Chiropractic + Naturopathic Doctor • December 2015 • Business Talk

Albert Einstein once said, “If you can’t explain it simply, you don’t know it well enough.” If I had to pinpoint the genesis for my success, it would be when I learned how to answer common questions about what I do as a chiropractor, in easy-to-understand terms – in ways everyday people would comprehend.

Today I run a multidisciplinary practice with chiropractors, physiotherapists and massage therapists. I attract 600 new chiropractic patients every year.

The secret to my success? I started preparing for private practice while I was in school. I spent two hours per week on networking and building my future practice by making it a point to meet two new people every week – whether it was the lady at the post office or the butcher at the grocery store. When it comes to preparing for your practice, the earlier you begin, the more prepared you will be in the future.

A chiropractor and my former patient communication teacher at chiropractic college, Dr. Christopher Good, brought the importance of this to my attention back in sixth trimester. Good is now a faculty member and teacher at the University of Bridgeport College of Chiropractic in Connecticut.

I started my practice right out of school and I used a lot of what he said and taught as my guide to build my practice. In particular, I used his “moment of truth” questions, which was a list of more than 100 questions that, as chiropractors, we should be able to answer in a sentence or two the moment someone asks us.

I used these questions and added more of my own to help me explain the answers to people right away. The answers I provided gave them confidence in my ability, and resulted in them becoming my patients and referring many others.

Good used to say, “It’s a moment of truth when someone is going to form an opinion about you, your practice or the profession.” At that moment you can either take a step forward and address the issue in a forthright, honest and positive way, or take two steps back and stumble and mumble or try to deflect the question.

I was recently granted an exclusive interview with my former teacher, and he provided in-depth answers and explained how being prepared provides the basis for long-term success in practice.

Anthony Lombardi (AL): Why do you feel that your 100-question “hot list” works so well for chiropractic students and new grads entering practice?

Christopher Good (CG): One of the biggest obstacles that prevent people from seeing a chiropractor is their lack of understanding. Not only do they not know about what we do and treat, but there is also a lot of misinformation and disinformation spread about.

Honest and understandable statements about chiropractic make a great impression and that opens the door to new patients. Also, by practicing the answers you get a lot more comfortable and confident in your responses, and in the public’s mind, that translates into a doctor who is probably excellent at working with patients too.

AL: I recall one story you told the class when you had your practice out of your home in New York State. You said you made it a point to see how well your practice could do without promoting and advertising.

A bulk of your clientele was the Amish community. You said, from a business perspective, you did very little (by design) but you made sure you delivered an outstanding product. As I recall your adjusting skills were en pointe and I imagine your patients reaped the benefits of your clinical skills. What other intangibles do you attribute to your success that made your patients keep coming back?

CG: The other intangibles that made patients want to receive care included other high quality interactions, in addition to getting a great adjustment.

I focused on becoming excellent at doing the things we are known for and the evidence shows we have great results with. It starts with a comprehensive history and examination especially focused on the incoming complaint. delivering the diagnosis and prognosis in understandable terms builds the circle of trust, especially when the patient chooses what type of treatment he/she wants and for how long.

For treatments, I was always willing to work on the soft tissue component of the problem using hands-on techniques even though it took more time. And patients always got one or two simple things to do at home, and a warm goodbye and thank you.

Also, at every visit we had two conversations, one about their condition and one about their personal life. Building rapport in this way made patients feel special.

Finally, transitioning from symptomatic care to rehabilitation care to wellness/supportive care was always done with agreement and their understanding. When it came to wellness/ supportive care, we always agreed on the next visit date based on their feedback and my examination findings. We usually found their optimal visit frequency by adding a week or two to the time since their last visit.

At some point, the patient would say he was glad he was coming in this week because he could feel it was time, and then we knew this was their length of time between visits. Some patients came in once a week, some once a month, some once a year. But it was always their choice based on their feedback.

AL: When you taught me it was during a different time when technology wasn’t as mainstream as it is today. Do you feel practice development today is as dependent on technology or are the basics still the basics in any time period?

CG: I think that fundamentally the principles that have succeeded over the centuries still apply today. Patients want to like, respect and have confidence in their doctor and it is up to us to give them the reasons to do so.

