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WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
YOUR PRACTICE PARTNER
                           Issue 1: January 20, 2020 chiroeco.com

WELLNESS
 CLINICS
Moving Chiropractic into 2020
   CBD for     New DME         Point-Counterpoint:
Inflammation   Rules on             Pediatric
 and Anxiety    Horizon           Chiropractic
WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure, or prevent any disease.

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WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
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WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
V O L U M E 6 6 , I S S U E 1 • J A N U A R Y 2 0 , 2 0 2 0 • TA B L E O F C O N T E N T S

                                                  FEATUREDCONTENT
                                                  18 Positioning chiropractic for                                                                               52 Case study: Modern chiropractic,
                                                  wellness in 2020                                                                                              laser therapy helps powerlifter to record year
                                                  The industry needs to shore itself up on                                                                      Formerly-debilitated patient returns to competition at age 71
                                                  several fronts to enter the mainstream                                                                        BY JEROME RERUCHA, DC, BS, CSCS, CHPS
                                                  BY TIMOTHY J. BURKHART, DC, BCIM, AND
                                                  RYAN M. BURKHART, BS, DC
                                                                                                                                                                70 Book reviews, latest releases
                                                                                                                                                                8 books by chiropractors, for chiropractors
                                                  40 How CBD supports health during pain,                                                                       BY CHIROPRACTIC ECONOMICS STAFF
                                                  inflammation, anxiety and more
                                                  An endocannabinoid deficiency can result
                                                  in a host of patient afflictions                                                                              76 Buyers Guide: Supplies
                                                  BY CHRIS D. MELETIS, ND

                                                  PROFESSIONALDEVELOPMENT
                                                  ST U D E N T D C
                                                  64 Mentoring benefits the mentor and mentee                                                                72 Point-Counterpoint: Pediatric Chiropractic
                                                  From CAs to office staff to fellow DCs, mentoring and finding
                                                  a mentor has wide-ranging benefits to the profession
                                                  BY GARY BORING, DC, BCOA, LCP (HON.), FICA

                                                  PERFECTPRACTICE
                                                  C L I N I C A L CO N C E R N S                                                                             P R AC T I C E C E N T R A L

                                                  28 Lower extremities and                                                                                   46 How to avoid burnout
                                                                                                                                                             Follow these tips to extend your career
                                                  whole-body wellness                                                                                        and retire on your own terms
                                                  Even a neck or upper-back issue can start at the feet                                                      BY JAMES R. FEDICH, DC
                                                  BY KEVIN WONG, DC

                                                                                                                                                             F I N A N C I A L A DV I C E
                                                  34 Chiropractors beware                                                                                    58 2020 Medicare DME changes
                                                  Employment laws that formerly exempted
                                                  small offices are changing                                                                                 and chiropractic
                                                  BY KEITH GUTSTEIN AND KAITLIN SILLETTI                                                                     New competitive regional DME provider bidding on
                                                                                                                                                             patient care is coming — how to minimize the impact
                                                                                                                                                             BY CHIROPRACTIC ECONOMICS STAFF

 “DCs are uniquely positioned to
help address the growing opioid
   crisis, skyrocketing health care
  costs, generally poor allopathic                BACKLOG                                                                                                         EVERYISSUE
management of musculoskeletal                     14 H ealth News, New                                                                                             8 Letter from the Editor
                                                       Technology, Awards
        injuries, and chronic pain.”                   & Practice Advice
                                                                                                                                                                   10	ChiroEco.com Resources
     ­— Jason Garrett, DC, managing vice
                                                                                                                                                                  74 Product Showcase
                                                  14 Don’t-Miss Events
                                                                                                                                                                  76 Buyers Guide
                    president of Airrosti         15 	By The Numbers:
                                                       Wellness                                                                                                   84 Datebook
                                                  15 Staff Product Pick                                                                                           86 Marketplace
                                                  15 Profitable Practice                                                                                          88 Ad Index

                                                  PHOTO CREDITS: ALL IMAGES ARE FROM ADOBESTOCK.COM UNLESS OTHERWISE NOTED.

