Posts Tagged ‘Potential’

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…

THE ADJUSTMENT SECRET FORMULA

Tuesday, July 24th, 2007

What are the secret ingredients which define a chiropractic adjustment? What are the features that separate an adjustment from other therapeutic modalities? What are the factors that differentiate a good adjustment from a bad adjustment?

Most definitions of “Adjustment” are very mechanistic in nature: “Moving the joints of the spine beyond a person’s usual physiological range of motion using a fast low-amplitude thrust”; “low-amplitude, high-velocity thrusts in which vertebrae are carried beyond the normal physiological range of movement without exceeding the boundaries of anatomic integrity”. The glaring pitfalls of such predominant definitions are that not all chiropractic adjustments carry the joints into their para-physiological range: Does this mean that SOT Blocks are not an adjustment, and that all instrument-based adjusting protocols are not chiropractic?

Perhaps it is time that we re-define the core components that describe a chiropractic adjustment?

Early chiropractic concepts spoke of universal and innate intelligence, the mental impulse, and proposed that a chiropractic adjustment doesn’t correct anything, but innate utilises the forces transmitted to the body following an adjustment to correct itself: In other words, the body is intelligent, but sometimes needs information from an external source to be able to make better perceptions, decisions and choices.

So, an adjustment is not so much an imposition of our will upon another person’s physiology; as it is the delivery of a new and enlightening piece of information which attempts to facilitate neurological change.

Torque Release Technique defines an Adjustment as “communication through touch”. What are the fundamental factors of this healing touch?

Perhaps we could define these in a physics-like formula…

A = F × CV × I2

In long-hand this translates to: Adjustment equals Force times Correctional Vector times Intent (squared).

Let’s explore this formula in greater detail:

The times signs indicate that each factor has a more significant impact on the other and on the total result than if instead the addition symbol was present; and that if all factors are present the resulting answer will be huge:

For example, in mathematical terms if each factor = 10, then A = 10 × 10 × 100 = 10,000

If the symbols had been additive the answer would be A = 10 + 10 + 100 = 120

If you minimise one of the factors then the answer is minimized:

To alter the above example slightly, if F = 1, then A = 1 × 10 × 100 = 1,000

The square symbol shows the “I” factor has the potential for greater impact: If this factor is small then the formula will not change much. Increase this factor and its impact becomes greater and greater at an exponential rate:

For example if we alter our original formula so that I = 1, then A = 10 × 10 × 1 = 100

Whereas if I = 100, then A = 10 × 10 × 10,000 = 1,000,000!!

Now let’s define the factors in more detail:

Force = Mass × Acceleration:

This is an old Newtonian formula. Every adjustment has force – an adjustment with no force at all is just a good intention. To increase force we either increase the mass or the acceleration, and if you increase both then the force greatly increases. In terms of a chiropractic adjustment, any experienced chiropractor knows the importance of speed over mass: The quicker you are the less the mass you have to use, and the more easily an adjustment is accepted. I guarantee that an adjustment will appear “heavy-handed” to a client due to excessive mass, and not due to excessive speed

Correctional Vector = Contact Point + Three-Dimensional Vector:

The force of an adjustment must have a point of contact and a direction: Specificity is what separates chiropractic adjustment from so many other therapeutic modalities, and without correctional vector I doubt that chiropractic would have attained separate and distinct status. Firstly we are more discerning in where we place our hands; for example, we don’t just stretch the lumbar spine, we adjust an L5.

Also integral in most chiropractic adjustment protocols is the direction in which we apply our force: Our predominant “listing” systems incorporate three letters to define the direction and combination of vectors in three dimensions, which we utilised in our adjustment. And we may even add a fourth letter to further define our contact point… For example: C2 PLI-S – we contacted C2 and our vector was in a direction to reduce the left and inferior vectors of the subluxation, and we used the spinous process as the contact point.

Intent = Become One + Visualisation + See Whole

R.W. Stephenson described the essential components of intent. Intent could be simply explained as what we are thinking about as we deliver an adjustment. But it can also mean much more than this as it may include our own emotional, physiological and even spiritual states.

“Become One” encompasses an almost spiritual connection that occurs when we as a practitioner enter into another’s “energy” or “intelligence” field. The insinuation is that when we come so close there is an influence between the two fields of intelligence. This has ramifications at a diagnostic level in the sense that we can potentially gather much deeper levels of information if we are perceptive to the other person’s “field”; and at a therapeutic level we potentially enter into a deep level for the transaction of information taking place.

