tag:typepad.com,2003:weblog-1250480 %ISSUE_DATE%T09:25:32-07:00 Focus on hardware and diagnostics. TypePad tag:mpamedia.com,2008:post-55724 2012-01-29T12:00:32-07:00 2012-01-29T12:00:07-07:00

The use of manipulation in the management of biomechanical disorders of the spine may now be regarded as a mainstream approach across health care. However, the management of visceral disorders through treatment of the spine remains controversial, and the association of particular spinal regions with specific visceral disorders, a core precept of the meric system, is regarded with considerable scepticism outside of chiropractic.

By Brian Budgell, DC, PhD The use of manipulation in the management of biomechanical disorders of the spine may now be regarded as a mainstream approach across health care. However, the management of visceral disorders through treatment of the spine remains controversial, and the association of particular spinal regions with specific visceral disorders, a core precept of the meric system, is regarded with considerable scepticism outside of chiropractic. tag:mpamedia.com,2008:post-55689 2012-01-01T12:00:32-07:00 2012-01-01T12:00:07-07:00

How often does a patient come in with an MRI showing a herniated or extruded disc who has been told they need surgery? Examination may show minimal weakness or even diminished reflexes. The problem is that often, the patient did not receive a functional examination to determine other possible causations or treatments that might help repair the area without surgery.

By Warren Hammer, MS, DC, DABCO How often does a patient come in with an MRI showing a herniated or extruded disc who has been told they need surgery? Examination may show minimal weakness or even diminished reflexes. The problem is that often, the patient did not receive a functional examination to determine other possible causations or treatments that might help repair the area without surgery. tag:mpamedia.com,2008:post-55587 2011-10-21T12:00:32-07:00 2011-10-21T12:00:07-07:00

Discussion of reflex testing concludes this series on the six primary areas of neurological examination, which also includes mental status, cranial nerves, coordination, and motor and sensory testing. When performed and interpreted correctly, reflex testing provides the examiner with some of the most object evidence that can be obtained in neurological testing. Deep-tendon, pathological and superficial reflexes all supply a wealth of information on localization and identification of upper and lower motor neuron lesions.

By K. Jeffrey Miller, DC, DABCO Discussion of reflex testing concludes this series on the six primary areas of neurological examination, which also includes mental status, cranial nerves, coordination, and motor and sensory testing. When performed and interpreted correctly, reflex testing provides the examiner with some of the most object evidence that can be obtained in neurological testing. Deep-tendon, pathological and superficial reflexes all supply a wealth of information on localization and identification of upper and lower motor neuron lesions. tag:mpamedia.com,2008:post-55514 2011-09-09T12:00:32-07:00 2011-09-09T12:00:07-07:00

There are five primary sensory modalities typically tested in a routine neurological examination. Three of these, vibration, joint position sense and pinprick, are the focus of this discussion. Light touch and temperature are discussed, but not described in detail. Likewise, higher sensory functions such as stereognosis and graphesthesia are not discussed, as they are seldom the reason for presentation in a chiropractic practice.

By K. Jeffrey Miller, DC, DABCO There are five primary sensory modalities typically tested in a routine neurological examination. Three of these, vibration, joint position sense and pinprick, are the focus of this discussion. Light touch and temperature are discussed, but not described in detail. Likewise, higher sensory functions such as stereognosis and graphesthesia are not discussed, as they are seldom the reason for presentation in a chiropractic practice. tag:mpamedia.com,2008:post-55508 2011-08-26T12:00:32-07:00 2011-08-26T12:00:07-07:00

As health care providers, we have been trained to take a thorough history and perform physical, orthopedic and neurological examinations, as well as utilize radiography or MRI when there are indications of serious spinal pathology, to arrive at a specific diagnosis. Traditionally, determining the precise diagnosis has been considered essential in order to determine the appropriate treatment plan. This, of course, is perhaps even more true in allopathic medicine than in chiropractic. Enormous amounts of time and money can be spent on specialized and technologically sophisticated tests that have been integrated into the diagnostic process.

