As demonstrated by the beautiful casinos in Vegas....You can't beat the system forever.
Medicare has expressly defined maintenance care and clearly stated it is a non-covered service. Nevertheless, many chiropractors have tried to beat the system and bill for maintenance care (as defined by Medicare---a practice management company's definition is not relevant!).
From the May, 2009 OIG (Office of the Inspector General) Medicare Report
DOWNLOAD THE OIG REPORT
- In 2006, Medicare inappropriately paid $178 million (out of
$466 million) for chiropractic claims for services that medical reviewers
determined to be maintenance therapy ($157 million), miscoded
($11 million), or undocumented ($46 million).
- 47 percent of all allowed chiropractic claims that met study criteria.
Claims representing $36 million had multiple errors
- Efforts to stop payments for maintenance therapy have been largely ineffective.
- 78 percent of those treatment episodes that became maintenance therapy did so by the 20th visit.
- Chiropractors often do not comply with the Manual documentation requirements.
Transformational changes available in a client are directly related to the philosophy, personal experience and tools of the practitioner. As health practitioners it is vitally important to take our awareness into more expansive and exciting areas beyond conditioned, limited belief systems and beyond techniques to provide quicker and greater results with our clients.
Let's accept, for the moment, that there is a creative, universal heart based energy that could be called the Living Library of unlimited resources and knowledge. Wow! And, we are a part of and a replication of that energy in an individualized human form but with programs in our chromosomal makeup and conditioned self-images that keep us from accessing the full potential that is available. Eco-physicists estimate that we are using much less than 10% of potential, so, we have a great playing field available.
I remember a conversation with John McEnroe in the summer of 1989 after he had returned from a tournament in Texas where he just barely lost to Ivan Lendl. He said, "Mark, if I had just even a quarter of a percent more, I would have beaten him". A quarter of a percent, .025 of 100, that doesn't seem like much, yet he knew, as I believe we all know, that there is always much more potential whether we are parents, scientists, healthcare practitioners, scholars, athletes, politicians, etc. A small paradigm shift has the ripple effect of producing many positive and far reaching results.
To understand and appreciate the extent of our individualized personal computer which is part of the Living Library, let's again acknowledge that this living computer runs our entire system including circulation, respiration, digestion, endocrine, hormonal, etc. and without biological and/or psycho-emotional interferences would run optimally. Well, what are these interferences?
For the sake of simplicity, let's just say that on a physical level they manifest as blockages, hardness, tightness and shortening of tissues, distortion from balanced alignment, nerve impingements, limited range of motion, limited flexibility, etc. On an emotional level, interferences could be dysfunctional emotions such as anger, grief, rage, poor attitudes (fixated emotional states). On a psychological level they are expressed as limited belief systems, filtered and biased realities, personal victim states, etc.
Is an interference/holding pattern a component of all of these levels, psycho-emotional somatic? Does physical trauma affect the emotional and psychological state? Does an emotional trauma affect you physically and psychologically? Does it affect the internal biochemistry of the hormonal flow? Could one create autointoxication with unsupportive emotions? Does a psychological trauma deeply affect the emotional and physical responses? In my experience, absolutely!
Some areas of our body are more resistant to opening up, loosening, and receiving the benefits of improved circulation and joint flexibility. In my thirteen years of professional massage practice, the shoulder joints, and shoulder blade area are two that pose these particular tension or “holding on” patterns. Sometimes, a complementary and gentling therapy that can assist in getting the muscle & joint in this “guarded” area to trust enough to let go, is music therapy. All of us innately respond on some level to certain types of music I’ve experienced that musical notes literally enter my ears, circulate through my brain, and come out through my hand movements, as if I am massaging those sound vibrations into the clients soft tissues. Since I already “have a feel” for how most musical rhythms move my own body, it is easy for me to introduce them into others bones and muscles, and observe the relaxing and loosening effect on them as well.
One way that I have been experimenting with recently, is to have a particular piece of powerful music in a small hand held tape player, similar to a Walkman, and when the “time is right” to lay it alongside the area of the of the shoulder joint or shoulder blade where I am endeavoring to free up some space in the recipients joint and musculature. One recent snowy Saturday morning, a massage therapist friend was willing to let me play around with this approach, and I had picked out a slow drumming sequence to start, and followed it up with a more vigorous pattern of percussion sounds. It so happened that these spontaneous drum sounds were ones I had recorded from a drum circle in Hot Springs’ Gulpha Gorge park in which I was a drummer also. It was very easy for me to “get into the groove” of those very metered rhythms, and soar over her scapular area with one hand, and circulate around the pelvic ridge with the other hand.
At one point, I gave a word of explanation to her, as I am prone to do with clients in general. I said: “These drum sounds are to help “open up your shoulder girdle, and then the knife portion of my hand will stretch the tissues even more. Also, I’ll be rubbing those soothing, harmonious sounds into the core of your bones, and to close, I’ll seal it off with more of these rhythmic notes.” She went for it, and what ensued was quite enjoyable to both of us, and at the end she responded: “that was very interesting.” In concluding the session, I struck out from concentrating on the shoulder area, and began doing “percussive” tapings all over her whole back area, at which point, she uttered: “that pelvis area really needs some work!” More intertwining ensued with encircling motions around the alternate shoulder joint, and hip socket area (opposite sides being worked at the same time to facilitate cross neurological balancing.)
