or personal relationships. Results: Surveys completed after first-time and repeat visits (n=2,756 surveys) indicated that most participants agreed or strongly agreed they felt more relaxed after sessions (97.9%), less stress (94.5%), more energy (84.3%), and less pain (78.8%). Ninety-seven percent (97%) would recommend it to a co-worker. Among surveys completed after five or more visits, more than half (59%-85%) strongly agreed experiencing increased compassion with patients, better sleep, improved mood, and more ease in relations with co-workers. Perceived benefits were sustained and enhanced by number of visits. The most frequently reported health habit changes were related to exercise, stress reduction, diet/nutrition, and weight loss. Conclusions: This evaluation suggests that a hospital-based wellness clinic based on CAM principles and modalities is feasible, well-utilized, and perceived by most participants to have positive health benefits related to stress reduction at work, improved mood and sleep, and lifestyle.

2) Brain-modulated effects of auricular acupressure on the regulation of autonomic function in healthy volunteers.

Evid Based Complement Alternat Med. 2011 Aug 29. Gao XY, Wang L, Gaischek I, Michenthaler Y, Zhu B, Litscher G.

Auricular acupuncture has been described in ancient China as well as Egypt, Greece, and Rome. At the end of the 1950s, ear acupuncture was further developed by the French physician Dr. Paul Nogier. The goal of this study was to develop a new system for ear acupressure (vibration stimulation) and to perform pilot investigations on the possible acute effects of vibration and manual ear acupressure on heart rate (HR), heart rate variability (HRV), pulse wave velocity (PWV), and the augmentation index (AIx) using new noninvasive recording methods. Investigations were performed in 14 healthy volunteers (mean age ± SD: 26.3 ± 4.3 years; 9 females, 5 males) before, during, and after acupressure vibration and manual acupressure stimulation at the “heart” auricular acupuncture point. The results showed a significant decrease in HR (P ≤ 0.001) and a significant increase in HRV total (P = 0.008) after manual ear acupressure. The PWV decreased markedly (yet insignificantly) whereas the AIx increased immediately after both methods of stimulation. The increase in the low-frequency band of HRV was mainly based on the intensification of the related mechanism of blood pressure regulation (10-s-rhythm). Further studies in Beijing using animal models and investigations in Graz using human subjects are already in progress.

3) Exercise and Auricular Acupuncture for Chronic Low-back Pain: A Feasibility Randomized-controlled Trial.

Clin J Pain. 2011 Jul 12. Hunter RF, McDonough SM, Bradbury I, Liddle SD, Walsh DM, Dhamija S, Glasgow P, Gormley G, McCann SM, Park J, Hurley DA, Delitto A, Baxter GD.

OBJECTIVES: To evaluate the feasibility of a randomized-controlled trial (RCT) investigating the effects of adding auricular acupuncture (AA) to exercise for participants with chronic low-back pain (CLBP).

METHODS: Participants with CLBP were recruited from primary care and a university population and were randomly allocated (n=51) to 1 of 2 groups: (1) “Exercise Alone (E)”-12-week program consisting of 6 weeks of supervised exercise followed by 6 weeks unsupervised exercise (n=27); or (2) “Exercise and AA (EAA)”-12-week exercise program and AA (n=24). Outcome measures were recorded at baseline, week 8, week 13, and 6 months. The primary outcome measure was the Oswestry Disability Questionnaire.

RESULTS: Participants in the EAA group demonstrated a greater mean improvement of 10.7% points (95% confidence interval, -15.3,-5.7) (effect size=1.20) in the Oswestry Disability Questionnaire at 6 months compared with 6.7% points (95% confidence interval, -11.4,-1.9) in the E group (effect size=0.58). There was also a trend towards a greater mean improvement in quality of life, LBP intensity and bothersomeness, and fear-avoidance beliefs in the EAA group. The dropout rate for this trial was lower than anticipated (15% at 6 mo), adherence with exercise was similar (72% E; 65% EAA). Adverse effects for AA ranged from 1% to 14% of participants.

DISCUSSION: Findings of this study showed that a main RCT is feasible and that 56 participants per group would need to be recruited, using multiple recruitment approaches. AA was safe and demonstrated additional benefits when combined with exercise for people with CLBP, which requires confirmation in a fully powered RCT.

4) Effect of electroacupuncture of auricular concha on inflammatory reaction in endotoxaemia rats.

Zhen Ci Yan Jiu. 2011 Jun;36(3):187-92. Zhao YX, He W, Gao XY, Rong PJ, Zhu B.

OBJECTIVE: To evaluate the effect of electroacupuncture (EA) of the auricular concha (EA-AC) on serum cytokines contents and pulmonary transcription factor nuclear factor-kappaB (NF-kappaB) expression in lipopolysaccharide (LPS) induced endotoxaemia rats so as to study its mechanism underlying cholinergic anti-inflammatory efficacy.

