Richard Barwell, D.C.

Dr. Barwell is the Founder and President of the Chiropractic Equity Offices, Inc. program, and has more than thirty years of experience in chiropractic practice. After graduating from Canadian Memorial Chiropractic College with clinic honors in 1964, he started a family Wellness Practice in British Columbia. He has since established numerous successful practices, won several awards and guest lectured at various chiropractic institutions. Before establishing CEO, Inc. Dr. Barwell was the Director of Seminars and Programs at Quest and Executive Director of the Chiropractic Leadership Alliance.

Posts by Richard Barwell, D.C.

The Truth of the Matter Pt VIII — In Search of the Magic Bullet

Ah the “Holy Grail” in Chiropractic.

It continually shows up in our dialog but takes on different forms. We can trace the roots back to D. D’s insight regarding the first adjustment of T4 to restore Harvey Lillard’s hearing. The application of x-ray plates and the supposition that a vertebral mal-position was the magic subluxation was the next step. All we needed to do then was adjust the magic spot and all would be well.

Our great desire to make the application of Chiropractic simple has lead to hundreds of techniques, all claiming to have the answer as to where to adjust a patient for the best results. We have seen personal battles and challenges that have created splits within the profession based on this “magic bullet” concept of Chiropractic care.

The over simplification of Chiropractic stems from the lack of the ability to explain the great benefits the practitioner sees in his/her practice. Any DC, having been in practice for more than 10 years, has most likely seen good patient responses to a variety of techniques.  By far the most used approach in practice, when it comes to describing a technique, is called “diversified”. Which just means the practitioners use a variety of techniques in their practice? This puts a “twist” in the “magic bullet” quest when addressing the concept of a “one technique is the answer” approach.

My 32 years of practice taught me that I needed to evaluate the needs of each patient and closely monitor their responses to care. There were patients whose nervous systems where so damaged that only very light forms of care were indicated, while others needed to have a “kick start”.  Well, not actually kicked, but a firm manual adjustment was the only care that altered their current poor neurological pattern.

The search for the simplest answer continues to persist in the profession and we now have an additional “Simple Simon” format.  The magic wellness index number, – “if you’re a 3, your bad, and if you’re now a 20 you’ve improved” approach.  My question is based on “What”? This is like evidence based care – based on what evidence? – Symptom relief? – Reduction of drug use? Who compiled these numbers? What was the baseline data? Was it from acceptable research or did someone just make it up? The concept may be good but we need to be very careful about our supporting claims.

Chiropractic has been doing this for years and it is one of the challenges that continue to get us in trouble. Where is the proof that a straight spine makes you healthy? Or that a normal cervical curve improves your health?  Now that I have your attention listen up – How do we explain the patients who improve (at least symptom relief) while their curves don’t change? How do we explain how the light touch techniques get great results? Where is the magic bullet here?

As we continue to demonstrate the power of the adjustment to improve the neurological response through pre and post NeuroInfiniti stress response evaluations we have begun to see that all the techniques have merit. Not only is there no “Magic Bullet” for technique but how can you measure health through a number? It reminds me of the scene in “Dead Poet’s Society” where measuring poetry was reduced to a graph and number rating.

Look at this definition of Health

“The states of health or disease are the expressions of the success or failure experienced by the organism in its efforts to respond adaptively to environmental challenges.”

Success or failure starts at the central nervous system and ends with the body’s systems being able to respond and adapt to its environment. This is a very complex, interrelated, closed loop system that continues to respond to health challenges on an individual basis. The Stress Response Evaluation (SRE) shows how individuals continue to change and adapt. We continually get asked, “Does this SRE tell you where to adjust?” Ah, in search of the “Holy Grail” once again!

The reason we call our career “practice” is because what we get to do every day, with every individual, is to think, apply our training and experience, so that we meet the needs of that individual in front of us.

For me the “Magic Bullet” is the adjustment and the “Holy Grail” is what the nervous system does with that stimulus.

The Truth of the Matter Pt VII — Moving Forward by Going Backward

Dr. Alvah Byers, a pioneer in biofeedback and a research Psychologist, taught me more than he thought I was absorbing. As a Chiropractor, I tend to exercise by jumping to conclusions. After all, that was really my training. As a profession, we do this all the time. Just this morning I had a phone conversation with a DC who was explaining how his technique could access and alter brain function. The explanation was in great detail and while it sounded very logical, without any method of objective measurement and reproducibility, it was really just another exercise of conclusion jumping. Now don’t get me wrong here.  I’m not “dissing” the DC or the idea. One of Dr. Al’s teachings was that there is a difference between possible and probable. What the DC said may be possible; but without proof, the probability must be questioned.

When we (Drs. Long, Byers, et al) started doing the studies on the effects of the adjustment on brain wave activity, I had already jumped and said that I expected to see changes. Dr. Byers cautioned me on this and suggested that perhaps any changes might be the result of the people selected, or the room, or some other yet unconsidered factor. I thought he was just being a stick in the mud or worse, someone who was going to find that Chiropractic didn’t do anything and it was simply a placebo effect. (my secret greatest fear) His next suggestion made matters even worse – he suggested that we do a Null Hypotheses. I must have given him that dumb stare as he then said, “That is where we prove that the adjustment does nothing!” Oh well, this made me happy!!! (a lot of sarcasm here) I was dumbfounded! I mean, I really liked Dr. Byers (who has since passed away) – he was a dear friend, but I just wasn’t sure if I should hit him or not. He suggested that we prove the adjustment does nothing! All of a sudden I got very nervous.

