Chiropractic Economics, Issue 18

Open up to see what it’s all about

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FEATUREDCONTENT

22 Ageless chiropractic 30-64 is the common chiropractic patient age range — which needs to be extendedBY ACA COUNCIL ON WOMEN’S HEALTH

18 DCs in the newsIn the midst of COVID, the opioid epidemic and economic struggles, DCs are stepping up to assist in their communities BY CHIROPRACTIC ECONOMICS STAFF

74 ACA goes virtualAmerican Chiropractic Association to host virtual annual meeting in Feb. 2021 BY CHIROPRACTIC ECONOMICS STAFF

90 Buyers Guide: Anti-aging

Chiropractic Economics (ISSN 1087-1985) (USPS 019-178) is published monthly except semi-monthly (twice a month) in January, February, April, May, June, August, September, and October; 20 issues annually. Address: Chiropractic Economics Inc., 820 A1A N, Suite W18, Ponte Vedra Beach, FL 32082. Phone: 904-285-6020; Fax: 904-285-9944. Website: www.chiroeco.com. (A Florida Corporation) Postmaster: Please send form #3579 to Chiropractic Economics, PO Box 3521, Northbrook, IL 60065-9955. Periodicals class postage paid at Ponte Vedra, Florida and at additional mailing offices. GST #131868416. Subscription Rates: U.S. and possessions, $39.95 one year, Canadian subscribers add $35 per year shipping and handling; overseas subscribers add $60 per year shipping and handling. Students, $19.95, Single copy, $4. Statement: While encouraging the free expression of opinion by contributors to this publication, Chiropractic Economics and members of its staff do not necessarily agree with or endorse the statements made in the advertisements or contributed articles. Chiropractic Economics is owned by Arthur J. Gallagher Risk Management Services, Inc., Nicholas Doyle, Area President. Authorization for the use of photographs and/or illustrations is the responsibility of the author(s). All materials submitted for publication shall remain the property of this magazine until published. Change of Address: Six to eight weeks prior to moving, please clip the mailing label from the most recent issue and send it along with your new address (including zip code) to the Chiropractic Economics Circulation Department, PO Box 3521, Northbrook, IL 60065-9955. For a faster change, go to www.ChiroEco.com and click on “Magazine.”

V O L U M E 6 6 , I S S U E 1 8 • N O V E M B E R 1 2 , 2 0 2 0 • TA B L E O F C O N T E N T S

PHOTO CREDITS: ALL IMAGES ARE FROM ADOBESTOCK.COM UNLESS OTHERWISE NOTED.

PERFECTPRACTICE PRACTICE CENTRAL

86 6 steps to make difficult staff situations disappearHow labeling, expectations and attitudes can contribute to your negative subconscious actions

BY MONICA WOFFORD, CSP

MARKETING

66 Profile: Community outreach programsCommunity groups and organizations are hungry for health, wellness information

BY CHIROPRACTIC ECONOMICS STAFF

TECH TALK

46 Not TENS, but TEMSIntroduced two years ago in the U.S., it’s a one-two punch for both back pain and weight loss

BY BALDEV SANDHU, MD

54 Telehealth: ‘Then everything changed’Like it or not, COVID and telehealth’s proliferation will impact DCs

BY KARLOS BOGHOSIAN, DC

80 Switch your EHR with these 4 goals in mindThe transition and modern applications are among new electronic health records considerations

BY CHRISTINA DEBUSK

WELLNESS

28 Research on the gut-joint connection for OA and inflammationOsteoarthritis (OA) and inflammation from an unbalanced gut microbiome resulting in joint pain and degradation

BY ROB SILVERMAN, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISM, CKTP, CES, HKC, FAKTR

76 Top 5 anti-aging supplementsInside and out, new research is showing the benefits for patients

BY TINA BEYCHOK

CLINICAL CONCERNS

34 Evaluating and listening to the bodyUnderstanding musculoskeletal injuries through the health of the overall architectural structure

BY TIM MAGGS, DC

CODING

60 Should you bill insurance for therapeutic light therapy?Options include cash-only, insurance, and selling units for at-home use

BY ROB BERMAN, MBA

FINANCIAL

40 Find and remove revenue cycle interferencesYour revenue cycle is a ‘nervous system’ of signs, symptoms and conditions

BY BRANDY BRIMHALL, CPC, CMCO, CCCPC, CPCO, CPMA

BACKLOG14 Health News,

New Technology, Awards & Practice Advice

14 Don’t-Miss Events15 By The Numbers: The Body Issue16 Staff Product Pick 16 Profitable Practice

EVERYISSUE 8 Letter from the Editor 10 ChiroEco.com Resources 90 Product Showcase 92 Buyers Guide 104 Datebook 106 Marketplace 108 Ad Index

“The sign of a good doctor should be how many medications he

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LETTER FROM THE LETTER FROM THE EDITOR

BPA Worldwide Chiropractic Economics’ subscriptions are audited by BPA Worldwide, the most dominant global media auditing company for B2B publications in the world. BPA certifies that Chiropractic Economics has the highest number of requested readers in the profession. Chiropractic Economics is the only independently audited requested publication serving the chiropractic industry.

EDITOR-IN-CHIEFRichard [email protected]

ASSOCIATE EDITORAllison M. [email protected]

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ART DIRECTORMichael [email protected]

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ON YOUR MIND:

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BUSINESS & EDITORIAL OFFICES820 A1A N, Suite W18 Ponte Vedra Beach, FL 32082 Phone: 904-285-6020 Fax: 904-395-9118chiroeco.com

FOR THOSE OF YOU ATTENDING FCA’S THE NATIONAL, welcome to Orlando!As we go to press in mid-October, The National by Florida Chiropractic Association convention on Nov. 5-8 “will provide the safest possible environment with proper social distancing and hygiene protocols,” according to the FCA.

“While it will look a little different, attendees will still have access to all the benefits they are accustomed to — 150 hours of CEs to choose

from, internationally recognized speakers, various tracks and specialties and more,” says the FCA’s Debra Brown Hagan. “As an extra measure, FCA has put together a Safe Space 2020 Safe + Clean Plan that will couple with the Hyatt’s new Global Cleanliness Standards to ensure the well-being of all attendees.”

For those not ready or able to attend in person, the convention will host a virtual component, featuring many of the same in-person benefits.

“We are providing our attendees with what they have loudly voiced they wanted — a hybrid event,” said the FCA’s Jen Porro. “While some 70% of survey respondents want to attend live, those who aren’t ready for a face-to-face event can still attend.”

For more info, visit TheNationalChiro.com.

New patient health perspectivesSince March and the onset of COVID-19, more patients have proactively tried to change their physical health.

According to Nutraceuticals World, 35% more consumers are proactively trying to take care of their physical/emotional health now than before the pandemic, and 22% have changed their eating habits to be healthier.

Current and underlying conditions are surprisingly high. More than 50% of people are dealing with one or more chronic conditions (3.5 on average) and trying to prevent 6.1 conditions according to Hartman Group’s 2019 “Health + Wellness: From Moderation to Mindfulness” – and this was prior to the onset of COVID-19. Weight remains the most critical statistic as sales of diabetes-support food and drinks spiked to 9X the sales from March-April 2020 compared to the same period in 2019. Weight control product sales increased 11X, and hypertension products increased 22%.

The McKinsey Global Institute outlines how prioritizing health is a prescription for the U.S. recovering from COVID-19 and regaining prosperity, reminding us that the health of U.S. citizens and the U.S. economy are linked. This is in opposition to how the U.S. has approached health care over recent years, prioritizing cost over widespread coverage.

Health care as preventative careIf health can be re-framed as an investment, McKinsey says, then the U.S. can offset some of the $3.2 trillion the U.S. economy loses annually to early deaths and lost productivity due to diseases. No. 1 among these economically debilitating disorders? Musculoskeletal disorders, with weight issues (diabetes) also in the top five.

It’s never too late to start, as 20 years from now that $3.2 trillion will increase by another 20% if we stay on the current path, according to the Institute for Health Metrics and Evaluation (IHME) at the University of Washington.

The key to achieving these health benefits, the IHME says, is something that chiropractors are familiar with — prevention. Not only would this vastly increase health, but it would provide resilience when the next pandemic surfaces.

Doctors of chiropractic can respond accordingly in their marketing efforts in regard to chiropractic preventative care and wellness and weight loss services. In the current trajectory of American health, what an opportunity to make a difference.

Our “The Body Issue” brings you new research on the gut-joint connection, ageless chiropractic, and listening to the patient body, among other great articles. Thank you as always for your letters and support, and stay safe out there — for the benefit of yourself and your patients.

To your practice’s success,

Richard Vach EDITOR-IN-CHIEF

THE BODY ISSUE POOR HEALTH AND THE LACK OF PREVENTATIVE CARE COSTS THE U.S. AN ESTIMATED $3.2 TRILLION ANNUALLY

FOUNDED 1954William L. Luckey and Helen C. Luckey


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D’Youville ranks as top private university in its regionFor the second consecutive year, D’Youville has been ranked as the top private university in Western New York, according to the 2021 U.S. News and World Report rankings. It is the second-highest nationally ranked university in Western New York.

Lorrie Clemo, PhD, president of D’Youville, cites the dedicated efforts of faculty, administration and staff in achieving this distinction.

“U.S. News and World Report continues to recognize the excellent quality of D’Youville’s academic programs, as well as the exceptional experience we offer our students through our updated learning spaces, latest technology and increased scholarship opportunities,” she says.ChiroEco.com/usnwr

NYCC alumnus named Researcher of the YearNew York Chiropractic College announced that Steven Passmore, DC, a 2006 alumnus, adjunct assistant professor and research affiliate, has been named 2020 Researcher of the Year by the Canadian Chiropractic Association.

The award recognizes an investigator whose contribution has improved treatment of chiropractic patients and demonstrated outstanding research achievement and knowledge advancement.

“We are proud to have Dr. Passmore as both a graduate and a member of the NYCC team,” NYCC President Michael Mestan, DC, said. “The research he has conducted is profound for the entire chiropractic profession as well as patients in need of innovative health care treatment.”ChiroEco.com/passmore

Parker University named a ‘2020 Great College to Work For’Parker University has been recognized as one of 79 colleges and universities deemed a Great College to Work For®. Based on employee engagement survey results, the Great Colleges to Work For® program identified Parker’s workplace as one that has excelled in three categories, including Compensation and Benefits, Respect and Appreciation, and Supervisor/Department Chair Relationship.

This year’s recognized institutions “deserve special kudos,” said Richard K. Boyer, senior consultant at ModernThink, the awards’ sponsor. “[They] prove that it is possible to be a great workplace even in the face of disruption, uncertainty and limited resources.”ChiroEco.com/parker-honor

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MISSED THE LAST ISSUE?

A Beam of Healing RevenueLaser Therapy is Providing Pain Relief for Patients and a Revenue Source for DCs

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SOCIALMARKETING

Do you currently take probiotics? Which ones do you recommend to patients?

Expert tips for building leads from FacebookTristan Schaub, co-founder of ChiroSushi & Katana (the “#1 Patient Relationship Platform”), took time to answer our readers’ questions about how to generate chiropractic leads with Facebook:What do chiropractors need to do to get leads on Facebook?They need to know their intent with any post — either paid or organic. Is it Top of Mind Advertising (TOMA) or list building (emails/followers)? Most likely, the focus is conversions, but Facebook isn’t built like Google. Facebook is still dollar-for-dollar the best platform for TOMA and list building.

The focus on Facebook should be creating and building “Groups.” Higher engagement and reach occur in groups and is a focus of Facebook. The second area should be paid ads.Should DCs post on their personal FB pages, or business pages, or both? Both. But keep both pages entertaining and “spam free.” The number one thing humans desire in relationships is appreciation. Being friends with patients allows them to show appreciation in the purest sense — with a “like!” How do DCs determine what to post about, and how often?Follow Google Trends and other tools that show what their target market is searching. We know social leads to search and vice versa. So running out of content ideas should never happen. Remember: It’s not about you, the provider — it’s about your clients. —Michele WojciechowskiFor more social marketing information, visit the Business Tips section of chiroeco.com.

Each month we’ll ask a new question on our Facebook page. Join the conversation at facebook.com/ChiroEcoMag

FACEBOOKQUESTION

How do you explain to patients the need for regular chiropractic care as they age?

17,235 followers

eBooksVisit our eBooks page to see the latest specialty publications on cutting-edge topics such as CBD, PEMF and clinical nutrition.ChiroEco.com/chiropractic-ebooks

Email CoursesTry one of our eCourses and get up to speed with lessons on business and chiropractic sent straight to your inbox.ChiroEco.com/chiropractic-ecourses

PodcastsWe’ve interviewed some of the best minds in chiropractic. Listen on the go. ChiroEco.com/podcast

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cardinal_chiropracticIf you’re struggling with the same problems and not finding the answers you’re looking for, it’s time to try something different. Corrective chiropractic care may be the answer you’ve been looking for.

TOP TOP INSTAGRAM POSTS Tag #ChiroEcoMag for your chance to be featured

shanecuppettIn the age of HIIT workouts, endless mobility regimens, and the obsession with glute training, I can’t agree with this more!

alignedchiropracticChiropractors seek to locate and address the problem, not just mask the symptoms.

drbrantleymeierThis is what happiness looks like to me!

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balancewellspace“More people die of a sedentary lifestyle than from smoking.” —C. Everett Koop, former United States Surgeon General

12 CH IROPRAC TIC ECONOMICS • NOVEMBER 12 , 2020 CHIROECO.COM 12 CH IROPRAC TIC ECONOMICS •

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Cleveland University-Kansas City (CUKC) shared the loss of a long-time member of its university family when Ruth Sandefur, DC, PhD, passed on Sept. 15 at her home in Florida. A tireless supporter of the chiropractic profession, she was an alumna who was a practitioner, educator, researcher, administrator and treasured friend to many.

A 1967 graduate of CUKC, Sandefur, along with her husband and classmate, Al Sandefur, DC, opened a private practice in Leavenworth, Kan. They had two children, Danny and David Sandefur, DC, a 1996 Cleveland graduate.

In 1983 Sandefur returned to her alma mater to pursue a career in education. She began as an associate professor of diagnosis, and over the next 23 years served the institution as associate research director and later, academic dean, before retiring in 2010 as vice president for academic affairs.

Following her retirement, Sandefur frequently returned to campus to work on

special projects in the Cleveland archives. She served as historical collections associate from 2012 until her death. For friends and colleagues who would like to remember Sandefur, visit cleveland.edu/give.Visit cleveland.edu for more information.

S C H O O L N E W S

CUKC announces passing of former administrator Sandefur

DON’T MISSCONFERENCES

CORE STRATEGIES for Systemic Inflammation & Chronic PainDecember 5-6 • Salt Lake City, UtahThe main topics will be current epidemics of chronic pain, metabolic syndrome, autoimmunity, brain inflammation and cognitive decline. Dr. Andre Camelli will introduce low-level laser technology (LLLT) or photobiomodulation as a very effective core technology to add to a practice.

Super Highway to Health: Advanced Protocols for Clinical SuccessDecember 5-6 • Chicago, Ill.Robert Silverman will lead participants through an innovative demonstration showcasing how to use and maximize the efficacy of leading-edge laser therapy technology. The gut-to-brain axis will also be discussed, with a special emphasis on understanding Alzheimer’s and treating concussions for faster recovery.