“Visualisation” defines the need to see what we are doing: Can we imagine the structures and tissues that we are examining; can we envisage the impact that our testing and corrective vectors are having on the person’s physiology; can we see the effects of our adjustment before they actually occur?

“See whole” describes our intent: Wholeness. After our practice member is adjusted their mind/body is able to better perceive itself, the communications between mind and body are restored, and their physiology becomes more efficient and effective. Do you expect this? Do you actually SEE this occurring in your mind’s eye?

What separates an adjustment from other therapeutic modalities? The size of each factor illustrates its relative importance in the formula:

Massage = f ( m × a ) × CV × I2

Therapeutic massage is separated from relaxation massage by how deep the practitioner penetrates; that is by how much mass they use: Mass is probably the most dominant vector in the therapeutic formula. Acceleration is extremely small as most massage involves slow strokes. The vectors are usually unfocussed and very mixed, sometimes the more directions you sweep across a muscle the better. Intent is somewhat diminished due to poor visualization (most masseurs have inferior anatomical and physiological knowledge) but will have a high degree of connection and a desire to see whole.

Manipulation = f ( m × a ) × CV × I2

Manipulation is usually a mechanistic attempt to produce separation and preferably cavitation of joint surfaces: The Mass is increased and Acceleration is relatively high to achieve this end. Correctional vectors are minimised usually only involving two dimensions and are not seen as so important many times both directions/sides being manipulated to maximise the stretch effect. The intent is small, the need to become one being irrelevant, visualization being for the purpose of finding the structure to be manipulated and the outcome seen being no bigger than to cavitate a joint or to increase flexibility.

Acupuncture = f ( m × a ) × CV × I2

An acupuncture needle delivers minimal mass with no acceleration, so force is almost absent. The correctional vectors are so important, much care being taken in the location of the needles and in the precision of their insertion. The contact points are very different to a chiropractic adjustment relying on a totally different bodily system. The vitalistic intent of the acupuncturist must be considered equal to that of the principled chiropractor as they too expect great things from their therapeutic modality and it could even be argued that they are bolder in their therapeutic claims.

What differentiates a great adjustment from a bad adjustment? The adjustment with “that something extra” requires a precise combination of the secret ingredients…

Great Adjustment = f ( m × a ) × CV × I2

Bad Adjustment = f ( m × a ) × CV × I2

Keys to the adjustment with “that something extra”…

  • Maximise acceleration and minimise Mass.
  • Utilise a precise system to determine the most effective combination of contact point and correctional vectors.
  • Maximise Intent by respecting and perceiving the connection between you and your practice member, visualizing every aspect of your analysis and correction, and having a clear picture of the intended outcomes.

Click Here To Find Out More About TRT Training…

CHIROPRACTIC EVOLUTION

Tuesday, July 3rd, 2007

Through the mid-nineties pivotal chiropractic research was conducted and was published at the beginning of the 21st Century, and yet a large segment of the profession missed it! Why?

1) The findings weren’t published in a peer-reviewed chiropractic journal – they were actually published in two major psychiatric journals; the Journal of Molecular Psychiatry (published by Nature) and the Journal of Psychoactive Drugs: No chiropractor would have received these journals in their post-box.

2) The research involved a patient population commonly ignored by comfortable middle-class chiropractors, namely an addicted population. But this study population was chosen for very specific scientific reasons – they biogenetically possess an inability to achieve a state of wellbeing.

Why was this research potentially so paradigm shifting for the chiropractic profession?

1) The design of the study was overseen by a leading medical biostatistician from the University of Miami, School of Medicine: Nothing was included in the study unless it stood up to his rigorous statistical and evidence-based standards.

2) The study involved randomization, and all of the scientific design expected of longitudinal clinical research, and, three-arms – not just active treatment and control groups, but also a placebo-control group.

3) The acceptance and rejection of various chiropractic examination procedures which lead to a short-list of evidence-based indicators of Subluxation, ultimately synthesizing a technique for analyzing and differentially diagnosing a Primary Subluxation.

4) The need to design an adjusting instrument that provided true reproducibility of the adjustive thrust and the vectors of the classic chiropractic adjustment – the Toggle Recoil.

5) Acceptance of the research results by peer review panels far more rigorous and skeptical than normal chiropractic peer review.

