Scoliosis and Chiropractic Treatment

Scoliosis is "a lateral curvature in the normally straight vertical line of the spine". In layman's terms, the spine has a sideways curve in the shape of either a "S" or "C". If the curve is at or above 60 degrees, then scoliosis can be spotted visually due to the patient's waist and shoulders being uneven. The actual cause of the various types of scoliosis is currently unknown. Some people have it when they are born, noticed during adolescence/early 20's, or in the later years of their life (it is more common in children and adults 18-25). Every case is unique to that particular patient. Whether the scoliosis is mild or severe, there will be some level of pain and stiffness. Getting in to see a chiropractor as soon as possible is the first step in the rehabilitation process.

How is scoliosis diagnosed? In some, the curvature of the spine is visually detectable, while others need special testing to make an accurate diagnosis. The main test is called an "Adams Forward Bending" test. There are also other reliable tests such as X-rays and palpation, orthopedic, and neurological testing to determine the extent of the damage that has been caused by scoliosis. The chiropractor will also take a detailed history of the patient's medical history, family's medical history, as well as work-related and/or recreational/daily activities.

How is scoliosis treated? The methods of treatment depends on the severity of the disorder. Traditional methods are the use of an orthopedic brace, moist heat, and surgery. The use of an orthopedic brace helps prevent the spine from further curvature. It holds it in place but does not limit (all or most) of the patients mobility or interrupt daily or recreational activities. Moist heat is used to decrease pain and stiffness. If it is an extreme case, surgery may be required. Spinal Fusion Surgery places rods and hooks along the spine to prevent any further curvature. There is also placement of a spinal cord monitor to lessen the chances of paralysis. This form of treatment is the absolute last resort, due to the high risk factor for further injury or complications.

There is another option available...chiropractic treatment. Use of a chiropractor for treating scoliosis is gaining respect and popularity among patients and within the medical community. It is now recognized as a reasonable and practicable form of medical care. It not only treats the existing condition, but prevents that condition from worsening. It also aids in the prevention of new medical issues rising to the surface. A majority of patients who suffer from scoliosis, and have used this form of treatment, showed dramatic favorable results in the size of the spinal curves. Studies also showed that after chiropractic care patients saw an increase in overall stability and even a total correction of the spine. In essence, it has improved their quality of life and and decreased the need for more traditional methods of care.

After an initial assessment, the chiropractor and the patient's physician will decide which treatments will be the most beneficial and produce an optimal end result. Some of the chiropractic treatment options are spinal manipulation, shoe lifts, electric stimulation, and isotonic or other exercise methods. It will be up to the chiropractor and the patient's physician which of the above methods will be used. If none of the above methods will work, they will refer the patient to a specialist.

It is important to remember that for any treatment to work, regular visits to a primary care physician, specialist (if any), and chiropractor. They can track the progress of a patient throughout the rehabilitation process. This will allow them to decide if the current treatment is working or if any changes need to be made.

Scoliosis is a condition that needs to be treated by a team of medical professionals. Their goal is to increase muscle strength, and improve mobility. It will also help the patient become more independent, and making them less dependent on medications by decreasing pain/soreness and stiffness. Get with a physician and chiropractor today and start enjoying all that life has to offer.

Chiropractic Techniques Examined - Gonstead and Activator

The chiropractics profession has been around a long time and over the years dozens of different spinal manipulation methods have developed. Two of the most commonly used techniques are the Gonstead Technique and the Activator method. Which one is better for you? The following information may help you decide.

The Gonstead Technique

This technique was started by Dr. Clarence S. Gonstead of Wisconsin when he became a chiropractor in 1923. His idea of chiropractics references all body misalignments to the pelvic girdle, the body's foundation according to the Gonstead theory.

Just like a building's foundation needs to be level and firm to support the top of the building, the body's foundation of the pelvic bones and the lower back bones needs to be level and in balance for the rest of the body to be secure and functioning well.

If these base bones become out of place at all through accidents or just abnormal movements, the whole body can be thrown out of whack. When the body is unable to naturally correct these misalignments, chiropractics is the key to setting things straight again.

Those using or following this concept will look carefully for misalignments in the upper back, but especially in the lower back near the pelvic bones. Manual techniques are often accompanied by spinal X-rays to get a complete understanding of the spine's shape.