                                                  Chiropractic Economics (ISSN 1087-1985) (USPS 019-178) is published monthly except semi-monthly (twice a month) in January, February, April, May, June, August, September, and October; 20 issues annually.
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6     CHIROPRACTIC ECONOMICS                •   JANUARY 20, 2020                                                                                                                                                          CHIROECO.COM
WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
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WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
LETTER FROM THE EDITOR
                                      NEW POLL SHOWS THE                               “...AMONG GENERAL AND FAMILY PRACTICE PHYSICIANS,
                                      LANDSCAPE HAS CHANGED?
                                                                                       THE MOST COMMONLY-RECOMMENDED WAS CHIROPRACTIC
                                      We are in the midst of an inte-                  OR OSTEOPATHIC MANIPULATION...”
                                      grated medicine revolution where
                                      MD slander and attacks on chiro-                 reason: doctors were prescribing — and the industry was supplying
                                      practic, for the most part, are being            — stronger pills.”
                                      cast aside in the best interests of                 Also introduced last year was The Chiropractic Medicare Coverage
                                      patients. We’re increasingly seeing              Modernization Act of 2019, which could align Medicare’s coverage of
                                      MDs, DCs, PTs, etc., working side by             chiropractic services with other federal health care providers.
                                      side in facilities that have broken
LET ME KNOW WHAT’S                    down the walls of health care.                   New poll shows changing attitudes
ON YOUR MIND:                                                                          But perhaps the best news for integrated medicine and chiro-
EDITORIAL@CHIROECO.COM                MD attack dogs still remain                      practic emerged last month when a study published in the Journal
                                   The AMA for years waged a coordi-                   of Alternative and Complementary Medicine revealed that U.S.
      nated campaign to destroy chiropractic, “a plan of containment                   physicians were recommending CHAs (complementary health
      and elimination by the American Medical Association” that                        approaches) to their patients at a significantly-increased rate.
      became embedded in its MD membership.¹                                              The 2012 Physician Induction Interview of the National
         This coordinated effort and mis-education is largely aging                    Ambulatory Medical Care Survey was used to assess whether
      out of the profession, but is unfortunately continued today                      U.S. physicians recommend CHAs to their patients, and showed
      by a handful of MDs through coordinated websites such                            that among general and family practice physicians, the top most-
      as ScienceBasedMedicine.org and PainScience.com. In a                            commonly-recommended CHA was chiropractic or osteopathic
      review of the book The Medical War Against Chiropractors,                        manipulation (54%). “These findings may enable consumers,
      ScienceBasedMedicine.org itself admitted, “The AMA did some                      physicians, and medical schools to better understand potential
      very regrettable things. They used inappropriate language,                       differences in use of CHAs with patients,” the authors write. And
      referring to chiropractors as rabid dogs. They attacked                          surely the numbers have advanced additionally over the last eight
      chiropractors as killers without any supporting evidence. Their                  years since the survey.
      intent was to destroy chiropractic. They tried to conceal what                      These findings may also indicate that a new generation of
      they were doing. Their biggest mistake was to prohibit MDs from                  doctors, like their patients, are ready and willing to embrace an
      associating with chiropractors … The AMA distributed ‘Quack                      integrated care and wellness approach that is patient-centered.
      Packs’ and 10,000 copies of an anti-chiropractic book…”²                         We’re 33 years removed from United States District Judge Susan
         The remaining modern attacks by these websites end up in                      Getzendanner ruling that the AMA and its codefendants were guilty
      publications such as Forbes, the Washington Post and Wired,                      of violating the Sherman Antitrust Act and that in the ruling “the
      and on television on CNN and Dr. Oz. The industry’s Foundation                   AMA decided to contain and eliminate chiropractic as a profession”
      for Chiropractic Progress (F4CP) responded to all these outlets’                 and “to destroy a competitor.”
      attacks in 2019, refuting false claims with facts.                                  As all health care entities in 2020 deal with a difficult, ever-
                                                                                       changing landscape, statistics show we’re moving on from turf
      The good news … and more good news                                               battles to find ideal multidisciplinary solutions for patient care.
      In 2019 we saw the U.S. government recommend opioid patients
      referred to DCs for pain management, and a crackdown on                          To your practice’s success,
      opioid manufacturers who recruited and encouraged some MDs
      to up their prescriptions to further hook consumers.
         As Fortune reported last year, “In 2012, as the death toll from
      the nation’s opioid crisis mounted, drug companies shipped out                   Richard Vach
      enough of the powerful and addictive painkillers for every man,                  EDITOR-IN-CHIEF
      woman and child in the U.S. to have nearly a 20-day supply. The                  			References available at chiroeco.com.

                       EDITOR-IN-CHIEF                          DIRECTOR OF SALES                        Creighton Blanchard
                       Richard Vach                             Susan Nevins                             904-395-3648
                       rvach@chiroeco.com                       904-567-1554                             cblanchard@chiroeco.com
                                                                snevins@chiroeco.com                     ADVERTISING COORDINATOR
                       ASSOCIATE EDITOR                         NATIONAL ACCOUNT EXECUTIVES              Erisilda Marku                BPA Worldwide Chiropractic Economics’
                       Allison M. Payne                         Janice Ruddiman Long                     904-425-1136                  subscriptions are audited by BPA Worldwide,
                       apayne@thedoylegroup.com                 904-567-1541                             emarku@thedoylegroup.com      the most dominant global media auditing
                                                                jlong@chiroeco.com                                                     company for B2B publications in the world.
                       DIRECTOR OF CREATIVE                                                              BUSINESS &                    BPA certifies that Chiropractic Economics has
                       Elizabeth Blacker                        Jeff Pruitt                              EDITORIAL OFFICES             the highest number of requested readers
                                                                904-567-1542                             820 A1A N, Suite W18
                       eblacker@thedoylegroup.com                                                        Ponte Vedra Beach, FL 32082   in the profession. Chiropractic Economics is
                                                                jpruitt@chiroeco.com                     Phone: 904-285-6020           the only independently audited requested
                                                                                                         Fax: 904-395-9118             publication serving the chiropractic industry.
                       ART DIRECTOR                             Jennifer Jolly                           chiroeco.com
                       Michael Martinson                        904-395-3394
                       mmartinson@thedoylegroup.com             jjolly@chiroeco.com
                                                                                                         FOUNDED 1954
                                                                                                         William L. Luckey and
 8    CHIROPRACTIC ECONOMICS                        •   JANUARY 20, 2020                                 Helen C. Luckey                   CHIROECO.COM
WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
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WELLNESS CLINICS - YOUR PRACTICE PARTNER Issue 1: January 20, 2020 chiroeco.com - Chiropractic Economics
CHIROECO.COM
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 Webinars • Podcasts • Resource Centers • Videos • Job Board • Buyers Guide • Surveys • Industry Research • School Guide • Students • Products & Services • Current News