When he finally got my attention he explained, “If we set out to prove that nothing happens when you adjust someone, and we are wrong, it means that the adjustment ‘does’ do something. Then the challenge becomes one of now knowing that the adjustment changes something, – what does it change?” He continued, “Then we can start looking at: How does it change activity? or, How can we improve the adjustment’s effectiveness? But first, we have to go backward (Null) before we can go forward.”

Here I was, prepared to jump all over the place and he just sat me down into a chair and said, “Sit still for a minute, and let’s look at why Chiropractic continues to have problems as a viable profession”. He got my attention!!!

I know that there are many DCs out there in “Wonderland” who get upset with me using the terms viable or verifiable, and Chiropractic in the same sentence but the truth of the matter is that it is exactly the challenge we face.

We continue to attempt to justify Chiropractic on the basis of narrative reports. These are known as anecdotes or stories. This form of information gathering doesn’t even make it to the lowest rung of the research acceptance ladder, the case study.  I continually hear from DCs using one technique or another that their technique can discover incredible facts about neurological function and because of this, they get better results. When I question them about how they know, I get one of those, “oh you’re one of those disbelievers” looks. Listen folks, I want, I mean I really, really want everyone of them to be right; but I also want to stop simply exercising my conclusion jumping and start exercising my brain through reproducible proof that will move Chiropractic forward.

So here is something I learned from Dr. Al. Real research does not care about the direction of the results except that they are reproducible.  Real research may show that what you did produced nothing and there is value in that knowledge. Or it may prove that what you did produced unexpected results. There is also value in that knowledge. It may show that the patient’s narrative doesn’t agree with objective findings – The results are just results. The key is, can we start a care prediction that is greater than chance, based on our research? Not yet but soon!

So this is what we know about research and Chiropractic. First we have to back up and start with the Null Hypothesis. After 114 years of Chiropractic care, we can safely say that there is more than enough evidence (even though poorly gathered) to prove that Chiropractic adjustments do change something. Further, and critically important, this something is greater than joint motion, otherwise you can’t offer any explanation as to the effectiveness of techniques such as TRT, Network and many others. Now in order to move forward, we need to find out what that “something” is and what it affects. We need to be willing to put our techniques to the test of objective measurement, stop conclusion jumping and through real research move Chiropractic forward. Thank you Dr. Byers you were a great friend to both me and to this profession.

Click HERE to read the next article in this series.

The Truth of the Matter Pt VI — The Nasty Truth about Prescription Drugs

The AARP news bulletin continues to offer interesting facts about the myths and truths in the health care field.

One that received my recent attention is “The 50 Most Prescribed Drugs”1. It starts with this statement by Betsy Towner, “Prescription drugs …. consume more than 10 percent of the nation’s annual health care costs…. Though brand-name drugs make up only 22 percent of the names on the list, they represent 62 percent of the $53.2 billion cost.”  Now we are talking big money here but worst than this, the drugs are not a means to an end! There is no end to drug consumption, outside of death, so it never gets better.

The number one drug most prescribed is (drum roll please) hydrocodone with acetaminophen for PAIN with 121.3 million prescriptions and a retail cost of $1.78 billion. This is just for pain relief, not corrective medicine. (If there is such a thing). The next in line is Lisinopril for hypertension at 69.8 million prescripts at $686 million in cost.

What really got my attention was that out of the top 50: ten were for depression and anxiety; 9 for hypertension; 6 for bacterial infection; 4 for high cholesterol; and 4 for pain. That counts for 82% of the top 50 most prescribed drugs!!!  This means that the major problems we are facing are depression and anxiety, hypertension, bacterial infection, cholesterol and pain.

Has anyone even asked “WHY” we are challenged with these problems? All of this drug use is directed toward symptom control, not cause reduction. How about asking the question, “How did we all get so focused on symptom based care?” Look at the mess with bacterial infection drugs. The use of antibiotics has only lead to increased resistance to the drug by the bacteria. How many people are either addicted to pain reduction drugs or have used them to cover a more serious problem until it is too late for more effective care?  Once people start on drugs to control hypertension, cholesterol, anxiety or depression, will they ever be able to get off the drug? Not likely!

This is the nasty truth! Now please answer this, “Why has the chiropractic profession bought into the concept of symptom based care?” Is it because we have been very carefully taught that this is the only approach in health care? – or is it motivated by MONEY? (Insurance will pay for x number of visits, so just go with the flow and take the money.

Health research today continues to direct our attention toward “cause” rather than symptoms.  This attention goes all the way up to and including cancer2 (the ugly of the ugly), as well as other nasties such as A.L.S., fibromyalgia and other autoimmune system killers. When we look down to the other end of the scale, we find pain and depression/anxiety. The message is becoming clear that in the search to rid the world of pain and suffering, somewhere we missed the boat. Many years ago Hans Selye3 talked about the effects of stress on health and while we knew that stress was a factor, we had no idea that it was the door to understanding the human condition.

Each of the conditions listed in the 50 most prescribed drugs are the result of a breakdown in one or more systems of the body due to abnormal neurological responses to stresses in our lives. The nervous system becomes less able to adapt to a stressor and/or to reset to normal once the stressor is removed. It seldom happens suddenly; but usually, over time, the controls in the body shift and an imbalance within the body occurs. As time goes on the imbalance will create symptoms and at this point drugs are prescribed. The real heartbreak is that these drugs will create further imbalances (known as side effects) and further failure is inevitable.

It is beyond time that change take place in the health care field. $53.2 billion cost in the top 50 prescribed drugs alone to deal with “after the fact care” and not one of them addresses the cause of the problem! This is either criminal or a case of mass stupidity!