FE ATU R E D WE B INAR

Harnessing the Endocannabinoid System Immune Competence and Inflammation ControlOn DemandOptimal human physiology depends upon a healthy endocannabinoid system as it is integral to innate stress response, immune regulation and inflammatory homeostasis — with Chris Meletis, ND.Learn more at chiroeco.com/events.

BACKBACKLOG CATCHING UP ON THE LATEST NEWS, TRENDS AND INNOVATIONS FROM THE CHIROPRACTIC COMMUNITY

H E A LT H N E W S

Some ventilation systems may increase COVID-19 risk

Ventilation systems in many modern office buildings, designed to keep temperatures comfortable and increase energy efficiency, may increase the risk of exposure to the coronavirus, particularly during the coming winter, according to research published in the Journal of Fluid Mechanics.

A team from the University of Cambridge found that widely used “mixing ventilation” systems, designed to keep conditions uniform in all parts of the room, disperse airborne contaminants evenly throughout the space. These contaminants may include droplets and aerosols, potentially containing viruses.

The research has highlighted the importance of good ventilation and

mask-wearing in keeping the contaminant concentration to a minimum level and hence mitigating the risk of transmission of SARS-CoV-2, the virus that causes COVID-19.

The evidence increasingly indicates that the virus is spread primarily through larger droplets and smaller aerosols, which are expelled when we cough, sneeze, laugh, talk or breathe. In addition, the data available so far indicate that indoor transmission is far more common than outdoor transmission, which is likely due to increased exposure times and decreased dispersion rates for droplets and aerosols.

“Understanding the role of ventilation is critical to estimating the risk of contracting the virus and helping slow its spread,” said Professor Paul Linden from Cambridge’s Department of Applied Mathematics and Theoretical Physics (DAMTP), who led the research. “Keep windows open and wear a mask appears to be the best advice.”SOURCE: Science Daily

Ruth Sandefur, DC, PhD


“FUNCTIONAL MEDICINE EXCELS IN TRACING INFLAMMATION UPSTREAM TO FIND ROOT CAUSES, AN APPROACH THAT WILL OFTEN UNCOVER A HIDDEN CAUSE OF JOINT PAIN AND OSTEOARTHRITIS.” — ROBERT SILVERMAN, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR

S C H O O L N E W S

NYCC community follows new health and safety pledge

BY THE NUMBERS:

THE BODY ISSUE“More than eight in 10 consumers (81%) believe chiropractic

care is effective for professional and amateur athletes.”— Harris Poll

As part of New York Chiropractic College’s ongoing actions to address the COVID-19 global health crisis, college President Michael Mestan, DC, recently reminded the community to “stay the course” in following best practices and regulations and invited faculty, staff and students to join him in taking the #NYCCBlueWay pledge.

A vow to protect one another and adhere to health and safety guidelines, the #NYCCBlueWay pledge is a way for the school’s community to further commit to their pursuit of wellness for the NYCC community and others.

“Join me and affirm your commitment to following health guidelines and protecting the safety of yourself, your college and your community,” Mestan said. “Let it serve as a reminder that we have been called to the higher purpose of health care and, in this crisis and beyond, we will act with the intelligence and integrity that are core tenets of our chosen discipline.”

Mestan said he has seen students, faculty and staff work diligently to make wise choices and follow guidelines, and is proud of the respect, selflessness and dedication the community has demonstrated during these challenging times. “I know it hasn’t been easy,” he said.

Since the beginning of the pandemic, NYCC has worked closely with public health experts and professionals across the college to create its reopening plan and make necessary adjustments as new information and guidelines become available. The community’s commitment to following the #NYCCBlueWay and the NYCC Reopening Plan have been instrumental in helping ensure the safety and health of students, faculty and staff.Read the #NYCCBlueWay pledge at nycc.edu/nyccblueway.

CH IROEC O.C OM NOVEMBER 12 , 2020 • CH IROPRACTIC ECONOMICS 15

U.S. adults who sought chiropractic services in 2019Source: Entrepreneur.com

The dirtiest part of the body? The navel, where in terms of the diversity of microorganisms,

is so turbulent life “boils” in itSource: University of North Carolina

The speed air exits the nose when a person sneezes

Source: Sciencebob.com

The number of bacteria in the human body compared to cells

Source: Livescience.com

Average weight in pounds of an American woman, with a 40.3-inch waist

Source: National Center for Health Statistics

100

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No.

170.5

1

35.5

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BACKBACKLOG

The Mary Black Foundation recently awarded new grants to 19 nonprofit organizations serving Spartanburg County, S.C., including a $15,000 grant to Sherman College of Chiropractic to support the Chiropractic Health Center, which provides chiropractic care for the local community.

The foundation’s most recent grant cycle focused on the systemic challenges posed by the COVID-19 pandemic.

“With support from the Mary Black Foundation, we can continue to promote a more healthy and vibrant community through chiropractic care,” said Vice President for Institutional Advancement and

Public Relations Ohmar T. Land, DM. “During these challenging times and beyond, it is a top priority for Sherman College to build more strategic relationships throughout Spartanburg to share our resources and services. We are grateful for the support the foundation has provided to our health center and for their confidence in us as we continue to care for our community.”

The Mary Black Foundation has committed to providing over $3.1 million in grants for 2020.

“This year has been extremely challenging for the nonprofit sector and the many individuals and families they serve,” said Molly Talbot-Metz, President and CEO. “Our board of trustees made the bold decision to increase our spending in 2020 to meet the many needs facing our community this year.” For more information, visit maryblackfoundation.org.

AWA R D S N E W S

Mary Black Foundation awards Sherman College $15,000 grant

Finding the root cause with functional medicineTo understand whether functional medicine (FM) training has a place in your practice depends on what this clinical model offers your patient population.

FM is a clinical model in which the practitioner treats the patient as an individual, finds the root cause (mechanism) for their health problems through comprehensive diagnostic testing, and constructs a customized treatment plan for each patient. The doctor then prescribes nutritional supplements, dietary programs, chiropractic adjustments, and various lifestyle modifications to remove the interference to self-healing.

Indeed, it sounds a lot like chiropractic. We can call it “Functional Medicine,” clinical nutrition, or chiropractic. The bottom line is that it works for the patient. It’s what the broader patient population (the 90%) wants and needs, the patient is willing to pay out of pocket for the service, and it gets patients into the practice.

When applied mindfully, FM can remind you of the authentic chiropractic philosophy that started a great profession. This reconnection with your roots and core philosophy has the potential to reinvigorate the spirit of individual chiropractors and inspire the masses to take a fresh look at the profession.

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From left, Dr. Neil Cohen and Dr. Ohmar Land from Sherman College with Natalia Swanson, Keisha Gray and Amy Page of the Mary Black Foundation during their visit to Sherman College.

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SPOTLIGHT

DCS IN THE NEWSIn the midst of COVID, the opioid epidemic and economic struggles, DCs are stepping up to assist in their communitiesBY C H I R O P RAC T I C E CO N O M I C S STA F F

A GROUP OF GEORGIA CHIROPRACTORS AND COMMUNITY LEADERS launched a public awareness campaign promoting the benefits of natural pain relief — such as chiropractic care — over controlled pain medi-

cation to fight the opioid crisis, according to Patch.com. “Painful Condition? Get Relief. Without Addiction.” is the campaign’s message, funded by a grant from The William M. Harris Family Foundation, with Life University, the Georgia Chiropractic Association, and the Georgia Council of Chiropractic coming together to create the campaign. “We could end this crisis if

more patients knew of safer ways to treat back and neck pain,” said Leana Kart, DC, spokesperson for the campaign. Find more info at ReliefWithoutAddiction.org.

Chiropractor Jordan Estrada has become a TikTok star, leveraging the social media app for millions of views to his video posts that remix pop songs while passing on tips for treating back, neck and knee pain, according to Insider.com. The Houston-based DC says, “I finally found my niche,” after a lifelong interest in music that included performing in school bands. “One day it clicked. I was listening to remixes of ‘Savage’ and thought, why don’t I make my own? I could combine my passions to make music and make it informational.” That video now has more than 16 million views and has inspired other DCs on social media.


SPOTLIGHT

Precure Chiropractic and owner Michael Precure in Las Cruces, N.M., donated $7,560 to La Casa Inc., the only domestic-violence shelter in Las Cruces, according to the Las Cruces Bulletin. The money was raised through the “Give Back Movement,” a national chiropractic awareness program that provides in-office wellness checks and free spinal screenings with the mission of giving back to a local charity. Certificates are given to participants allowing for a new-patient appointment for $40, and that money is then donated, and has resulted in more than 200 “gifts of health” certificates redeemed.

The Lynchburg Chiropractic Center in Virginia donated $6,700 to Miriam’s House, a Lynchburg nonprofit working to end homelessness by connecting families with stable and affordable housing, according to ABC 13 News. The office made the donation as part of the “Give Back Movement,” the national chiropractic

awareness program, where every time the office received a new patient, they donated the appointment exam and X-ray charge amount of $40. Lynchburg Chiropractic is served by Joey Arthur, DC; Morgan Nails, DC; and Benjamin Zaccagnino, DC.

Personal care items for those in need were collected when Waypoint Chiropractic, a clinic in Bozeman, Mont., sponsored a charity drive for Love INC (Love In the Name of Christ), which distributes funding and personal care items such as socks and underwear, and computers and laptops less than three years old. The clinic also gave away a Yeti Cooler and other prizes to people and patients who donated, according to StreetInsider.com. “We will be donating $20 to Love INC for every new patient exam,” said Cary Gentry, DC, who is certified in the Torque Release Technique (TRT) and is the only Proficiency Certified TRT doctor in Montana.

The campaign launched by a group of Georgia chiropractors

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T H E TA K E AWAY

More than 100 million Americans report chronic pain each year. As the popularity of natural health care spikes, pediatric chiropractic care remains widely used and the U.S. senior population grows, DCs need to be promoting ageless chiropractic care.

AGELESS CHIROPRACTIC30-64 is the common chiropractic patient age range — which needs to be extendedBY T H E AC A CO U N C I L O N WO M E N ’ S H E A LT H

TIME TO READ: 5-7 MIN.

ONE OF THE BEAUTIES OF CHIROPRACTIC CARE IS THAT IT IS AGELESS. Chiropractic care can be

effective throughout the entire lifespan of the patients we treat, for a variety of reasons from chronic

and acute pain to general wellness, health and prevention.

According to the 2020 National Board of Chiropractic Examiners’ (NBCE) Practice Analysis of

Chiropractic, 65% of chiropractic practices focus on wellness and maintenance of health, and 33%

focus on nutritional guidance.¹ Across the board, patient demographics are most commonly females

between the ages of 30-64 years old.1

However, this does not mean women are the only individuals seeking chiropractic care. In the U.S.,

women make approximately 80% of the health care decisions for their families and can serve as a

gateway to additional patients who may seek chiropractic care, such as their children.2


FEATURESTORY

It starts with pediatric chiropractic Chiropractic pediatric care is widely utilized and sought after by parents and caregivers for a variety of conditions such as otitis media, colic, breast-feeding challenges and musculoskeletal complaints. In addition to supplements, some parents and care-givers seek manual therapy for their children, which can include soft tissue mobilization and manipulation.

According to the 2017 National Health Interview Survey, chiropractic is the third most-commonly-used complementary and integrative practice utilized in the United States behind yoga and meditation, but there are some key factors that influence who seeks this care.3 For example, the survey found that males and females used chiropractic care equally, and that older children between the ages of 12-17 years were more likely to have used meditation and chiropractic than younger children.3

In addition, the survey determined that non-Hispanic white children were more likely to use yoga and chiropractic care than non-Hispanic black children or Hispanic children.3 Furthermore, the socio-demographics of pediatric and adolescent patients do influence whether they seek care from chiropractors, as 11- to 17-year-olds, Midwest residents, higher-income families, white persons, and those who had utilized other complementary and alternative modalities demonstrated higher odds of utilizing chiropractic care.⁴ As practitioners it is important we become proactive in educating caregivers about the need for care.

As adolescents are a much more likely pediatric population to seek chiropractic care, practitioners should be cognizant of the recent increases in reported pain from this population. Depending upon when practitioners graduated from chiropractic programs, it was often stated that children do not experience chronic pain, and if they did, there was significant reason for concern. In today’s society, however, adolescent musculoskeletal pain is much more common. In addition, the rate of adolescent pain is higher in females than in their male counterparts, and neck and back pain account for higher levels of disability in this population.⁵ Chiropractic clinicians are uniquely poised to help these patients through manual therapy.

Caring for the female patientAs mentioned, women are more likely to seek chiropractic care and to be gatekeepers for patients and our practices.

It has been identified, however, that women’s pain is often overlooked in comparison to that of their male counterparts.6 As providers it is important that we take the time to listen to our patients’ presentations and not form judgements based on sex, race, gender or religion. Female patients seek the care and treatment of chiropractors for a variety of reasons and are also more likely to use other alternative modalities, such as yoga and meditation, than their male counterparts.

Females have a much greater emphasis throughout their lifespan on feeling well and thriving. As chiropractic practitioners, our correlating integrative treatments and modalities that can assist the female patient in thriving to live her best life is important more now than ever.

The rapidly-growing senior populationBy 2030, which is only a few short years away, one in five adults in the U.S. will be 65 years of age or older.8 As our bodies age, mobility may become limited, joints may ache more often than they once did, and balance may begin to decline. As chiropractic

Depending upon when practitioners graduated from chiropractic programs, it was often stated that children do not experience chronic pain…

1/3APPROXIMATELY 33% OF

THE U.S. POPULATION REPORTS CHRONIC PAIN


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FEATURESTORY

practitioners, we must be conscious of the growing needs of this population as it relates to manual therapies and rehabilitation, and be aware that in many cases, polypharmacy does exist.9

With a third of the U.S. population reporting chronic pain, many of whom are women, we have a responsibility as natural health care providers to consider how we can help regardless of age or gender, as this population with chronic pain is sure to increase.7 As COVID-19 has impacted the world, patients of all ages and genders are presenting with a variety of conditions,

many of which are related to a decrease in movement, postural changes from workspaces that are not ergonomically correct, and an increased use of technology and stress.

Now, more than ever, patients need chiropractic care — which is ageless, knows no boundaries, and can be used effectively across the lifespan — to maintain health and wellness.

Learn more about the ACA Council on Women’s Health at acatoday.org.References can be found online at chiroeco.com

ACA Key Messages & Facts for DCs & Patients• A poll conducted by the American Chiropractic Association found that more

than 90% of respondents said their patients or people they knew were

experiencing more musculoskeletal issues since having to shelter in place at

the beginning of the pandemic.1

• Even before the coronavirus pandemic, there has been a trend toward

inactivity caused in part by sedentary occupations, motorized transportation

and increased use of technology.2

• According to the National Center for Health Statistics, more than 4 in 10

Americans are obese.3

• According to the CDC, obesity increases the risk of serious illness from

COVID-19. Obesity is defined as a body mass index (BMI) of 30 or above.4

• Physical activity can improve symptoms, decrease disability and improve

function and well-being in a range of chronic musculoskeletal conditions.5

• Physical activity also reduces risks of cardiovascular disease and diabetes

beyond that produced by weight reduction alone.6

• The coronavirus pandemic may limit where we can go, but it’s important to

remain mindful of our health and try to get enough physical activity daily.