At the very end, I ventured onto the backs of the calves, and thighs, and taped my way across the bottoms of the feet, and buttocks too. This I felt would return any “separated body parts” or shut off emotions into the whole of her integrated system. Only time will tell how effective this intervention is, and what further potential it has for helping us to move and posture our cells more freely each and every day of our lives.
Just recently another client, Marie, recently back from a trip to Nepal received some percussive massage from me over her lower back and legs, with the inspiring words: “let this beat help you flow more freely as you visualize yourself walking in a perfectly balanced way, accident free!” (Note: She had complained of having repeated bumps and bruises on her legs.) She commented later on how much she enjoyed this session. From my point of view, rhythm and massage are integrally wedded as therapeutic modalities, and the more aware both practitioners & recipients are about their intertwining, the better the outcome.
I have found in my holistic chiropractic practice that the number one most common cause of most neck, back and joint stiffness and pain, also including arm, elbow, hand, leg, knee and foot problems and also including exacerbation of chronic fibromyalgia pain, is slouching during waking hours and sleeping on the abdomen, sleeping with the arms and hands above the shoulders, sleeping on the same side or painful side most of the time, and sleeping in a twisted position that interferes with the blood and nerve circulation to the muscles and joints that cause stiffness and pain. The number two cause is diet and lifestyle related toxicity caused by unhealthy foods, milk, cheese, ice cream, chocolate, MSG, coffee, wine, beer, alcohol, cigarettes, street drugs, medications and anything that poisons the body that stresses, irritates and spasms skeletal muscles that pull the neck, back and joints out of alignment and fixate them causing joint stiffness and pain. The number three cause is low thyroid function indicated by a basal resting temperature below 98.2 F that does not allow the needed warming effect of muscles and connective tissue that leads to joint stiffness and pain.
The solution is to stand and sit up straight and sleep in an untwisted position on the back or sides or on the good pain free side with the arms and hands below the shoulders and not under the neck or body; eliminate all dairy, chocolate, MSG, coffee, alcohol, cigarettes, street drugs, medications and anything that poisons the body; and take, if prescribed, Armour or Cytomel thyroid medication to raise the body temperature to warm the muscles and joints.
The easiest way to conceptualize this is that improper posture and sleeping position, unhealthy lifestyles and low body temperature causes toxicity, inflammation, water retention, edema and swelling that sensitizes and presses on your nerves and spasms your neck, back and joint muscles and is the root cause of most pain anywhere in the body. When the body is toxic, inflamed and swollen, it is more likely that stress, minimal physical exertion, exercise, massage and even chiropractic treatments can cause more inflammation, swelling, stiffness and pain, because the underlying causes have not been corrected.
Massage, exercise, physical therapy and chiropractic treatments help spinal and joint stiffness and pain but the best results are obtained when combined with improving sleeping position, cleaning up lifestyle and correcting thyroid function to eliminate the inflammation and swelling in the tissues, spine and joints. In some cases, the person will need to correct sleeping position, improve lifestyle and treat underlying metabolic disorders first before receiving a program of massage, exercise and chiropractic that otherwise may cause too much irritation, inflammation, swelling and pain.
There is a strong human tendency to deny the role played by posture, sleeping position, lifestyle and thyroid dysfunction related toxicity, inflammation, swelling and neck, back and joint pain and to blame all of this on accidents, turning the wrong way, working too hard and sitting too long, because it is easier to blame your problems on something that happened to you instead of something you did to yourself, i.e., unhealthy foods and bad habits that made you an accident waiting to happen. This means that your longstanding unhealthy posture, sleeping, and lifestyle habits and low body temperature problems made you toxic, inflamed, swollen and inflexible before the accident, etc., thereby causing a greater likelihood to be "injured" in the pre-existing weak places in your tissues and joints.
This tendency to deny your own role in contributing to injury, slow healing and chronic stiffness and pain can be seen in the too often expressed "fix me 'cause I won't or can't fix myself" attitude that you need a massage or chiropractic adjustment "fix," and when this does not work, as is often the case, you blame it on the massage therapist or the chiropractor instead rightfully on yourself. Or you demand a pain pill "fix," not seeming to care that popular NSAID pain pills (Advil, Motrin, Aleve, etc.) and stronger prescribed pain killers only cover-up symptoms of joint stiffness and pain and cause more leaky gut syndrome, toxicity, inflammation, swelling, stiffness, pain, chronic degeneration and arthritis in the long run.
In regards to thyroid dysfunction, the human tendency is to ignore low body temperature problems; say you don't want to or need to take Armour or Cytomel thyroid medication; "believe" your Establishment doctor who typically ignores the body temperature test, relies on the inadequate blood thyroid test only and says nothing is wrong with your thyroid (but something is terribly wrong -- your body temperature is too low); trust taking Synthroid that is not as good as Armour and Cytomel according to holistic medical doctors; and sloppy-thinking claims that you used to have a thyroid problem when in most cases, you still have a thyroid dysfunction problem that both yourself and your Establishment doctors ignore and mismanage.
Avoid Establishment massage therapists, chiropractors and medical doctors (and politicians) who arrogantly claim to fix you when you need to fix yourself and often make you worse by prescribing only quick fixes that do not improve your lifestyle and do not correct the underlying causes of neck, back, joint and other health problems. All too often, health care providers avoid confronting patients about their unhealthy lifestyles and attitudes out of a concern of offending them and ultimately losing them as patients. This deadly attraction is, unfortunately, mutual in that patients commonly choose the easy way out by consulting doctors that don't question bad habits and self-destructive attitudes. Over the past 20 years, I have seen many patients and friends go to Establishment medical doctors that are least likely to confront and challenge their unhealthy lifestyles and self-destructive attitudes. The easy way is not the best way in regards to your health, body, mind and spirit.