The theory then is once the exact problem vertebra is located, that problem area and nothing else should be adjusted back into place. Everything else will naturally fall into alignment when the root problem is fixed.

The Activator Method

This technique was created by Arlan Fuhr in the early 1960s with the introduction of his spring-load tool called the activator. The tool is used to replace manual manipulation of the spine and is often less jolting on the patient.

This is because the activator is used to pop misaligned vertebrae or joints back into place individually. In this procedure, the chiropractor has the patient lay flat, face down on a table while the doctor compares the length of the patient's legs. If one leg appears shorter than the other, the chiropractor will press on individual vertebrae on the back to see if that makes a difference in the length of the leg.

That vertebra is then adjusted with a special tool and the doctor repeats this process until all necessary vertebrae have been realigned.

This is a very popular treatment in the United States today. A National Board of Chiropractic Examiners survey from 2003 found that almost 70 percent of American chiropractors employed the activator procedure in their practices. And this technique is taught is most of the chiropractics schools around the country today.

Both these procedures have many ardent followers among chiropractors and patients. Both have plenty of people who love each style and claim it works the best. You may need to try each method for yourself before you can determine which the best solution for your back troubles is.

Winter Back Pain - Slipping on the Ice Means Visiting Your Chiropractor

With the onset of cold weather, a brand new danger lurks it's ugly head for those with underlying structural problems associated with their spine. The drop in temperature can affect our hydration levels and the overall tone of our muscles, but more importantly ice is everywhere and can lead to lots of back problems from the trauma... even if you don't actually fall down.

How can this be? Let's start with the fall. It's pretty obvious that if you fall down, you will likely affect your spine. The impact and shock of hitting the ground can move things out of place. It's that movement of vertebrae out of place that can cause spinal problems. The effect may not occur right away. You may just notice that "something's not right," but not enough that you decide you absolutely must do something about it right away.

It's these warnings that are the easiest to ignore. Many times people will ignore the warning signs and simply wait until they are bending down to do a simple task like picking up socks when they unexpectedly cannot move. They are doing something "dangerous" like throwing a small pillow when their back seizes up. These are the types of stories I hear everyday.

The overlooked trauma is when you don't actually fall. You come close, maybe grab on to something nearby. Still, your muscles tense up, you get scared, and then thank your lucky stars that you didn't actually fall on to the ground. It's these "near misses" that can still affect your spine.

That sudden seizing up of the muscles can also throw things out of place. The muscles attach to the spine and when they tense up, knot up, or spasm they will cause the joint to stop functioning as it is designed. Time to see the chiropractor.

The chiropractor will find the areas of your spine that have moved out of place, help move them back into place, and restore the body's normal function. The relief happens pretty quickly in most cases. A problem caught early is always easier to take care of before the crisis occurs. Not to mention how much a frozen back can ruin your entire week.

Chiropractic Exercises to Relieve Back Pain

Try these three extremely effective and quick exercises to decrease your middle and upper back pain. Better yet, you can do them at home, and it just takes a few minutes.

Almost everyone has back pain at some point. If you constantly bend and twist, you are constantly at risk of hurting your back. Therefore, if you do have to bend or twist, make sure you're doing so properly. You should also be aware that there are lots of different kinds of exercises that you can do so that if you do have back pain, you can get rid of it. When you do these exercises, you should feel better very quickly. However, do go see your doctor if you have severe pain, and don't do these exercises until your doctor says it's fine.

The first exercise that can help you with your middle or upper back pain involves your hamstrings. Hamstring stretches actually do help your back, even though that might not make sense. Why? Because everything in your body is connected to something else, and if you have tight hamstrings, this can make you have a tight back, too. And if a tight back is allowed to continue, you could eventually have back pain because of it. So, stretch your hamstrings by standing up, bending your knees just slightly, and then bending over to touch your toes. More than likely, you're not going to be able to touch your toes, but if you try to do so every time you do this, you should see that you get farther every time you try.

Next, try this exercise for middle upper back pain, called the "cat stretch." With this particular type of stretch, you stretch your back. Get on the floor, on all fours, and position your hands and knees as though you're simply going to crawl. Keep your hands and knees in place, and then just lean back. Look at your dog or cat sometime when he or she stretches. This stretch should look like that for you. When you do this "cat stretch," you're stretching your back muscles. This will make your back less tight, which will alleviate pain.