     TRENDING STORIES                                                                                                                             RESOURCES @CHIROECO.COM

                                                                                                                                                   eBooks
                                                                                                                                                   Visit our eBooks page to see the latest specialty
                                                                                                                                                   publications on cutting-edge topics such as CBD,
                                                                                                                                                   PEMF and clinical nutrition.
 Foundation for                                Life University                            Tendon stem cells                                        ChiroEco.com/chiropractic-ebooks
 Chiropractic Progress                         launches College of                        could revolutionize
 wins gold at 2019                             Online Education                           injury recovery
 PR World Awards                               Life University announced the launch       Once tendons are injured they rarely
                                                                                                                                                   Email Courses
                                               of the College of Online Education,        fully recover, which can result in limited
 In October the Foundation for
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 Chiropractic Progress, a not-for-profit
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 organization dedicated to educating
 the public about chiropractic care,           and around the world a unique,             culprit is fibrous scars, which disrupt                  lessons on business and chiropractic sent straight
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 was named a PR World Award® Gold              personalized educational experience.
                                                                                              Working with Carnegie Institution                    to your inbox.
 Winner in the health care category for             “Our mission and vision to change
 its campaign, “Save Lives, Stop Opioid        the way the world thinks about             for Science’s Tyler Harvey and Sara
                                                                                          Flamenco, Chen-Ming Fan led recent
                                                                                                                                                   ChiroEco.com/chiropractic-ecourses
 Abuse, Choose Chiropractic,” to educate       health, performance and well-being
                                               is too expansive to contain to a single    research that revealed previously
 consumers about the benefits of drug-
                                               physical location,” Life University        undefined tendon stem cells in the
 free chiropractic care.                                                                  patellar tendon; these could potentially
      “Our team worked hard on this wide-
 reaching awareness campaign about …
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                                               in a video message to prospective          be harnessed to improve tendon
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                                                                                                                                                   Podcasts
 how chiropractic care is a safe, effective,   students.
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                                                                                          completely, it was thought that tendon
                                                                                                                                                   chiropractic. Listen on the go.
 S. Greenawalt, founder and chairman of        academic rigor and learning outcomes
 F4CP and CEO of Foot Levelers. “That is       as on-campus classes.
                                                                                          stem cells might not exist,” said Harvey.                ChiroEco.com/podcast
                                                                                          “Many searched for them to no avail,
 why it is gratifying and an honor to be            For more information, visit           but our work defined them for the
 awarded for our efforts and success.”         life.edu/online.                           first time.”
 ChiroEco.com/f4cp-gold-award                  ChiroEco.com/life-online-ed                ChiroEco.com/tendon-stem-cells

  SOCIALMARKETING                                                                                              FACEBOOKQUESTION
  Be known as a one-stop shop                                                                                                          17,014 followers

  for whole-body wellness                                                                                                  What services do you offer patients besides adjustments?
                                                                                                                           What are your most popular of these services?
  Many people think of chiropractors as spine specialists only — so if you are expanding your practice
  with other therapies, use social media marketing to position yourself not only as a spine doctor, but
  also as a practitioner of a whole-body wellness approach.
      Consider all the services your practice currently offers besides adjustments. This may include
  nutrition counseling, weight loss, massage therapy, assisted stretching, chronic pain interventions,
  headache help, muscle and joint injury or disorder treatments, laser therapy, TENS therapy or
  custom orthotics, just to name a few. You probably also carry a range of dietary supplements and
  other retail products.
      Instead of cramming all your products and services into one ad, consider creating specific
  marketing materials for each service you offer, then promote them individually using your social media
  networks. Patients may be coming to your practice for an adjustment and a massage, for example, but
  may not know you can provide them with help losing weight or managing headache pain.
      Use your Twitter, Facebook, Instagram and other social channels for promoting your ancillary
  services, via photos and video clips with appropriate hashtags. Any one of your services could bring
  in a new patient who can then find out all that your practice has to offer.                                     Each month we’ll ask a new question on our Facebook page.
  For more information on social media marketing, visit the Business Tips section of ChiroEco.com.
                                                                                                                     Join the conversation at facebook.com/ChiroEcoMag

  TWITTER DISCUSSION                                                                                           MISSED THE LAST ISSUE?

  What is the best way to educate potential                                                                      2020 BUYERS GUIDE
  patients on the value of chiropractic care?                                                                    The best in chiropractic
                                                                                                                 products, services and
                                                   Use the hashtag #CE65                                         companies serving the
                                                   for the chance to be                                          industry
                                                   featured on our Twitter
                                                   @ChiroEcoMag                                                  ChiroEco.com/magazine

10     CHIROPRACTIC ECONOMICS                              •    JANUARY 20, 2020                                                                                                       CHIROECO.COM
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TOP INSTAGRAM POSTS
                                                                                                            Tag #ChiroEcoMag for your chance to be featured

                                                                                                                                    palmercollege
                                                                                                                                    Are chiropractors real doctors? It’s a question our profession is
                                                                                                                                    asked often so we want to be a part of the solution in educating
                                                                                                                                    the public. The answer is “Yes!”

     chiroecomag
     Life isn’t perfect, but after an adjustment it definitely feels a little closer!

     dc.macphee
     Chiropractic isn’t just for your spine! We treat           chirowell250
     extremities as well. Adjusting the ankle can               Make your appointment with us today. Your health is our             letschalkaboutchiropractic
     help restore mobility and reduce pain.                     TOP priority!                                                       Get adjusted and then TACO ‘BOUT it with someone!

