We are in the Recovery Balm business...

I've been working with Justin from Better You LLC for nearly a year now, trying to get this Recovery Balm dialed in.  Justin's day to day work revolves around making beard balms here in Boise.  He's become quite successful with his business and our work together will definitely add some depth to his and my business development.

What I've learned from being a sports chiropractor for nearly a decade now, is that, you have to find other avenues that will make you money besides showing up to appointments on the regular.  You have to find a niche market that will not only add depth to your patient care (i.e., cooling tissues after they've been worked) but also, a way to get your clinic's name out there in a manner that is within the scope of your daily work.  R3 is a way for us to do exactly that by targeting those in our local area that are in pain, that need a recovery balm, to help them stay active.

I am very excited for this product!  It works great too, so that's awesome.  It is pretty intense initially but then fades over about an hour.  Being it is oil based, the effects last a bit longer than the competition. 

I use the balm to cool tissues and reduce pain after I get the region I am working on moving better via manual therapy.  The patients love how it helps reduce pain and provides a soothing after-tone to painful manual work.

As a business owner, I am limited within the chiropractic realm to maximize profits by not being able to clone myself...  yet.  All joking aside, I cannot be in two places at once.  I cannot provide exactly the same treatments through training others.  And I cannot pay the rent without being onsite, all the time.  It's pretty intense because the pressure of providing quality care is there on the regular and the clients expect us to deliver what we believe are our strengths.  I believe in us.

I've hired 10 massage therapists, a PT and an MD that focuses on trigger point therapy over that last 3 years to reach more people.  As a business, this has helped keep us cash-flowing well enough for our recent gym expansion and subsequent increase in service offerings.  Our team includes veteran therapists and doctors, which adds a huge level of quality to our clinic.  I believe our current team is the best in Boise in myofascial rehab.

All business aside, I love what I do.  I absolutely love it!  Seeing all the patients obtain relief and the ability to continue living their active way of life, is a true testament to the power of our therapies.  Onward we go!

Thanks for reading,

Dr. Spangler

www.trailheadclinic.com
www.myofly.com

Fast Forward 7 years...

Hello and welcome back to my blog, Chiropractique. 

I wrote in this blog for a number of years and had nearly 30,000 hits a month at it's high point.  My hope is to begin writing consistently again on a weekly manner. 

To get you all caught up, I am now finishing my 8th year in practice in Boise Idaho.  Thinking back on the long road I took to get where I am now, is very interesting, to say the least.  Back when I was writing consistently in this blog, I couldn't fathom having 8 years in practice under my belt.  Here we are.

I've gone through a lot in practice since the start.  Many different cases have walked through my doors.  Some easy, some very complex.  I've grown from a single doctor practice to three docs and 9 massage therapists.  I've gone through hardship both personally and professionally.  I've had to hire and fire people and I've been to the brink of nearly losing all I've built due to a few trusted contractors that tried to end it all. 

My optimism has not faded due to any hardship.  I still believe strongly in what I do.  Recently, we moved last June into a large facility in downtown Boise.  At our high point, we have seen nearly 350 patients a week between all of us.  That is a lot! 

We just opened our 1000 square foot gym this past month and have begun hiring and recruiting physical therapists to help more people.  Things have rapidly advanced during the past year and have no real end in sight.  They all say, this is a good thing... 

The work that comes with such numbers is immense.  The charting and phone calls alone take a lot of time beyond the one-on-one time we spend with patients.  Managing employees and contractors is no easy task either.  At some point, I will decide to stop taking on so much and delegate to others.  The process has started but will take a bit of time.

For now, my goals for the clinic are to continue growing the physical therapy side of it and look for a sports chiropractor to help out and find a buyer for my clinic in 10 years or so. 

Personally, everything I've planned for this clinic has worked out beyond my expectations.  I never thought it would become a 3,000 square foot giant with 4 disciplines working under one roof.  I dreamed of it but had no idea how to get it there.  We are here.

I'll update weekly from here on.  Some clinical stuff and some business stuff.  The struggles I face daily and the many successes as well. 