You can also strengthen your back to alleviate back pain, and because of that, you should do some strengthening exercises, too. Most people injure their backs because their backs are either weak, tight, or both. Your lower back is usually going to give you the most problems. First, try doing something called the "Superman." Lie flat on the floor, face down, and lift your back, stretching your legs and arms out behind you at the same time, and keeping them straight and "pulling back." Hold this position for a few seconds, and then return to starting position. These and other exercises can most certainly help decrease middle and upper back pain.

These exercises are simple but very effective, and they can be beneficial right now. In no time, your middle or upper back pain could be a distant memory. Do these exercises to enjoy the quality of life you've been missing.

Managing the Chiropractic Associate - The Contract

I am often surprised at how many associate type arrangements that I come in contact with, either through a chiropractic friend, though a client or in a story about a chiropractic business owner where there essentially is an employer/employee or at least an owner/independent contractor (IC) relationship, and there is absolutely zero contract in place.

Now I will admit, early in my career I too operated without a 'written' contract. My assumption at the time was that if the doctor I had the arrangement with didn't want one, then I would be better off not being 'locked in' either. Well, in that situation it all worked out well, but since then I am constantly witness to so many associate/partnership arrangements gone bad. Truly, the minor work involved in setting up a chiropractic associate contract will almost always save a ton of trouble and money down the road. And, it benefits both sides to know exactly what the arrangement and expectations are.

So, suffice it to say, there should never be a work type arrangement between a clinic and an incoming doctor that is not laid down on paper. Granted, there is such a thing as a 'verbal contract' but the facts within those 'contracts' always become clouded, and then it is essentially your word verses mine. At the minimum the exchange of emails can solidify at least the outline of an arrangement and can be considered legal. But, nothing will stand up as well as an actual attorney prepared chiropractic associate contract. (I should mention too that you do not need an attorney to write up the agreement, you can prepare a document yourself and it can be just as binding, however, almost always I have found that a good attorney will bring to light issues that you have overlooked, and will word things in the way as to be of much greater protection. Therefore, I always use an attorney or attorneys to prepare the final draft of my contracts).

However, either way you need to be able to put together the basics of what will be included in that chiropractic associate contract. If you leave it up to the attorney completely I guarantee that he will miss issues that are very important to you and to the arrangement because they are industry specific, and it is doubtful that he will have prepared a large number of this specific type of contract to have that knowledge.
So, let's get started on what your considerations should be.

The first consideration is whether to hire this new associate as an employee or bring him on board as an independent contractor. This is a VERY important distinction, from a variety of standpoints. I will go over the basics concerning the pros and cons and let you decide for yourself which legal distinction will work for you.

From an expense standpoint, both the owner and the associate chiropractor (if he is an astute businessman) would benefit more having the arrangement be that of an IC. Reason being, the owner will save a lot of money on employment taxes, which are.765% of the gross salary. If you pay an associate 80K in salary and bonuses (other benefits aside) you are in reality paying $86,000+. This also benefits the owner who would not be expected to pay any other benefits either, i.e., health insurance, sick days, vacation days, retirement, and so on.

Initially the average associate chiropractic employee might be under the assumption that this will cost him more because they will be responsible at the end of the year for withholding all their own taxes. In actuality this is a very beneficial situation because if the doctor sets himself up in the proper legal entity and then arranges his pay as business income and therefore pays expenses out of these funds and pays himself a combination of salary and bonus, he will come out much better in the end.*

Now, from the standpoint of security, the IC arrangement might not be as good of a situation for the owner. Reason being, if an associate is an IC, then by virtue of what that means he would also be able to work elsewhere at the same time if he wants (think, for example, hiring a plumber). And even though you will have non-compete language in your contract, this might be much harder to enforce if your associate is an IC.