Unfortunately, the same mind set influences Establishment doctors and therapists to avoid identifying and correcting the underlying metabolic disorders routinely mismanaged by orthodoxy to keep patients sick and dependent and coming back for more bad medicine. Orthodox doctors have a realistic fear that the Establishment will remove the license of any health care provider who does not cover up symptoms with drugs, adjustments, exercise, massage and supplements. Seek out a holistic doctor or therapist to get to the root cause of neck, back and joint pain and other health problems. Take responsibility for being your own doctor, because no doctor can help you as much as you can help yourself by improving posture, sleeping position, diet, lifestyle and metabolic function.
Correcting your posture and sleeping position is easy to understand although it is difficult to give up a favorite way of carrying yourself and sleeping. If you set your mind to it, you will learn to carry yourself and sleep in the proper position, and you can ask your family and friends to help remind you.
It is another, more difficult, matter to give up favorite unhealthy foods and bad habits, but it helps, when you understand how dairy foods, for example, cause stiffness and pain. You may not be quite ready to let go of milk, cheese, yogurt, cream and ice cream, and it may take some real effort. Keep in mind that the rewards in feeling better are considerable.
Dairy foods, other allergy and unhealthy foods and bad habits poison, irritate and inflame the intestinal walls and break down the its immune system making it abnormally permeable or leaky to all the wrong things. This is called leaky gut syndrome that allows germs, candida, feces, cow and other animal antibodies, large fats and proteins to readily pass through the sick colon wall into general circulation. The blood and lymph carry these toxins and harmful elements throughout the body poisoning, inflaming and swelling all tissues and joints thereby causing painful muscle spasms, fibromyalgia and joint stiffness and pain.
The lungs and kidneys as eliminative organs attempt to clean up the toxins and destructive factors in the blood and lymph that in turn causes lung problems that leads to mid-back, neck, shoulder and arm, elbow and hand problems and also causes kidney problems that leads to low back, buttock, hip and leg, knee and foot problems as follows.
Dairy food toxins cause chronic allergy histamine reactions, mucus congestion, inflammation and infection in the sinus, ears, eyes, and cervical lymph glands. Dairy foods and chocolate, also poison the lungs causing thoracic vertebrae T2-4 spinous pain in the lung place. It poisons the liver causing pain between the spine and shoulder blades in the liver reflex place; it poisons the gall bladder causing stiffness and pain between the neck and shoulders. This combined irritation, inflammation and swelling in the head, neck and upper thoracic area causes neck, mid back, shoulder, arm and hand, and spinal and joint subluxation-fixation, stiffness and pain. Dairy also poisons the kidneys causing low back, sacroiliac, hip and knee problems; and it poisons the intestines causing constipation and low back problems.
To emphasize the process that causes most neck and back stiffness and pain, understand that toxins and harmful elements in the blood first poison and irritate the lungs, then irritates the nerves from the upper back spine to the lungs and also irritates nearby nerves to the paraspinal muscles in the upper back (thoracic vertebrae 2 to 4 lung place). Because the affected nerves are interconnected to other nerves in the area, irritation originally limited to the lung place in the spine spreads and causes muscle spasms and joint stiffness and pain in the shoulder blades, shoulders and neck that becomes chronic over time. Since this is a slow process during years of abuse caused by an unhealthy toxic, lifestyle and improper posture and sleeping position, the cervical vertebrae 4 to 6 in the neck become fixated and subluxated. As a result of constant irritation, inflammation, congestion and muscle spasms in the area, the vertebral bodies of the neck and disc material between them start to break down and degenerate over time eventually causing blood and nerve circulation problems and muscle spasms in the arms, elbows and hands, especially if the person sleeps on his stomach or with his arms above his shoulders. In short, toxic blood from dairy, chocolate, cigarettes, etc. eventually causes mid-back, neck, shoulder and arm muscle spasms and joint stiffness and pain.
In a similar manner, blood toxic from dairy, coffee, alcohol, cigarettes, etc. is cleaned up by the kidneys day-to-day over the years. The kidneys are constantly irritated, inflamed and congested, all of which increase the likelihood of kidney dysfunction and stones. The nerves to the kidneys from the spine are in turn irritated causing thoracic vertebrae 8 to 12 kidney place irritation, inflammation and congestion. Nearby nerves to the kidney muscles, i.e. iliopsoas muscles, go into spasm as a result of constant irritation. The iliopsoas muscles attach along the sides of the low back spine, pelvis and lesser trochanter of the femur (leg bone near the hip joint). When the iliopsoas muscle goes into chronic and sometime acute spasm, it literally pulls the low back, pelvis, sacro-iliac and hips out of alignment and the joints fixate causing stiffness and pain. Interference to the nerves and blood supply to the legs is caused over time by pressure on the nerves and blood vessels as a result of degenerative disease of the spine and discs caused by chronic irritation and inflammation caused by lifestyle related toxicity. In short, toxic blood from dairy, coffee, alcohol, not drinking enough water, etc. eventually causes low back, buttock, hip, leg, knee and foot stiffness and pain, especially when the person twists his low back when sleeping or sleeps on the same side too much.
