CHIROPRACTIC EXCELLENCE

The Million Dollar Question

Many of us now call ourselves “Wellness DCs” or “Healthy Lifestyle Doctors” or some other impressive sounding title - I guess we are trying to differentiate our services from the other “garden variety” DCs? But these titles often are a reflection of us, and not a true reflection of how our customers really see us, or how they themselves behave. Maybe we exercise regularly, get adjusted every 1-2 weeks, keep a positive outlook, eat organic etc. But then we have 80% of our practice on monthly schedules, and have no discernable influence on their other healthy habits?

I suffered a daunting revelation when I upgraded my technique and scheduling systems to a more “wellness” driven focus. You see I used to spend ~15 minutes with each client, and they loved my soft-tissue techniques, and often complimented me on my ability to find the sore spots and to provide instantaneous relief from their musculoskeletal aches and pains. Not that there is anything wrong with this - but my mission is to improve the health and wellness of everyone that I can influence - not to be the natural alternative to Nurofen and Panadeine. And when I changed my technique to a neurological model, many left the practice before they could possibly experience the extra health benefits - why? “Because I didn’t rub their shoulders”!

So, what do YOUR clients really think of YOU? Here is the million dollar question to ask your practice members that will inform you of the truth…

“If you could come and have an adjustment whenever you wanted to, and it didn’t cost you anything, how often would you come?”

1) If the answer is, “Oh I’d come every single week, and sometimes even more”: Congratulations - you probably are truly a wellness DC - your clients truly comprehend the global benefits of an adjustment. They probably perceive the reduction in tension and stress, the improved sleep patterns, the maximised immunity, and the increases in energy after each adjustment.

2) “Oh, I’d come every 4-6 weeks”: Maybe you should replace the title “Wellness” with “Maintenance” DC. Your clients have probably discovered that if they go longer than 4-6 weeks, that their aches and pains start to increase in severity and regularity. Your periodical adjustments offer them effective and lasting pain relief.

3) “Oh, I’d come a 2-3 times a year”: I actually don’t quite understand this concept - maybe it’s because they get their car serviced twice a year, and go to the dentist twice a year, and floss their teeth twice a year, and make love twice a year? I’m not sure of what possible benefit two adjustments per year could have - maybe I underestimate the power of an adjustment?

4) “Oh, I’d come in whenever I had a problem”: Whoops, if you get a lot of this answer, then it is time to change your title to “garden variety DC”.

To take this question to the next level: If your practice members answer that they would like to come more often than they actually do - the next question to ask is - “What do we need to do to help you come as often as you would really like to?” - now its time to work out a strategy, schedule, fee, that makes their dream a reality…

Click Here To Find Out More About Practice Change Coaching…

Imagine if every Australian was allowed to receive one adjustment per week, and that adjustment was covered under Medicare? But here’s the condition: You can only deliver one adjustment per week, per person, and you have to demonstrate the measure benefits of those adjustments every three months using impartial objective outcome tools. I guess there would be a minority of DCs who would think they had found easy street and delivered any old adjustment, in any old fashion, without much consideration for where or how they delivered that adjustment - just so long as the cheques kept rolling in. But for the rest of us, we would want to be completely diligent in ensuring that this one adjustment was a good one, a really good one, and that we adjusted the segment which most needed to be adjusted, and in the right direction because you can’t just hit it on both sides - you only get one shot!!

Think about this in the context of how you currently prioritise how you deliver your adjustments each and every day:

1) Do you start at the bottom and work your way up, or some other variation of this theme? Check and adjust the low back, check and adjust the thoracics, then roll them over and check and adjust their neck? Most DCs have an order in which they adjust everyone. It may not be the order I mentioned, but in most cases it will be a “routine” based on the practitioner’s habit as opposed to some patient-centred findings dictating where you start and finish. STOP IT: Take an extra few seconds to analyse your patients’ spines and make a decision about which is the most important adjustment to make on that visit.

2) Do you adjust the same segments in the same order, any three visits in a row? I thought your practice members were supposed to be getting better and progressing to a new level of health - why then would they continue to have the same subluxations? If you are activating retracing in their body then surely the next layer of subluxation should appear and need to be corrected? And, since they last saw you a lot of different stresses have presented, so they may have a new and different layer appearing on the next visit. Why do we say that the body is a self-healing adaptive organism and then fail to adapt and change our adjustments to keep up? BEWARE: If you check your notes and see that patients are getting the same mix of adjustments on every visit then there’s only two options - A) you put the stuck pattern there with your repetitive habituating stimulus, or, B) their spine isn’t evolving under your care - either way you need to try a new strategy.