                                                                                        meridian_chiropractic_mn
                                                                                        Bookmark this shoulder stretch for later!

      chamberlainchiro                                                                  drhansen_rhinochiropractic
      I don’t know about who your chiropractor is but I sure know that                  Chiropractic adjustments help to            drbraglia
      the doctors at our office are totally awesome!                                    relieve stress in several ways.             When things change inside you, things change around you too.

12   CHIROPRACTIC ECONOMICS                              •     JANUARY 20, 2020                                                                                                  CHIROECO.COM
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BACKLOG
BACK                                                           CATCHING UP ON THE LATEST NEWS, TRENDS AND
                                                               INNOVATIONS FROM THE CHIROPRACTIC COMMUNITY

     “ONE KEY TO [PATIENT] LIFESTYLE                    CHIROPR AC TIC N E WS
     CHANGES IS EDUCATION. IT IS OUR
     RESPONSIBILITY TO INTERPRET                        New UnitedHealthcare benefit for low-back pain
     CURRENT HEALTH INFORMATION,                        reduces invasive procedures, addresses opioid epidemic
     EVALUATE THAT INFORMATION AND
     PROVIDE OUR PATIENTS THE HIGHEST                   On Oct. 29, UnitedHealthcare announced a
     QUALITY CARE…NO MATTER WHAT                        new benefit for people with acute low-back
     THE LEVEL OF AN INDIVIDUAL’S                       pain that makes it more affordable to access
     HEALTH, WE CAN IMPROVE UPON IT.”                   physical therapy and chiropractic care,
                                                        helping to improve health outcomes, reduce
     — SHANE SILVER, DC,
     ON CHIROPRACTIC AND WELLNESS                       costs and avoid often unnecessary invasive
                                                        treatments and opioid prescriptions.

      DON’T MISS
      CONFE RE NCES                                        With this new benefit design, plan
      Parker Seminars Las Vegas                         participants enrolled in certain employer-
      February 6-8 • Las Vegas, NV                      sponsored health plans can pay $0 out-
      The Expo Hall at Parker Seminars in               of-pocket (waived deductible or copay) if
      Las Vegas will showcase more than                 they select physical therapy or chiropractic
      200 industry-leading companies                    care for the treatment of low-back pain,            noninvasive treatments such as physical
      displaying the latest advancements and            helping encourage people to choose these            therapy and chiropractic care. For example,
      technology that will allow chiropractors          noninvasive options.*                               people with a co-pay of more than $30 were
      to stay ahead of the competition.                    Based on a UnitedHealthcare analysis, by         29% less likely to see a physical therapist
      This year the theme is Mastery, so                2021 this benefit design has the potential to       than patients whose co-pay was $0. There
      join industry movers and shakers for              reduce the number of spinal imaging tests           was a similar correlation between deductible
      a weekend of education, networking,               by 22%, spinal surgeries by 21%, opioid use         and choice of physical therapy as the care
      entertainment and much more.                      by 19%, and lower the total cost of care for        option for low-back pain, according to a
                                                        eligible plan participants and employers.1          recent study published in The American
      Activator Methods International:                     “This new benefit design may help                Journal of Managed Care.
      Hawaii Seminar                                    encourage people with low-back pain [to] get           Nearly 70% of people experience low-
      February 22-23 • Honolulu, HI                     the right care at the right time and in the right   back pain at least once in their lifetime, and
      The Hyatt Regency Waikiki Beach                   setting, helping expand access to evidence-         about one-quarter of adults in the United
      Resort & Spa hosts the seminar,                   based and more affordable treatments,” said         States report experiencing the condition in
      featuring clinical topics such as Internal        Anne Docimo, MD, UnitedHealthcare chief             the past three months.2, 3 Despite clinical
      & External Rotation of the Proximal               medical officer. “With millions of Americans        recommendations against it, opioids are
      Tibia, Anterior, and Posterior Proximal           experiencing low-back pain currently or             prescribed for nearly 9% of new back-
      Tibia; Inferior, Lateral & Medial Patella;        at some point during their lifetimes, we            pain cases, with this condition ranking as
      Inferior First Metatarsal and Inferior            believe this benefit design will help make a        the most common reason for an opioid
      Medial First Cuneiform, Inferior                  meaningful difference by improving health           prescription.4
      Metatarsal Heads; About the Shoulder,             outcomes while reducing costs.”                        To treat low-back pain, the American
      Frozen Shoulder Syndrome, Rotator Cuff               The benefit covers, at no additional out-        College of Physicians (ACP) recommends
      Involvement; and more.                            of-pocket cost, three physical therapy or           exercise and the use of non-pharmacologic
                                                        chiropractic visits, along with additional          and non-surgical approaches including
      WEBINAR                                           visits normally covered under the plan, to          physical therapy, chiropractic care,
      CBD to Support Pain and                           a qualified care provider. This design helps        acupuncture and nonsteroidal anti-
      Inflammation, Adrenal                             make it more affordable for people with             inflammatory drugs.5
      Fatigue, and Anxiety                              low-back pain to obtain treatment from                 * Eligible plan participants must have
      On Demand                                         chiropractors and physical therapists in            remaining physical therapy or chiropractic
      Dr. Chris Meletis helps separate the              UnitedHealthcare’s network.                         visits under their plan; the new benefit design
      hype from the science, helping DCs                   The benefit design was informed by               does not increase the maximum number of
      thrive with insights into how the                 a recent analysis by OptumLabs and the              covered physical therapy or chiropractic visits
      endocannabinoid system functions.                 Boston University School of Public Health           per year.
      Watch now at ChiroEco.com/cbdpain.                that showed higher out-of-pocket costs
                                                        made it less likely for patients with low-back      Read more: ChiroEco.com/new-uhc-benefit
      Learn more at ChiroEco.com/events.                pain to choose clinically-recommended                    References can be found online at chiroeco.com