By Malik Slosberg, DC, MS As health care providers, we have been trained to take a thorough history and perform physical, orthopedic and neurological examinations, as well as utilize radiography or MRI when there are indications of serious spinal pathology, to arrive at a specific diagnosis. Traditionally, determining the precise diagnosis has been considered essential in order to determine the appropriate treatment plan. This, of course, is perhaps even more true in allopathic medicine than in chiropractic. Enormous amounts of time and money can be spent on specialized and technologically sophisticated tests that have been integrated into the diagnostic process. tag:mpamedia.com,2008:post-55471 2011-08-12T12:00:32-07:00 2011-08-12T12:00:07-07:00

Testing motor function has several facets. Strength, lower motor function, upper motor function and tone are standard neurological components of motor testing. Some also bring manual muscle testing (reflexive test, applied kinesiology) into this realm, but it has a different purpose and performance, and will not be discussed in this writing.

By K. Jeffrey Miller, DC, DABCO Testing motor function has several facets. Strength, lower motor function, upper motor function and tone are standard neurological components of motor testing. Some also bring manual muscle testing (reflexive test, applied kinesiology) into this realm, but it has a different purpose and performance, and will not be discussed in this writing. tag:mpamedia.com,2008:post-55470 2011-08-12T12:00:32-07:00 2011-08-12T12:00:07-07:00

Say goodbye to cookie-cutter treatment programming - toss it, get rid of it, abandon it and lose it. You get the point. Your patient deserves more. Every person is unique in what they require to get well. Everyone wants to get out of pain. Pain is a very powerful motivator for change. I have yet to meet anyone who actually enjoys being in pain. However, what individuals need to get out of pain can vary greatly. This is where your clinical expertise is the game changer. You also need a "human element" that is critical to long-term success.

By Perry Nickelston, DC, FMS, SFMA Say goodbye to cookie-cutter treatment programming - toss it, get rid of it, abandon it and lose it. You get the point. Your patient deserves more. Every person is unique in what they require to get well. Everyone wants to get out of pain. Pain is a very powerful motivator for change. I have yet to meet anyone who actually enjoys being in pain. However, what individuals need to get out of pain can vary greatly. This is where your clinical expertise is the game changer. You also need a "human element" that is critical to long-term success. tag:mpamedia.com,2008:post-55412 2011-07-01T12:00:32-07:00 2011-07-01T12:00:07-07:00

This concludes our series on patient "M," who entered my office in January hoping that manipulation would provide her some relief. The complaints noted on her intake form included pain in her head, neck, upper back, middle back, lower back, arms and legs. During the history, we discovered she also had fatigue, brain fog, dizziness, burning feet (especially at night), poor exercise tolerance, hair loss and difficulty sleeping.

By G. Douglas Andersen, DC, DACBSP, CCN This concludes our series on patient "M," who entered my office in January hoping that manipulation would provide her some relief. The complaints noted on her intake form included pain in her head, neck, upper back, middle back, lower back, arms and legs. During the history, we discovered she also had fatigue, brain fog, dizziness, burning feet (especially at night), poor exercise tolerance, hair loss and difficulty sleeping. tag:mpamedia.com,2008:post-55399 2011-06-17T12:00:32-07:00 2011-06-17T12:00:07-07:00

With chiropractic backgrounds rooted in motion palpation and functional rehabilitation, we have observed that the upper-thoracic spine may be the most commonly restricted area in the locomotor system. This restriction of multiple segments (C7-T5) is likely related to cervical disc herniations; degenerative changes at the lower cervical spine; shoulder impingement and rotator-cuff pathologies; and low back pain.

By Craig Liebenson, DC and Brett Winchester, DC, FASBE(C), DAAPM, DAAMLP With chiropractic backgrounds rooted in motion palpation and functional rehabilitation, we have observed that the upper-thoracic spine may be the most commonly restricted area in the locomotor system. This restriction of multiple segments (C7-T5) is likely related to cervical disc herniations; degenerative changes at the lower cervical spine; shoulder impingement and rotator-cuff pathologies; and low back pain. tag:mpamedia.com,2008:post-55392 2011-06-17T12:00:32-07:00 2011-06-17T12:00:07-07:00

Coordination deals with the ability to move in a smooth manner and the capability to perform alternating movements. Coordination relies on proper function of multiple aspects of the nervous system, including proprioceptive, motor, sensory, extrapyramidal, vestibular and – most importantly – cerebellar function.