• Even before the pandemic, more than half of all U.S. adults failed to meet

the surgeon general’s physical activity recommendations.8

• The number of Americans suffering from anxiety and depression has more

than tripled during the COVID-19 pandemic.9

• Deaths from falls among seniors age 75 and over have increased three-fold

in recent years and total about 25,000 annually.14

• An active lifestyle, leading to a higher level of physical fitness, is related to

better spinal control in middle-aged men and women.16

• Bone mass usually peaks in the third decade of life, but physical activity can

improve the strength of your bones at any age.17

• Low-back pain is the single leading cause of disability worldwide.18

• Back pain is one of the most common reasons for missed work. One-half of

all working Americans admit to having back pain symptoms each year.19

• Back pain alone accounts for more than 264 million lost U.S. workdays in

one year.20

• Experts estimate that as much as 80% of the population will experience

back pain at some time in their lives.21

• Low-back pain costs Americans at least $50 billion in health care costs each

year22 —factor in lost wages and decreased productivity and that figure

easily rises to more than $100 billion.23

• Almost half of all U.S. opioid overdose deaths involve a prescription opioid.24

• Back pain is one of the leading reasons people are prescribed opioids.25

• Research shows that opioids do not provide clinically meaningful pain relief

for people with chronic back pain.26

• As many as 1 in 4 people who receive prescription opioids long-term for

non-cancer pain struggle with addiction.27

• Almost 80% of Americans prefer to first use options other than prescription

drugs for their pain.28

• Patients who saw a chiropractor as their initial provider for low-back pain

had 90% decreased odds of both early and long-term opioid use.29

• A clinical comparative trial found that chiropractic care combined with usual

medical care for low-back pain provides greater pain relief and a greater

reduction in disability than medical care alone.31

• Injured workers with similar injuries are 28 times less likely to have spinal

surgery if the first point of contact is a doctor of chiropractic (DC) rather

than a surgeon (MD).32

• In 2017, the American College of Physicians updated its guidelines for the

treatment of acute and chronic low-back pain to recommend first using

noninvasive, nondrug treatments —including spinal manipulation — before

resorting to over-the-counter and prescription drugs.33

• In January 2015, the Joint Commission, the organization that accredits

every major hospital in the United States, recognized the value of nondrug

approaches by adding chiropractic care to its pain management standard.34

References available at acatoday.org.

Females have a much greater emphasis throughout their lifespan on feeling well and thriving.


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RESEARCH ON THE GUT-JOINT CONNECTION FOR OA AND INFLAMMATIONOsteoarthritis (OA) and inflammation from an unbalanced gut microbiome result in joint pain and degradationBY R O B S I LV E R M A N , D C , DAC B N , D C B C N , M S , CC N , C N S , C S C S , C I I S N , C K T P, C E S , H KC , FA K T R


T H E TA K E AWAY

Research points to restoring the health of patients’ gut microbiome to reduce inflammation, joint pain and osteoarthritis, eliminating the problem at the source and restoring balance.

OSTEOARTHRITIS (OA) IS THE MOST COMMON JOINT DISORDER in the United States, affecting over 32.5 million U.S. adults. It’s the most common musculoskeletal condition seen in any medical practice. The majority of patients are aged 60 or older. Painful knee arthritis, for example, occurs in 10% of men and 13% of women over age 60.1

Traditionally, the causes of OA are older age, female gender, being overweight or obese, repetitive use, weak muscles and knee injury. The standard treatment consists of recommending weight loss to relieve loading on the joints and exercise and physical therapy to improve muscle strength. NSAIDs are often prescribed to relieve inflammation and pain, creating an increased risk of gastrointestinal tract injury, including leaky gut syndrome.2

To the causes and treatment of OA, we now need to add the gut microbiome.

The Gut-Joint ConnectionLike metabolic syndrome and obesity, osteoarthritis is char-acterized by low-level overall inflammation as well as joint inflammation. People with one or more of these conditions usually also show high levels of lipopolysaccharides (LPS) in their blood.

Also known as endotoxin, LPS is released from the outer cell walls of gram-negative bacteria when they are destroyed in the digestive tract. LPS escapes into the bloodstream when the tight junctions of the intestinal wall open due to leaky gut syndrome, causing systemic inflammation through the inflammasome NLRP3 (an inflammasome is a protein complex that triggers the proinflammatory process). Among other impacts, LPS causes joint pain and cartilage degradation.

Recent research suggests that LPS-driven inflammation might be a critical hidden risk factor for OA. In combination


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WELLNESSAPPROACH

with inflammatory mechanisms from metabolic syndrome and obesity, LPS is a double-hit to the body. The resulting inflammatory response targets the joints.3

Inflammation from LPS indicates an unbalanced gut microbiome, with too many harmful bacteria releasing endotoxins. The functional medicine approach of looking at systems is beneficial for fixing gut dysbiosis. Better diet, prebiotics and probiotics, and more physical activity can shift the balance away from the LPS-producing bacteria and back toward a more diverse array of gut bacteria. When LPS-induced inflammation is reduced, joint pain is usually reduced as well.

Gluten intoleranceAntibodies to gluten, a protein found in wheat, rye and barley, are another significant driver of inflammation and OA. Gluten is two proteins bound together: about 30% is glutenin, and about 70% is gliadin.

People with celiac disease (CD) have an autoimmune response to both gliadin and glutenin; the response damages the villi of the small intestine and causes systemic inflammation. The inflammation is the root cause of autoimmune arthritis that often develops in people with celiac disease — they are four times as likely to have arthritis as people without celiac disease. A gluten-free diet reduces not only celiac symptoms but also joint inflammation.4

People who are allergic or sensitive only to gliadin — non-celiac gluten sensitivity or NCGS — don’t have damage to the villi, but they may have similar digestive symptoms and inflammation that leads to joint pain and osteoarthritis.5

Celiac disease is usually seen as genetic, but recent research suggests that gut dysbiosis may have a significant role in the development and possible treatment of both celiac disease and non-celiac gluten sensitivity. Levels of the beneficial Bifidobacterium tend to be low in people with CD and with NCGS, for example.6

For some people with either condition, raising the level of beneficial bacteria in the gut may improve gluten tolerance, support a strong gut barrier and reduce inflammation. Probiotics alone may not be enough — a study that gave Bifidobacterium supplements to volunteers with celiac disease found they didn’t help.7 While it’s possible that probiotics would be more helpful for NCGS, avoiding foods with gluten and improving the gut microbiome through diet may be more effective. A high-fiber, plant-based diet with fermented and prebiotic foods, along with a prebiotic supplement, is a good approach.

LectinsOsteoarthritis can also be driven by lectins and agglutinins, sugar-binding proteins found in all plant foods. They’re espe-cially abundant in beans, peas, lentils, peanuts, nightshade vegetables such as tomatoes, and grains, including wheat, barley, quinoa and rice. Wheat germ agglutinin (WGA) is found in wheat.

In sensitive individuals, lectins and WGA cause digestive upsets, including bloating, vomiting and abdominal pain. The damage can be more severe in some cases. The lectins and WGA may bind to receptor sites on the intestinal mucosal wall and trigger leaky gut syndrome and dysbiosis. They may also be another hidden cause of osteoarthritis.8

In combination with inflammatory mechanisms from metabolic syndrome and obesity,

lipopolysaccharides are a double-hit to the body.

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References can be found online at chiroeco.com

The lectins enter the bloodstream through open tight junctions and bind to cartilage and connective tissue, causing inflammation that leads to osteoarthritis.

Because lectins are found in almost all plant foods, they can’t be eliminated from the diet. The damage can be reduced or eliminated by avoiding high-lectin foods such as red kidney beans and thoroughly cooking all beans and legumes. Sensitive individuals may need to cook other high-lectin foods before eating them.9

Restoring the gut microbiomeLPS, gluten and lectins all cause severe disruption to the gut wall and the gut microbiome, causing leaky gut syndrome and dysbiosis. Although the cause is different in each case, the result — systemic inflammation causing joint pain and osteoar-thritis — is the same.

Functional medicine excels in tracing inflammation upstream to find root causes, an approach that will often uncover a hidden cause of joint pain and osteoarthritis. If a problem such as gluten intolerance is discovered, dietary

changes to eliminate the source are just the first step. Fixing the leaky gut and restoring balance to the gut microbiome are essential.

As the great Dr. Vladimir Janda once said, “He who treats the site of pain is lost.” Nothing may exemplify this more than the gut-to-joint connection.

ROB SILVERMAN, DC, DACBN, DCBCN, MS, CCN, CNS, CSCS, CIISN, CKTP, CES, HKC, FAKTR, is a chiropractic doctor, clinical nutritionist, national and international speaker, author of Amazon’s #1 bestseller, “Inside-Out Health,” and founder and CEO of the Westchester Integrative Health Center. The ACA Sports Council named him “Sports Chiropractor of the Year” in 2015. He is on the advisory board for Functional Medicine University and is a seasoned health and wellness expert on both the speaking circuits and within the media, as well as a frequent health expert contributor on national blogs such as Consumer Health Digest. He has appeared on FOX News Channel, FOX, NBC, CBS, ABC, The Wall Street Journal and NewsMax. His new book, “Superhighway to Health,” is expected to be published in 2020.

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CLINICAL CONCERNS

EVALUATING AND LISTENING TO THE BODYUnderstanding musculoskeletal injuries through the health of the overall architectural structureBY T I M M AG G S , D C


T H E TA K E AWAY

Patients may forget the sources of injuries and aches, but the body never lies. Use the following biomechanical evaluation to get to the bottom of a patient’s imbalance to their “architectural structure.”

I WAS RECENTLY SPEAKING WITH A MEDICAL RADIOLOGIST who said to me, “So let me get this straight. You’re saying that if someone has a normal lordotic cervical curve and they’re in a motor vehicle accident, and someone else who has an abnormal cervical curve is in an identical accident, the individual with the abnormal curvature will fare worse than the individual with a normal cervical curvature, assuming all circumstances surrounding this accident are identical.”

“Exactly,” I said. “Makes sense,” he answered.

The anatomy of musculoskeletal injuries Most offices have endured that older overweight patient who’s driven a truck for 35 years and went to a chiropractor 28 years ago for “a bone being out” and didn’t need to go back for a second visit.

“Well, doc, that bone’s out of place again.” At least, that’s what this patient thinks.

After many years in practice and much experience gained along the way, I’ve come to the conclusion that the public has no understanding of how the body works or heals. We’ve


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all been trained wrong by the media, the medical community, our academic establishments and our governmental agencies. Back pain is not the enemy. Back pain is a result of tissue becoming injured through trauma, repetitive activity or abnormal overloading. Once symptoms come on, we now have two objectives: Balance the abnormal loading and heal the injured tissue to the level or degree to which it can heal.

Patient examplesTwo patients immediately come to mind when I want to explain how the body works. The first is a 22-year-old male who’s had severe low-back pain for the past three years. So much so, he’s basically stopped his life. Dropped out of college, no exercise, minimal activity. Incredibly, he’s been to 30 doctors and

therapists over this amount of time. All of them attempted their recipe for success, but the fact that he came to me, his 31st appointment, is suggestive they didn’t provide him with appropriate solutions.

The failure in this case was that no one thoroughly diagnosed this patient from a biomechanical perspective and no one provided the appropriate treatment to allow the injury to heal. Upon standing X-ray while barefoot, he had a 9.6-mm difference in femoral head height (Fig. 1). Upon MRI of the low back, he had a significant protrusion at L5. He was proud to tell me he wore his podiatrist-recommended custom orthotics constantly. Upon X-ray of the low back with them on, his femoral head height difference grew to 11.4 mm (Fig. 2). Most of the treatment he

received was medication, stretches, chiropractic adjustments and home exercises. He never received the appropriate combination of treatments and recommendations — and no one even knew about his femoral head height difference. That too needed to be addressed.

My second patient is a 27-year-old professional runner originally from Kenya and now residing in Boulder, Colo. For 18 months she’d suffered with heel pain, despite running 85-95 miles per week. She visited 10 doctors and therapists, and none of them ever told her what her problem was, nor how to fix it. She then flew to Albany, N.Y., where we examined, X-rayed and took an MRI of her heel. No one had done any imaging up to this point. Upon X-ray, we found a heel spur (Fig. 3) and upon MRI we found bone marrow edema, or inflammation (Fig. 4). This is better known as a stress reaction.

Any intelligent person might ask, why is only one heel injured? Both feet have taken the same number of steps. The reason is her unique biomechanical imbalances. A standing X-ray of her low back while barefoot showed she had an 8-mm difference in femoral head height (Fig. 5), but when we X-rayed her with her custom orthotics on, the femoral head height was reduced to 1.5 mm (Fig. 6). Now that the biomechanics are improved, the appropriate treatment to

Figure 1 Figure 2

We’ve all been trained wrong by the media, the medical community, our academic

establishments and our governmental agencies.


CLINICALCONCERNS

heal the stress reaction was provided and she resumed running pain-free after 18 months of suffering.

Maggs Law of Tissue Tolerance “When the loading of a tissue exceeds the capacity of that tissue, compensa-tory physiological changes occur.”

I spend much of my day teaching people how the body works. I begin by telling them we are all born as Crooked Man (Fig. 7). And then we have a lifetime of slips and falls and bad habits, and the tissue accumulates all these stresses. If our life was a ballgame, our musculoskeletal status would be the score of the game and our life would represent the game itself. So, if there’s a herniated disc, that’s the score. If there’s a chronic strain/sprain of the right knee, that’s the score.

The body is nothing more than the accumulation of all the stresses, injuries, bad habits and hereditary weaknesses we’ve collected during our lifetime. I tell them, “The body keeps a perfect scorecard of every banana peel we ever step on.”

What’s more, I tell patients the body doesn’t lie. They’ll come in with an acute low back and when I ask them what they did to cause it, they say “Nothing!” I proceed to tell them that the body doesn’t lie. People lie, but the body doesn’t. Now, they may not remember what they did, or they may not know the body accumulates stresses over one’s lifetime. But the body is telling the truth.

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CLINICALCONCERNS

The biomechanical evaluation No one has ever recommended that we can get a relatively accurate status report of a patient’s musculoskeletal system even when they’re not injured. We’re all taught how to examine an injured patient, but not an asymptomatic patient. Remember, underneath every injury is Crooked Man. There are a series of biomechanical faults that will play a role in this patient’s future regarding vulnerability to injury and premature degeneration.

When looking at Crooked Man, we can see that all imbalances originate in the feet. The human being is an architectural structure, and the foundation is paramount for maximum balance.

For the biomechanical evaluation:

1. A digital laser foot scan is performed on all patients to measure the amount of space under each foot and to get an exact impression

of both feet. Anything but two perfectly balanced feet demands the recommendation of custom orthotics.

2. We then perform a physical exam, looking at joint ranges of motion, leg length, internal or external foot rotation, muscle compliance, etc.

3. We finish with two standing X-rays of the low back and two standing X-rays of the neck, all taken with the patient barefoot.

Managing health, not just alleviating symptoms The human body is not just a diagnosis when injured; it’s an architectural struc-ture that will be influenced by gravity, aging and stresses over the course of a person’s lifetime. The doctor of the future is one who will help a person manage and maintain the health of this structure, not just alleviate symptoms when they arrive.

Our jobs should be to improve overall

loading of the body, improving and maintaining joint mobility. All of this will improve quality of life, and that’s what patients are looking for.

There’s no profession more qualified than the chiropractic profession to provide such care.

TIM MAGGS, DC, has been in practice for 40 years, and now specializes in the evaluation, care and treatment of middle and high school athletes. He is the developer of The Concerned Parents of Young Athletes™ Program, designed to raise awareness of sports biomechanics. He writes for Foot Levelers and can be reached at CPOYA.com.

Figure 7

Figure 5 Figure 6

The human being is an architectural structure, and the foundation is paramount for maximum balance.