6) A documentary featured on Discovery Health Channel highlighting the findings of the research and giving chiropractic a glowing review.

What was so impressive about the results? To understand this we need to tell you a little about the clients accepted into the trial: These were recovering addicts with many substance-abusing habits, who were undergoing normal 30-day withdrawal in an in-patient facility… Nasty stuff: Major withdrawals, cravings, severe physical and mental symptoms, abstinence-based challenges… all going on at the same time. What happened when they received specific chiropractic adjustments?

1) They finished the program: The gold-standard of recovery is how many clients make it to the end of the thirty days? Good rehab facilities achieve somewhere around 70% retention. When they were adjusted as well, the retention rate increased to 100%… That’s right no-one left! In recovery circles it is common knowledge that if someone drops out of care it isn’t because they’ve started a new job, or had a miraculous healing and didn’t need to hang around. No, they’ll usually be back in their old haunts doing the same old stuff. This finding is huge – if they stayed they must have been doing really well.

2) Their anxiety levels dropped dramatically: This research project didn’t just measure one outcome, it also utilized internationally accepted state of wellbeing questionnaires: When the clients were adjusted the Spielberger’s State of Anxiety Test scores dropped the same amount that it normally takes six months of standard care to achieve.

3) Their depression levels dropped markedly. When the clients were adjusted the Beck’s depression inventory scores dropped the same amount that it normally takes twelve months of standard care to achieve.

4) They didn’t need the usual nursing and first-aid measures demanded by this population. Nursing station visits are actually the biggest overheads in running a rehab facility: When the clients were adjusted only 9% needed to make any nursing station visits – the placebo and normal care groups made visits in 56% and 48% of cases respectively (that’s right the placebo group was more miserable than the normal care group – so much for the argument that chiropractic is a good placebo – this suggest it’s actually a “nocebo”!)

Now wait a minute I hear many of you saying – “I have no interest in treating drug addicts in my practice, so why would I want to learn a technique to treat them?”

Here is the point… the CHIROPRACTIC IN THIS STUDY DID NOT TREAT ADDICTION, IT ADJUSTED SUBLUXATIONS. The in-patient program treated the addiction with the normal abstinence strategies, group therapy, counseling etc. The chiropractic produced massive increases in state of wellbeing, helping the recovery to be more effective. You need to learn how to produce such massive increases in state of wellbeing to, in all of your practice members…

Isn’t this what great chiropractic is about? We don’t fix them, but when we adjust them their body’s healing and recuperative processes are exponentially released to fulfill their true potential – great chiropractic that is…

So why would you learn Torque Release Technique the chiropractic model that evolved through this scientific process?

1) Wouldn’t you love your client retention to reach record proportions? There’s only one thing that really increases retention – RESULTS. You might be a great salesperson and be able to coerce people into hanging around, but when they FEEL the benefits they don’t need any convincing.

2) No-one refers like an excited customer: Do you think that massive changes in emotional and mental status would excite your clients? When their back pain’s gone they quickly forget why they are coming to see you: But when the lights get turned on every adjustment, you’ll be impressed when they start to ask if it is alright for them to regularly come back for more, and and can they bring someone else with them?

3) If we are truly a wellness profession, then our clients’ dependence on symptomatic and crisis care should start to vanish. How thankful do you think your clients will be when they notice how they aren’t spending so much on panadol, panadeine and nurofen, and they no longer have to spend ages sitting in the MD’s waiting room with all those miserably infectious people? How much easier will your practice hours be when no-one is winging and whining about their latest ache?

4) Wouldn’t you like to get to the end of the day after having seen more clients than ever before, and not be emotionally and physically spent? With TRT you can speed up your decision making, reduce the number of adjustments per visit, and minimise all the extra stuff you do trying to hit the right spot.

5) So you can be sure you are using the most evidence-based technique ever available to the chiropractic profession. Make sure you have total proficiency in the procedures accepted by one of medicine’s top biostatisticians – discover if you’re wasting your time doing stuff that was rejected?

6) So you can access the Integrator Adjusting Instrument, the only instrument with pre-loading, recoil, torque, stunningly high speed (1/10,000 sec), low force, and neurologically-based impulse frequency.

7) To be trained in the technique that provides you with the vitalistic, tonal, non-linear, neurologically-based adjusting technique to go hand-in-hand with your vitalistic chiropractic philosophy – Leave behind the mechanistic methods that have held back chiropractic practice in the twentieth century.