By K. Jeffrey Miller, DC, DABCO Coordination deals with the ability to move in a smooth manner and the capability to perform alternating movements. Coordination relies on proper function of multiple aspects of the nervous system, including proprioceptive, motor, sensory, extrapyramidal, vestibular and – most importantly – cerebellar function. tag:mpamedia.com,2008:post-55256 2011-04-09T12:00:32-07:00 2011-04-09T12:00:07-07:00

Of the six components of the neurological examination, the cranial nerve examination is perceived as being the most complicated and thus the most difficult and time consuming. In truth, the examination is indeed the most complicated, but complicated does not always equate with difficulty or time commitment. Initial screening of the cranial nerves can actually be relatively easy.

By K. Jeffrey Miller, DC, DABCO Of the six components of the neurological examination, the cranial nerve examination is perceived as being the most complicated and thus the most difficult and time consuming. In truth, the examination is indeed the most complicated, but complicated does not always equate with difficulty or time commitment. Initial screening of the cranial nerves can actually be relatively easy. tag:mpamedia.com,2008:post-55219 2011-03-12T12:00:32-07:00 2011-03-12T12:00:07-07:00

A few years ago, I saw a short health segment on the evening news about training dentists to recognize the difference between patient fear and patient pain during dental procedures. The method was simple: watch the patient's eyes and eyebrows. If the eyes were wide open and the eyebrows were elevated, then the patient was apprehensive or fearful. If the eyes were closed and the eyebrows were lowered and furrowed, then the patient was in pain. I have been trying to find a reference for this, but so far I have not. I cannot remember when or where I saw the news segment (I travel a lot).

By K. Jeffrey Miller, DC, DABCO A few years ago, I saw a short health segment on the evening news about training dentists to recognize the difference between patient fear and patient pain during dental procedures. The method was simple: watch the patient's eyes and eyebrows. If the eyes were wide open and the eyebrows were elevated, then the patient was apprehensive or fearful. If the eyes were closed and the eyebrows were lowered and furrowed, then the patient was in pain. I have been trying to find a reference for this, but so far I have not. I cannot remember when or where I saw the news segment (I travel a lot). tag:mpamedia.com,2008:post-55184 2011-02-26T12:00:32-07:00 2011-02-26T12:00:07-07:00

Do you ever feel weird when new patients come in who have been to other chiropractors and say, "Adjustments only provide temporary relief"? I'm sick of hearing it. Don't get me wrong: I love seeing new patients, but I feel bad that this person almost gave up on chiropractic care altogether! Most chiropractors I meet are warm and caring, and they have a curious presence about them. The overwhelming majority genuinely want people to get better.

By Jeffrey Tucker, DC, DACRB Do you ever feel weird when new patients come in who have been to other chiropractors and say, "Adjustments only provide temporary relief"? I'm sick of hearing it. Don't get me wrong: I love seeing new patients, but I feel bad that this person almost gave up on chiropractic care altogether! Most chiropractors I meet are warm and caring, and they have a curious presence about them. The overwhelming majority genuinely want people to get better. tag:mpamedia.com,2008:post-55151 2011-02-12T12:00:32-07:00 2011-02-12T12:00:07-07:00

There are six standard components of a neurological examination: mental status, cranial nerve, coordination, motor, sensory and reflex testing. While they are standards in medical neurology, the same does not apply in chiropractic practice. Chiropractors are trained to test these standard components, but they seldom do so consistently. Of the six components, motor, sensory and reflex testing dominate chiropractic examinations, while mental status, cranial nerve and coordination testing are secondary and in some cases nonexistent. (This last statement is based on my many years of peer-review and malpractice defense work.)