Today the role of the Stress/Recovery response has become the new direction for optimizing our ability to be healthy. Today the medical research has provided the link between stress and the neurological response. Today the role of chiropractic care to improve neurological function is fact4,5. Today is the time for the real chiropractic message to be told!

Click HERE for the next article in the series.

 

  1.  Betsy Towner – AARP Bulletin October 2009 Volume 50, No 8, page 39 bulletin.aarp.org
  2. Meisel et al., Nature Rev. Neurosci. 6:775-786, 2005
  3. “A Syndrome Produced by Diverse Nocuous Agents” – 1936 article by Hans Selye from The Journal of Neuropsychiatry and Clinical Neurosciences
    • The Stress of life. New York: McGraw-Hill, 1956.
    • Selye, H. “Stress and disease”. Science, Oct.7, 1955; 122: 625-631.
    • From Dream to Discovery: On Being a Scientist. New York: McGraw-Hill 1964
    • Hormones and Resistance. Berlin; New York: Springer-Verlag, 1971.
    • Stress without Distress. Philadelphia: J. B. Lippincott Co., c1974.
  4. Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study Heidi Haavik Taylor – Bernadette Murphy – Clinical Neurophysiology 118 (2007) 391-402
  5. A Four Case Study: The effect of the Chiropractic adjustment on the brain wave pattern as measured by EEG. Richard Barwell, DC; Annette Long, Ph.D.; Alvah Byers, Pd.D; Craig Schisler, B.A., M.A., DC. Sherman Chiropractic College, International Paper and Research Symposium, 2005

The Truth of the Matter pt V — The Lifetime Wellness Patient!

The Lifetime Wellness Patient!

While not as allusive as a unicorn the amount of effort, sales energy and just plain misconception that is attached to the “Lifetime Wellness Patient” tends to put them into the same category. There has been practice management programs built around the perfect practice based on patients who become “regular” patients since the beginning of the Chiropractic profession.   So much so that this pressure to convert every patient entering into Chiropractic care in this idyllic patient that the profession has become tainted in the public opinion. If you have not heard the comment, “once to start going to a chiropractor they want to keep coming” you haven’t been listening.

Now don’t get me wrong with this – I’m not opposed to a regular life time patient but the way we have gone about developing this type of client has created some serious criticisms. Over my years in practice I seen and heard about every method of practice management around and most are just a rehash of the same approach just tied with a new ribbon. The main challenge to the method was that most practice management is based on selling and much of it involves high pressure fear selling.  I know of one system that taught the DC to confront the new patient with the challenge that if they didn’t bring in their entire family and have them all sign up for life time wellness care they would not be accepted as a patient. Take about pressure selling – no thanks and no thanks for my profession as well.

Jim Parker realized that the profession needed help in how to build a stable income practice. He developed a care plan with a goal to build regular visits programs. He called it the maintenance based practice. The method was simple and easy to recommend. New patients were booked three times a week for two weeks, twice a week for 2 weeks and then once a week for two weeks. Within that 6 week period the majority of patients responded with reduction of their presenting problems. The final step was then to convert them into once a month regular care for maintenance. While this method was very successful, the challenge was that not one of the steps was based on any objective information as to why the visit schedule changed. So it came down to the intent of the care wasn’t about the patient’s needs but rather the Doctors need for a stable income. My exposure to many of the practice management program over the years has left me with the opinion that the maintenance plan was the basis for most with a twist added to make them seem different.

So is there such a thing as a lifetime wellness patient. Listen up if the people of the world knew what I know based on my years of experience with Chiropractic care they would all volunteer to be under regular chiropractic care in their lifetime. That said, what is it that I know that they don’t. This is the secret to building a patient committed based practice. If my commitment is based on knowledge which allows me to make an informed decision wouldn’t it be the way to build the commitment in others? Presenting the facts and options so that the patient makes the ideal choice will bring about and higher level of commitment on the part of the patient.

Now I need to clarify a couple of issues here – 1.  What does Regular visits mean and 2. What is wellness?  Both of the words have little meaning in the real world. Regular visits can mean any number from every day to every year, so we need to start using a different term as it applies to each patient. Regular for some may be three time a week or once every two week. The term wellness is also a slippery slope with little to no meaning. Wellness for someone diagnosed with a term illness versus someone eighteen years old and in good condition will have completely different meaning.

Life time wellness patients are the strength of any successful practice but the truth of the matter is that the intent of the care, based on mutual agreement of Patient and doctor is the keep to these long term relationships. The first stage of care intent may be to help the patient get the current challenge under control. This involves more than simply symptom reduction and address the cause of the neurological challenge at the center of the issue.  The next step would be to start monitoring the changes in neurological function and helping the system back to stabilization. The last step is greater than maintenance and is focused on peak performance. This involves monitoring the patient neurological responses throughout life and responding with appropriate care which the intent of keeping the system in balance.

How does the patient gather the knowledge about their choices in health care? Well not from medical ads seen on television, in magazines, on the radio or now the Internet! If you want to build a practice  based on patient  making the right choices about Chiropractic in their lives you best  be ready to offer the information in your office. B.J. Palmer bought a radio station so that the public would get to know what he knew.

Click HERE to read the next article in this series.

An Open Letter to the Profession

In the words of Bob Dylan,

Come gather ’round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone.
If your time to you
Is worth savin’
Then you better start swimmin’
Or you’ll sink like a stone
For the times they are a-changin’.”

 

While change is a constant, there are times when those changes are critical. The dinosaurs are a good example. Adapt or die is the law of survival.