Often after over-indulging in dairy, chocolate, coffee, alcohol, etc., the patient comes in for acute neck, back and joint stiffness and pain. Some patients appreciate learning that eliminating these toxic foods and habits can make them feel better. Some patients aren't interested in improving their lifesyle.
Allergy is involved in around 80% of all health problems, and in addition to dairy, allergy to chocolate, MSG, wheat, corn, soy, coffee, wine, alcohol, cigarettes and other high allergy and toxic substances are a common cause of fibromyalgia, neck and back stiffness and pain. In some ways, you can view allergy, especially food allergy, as just another toxic insult to the neck, back and joints.
About half the population has hypothyroidism, also called thyroid dysfunction, that is another common cause of fibromyalgia, neck and back stiffness and pain and also fatigue, depression and a wide range of other health problems. Orthodox medical blood tests for hypothyroidism often give a false negative reading, because you may have adequate T4 thyroid in your bloodstream, but this does not mean that you can convert T4 in the blood to T3 at the cell level.
Holistic medical doctors, chiropractors and naturopaths recommend the temperature test for low thyroid function. If your body can make the necessary conversion from T4 to T3, your temperature will be in normal range of 98.2 to 98.8 F. Take your oral temperature by the preferred method using a digital electronic thermometer or use a regular thermometer. Take your temperature four times a day immediately upon waking up, after resting about 3 hours after you wake up, in the afternoon and in the evening. If your average temperature is below 98.2 F, this is an indication of low thyroid function. Temperatures above 98.8 F can indicate temporary infection, chronic infection or hyperthyroidism. Consult a holistic medical doctor for diagnosis and treatment of low or high thyroid dysfunction, infection and disease.
In the past, desiccated Armour thyroid was recommended by holistic medical doctors, but it was discovered that many people have a special hypothyroid problem called Wilson's Syndrome that means the body can not convert T4 in the blood to T3 in the cells. And since Armour thyroid has both T4 and T3, the T4 portion may not be converted to T3 and may actually worsen hypothyroidism symptoms, including neck, back and joint problems. Your holistic medical doctor may put you on Cytomel T3 thyroid medication, and later at the right time take you off thyroid medication to allow your natural thyroid function to take over. Some medical doctors recommend Armour thyroid at first and continue with it and other medical doctors prefer Cytomel and some doctors recommend both Armour and Cytomel at the same time or consecutively under their direction.
As I understand it, the rule of thumb is to take adequate thyroid medication to raise your body temperature to the normal 98.6 F range. Consult a holistic medical doctor in this regard.
Taking thyroid medication, if necessary, increases and normalizes the body temperature and this warms the muscles, connective tissue and joints making them more flexible and healthy.
Most Establishment medical doctors discredit the basal resting temperature test, Armour, Cytomel and holistic medical doctors. Orthodox medical doctors does seem to mind that the blood temperature test alone is often inaccurate and that Synthroid thyroid medication, the most commonly prescribed medical drug, is not that effective in correcting thyroid dysfunction and raising the body temperature to normal. If you are taking Synthroid and your body temperature is below 98.2 F, consult a holistic medical doctor who may switch medications from Synthroid to Armour or Cytomel. Holistic medical doctors are also more likely to search for other causes of low body temperature as compared to Establishment medical doctors that may prescribe Synthroid without much concern for normal body temperature or other related health problems.
Dr. John Lowe, D.C. reported in The Journal of Myofascial Therapy, April, 1995, that many fibromyalgia patients with hypothyroidism who fail to benefit from T4 or Armour desiccated thyroid completely recovered when they switched to Cytomel T3 thyroid medication. In a telephone conversation, Dr. Lowe and I shared success stories of helping many patients with fibromyalgia, neck, back and joint problems simply by a program of detoxification, elimination of unhealthy foods and bad habits and adoption of a more healthy lifestyle.
Chiropractors can educate you about this process and also refer you to holistic medical doctors for treatment of thyroid dysfunction. Chiropractors are not licensed to practice medicine, diagnose thyroid dysfunction or prescribe or sell Armour or Cytomel thyroid medication.
Chronic candidiasis, also frequently ignored and mismanaged by orthodoxy, is also a very common cause of neck, back and joint stiffness and pain and fibromyalgia, because candidiasis poisons you and diminishes your immune system. When infected, massive amounts of debris from millions of candida organisms dying daily makes you toxic and your immune system gets completely worn out fighting off these invading toxic protein parts. Consequently, candidiasis induced intestinal toxicity and immune dysfunction causes worse leaky gut syndrome, more systemic toxicity, more infections and degenerative diseases, more fatigue and depression, more inflammation and swelling and more neck, back and joint stiffness and pain and fibromyalgia pain all over your body.
For candidiasis, your holistic medical doctor may prescribe Nystatin and in very difficult cases of candidiasis, he may prescribe Diflucan. You might consider taking silymarin concentrate capsules concurrently with candidiasis therapy to help protect the liver. Holistic doctors may recommend grapefruit extract capsules, acidolphilus, caprylic acid capsules, and garlic for candidiasis in between medical treatment with Nystatin or Diflucan. Taking only natural therapies like grapefruit extract capsules, etc. for candidiasis, especially difficult cases, is simply ineffective. Consult a holistic medical doctor for medical treatment with Nystatin or Diflucan.
Some holistic doctors report that klebsiella infection in the intestines may be a cause of neck, back and joint stiffness and pain.
Again, it bears repeating that anything that causes toxicity, leaky gut syndrome, inflammation and swelling, as does dairy, chocolate, MSG, allergy, hypothyroidism and candidiasis, also causes neck, back and joint stiffness and pain and fibromyalgia. Correct the underlying causes to get the best results.