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FIND AND REMOVE REVENUE CYCLE INTERFERENCESYour revenue cycle is a ‘nervous system’ of signs, symptoms and conditionsBY B RA N DY B R I M H A L L , C P C , C M CO, CCC P C , C P CO, C P M A


T H E TA K E AWAY

Check these six revenue cycle interferences against your practice’s checks and balances to see if they impact cash flow, collections and even time management.

AS DOCTORS AND CHIROPRACTIC ASSISTANTS, WE COMMUNICATE TO OUR PATIENTS how interferences in their nervous system are often a cause or contributor to physical signs, symptoms, or more problematic and severe conditions they may be experiencing and seeking care for. We educate our patients that if these interferences are untreated and unmonitored, the effects can become more severe, take more time and treatment to improve or repair, and even be the source for new potential signs, symptoms and conditions that didn’t exist before.

However, with routine evaluation and appropriate care, these signs and symptoms are minimized or eliminated, and more challenging conditions are improved or sufficiently

managed — which allows the patient to function more optimally and free of, or with minimal, nervous system interferences.

Your practice’s ‘nervous system’I believe that the outstanding care chiropractic practices render to their patients makes up the “heartbeat” of the prac-tice, if you will. After all, without patients, there is no practice.

To use a similar analogy — in my view, the revenue cycle system is essentially the “nervous system” to the practice. In other words, interferences in the revenue cycle system are the result of numerous signs, symptoms and conditions related to practice cash flow, collections and even time management.


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Here are just a few:

� Rejected or denied claims

�Over-the-counter collections uncertainties

� Inability to properly communicate with patients regarding financial responsibilities

� Aging accounts-receivable balances — including patient and insurance balances

� Stifled cash flow and collections

� Practice workforce uncertainties and frustrations

� Loss of valuable provider or CA time tending to revenue cycle challenges

� Audit- and compliance-related vulnerabilities

As with the body and nervous system, the revenue cycle system has many possible causes and effects of interferences, as well as many areas or regions in the system where this can occur. Likewise, each area of the revenue cycle system is closely connected to one or more others, increasing the likelihood of interferences occurring in other places as well, particularly if the system is neglected or improperly maintained.

Where are your interferences?Sufficiently understanding the many parts to your revenue cycle system and periodically evaluating each of them serves as a great diagnostic tool for your practice. On a broad scope, here are a few of the most common revenue cycle

system interferences or reasons for interferences that practices encounter:

Interference 1: A single gatekeeperOnly one person who knows what to do, when tasks should be done and how to accomplish them.

This scenario creates immeasurable vulnerabilities to providers because they are extending a blind trust in the financial health of their entire practice — even those with a superstar CA at the helm of these processes. When that CA moves on or takes time off, the many keys to the revenue cycle system go with them.

Interference 2: Passing the batonIt takes weeks and sometimes several months to really learn and become comfortable with some job duties.

The many parts of the revenue cycle system are certainly no exception. Adding an additional team member or replacing an existing team member generally relies on brief person-to-person training, which results in misunderstanding, confusion, essential skipped components, limited to no checks and balances, important elements slipping through the cracks, etc.

In many cases where adequate understanding and training is critical, the baton simply doesn’t get passed or is simply just dropped without anyone even realizing it until incoming collections and cash flow are restricted, leaving the practice to worry about what happened, when and how.

Interference 3: Insufficient or absent trainingMany CAs find that they must create their own systems and procedures, often without the tools and resources that would be necessary to give them certainty and confidence in their job.

In many cases where adequate understanding and training is critical, the baton simply doesn’t get passed

or is simply just dropped…

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Sometimes those in charge of billing and collections didn’t even realize that was going to be their role when they were hired. They have limited to no understanding of coding requirements, what’s necessary for clean claims and submission, how payor policies and network requirements apply, the necessity of state law knowledge for both insurance and self-pay patients, and the list goes on. Often when asking why something is done a certain way, I am told, “We just do it this way because that’s what we’ve always done.”

In this scenario, CAs often feel a lack of confidence in their own performance, and perhaps even know that there are missing pieces, but have nowhere to go with questions and concerns. The result: billing-and collections-related errors, uncertainty in what or how to communicate with patients about finances, loss of practice money and time, sometimes higher rates of staff turnover, etc.

Interference 4: Lack of understanding of the revenue cycle systemThe revenue cycle system is quite complex — far more than simply just billing and collecting.

Consider the following components: insurance verifications, electronic and paper claims, federal payors, Personal Injury and Workers Comp. payors, patient financial communications, over-the-counter collections, rejection management, claims processing and posting, in-/out-of-network guidelines, patient invoicing, non-covered or alternative treatment procedures, correct coding, claims review and posting, self-pay patients, appeals, follow-up and aged receivable management, etc.

This limited list of revenue cycle system components often brings to the surface many questions and concerns that practices have in one or more of these areas. It is very easy to get stuck in the daily mechanics of data entry and billing while many of the crucial components to the revenue cycle system are set to the side, forgotten about, or never even fully understood.

Interference 5: Time management challengesThere are so many hats most CAs in a practice wear on a day-to-day basis.

Even the most talented CAs can find themselves constantly playing catch-up and with a growing to-do list that there never seems to be time for. In this scenario, it is often those revenue-cycle-related tasks that may be more time-consuming that are set to the side and left unattended.

Interference 6: Insufficient billing, collections and accounts receivable systemsUnattended or poorly attended systems will result in a growing restriction of cash flow.

The older the balance (from patients and payors), the more difficult it becomes to collect and the more costly it becomes to the practice. Motion is a sign of life — water, air, blood and even cash flow. Stagnant monies in billing, collections and accounts receivable systems have many long-term effects to a practice. These interferences minimize growth, expansion, workforce confidence, efficiency, patient relationships, practice overall value, financial health and more.

Implement a corrective planIn my office I work with practices every day to help identify and remove those revenue cycle systems interferences. In some cases, practices are aware of where interferences are occurring but need assistance to establish necessary action steps for a productive and manageable path forward. In many other prac-tices, we often are able to identify unknown interferences that may have been restricting cash flow for months or even years.

In most practices these interferences are generally found to be in more than one area and prioritizing a corrective action approach can be daunting to a practice. The good news is that improvement and correction are possible for every practice. The great news is that by properly evaluating and implementing a corrective action plan for your revenue cycle system, the stifled cash flow, compliance vulnerabilities, time-management challenges, and other symptoms or conditions your practice is experiencing, they will either diminish or disappear completely. Additionally, moving forward, your practice will be able to identify new interferences more quickly as they occur and be better prepared to address them promptly with confidence.

Consider your own practice revenue cycle systems interferences, as well as the related symptoms and conditions you may be experiencing as a result. Right now is always the best time to take a proactive approach to evaluate and remove revenue cycle system interferences. Freeing your practice of those restrictions that are costing you time, confidence and money will ultimately improve the overall function of your entire practice.

BRANDY BRIMHALL, CPC, CMCO, CCCPC, CPCO, CPMA, can be reached at the certified on-demand Virtual Chiropractic Assistant at CHelpDesk.com.

The revenue cycle system is quite complex — far more than simply just billing and collecting.


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TECHTALK

TRANSCUTANEOUS ELECTROMAGNETIC MUSCLE STIMULATION (TEMS) IS A NEW TREATMENT MODALITY that chiropractors may want to consider introducing to their practice, involving the use of focused electromagnetic resonance to cause supra-maximal contraction of the treated muscles.

Chiropractors are familiar with Magnetic Resonance Imaging (MRI) for soft-tissue imaging, which was a significant advancement over X-ray imaging. As in X-rays, the energy emitted in an MRI is collimated and a small portion of that energy is absorbed. The balance passes harmlessly through the body to record the images that are then provided to the physician.

By focusing and increasing the energy, X-ray beams can be used for a different purpose, namely to destroy cancer cells.

Magnetic resonance and muscle massSimilarly, it was recently discovered that by focusing the energy beam and increasing energy levels, magnetic resonance increases muscle mass by causing supra-maximal muscle contractions.

These are unlike any muscle contractions that can be induced by using a TENS machine because these contractions are entirely painless and occur in rapid sequence.

It is estimated that one 30-minute session of TEMS

NOT TENS, BUT TEMSIntroduced two years ago in the U.S., it’s a one-two punch for both back pain and weight lossBY B A L D E V SA N D H U, M D

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T H E TA K E AWAY

A new treatment technology initially for weight loss and cosmetic treatments has shown its value in also reducing back pain in studies.


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therapy to the abdominal musculature is equivalent to 20,000 abdominal crunches. A 30-minute TEMS session to the gluteal muscles is equivalent to 20,000 squats. Repeated treatments cause a rapid increase in muscle mass which then utilizes fat as an energy source, so in addition to having stronger musculature, the patient loses fat.

In one study conducted by David E. Kent and Carolyn Jacob, muscle mass was documented by CT scanning to increase by 16% and the overlying fat layer was decreased by 19% at eight weeks following completion of four 30-minute treatments delivered over a 14-day period. These studies were replicated by Brian Kinney, MD, at the University of Southern California-Los Angeles.2

In these studies, the increase in muscle mass and decrease in fat was documented with MRI studies. Ultrasound was used to measure the reduction of fat, which again averaged 19%, in a third multi-center study conducted by Bruce Katz and associates.3

In each of these studies the treatment was referred to as HIFEM for High Intensity Focused ElectroMagnetic Therapy, but Transcutaneous Electromagnetic Muscle Stimulation (TEMS) more accurately describes the treatment being performed and is better understood by patients.

Cosmetic treatment to back pain applicationCosmetic physicians could immediately see that this was the “holy grail” of non-invasive body contouring, and although it was expensive at $3,200 for the four-treatment session package, it is estimated that already over 200,000 patients have undergone TEMS treatment since it was introduced in the United States just under two years ago.

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While this was essentially a cosmetic treatment, some patients started reporting that not only did they look better, with their firmer musculature and associated weight loss, but their back pain had also improved. A sufficient number of patients made this comment and I was intrigued to ask Jeffrey Massarone, DC, ND, about this finding. His take was that this was the missing piece in the chiropractic treatment of back pain.

“Most back pain occurs in the lumbo-sacral area and cervical area of the spine,” Massarone said. “Pain in the mid-back, namely the thoracic spine spanning the T1-T12 vertebral segments, is oftentimes attributed to dysfunction in the cervical and lumbar spine regions. This is most likely because these vertebrae are braced by the bony thoracic cage and significant vertebral movement requiring adjustment can therefore only occur in the cervical or lumbo-sacral area. While chiropractors have traditionally concentrated on the back, if you could strengthen the abdominal musculature there would automatically be less strain on the back. Strengthening the rectus abdominis and external oblique muscles by 16% would stabilize the back and account for the reported back pain relief.”

Patient pricing and benefitsMassarone’s feeling was that since insurance is unlikely to pay for TEMS, but it could be offered to patients as a cash add-on service, even insurance-based patients would see the value of strengthening their core musculature if it could be priced at $1,200 for a six-treatment package.

With his dual degrees in chiropractic and naturopathy, Massarone has consulted for a number of nutraceutical companies that sell weight-loss supplements.

I personally was unaware that many chiropractors have expanded their practices to include weight loss, which only makes sense as weight loss is an important part of treating back pain. Massarone was excited about the possibility of introducing TEMS therapy as the cornerstone of a weight-loss practice.

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“Realistically, while supplements play a role in weight loss, the only surefire way to lose weight is by a combination of calorie restriction and exercise,” Massarone said. “If chiropractors have a TEMS machine in their office, in addition to treating back pain they can utilize it to provide all the benefits of exercise that result in weight loss as a part of their weight loss program. In fact, more income may be generated by the use of the TEMS machine than in treating back patients, but one machine that provides two sources of incomes would be a godsend to most chiropractic practices.”

A small footprint with big resultsThe other thing chiropractors should be aware of is that a TEMS machine takes up less than two square feet of space and can be put in any treatment room that has an examining table. Treatments do not need to be supervised, as once the paddles that deliver the energy are placed on the patient and treat-ment has started, no further physician intervention is required.

The initial investment in the first generation of TEMS machines was quite expensive, but as with all new technology, prices are dropping rapidly and the newer machines are technologically more capable. Just as different exercise sets can be done to increase muscle mass and definition (think bodybuilders who compete in competitions) versus strength (think Olympic weight lifters), the newer TEMS machines have different programming to allow you to help patients achieve their goals, whether it be alleviation of back pain or weight loss, without going to a gym or breaking a sweat.

I foresee a TEMS machine in every chiropractic and weight-loss clinic in the near future.

BALDEV SANDHU, MD, is an attending plastic surgeon at Hoboken University Medical Center and a consultant to several nutraceutical companies and laser manufacturers. He can be reached at baldevsandhumd.com.


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WHEN PATIENTS AND HEALTH CARE PROVIDERS THINK OF TELEHEALTH IN CHIROPRACTIC SERVICES, the two never seemed to add up. After all, chiropractic care is literally a very hands-on clinical application and seemingly difficult to conduct through a Zoom or Facetime call. Dating back several years, telehealth was an option used sporadically in chiropractic care and was mostly utilized in radiology, where readings of X-rays or MRIs would be transferred via a telehealth visit.

Telehealth’s explosive growthTelehealth is currently a $2.6B industry, according to IBISWorld, and has grown 25% since 2015, outperforming growth in the life sciences sector. As telehealth became more prominent in other health care disciplines, the Federation of Chiropractic Licensing Boards (FCLB) took notice and launched a proactive exploration of how telehealth could be applied to chiropractic care and what regulatory structures might be needed to ensure patient safety and encourage best practices.

Then everything changed. Across the nation, many businesses closed, schools shut down, and stay-at-home orders went into effect to prevent the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Thankfully, chiropractors were deemed essential personnel and were able to continue caring for patients. However, many patients under chiropractic care decided to stay home and postpone care instead of seeing their chiropractor. With the coronavirus keeping people quarantined at home, some practitioners adopted telehealth services to continue connecting with and caring for patients.

As telehealth proliferated in the health care industry a different mindset started to take place, and the idea of serving chiropractic patients via this medium started to take shape. Telehealth has its limits in chiropractic, but there might be potential to utilize this platform to align with the CDC guidelines for social distancing. Of course, adjustments simply cannot be done via conference call. However,

TELEHEALTH: ‘THEN EVERYTHING CHANGED’Like it or not, COVID and telehealth’s proliferation will impact DCsBY KA R LO S B O G H O S I A N , D C


T H E TA K E AWAY

The Federation of Chiropractic Licensing Boards outlines patient protection and regulation for telehealth in DC services, changes in 2020, and Oregon’s exemplary regulation model.


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neuromusculoskeletal telehealth services could include follow-up examinations, risk assessments, advice, patient monitoring and instructions for spinal care.

Regulatory measures for chiropractic telehealthTelehealth is regulated by the licensing boards, and chiroprac-tors choosing to launch a telehealth platform should follow accepted best practices. Synchronous guidelines dictate that the proper telehealth structure include secure patient messaging, electronic health records, patient scheduling and records application.

Furthermore, emphasis is placed on using computers with HIPAA-compliant security requirements that perform synchronous video capability. It was also advised that chiropractors (and staff) pay particular notice to proper lighting, clutter-free backgrounds, professional appearance, and clearly written educational materials.

FCLB is a clearinghouse of information and works with state chiropractic boards to maintain continuity and regulations particular to the health and safety of patients. It is advised

that practitioners seek guidance from their state licensing board and their malpractice carriers regarding telehealth requirements.