Best in Health,

Dr. Spangler

The Reality

I just finished my sixth month in practice yesterday.  I cannot say that it has been easy trying to establish my name in town, but I can say, the reward of helping patients overcome their musculoskeletal problems with non-invasive therapies and treatments is amazing.  Saving people from surgery and unneeded invasive treatments is a real joy.

The past six months have had some glitches.  Some cases have trickled in that I have had to do major research to figure out what the source of pain is.  I've ordered blood work, MRI's, CT studies and X-ray radiographs to rule out serious disease.  At times, the studies come up negative and others, it is quite fence-straddling.   That said, with uncertainty minus pathology, creativity is sparked for an interesting approach to the patient's dilemma.

What I have found is that nobody understands what I do until I tell them or show them.  I have also found that medical doctors in my town are largely anti-chiropractic even if the approach is along the lines of physical medicine.  I've approached patient care from the physical medicine methodology from day one and I've yet to obtain a patient referral from a medical doctor or medical provider.  I do communicate with the doctors I refer patients to and they keep me updated as well, but they are reluctant to refer patients to me.   The lack of trust in what I do and in the chiropractic profession as a whole, makes it very challenging to grow my practice.

I've often wondered how easy it would be to build a PT practice or a medical practice.  I can only imagine more doors would be open for professional referrals if the credential I worked my booty off to obtain started with an M and ended with a D.  With that said, I can breath a sigh of relief when I can use creativity to my advantage and solve stagnant musculoskeletal issues that have faded through the medical system's rigorous tests and treatments.  When an MRI shows no reason whatsoever for a patient's chief complaint and their blood work is within normal limits, what is the reason for their pain?  Is it all in their head?  My answer is that medical tests do not solve all the answers and being that medical therapies are largely dictated by the results from these tests, nothing can be done except nerve blocks and inflammatory control.

Anecdotally, I have a patient who has suffered from thoracic pain for over 4 years who has had every test in the book to diagnose the issue.  When all the tests came up short, they prescribed her anti-anxiety medications.  This, in my opinion, is a very wasteful system and a failure of intuition and knowledge of musculoskeletal imbalance.  After treating her with IFC, scapular distraction and Graston Therapy, she is now 90% pain free and is no longer taking anti-anxiety medication.

Anecdotes are anecdotes and they are not at all scientific truth and they can be skewed in many ways to promote bias.

With that, in the past 6 months, I've also had cases that have not responded to my conservative approach and have responded to epidural injections and invasive therapies.  It really comes down to respecting your scope of practice and other practitioners who have training in the more invasive treatment options.  Fine tuning our skills in diagnostics and implementation of conservative care is the most important development we can do, because it intervenes when appropriate either when a patient has exhausted all options or when they start fresh with us.

My issue after 6 months of practice is this:  Medical providers largely do not understand anything other than THEIR approach to care and when you approach them they push away.  If they were scientists who believe in empirical evidence which drives implementation of care, then they'd seek to understand procedures and therapies that are effective no matter what.  But when bias absorbs objectivity, poor decisions are made that lead patients to treatments that are risky, wasteful and purely for the ego boosting satisfaction the overseeing doctor personally needs.  Does this sound like science?

Trust your intuition, understand your orthopedic and neurologic tests and order tests if no answers are prevalent.  If there is still no answer, then treat the condition from a layered perspective; fascia, muscles, then joints.  Measure your performance by the results your therapies obtain and then boast from rooftops what you have done!

All for now,

Dr. Spangler
www.trailheadclinic.com

The Principles Applied

In practice, you are faced with applying theory to reality.  When things get serious, all cylinders must fire to make quick decisions to guide patient-care.  All those hours studying pathology, biomechanics and physiotherapeutics comes into place and an outcome happens.  

Most of the time, a positive outcome happens.  The patient sings you praise and a deserving pat on the back occurs.  Other times, things don't go as planned and you must direct patient care as taught in school - such as, refer for medication or a surgical consult.  Of course, we do all we can before referring, but under law, we must keep the patient's wellbeing in mind and decide when they have maximized our abilities.