The chiropractic profession has been in a fight for survival from its beginning and this is the time for the choice that will determine whether the profession lives on as viable alternative to drug based medicine or vanishes into the world of physical medicine. While there are many who view the latter as a good step, there are just as many who are strongly opposed.

There have always been divisions within the profession but never on such a critical scale. The creation of these divisions has two separate foundations: the first being the dedication to the theory of vertebral subluxation as cause and the second being reimbursement for service rendered.

On the Theory of Vertebral Subluxation as Cause.

The original concepts of a misaligned vertebra and the theory of nerve root pressure creating nerve interference and therefore dysfunction, to this day has not been supported. It is still a theory1. This fact has left the basic concepts of the entire profession as questionable. Meanwhile, we still have a great number of chiropractors staunchly defending this theory and using the positive results of Chiropractic care as their proof. As the basic concept of vertebral subluxation is not supported there is no explanation offered as to how these results are achieved. Instead of focusing on “why” the adjustment gets results, the hardcore of the profession continues to defend vertebral subluxation as the heart and soul of Chiropractic. This has only served to alienate the side of the profession not accepting the old theory.

What has exacerbated the problem is that the Chiropractic colleges, in attempting to bring their curriculum up to university standards, have found it necessary to drop much of the old chiropractic theories and education. This shift has pushed the profession toward physical medicine and away from any connection with the adjustment and neurological responses. In so doing, they have ignored the century old history of fantastic responses to Chiropractic care in areas beyond pain relief or improved joint function.

 On the Influence of Reimbursement for Service Rendered

The other mitigating factor in the shift of the profession lies in access to health insurance for services rendered. The inclusion is not so much about being recognized as a health profession as it is about security of income. In the beginning the profession saw its inclusion as vindication and acceptance. The long road, now in place, has shown this to be a misconception. The misconception lies in more than one area, one being the terms used such as, “Health” insurance. It has little to do with health and is really medical care insurance which in turn exposes number two misconception inclusion. Unless chiropractic becomes a medically modeled profession, it will be totally excluded. Once again the Colleges are well aware of this and will continue to move their education toward a model that will garner income for their graduates. (Remember that Colleges are profit run organizations even though they may claim not to be.)

 On the Effects of Politics on Scope of Practice.

All of these challenges, opinions, and political maneuverings have had a dramatic effect on the “Scope of Practice” of Chiropractic and then you have to add in the local effects of States, Provinces, and/or Countries. There have been two documents produced which address the Chiropractic Scope of Practice. One is the Mercy Documents2 and the other the Council of Chiropractic Practice (CCP) guidelines3.

While both are registered documents, the Mercy guidelines are very medically modeled and dated 1993. The CCP guidelines are much more Chiropractic modeled and have gone through a series of updates with the latest being 2013. The CCP organization is composed of elected members from a worldwide base. Elections are held each year and the updates are from member reviews of new research. The update includes current research that pertains to Chiropractic. One of the most important changes in the last Guidelines update is as a result of the information regarding the research on the effect of the chiropractic adjustment on central nervous system function. Three papers now show that the adjustment directly alters CNS function4,5,6. This information dramatically shifts the focus position of vertebral subluxation nerve root interference as cause, to the effect of the adjustment to improve brain function.

The new information takes the old concepts of vertebral subluxation as representing the best and only interest of Chiropractic and places it in the history books. This does not suggest that vertebral subluxation does not exist, but rather places it in the perspective of a third level response. Compromised Neural Integrity (CNI) due to neurological stress overloads and inappropriate neural responses are the primary damage. This in turn creates abnormal muscle activity throughout the body’s various systems and in the case of the structural system, the vertebral subluxation.

This research has changed the playing field for the Chiropractic profession. As the profession has been affected by the shift in the education toward physical medicine and structurally based care, not only has the scope of practice been reduced, but the very future of the profession is in jeopardy.

It is interesting to note that at the time when the colleges have turned away from the core principles of Chiropractic, along comes this groundbreaking research to support the greater picture of Chiropractic. The challenge now lies in “how” and “if” the profession is willing to entertain the new direction.  This has to start at the grass roots level.  Change does not come from the higher levels of education as they are the standard of yesterday. The changes start with the research being made available to the profession and with it must come evidence based application in the practice environment.

The profession has a history of outrageous claims based on non-supported concepts so the responsibility lies on those presenting the new direction to provide solid, reproducible, objective evidence to the effectiveness of the adjustment to alter CNS function. This includes certified accurate instrumentation.

That said, there are other aspects that needs consideration, which include understanding and defining the subluxation as applied to both the profession’s historical standing and current research. The chiropractic adjustment also needs defining in this context.

On the New Direction for the Profession

The CCP guideline committee took on this task during the 2013 update. In light of the new research on the adjustment and the CNS responses the committee, after 2 years of work, listed this definition.

Subluxation is a neurological imbalance or distortion in the body associated with adverse physiological responses and/or structural changes, which may become persistent and progressive. The most frequent site for the chiropractic correction of subluxation is via the vertebral column.”                CCP Guidelines 2013.

This not only represents a radical shift of the definition but also a radical shift for the entire profession. It shifts the direction away from the structural model and restriction to spinal or joint care to a total neurological foundation. It opens the scope of practice from a pain reduction model to a model based on functional neurology.  This model supports all technique approaches and calls for Chiropractors to look to the appropriateness of their care plans. This also calls for neurological assessments pre and post care.

Defining the adjustment from a neurological assessment calls for new approach as well. As the research now shows that the adjustment alters CNS function, we can no longer use terms such as realignment or joint play to describe an adjustment. The new definition calls for a two-step clarification.

Step one – The definition of feedback is important.