Telehealth regulatory model — the Oregon exampleIn late March of this year, the Oregon Board of Chiropractic Examiners reviewed the state’s telehealth rules and offered clear guidance to chiropractors for offering telehealth services to both new and existing patients.

In their guidance, the Oregon board specified a number of documentation requirements. In addition to primary complaints and the reason for the visit, the board recommends documenting start and end times. If, based on the complaints, the chiropractor determines that care via telehealth is both possible and beneficial in a particular case, he or she then needs to further document personal, family and health histories.

Oregon’s guidance further outlines necessary visual evaluations such as postural analysis and range of motion as well as patient self-reporting including height, weight, blood pressure, pulse and diet.

Telehealth is regulated by the licensing boards, and chiropractors choosing to launch a telehealth platform should follow accepted best practices.

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Based on visual evaluations and patient self-reporting, chiropractors may offer provisional diagnoses, a report of findings, patient PARQ and consent to provide care, as well as clinical recommendations. Again, the Oregon board’s guidance includes fully documenting all findings and recommendations.

Ultimately, as in personal visits, thorough documentation during telehealth practice protects the patient, ensuring the chiropractor is building a complete picture of patient health and offering clear guidance for home care. Additionally, by documenting, chiropractors manage their own risk and reduce exposure to board actions or malpractice claims.

Launching your telehealth practiceA growing number of continuing educa-tion providers offer telehealth courses aimed at helping chiropractors under-stand the relevant regulations and documentation requirements as well as explore telehealth-friendly services and workflow scenarios.

For doctors of chiropractic who wish to include telehealth in their own practice, the Federation of Chiropractic Licensing Boards highly recommends including a PACE Recognized telehealth course as part of the process in building this avenue of practice. To protect their patients and themselves, practitioners need to have a solid understanding of the strengths and limitations of telehealth as well as the regulations that govern practice in both the chiropractor’s and the patients’ jurisdictions.

As the industry utilizes this platform more frequently, there is an expectation for updated best practices to be discovered and shared. To date, we are learning that the virtual, telehealth platform will likely grow within chiropractic. The feasibility of real-time telecommunication appears to be an effective supplement that is an option

to conventional methods of modern health care delivery. Telehealth, when used properly, enables continuity of care and connection for chiropractors and their patients.

KARLOS BOGHOSIAN, DC, is the current President of the Federation of Chiropractic Licensing Boards, a not-for-profit, 501(c)(3) organization whose membership comprises the United States chiropractic licensing boards, certain Canadian provincial registration boards, and the chiropractic licensing board of New Zealand. FCLB lessens burdens on state government by providing programs and services to its membership.

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SHOULD YOU BILL INSURANCE FOR THERAPEUTIC LIGHT THERAPY?Options include cash-only, insurance, and selling units for at-home useBY R O B B E R M A N , M B A


T H E TA K E AWAY

Most health care providers charge cash for in-office light therapy procedures, but a number of CPT codes are also available for DCs to consider.

THERE ARE A VARIETY OF TYPES OF LIGHT THERAPY AVAILABLE FOR YOUR PATIENTS. These range from therapeutic (pain and increased circulation) to Seasonal Affective Disorder (SAD), dermatology (typically using ultraviolet light) and photo-dynamic for killing cells.

PubMed has over 4,000 articles that outline research involving light, whether it is LED light therapy or lasers. Despite an overwhelming number of positive studies, not all insurance companies or other third-party payers will pay for these therapies.

Payments in the health care industryMany providers will simply charge cash for the in-office proce-dures. The number of treatments will vary depending on the disease state and the underlying conditions of the patient.

The road to success leads through the patient being presented with a treatment plan they understand and agree

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to follow. Confirm that the patient understands that insurance may not cover the treatments. You are selling the value of the service, which is independent of how insurance may apply in a given situation.

PRO TIP: Consider selling units for at-home usage instead of, or in addition to, in-office treatments. You would purchase wholesale and sell retail without insurance hassles. Chronic conditions would need ongoing treatments for longer periods of time.

Cash has its advantages as:

� You are paid immediately, even if you take the payments in installments;

�No insurance paperwork;

� Staff saves time handling all the billing and resulting insurance company questions, denials and delays.

Trying the insurance routeThere are not any specific CPT codes for therapeutic light therapy. Regardless of which code you choose, always include a statement describing the treatment and therapy.

When you think about the variety of CPT codes available to you, consider:

� Attended versus unattended;

� Does the code require a time component, usually 15 minutes per unit;

� Codes ending in “9” require more documentation.

Chiropractors have over the years utilized a variety of codes. Before using any of the codes to describe light therapy, you should check with your participating carriers to see if light therapy is allowed under the code you intend to utilize.

Below is a chart summarizing some CPT codes and whether they are attended, timed or require extra documentation:

Here’s how you would file the codes for payment:

97026 — This CPT code is for infrared light therapy. Billing might look like “97026: Attended infrared light therapy,” or “97026: Attended infrared therapy.”

PROS AND CONS: Light therapy is generally designed to be unattended and 20 minutes or more in duration. You would be dedicating a staff member to stay in the room with a modality that does not require their presence.

97032 — This CPT code is for attended electronic photonic stimulation (15 minutes). Billing might look like “97032: Attended electronic photonic stimulation,” or “97032: FDA cleared photonic stimulation.”

PROS AND CONS: Light therapy is generally 20 minutes or more, so you are covered on the minimum time. The patient chart will need to be notated as to starting and ending time. Be sure to notate body part(s) treated. You would be dedicating a staff member to stay in the room with a modality that does not require their presence.

CPT CODE ATTENDED TIMED EXTRA DOCUMENTATION

97026 YES NO NO

97032 YES YES NO

97039 YES NO YES

97112 NO YES NO

97139 YES NO YES

97799 NO NO YES

Before using any of the codes to describe light therapy, you should check with your participating carriers…

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97039 — This CPT code is for an unlisted modality with constant attendance. Billing might look like, “97039: Attended infrared therapy,” or “97039: Attended light therapy.”

PROS AND CONS: The “unlisted” nature of the code can result in rejection or hand audits. Since the code ends in “9” an additional one page of documentation will be necessary. Include a description of the services and the name of the device. You would be dedicating a staff member to stay in the room with a modality that does not require their presence.

97112 — This CPT code is for neuromuscular reeducation (15 minutes). Billing might look like, “97112: Neuromuscular reed-ucation,” or “97112: Neuromuscular reeducation with light therapy.”

PROS AND CONS: No staff attendance is required. Light therapy is generally 20 minutes or more, so you are covered on the minimum time. The patient chart will need to be notated as to starting and ending time. Be sure to notate body part(s) treated.

97139 — This CPT code is an unlisted therapeutic procedure with constant attendance. Billing might look like, “97139: Unlisted therapeutic procedure with FDA cleared light therapy — constant attendance.”

PROS AND CONS: The “unlisted” nature of the code can result in rejection or hand audits. Since the code ends in “9” an additional one page of documentation will be necessary. Include a description of the services and the name of the device. You would be dedicating a staff member to stay in the room with a modality that does not require their presence.

97799 — This CPT code is for physical medicine and rehabil-itation unlisted service or procedure. Billing might look like “97799: Unlisted service or procedure performed with FDA cleared light therapy.”

PROS AND CONS: The “unlisted” nature of the code can result in rejection or hand audits. Since the code ends in “9” an additional one page of documentation will be necessary. Include a description of the services and the name of the device.

Insurance coding factors for consideration:

�More documentation is better than less documentation.

� Codes ending in “9” require a note of explanation, such as “FDA cleared light therapy.”

� Timed CPT codes require start and stop times.

� Policies vary state to state and plan to plan among private payers.

� If you are billing insurance, then notify the patient in advance that the service may not be covered. The patient needs to understand their financial liabilities.

Is Medicare a good option?No. Medicare is not known for paying for light therapy. Should a patient request you submit to Medicare then use your local Medicare carrier’s recommended CPT code for light therapy and add a GY modifier for denial purposes.

GY is shorthand for “items or services statutorily excluded or does not meet the definition of any Medicare benefit.” GY coding is indispensable because the Medicare Explanation of Benefits needs to show “PR” remark (patient responsibility), not “CO” remark (contractual obligation).

Many private payers do not cover in-office light therapy. Therefore, most of your colleagues have found it easier to simply charge cash. As always, good documentation is necessary. And, remember if you sell a unit for at-home usage you can charge cash.

ROB BERMAN, MBA, is a partner at Energia Medical LLC, a national distributor of light therapy pads and controllers. He helps health care providers improve patient outcomes while increasing provider income. He has held a variety of sales and marketing positions during his career, which include building and managing a marketing department, directing product development and product management for multiple organizations, and serving as a general manager for a variety of business units. He can be contacted at 860-707-4220, [email protected] or energiamedical.com.

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Whether it’s general health, aging, neurology, pregnancy, kids’ health, stress or nutrition, there are numerous groups and organizations in your community looking for information which can be converted into new patient streams.

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COMMUNITY OUTREACH AND WELLNESS PROGRAMS ARE A NATURAL BUSINESS FIT FOR CHIROPRACTORS who focus on nutrition, whole health or other forms of wellness.

Holland Chiropractic, “A Maine Vitality Center” in Bath, Maine, provides an excellent example of a menu of programs for groups and organizations while also offering complimentary health screenings and complimentary monthly “Wellness News You Can Use” newsletters.

“Depending on individual needs, we can provide any or all of these services to your group or organization,” Samantha Martin, director of community outreach, writes on the Community Outreach tab on their website. “We at HCWC strongly believe that individuals who are well-balanced in every aspect of their lives lead a healthier, happier life. This is why we have chosen to offer our services to the community.”

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Program DescriptionsThe Four Keys to Health: This program is designed to create an awareness of the four key requirements for optimal health. Food, water, oxygen and proper nerve function are all essen-tial for health and well-being. During this presentation, we will define health and discuss the lifestyle habits that will create balance and integrity, thus empowering participants to make a lasting shift in the continuum from sickness and disease toward health and wellness.

Health from Within: We introduce our audience to a definition of health based on physiological function and balance where the body can adapt to stress and repair damaged tissues effectively and efficiently. We discuss the three types of stress and the adaptive processes that can lead to health. We will also review the adaptive processes that can lead to disease, focusing on lifestyle while providing participants with tips and ideas to propel them toward health and wellness.

Neurology of the Subluxation: This is an in-depth program that compiles decades of scientific research designed to educate allied health professionals. The neurophysiological effects of spinal subluxation on muscular activity, circulation, immune function, adaptability to stress, and visceral function are all grossly misunderstood. This research points out neurological compensation patterns, short-term effects of the spinal adjust-ment on afferent and efferent function, and the long-term benefits of lifetime spinal care.

Benefits of Chiropractic Care During Pregnancy: Our audience will be educated on the importance of spinal balance and proper neurological function to support pregnancy and fetal development, and promote effective labor and delivery. This program was designed for expecting mothers, their families, and allied health professionals (midwives, nurses, obstetricians and pediatricians). We will discuss the importance of exercise, appropriate stretches, and regular spinal check-ups.

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as opposed to creating health. It looks at trends in medicine and the real-life effects on today’s senior population. We conclude with practical ideas for seniors that will help them create lasting change in their health as well as their medicine cabinets.

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The Intelligence Within: Participants will learn the power of innate intelligence and the power of knowledge and limitless potential. They will also understand the value of spinal health and balance in the creation and maintenance of good health. Our thoughts create our reality — change your health by changing your thoughts.

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Backpack Safety and Body Awareness: Audience members will understand why it is important to help children develop body awareness and proper spinal hygiene. This presentation leads the audience through a process of recog-nizing the lack of values that causes improper decision-making, and helps them develop the value system neces-sary to start making healthier decisions.

Changing Perceptions in Health Care: This program is packed with research and information showing the ineffec-tiveness of medicine in the “sick care” system, while highlighting the effective-ness and safety of natural “health care” and chiropractic care. This program will provide individuals with the tools neces-sary to become an active participant in their own health care.

Welcome to a Life without Headaches and Drugs: This program was designed to describe the neurological, circu-latory, and chemical causes of headaches. Participants will learn the perils of a pharmaceutical approach of symptom-chasing in contrast to the chiropractic approach of correcting the cause of the problem.

Understanding Physical Stress: During this presentation, participants will learn: (1) the real-life causes of stress, (2) the relationship between stress and disease, (3) how to recognize and deal with stress in daily life, and (4) how to gain a better understanding of disease prevention and maintenance of health.

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women: (1) the benefits of breastfeeding, (2) how breastfeeding helps develop the neurological, immune and digestive systems of the baby, (3) the advantages of breastfeeding for the mother, as well as (4) challenges of breastfeeding and caring for a new mom’s health and well-being after the child is born.

Nutrition and Your Health: The old adage that you are what you eat is not the real truth. The real truth is you are what your body can do with what you eat. Real information to help your audience learn basic facts about nutrition and under-stand how proper spinal and nervous system function is essential for proper nutrition, from digestion to assimilation of nutrients. We focus on the visceral effects of subluxation and the impact on nutrition.

How to Create a Metabolism That Will Burn Clean and Efficient for Life: Our audience will be educated on what the body’s metabolism is and how it works. We’ll show them how to increase their metabolism to achieve weight loss and maintain their ideal weight once they achieve it. We will discuss the four essentials of metabolism, the thermic effect of food, and the impact water, oxygen, and the nervous system have on our metabolism — lifestyle choices are the key.

Reducing Stress — How to Add Quality and Years to Your Life: During this presentation, participants will learn not only what stress is and common causes of stress, but the stress connection to disease. They will learn that their spinal cord is the lifeline of information from their brains to their bodies and how they


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can improve their bodies’ ability to handle stress, and even increase white blood cell production to fight disease.

How to Enhance Your Performance: This presentation intro-duces several very successful athletes like Tiger Woods, Lance Armstrong, and Martina Navratilova, and points out something special they have in common — they are among the best in their sports fields and they all view chiropractic as absolutely essential to their training and overall well-being. We cover lifestyle habits both good and bad, the importance of proper nutrition, adequate water intake, the benefits of healthy thinking and more.

Chiropractic for Children: This presentation starts off with the definition of health and explains what chiropractic is. We discuss what subluxations are, symptoms that may indicate subluxations, and the many causes of subluxations, including the birthing process. We discuss why and when a child should be taken to a chiropractor.

Children’s Health & Nutrition: Covers the probabilities for children’s health and nutrition in a failing health care system, charts obesity trends among U.S. adults from 1985-2006, high-lights the possibilities of health through healthy eating, moving and thinking well, and discusses chiropractic’s role in children’s wellness. Probabilities or possibilities: Which do you choose?

Strategies for Healthy Living: We do an in-depth comparison of the allopathic model of sick care and the chiropractic well-ness model of health care. It covers the cost of the allopathic model, including a Health Care Report Card. This presentation perfectly clarifies and discusses the true essence of health, the real cause of disease, and the idea of what is possible in a fully integrated chiropractic wellness lifestyle. Why just survive when you can thrive?

For more information or to see how Holland Chiropractic frames their community outreach offerings, go to HollandChiropracticCenter.com.

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NEWS

AMERICAN CHIROPRACTIC ASSOCIATION TO HOST VIRTUAL ANNUAL MEETING IN FEB. 2021

THE AMERICAN CHIROPRACTIC ASSOCIATION (ACA) has announced plans to hold its first virtual annual meeting in February

2021. The ACA says the online format will enable the organization to bring members of the chiropractic profession together to learn, advocate and network while ensuring the highest level of safety for all participants amid continuing COVID-19 concerns.

