Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 1101
Office Systems 96 OS
Preamble: Many of the issues I bring to you are very small, yet each issue is just that, an issue. If you take care of the small issues, then you will be able to build and more importantly, focus on the bigger issues...a larger practice and more family time. -Mark Studin 2006
Leaving the pain model and how chiropractic works
Dr Stuidn: What's going on?
Guest Doctor: I was reading one of your consultations under report findings. I've known that my treatment plan and less patient visit average isn't in that same practice spectrum. It's lower than I would like.
Dr Studin: What is your PVA?
Guest Doctor: Probably averaged 14 to 16 visits.
Dr Studin: that you recommending or the patients are following?
Guest Doctor: A little bit of both. Most of it is my fault.
Dr Studin: All of it's your fault. Let me rephrase that. It's not a fault scolding issue, it's just a responsibility issue. It's all your responsibility. So let me just briefly outline. So you just, so we're on the same page about PVAs and then we'll talk about the solutions and what you choose to do because you can choose to keep your practice at this level a lot of people do, or you could choose not to. It's not a caste system or you're born into poverty and you have to stay there the rest of your life because the law says so. So when you're at a PVA up to 30, that's a pain practice. If you're below 22, it's a failing pain practice because if you are too slow months, you're screwed. You can't pay your bills because your patients aren't coming in enough. Just can't afford that, but then when you get 30 to 60 or a reconstructive practice where you're reconstructing spine and above 60 year and a wellness practice, but really you're in a managed and unmanaged reconstructive practice. Did you finished all the consults or you're still getting through the infrastructure?
Guest Doctor: I'm still working through them. My biggest thing is I was around the report of findings. You're mentioning stuff about Merrick chart.
Dr Studin: And by the way, when you get this section number four office systems and getting paid, the first three consultations is how to do a report of findings, what to buy, what to put up. And there's a script in there how to tell the patient and the audio video section there is a complete video of how to do a report of findings that you could watch over and over until it's burned into your brain. Now, but here's the thing and this is really important because this will help clarify, what do you want do with your patients? Do you understand what we do in chiropractic and what subluxation is or bio Neuromechanical disorder, because to get the words, I mean, I don't care if you're, if you're a subluxation based guy, if you're a non subluxation, it's all philosophical. But you understand physiologically what we do?
Guest Doctor: I would say I do.
Dr Studin: Then explain to me when you adjust someone, what you are looking for and exactly from a physiological perspective what you do. Explain it to me. I want it in scientific technical terms.
Guest Doctor: Scientific technical terms would be I'm palpating emotion segment that's either fixated or a variant motion and I'm going to manipulate and joint mobilize that segment to the motion in there to free up that segment.
Dr Studin: You're a perfect physical therapist cause that's exactly what physical therapy does. Here's what I do. I'm going to evaluate the patient. I'm going to look at an X-ray. I'm going to muscle test them. I'm going to range of motion, I'm going to look for joint fixations and I'm going to find the bio mechanically fails motor unit. Then I am going to deliver a high velocity, low amplitude chiropractic spinal adjustment. And what that's going to do? That's going to separate because what happened is through either a micro or macro trauma and repetitive movement that creates average stress or a macro trauma, like a full sports injury, slip and fall. Any one of those things. There's a plate like a disc in between the fence and that's a spacer. And when that little plate that goes out of position, it allows those sets, those no susceptible feed into the lateral horn up through the pericardial gray area into the thalamus and ping pong around multiple areas in the brain to try to create homeostasis. Now the brain says he fairly down through the soundness, back down through the spinal tracks in the periodical ductile gray area. He fairly two muscles in disparate areas to get into pole, to create, homeostasis or sagittal balance front to back balance, side to side with curves, etc. And I might have painted disparate areas from that one area because there's going to be pulling. Now what's the ideology of that? If I had a whiplash and a car accident at a sports injury, a slip and fall, what I'm doing is the ligament goes beyond this pair of physiological limits. We know that when a ligament tears or ligament by the way is made up of Collagen and Elastin and there were fibroblasts in that ligament and as you're going through puberty, the fibroblasts are making more ligaments. When you hit puberty, those fibroblasts go dormant. They don't go away. They just go dormant. So therefore when you're seat, you don't have like 62 feet of ligaments, you be fluffy all over the place. You're like dumpy but you're not. So therefore when you have trauma and you tear the ligament, the fibroblasts become activists. Now instead of Collagen and Elastin being repaired, the body can only produce Collagen, no longer Elastin. So a joint becomes stiffer, more adhesive and the permanently locks it into either an elongated or shortened position cause that either fast to fill in that tear or the body tries to contract it with muscles around it, ligaments to contract tolerability. It's too short. Now what happens is that he comes permanently, accurately positioned the morphology of the ligament That is average, now it's pulling the bones in the wrong position. Now you've got something called Wolff's law. When there's average pressure on a bone, it remodels, which then explains the PA or the P as electric effect. Then explains that when the body's going to try to create homeostasis with positive and negative charges, and I'm not going to explain the whole joint physiology, but it's going to suck calcium from the bone and that's what the Wolff’s law is, it's remodeling the bone because it's sucking calcium. Now it's abnomally position. We'd go back to those individual motor