Feedback: A procedure whereby the consequence of an action serves to continually modify further action.

As that is exactly what the adjustment does within the CNS an appropriate definition of the adjustment is:

A Chiropractic procedure whereby the consequence of an action serves to continually modify further action within the nervous system with the intent of creating harmony within the body’s systems.

 The impact of the new information is in a shift from the physical concepts of Chiropractic – this being:  vertebral misalignment or vertebral subluxation and its correction as the main focus of chiropractic, to a total neurological foundation based on the effectiveness of the chiropractic adjustment’s ability to improve neurological function. The neurological recovery ability is a key factor of the effect of the adjustment which is the connection to the cataloging of the adjustment as a neurofeedback response.

The researchers dealing with bio/neurofeedback over the last 50 to 60 years have established the science of this field7 and once we were able to show the adjustment’s responses and subsequent ongoing changes in neurological function, it became self-evident that the chiropractic adjustment is a feedback event.

The next step was to use the adjustment as a neurological pattern interrupt and then apply bio and neurofeedback as a method to train the patient’s neurological pattern to a more ideal response.

This brings us back to scope of practice. To date there are no license requirements in place governing bio/neuro feedback. Australia has just taken the first steps to regulation but not so in North America. These are both valuable tools in the field of Neurologically Based Chiropractic and need to be included in our practice guidelines. They are included in the CCP guidelines for Chiropractic practice. That said, correct application is a necessity and those using the system should require training.

On the Intent of this Letter

 This letter is intended to provide information, evidence, and be thought provoking, not just to Chiropractors in practice but across the scope of bodies governing the practice of chiropractic worldwide.  Throughout North America, we have State and Provincial boards comprised of Chiropractors and the public controlling the profession based on concepts that are over100 years old or thinking that Chiropractic is just another branch of medicine.   Neither of these is acceptable. The boards are responsible for the protection of both the public and the profession; however, when they make rulings based on outdated information they serve neither.

I am calling for the profession to get activated, to get involved because you can’t change something from outside or through inactivity. So you don’t like your State or Provincial association position – get active and change them.  The scope of practice for Chiropractic is in your hands. You can let medical insurance coverage or the product of the chiropractic education system define Chiropractic and reap the consequences. Talk to your Boards and Associations! It is time for Chiropractors to define Chiropractic and its scope of practice.

Chiropractic is not medicine.   Chiropractic deals directly with neurological function.  Medicine deals with pathology.  Change will only happen through action!

Come writers and critics
Who prophesize with your pen
And keep your eyes wide
The chance won’t come again
And don’t speak too soon
For the wheel’s still in spin
And there’s no tellin’ who
That it’s namin’.
For the loser now
Will be later to win
For the times they are a-changin’.

 

 

References

1. Bolton P (2000). “Reflex effects of vertebral subluxations: the peripheral nervous system. An update.”. J Manipulative Physiol Ther 23 (2): 1013

2. www.chiro.org/LINKS/GUIDELINES/…/Mercy_

3. ccp-guidelines.org

4. Richard Barwell, DC; Annette Long, Ph.D.; Alvah Byers, Ph.D; Craig Schisler, B.A., M.A., DC. The Effect of the Chiropractic Adjustment on the Brain Wave Pattern as Measured by EEG. – A Four Case Study
International Research and Paper symposium 2005 Awarded the best research paper in review Sherman Chiropractic College

5. HeidiHaavikTaylor*,BernadetteMurphy  Cervical spine manipulation alters sensorimotor integration:  A somatosensory evoked potential study. Human Neurophysiology and Rehabilitation Laboratory, Department of Sport and Exercise Science, Tamaki Campus, University of Auckland, Private Bag 92019, 261Morrin Road, Glen Innes, Auckland, New Zealand Accepted 11 September 2006

6. Takeshi Ogura, oc, PhD; Manabu Tashiro, MD, phD; Mehedi Masud, MD, phD; Shoichi Watanuki; Katsuhiko Shibuya, us;Keiichiro Yamaguchi, MD, phD; Masatoshi Itoh, MD, phD: Hiroshi Fukuda, MD, phD; Kazuhiko yanai, nro, prroCerebral Metabolic Changes in Men After Chiropractic Spinal Manipulation for Neck pain.

7. Alvah P Byers (1998) The Byers neurotherapy reference library: Version 1.02  

The Truth of the Matter Pt IV– The Neurodynamics of Change

The Neurodynamics of Change

While the sky may not be falling, the world most certainly is shifting. The North Pole is now hundreds of miles away from the area I was taught in school.  In my lifetime weather patterns are changing which in turn is changing the fauna. Birch trees in northern Canada are 200 miles north of where they were found 40 years ago. Summers are hotter and winters are less predictable. Population is increasing and with this comes an increase in noise, air pollution and trash. The oceans are warming and fish populations are dying.

Meanwhile we continue to live, hoping our lifestyle will not be affected.  The question now is, “How are we doing with all these changes going on around us?” As we all tend to be self-centered, we measure the effect of these changes on our own life and not from a global perspective.  It always amazes me how often I hear people dismiss any challenge to their current position until some act or event directly affects them.

My childhood to young adult life found me living next to a volcanic mountain that constantly had steam being produced from its 10,000 foot peak. Then came the eruption of its sister mountain named Mt. St. Helens and my perspective changed! That beautiful mountain was really dangerous.

Radio, television and now the Internet has provided access to information on an instant basis, even when the information has little or nothing to do with our lives. Most of it is not good news and it is presented repeatedly, to the point where we become involved emotionally with no ability to offer any constructive action.