ACA’s annual meeting, ACA Engage, normally takes place every winter in Washington, D.C. It is the chiropractic profession’s premier national conference, attended by doctors of chiropractic, chiropractic assistants (CAs) and students, as well as vendors who serve the industry. The ACA House of Delegates also convenes during the annual meeting to chart the future direction of the association.

“In addition to providing dynamic content and opportunities to learn, advocate and grow as leaders, the health and safety of our members and colleagues is a top priority of ACA Engage this year,” said ACA President Robert C. Jones, DC. “Using new tools as well as best practices gleaned from other organizations who have faced similar challenges, we are excited to move forward with Engage 2021 as a fully virtual experience.”

Earlier this year, ACA transitioned its Faculty Symposium and its Student Leadership Conference to virtual formats. Both events were well-attended and garnered positive reviews from participants.

“ACA Engage brings together some of the most dedicated doctors and students in the industry,” Jones said in welcoming

ACA members last year. “We are here to make a difference for our profession and, most importantly, for chiropractic patients nationwide. With the opioid epidemic still making headlines, the services of doctors of chiropractic have never been more relevant and needed in this country. We offer a safe approach to pain relief and health care that can improve the lives of many people and potentially help many others to avoid unnecessary risks.

“As our population ages, it’s also crucial that seniors have better access to our services to stay healthy and mobile into their golden years. Our Medicare bill, H.R. 3654, aims to make that possible. Today, we not only have research supporting what we do but also a compelling story to tell our leaders on Capitol Hill, who want to collaborate with health care providers and find solutions to public health challenges. You, our ACA members, are the best people to tell that story. We thank you for joining us during this important week. Together, we are paving the way to a brighter future.”

Last year’s conference closed with a McAndrews Leadership Lecture on the final day delivered by Richard Brown, DC, secretary-general of the World Federation of Chiropractic and recipient of ACA’s 2020 Chiropractor of the Year Award. Brown spoke on where the chiropractic profession finds itself now: supported by a growing body of research, meaningfully participating in integrated practice settings and well-positioned to make an impact on serious public health challenges such as chronic back pain and the opioid epidemic.

“We stand at a time when there has never been a greater need for the healing powers of doctors of chiropractic,” he said.

Visit acatoday.org/engage for more information about the annual meeting as it becomes available.


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When considering supplements to offer your wellness patients interested in anti-aging, do not discount classics such as garlic which, as new research shows, could prevent UV-induced skin aging altogether.

THE ANTI-AGING SUPPLEMENTS MARKET REMAINS ON AN UPSWING, with no sign of slowing down at any time in the near future. All you need to do is keep two numbers in mind: 74 and 37.

Those numbers represent the age span from the oldest of the baby boomers to the youngest of the Gen Xers. They are important because they are a reminder why you should be focusing at least part of your practice on anti-aging, given the wide range between those two numbers.

One of the easiest ways to help your patients who are concerned about the effects of aging on their health is by guiding them toward anti-aging supplements that can offer the best results, backed up by proper scientific research.

Anti-aging from the inside: curcuminCurcumin is probably the best known of all the anti-aging supplements. It is the main active ingredient in turmeric, which is used for making curry sauce in Indian dishes.

As a prized part of Ayurvedic medicine, curcumin has been used for a wide array of conditions associated with

aging, including cardiovascular disease, atherosclerosis, neurodegenerative diseases, cancer, osteoporosis, diabetes, hypertension and chronic kidney disease.1

Researchers believe curcumin’s anti-aging properties are a result of its ability to activate sirtuins and AMPKs, which are proteins that help prevent cells from no longer multiplying.2

Green tea and epigallocatechin gallate (EGCG)Epigallocatechin gallate (EGCG) is a compound often found in green tea, and there are a number of studies showing its bene-fits for cardiovascular and metabolic diseases.

A 2018 article published in the Journal of Ethnopharmacology conducted a review to determine a pattern of similarity among the findings.3 The authors of the paper found that EGCG had a wide range of therapeutic benefits, including treating atherosclerosis, cardiac disease, diabetes, cancer and myocardial infarction. They concluded that these findings were promising and should prompt further research into the health benefits of EGCG.3


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Anti-aging from the outside: collagenCollagen is a protein the body naturally forms to help fill out the skin over the structure of the skeleton. It provides the face with the firm, round appearance we associate with youth.

Unfortunately, the body will lose collagen as it ages. However, collagen supplements can help counteract this process.

For example, a 2019 article in the journal Nutrients reported the results from studying a group of women taking a supplement containing 2.5 grams of collagen as compared to placebo. At the end of the 12-week study, the women taking the collagen supplement reported significant improvement in skin hydration, smoothness and elasticity, compared to the placebo group. Furthermore, their results were retained at follow-up and were well-tolerated.4

Coenzyme Q10 (CoQ10)CoQ10 is an antioxidant that the body naturally produces to protect against cellular damage. Similar to collagen, the body will also lose CoQ10 over time.5 As a result of this loss, CoQ10 supplementation continues to gain popularity.

A 2015 paper in the Journal of Nutrition, Health & Aging examined the effects of CoQ10 on quality of life, hospital visits, and physical and mental performance. A group of 443 study participants were given either a CoQ10/selenium yeast supplement or a placebo over a period of 48 months. At the end of the study period, the researchers found that CoQ10 supplementation showed improvement on all measurements.6

Skin aging and garlic supplementationGarlic can do more than just spice up your patients’ pasta. Animal studies have shown promising results for garlic having protective effects against skin aging as a result of excessive ultraviolet exposure.7

This type of skin aging commonly occurs from excessive sun exposure without proper protection. A 2016 article compared the effects of UV irradiation on hairless mice that were either fed a 1% or 2% garlic supplement, and a control UV-only group. UV exposure induced rough, wrinkled skin with noticeable scarring.

However, garlic at either dose diminished wrinkle formation. Furthermore, the researchers speculated that the antioxidant effects of garlic could prevent UV-induced skin aging altogether.7

Your baby boomer and Generation X patients are likely more active and health-conscious than their parents. As part of their focus on wellness, they will rely on your expertise about nutritional anti-aging supplements. This is why it is important to stay abreast of current research in the anti-aging field and the hot supplements wellness patients are demanding.

TINA BEYCHOK is an editor and writer with expertise in technical, academic and scientific materials. She is a regular contributor to Chiropractic Economics and resides in Long Beach, Calif. Her online portfolio can be viewed at thatwordgrrl.com, and she can be contacted at [email protected].


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TECHTALK

ELECTRONIC HEALTH RECORDS (EHRS) AID IN THE DATA COLLECTION AND RECORD-KEEPING PROCESS, but this type of software has even greater implications with the capacity to alter the “operation, organization, and cultural process” of your entire practice, depending on your EHR target goals, according to the American Health Information Management Association.

That’s why it is so important to select an EHR that enhances versus hinders your office in these areas.

If you don’t feel as if your current EHR is adding enough value to your chiropractic practice, or that it is not offering the features you desire, it may be time to make a switch. Here are the top four issues to watch for during this process, ensuring that you will move to an EHR that serves both you and your patients better.

Whether your current records meet your long-term EHR target goalsTransitioning to a new EHR can be a drawn-out process. Even after all of your data is in the new system, your staff will be spending a decent amount of time learning how to use its various features and functions. Altogether, this can take several months, if not longer.

That’s why Medscape says that the process of switching to a new EHR “should be driven by long-term needs and goals.” This prevents you from going through the time-consuming process of changing over only to realize that the new software or program will not suit your future needs.

Try to imagine what your practice will look like five, 10 or 20 years from now. What EHR features could help you run a more

SWITCH YOUR EHR WITH THESE 4 GOALS IN MINDThe transition and modern applications are among new electronic health records considerationsBY C H R I ST I N A D E B U S K


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You and your office manager have reasons and needs when making the decision to switch to a new EHR, but also keep these goals in mind for an easier transition, and for both staff and patient satisfaction.


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profitable business, taking you from where you are now to where you want to be, and meeting your target goals? Which vendors seem to progress with the times, continuing to provide your office with updates that can make your office run more efficiently and smoothly?

Be wary of brand over functionalityHealthcare IT News reports that 71% of smaller-level health care providers noticed a drop in interoperability after making an EHR switch. Two issues blamed for unintentionally choosing a system that was unable to effectively exchange and make use of health care data were “brand-name recognition and overeager sales pitches,” both of which are alleged to hide this type of issue.

Avoiding this trap involves doing your due diligence when researching your EHR vendor, even if it is a brand name. In addition to collecting information from the vendor itself, look online to see what other health care providers say about the software or company. Read reviews to learn where the vendor excels and where you may encounter issues.

Try to imagine what your practice will look like five, 10 or 20 years from now.

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In late October the U.S. Department of Veterans Affairs (VA) was planning

on unveiling its Electronic Health Record Modernization (EHRM) program,

VA officials told members of Congress in September. The release is ahead

of an all-encompassing EHR, the Military Health System (MHS) GENESIS

covering health records for all service members, slated for 2023.

“We are ready,” Travis Dalton told a House Veterans Affairs’ Technology

Modernization Subcommittee. Dalton is president of Cerner Government

Services, an IT company overseeing the scheduled EHRM program work.

The project was delayed in February, then delayed again after the onset

of COVID-19.

“Getting everyone trained is a challenge” with the new program, said

Laura Kroupa, MD, chief medical officer in the EHRM office at the Veterans

Administration, speaking to the house subcommittee.

The planned deployment of the system involved facilities in Spokane,

Wash., Ohio, Indiana, Kentucky and Michigan.

The 2023 launch of the Military Health System (MHS) GENESIS will create

a single EHR for all service members and will eventually be deployed to cover

all veterans in all branches of service. The deployment will cover all military

hospitals and clinics, and will hopefully be another step toward a civilian

system where doctors of chiropractic, MDs and other health care professionals

can have equal access to patient data across all spectrums of care.

— RICK VACH is editor-in-chief of Chiropractic Economics.

U.S. military to upgrade VA EHR before GENESIS debut in 2023BY R I C K VAC H

The vendor’s level of data portability assistanceOne of the biggest headaches associated with changing EHRs is transitioning your data from the old system to the new. This can take quite a bit of time and effort on your staff’s part. It can also be frustrating if they face any issues during the changeover process.

That’s why the Office of the National Coordinator for Health Information Technology says that an EHR vendor’s transition services should be a “significant factor” to consider before signing up with that particular company. Transition services to inquire about include:

� offering adequate support during the transition period, both as an incoming and outgoing EHR (at the beginning and end of the contract)

� optimizing data storage so it can be easily transferred from one system to another

� access to tools that enable you to transfer the data on your own

� access to an archival copy of the software so you have continued access to your information even if you choose to later switch to a different EHR

Your patients’ office accessibility under the new EHRIn its June 2020 issue, the Journal of the American Medical Informatics Association published a study showing that the Mayo Clinic suffered “significant drops” in patient satisfaction levels after switching EHRs. The biggest reason cited for this decline was patients’ inability to easily access this health care agency. Access referred to issues with trying to get the clinic on the phone and problems with appointment scheduling.

When switching EHRs, check in with your patients regularly to get feedback about their interactions with your new system. Ask whether they’ve had any troubles so you can quickly identify any problem areas. Asking their input also shows that, while you are focused on creating an effective and efficient office, you want a system that works for them too as you pursue your new EHR target goals for improved productivity. Find a system that provides patients as much value as it provides you.

CHRISTINA DEBUSK is a freelance writer who specializes in content related to natural health and wellness, personal development and small-business marketing. She can be contacted through ChristinaMDeBusk.com.

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6 STEPS TO MAKE DIFFICULT STAFF SITUATIONS DISAPPEARHow labeling, expectations and attitudes can contribute to your negative subconscious actionsBY M O N I C A WO F F O R D, C S P


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Bring out a new level of teamwork, performance and camaraderie among staff with six steps to remove difficulties from the office — and to look at your individual staff members in a new light.

WHETHER IN A LARGE OR SMALL PRACTICE, WE’VE ALL ENCOUNTERED DIFFICULT PEOPLE, or possibly patients. We may even have wanted to make them disappear (without having to go to jail). But what if you could? What if you could make them, or at least their difficult behavior, disappear? You can, and these six steps may make it feel a little bit like magic:

Be a better leaderA leader makes stress and difficulty disappear by making one decision: to minimize each.

Whether you lead a practice, co-lead a family, or are the supreme chief in charge of your own office and everyone in it, you have a responsibility to focus daily on how to help those you have the privilege of leading. This includes understanding and developing rapport with those creating conflict, or those who are the focus when employees start describing “difficult people.”


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Recognize when it may have been you who made a bad hiring decision and be ready to make changes when development no longer seems plausible. The truth is most people are only difficult to the degree of our expectations and how that differs from what comes naturally to them — so there may also be room for you to improve your leadership by adjusting or changing your expectations.

Lessen the labelingBeing a better leader is not always easy. The far easier course of action is to engage in the rapid application of labels.

Labels take on a life of their own, and once you decide a label fits a person, your brain looks for all the ways to validate your decision. In other words, when you decide, your brain looks for ways to detect the behavior because we tend not to argue with our assessments that we believe to be accurate. Do you really want to see more difficulty or less? If the latter, fewer labels and more effective leadership of differences is best.

Increase rewards and consequencesTrue at work or at home, and a known truth about simple human behavior, rewards and consequences guide responses. Without rewards to steer staff in a specific direction and a consequence to help them steer clear of the opposite of your preference, employees will do whatever is easiest.

At home when someone tries to meet your needs and their “reward” is you reminding them it’s not good enough, they’ll run from the nagging faster than toward trying to meet the standard for which you asked. At the office, more work, which is usually what we dole out when they finish early, is not a reward for working quickly. Additionally, ignoring a problem, which many doctors do when the solution is unclear, is a reward for someone continuing to exhibit difficult behavior. Are you being purposeful about the behavior you’re encouraging?

Examine expectationsManagement books tout “Inspect what you expect,” but if upon inspection you find your expectations are out of whack or just plain inappropriate for that person, change is required or you’ll continue to face frustration.

Labels take on a life of their own, and once you decide a label fits a person, your brain looks for all the ways to validate your decision.

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Not only is it good leadership of your practice to align expectations with the team members you’ve hired, but, if you also expect one of them to be difficult, they’ll continue to confirm it. When it comes to difficult people and making their behavior seem to disappear in an instant, consider your expectations as a valuable part of the equation. How often do you look at your laid-back, emotionally empathetic son and expect him to suck it up, take charge and take initiative? How often do you look at your star performer, who could engage strangers at the grocery and expect her to also be the start of organizing your electronic records?

Take a look at what/who you lead (and love) and align your expectations accordingly. Also remember that a realignment is different from acquiescence. You wouldn’t tell a patient to live with a chronic pain; you’d realign their body and often, their thinking about the value of chiropractic.

Align attitudes and actionsThe common truth about relationships, both with your team and your patients as well as your family members, is “It takes two to tango.” If difficulty exists between the two of you, you are part of the challenge.

If you’re the only one excited about a new goal for the office this quarter and you sense the team isn’t really interested, continuing to act as if they’re on board and being frustrated

when they’re not is a recipe for creating difficulty that you’ll likely label lack of engagement. Figure out the root cause. Do some digging. You don’t treat a patient without data and an X-ray, so stop acting as if you have all the data on the team before you’ve asked key questions.

Is what they’re doing or feeling really all that bad, or are you just bummed that they’re not excited? Did you give them enough information on the outcome or a big enough reward upon this goal’s achievement? Have you led the team so that they want to join you on this journey or are you simply insisting they come along because you said so or because you’re the doctor?