units and the FA sets in that little plates. Even though I'm repositioning that properly, the body has been conditioned muscularly to hold it wrong. Now what happens is I'm going to put it back in the right position, but if the bones of remodel based upon the Wolff's law and a lifetime of accurately being positioned, it's going to continue to try to create homeostasis because the brain does that. And then over a period of time when those muscles are pulling from to create homeostasis, the muscles are going to go into permanent tetanus. If they can hold forever, kind of like you in the gym, lack the gas and it builds up, you get that burn, but the muscles go into permanent spasm and it locks it into the one position which creates even further PA's with electric effect into generation based upon Wolff's law. And now people starting to lean forward like the elderly in nursing homes, the prototypical leaning over a walker and those things. So what I do in Chiropractic is early on I tried to get those FA sets to separate, get us precutur to align now on the FA sets are in appropriately position and they move about 0.7 millimeters. That's it in a chiropractic spinal adjustments, it's going to allow the disc above and below, which is the second Jello to actually move a little bit and a little by little, we are adjusting them and retraining those muscles and those ligaments to move just a little bit. The whole spine is going to react because the brain's going to know there's no pressure on there and ease up while the other disparity areas to create homeostasis. That takes time, but I can't start to do that until the pain goes away because the pain is almost always muscle spasm and while the muscle is spasming, that is continuing to pull the spine in the wrong position once the pain goes away is one as the first time, but I can actually make a structural correction and that's fine to prevent you from being bent over that Walker 30/40/50/60 years from now , because once that bone remodels, I can never undo it. That's the two phases of chiropractic care. One is to get you out of pain. The second is to make those corrections and reconstruct your spine. The third phase that people call wellness is not wellness. The third phase is over time when you go into your appetitive lifestyle, pulling, pushing stress in, lifting, carrying, etc. Twist it, you're constantly, because again, you've got a weakness in there because the collagen and Elastin are replace by collagen. It's a weakness. So I'm going constantly keep it in the right position to keep you biomechanically balanced to prevent those bones for remodeling based upon Wolff's law, that’s chiropractic care.
Guest Doctor: No one has ever explained it to me like that. In the past I've been practicing for a while and it's all salesy of high visits, but it's all from a sales perspective, no cause they're logical. I felt like in my heart I couldn't tell someone they needed that many visits because they came from a sales approach.
Dr Studin: We're very different in what we do and how we do it. And there's very few people in the world that know what you now know.
Guest Doctor: All 100%. And that makes complete sense to me.
Dr Studin: And by the way, everything I just explained to you is literature based. I didn't make any of them. This is what you are involved in. Now when you read through the consultations, hopefully you will look at them differently as you start getting, your academics behind you and you need to, you really need to get trauma qualified and beyond. This is what you are. This is what you're going to learn. What I'm starting to tell people also, there's a lot of salespeople in our profession, a lot of self-proclaimed gurus that really pissed me off because they're hurting our profession. Everything we do is literature based, is evidence based. You now should be going out there and telling everyone in the world get involved in this program it's self-serving for me? Yes. But, the reality is this is what they're going to learn. This is what's going to Cannibal chiropractic into where we need to be.
Guest Doctor: On that note, what about utilizing like static surface EMG? Cause you talked about it, you said if you are practicing today you could probably use that as a demonstrative tools and the patient doing baselines and then doing a wrap.
Dr Studin: I used surface EMG when it came out in the 90s I use it probably as much. I was seeing 650 patients a week. So I had a lot of people to do it on. So I probably did it on maybe more than anyone in the country when this first came out. Surface EMG is wonderful and all it shows is one thing, muscle spasm, nothing else. And I know my own vision and all the other stuff but remember if I did it today, I would do it. I wouldn't build for it. That's number one because it's got a bad stigma about it.
Guest Doctor: Yeah, I wouldn’t build for it, I was just wanted to use it to help my patients education.
Dr Studin: And it's great but ,the surface EMG with the range of motion is good, but it doesn't do any, even though the claims by the owner who's been all over me to look up to give his program that gold star, it's range of motion. I mean, the patient is not faking it because there's no muscle spasms, it's not faking it. That's about what it shows.
Guest Doctor: It's still a symptom. It's still not getting to the diagnoses.
Dr Studin: I have no problem with using surface EMG as educational. However, here's my last suggestion. Don't make any wholesale changes in your practice until you finish reading the six sections and getting through them. Have you been listening to the podcasts all the time?
Guest Doctor: I was listening to this morning. I love it.
Dr Studin: You have to get through the first six sections. It's build your infrastructure, CV, narrative, office systems, Laura as mean as a marketing. Those six sections are critical that you get through.Then you start your academics after you read through those six sections and get through them or listened to the podcast. And then let's have another conversation.
Guest Doctor: Last question, narrative reports, there is not a code for it. How can I bill an attorney for a narrative report? An attorney was asking for one.
Dr Studin: You don't have a code, just send them a bill. You're not charging the insurance company, just set up a bill.
Guest Doctor: More like $400/450 what's normal from there?
Dr Studin: Surgeons charge a $1,000 so you can charge $400/450 for you, up to $500 is fine. The 500 is the range. You