The Neurodynamics of this input is too great and our bodies are not designed to deal with this type of stress. Our stress response is designed for personal short term reaction and resolution of the challenge. When we start looking at the amount of stressors in our lives, we start to become aware of how much life has changed in the last 100 years. We have come from the basic stressors being the need for food, shelter and protection from predators to an over-whelming level of sensory, emotional, electromagnetic and physical stressors.  The effect of these is to overload the processing resources of the Central Nervous System.

A stressor is a message of a threat to survival and this in turn demands a counter response. The control system in charge of recording the threat and programing the response is the Central Nervous System. Now we have the control system so over loaded that incoming information designated for some specific region of the brain gets shifted to a different region is acted on based on the incoming information. However, because it is the wrong information for that region the response is inappropriate. This now creates stress within the systems and neurological imbalance spreads.

The stress effects reach all the way from cortical neurological networks to immune and endocrine system functions.  Today we are seeing an exponential growth in autoimmune system disorders and multiple chemical sensitivity illnesses.  These are all directly traceable to stress effects.  Today research attributes stress as the foundation of 95% of all illness and disease. The other 5% are called genetic in nature which is really “stress” at the cellular level.

The only way the nervous system can inform the conscious mind that there is an imbalance, which is now beyond safety limits, is to create signs or symptoms.  Medicine can only come into play based on these signs and symptoms and while drugs may seem like a good way to reduce the challenges, they do nothing to reduce the basic cause of the problem. In fact, over time they create an increase in the imbalance and become a stressor, which creates the need for more drug therapy. This medical approach has led to the situation today where the average American of age 50 is on at least 5 different medications and by age 70 – 7 to 8 drugs.  This system is failing to the point where prescription drugs have become the number one cause of death in America today.

Three research papers have demonstrated the effectiveness of Chiropractic care to improve the processing resources of the Central Nervous System. Today instrumentation is available to analyze the state of neurological responses to critical stressors and congruent recovery ability. The stress response report can show the level of neurological imbalance and therefore help design an ideal care and retraining program.

Stress is part of life; learning how to cope is part of living well.  Neurologically Based Chiropractic and the NeuroInfiniti are the future of the profession and the way back to health.

To read the next article in this series, click HERE.

The Truth of the Matter Pt III – Chiropractic and Neuroscience

Chiropractic and Neuroscience

These are the days my friend!  At long last the Chiropractic Profession can break the bonds that have kept it under challenges, misunderstanding and suppression for the last one hundred plus years. While many will continue to fight change and want to stick to the old theories of vertebral subluxation, the new information coming from the field of neuroscience has provided the opportunity for a new understanding as to “why” Chiropractic continues to get such outstanding results.

The rule is that over time new knowledge will create change. This does not mean that the “change” will be welcomed with open arms, but the truth of the matter is that without change there is no growth. As for the chiropractic profession, the need to change is being driven by factors such as the insurance coverage game, and the reduction of our scope of practice to pain reduction.

The further we moved down the road to ensuring insurance coverage, the more we have been forced to find billing codes for reimbursement which unfortunately are all medically modeled and therefore symptom based. We are well aware that Chiropractic plays a role in pain and /or symptom reduction; however, by limiting the profession to this level of participation we not only sell our value of care short but also the real benefits for the patient.

The demand for billing codes, diagnosis and evidence based care has forced the profession into the medical model which in turn moved all research toward the study of care as it pertains to some disease diagnosis. In order to present a diagnosis we have had to fall back onto the symptoms based disease classification. What this means is that we have been pulled into the game of treating symptoms which removes us from the field of a health profession and into the business of disease management.   I understand I can’t answer for everyone reading this article but this was not the reason I became a Chiropractor.

In my presentations I like to ask the DCs in the audience if they have ever had a “Chiropractic miracle” happen in their practice. It may be something as simple as the disappearance of some health challenge that the patient never mentioned before all the way to someone regaining the ability to walk or a autistic child breaking through. Without fail the stories start to come forward.  Someone who had low back pain not only had their pain go away but their high blood pressure dropped as well.

Here is the point I wish to make. Chiropractic has so much more to offer than what the insurance companies or medical billing diagnoses impose. These two influences continue to degrade our services.  The catch is that the new information from neuroscience and research within the chiropractic profession has changed the role of chiropractic care. The old theory of nerve interference from vertebral subluxation has now been superseded by research which clearly shows the problem is Compromised Neural Integrity (CNI) at the central nervous system level. Research has also revealed that the “Adjustment” acts as a neurological pattern interrupt which allows the CNS to reset the CNI to a more appropriate function.

If this information caught your attention, just wait for the next edition.  The future is bright if you aren’t afraid of change!   With this information these really are “The Days”!!

To read part IV in The Truth of the Matter series click HERE.

The Truth of the Matter PT II — Foundation of Care Plans

Foundation of Care Plans

One of the greatest challenges for the  clinical application of Chiropractic care
lies in the justification of care plans for patients, which become moving
targets depending on the intent of the care.
We see a wide range of patient care plans across the spectrum of
chiropractic offices which creates confusion and challenges to the profession.

If the intent of care is to simply reduce pain then the
care plan ends once the pain is reduced. However, if the intent is to stabilize
neurological function, then care ends once that has been demonstrated.
  The important aspect to either of these
examples lies in the ability to measure the outcome of care intent.

Chiropractic has come under criticism due to a lack of
evidence of many claims being made about how Chiropractic alters a patient’s
health.  The profession has relied on
subjective responses to substantiate these claims. While this continues to work
on a practice survival approach, it does nothing to bring credibility to the
profession from a science foundation. Therein lies the great challenge to the
future of the chiropractic profession. Chiropractic continues to have post
graduate programs on practice building based on care plans with questionable
foundations. Most Chiropractic colleges have moved the focus of Chiropractic
care from a neurological foundation to physical medicine.  This shift in education has moved
Chiropractic into the realm of physical therapy which brings with it a shift in
the intent of care.