Up your EQLearning more about how others behave and how you can communicate in a language they readily understand is a way to elevate your emotional intelligence (EQ). Accepting that how they do things or share things is different, but perhaps not inherently difficult, elevates your EQ even further.

When you become interested in learning about personalities and natural tendencies, you’ll become a leader who breaks the connection between difficult and different, and that is truly where the magic happens.

These are seemingly simple steps. Deceivingly easy to implement, but critical to the removal of difficulty and your effective leadership. Putting each in place in your practice will make where you work much less frustrating. Leading with the use of these steps on a regular basis, both by you and those you have the privilege of leading, will not only eradicate most of your difficulty but will bring out a new level of teamwork, performance and camaraderie. Those three little words will translate to making patients very, very happy.

MONICA WOFFORD, CSP, is a leadership development expert, CEO of Contagious Companies Inc., and author of “Make Difficult People Disappear.” To learn more, email [email protected], go to ContagiousCompanies.com, or call 866-832-0121.

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To search for more products, or to submit a product, go to ChiroEco.com and click on “Products and Services.”*These statements have not been evaluated by the Food and Drug Administration. These products are not intended to diagnose, treat, cure or prevent any disease.

CBD MASSAGE OILBeyond Botanicals’ Energy massage oil is blended from a base of coconut and sweet almond oils for maximum absorbancy and ease of use. This oil has a bright, fresh, rejuvenating blend of orange, grapefruit, tangerine, spearmint and lemon essential oils. It also contains full-spectrum CBD oil with many healthy terpenes and cannabinoids. Because of how quickly the base oils soak into skin, these compounds rapidly reach problem areas and provide relief at the source of discomfort.203-482-1951 • beyondbotanicals.com

AYURVEDIC BOTANICALAndrographis, a powerful Ayurvedic botanical, is helpful in many areas, including liver support, immune function and joint health. The product’s maker, EuroMedica, suggests taking one capsule daily, or as directed by your health care practitioner. Each bottle of Andrographis EP80 Extra Strength contains 60 capsules.*866-842-7256 • euromedicausa.com

ADJUSTING INSTRUMENT REPAIRWorldwide Chiropractic Repairs offers repair services for a wide range of both mechanical and electronic chiropractic adjusting instruments. Repair can be a cost-effective alternative to buying a new instrument. Broken tools you send in are repaired by skilled technicians and returned to you with a full one-year warranty and free shipping.770-899-7239 • chirorepairs.com

CHIROPRACTIC TVThis waiting room TV channel was built for the sole purpose of growing chiropractic businesses. ChiroChannel is customized to your practice, your brand and everything about you, and contains built-in tools for automation, repetition, and managing multiple TV monitors. The channel offers a full library of ready-made content, customizable animations, video backgrounds and pixel-perfect editing. The company also offers support, training and strategy sessions at no extra charge.888-649-5289 • thechirochannel.com


http://ChiroEco.com

CBD BALMThis CBD-infused, full-body soothing balm contains a unique blend of therapeutic botanicals and essential cannabinoids, delivering full hemp plant strength plus emollients from organic seeds to penetrate deeply into your bones, ligaments and joints.888-578-5900 • aspengreen.com

TENS UNITThe Chiro1 TENS comes with a battery, a four-pack of electrodes, TENS leads, and a hard-shell carrying case. It is dual-channel and can be operated in modulation mode, burst mode or constant (continuous) mode. It contains a timer that can be set for 30 or 60 minutes.866-318-3251 • chiro1source.com

SANITIZER STATIONThis Wall Mounted Sanitizer Dispenser features a 1,000-milliliter capacity and a sensor, so you can dispense hand sanitizer touch-free. Powered by AA batteries (not included), it also has a low-battery indicator light so you know when it’s time for new ones. Two different models are available: one for liquid sanitizer, and one for foam.800-747-3488 • scriphessco.com

CHIROPRACTIC STORIESIn “Mission Chiropractic: Changing the World by Touching Lives,” author Peter Morgan, DC, shares stories from his mission trips bringing chiropractic to many underserved places in the world, including Haiti, the Dominican Republic and others. “My mission is to serve my community and to serve people in developing nations with quality health care and to direct people to the realization that health comes from within,” Morgan writes, “and ultimately that the maintenance of health is superior to the treatment of disease.”amazon.com


ANTI-AGINGChiropractic Economics is pleased to present the profession’s most comprehensive Anti-Aging list. The information below was obtained from questionnaires completed by the listed companies. Companies highlighted in RED have an advertisement in this issue.

BUYERSBUYERSGUIDE

3 CARE THERAPEUTICS888-372-3421omega3care.com

A.C. GRACE CO.800-833-4368acgrace.com

ACCUFLEX TABLES & LASERS573-745-1086accuflextables.com

ACUINTERNATIONAL SUPPLIES INC.888-322-8468acuinternational.com

ADVANCED MUSCULOSKELETAL THERAPIES770-612-8245themiraclewave.com

ADVANCED PHOTONIC SYSTEMS LLC800-210-5060advancedphotonicsystems.com

ALT-MED LABS INC.800-876-7722altmedlabs.com

ANABOLIC LABORATORIES800-445-6849anaboliclabs.com

ANESTHALL TOPICAL ANALGESIC800-994-3776purplecream.com

APEX ENERGETICS INC.800-736-4381apexenergetics.com

AQUA DETOX USA704-951-4553aquadetoxusa.com

ASPEN LASER SYSTEMS877-817-0365aspenlasers.com

AVANT WELLNESS949-682-8268lz30laser.com

AYUSH HERBS INC.800-925-1371ayush.com

BANNER THERAPY PRODUCTS INC.888-277-1188bannertherapy.com

BASELINE NUTRITIONALS800-869-5060baselinenutritionals.com

BEAUTIFUL IMAGE800-800-0838beautifulimagellc.com

BELLECORE LLC800-867-7414bellecore.com

BERMAN PARTNERS LLC860-707-4220bermanpartners.com

BIOACTIVE NUTRITIONAL INC.800-288-9525bioactivenutritional.com

BIOCELL TECHNOLOGY LLC714-632-1231biocelltechnology.com

BIOGENETIX833-525-0001biogenetix.com

BIOPHARMA SCIENTIFIC LLC877-772-4362superfoodsolution.com

BIOPHOTAS INC. - CELLUMA714-838-1956biophotas.com

BIOPROTEIN TECHNOLOGY 800-280-2456bioproteintech.com

BIOSONIC TECHNOLOGIES800-800-0838biosonict.com

BIOTICS RESEARCH800-231-5777bioticsresearch.com

BIOTONE800-445-6457biotone.com

BIOVI LLC888-982-4684biovibrands.com

BLIND SPOT MAPPING530-949-1353blindspotmapping.com

BLUE SPRING INT’L866-470-4930doctorspainformula.com

BODYSITE.COM561-247-3839bodysite.com

BODYZONE.COM770-922-0700bodyzone.com

BONVITAL INC.239-481-1002nutribonvital.com

BRAIN BRILLIANCE843-709-9113brainbrillianceinc.com

BRAINCORE THERAPY800-491-6396braincoretherapy.com

BRITISH INSTITUTE OF HOMEOPATHY609-927-5660bihint.com

BRYANNE ENTERPRISES INC.877-279-2663bryanne.com


THENATIONALCHIRO.COM/OVERVIEW

EDUCATION• 20 hours of CE with all requirements for the state of FL

• The ability to create a customized learning experience from the many options available to you

• Training for your Staff

LICENSING• CEs Approved in 45 States*

CHIROPRACTIC SPECIALTIES• Specialty/Diplomate hours while acquiring CE

RESEARCH• World-Renowned Speakers with Years of Experience

EXTRAS• The Largest Expos to Shop and Explore

• Complimentary Luncheons and Receptions

• First Class Locations and Family-Friendly Resorts

• Convenient weekend schedule

• Same Early Bird Registration Fees

• Locations Close to the Coast for Beach Access and Family Fun

*Approval anticipated in all but AZ, CA, OK, TN, WI

Each of these live events follow FCA Guidelines for Clean and Safe Events

February 4-7, 2021Sheraton Bay Point ResortPANAMA CITY

March 25-28, 2021World Golf Village RenaissanceST. AUGUSTINE

November 18-21, 2021Naples Grande Beach ResortNAPLES

June 24-27, 2021Trump National Doral MIAMI

August 26-29, 2021Hyatt Regency OrlandoORLANDO

YEARS OFCHIROPRACTIC

LEADING THE NEW NORMAL WITH THE SAME WORLD-CLASS EDUCATION

These events help underwrite lobbying activity on your behalf.

• LIVE & VIRTUAL OPTIONS •

2021 CONVENTIONS BY FCA

https://thenationalchiro.com/overview

BSTRONG4LIFE866-515-4907bstrong4life.com

BUCKEYE NUTRITIONALS330-665-1003buckeyenutritionals.com

C’EST SI BON CO. 888-700-0801bestchlorella.com

CAO GROUP801-495-5545caogroup.com

CARLSON LABORATORIES847-255-1600carlsonlabs.com

CBD CLINIC888-422-3254cbdclinic.co

CELL SCIENCES SYSTEMS LTD.800-872-5228alcat.com

CHINA-GEL INC.800-898-4435chinagel.com

CHOPRA CENTER ONLINE STORE800-858-1808store.chopra.com

CHROMOGENEX US508-816-7711ilipo.com

CLEARLIGHT INFRARED SAUNAS800-798-1779infraredsauna.com

COGENT SOLUTIONS GROUP859-259-0300cogentsolutionsgroup.com

COLLAGEN MD800-346-2922collagenmdprofessional.com

COLLAGENTEX450-622-4004collagentex.com

CONTINENTAL VITAMIN CO.800-472-4221meyerdc.com/cvc-labs

CONTROL 800-699-0527control-bar.com

CORGANICS866-939-9541reliefcream.com

CRYODERM800-344-9926cryoderm.com

CURAMEDIX877-699-8399curamedix.com

DACREMA BOTANICALS484-838-8778dacremabotanicals.com

DAIWA HEALTH DEVELOPMENT866-475-4810dhdusa.net

DAVINCI LABORATORIES OF VERMONT800-325-1776davincilabs.com

DEE CEE LABORATORIES INC.800-251-8182deeceelabs.com

BUYERSBUYERSGUIDE


https://nutri-spec.net/

SHOCK WAVE THERAPYKeep Your Patients Moving...

Research Supports up to 40% Faster Recovery

www.amttherapies.com

Benefits:Non-InvasivePromotes Faster HealingSuccess Rates >82%Short Treatment Times Increase Your Revenue

ASK ABOUT

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Visit us at Booth 208 at The National

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BUYERSBUYERSGUIDEDESERET BIOLOGICALS800-827-9529desbio.com

DESIGNS FOR HEALTH800-847-8302designsforhealth.com

DIAMOND-HERPANACINE ASSOCIATES888-467-4200diamondformulas.com

DOUGLAS LABORATORIES800-245-4440douglaslabs.com

DR. H REJOINT201-875-8055drhrejoint.com

DR. STAN GUBERMAN800-333-9942drguberman.com

DRUCKER LABS888-881-2344druckerlabs.com

DYNAMIC HEALTH LABS INC.800-396-2114dynamic-health.com

DYNATRONICS800-874-6251dynatronics.com

EDOM LABORATORIES800-723-3366edomlaboratories.com

ENERGIQUE INC.800-869-8078energiqueherbal.com

ENLIVEN ESSENTIALS516-306-6589enlivenessentials.com

ENVIROMEDICA800-257-3315enviromedica.com

ENZYME FORMULATIONS800-614-4400loomisenzymes.com

ENZYME PROCESS CO.800-521-8669enzymeprocess.co

ENZYME SCIENCE855-281-7246enzyscience.com

ENZYMES INC.800-637-7893enzymesinc.com

ERCHONIA888-242-0571erchonia.com

ESSENTIAL FORMULAS INC.972-255-3918essentialformulas.com

ESSIAC 561-585-7111essiac-canada.com

EUROMEDICA866-842-7256euromedicausa.com

FENIX NUTRITION855-527-4464fenixnutrition.com

FIRST PRIORITY MEDICAL CENTER877-398-7171firstprioritymanufacturing.com


FLEXCIN INT’L INC.800-505-0575flexcin.com

FOREST HERBS RESEARCH643-548-2741kolorex.com

FUNCTIONAL REMEDIES303-981-6893cbdrx.com

FUTURE PEPTIDES347-855-4713futurepeptides.com

GEMATRIA PRODUCTS INC.760-931-8563gematria.com

GOLDEN SUNSHINE USA INC.800-798-3977pain-terminator.com

GREEN ROADS WORLD833-462-8922greenroadsworld.com

HEALTH LOGICS888-402-1600health-logics.com

HEALTH SECRETS USA313-561-6800healthsecretsusa.com

HEALTHWISE800-395-8931healthwisenri.com

HEALTHY YOU800-826-9946healthyyouweb.com

HIMALAYA HERBAL HEALTHCARE800-869-4640himalayausa.com

HOPE SCIENCE866-628-8725hopescience.com

HUMAN TOUCH LLC866-369-9426humantouch.com

HYALOGIC866-318-8484hyalogic.com

ICA HEALTH LLC866-921-5882icahealth.com

IHEALTH PRODUCTS INC.800-930-6493ihealthproducts.com

IN LIGHT MEDICAL888-455-4116inlightmedical.com

INTEGRATIVE THERAPEUTICS800-931-1709integrativepro.com

INTERCEUTICALS INC.781-631-9154interceuticals.com

INTERNATIONAL ACADEMY OF MEDICAL ACUPUNCTURE 800-327-1113iama.edu

INVISA-RED770-792-1873invisa-red.com

JOHARI DIGITAL858-657-9226joharidigital.com


BUYERSBUYERSGUIDEJUVENON800-588-3666juvenon.com

KARUNA CORP.800-826-7225karuna.com

KIBOW BIOTECH INC.888-271-2560kibowbiotech.com

KING BIO 800-543-3245safecarerx.com

LASER FAT LOSS BUSINESS773-665-4005laserfatlossbusiness.com

LEGACY FOR LIFE877-557-8477legacyforlife.net

LIFE EXTENSION866-585-1435lifeextensionretail.com/epartner

LIFETEC INC.800-822-5911lifetecinc.com

LIGHTFORCE THERAPY LASERS877-627-3858litecure.com/medical

LIPO-LIGHT877-788-5476lipolightpro.com

LOGOS NUTRITIONALS LLC800-556-5530logosnutritionals.com

LSI INT’L800-832-0053lsiinternational.com

LYPOSSAGE877-346-1156lypossage.net

LZR7888-333-7511lzr7.com

MASSAGE WAREHOUSE800-910-9955massagewarehouse.com

MASTER SUPPLEMENTS INC.800-926-2961master-supplements.com

MATRIX HEALTH PRODUCTS360-816-1200matrixhealth.com

MEDI-STIM INC.800-363-7846medi-stim.com

MEDICARDIUM808-573-8166medicardium.com

MEDINATURA844-633-4628medinatura.com

MEDIRAL INT’L INC.303-331-6161mediral.com

MEDTRAK/IN BALANCE888-239-6436medtrakonline.com

MEDZONE CORP. - PAINZONE866-633-9663ipainzone.com

MEMBRELL LLC800-749-1291membrell.com

METAGENICS800-877-1703metagenics.com

MOUNTAIN STATES HEALTH PRODUCTS800-647-0074mhpvitamins.com

MT. CAPRA PRODUCTS800-574-1961mtcapra.com

MULTI RADIANCE MEDICAL800-373-0955multiradiance.com

MUSHROOM WISDOM800-747-7418mushroomwisdom.com

MYO TECHNOLOGIES INC.910-509-7192myoinc.com

MYO-BREATHE LLC800-803-1535myo-breathe.com

MYONATURAL866-276-6058myonatural.com

N.E.T. INC.800-888-4638netmindbody.com

NATURAL WELLNESS CENTERS OF AMERICA949-600-6515nwcnaturals.com

NATURE’S RITE888-465-4404mynaturesrite.com

NATURETECH800-865-1475naturetech.com

NEUROCARE SYSTEMS800-900-4045neurocaresystems.com

NEWMARK866-963-9675new-mark.com

NEWTON HOMEOPATHICS800-760-5550newtonlabs.net

NEXT GENERATION THERAPEUTIC303-589-4517ngtlasers.com

NORDIC NATURALS800-662-2544nordicnaturals.com

NOVOLIFE866-759-3746novolife.net

NULEAN INC.800-948-5307newpatientsuccess.com

COMPANY LISTINGS HIGHLIGHTED IN RED

have an advertisement in this issue.