14   CHIROPRACTIC ECONOMICS                  •     JANUARY 20, 2020                                                                      CHIROECO.COM
INDUSTRY NEWS                                                                                      BY THE NUMBERS:
Manual therapy providers
attend spine conference
                                                                             WELLNESS
                                                “For the last three years, life expectancy in the United States, the richest
                                                   nation on Earth, has declined. This decline in life expectancy is being
                                                     driven by rising death rates in young and middle-aged Americans.”

                                                                                                   57%
                                                                                                                                     — The Washington Post

More than 160 members of the chiropractic,
physical therapy and osteopathic professions
forged a new spirit of cooperation and                                                                             Americans who see sleep as a
understanding during the Interprofessional                                                                          “luxury” and not a necessity
Collaborative Spine Conference (ICSC), which                                                                              Source: National Sleep Foundation

                                                678,000
took place Nov. 8-9 in Pittsburgh, Pa.

   Organizers of this event hope to enhance
patient outcomes as well as increase            People who die each year due to an unhealthy diet
integration of manual therapies for back pain              Source: The Center for Science in the Public Interest

                                                     $15,000
in the wake of the ongoing opioid crisis.
   ICSC was organized and hosted by the
American Chiropractic Association, with
the support of the American Academy of
Orthopaedic Manual Physical Therapists and
the Academy of Orthopaedic Physical Therapy,
which represent three of the major provider
groups of non-drug manual therapies for pain.
   Manual therapies such as spinal                                      Approximate health care costs per U.S. employee annually
                                                                                                     Source: National Business Group on Health

                                                3outof4
manipulation, physical therapy modalities,
massage and acupuncture have received
increased attention and support in recent
years from the Centers for Disease Control
and Prevention and the American College
of Family Physicians for their ability to
effectively manage many cases of back pain
and in some cases reduce or alleviate the
need for prescription opioids.                       Employers who say health care apps have
   “The chiropractic profession was honored           increased their employee participation

                                                  367%
                                                                 Source: National Business Group on Health
to take part in the Interprofessional
Collaborative Spine Conference,” said Michele
Maiers, DC, MPH, PhD, vice president of the
ACA. “We are committed to working together
with our colleagues in physical therapy and
osteopathy to raise awareness and promote
integration of non-drug manual approaches.”

Read more: ChiroEco.com/icsc
                                                                         Increase in internet searches for CBD information in 2019
                                                                                                                   Source: Gear Hungry

CHIROECO.COM                                                          JANUARY 20, 2020                     •       CHIROPRACTIC ECONOMICS                     15
BACKLOG
BACK
     SCHOOL NEWS                                                                                                                   STAFF PICK
     Palmer College of Chiropractic opens new student clinic

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     nearly $20 million in capital projects at its                  Dennis Marchiori, DC, PhD, chancellor and
     main campus in the Quad Cities, the school                     CEO. “The Palmer Chiropractic Student Clinic                   Why you should choose this product
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                                                                    offering 25 treatment rooms. It will also be                   makes it simple for you to start with a small
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        The $3.4 million expansion of the existing                  imaging interpretation. One-hundred-inch                       company also offers gummies in sour bear or
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        “We’ve been quietly working on this project
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     for the past year, creating a student clinic that

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         IASTM provides multiple benefits, some of which include “an increase in blood flow, reduction in
     tissue viscosity, myofascial release, interruption of pain receptors, and improvements of flexibility of
     underlying tissue,” according to a systematic review published in Physical Therapy Reviews in 2017.
         Studies such as these highlight the effectiveness of IASTM for tennis elbow and other chronic
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         “Every practitioner wants to improve the overall health and function of their patients,” says
     IASTM practitioner Shannon Turek, DC. “IASTM alone, or better yet in conjunction with other
     therapies such as spinal adjustments, can help achieve that mission.”
     To learn more, go to Chiropractic Economics’ Sports Chiropractic resource center at chiroeco.com/sports-chiropractic-guide.

16   CHIROPRACTIC ECONOMICS                         •    JANUARY 20, 2020                                                                                     CHIROECO.COM
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18   CHIROPRACTIC ECONOMICS   •   JANUARY 20, 2020   CHIROECO.COM
FEATURESTORY

POSITIONING
CHIROPRACTIC FOR
WELLNESS IN 2020
The industry needs to shore itself up
on several fronts to enter the mainstream
B Y T I M O T H Y J . B U R K H A R T, D C , B C I M , A N D R YA N M . B U R K H A R T, B S , D C

TIME TO READ: 10-12 MIN.

 T H E TA K E A W AY
 DCs adopting new technologies and techniques to expand practices into wellness can further propel chiropractic into the mainstream. Every DC
 should be open to utilizing advanced therapies as well as educating patients and the public as to the benefits of regular chiropractic treatment.

