Dr. Dennis Perman’s Message of the Week: A Birthday Gift For Chiropractic

September 22, 2014

A Birthday Gift For Chiropractic

Dear Doctor:

January of 2015 will mark forty years since I first set foot on the campus of the Columbia Institute of Chiropractic, which morphed into my alma mater, the New York Chiropractic College. It seems like only yesterday that my face was flushed with positive expectancy, my heart was open, and my desire to serve and succeed was surpassed only by my curiosity about what I was getting myself into.

Now I see my son Daniel entering the clinic at Life West, not so much following in my footsteps as blazing his own trail, pointing consistently and passionately in the direction of his dreams. It’s inspiring to see the baton passed and the destiny of chiropractic unfolding – like Moses, I may not get to set foot in the promised land, though I can see it from here, but I am certain that this next generation will motivate the public to take the actions necessary to break through to higher health consciousness.

Between the talent of these young doctors and the burgeoning disdain that is ever-developing around the greed and malfeasance of organized health, there’s no question that a massive paradigm shift is coming, and nowhere is this better illustrated than under The DCTree.

What is The DCTree? It’s a group of committed young chiropractors and students who are dedicated to the interconnection and synergy of chiropractors and chiropractic students worldwide. The brainchild of Cory St. Denis, Lance Rynearson and Shaughnessy Reid from Logan College of Chiropractic, it aims to be a compendium of neurologically-based chiropractic thought, for chiropractic students to pool resources and learn from field practitioners and mentors and facilitate their integration into the reality of chiropractic practice.

I had the privilege of addressing this fledgling group this past weekend, and I was struck with the serious nature of their approach — with the guidance of dear friend and longtime Masters Circle member Patrick Keiran of Jay, Maine, they brought in top brain-based talent, like Richard Barwell, Tedd Koren, and Patrick Porter, and orchestrated a focused, meaningful seminar, which was extremely well-received by a roomful of engaged chiropractors.

But what set this event apart was the exuberance of the recent and soon-to-be graduates, wide-eyed with discovery and building upon their perceptions of things natural. I remember when the light first went on for me, realizing that health and wellness came from above down, inside out — for The DCTree, it’s more than lip service or dogma, it’s real, and it makes me more confident in our profession’s ultimate success. With health and wellness in the capable hands of such fine young leaders, our future is assured.

Please nurture and support this significant effort — we’re not that far away ourselves from those early feelings of wonder and awe at the magnitude of our potential contribution to society, and the intense compelling desire to do something that makes a difference. Go to TheDCTree.org and read their posts, add your two cents, and be a part of this blossoming movement. You have so much to share, and who knows, you could learn something, too.

Dennis Perman DC,
for The Masters Circle

Purposeful Connections: Just A Trip To Mexico?

Wouldn’t it be nice if a group of practicing chiropractors got together in your area, organized group meetings to share practice building experiences, host local EPOC meetings, and created a community that boasts mountains of valuable content?

The Legion of Chiropractic has already got you covered.   Our profession is teeming with fantastic grass-roots entrepreneurs, groups and organizations, gadgets and gizmos, leaders, followers, and even naysayers.  Because there are events like Purposeful Connections in Cancun, Mexico, that meet together once a year for a transformational series of lectures by guest speakers from all over, chiropractors are able to bring it all home and get back to practicing chiropractic with youthful enthusiasm.

I was lucky enough to attend Purposeful Connections this year with my business partner and mentor, Dr. Patrick Keiran.  With both of us on the speaking circuit sharing our expertise and experience in Neurologically Based Chiropractic and the DCTree, we had an amazing time engaging in discussions on philosophy, technology, practice improvement, team building, and a  host of  “sunset on the beach” meetings to recap on each days activities.  There was tons of laughter, networking, growth, and even some tears.  Two people actually got engaged at the final sunset growth session, which was really cool!

I may be a recent graduate, but I am an experienced relationship builder and I would recommend that people log on to the Legion of Chiropractic website, see what this engaged group is doing, and participate.


What’s stopping you from growing?

Finding Your Voice

We are creating something new.

That’s why I have compiled a network of amazing Doctors of Chiropractic, brain-based wellness experts, researchers, various students, along with entrepreneurs and tech gurus.  Together, this team has worked to build an online networking tool, known as The DCTree.  I have no doubt that this network can be used to meet personal and professional goals.

We must recognize that we are always learning. Wether your success comes from free DCTree resources or productive web solutions, our intent is to use these relationships to document our usefull experiences.  I believe by doing so, it will allow us all to grow and benefit.  That is why I am working together with the DCTree team to help expand our mission –> see here:  http://thedctree.org/what-can-the-dctree-do-for-you/

Are you a DC student looking to build your network? Join us at one of our many events.

Are you a chiropractic entrepreneur or blogger, interested in participating?  Contact: info@thedctree.com

Are you an experienced professional, willing to share your insights to the next generation?  link us up- we proudly share your content/info.

To reaching your potential,

Cory St. Denis, D.C.




PODCAST POST: Interview with Dr. Cory St. Denis


Cory St. Denis is the Co-Founder and Creative Director at the DCTree. This movement and company sprouted from his vision of ensuring all Chiropractic students receive the cutting edge technique, neuroscience and identity building information he was exposed to at training sessions with his mentors. He is passionate about building a coalition to bridge the gap between new Chiropractors and practice fulfillment. At the time of this interview, he was a doctoral student and senior intern at Logan University.

Optimistic Quote – Affirmation

“You are the average of the six people you spend the most time with”.

Top Three Core Values

1. Honesty

2. Health

3. Passion

Life & Practice Struggle 

Applying himself to the academics of Chiropractic college.

What’s Working and Amazing in Life & Practice

DcTree website development and creation. Professional networking site.


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’.




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

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

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

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.