For the complete listing of services

these companies provide, and to view

our complete online directory, visit

ChiroEco.com/buyers-guide


Elevate Your Patients’ Health and WellnessYour patients need you now more than ever before. The COVID-19 pandemic has further solidified your role as an essential healthcare professional and the demand for optimal wellness is higher than ever.

Let the Foundation for Chiropractic Progress (F4CP) do the heavy lifting when it comes to marketing your practice. For a monthly donation of $100 or less, F4CP membership provides you with elite-level promotional resources to help inspire your patients, grow your practice and support your profession.

The best part? All of our marketing resources have been designed to be easily implemented by your office staff so that you can focus on what you do best: care for your patients.

As a Gold member, your $100 monthly donation allows you to customize ALL of our resources with your practice logo, contact information and practice details to reach your community.

Let us help you, while you help your patients stay healthy now and in the future.

Click-to-Share Social Media Posts

Monthly Marketing Roadmaps

Infographics

Downloadable PowerPoint Presentations

White Papers & eBooks

Posters

Brochures

Advertisements

& More! For more information or to enroll as an F4CP

member today, visit: www.f4cp.org/CE

F4CP-80 CE Elevate Your Patients-8.375x11.125.indd 1 4/9/20 1:35 PM

https://www.f4cp.org/CE

NUTRA SUMMA866-866-3993nutrasumma.com

NUTRACEUTICS CORP.877-664-6684nutraceutics.com

NUTRAGEN HEALTH INNOVATIONS877-417-7873nutragen.com

NUTRALIFE HEALTH PRODUCTS INC.877-688-7254nutralife.com

NUTRI LIFESCIENCE941-757-9918nutrilifescience.com

NUTRI-SPEC800-736-4320nutri-spec.net

NUTRI-WEST800-443-3333nutriwest.com

NUTRILITE800-253-6500nutrilite.com

NUTRITIONAL FRONTIERS412-922-2566nutritionalfrontiers.com

OMEGABRITE800-383-2030omegabrite.com

OPTIMAL HEALTH SYSTEMS800-890-4547optimalhealthsystems.com

OPTP800-367-7393optp.com

ORGENETICS INC.714-990-0900orgenfamily.com

ORIGINAL MEDICINE800-622-8986original-medicine.com

OXYRUB PRO 888-349-0397meyerdc.com/oxyrubpro

PAIN & STRESS CENTER800-669-2256painstresscenter.com

PERFORMANCE HEALTH/THERA-BAND800-321-2135thera-band.com

PERFORMANCE HEALTH/THERA-PEARL877-732-7509therapearl.com

PERSPECTIS INC.866-586-2278backvitalizer.com

PHARMAX/SEROYAL888-737-6925seroyal.com

PHION NUTRITION480-556-0210phionbalance.com

PHYSIOLOGICS800-765-6775physiologics.com

PILLOW OF HEALTH630-338-1327pillowofhealth.com

PIVOTAL HEALTH SOLUTIONS800-743-7738phschiropractic.com

POSTURE MEDIC 877-215-1124posturemedic.com

PREMIER RESEARCH LABS800-325-7734prlabs.com

PREVENTION PHARMACEUTICALS888-677-5453omax3hcp.com

PROGENA PROFESSIONAL FORMULATIONS505-292-0700progena.com

PROGRESSIVE LABORATORIES INC.800-527-9512progressivelabs.com

PROMED PRODUCTS800-542-9297promedproducts.com

PROTHERA INC.888-488-2488protherainc.com

PROTOCOL FOR LIFE BALANCE877-776-8610protocolforlife.com

PULSED ENERGY TECHNOLOGIES818-982-2021pulsedenergytech.com

REZUME BY CRYODERM954-978-9290cryoderm.com

RICHMAR888-549-4945richmarweb.com

ROMFAB818-787-6460fastexercise.com

SARATI INT’L800-900-0701sarati.com

SCIENCE BASED NUTRITION937-433-3140sciencebasednutrition.com

SCIMERA BIOSCIENCE855-724-6372scimera.com

SCRIPHESSCO800-747-3488scriphessco.com

SEDONA LABS888-816-8804sedonalabspro.com

SIERRASIL HEALTH INC.877-743-7720sierrasil.com

SINGLETON SYSTEMS801-983-6888nutrition4chiros.com

SLENDERRAY800-916-7536slenderray.com

BUYERSBUYERSGUIDE


B E T H E S T O R M

P A R K E R S E M I N A R S L A S V E G A S 2 0 2 1

We want you to come “Be the Storm” with Parker Seminars … live and in-person! Throughout this year, we have been cooped up in our houses and offices, but now you have the chance to venture to beautiful Las Vegas, Nevada! It is time to take charge and lead the way in this new era of healthcare!

VISIT OUR WEBSITE AT PARKERSEMINARS.COM/LASVEGAS TO REGISTER TODAY!

February 18-20, 2021

ParkerSeminars.com/LasVegas ParkerSeminars | @ParkerSeminars

125thCELEBRATE THE

ANNIVERSARY OFCHIROPRACTIC

https://parkerseminars.com/lasvegas

BUYERSBUYERSGUIDESOLUTIONS4877-817-6074solutions4.com

SOZA WEIGHT LOSS877-551-7692sozapartner.com

SPINAL TOUCH FORMULAS800-421-5443spinaltouchformulas.com

STANDARD ENZYME CO.770-537-4445standardenzyme.com

STANDARD PROCESS INC.800-558-8740standardprocess.com

STEM CELL INSTITUTE OF AMERICA800-391-6040americastem.com

STOCKTON ALOE1 INC.866-691-0201aloe1.com

STONE AGE WELLNESS888-368-8933stoneagewellness.com

SUMMUS MEDICAL LASER615-595-7749summuslaser.com

SUN CHLORELLA USA800-829-2828sunchlorellausa.com

SYSTEMIC FORMULAS CORP.800-445-4647systemicformulasmedia.com

TENSNET877-341-8367tensnet.com

TEXAS BEAUTY INSTITUTE877-496-8838texasbeautyinstitute.com

THE SPA EXCHANGE LLC952-938-2652thespaexchange.com

THERALASE866-843-5273theralase.com

TRANSFORMATION ENZYME CORP.800-777-1474transformationenzymes.com

TRIELEMENTS888-876-3240trielements.com

TRUGEN3844-387-8436trugen3.com

TRUWELL HEALTH & WELLNESS866-878-9355truwell.net

UAS LABORATORIES800-422-3371uaslabs.com

VERVITA PRODUCTS LLC616-453-2306vervitaproducts.com

VIATREXX BIO INC.888-337-8427viatrexx.com

VIBE FOR HEALTH866-520-4270vibeforhealth.com

VITAL NUTRIENTS888-328-9992vitalnutrients.net

VITAMIN RESEARCH PRODUCTS800-877-2447vrp.com

WAI LANA 800-624-9163wailana.com

WEI LABORATORIES INC.408-961-9223weilab.com

WEIGHT LOSS PRODUCTS727-826-0946hcgmax.com

WEIGHT-A-MINUTE INT’L605-388-3755weightaminute.com

WELLNESS BELTS INC.705-241-1481wellnessbelts.com

WELLNESS WATCHERS GLOBAL AND GREENS FIRST866-410-1818greensfirst.com

WHOLE-ISTIC SOLUTIONS866-814-7673whole-isticsolutions.com

WISE ESSENTIALS800-705-9473wiseessentials.com

WISE WOMAN HERBALS 541-895-5172wisewomanherbals.com

WORLD NUTRITION INC.800-548-2710worldnutrition.net

WR MEDICAL ELECTRONICS CO.800-321-6387therabathpro.com

WUJI FIRGROVE LLC866-968-9854wujilife.com

YAMUNA BODY ROLLING800-877-8429yamunabodyrolling.com

YASOO HEALTH INC.888-469-2766yasoo.com

YOLO MEDICAL INC.877-738-8119yolomedical.com

YOUNG INNOVATIONS888-279-9904envypillow.com

ZYCAL BIOCEUTICALS INC.888-779-9225zycalbio.com

COMPANY LISTINGS HIGHLIGHTED IN RED

have an advertisement in this issue.

For the complete listing of services

these companies provide, and to view

our complete online directory, visit

ChiroEco.com/buyers-guide


A.M. Best rating as of 7/10/2019. ChiroPreferred is the marketing name used to refer to the chiropractic-related products offered by MedPro Group. MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are underwritten and administered by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product and credit availability is based upon business and/or regulatory approval and may differ among companies. © 2020 MedPro Group Inc. All Rights Reserved.

Stability and securitywhen it matters most.

ChiroPreferred is the only malpractice insurance program offering coverage from an A++ financially-rated carrier

with over 120 years of integrity and experience. We’re also part of the Berkshire Hathaway family.

What does this mean for you? That we make it easy to switch to coverage that offers you the peace of mind that

we’ll be there to protect you today and every day after.

Contact us today to upgrade your malpractice insurance.chiropreferred.com/CE10

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8 3 3 . 4 C H I R O S | S O L U T I O N S @ C H I R O P R E F E R R E D . C O M

YE ARS OF E XPE RIE NCE

1 OPEN CAMERA

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3 GET QUOTE

120+

https://www.chiropreferred.com/ce10

DATEDATEBOOK

NOVEMBERNOV. 14-15TREATMENT OF FUNCTIONAL MOVEMENT DISORDERSColumbus, OHSponsor: Foot Levelers540-345-0008FOOTLEVELERS.COM

NOV. 21-22BASIC ACUPUNCTURE SESSION 2Chesterfield, MOSponsor: Logan University800-842-3234LOGAN.EDU

DECEMBERDEC. 5-6THE OVERTRAINED YOUTH ATHLETECharleston, SCSponsor: Foot Levelers540-345-0008FOOTLEVELERS.COM

DEC. 5-6CORE STRATEGIES FOR SYSTEMIC INFLAMMATION & CHRONIC PAINSalt Lake City, UTSponsor: Erchonia888-242-0571ERCHONIA.COM

DEC. 5-6FAKTR REHAB SYMPOSIUMAlbuquerque, NMSponsor: Southeast Sports Seminars877-489-4949SPORTS-SEMINARS.COM

DEC. 5-6FAKTR REHAB SYMPOSIUMPhoenixSponsor: Southeast Sports Seminars877-489-4949SPORTS-SEMINARS.COM

DEC. 12-13BASIC ACUPUNCTURE SESSION 3Chesterfield, MOSponsor: Logan University800-842-3234LOGAN.EDU

DEC. 12-13CHARRETTE’S ADVANCED APPROACH: BIOMECHANICAL TESTING, TREATMENT, AND EXTREMITY ADJUSTINGDallas, TXSponsor: Foot Levelers540-345-0008FOOTLEVELERS.COM

DEC. 12-13FAKTR REHAB SYMPOSIUMSan Juan, PRSponsor: Southeast Sports Seminars877-489-4949SPORTS-SEMINARS.COM

JANUARY 2021JAN. 9-10ADVANCED ACUPUNCTURE SESSION 1Chesterfield, MOSponsor: Logan University800-842-3234LOGAN.EDU

JAN. 16-17BASIC ACUPUNCTURE SESSION 4Chesterfield, MOSponsor: Logan University800-842-3234LOGAN.EDU

FEBRUARYFEB. 13-14ADVANCED ACUPUNCTURE SESSION 2Chesterfield, MOSponsor: Logan University800-842-3234LOGAN.EDU

FEB. 18-20PARKER SEMINARSLas VegasSponsor: Parker Seminars888-727-5338PARKERSEMINARS.COM

FEB. 20-21BASIC ACUPUNCTURE SESSION 5Chesterfield, MOSponsor: Logan University800-842-3234LOGAN.EDU

Taught by an FMT Instructor All required digital course notes supplied

Flexible, self-paced training platform

Discounts on FMT related products

HD professional video capture of a live FMT course

Minimal impact to your normal routine

No travel costs

Integrated quizzes to reinforce learning

THE EVOLUTION IS HERE

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Statement of Ownership, Management & Circulation (PS Form 3526-R): 1. Publication Title: Chiropractic Economics. 2. Publication Number: 1087-1985. 3. Filing Date: 9/30/2020. 4. Issue Frequency: One issue Mar, July, Nov and Dec. Two issues Jan, Feb, April, May, June, Aug, Sept and Oct. 5. Number of Issues Published Annually: 20. 6. Annual Subscription Price: $39.95. 7. Complete Mailing Address of Known Office of Publication: 820 A1A N Hwy, Suite W18, Ponte Vedra Beach, FL 32082. 8. Complete Mailing Address of Headquarters or General Business Office of Publisher: 820 A1A N Hwy, Suite W18, Ponte Vedra Beach, FL 32082. 9. Full Name and Complete Mailing Address of Publisher: Nicholas Doyle, 820 A1A N Hwy, Suite W18, Ponte Vedra Beach, FL 32082. 9. Editor: Rick Vach, 820 A1A N Hwy, Suite W18, Ponte Vedra Beach, FL 32082. 10. Owner: Arthur J. Gallagher Risk Management Services, Inc., 820 A1A N Hwy, Suite W18, Ponte Vedra Beach, FL 32082. 11. Not Applicable. 12. Tax Status: Has Not Changed During Preceding 12 Months. 13. Publication Title: Chiropractic Economics. 14. Issue Date for Circulation Data: Issue 16, September 2020. 15. Extent and Nature of Circulation: 15a. Total Number of Copies: 28,742/25,000. 15b. Paid and/or Requested Distribution (1) Outside County Paid/Requested Mail Subscriptions: 19,111/22,825. (2) In County Paid/Requested Mail Subscriptions: 0. (3) Copies Distributed Outside the USPS: 39/11 (4) Requested Copies Distributed by Other Mail Classes Through the USPS: 0. 15c. Total Paid and/or Requested Circulation: 19,150/22,836. 15d. Non-requested Distribution (1) Outside County: 8,858/1,661. (2) 0. (3) 0. (4) Non-requested Copies Distributed Outside the Mail: 597/379. 15e. Total Non-requested Distribution: 9,455/2,040. 15f. Total Distribution: 28,605/24,876. 15g. Copies not Distributed: 123/114. 15h. Total Sum: 28,728/24,990. 15i. Percent Paid and/or Requested Circulation: 66.95%/91.80%.I certify that this information is true and complete. Nicholas Doyle, Publisher.

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Chiropractic Economics, Issue 18

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