I've had a few cases that have required challenging decisions.  Two of which, made me decide to purchase an ultrasound/electric stimulation machine because I was limited with my approach of using moist heat, PNF stretching and soft tissue therapies.  Sometimes you need a powerful tool to calm tissues down prior to manual therapy.  I am excited to add this equipment to my practice!

On the upside, there are a lot of patients that respond favorably to conservative manual therapy and traditional chiropractic adjusting.  They thrive under this approach and they are a real joy to treat.  Others take forever to respond to therapies we know work for most patients suffering from identical symptoms.  The trick is being flexible and open to changing the game plan.  We must be willing to order additional tests, refer for cortisone shots or buy equipment able to handle the cases.  Do whatever it takes to help the patient.

When they get results, even if it wasn't due to your direct care, they will feel comfortable referring their friends and family to you because they know you made the right decisions to get them appropriate care.  If you did all you can do and they still aren't better, they will respect you if you send them to a practitioner with a wider scope of practice who is able to provide relief.  

It really is all about results.

All for now,

Dr. Spangler

Trailhead Chiropractic

Kinesiology Tape?

Recently, I was interviewed on a local television show here in Boise called Healthy Idaho.  Though nerve wracking, it was fun to explain the therapeutic process I use with most patients.

To start my 4th month in practice this way was a real treat!  My goal was not to just explain how kinesiology tape works but also to show how I use manual medicine in combination with kinesiology tape.  This all happened in about 4 minutes.

The goal of using kinesiology tape is really icing on the cake with most therapies.  Theoretically, kinesiology tape provides a gentle tug on the skin and lower fascial layers, which allows agitation to occur and mechanical lifting of the superficial tissues.  Hence, greater blood flow to the local area and an increased rate of healing.  An additional theory is that the tape stimulates surface receptors of the peripheral nervous system, providing greater proprioception.   Proprioception is a term used to describe the body's way it monitors and adapts to the physical demands of an ever-changing environment.  For example, if a rock pokes you in the foot or you step onto an uneven surface, you can and do adapt to the situation without even looking at the object by gaining feedback from joint and surface receptors of your peripheral nervous system.

Another quality of kinesiology tape is pain reduction.  Pain and soft touch receptors use different pathways in the spinal cord which transmit their information to the brain.  Applying a gentle tug on the skin with elastic kinesiology tape, tells the brain that there is more than just pain receptors being activated. The brain interprets the information as an either-or situation and with greater soft-touch receptors being activated than pain receptors, pain reduces as a result.

Kinesiology tape is quite versatile.  We can use it to reduce swelling by cutting the tape a certain way.  We can provide stability to an unstable area by stimulating proprioceptors around a joint.  And we can create a fascial pull to the skin by stretching the tape and anchoring it around a painful area.

Is kinesiology tape the only thing that needs to be done to fix musculoskeletal problems?  Absolutely not! I use it as icing on the cake in conjunction to adjusting joints, stretching tight muscles, stimulating tissues to heal with the cold laser and teaching proper firing sequences of muscles (ie., sword/seatbelt patterns, D1-D2 patterns for the lower extremites etc.).

Throwing kinesiology tape on an undiagnosed problem is no different than chucking pain pills at it and hoping it will go away.  Diagnosing a condition is key to using such a therapy because there are many, many reasons for musculoskeletal pain or pain in general.  Sometimes kinesiology tape is contraindicated as a therapy and can make a condition worse due to the lack of appropriate intervention.

Take home message:  Get evaluated before using it.

I hope this information helps folks understand the role of kinesiology tape and the importance of being evaluated by a professional prior to using it.

All for now,

Dr. Spangler
Trailhead Chiropractic

What is Our Role?

Wrapping up my third month in practice recently was a real treat!  The clinic is growing weekly with new referrals from previous patients and marketing efforts aimed at getting the word out are finally coming to fruition.  It is amazing what happens when you focus on solving problems versus selling a protocol.

I recently gave a talk at Boise Cascade, a timber and paper company, to help explain my approach to patient care and to give insight into when traditional chiropractic adjusting is appropriate and how it can be used to inappropriately create dependency for the adjustment.  