Case Findings: A waitress advised to test for food allergy found that eliminating wheat in her diet solved her low back and female disorder problems. A contractor reported that the cinch in his side and the kidney area back pain, which had bothered him for over ten years, quickly disappeared when he gave up his Pepsi habit. Not sleeping on her bad side cleared up a troublesome hip, thigh and knee problem for a janitor who wasted over a thousand dollars on drugs and herbs. A construction worker on low back disability was able to return to work by not drinking beer and coffee. Eliminating dairy and chocolate helped a chiropractor with chronic sinus congestion and neck stiffness and pain. A Buddhist minister solved his kidney, low back and neck problems by drinking more water, by eliminating dairy and coffee and by treating hypothyroidism. After taking thyroid medication for a short time, a real estate broker reported relief of chronic low back and hip stiffness and pain and was able to exercise and run without any discomfort. A woman with mental illness, back pain and severe fibromyalgia pain all over her body recovered her health by eliminating dairy and other unhealthy foods from her diet and by taking thyroid medication. A friend with chronic neck stiffness and migraines found relief by not eating chocolate and foods containing hidden MSG. A diabetic with out of control blood sugar, staph infection on his legs, and neck stiffness and pain corrected all of these problems and reduced his insulin by taking thyroid medication, eliminating dairy and drinking more water. Wellness awaits you !
In his book, No Milk (1991), Daniel Twogood, D.C. writes that patients who complain of headaches and neck and back stiffness and pain will almost always respond after they have eliminated all chocolate, dairy and MSG from their diets. Dr. Twogood cites numerous case studies which outline how many offending foods and substances are hidden in processed foods. He points out that patients typically do not know that dairy foods and chocolate may be causing their neck and back problems.
Sami Bahna, M.D. and Douglas Heiner, M.D., authors of Allergies to Milk (1980) review the scientific literature documenting the gastrointestinal, respiratory, dermatological, hematological, cardiovascular, urinary, central nervous system and musculoskeletal symptoms caused by dairy foods, and note that most of these symptoms improve or disappear when dairy foods are eliminated from the diet. These studies support the idea that dairy foods are a cause of neck, back and joint problems.
The following books and doctors report that dairy foods, allergy, hypothyroidism and MSG cause musculoskeletal stiffness and pain: The Milk of Human Kindness is not Pasteurized (1985) by William Campbell Douglass, M.D.; The XO Factor (1983) by Kurt Oster, M.D. and Donald Ross, Ph.D.; The Food Allergy Plan (1986) by Keith Mumby, M.D.; the pioneer specialists in food allergy, Theron Randolph, M.D., Marshall Mandell, M.D. and Abram Hoffer, M.D.; Hypothyroidism: The Unsuspected Illness (1976) by Broda Barnes, M.D.; Solved: The Riddle of Illness (1984) by Stephen Langer, M.D.; In Bad Taste: The MSG Syndrome (1990) by George Schwartz, M.D.; Thyroid Power: 10 Steps to Total Health by Richard L. Shames, MD and Karilee H. Shames, RN, PhD.
About the author: Dr. Grady A. Deal, Ph.D., D.C. is a holistic, nutritional chiropractor with a Ph.D. in psychological counseling. Dr. Deal is founder-director of Hawaiian Wellness Holiday, a health vacation program on beautiful Kauai, Hawaii, and he is author of Dr. Deal's Delicious Detox Diet, Weight Loss, Wellness Lifestyle, Dr. Deal's Delicious Recipes and Dr. Deal's Holistic Chiropractic Examination Protocol books.
Marketing and Advertising Strategies for Exercise Professionals:
The yellow pages is the first place that a prospective client will let their “fingers do the walking”. While the yellow pages is a good place to advertise, this is not where you will get most of your clients, most of your clients will come from other clients or professional referrals. The size of an ad in the yellow pages probably does not make much difference. Prospective clients will either go to the largest ad or just proceed alphabetically, or perhaps they are going to pick the closest facility to either home or work. Do not spend a lot of money on a yellow page ad, the return on investment is poor.
Save your money for a good answering service or a cell phone. A single or double line ad in bold will serve most needs for yellow page advertising. Remember, your yellow page advertising representative works for the company that profits from your advertising, they like to encourage larger ads.
Your well designed and eye catching business card is your most important piece of advertising. Cards can easily be placed or left in a large variety of locations. Your business card should be simple and contain only the information that pertains to your professional credentials and how to reach you. Artwork or photographs are a good idea, but the plain professional card is just as good. Your business card should list your training and association memberships. You can even add a brief slogan or statement like, “your health is our concern”. Leave your business card in the following locations:
With all health care professionals
Anywhere you make a business call
Health food stores
Associations that services client populations that you treat
At all group athletic events
Public bulletin boards
With the waitress that served your lunch
With service clubs and organizations
With support groups
Anywhere that makes sense to you
The locations mentioned above are also the contacts that you want to develop as referral sources. For example, health food stores see a lot of health conscious people in a single day. If you offered to provide discounted classes or training to health food store staff, the staff in turn would probably not hesitate to refer clients to you. Psychologists see many clients who are experiencing various levels of stress. Psychologists are a good source to market, they frequently practice in groups and you could offer them discounted services in order to educate them regarding your services.