AS AN ALTERNATIVE TO TRADITIONAL MEDICINE, AN INCREASING NUMBER OF PEOPLE ARE SEEKING

CHIROPRACTIC CARE CENTERED AROUND WELLNESS AS WELL AS SPINAL-RELATED COMPLAINTS.

   Chiropractic wellness care can foster lasting value through improved bodily function, a welcome

change from drugs, surgery, basic biometric screening and late intervention offered by allopathic

counterparts. Standard medical recommendations for back pain, such as bed rest and medication,

have been shown to be ineffective. Incorporating chiropractic care and other conservative options

allows for improved outcomes that last.1

   Growing public awareness and compelling research are creating multiple opportunities in the health

care marketplace for doctors of chiropractic.
CHIROECO.COM                                                                        JANUARY 20, 2020            •   CHIROPRACTIC ECONOMICS           19
FEATURESTORY

           Most individuals seeking chiropractic care will require
         management rather than a singular intervention. Working
       together with you, patients who are informed, committed to
       their care plan, and want to avoid the dangers of drugs and
              surgery are those chiropractic care serves best.
     A bigger pond to fish in                                             Becoming the leading force
     Governing agencies and insurance companies are helping to            From a wellness standpoint, the understated power of the body
     create a larger marketplace for chiropractors in the field of pain   to heal itself and the lack of long-term outcomes noted with
     management. Data collected by large health systems across            allopathic interventions is the strength of chiropractic.5 A greater
     the United States confirm the benefits of a natural approach         role of non-invasive care for chiropractors will allow for patients
     compared to drugs and surgery. Research presented by the             to avoid devastating outcomes associated with medicine and
     American Academy of Pain Medicine suggests that chiroprac-           spinal surgery.
     tors can play an important role combating the opioid epidemic           Chiropractic should be a leading force for non-surgical and
     in America, and one recent study found a 50% reduction in            drug-free approaches. The profession is poised to fill this niche
     filled opioid prescriptions for patients who utilized chiropractic   through both traditional manual treatment and utilizing state-
     services for pain management.2 This echoes many previous             of-the-art equipment. Optimizing each individual practice for
     studies, which show how utilizing chiropractors as primary care      excellence might mean updating equipment, adding a new
     providers reduces the likelihood of undergoing spinal surgery        technique, or utilizing advanced therapies. Reading trade
     and incurring additional health care costs.3-4                       magazines or attending conventions can assist doctors in
                                                                          determining which protocol or device could be the best fit for

20   CHIROPRACTIC ECONOMICS             •   JANUARY 20, 2020                                                                CHIROECO.COM
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FEATURESTORY

       The validity and value of treatment is not determined by the
        patient, insurance company or even Medicare policy. Value
            and the care plan are determined by the clinician.
     his or her practice. Every doctor of chiropractic should be open   Barriers to advancement
     to adopting new technologies and techniques to provide better      Despite the advancement seen in the chiropractic profession,
     measurable outcomes and proven results. Providing a better         there are still barriers that limit practice to the fullest. The most
     way for our communities begins with excellent care through         common barrier is misconceptions. Often due to a lack of educa-
     great results and building relationships.                          tion, many patients perceive chiropractors as the doctor who
                                                                        “cracks bones back into place.”
     Technology will lead the way                                          Furthermore, we are sometimes labeled as quasi-scientific,
     Great strides are already being made in chiropractic to provide    unessential, expensive or outright scammers despite little basis
     the best outcomes with repeatable treatment protocols. Many        for these accusations. As a profession, doctors of chiropractic
     clinics are now adopting and utilizing app-based software or       should avoid making concessions in patient education that
     smart devices.                                                     support these views or devalue our services. It is our job as
        This disruptive technology, applied with adjusting or           providers to tell both existing and new patients the benefits of
     traditional manual care, allows for treatment to become more       treatment.
     potent and efficient.6 Enhanced technology also shapes our            Whether improved bodily function, reduction in frequency
     knowledge and understanding of the conditions commonly             and severity of a symptom, or better health, there should be an
     treated in practice. Advanced imaging provides clarity for soft    aim or goal to care. These objectives should be reviewed every
     tissue evaluation; detecting spondylolysis before displacement,    few visits. This may be accomplished with outcome assessments.
     improved understanding of tendinopathy and arthropathy,            Regular re-evaluations will create an opportunity to reiterate the
     and visualization of disc bulging or herniation. Neurological      progression of care. The outcome of care should be focused on
     evaluation is also boosted through ever-advancing imaging          the measurable rather than the nebulous results. This creates a
     techniques and evaluation. As health care technology continues     purpose behind care, and effort should be made in separating
     to advance, chiropractors should also be adapting clinical         visits with purpose from a redundant appointment without a
     practice to keep pace.                                             clear intention. Doctors and patients both benefit from this
                                                                        consistency in communication and goal-setting.