Many folks in the crowd were long time users of traditional chiropractic.  There was some eyebrows raised when I told them there is more to chiropractic than simply adjusting the spine for every condition.

It was evident that there has been a lot of DC's in Boise pushing subluxation theory on patients.  The claim of better nerve flow for optimum health has been the hallmark for many successful clinics in town.  From my perspective of wellness obtained through fitness, I have some reservations in building a practice this way because it falsely represents the reality of what's going on when a person gets adjusted.

I continued by explaining that most conditions require a fair amount of myofascial release and rehabilitation of dormant motor programs instead of simply adjusting the area over and over.  I explained how our dominant movement patterns throughout the day set us up for dysfunction because of adaptation of soft tissues.  I then explained the force-couple relationship involved with overactive muscle groups and the risk of demanding excessive loads through "rare" activities, such as: skiing and snow boarding with such dysfunction.  It was wordy but they were deeply interested.

The intention of explaining things logically to this crowd was purely educational and objective.  I told them I don't adjust every condition and the assessment approach I use helps depict what tissues are causing the restricted motion.  I explained how traditional chiropractic adjusting creates movement to the deeper musculoskeletal structures such as: the ligaments, joint capsules and surrounding stabilizer muscles.  I then helped explain how some conditions are myofascial and using traditional adjusting on these problems will not completely solve the issue.  I told them, this is where dependency on traditional manipulation is established.  I ended with explaining how it is no different than PT's using exercises as the only tool to fix problems or MD's focusing on medication only.  We must be versatile.

If our role is to be technicians that merely provide adjustments to patients, I feel we are doing a great disservice to the community.  If we focus on getting patients better, our clinics grow because that is what they want - results.

All for now,

Dr. Spangler
Trailhead Chiropractic

Justifying the Adjustment

As I finished my second month in practice last week, I began thinking about a topic worth writing about that may stir the pot a bit and provide insight into what it's like trying to build my reputation on results.

In school, we are thoroughly taught how to adjust every joint in the body.  They teach us that adjusting is the best method to use in practice and they raked us over the coals heavily to conform.  The dogmatic approach they used, builds a complex, as if we have to adjust people no matter what and that is what patients are seeking when they come into our practices.  I am here to say, this is a mindset of the past.  People want results, not adjustments.

What has been eye-opening is how many people fear getting adjusted.  Most say it is because they remember seeing some bad guy getting his neck snapped in the movies.  They tense up and protect the area from any harm.  So even if an adjustment is given, the soft tissues absorb a ton of the force and the joints do not get a therapeutic manipulation.

If you step back and forget about their fears and actually assess the physical issue, the specific tissues in need of manual therapy display themselves.  Is it a capsular end feel or a spongy end feel?  Are there sore origins and insertions of muscle groups?  What's the history?  Could there be fascial adhesions?

Now if you go and adjust them without assessing things thoroughly or explaining things logically, there is a lack of trust built and a negative viewpoint of chiropractic is planted in the patient's head.  You don't have to adjust people just because you are a chiropractor.  If they need it, that's another story.  I personally look at chiropractic adjustments as an aggressive/last resort therapy that should only be used if absolutely necessary.  If other less aggressive therapy fails to give relief or restore motion, then I reassess and adjust the patient.  People seem to really respect this approach and they trust it because they feel I am taking their condition seriously and do what is necessary.

It comes back to why are we doing what we do.  Are we trying to get people to come back over and over for meaningless therapy that doesn't affect specific tissues?  Or are we trying to help people get over their specific condition with tissue specific therapy?  The ethical answer is the latter.  You can do just as well and even better if you are honest about what the patient really needs versus approaching patient care with dogmatic/engrained thoughts.

Too often, chiropractors adopt the mold of businessmen/women first and doctors second.  Trust is key with running/building a practice and if you depict specifically what issue the person is dealing with and apply your therapy directed at specific tissues in need, business will flourish.

If you use one tool for every job you'll fix 10% of the issues and screw up or mildly help the other 90%.

Food for thought,

Dr. Spangler
Trailhead Chiropractic