METHODS: Male SD rats were randomized into normal control, model (LPS), simple EA-AC, EA-AC + LPS, vagal nerve stimulation (VNS) + LPS, and EA-Zusanli (ST 36) + LPS groups (n = 12/group). Endotoxaemia model was duplicated by intravenous (tail vein) injection of LPS (0.5 mL/kg). Two intradermal needles were inserted into the central sites of the cavity of concha and cymba of auricular concha respectively on each side and stimulated electrically by using an electrical stimulator (i.e, EA-AC). VNS was applied to the left cervical vagal nerve, and EA (1 mA, 10 Hz, pulse-width 1 ms) was also applied to bilateral “Zusanli” (ST 36). Serum cytokines (TNF-alpha IL-6) contents 2 h after modeling were determined by using enzyme linked immunosorbent assay (ELISA), and pulmonary NF-kappaB p 65 expression 2 h after modeling was detected by using western blotting.

RESULTS: Compared with the normal control group, serum TNF-alpha and IL-6 contents, and pulmonary NF-kappaB p65 expression level in the model group were increased significantly (P < 0.01). In comparison with the model group, serum TNF-alpha contents in the simple EA-AC, EA-AC + LPS, VNS+ LPS and ST 36 + LPS groups, and serum IL-6 contents and pulmonary NF-kappaB p 65 expression levels in the simple EA-AC, EA-AC + LPS and VNS + LPS groups were down-regulated considerably (P < 0.05, P < 0.01). Compared with the VNS + LPS group, serum TNF-alpha -28) and IL-6 contents, and pulmonary NF-kappaB p 65 expression level in the ST 36 + LPS group were increased significantly (P < 0.05, P < 0.01). In comparison with the EA-AC + LPS group, pulmonary NF-kappaB p 65 expression level in the ST 36 + creased remarkably (P < 0.05).

CONCLUSION: Both EA of auricular concha and vagus nerve stimulation can increase serum TNF-alpha and IL-6 contents, and down-regulate pulmonary NF-kappaB p 65 expression level in endotoxaemia similar cholinergic anti-inflammatory mechanism between them.

5) Ear acupuncture in the treatment of migraine attacks: a randomized trial on the efficacy of appropriate versus inappropriate acupoints.

Neurol Sci. 2011 May;32 Suppl 1:S173-5. Allais G, Romoli M, Rolando S, Airola G, Castagnoli Gabellari I, Allais R, Benedetto C.

Ear acupuncture can be a useful mean for controlling migraine pain. It has been shown that a technique called the Needle Contact Test (NCT) can identify the most efficacious ear acupoints for reducing current migraine pain through just a few seconds of needle contact. The majority of the points were located on the antero-internal part of the antitragus (area M) on the same side of pain. The aim of this study was to verify the therapeutic value of area M and to compare it with an area of the ear (representation of the sciatic nerve, area S) which probably does not have a therapeutic effect on migraine attacks. We studied 94 females suffering from migraine without aura, diagnosed according to the ICHD-II criteria, during the attack. They were randomly subdivided into two groups: in group A, tender points located in area M, positive to NCT were inserted; in group B, the unsuitable area (S) was treated. Changes in pain intensity were measured using a VAS scale at various times of the study. During treatment, there was a highly significant trend in the reduction of the VAS value in group A (Anova for repeated measures: p < 0.001), whereas no significance was observed in group B. VAS values were significantly lower in group A than in group B at 10, 30, 60 and 120 min after needle insertion. This study suggests that the therapeutic specificity of auricular points exists and is linked to the somatotopic representation of our body on the ear.

6) Effects of magnetic auricular point-sticking on adjuvant anesthesia and postoperative recovery of body function.

Zhongguo Zhen Jiu. 2011 Apr;31(4):349-52. Li WS, Cui SS, Li WY, Zhao WX, Wanlai SQ.

OBJECTIVE: To prove analgesia and sedative effect of adjuvant anesthesia with magnetic auricular point-sticking on abdominal gynecological operation and its effect on postoperative recovery of body function.

METHODS: Ninety-two patients with abdominal gynecological operation were randomly divided into 3 groups. The auricular point-sticking group (APS group, n=31) was pasted and pressed by plasters with magnetic beads at bilateral Shenmen, Pizhixia (subcortex), Zigong (uterus) and Penqiang (pelvic cavity), etc. the night before operation. The placebo group (n=31) was pasted by plasters without magnetic beads. The blank group (n=30) was given no intervention. The mental and gastrointestinal functional changes before and 3 days after the operation were observed.

RESULTS: As compared with those in the control group and the blank group, the postoperative score of Self rating Anxiety Scale (SAS) was less (25.5 +/- 0.81 vs. 28.9 +/- 3.19, 28.3 +/- 2.36, both P < 0.01), with lower-dose of Innovar [(2.5 + 1.1) mL vs. (3.4 + 1.8) mL, (3.2 + 1.6) mL, both P < 0.05], earlier exsufflation after the operation [(34.2 + 12.1) h vs. (46.3 + 10.9) h, (43.2 + 14.8) h, both P < 0.01] and higher level serum of beta-endorphin before and after the operation in the APS group (all P < 0.05).