As well, from the owner's point of view there is another risk when it comes to hiring an associate chiropractor as an IC. The IRS actually has very strict language as to who can qualify as an IC and who cannot because they don't want people realizing those tax advantages described above. Therefore, in reality, as an associate chiropractor it is pretty hard (but not impossible) to comply with the IRS rules. Here is an article that will better lay out the aspects that the IRS considers when deciding whether or not the worker in question is an IC or an employee: (IRS link provided at the bottom of this article). Now, all that being said, most people in the IC situation may forever operate under this IRS radar, enjoy the tax savings, and still maintain a viable non-compete in their contract. However, I have witnessed more than a few instances where the hired IC associate chiropractor became disgruntled and then reported the owner to the IRS, saying that they were actually an employee and not an IC. If the IRS determines that this is true, that they were actually an employee and not an IC (and it takes them really nothing to make this determination) then you not only become liable for all your back taxes on that 'employee' but also that employee's share of those taxes too. So, it is worth the risk? Only you can decide that.

As you can tell, this is a very in depth topic and I am not a lawyer. I just wanted to provide you some basics so you can discuss these issues with your accounting and legal counsel. The language you use in your chiropractic associate contract will differ significantly depending on whether you chose to hire your new associate chiropractor as an IC or an employee. This is further reasoning behind enlisting the assistance of a business attorney.

The aspects of the chiropractic associate contract I want to discuss next will comprise the 'bulk' of the document. These are the common issues as related to everything and NOT specific to the deal you worked out with your chiropractic associate. For example, pay, bonuses, time off, etc., will not be in this section. As well, following this list I will delve more into the topic of the non-disclosure agreement, as I believe this is one of the greatest concerns a hiring owner has. However, this more general section I will basically outline below is more generic in nature (which is nice so that you can use it in future employment situations as well). The individualized chiropractic associate contract aspects will be placed at the end, in an addendum or an exhibit.

So, without going into extreme detail regarding all these core aspects, I will just list them so you will be sure not to miss them in your legal document:

1) Recitals: corporate name(s), owner's name(s), associate's name.
2) Agreements: incorporation of recitals, term, representations and warrantees of provider (services administered, licensure issues, disciplinary past, compliance with state laws, rules, participation in insurance plans, etc.)
3) Duties of Provider: hours, duties, records
4) Relationship: IC or employee and the ramifications of those
5) Office Space, Personnel and Admin Support
6) Assignment of Fees; Billing and Collection: agreement of assignment of collections in their name to the corporation
7) Consideration for Services: referring to Exhibit or Amendment attached at end.
8) Insurance: who is to pay for
9) Control of Work: Warranties: (more for the IC relationship)
10) Confidentiality and Non-Disclosure/Non-Solicitation: (covered in more detail following this list)
11) Termination: reasons the employee can be let go immediately, as well as the notice that has to be given, on both sides, for ending the relationship.
12) Effects of Termination: how things like the books, records, personal items, etc., will be handled upon termination.
13) Miscellaneous: Assignment, Incurring Financial Obligations, No Third Party Beneficiary, Binding Nature, Governing Law, Entire Agreement, Notices, Waiver, Counterparts, Severability, Additional Documents.

Now, of greatest concern is usually the non-compete language. This is usually what concerns the hiring doctor the most, and for good reason. No one wants the nightmare of hiring an associate chiropractor, training him and letting him get close to your patients, to then leave one day and open up just down the street, draining you of everything you have built over the years. It is sad, but believe me, this happens.

The first thing for you to know, and something you would not voluntarily reveal to your chiropractic associate, is that the main reason for non-compete language is to create a defensive deterrent. That is to say, you want the associate to always be aware that should they leave that they have agreed that they will leave and comply with these tenants of the non-compete agreement, or suffer these _______ repercussions.

The unfortunate truth about non-compete agreements are that, legally, they hard to enforce (unless of course your attorney has done an excellent job drafting the language just right). Now, even if the language is good you will also have the issue regarding cost. Granted, once we are taken advantage of by someone we placed trust in often times in the search for justice we will make an emotional decision to pay whatever it takes to correct this wrong. But, what we really need to do is take a minute, look at the situation subjectively and answer this one question: "If it is going to cost me $10,000 (for example) to go after this person, have they or will they actually cause me much more than 10K worth of damage?" I had a chiropractic associate one time leave and a few months later go to work for another doctor essentially right across the street. We were infuriated; however, after careful consideration (and the prospect of spending 10K) we realize that her being there was actually zero cost threat to us. In this situation the patients were not fans of her treatment and loved our new doctor, so she was not going to take any business from us.