Today we find Chiropractic caught in a state of change
with older well established practices setting care plans based on one approach
and new grads setting completely different plans which leaves both the public
and the profession very confused.

The call for evidence based care started several years
ago and while this sounded like progress for the profession, the challenges
became what was to be considered acceptable evidence.  Enter the role of health insurance and
billing. The involvement of insurance coverage for Chiropractic has altered the
intent of care due to the need for medical coding. Medical coding is based on
signs and symptoms, so the standard of care is restricted by the reduction or
elimination of these signs and symptoms. This is the reason the Chiropractic
Colleges have moved the profession toward physical therapy and medical billing
models.

Enter the effect of neuroscience in the last 10 years
into this confusion and we have an opportunity to reverse the restrictions
placed on Chiropractic care.  The history
of Chiropractic reveals that the intent of the Adjustment was directly linked
to neurological function, albeit a theory of nerve root pressure at the
intervertebral foramen.  The critical
issue is that Chiropractic has a neurological foundation. Different techniques
or methods of adjusting added to the challenges within the profession as many
didn’t involve manual (structural) approaches; yet, the patients demonstrated
reduction in signs and symptoms. In many situations patients reported overall
health issues improving.

The missing link over the last 119 years has been the
ability to prove that Chiropractic adjustments directly alter central nervous
function. Today the evidence is in. Three papers have finally proved the
effectiveness of Chiropractic beyond symptom relief. Today you can set care
plans based on a patient’s neurological needs and measure their changes, which
provides evidence to support the need
for care beyond symptom relief.

Now the question is – how long will it take before the
profession and its educational institutions grasp the critical importance of
the neuro-scientific research information and bring the profession back to its
real potential
?

Survival of the vibrancy and health of both the profession and individual practices depends on the adoption of Neurologically Based Chiropractic (NBC).

The practice of today is able to measure and address the neurological condition and needs of the patient
and from this determines appropriate care plans. Even the term “wellness” takes
on a new meaning when we can establish care based on a specific neurological
response long after any sign or symptoms have gone. Welcome to the future of
Chiropractic.

See part III of the Truth of the Matter series by clicking HERE.

The Truth of the Matter Part I — Unreal Practice Expectations

 Unreal Practice Expectations 

I remember the excitement and anticipation I was
feeling 50 years ago as I realized my dream of graduation from Canadian
Memorial Chiropractic College was only 2 months away. I was ready, or at least
I thought I was, but what was to come certainly didn’t fit my expectations.

I had experienced my education at CMCC through the
worst of its years: low enrolment, internal upheaval at the college board
level, and subway construction going on under the classroom building and I mean
literally. There was a good side to this in that our class was fortunately
exposed to the likes of Drs. E. Homewood, H Himes, and R.J. Watkins. These men
were extraordinary chiropractors and it was through them that I, still today,
carry a commitment to the power of Chiropractic.

I returned to my home town in British Columbia to join
in practice with the man who had inspired me to enter this field. His name was
Gordon Potter.  Gordon went on to get his
MD degree and was then responsible for the Saskatoon experience that later included
Drs.WH Kirkaldy-Willis, and D. Cassidy. (This is another story).

Shortly after joining with Dr Potter, he sold his
practice to me and moved to Australia, so here I was in what would seem to be
perfect position. The one area of the education at CMCC that wasn’t covered
(well that is being nice) was how to run the business of practice. I had no
idea about setting care plans past symptom relief. Needless to say I had my
first lesson arrive rather quickly – if you are a half decent Chiropractor you
will see reduction of symptoms within 5 to 6 visits. This, I thought, was great
and while it got me great marks in Clinic, it creates a drop off of patients in
practice. Month’s end continually arrived and the bills seemed to be
approaching faster each month.

The only real practice management program around at the
time was Dr. Jim Parker’s and his method was to schedule a new patient three
times a week for 2 weeks, two times a week for 2 weeks and 1 time a week for 2
weeks,  then once a month. The idea was
to build a “maintenance” based practice with a secure stable income.  Sounded great to me – so implement and move
ahead, which I did.  There can be no
doubt about this – it worked, even though there was no clinical justification
for the care plan or the shift in the visit scheduling.  At this point I must remind you that we are
talking about the 1960s time frame so no insurance coverage, no care codes, no
CE credit requirements and a visit fee of $2.00 per visit. To top this off, it
was at the height of the attack on Chiropractic with the local MDs doing
everything they could to discredit you.

Things were not as “rosy” as I had dreamed while in the
shelter of College but I survived and in doing so saw a change going on the
profession. The desire and push within the profession for greater acceptance
was moving Chiropractic toward low back pain management. Then came “Socialized
Medicine” in Canada with the inclusion of Chiropractic services which included
a raise in pay to $4.00 a visit. Well, I thought I had it made and it was just
going to be easy street from here on out. Lesson 37 (I just don’t want to talk
about lesson 2 to 36 – just too painful). What I didn’t see was that we were
limited to 12 visits a year at $4.00 – wait – maintenance based practice at
once a month – hey, no problem – that meant all I needed was 30 patient visits
a day on the once a month plan to generate $2520.00 a month – gravy days!!!!! I
mean I know that gas was about .35 cents a gallon then so $2500 was a lot of
money.  It turned out it wasn’t as much
as I thought. (I was still in student poverty mode). Not only did this place a
huge demand on the need for new patients but also frustration in trying to
schedule patients onto the once a month plan.
As we had sold the public on spinal care and pain management.