Some weekly newspapers are a good source for inexpensive advertising. It is not the size of the ad that is important, but rather, consistency in advertising. In other words place a small inexpensive ad and leave it in place for weeks or months. A single ad or a short term ad is usually not very effective. The best buy in most small newspapers is the classified ad section, it is usually very inexpensive and in a small weekly paper it is usually read about as well as the rest of the paper. A one or two inch ad is usually a good purchase and once again in a small paper still gets the attention of most readers. If after an ad has run for two or three months no one seems to have seen it, find yourself another paper. If you live in a small area with only one paper then every one will see your ad. If you live in a larger area then find out which paper has the best readership and use that one.
The keys to successful marketing are as follows:
Keep your message simple.
Use a bold headline or attention statement and then a simple, short message.
Be consistent, leave the ad in place for weeks.
Don’t think that you have to spend a lot of money, you don’t.
Develop a program of regular consistent marketing and advertising exposure.
Spend time every day marketing your practice.
Look for free and easy opportunities to educate people regarding your business.
Remember the most important education and marketing is done in your facility and during the client visit.
Your business will grow mostly from referrals and not from advertising.
Successful Business Building:
First of all, here are guaranteed ways to fail in business:
Do not answer your telephone on a consistent basis.
Use an answering machine.
Do not establish regular office hours.
Do not spend time daily planning your practice growth and development.
Do not think about your business.
Do not tell people about your business.
Do not educate your clients.
Do not ask for referrals.
Do not work full time at building your practice.
Create a “bankers hours” schedule. Never work evenings or weekends.
Practice like everybody else.
Over charge for your services.
Act like you don’t care.
Do not act or dress in a professional manner.
Do not return phone calls promptly, within twenty minutes, or at all.
Do not visualize or pray for your personal success.
Using an answering machine to run your office is a guaranteed way to assure your failure in business. People want to reach a real human being and not a machine. In this age of advanced telecommunications you have many communications options. The best method of handling incoming calls is with a cell phone that you personally answer ten to twelve hours per day. The second best method is an answering service with a live operator answering your telephone and then paging you with the message, then you return the call within twenty minutes.
Client retention and business building begin the moment the client enters your office. Client education should be provided while the client is at your facility. This educational process serves several important functions, but the most important thing that it does, from the perspective of this guideline on business building, is it increases client retention and repeat visits. An educated client is more likely to seek future services.
If you want a successful exercise business you must behave and conduct yourself like a professional at all times:
· You must have regular and convenient business hours, this should include one or two evenings per week. Some clients need early morning appointments, you should accommodate the needs of your clients.
· You should be either in your office doing paperwork or making marketing phone calls, or doing business building activities outside of the office.
· You should attempt to schedule one or two contact lunches with either other professionals or services organizations per week.
· You should always be available by telephone or pager, and you should follow the twenty minute rule, return all telephone calls within twenty minutes.
· You should establish a reasonable fee schedule that describes both the services that you provide and the fees you charge for each service.
Lower cost care allows more clients to access your services.
The Essential Rules for Exercise Business Success:
Be professional at all times.
Develop a realistic and affordable fee schedule.
Be responsive, available, and in communication at all times.
Educate and reschedule the client.
Look like a professional.
Keep regular hours.
Promote yourself and your business every day.
Give referrals and seek referrals.
Go out of your way to serve the needs of your clients and other exercise and health care professionals.
Put service ahead of profit.
This article was prepared by Gregory T. Lawton, D.N., D.C., a Board Member of the American Medical Massage Association. The American Medical Massage Association is an association that represents a diverse group of medical massage therapists, physicians, physical therapists, occupational therapists, nurses and other allied medical personnel who practice clinical manual therapy for the purpose of connective tissue rehabilitation.
*Note: This article has been edited for space requirements, and adapted to allow a broader use in the professional community. We encourage you to view this article in its entirety.
The Patient Choice Practice:
Teaching with The Posture Principles II
Steven P. Weiniger, DC / Founder, BodyZone.com
AcuteCare is for pain relief. RehabCare, the second phase of a Patient's Choice Practice, helps to strengthen function. However, many insurance policies do not pay for non-acute care, so care must "make sense" to people before they will choose to pay, out of pocket, for RehabCare or WellnessCare.
The goal of helping people "Move Naturally, Feel Good, and Be Well" is great for health and well-being, but it may not be paid by insurance because it is viewed as "medically beneficial, not medically necessary. A biomechanical patient education model is necessary for patients to "get" the importance of keeping their body moving well.
People learn by synthesizing a combination of visual, auditory and kinesthetic (or touch) based information. This patient demonstration shows people how poor posture directly affects how their body functions.
Medical Massage Therapy
Marketing a Successful Cash Practice (Part I)
Gregory T. Lawton, D.C.
Inherent within the practice of medical massage therapy is the medical massage economic and financial model of office management. This practice management model is based on the medical practice model of treating patients according to their chief complaint, which is usually pain related, using a therapy plan that is specifically designed to treat the patients problems, and using therapeutic modalities along with manual therapy. The medical massage therapist who uses the medical massage model will treat more than one patient per hour. This practice model is effective in either a cash practice, with insurance billing, or a mixed cash and insurance practice.