22   CHIROPRACTIC ECONOMICS            •   JANUARY 20, 2020                                                               CHIROECO.COM
FEATURESTORY

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     “We have two Synergy Total
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     it! They are getting results.                                  The reimbursement barrier                     Communication remains the key
     I especially like the Synergy                                  Another source of compromise common           Regardless of technique or practice style,
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     “I have two Synergy Stations                                   Third-party payers, such as governmental      and evolving. Avoid the pitfall of “simple”
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     Martin Slaughter, DC - Starke, FL
                                                                    care. This is done through the number of
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                                                                    managers from discussing these topics
                                                                    in-office with patients. Regrettably, some
 “Home exercise with advice or training is recom-                   doctors over-exaggerate the extent of an
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24       CHIROPRACTIC ECONOMICS                            •   JANUARY 20, 2020                                                             CHIROECO.COM
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FEATURESTORY

         Instead of relying on the same few [chiropractic] analogies,
          challenge patients to reassess their views on health care.
                       Many patients are misinformed.
     patient can misinterpret this to mean a visit to the chiropractor is                               Follow-up management will build better long-term
     only necessary one or two times per year to optimize their health.                              relationships between the patient and the provider for a lasting
        A common correlation that should change surrounds the                                        outcome that will foster further referrals and improved practice
     intervertebral disc. Is the disc really like a jelly donut? That                                image. This will serve the profession well for 2020 and in the
     equivalence sounds silly. If it really is like a donut, why can’t we                            future.
     get a new donut full of jelly just like at the donut shop? Disc
     physiology, as well as pathology, is far more complex.                                          RYAN M. BURKHART, BS, DC, is committed to delivering innovative
        Comparisons to everyday life are useful to explain ideas                                     health care solutions to maximizing patient quality of life through
     such as misalignment, spinal maintenance and other complex                                      chiropractic care. He is accomplishing this mission through the
     disorders of human physiology. Instead of relying on the same                                   integration of the latest technologies and rehabilitation protocols into
     few analogies, challenge patients to reassess their views on                                    his family practice, Burkhart & Chapp Chiropractic PLC. He graduated
     health care. Many patients are misinformed. After all, a majority                               Summa Cum Laude from Sherman College of Chiropractic and is
     of people accept the concept that putting an addictive chemical                                 a member of the Michigan Association of Chiropractors. He can be
     in their body to relieve pain, for example, is a good idea.                                     contacted through burkhartchappchiropractic.com.

     Follow-up management and wellness                                                               TIMOTHY J. BURKHART, DC, BCIM, has successfully treated thousands
     Advancements in technology and practice, with improved clinical                                 of patients with acute to chronic neck and back pain since 1984. He
     research, allow for care to be cutting-edge. Symptoms are often                                 is an authority on the integration of NSSD into clinical practice. He
     not homogenous in etiology, and patients are more than a label                                  is a member of the ACA and MAC, and serves on the Davenport
     or diagnosis.                                                                                   University Health Professionals Advisory Board. He also developed the
        Most individuals seeking chiropractic care will require                                      Hill DT Solutions certification program. He can be contacted through
     management rather than a singular intervention. Working                                         hilldtsolutions.com.
     together with you, patients who are informed, committed to
     their care plan, and want to avoid the dangers of drugs and                                     Weigh in with your opinion at editorial@chiroeco.com.
     surgery are those chiropractic care serves best.                                                                                                 References can be found online at chiroeco.com

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26   CHIROPRACTIC ECONOMICS             •      JANUARY 20, 2020                                                                                                               CHIROECO.COM
CLINICAL
CONCERNS

     LOWER EXTREMITIES AND
     WHOLE-BODY WELLNESS
     Even a neck or upper-back issue can start at the feet
     BY K E V I N WO N G , D C

     TIME TO READ: 9-10 MIN.

      T H E TA K E A W AY
      Foot issues impact the entire axial kinematic chain, creating muscle issues and general biomechanical instability and stress.
      The feet, ankles, knees, hips and lower back are the first things to check and are intimately related to the upper body parts.

     THE ROOTS OF THE CHIROPRACTIC PROFESSION COME FROM                 listening to them. However, let’s not chase the pain at the
     AND FOCUS ON THE SPINE. It is something we learn very early        expense of finding and fixing the actual cause.
     on in our training and we carry this proudly into practice.
        The power the spine has in helping or hindering the nerve       Whole-body wellness
     impulses coming from our spinal cord to innervate every            Let’s take an average patient who presents to our clinic with
     part of the body is significant. We have all had the chance        lower-back pain. It is the most common reason a patient seeks
     in practice to see how effective adjusting the spine is on         chiropractic care. In fact, we are pigeonholed and stereotyped
     biomechanical and symptomatic relief. In practice, we often        as “back doctors.” That means we are known for treating
     find our patients presenting to us with specific pain. Of course   mostly that area, but that does not mean we treat “only”
     we want to address this pain and show the patient we are           that. Lower-back pain can be caused by or have a significant

28   CHIROPRACTIC ECONOMICS            •   JANUARY 20, 2020                                                             CHIROECO.COM
CLINICALCONCERNS

contributing factor from multiple areas of the lower extremity.
Let’s take a look and break this down so it makes more sense.
  Visualize a patient standing with their back toward you,
barefoot and in anatomical position (Fig. 1).

Figure 1

   You are an artist and the human body is your canvas. A
patient can present with pain in the lower back, pelvis, hips,
knees, ankles, feet — we never know how they will present.
Will it be one area? Will it be all of them? It doesn’t matter how
many parts are painful. It matters that you understand why
they are all painful.
   Because we tend to learn about the body in pieces as we go
through school, we tend to treat the body in pieces in practice.
But I want you to think of the body parts as they all relate to
each other. That’s the key to whole-body wellness.