By K. Jeffrey Miller, DC, DABCO There are six standard components of a neurological examination: mental status, cranial nerve, coordination, motor, sensory and reflex testing. While they are standards in medical neurology, the same does not apply in chiropractic practice. Chiropractors are trained to test these standard components, but they seldom do so consistently. Of the six components, motor, sensory and reflex testing dominate chiropractic examinations, while mental status, cranial nerve and coordination testing are secondary and in some cases nonexistent. (This last statement is based on my many years of peer-review and malpractice defense work.) tag:mpamedia.com,2008:post-55136 2011-01-29T12:00:32-07:00 2011-01-29T12:00:07-07:00

If there is one primary motivator that initially brings patients to our offices, it is pain. For example, one typical case we see is the patient who presents with lower back pain and is given spinal manipulation with or without some kind of therapy and corrective exercise. Our pain relief success rate is legendary with this approach for many of these patients, but for many others, their problems can be stubbornly persistent and complex, with chronic recurrences that frustrate the best efforts of doctor and patient.

By Robert "Skip" George, DC, CCSP, CSCS If there is one primary motivator that initially brings patients to our offices, it is pain. For example, one typical case we see is the patient who presents with lower back pain and is given spinal manipulation with or without some kind of therapy and corrective exercise. Our pain relief success rate is legendary with this approach for many of these patients, but for many others, their problems can be stubbornly persistent and complex, with chronic recurrences that frustrate the best efforts of doctor and patient. tag:mpamedia.com,2008:post-55111 2011-01-15T12:00:32-07:00 2011-01-15T12:00:07-07:00

The overhead squat is one of the most valuable assessments you can do with your patients. This single movement divulges crucial information about your client's mobility and stability in the kinetic chain. The assessment tests for bilateral symmetrical mobility and stability of the hips, knees and ankles. When combined with the hands held overhead, this test also assesses bilateral symmetrical mobility of the shoulders, as well as extension of the thoracic spine.

By Perry Nickelston, DC, FMS, SFMA The overhead squat is one of the most valuable assessments you can do with your patients. This single movement divulges crucial information about your client's mobility and stability in the kinetic chain. The assessment tests for bilateral symmetrical mobility and stability of the hips, knees and ankles. When combined with the hands held overhead, this test also assesses bilateral symmetrical mobility of the shoulders, as well as extension of the thoracic spine. tag:mpamedia.com,2008:post-55109 2011-01-15T12:00:32-07:00 2011-01-15T12:00:07-07:00

I am concerned, as I am at the start of every new year, about what is new or changing in the world of chiropractic billing and reimbursement. Are there new diagnosis codes for chiropractors? Are we changing from ICD-9 to ICD-10? Are there any new CPT codes for treatment, exams or physical medicine services commonly used by chiropractors?

By Samuel A. Collins I am concerned, as I am at the start of every new year, about what is new or changing in the world of chiropractic billing and reimbursement. Are there new diagnosis codes for chiropractors? Are we changing from ICD-9 to ICD-10? Are there any new CPT codes for treatment, exams or physical medicine services commonly used by chiropractors? tag:mpamedia.com,2008:post-55051 2010-12-02T12:00:32-07:00 2010-12-02T12:00:07-07:00

The indomitable and eminently quotable Teddy Roosevelt once declared, "A man who is good enough to shed his blood for the country is good enough to be given a square deal afterwards." Without too much wordsmithing, I could easily substitute "clinician" for "country" and "diagnosis" for "deal" and wind up with: "A man who is good enough to shed his blood for the clinician is good enough to be given a square diagnosis afterwards" or "A physician who is good enough to draw blood from the patient is good enough to give a square deal afterwards."

By Anthony Rosner, PhD, LLD [Hon.], LLC The indomitable and eminently quotable Teddy Roosevelt once declared, "A man who is good enough to shed his blood for the country is good enough to be given a square deal afterwards." Without too much wordsmithing, I could easily substitute "clinician" for "country" and "diagnosis" for "deal" and wind up with: "A man who is good enough to shed his blood for the clinician is good enough to be given a square diagnosis afterwards" or "A physician who is good enough to draw blood from the patient is good enough to give a square deal afterwards." tag:mpamedia.com,2008:post-55040 2010-12-02T12:00:32-07:00 2010-12-02T12:00:07-07:00

As chiropractors, we learn to assess, diagnose and treat conditions of the spine and extremities that cause pain, dysfunction and disease. As sports chiropractors, we take a step further by integrating rehabilitation, physiotherapy, sports-performance training and nutrition to provide a comprehensive approach to our patients. Often our focus is primarily on the location of pain, when it also needs to be seen as a messenger or signal.