CONCLUSION: The magnetic auricular point-sticking has sedative, analgesic and function-regulating effects on the abdominal gynecological operation.

7) Laser acupuncture and auriculotherapy in postural instability – a preliminary report.

J Acupunct Meridian Stud. 2011 Mar;4(1):69-74. Bergamaschi M, Ferrari G, Gallamini M, Scoppa F.

The risk of falling is rather high among elderly people. Indexes obtained through the Romberg stabilometric test on a force platform have been suggested to be correlated with the risk of falling. This work aimed to test the effectiveness of auriculopuncture and ultralow-power laserpuncture versus placebo (sham stimulation) in improving postural control in an elderly population. Balance performance was measured on a force platform before and after both forms of stimulation. Main balance parameters pointed to an average short-term improvement of about 15% 1 hour after treatment and 5-10% after an interval of 3 days. However, a few participants showed a better than 30% improvement with the same parameters. Although the sample size does not allow reliable statistical analysis, the modifications are remarkable and some differences are observed between the two kinds of stimulation. Further testing with larger sized groups and including one further group using both stimulations is suggested. Although postural instability has to be defined as multi-factorial, it is often associated with balance dysfunctions that cannot be related to vestibular or central impairments but rather to proprioceptive deficits. A significant role may be ascribed to (even subliminal) nociceptive interferences with proprioceptive inputs and to a reduced capacity for updating cortical motor control models in the case of progressively declining locomotor capabilities. The explanation tentatively put forward to account for the results observed in the present preliminary study is that laser acupuncture and auriculopuncture stimulations reduce nociceptive interference and thus improve postural control.

8) A clinical pilot study comparing traditional acupuncture to combined acupuncture for treating headache, trigeminal neuralgia and retro-auricular pain in facial palsy.

J Acupunct Meridian Stud. 2011 Mar;4(1):29-43. Ahn CB, Lee SJ, Lee JC, Fossion JP, Sant’Ana A.

Traditional acupuncture (TA) and ear acupuncture (EA) are used for treatment of headache, trigeminal neuralgia, and retro-auricular pain. The purpose of this study is to develop effective treatment using combined acupuncture (CA) which consists of TA and EA and to set clinical protocols for future trials. Participants were divided into TA (n = 15) control and CA (n = 34) experimental groups. Obligatory points among Korean Five Element Acupuncture and optional individual points along with symptom points were used in the TA group. The CA group was exposed to ear points of Fossion and TA. Acupuncture treatment consisted of six mandatory sessions per patient over 3 weeks and extended to 12 sessions. Pain was assessed using the visual analogue scale. We compared TA to CA and researched their relevant publications. No significant difference was observed between the two groups (p = 0.968) which showed pain-alleviating tendency. Pain alleviation was significantly different after the fifth and sixth sessions (p = 0.021, p = 0.025), with headache being the most significantly relieved (F = 4.399, p = 0.018) among the diseases. When assessing pain intensity, both the Headache Impact Test and the Migraine Disability Assessment Scale should be adopted for headache and the fractal electroencephalography method be used in pain diseases. In the future, studies should consist of TA, EA, and CA groups; each group having 20 patients. Treatment number should to be no less than 10 sessions. Korean Five Element Acupuncture should be a compulsory inclusion along with individual points being optional inclusion in TA. EA could be selected from Nogier, Fossion and so forth. In conclusion, acupuncture treatment, whether TA or CA, showed pain alleviation in headache, trigeminal neuralgia, and retro-auricular pain, but no significant difference was seen between groups. Prospective, well-controlled, and relevant protocols using multimodal strategies to define the role of TA, EA, and CA are needed.

9) Comparing the treatment effectiveness of body acupuncture and auricular acupuncture in preoperative anxiety treatment.

J Res Med Sci. 2011 Jan;16(1):39-42. Wu S, Liang J, Zhu X, Liu X, Miao D.

BACKGROUND: Preoperative anxiety has become more frequent in preoperative patients and can bring negative impact on operation outcomes. Many studies have reported the effect of body acupuncture in reducing anxiety syndromes. The aim of this study is to compare the treatment effect of body acupuncture and auricular acupuncture in preoperative patients with preoperative anxiety.

METHODS: Thirty five elective ambulatory surgery patients were selected in the randomized and blinded trial. Subjects were randomly categorized in two intervention groups, the body acupuncture group who received acupuncture in the special points of body, and the auricular acupuncture group who received ear acupuncture. Zung Self-Rating Anxiety Scale (SAS) was used before and after the study.

RESULTS: For the auricular acupuncture group, the mean score of SAS was 57.57 ± 8.22 before the intervention and 46.32 ± 6.37 afterward. For the body acupuncture group, the SAS score was 55.39 ± 5.41 and 44.82 ± 6.76 before and after the intervention, respectively. For both groups, the difference between pre- and post-treatment scores reached the significant level (p = 0.00).

CONCLUSIONS: Both auricular and body acupuncture treatment methods were effective in decreasing anxiety in preoperative patients.

Sounds like some good reasons to check out Auriculotherapy training to me… Go to to find out more…


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…