However, you have to stay current with the way people are becoming introduced to your practice and how you are keeping in touch with your patients. So, having a great website and being accessible on social media sites is important. Of course, depending on the quality and content, this can work for or against you. Using email and text messaging to contact your patients is critical, especially for patients who use these a lot.

Paying attention to rating websites (for example, Yelp) is also a smart thing to do, and don’t let bad comments go unanswered – or at least try to neutralize them.

Having another patient advocate on your behalf is pretty necessary in this day and age. This is especially true regarding the generation coming into adulthood. They have a very mixed bag of socially progressive beliefs coupled with a strong sense of entitlement. They are quick to react on social media to the things that upset them, almost to the point of absurdity. It’s why some of the edgy comedians are hesitant to go on college campuses these days. You ignore this at your own peril.

But ultimately, all people want to be heard and cared for on some level, and this is what we are all about. The rapport you build is unique to each person because of his or her beliefs, knowledge and life experiences.

The more you can listen with two ears – one for the clinical information, one for the personal information – the better the rapport building.

Chiropractic has always been a beautiful profession that changes lives in so many ways. We just need to position ourselves so people have the best opportunity to experience this.

Good was also kind enough to provide me with a copy of the Moment of Truth questions to share with our readership. If you would like me to send it to you kindly email me at [email protected]

DR. ANTHONY LOMBARDI, DC, is consultant to athletes in the NFL, CFL and NHL, and founder of the Hamilton Back Clinic in Hamilton, Ont. He teaches his fundamental EXSTORE Assessment System and conducts practice-building workshops to health professionals. Visit exstore.ca for information.

In my third year of practice my dear late mother asked me if I regretted not becoming a medical doctor. I told her, “No, mom, I will help more people with their health over my career than I would being a MD.” Now in my 25th year as a DC I know that more than ever.

When I was 20 years old I broke my neck in a diving accident. I spent four days on the couch in a tremendous amount of pain. Our family didn’t go to chiropractors at the time, but I had heard about them and sought help from a doctor in Winnipeg where I lived.

X-rays showed a compression fracture of C5, and Dr. Gus Lodewyks told me to go to the hospital immediately.

More X-rays, a rigid cervical brace, and a consult with an orthopaedic surgeon came next.

After some adjustments that relieved me of most of my pain, I attended the surgeon again. He was furious I was seeing a chiropractor and flabbergasted that I was so improved. “If you want to die or be paralyzed, keep on with the chiropractor,” he said.

I was to have a spinal arthrodesis (spinal fusion) of C5-C6. I returned to Lodewyks, my chiropractor, who explained my fracture was stable and did not require surgery. My decision to stay on with chiropractic care and reject surgery was a pivotal one that changed my life forever. (You can read more about my story on my website: fillupyourtoolbox.

Com) After getting well and seeing all the people I referred to chiropractic get better, I decided I wanted to be a DC.

Lodewyks became my mentor and took me to my first Gonstead seminar in Mt. Horeb, Wis. He coached me to adjust his neck a la cervical chair on the evening of my first seminar. After a couple of hours of trying, I made his lower neck move. I was thrilled and went on to study more Gonstead and many other techniques while at Palmer College.

By the end of my first year there, I was holding workshops at my apartment teaching other students how to do palpation exams, cervical chair adjustments and side posture adjustments.

Knowledge sharing The skills and techniques we have learned become part of our repertoire, our technique toolbox. If Lodewyks did not have his technique I would have been out of luck and would have succumbed to surgery. My life would have been vastly different.

My practice became busy early on and I noticed I started solving problems in the adjusting room with techniques and protocols that were a synthesis of all the approaches I had learned, plus some innovations that I developed myself.

I have been teaching “Fill Up Your Toolbox Chiropractic Technique Seminars” for nine years now and, by and large, it has been very well-received by the 100 or so chiropractors who have attended. I would like to share some of these techniques in the hope that readers might learn something from my experiences.

Somewhere in the ’90s I was scratching my head wondering what to do next with a patient’s difficult acute low back.

The adjustments I tried were not Effective. It struck me that the pelvis was rotated around the long axis. I decided to try something I had never done before – and it worked.

The following is a description of an adjustment that helps to correct sacroiliac rotation around the long axis. It is best used after you have done the usual initial corrections to lumbar and/or sacroiliac joints yet there is still a degree of dysfunction.

The pelvis can be considered to be like a ring that can misalign on the sacrum rotating around the long axis.