By Robert "Skip" George, DC, CCSP, CSCS As chiropractors, we learn to assess, diagnose and treat conditions of the spine and extremities that cause pain, dysfunction and disease. As sports chiropractors, we take a step further by integrating rehabilitation, physiotherapy, sports-performance training and nutrition to provide a comprehensive approach to our patients. Often our focus is primarily on the location of pain, when it also needs to be seen as a messenger or signal. tag:mpamedia.com,2008:post-55029 2010-11-18T12:00:32-07:00 2010-11-18T12:00:07-07:00

Sometimes the internal discourse that is common in our profession seems to get in the way of our acceptance of real help so that we can expand our profession and better serve our patients. Alteration of motion segment integrity (AOMSI) is a significant gift from the AMA that allows us to methodically locate, substantiate and objectively prove the severity of the spinal subluxation. Of course, it comes as a gift only as long as we handle it with a high level of responsibility.

By Jeffrey Cronk, DC, CICE Sometimes the internal discourse that is common in our profession seems to get in the way of our acceptance of real help so that we can expand our profession and better serve our patients. Alteration of motion segment integrity (AOMSI) is a significant gift from the AMA that allows us to methodically locate, substantiate and objectively prove the severity of the spinal subluxation. Of course, it comes as a gift only as long as we handle it with a high level of responsibility. tag:mpamedia.com,2008:post-55018 2010-11-18T12:00:32-07:00 2010-11-18T12:00:07-07:00

It starts with low energy and is usually blamed on stress or a busy schedule. Then she begins to crave sweets to stay focused and awake, especially in the afternoon. She turns to energy supplements to get through her workout. She doesn't sleep as well as she used to.

By G. Douglas Andersen, DC, DACBSP, CCN It starts with low energy and is usually blamed on stress or a busy schedule. Then she begins to crave sweets to stay focused and awake, especially in the afternoon. She turns to energy supplements to get through her workout. She doesn't sleep as well as she used to. tag:mpamedia.com,2008:post-54988 2010-11-04T12:00:32-07:00 2010-11-04T12:00:07-07:00

This is the first in a series of three articles on adjusting the pelvis. This column started as an in-depth description of various low-force adjusting methods. I have occasionally strayed, but low-force adjusting is the essence of what I share. Let's start with diagnosis and assessment of the whole of the pelvis, and then briefly talk about correcting the outer ring.

By Marc Heller, DC This is the first in a series of three articles on adjusting the pelvis. This column started as an in-depth description of various low-force adjusting methods. I have occasionally strayed, but low-force adjusting is the essence of what I share. Let's start with diagnosis and assessment of the whole of the pelvis, and then briefly talk about correcting the outer ring. tag:mpamedia.com,2008:post-54918 2010-10-21T12:00:32-07:00 2010-10-21T12:00:07-07:00

Put yourself in the position of a practicing doctor of chiropractic in Texas right about now (if you are one, this is easy). With the Texas Medical Board and Texas Medical Association breathing down your neck, threatening to take away your right to diagnose (or even use the word diagnosis in your scope-of-practice act, claiming that by medical definition, the word is reserved for medical doctors and doctors of osteopathy), a Texas judge has ruled in your favor - depending on your perspective. While Judge Stephen Yelenosky rejected the TMB/TMA reasoning that diagnosis does not apply to non-MD/DO providers, he did render the chiropractic scope-of-practice act null and void as currently written. By all accounts, any rewrite will need to update the current language in the act, which does not include the word diagnosis (but according to the Texas Chiropractic Association and others, clearly implies it by stating that DCs can "analyze, examine and evaluate"). It is unclear whether the revised scope will need to satisfy Judge Yelenosky's prior suggestion that chiropractic diagnosis should be limited to "the biomechanical condition of the spine and the musculoskeletal system."