The medical massage therapist who treats more than one patient per hour can charge less per patient visit than the therapist who provides 60 to 90 minute massage sessions. Medical massage therapists routinely charge between 15 and 25 dollars per 30 minute office visit as compared to therapeutic massage therapists who may charge from 45 to 100 dollars per hour. In most market areas there are far more patients who can afford to access massage therapy treatments when they are affordable. This is especially true for the patient whose condition requires two or three treatments per week. To the medical massage therapist, whose mission is to provide health care and not recreational massage, an affordable fee schedule is an important aspect of patient retention and practice building. If the incredibly high professional attrition and turnover rates for therapeutic massage therapists are any indicator, the therapeutic massage model based on the 60 or 90 minute massage session with higher per visits rates is simply not working for the majority of new therapists entering the massage field. Another reported element of attrition in the massage field is due to “burn out”, which may be related to the fact that many, if not most, massage therapists provide essentially the same massage session to every client that they see. The medical massage therapist who treats patients according to the patients presenting symptoms will provide a wide variety of treatments, techniques, and procedures that varies from patient to patient.
Within the health care community there is an ongoing debate regarding the merits of a cash or insurance based practice, the answer is probably to do both, but in some states, especially where there is no state licensure, the ability to bill insurance may be a rare event. A medical massage therapist who treats 10 patients per day on a half hour schedule and with an average fee of 20 dollars per patient will gross 200 dollars per day, 1000 dollars per week, 4000 dollars per month, and 48,000 dollars per year. Medical massage therapists who treat specific patient conditions with localized therapy as opposed to a “full body massage”, can easily see 45 to 50 plus patients per week.
Two of the well hidden secrets to successful practice building are:
- Building a practice is like priming a pump, the more patients that you see the more patients you will get.
- The main element in practice building is patient referral of new patients.
Many relaxation massage therapists attempt to build their practices with “high” fees and will often have a very small caseload of only two or three dozen patients. This is an “unhealthy practice”, in that this practice has too few patients overall and contributes to therapist burnout if from nothing else the boredom of seeing the same few patients over and over again. The therapist in this example has collected a small number of patients who will not take responsibility for their own healing process, but rather depend upon the therapist for continual maintenance care. This type of practice usually hovers around 16 to 24 patient visits per week and until the practice begins to suffer an inevitable slow down the therapist may think that they are doing well. These therapists have poor practice building skills and are seduced by the short-term income that they achieve with fewer patients and higher rates. Often these therapists are simply part time dabblers in massage therapy and it is in this group that the higher levels of attrition and drop out are seen. The healthy and growing massage practice will maintain a fairly constant level of 300 or more active patients that are in various stages of treatment from acute care to occasional maintenance treatment.
The professional medical massage therapist with a large successful cash practice will have a patient management plan that will include these actions:
- Will maintain a professional and efficient telephone answering and patient scheduling plan.
- Will thoroughly educate patients while they are in the office and on the treatment table.
- Will take control of the patient visit and develop a management plan for each patient.
- Will schedule the patient while they are on the treatment table and will direct the patient regarding when and how often they will return for treatment.
- Will handle patient objections by explaining the treatment, fees and total cost of care, and length of time of care before the patient even asks.
- Will schedule multiple visits for care on the patient’s first visit to the office.
- Will use patient education methods to get patient referrals.
- Will provide each patient with a simple drawing and notes that explains the patient’s condition and problem on the first visit.
- Will maintain a results oriented practice that achieves a clinical response during each patient visit.
- Will have efficient collection of treatment fees at the end of each visit.
Visit the article gallery again soon and read Part II of Marketing a Successful Cash Practice.
This article was prepared by Gregory T. Lawton, D.N., D.C., a Board Member of the American Medical Massage Association. The American Medical Massage Association is an association that represents a diverse group of medical massage therapists, physicians, physical therapists, occupational therapists, nurses and other allied medical personnel who practice clinical manual therapy for the purpose of connective tissue rehabilitation.
STROKE DUE TO CERVICAL MANIPULATION
by ALAN H. BRAGMAN D.C.
As an expert witness in the field of chiropractic negligence for over fifteen years, I have been involved in more than 600 cases throughout the United States. Of the cases reviewed, more than 125 involved allegations of a cerebrobasilar injury caused by chiropractic cervical manipulation. In all but a few of these situations, the chiropractor violated the standard of care and a causal relationship to the treatment and resulting injury was apparent. A stroke or arterial dissection associated with chiropractic treatment is a tragic, life-altering situation for all parties involved.
Vertebrobasilar accidents account for just over five percent of the malpractice suits filed each year, but they are among the most serious. These injuries frequently result in permanent neurological deficit, psychological trauma, quadriplegia and/or death. Many of these lawsuits result in settlements well in excess of a million dollars. This alone is a compelling reason to maintain higher limits of liability coverage.
Overall, the chiropractic profession has downplayed the risk of stroke through cervical manipulation. Early studies and opinions felt that the risk was minimal, and that cervical manipulation has not been conclusively proven to cause vascular accidents. More recent information and studies suggest the risk of stroke due to cervical manipulation is still very low, but higher than past information would indicate. One problem encountered researching this subject is the lack of complete, concise, accurate data from which to draw accurate conclusions. The number of patients under chiropractic treatment has increased dramatically in recent years, without a corresponding rise in manipulation induced strokes. Hopefully this indicates that even with more exposure, improved chiropractic education, screening procedures and increased awareness may be starting to have a positive effect.