It is a unique procedure that I have used daily for the last 10 years. This adjustment is easy to master and will be a useful tool in the chiropractor’s repertoire for the correction of the pelvic subluxation complex.

Presentation After adjustment of the low back, sacroiliac joints, thoracic area and/or ribs, there still remains sacroiliac joint restriction.

Active prone leg extension is weaker or compromised on one or both sides. Motion palpation of the sacroiliac joints using passive prone leg extension detects hypomobility on one or both sides.

The configuration of the sacroiliac joints will be described using the posterior/inferior iliac spine (PSIS) as per Gonstead listings. The sacroiliac PSIS is found to be exteriorly rotated on one side (EX) and interiorly rotated (IN) on the other side. Palpation of sacroiliac space between PSIS and sacrum on leg extension will be open or wider on EX side, while closed or narrower on IN side. Palpation tip: the lighter the touch, the better you will detect the EX and IN sides.

The PSIS of the EX Ilium is also rotated anteriorly and superiorly (ASEX) and posteriorly and inferiorly on the IN side (PIIN). The PIIN ilium will present with a shorter leg length on that side and longer leg length on the ASEX side.

The overall finding is rotation of the sacroiliac joints around the long axis with the listing ASEX on one side PIIN on the other.

Note that this adjustment is not used for the listings PIEX/ ASIN on the respective sides because of the orientation of the joint planes. If the leg length difference is negligible (minimal AS/PI) with EX/IN this adjustment may be applicable.

Most often, this adjustment is indicated when after using the usual methods of correction (i.e. side posture and/or drop-piece adjustment), there remains sacroiliac fixation or restriction.

This adjustment can also be used to correct the pelvis alone, especially when the patient does not tolerate or respond well to the side posture adjustment for the listings ASEX/PIIN.

The adjustment Patient is prone on an adjusting table equipped with a pelvic drop-piece. The crest of the Ilium is approximately five centimetres caudad to the level of the gap between the thoracic and pelvic drop-piece.

The doctor stands facing the patient on the side of the ASEX Ilium approximately at waist level.

Inform the patient that the doctor will be placing his or her arm under the patient’s waist at the level of the beltline.

The dominant arm reaches under the waist at the level of the anterior superior iliac spine (ASIS) with hand contact and fingers wrapped around the anterior portion of the iliac crest and ASIS of the PIIN or IN ilium. Fingers are pointing slightly caudally and medially on the PIIN or IN ilium side.

The other hand is contacting the ilium on the ASEX side or EX side, lateral to the sacroiliac, fingers directed caudally and medially with fleshy pisiform resting on the iliac notch.

Note that the doctor must obtain informed consent for the arm positioning under the waist after informing the patient that the procedure is to correct their pelvis.

First, show the patient where your arm is going to be placed, then get consent (patient initial beside brief outline of procedure, ex. “permission to perform adjustment for pelvic rotation around the long axis.”) The adjustment involves dropping the pelvic piece using three to five lbs. Of pressure, two to three times with emphasis on correcting the EX and IN rotation, while also correcting for AS and PI on the respective sides. The doctor places the pelvis in slight rotation to accomplish the untwisting of the rotation around the long axis on the ASEX/PIIN sides.

Post-check The post-check for this adjustment, if successful, will show a significant improvement in active leg raising ability while lying prone, greater than the improvement from the side posture or drop-piece adjustment alone.

Contraindications These include pregnancy, hernias, abdominal disease, abdominal cancer, acute lumbar subluxation.

Unique results The doctor’s hand placement, position of pelvis, use of the drop-piece and the fact that the pelvis is floating in a nonweight bearing position, allows an effective shearing force through the sacroiliac joint. The beveled surfaces of the sacroiliac joints and the line of drive through the joint plane line are very amenable to correcting the Gonstead listings in four directions simultaneously.

If you try this procedure, and you find it effective, please email me with your feedback at [email protected]. You can view a video demonstration on YouTube by typing in the search phrase, “P Hunter’s adjustment.” Whether you like this technique or not, your feedback is appreciated. Send me an email at [email protected]

DR. PAUL HUNTER, DC, is a 1989 graduate of Palmer College in Davenport, Iowa. He operates a successful private practice in Victoria, B.C. and teaches the “Fill Up Your Toolbox” chiropractic technique seminars.