Start with the foundation
The feet are the foundation of our whole body. You know there
is not just one arch under each foot, as the general population

CHIROECO.COM                                                         JANUARY 20, 2020   •   CHIROPRACTIC ECONOMICS   29
CLINICALCONCERNS

           Once you know how the lower extremity body parts are
           intimately related to the upper body parts, you see the
           patterns of subluxation and misalignment that emerge.
      believes. There are three functional foot arches (medial longi-      Over-pronation of the foot
      tudinal, lateral longitudinal, and transverse) and their main        The three functional arches collapse and cause the foot to
      jobs are to maintain balance and proper weight-bearing prop-         over-pronate. This process happens slowly and silently most
      erties of the feet. In up to 87% of the population, the three        of the time. Yes, we do get cases of plantar fasciitis, meta-
      arches are falling, collapsing or over-pronating. This results in    tarsalgia, neuromas and heel pain, but many of our patients
      their feet flattening.                                               never have any pain in their feet. They have no idea this foot
         Now think about this: Approximately nine out of 10 people in      flattening is occurring. If they feel no pain, they pay it no mind.
      the world have feet that are flat to some degree. The pronation      Once the feet flatten out enough, the force of the pronation
      ranges from mild to severe and usually involves both feet, with      begins to internally rotate the tibia bone.
      one being worse than the other. Flat feet have consequences             The knee cap now feels an inward pull, so it starts to
      biomechanically on the rest of the body. It’s impossible for         track medially within the patello-femoral groove. The inward
      them not to.                                                         rotation of the tibia continues to get stronger and stresses the
         Look at the picture (Fig. 2) and notice this individual who has   femur bone right along with it. As the femur bone experiences
      a left foot that is pronating worse than the right. Follow the       medial rotational stress, the medial knee is now compromised.
      pathway from the over-pronating left foot as it moves up the         ACL, MCL, patello-femoral tracking, meniscus and arthritis
      axial kinematic chain. Let me explain further.                       conditions are often seen here.
                                                                              The fun doesn’t stop there, folks! As the feet get flatter and
                                                                           worsen with time, the medial rotational force on the femur
                                                                           worsens. We now observe stress at the hip, sacroiliac joint
                                                                           and pelvis. Go back up and reference the picture I showed
                                                                           you earlier. Notice that the hips tilt inferior on the side of the
                                                                           flatter foot. You can even feel and observe slight to moderate
                                                                           lateral lumbar spine curvature that will be worse according to
                                                                           how over-pronated the foot is. We began at the bottom of the
                                                                           feet and we have traveled up to the lumbar spine, following the
                                                                           wave of negative effects the excessively-pronated foot inflicts
                                                                           upon the body.

                                                                           The axial kinematic chain
                                                                           When you see this picture, realize that to some degree this
                                                                           represents 80-90% of the patients who walk through your clinic
                                                                           door. You can see the pattern of what the feet do to the rest
                                                                           of the body. You and your patients are living proof of this. You
                                                                           are likely an over-pronator yourself and are no different than
                                                                           your patients. If you take 10 chiropractors, 8-9 of us will be
                                                                           over-pronating.
                                                                              To finish referencing the overall picture, note what is
                                                                           happening above the lumbar area. There is rotational stress
                                                                           on the spine (which happens to cause the misalignments and
                                                                           subluxations you keep finding). The shoulders become unlevel,
                                                                           then round forward, and the neck translates forward. Shoulder
                                                                           pain, neck pain and headaches are just a few of the symptoms
                                                                           we hear patients complain of.
                                                                              Don’t forget that while this process of excessive foot
                                                                           pronation is happening and we see the effects on the entire
                                                                           axial kinematic chain, muscles throughout the body are
                                                                           reacting as well. Patients love telling us about tight muscles,
     Figure 2                                                              muscle spasms and pulled muscles. You and I both know

30   CHIROPRACTIC ECONOMICS             •   JANUARY 20, 2020                                                               CHIROECO.COM
CLINICALCONCERNS

                 Once the feet flatten out enough, the force of the
                 pronation begins to internally rotate the tibia bone.
     tight muscles are indicators of bones that are out of place.      addressed, they have a positive effect on the thoracic and
     Biomechanical instability and stress will create muscle           cervical spine and shoulders.
     problems as well.                                                    I know checking the feet and lower extremity is not the
                                                                       most obvious thing to do — especially if someone is presenting
                                                                       with only neck pain, headaches or shoulder pain. But take one
                                       PERCENTAGE OF                   last look at the picture of the pronating person and now see
                                                                       how much sense it makes. You really don’t have to memorize
                                      THE POPULATION                   anything because you understand it.
                                                                          Once you know how the lower extremity body parts are
                                        AFFLICTED BY                   intimately related to the upper body parts, you see the
                                                                       patterns of subluxation and misalignment that emerge. Once
                                        ARCH ISSUES                    you know the patterns it’s harder to miss the big picture of
                                                                       what is actually the cause of patients’ pain when they come
                                        RESULTING IN                   in to you for care. Please remember: The lower extremities
                                                                       have a profound effect on the entire spine and on whole-
                                      FEET FLATTENING                  body wellness.

     Start low                                                         KEVIN WONG, DC, is an expert on foot analysis, walking and standing
     When you have a patient who has pain in different parts           postures, and orthotics. He discusses spinal and extremity adjusting
     of the body, you should always check the lower extremi-           at speaking engagements and writes for Foot Levelers. He can be
     ties. Once the feet, ankles, knees, hips and lower back are       contacted through orindachiropractic.com.

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