In 1972, Maigne suggested, " there is probably less than one death of this nature out of several tens-of-millions of manipulations". In 1982, Cyriak stated, " this risk works out to about one in ten million manipulations, and is no argument against manipulation reduction in suitable cases." In 1981, Hosek, et al. suggested, "we may form a conservative likelihood estimator by looking at the ratio of vertebrobasilar injuries to adjustments performed. This ratio would be 100 injuries per/100 million adjustments, about one in a million." In 1983, Gutmann concluded. "There are two to three serious incidents involving the vertebrobasilar system in one million manipulations to the upper cervical spine. " In 1985, Dvorak and Orelli stated that, "following an inquiry amongst the members of the Swiss Medical Group for Manual Medicine, it was calculated that there were slight neurological complications in one in 40,000; and one important complication in 400,000 cervical manipulations." Current studies estimate that one out of every two practitioners will have a patient suffer a serious cerebrovascular injury in his or her professional lifetime. Recent high publicity deaths of young adults in Canada from cervical manipulation prompted a population-based case-control study. The results from this study have prompted some medical experts to conclude that the risk of a vertebrobasilar injury from cervical manipulation may be as high as 1.3 incidents per 100,000 cervical manipulations. In March 2001 the New England Journal of Medicine estimated that the incidence of vertebral or carotid artery dissections may even be as high as one incident per 20,000 cervical manipulations. As more information is obtained the risk factors have steadily increased.
My experience as a forensic expert leads me to conclude that the risk of stroke from cervical manipulation is much greater than current literature suggests. In some cases I have reviewed, people died as a direct result of cervical spinal manipulation. In almost all of these cases dealing with vascular injuries, the incident could have been avoided or lessened with a proper history, through examinations with vascular screening, avoidance of rotational manipulation and/or closer monitoring of post treatment progress.
Recognizing the increased risk is just the first step. The next issue is how do these vascular injuries occur, and what are some of the risk factors? The vertebral arteries are where the vast majority of cervical manipulation injuries occur, with a smaller number affecting the carotid arteries. Injuries occur from either direct trauma to the vessel wall or through subsequent vaso-spasm following treatment. Research and current data suggest that rotational manipulation of the upper cervical spine is the type of maneuver most likely to cause a stroke. Damage to the arterial wall through stretching, kinking, tearing or direct trauma can cause sufficient damage to disrupt vascular flow to certain areas of the brain, resulting in ischemia. Damage to the inner vessel wall, the intima, may result in a dissection or tearing of the vessel wall. This damage can initiate the clotting response with subsequent embolus formation altering blood flow to the brain. Signs and symptoms of ischemia usually occur during or shortly after upper cervical manipulation.
The demographics of cerebrovascular injury with cervical manipulation indicate that middle aged men and women in the 30-45 age group are in the highest risk group. For years it was incorrectly assumed that this type of stroke risk was higher in the elderly, due to vascular degenerative changes and athrosclerosis. The most common presenting symptoms of patients suffering strokes are headache, neck pain and cervical muscle spasms.
Dr. Edward Sullivan published an excellent article in the 1988 edition of Chiropractic Economics entitled "Screening Prior to Cervical Adjustments Can Prevent Strokes." Dr. Sullivan recommends the following screening procedure prior to performing cervical manipulation:
Part 1-High risk categories noted in the history
2. Transient ischemic attacks
3. Smoking (length of time is important)
4. Whiplash or cervical strain/sprain
5. Family history of strokes
6. Medications affecting hemodynamics (antihypertensives, oral contraceptives or regular aspirin use)
8. Cardiovascular disease
10. Cervical spine spondylosis or spurring.
11. Constant headaches (several days duration)
13. Known congenital arterial cervical anomaly (absent vertebral artery etc.)
14. Cervical arterial surgery
15. Radiographic evidence of atlanto-occipital ligament ossification or a cervical anomaly ( spina bifida, posterior ponticle etc.)
Part 2-Symptomatic Systems Review
2. Bilateral blurred vision
3. Monocular blindness
6. Hearing loss in one or both ears
7. Slurred speech
9. Difficulty in swallowing
10. Loss of consciousness
11. Temporary lack of understanding
12. Drop attacks without loss of consciousness
13. Numbness of loss of sensation anywhere in the body
14. Weakness, loss of coordination or strength anywhere in the body
Part 3-Hypertension, subclavian, and carotid artery: stenosis/occlusion
Checking bilateral blood pressures; noting significant discrepancy
Palpate and measure bilateral radial pulse; checking for weakness or absence
Auscultate for bruits and palpate; Bilateral supraclavicular fossas and carotid bifurcations
Part 4-Vertebrobasilar artery functional maneuver test (George’s Test)
Have the patient rotate his/her head as far to the right as possible and hyperextend the neck for 3-5 seconds. Observe for signs of ischemia, if negative proceed to the left side.
The most common signs of vertebrobasilar ischemia include: Dizziness; nausea; nystagmus; blurred vision; syncope; slurred speech; weakness; parsthesia; and numbness.
If the patient has a positive George’s Test do not perform a cervical adjustment. If the history and review of systems place the patient in a high-risk category, referral to an appropriate medical specialist may be indicated. If the patient exhibits signs of ischemia during or following cervical manipulation do not re-adjust the patient. Observe the patient closely, periodically monitoring vitals while checking the progression of the ischemic signs and symptoms. If the ischemia persists or becomes more pronounced, immediately transport the patient to the nearest hospital.
The above screening procedures are highly effective in preventing cerebrovascular incidents, as evidenced by the experience at the National College of Chiropractic in their outpatient clinics. Several millions of cervical adjustment has been given at the National College, without a single reported vertebrovascular incident. The obvious conclusion is that cervical manipulation remains a safe effective procedure with minimal side effects when the standards of care are followed.