3) Do you have a system that allows you to make a live analysis and differential diagnosis of which subluxation wants to be adjusted at any given moment in time? When we teach TRT we show you 14 different indicators of subluxation and train you in the differential diagnosis technique that gives you absolute certainty and precision in making this vital decision…

Click Here To Find Out More About TRT Training…

An interesting question arising from my hypothetical above is for our profession as wellness providers. I used the weekly example based on the observation that:

1) If I could get adjusted as often as I liked I would probably get an adjustment every week;

2) I conducted a highly informal survey of a group of my practice members when I asked them “if you could get adjusted whenever you liked and it didn’t cost you anything, how often would you get adjusted?” The most common reply was “I’d come every week”;

3) I have been using functional assessment technologies in my practice for over a decade and have observed qualitatively and quantitatively the biggest changes when clients are getting adjusted weekly (go beyond three weeks and you will see a significant percentage of clients start to deteriorate functionally);

4) Many chiropractors I have met who claim to be wellness DCs get adjusted weekly and recommend weekly adjustments.

But, how much would this cost the community if every man, woman and child was adjusted weekly: Using the round figure of 20 million people and $40 per adjustment, that comes to $800 million per week.

Here’s the ultimate challenge: We would have to be able to demonstrate without a shadow of a doubt that we were saving the Australian economy at least $1 Billion per week? Can we do this? Your thoughts are welcome…

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.

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…

“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…

1. Speeds up your decision making – provides an extremely fast assessment process that delivers absolute certainty that you are adjusting each client exactly where they need to be adjusted on each and every visit.
2. Is so much easier on their own bodies – are you paying a personal physical and emotional price for the healing that you provide to others? Why not upgrade to a new-generation technique that is easy on your body and mind?
3. Provides an extremely effective low-force adjusting strategy – If you are like me, you may have steered away from instrument and low-force adjusting because you perceive it to be inferior to manual adjusting. The Integrator actually provides you with specifications that surpass manual adjustment – higher speed, greater specificity, recoil and torque, pre-loading mechanism to make every adjustment reproducible and consistent, exact correctional vectors, true adjustment for force, can deliver adjustments with spine in neutral posture to reduce iatrogenic risks.
4. Helps make the quantum shift to a neurologically-based system – You may think in your own mind, that when you produce a cavitation in your practice members’ subluxated spine, that you are releasing the flow of the mental impulse: But in most of your patient’s minds, they think you are cracking their back to stretch their stiff and sore bones… This is a sad but true fact about public perception. But, the good news is that when you shift to an assessment process which utilises neurological indicators, and adjust with an instrument that has been designed to initiate neurological change; it becomes so much easier to shift your practice members’ understanding to the fact that you are a nerve doctor, and not a back doctor.
5. Allows them to see more clients in less time – Speed up your assessment and clinical decision making, reduce the number of adjustments you perform on each visit, cut back on the extra stuff that you do out of habit as opposed to clinical necessity – All this translates to increased productivity and profitability, and decreased time wastage and brain drain.
6. Opens up your practice world to the emotional component of Subluxation – You don’t have to become a counsellor, but when more of your clients experience emotional, mental and even spiritual change following their adjustments, they’ll want to tell you about it. They’ll also want to tell their friends, family and colleagues about it; and usually what happens in a TRT practice is you become inundated with folks desiring and experiencing the same changes.
7. It fits snugly into a wellness paradigm - Chiropractic has succeeded in positioning its identity in the community: The average person on the street, the local GP, other health care professionals, and your local media all think you treat sore backs reasonably effectively, and then try to keep them coming back for no particular reason. If you want to reposition yourself as a “wellness” provider then you are going to have to appear very different; and your “product” or “unique selling proposition” needs to appear cutting-edge, exciting and modern. TRT fulfils all of these criteria – you’ll actually find your practice members asking “I know this is really great for my total health and energy, and I don’t seem to get sick very often anymore, but if I develop a sore back should I still come and see you, or should I go to one of those old-style chiros?”
8. It’s actually becomes easy to write a case study – Because the protocols of TRT analysis are well documented and consistent, because you learn neurological indicators that can be documented and even quantified, and because you seem to attract more diverse clinical presentations, most DCs find themselves having a steady stream of cases that can easily be written up and published.