By Editorial Staff Put yourself in the position of a practicing doctor of chiropractic in Texas right about now (if you are one, this is easy). With the Texas Medical Board and Texas Medical Association breathing down your neck, threatening to take away your right to diagnose (or even use the word diagnosis in your scope-of-practice act, claiming that by medical definition, the word is reserved for medical doctors and doctors of osteopathy), a Texas judge has ruled in your favor - depending on your perspective. While Judge Stephen Yelenosky rejected the TMB/TMA reasoning that diagnosis does not apply to non-MD/DO providers, he did render the chiropractic scope-of-practice act null and void as currently written. By all accounts, any rewrite will need to update the current language in the act, which does not include the word diagnosis (but according to the Texas Chiropractic Association and others, clearly implies it by stating that DCs can "analyze, examine and evaluate"). It is unclear whether the revised scope will need to satisfy Judge Yelenosky's prior suggestion that chiropractic diagnosis should be limited to "the biomechanical condition of the spine and the musculoskeletal system." tag:mpamedia.com,2008:post-54845 2010-08-26T12:00:32-07:00 2010-08-26T12:00:07-07:00

Let's discuss normal shoulder resting posture so we can determine if there is a link between a postural deviation and pain. Static postural analysis is performed before range-of-motion examinations, orthopedic testing, movement pattern assessments and palpation analysis. When I perform a static posture evaluation, I focus on subtle asymmetries or deviations from normal patterns to aid my diagnostic decisions and treatment transition decisions (passive care to active therapy). I allow myself the time to pause and focus on what I see posturally before beginning other procedures. The changes I see in static posture and functional-movement assessments, visit to visit, help me navigate through the treatment process.

By Jeffrey Tucker, DC, DACRB Let's discuss normal shoulder resting posture so we can determine if there is a link between a postural deviation and pain. Static postural analysis is performed before range-of-motion examinations, orthopedic testing, movement pattern assessments and palpation analysis. When I perform a static posture evaluation, I focus on subtle asymmetries or deviations from normal patterns to aid my diagnostic decisions and treatment transition decisions (passive care to active therapy). I allow myself the time to pause and focus on what I see posturally before beginning other procedures. The changes I see in static posture and functional-movement assessments, visit to visit, help me navigate through the treatment process. tag:mpamedia.com,2008:post-54745 2010-07-01T12:00:32-07:00 2010-07-01T12:00:07-07:00

Here's a fact that will leave you squirming in your seat - a recent study found that 85 percent of Americans have at least one form of intestinal or organ parasite feeding off their bodies. The worst part is you can't see them and you can't feel them, so how do you know they are there? By hiding out in the intestines, they get "first choice" of any nutrients fed to your system.

By Van Merkle, DC, CCN, DCBCN, DABCI Here's a fact that will leave you squirming in your seat - a recent study found that 85 percent of Americans have at least one form of intestinal or organ parasite feeding off their bodies. The worst part is you can't see them and you can't feel them, so how do you know they are there? By hiding out in the intestines, they get "first choice" of any nutrients fed to your system. tag:mpamedia.com,2008:post-54743 2010-07-01T12:00:32-07:00 2010-07-01T12:00:07-07:00

Patient-reported outcome measures (PROs) are increasingly necessary elements of good clinical practice in light of evidence-based protocols requiring outcomes measurement. Use of PROs can quantify patient function and progress. Moreover, self-evaluation as reported in PROs is thought to be a more accurate reflection of patient clinical state and progress than many objective clinical or physiological indexes measures (e.g., X-rays, range of motion, muscle strength) upon which we have traditionally relied. PROs can help determine whether treatment is necessary or effective, and when to stop care.7 Although the benefits of outcome measures are numerous, there are many barriers to their implementation and use.

By J. Michael Menke, MA, DC, PhD (c) and Ronald Feise, DC Patient-reported outcome measures (PROs) are increasingly necessary elements of good clinical practice in light of evidence-based protocols requiring outcomes measurement. Use of PROs can quantify patient function and progress. Moreover, self-evaluation as reported in PROs is thought to be a more accurate reflection of patient clinical state and progress than many objective clinical or physiological indexes measures (e.g., X-rays, range of motion, muscle strength) upon which we have traditionally relied. PROs can help determine whether treatment is necessary or effective, and when to stop care.7 Although the benefits of outcome measures are numerous, there are many barriers to their implementation and use.