I also noticed that all I ever saw in the office were
patients in trouble, and they had high expectations that I would “fix” them in
a few visits, no matter how long their challenge had been going on.

Over the next 20 plus years I saw the fee from
socialized medicine climb very slowly while the cost of operations of the
practice climbed and climbed and climbed.
The profession had agreed to a contract that would not allow us to bill
the patient more than their fee, so, the only answer was to see more patients.
Practices had to see 40 to 50 patients a day to have a survival practice. I got
very good at maintaining a high volume practice and after running at 120 to 130
patients per day I began to hate what I was doing. I was seeing patients with
complaints all day long and the minute I got them out of pain they were gone.
This was not the vision I had when I graduated. This was not the Chiropractic I
had dreamed about so many years earlier.

I have watched the decline of Chiropractic to the point
where Chiropractic offices have become: weight loss centers, supplement
dispensaries, Physical Therapy offices and/or stop smoking clinics, among other
things.  Listen up – I am not questioning
the value of any of these but what the hell happened to Chiropractic? Did
Chiropractic stop getting results? I don’t think so!

It all comes down to just some sound business
fundamentals.   When you lose your unique
marketing position you will get a decline in the return on your investment.
Chiropractic was once the leader in the alternative health care professions.
Today we are not even mentioned. Today the public views us as a strictly back
pain management profession in competition with medical pain killers (more
effective at killing pain) and Physical therapy (that has better insurance
coverage).

Where do we go from here?

We need to get back to our roots! This does not mean
back to a profession that is only philosophy based – that time has passed us
by. Today is the time of evidence based care. I think I heard someone ask,
“What evidence?”

Today Chiropractic stands at the most critical
crossroads in its history. As a profession and as individuals we have the
opportunity to retreat from the march into the medical model and to restore the
real power of Chiropractic.  Neuroscience
of the last 15 years now supports the basic tenet of Chiropractic – it is the
nervous system that controls the destiny of a person’s health. The search for
the evidence of what we have claimed for over 100 years is finished. The only
question that remains is whether the Chiropractic profession is willing to
stand up and be counted. We are no longer limited to back pain relief or by the
constraints of insurance coverage.

I am watching practices around the world present
Neurologically Based Chiropractic, a concept that I founded fourteen years ago,
and flourish in the times of diminishing practices that are stuck in the pain
relief model.  What are you missing? It
costs nothing to check it out!

I will be doing a series of these “The Truth of the Matter” articles for the DCTree — see the next article in the series HERE.

 

 

So You’ve Chosen A “Career”

I just have to look at the dictionary to be sure of what I write hereCareer– the course or progress of one’s life or lifework.  We tend to use the word career often and while we seem to have the right usage, it appears to me that we sell it far short of a complete meaning or application. Most often we hear it used as “chosen work”. Current concepts with regards to life and work is that most people will have 5 different careers in their lifetime. Anybody else see the misuse here? Our lifework is fast becoming a question of commitment.

When we look at the definition of career, the words which stand out for me are – “life” and “lifework”. It doesn’t say time period of work or current job. I clearly remember the “jobs” I had while attending Chiropractic College. They served a higher purpose, which was to earn enough money to allow me to continue in pursuit of my lifework – “Chiropractic”. I remember the challenges of the last two years of college – remember now this was before student loans, of working at three jobs, plus clinic, plus regular college courses. Looking back I would call this a serious pursuit. I think about the 50% of the class who dropped out over the years and wonder if they found a career in their lives. I know of a DC who took 8 years to complete the 4 year program – more power to him as I’m sure it would have been easier to drop out. He had a vision of his lifework and nothing was going to stop him from achieving it.
Many make the mistake of assuming that just because they have found their career, for the rest of their lives, the water will just flow downhill and all will be easy. I can guarantee this – there will be water shortages, flow blockages, floods and other diversions along the river bed; some so large that the downhill flow will seem to stop and you will find yourself in the middle of a great lake. Do not stop the forward motion; do not forget the intent of your career! At the end of the lake you will find the outlet and probably the ride of your life.If you are paying attention, you will have noticed that I slipped in the “INTENT” word. If you have had the good fortune and awareness to find your “CAREER” then you will find that along with this has come a clear understanding of the “INTENT” of the process. The mere fact that it is your “Lifework” suggests that there must be a level of intent or desired outcome involved.

Chiropractic has provided me that greatest of opportunity, to express a value of my life and I am thankful and humbled in its gifts. When I talk to others about Chiropractic I continually have a thought running in the background of the discussion; the thought being – If these people could only experience what incredible results Chiropractic has had for the people under care, they would literally “stand” in awe and respect. Children becoming responsive human beings, chronic illness disappearing, people regaining the ability to walk, asthma disappearing, and the list goes on. We in Chiropractic know these results because we have experienced these wondrous things.

Why?

Because we stayed the course and never lost sight of our lifework, our career. Part of any career is founded on the necessity of “earning a living” but if that is the only consideration then sadly it will not be a very fulfilling career. There will never be enough money to add up to the value of helping others; the personal value of what you do to enrich other’s lives. Bill Gates and Warren Buffet have created a foundation to help people but in order to do this they had to build a career of making money first. This is the difference between a “job” and a “career”.

The job of making money (pursuit) versus a career of helping others (Higher purpose).  As a Chiropractor, or Chiropractic staff or Chiropractic advocate you have the opportunity to get the human value return by just offering chiropractic care.
How does it get any better than this!
Richard Barwell, D.C.