If, on the other hand, things had been slightly different and she actively marketed to our patients and, over time, our numbers suffered substantially I promise you that legal action would have been taken.

Now, that being said, let me mention the main considerations when it comes to a non-complete: time and distance. See, any judge or mediator given the job of evaluating the situation is going to first decide if the contracted arrangement is reasonable (given the business) and if it is not too over-reaching in that it would limit the leaving doctors ability to make a living. Therefore, the terms of the non-compete need to be laid out wherein the doctor is not allowed to practice within so many miles radius for so much time. However, that needs to be followed up with language such as:

(i) Notwithstanding the foregoing subparagraph 11(b), if 2 years is determined by a court of competent jurisdiction to be overly broad, then the period shall be equivalent to 18 months;
(ii) Notwithstanding the foregoing subparagraph (i), if 18 months is determined by a court of competent jurisdiction to be overly broad, then the period shall be equivalent to 1 year;
(iii) And so on

By adding language such as this you allow the judge or mediator the option of picking something that he or she considers reasonable. Is this ideal? No, but it does offer some protection.

Following this, your attorney would need to add language related to this such as Liquidated Damages, Injunctive Relief; Legal Fees, Severability and Scope.

Now, equally important is to also include the very same type language as it relates to Confidentiality, Non-Disclosure and Non-Solicitation. Essentially, this means they will not take what is private to you and how you operate your business and make use of it elsewhere - like for a competitor. This includes anything related to your business methods, patient files, patient lists, and your employees (like trying to hire them from you).

Now, the individualized part, the part everyone often thinks will be the hardest is often the easiest part. That is the part that deals with pay. Now that the overall framework is set down, a page at the end of the chiropractic associate contract is attached that just says it like it is, either as an exhibit or an addendum. They will get paid X amount on X dates. The bonus structure will be X per every X and so on. Usually this page has no more than 1 or 2 short paragraphs on it. You can make it as simple or as complicated as you want.

As you can tell, this is a pretty extensive topic and I know I have only touched upon it, but I think you can definitely see how enlisting a professional in this realm is essential. However, now you should at least have a good framework to make sure your attorney covers the bases. As well, a good consulting group or chiropractic placement agency should be able to provide very good versions of the 2 types of chiropractic associate contracts for you to use directly which will save you hundreds of dollars by giving your attorney a framework by which to alter slightly for your own particular needs.
-Dr. Troy Counselman

IRS Link: http://www.irs.gov/businesses/small/article/0,,id=99921,00.html

Chiropractors - Discover What They Can Do to Help You Feel Better

Lifting heavy items, performing strenuous exercise or simply age can all affect the back. While some people can simply rest for a few days and eventually be back to normal, others will need to consult chiropractors to get some relief. Explore how this back specialist can help make your feel more comfortable.

What they do
When people have back issues or spine problems, they see doctors that specialize in helping the back. These doctors are known as chiropractors and they can help pinpoint the source of the back pain as well as help alleviate it. The methods of treatment are natural and non-surgical. Often times, the issue is a result of misaligned joints in the back. If not treated, these misalignments can affect the nervous system which can cause further damage to the body.

Assessment
As with many doctors, chiropractors do a full assessment of the patient before providing treatment or issuing a diagnosis. They will check medical history, may conduct a physical, do blood work and even perform x-rays to help see what could be the possible cause of the problem. He or she could also study the patient's posture and inquire about whether or not the patient practices good nutrition and proper exercise, all which can help ward off back pain.

Common services
To help relieve pressure on the joints, some chiropractors perform what's known as spinal decompression. The patient is first strapped to an instrument, and then this instrument proceeds to separate the patient's upper and lower body. The entire process can take up to 20 minutes, and is usually performed on people that have had to endure neck or lower back pain for more than a month. After this service is complete, the patient may be a little sore and it's recommended to take it easy and put ice on the affected region.

Another service people get is known as adjustment. This procedure involves having the doctor adjust a spine that is misaligned. While there may be a bit of pain at first, the final result is relief. Furthermore, some doctors recommend that the patient get involved in some type of healing exercises such as low back extensions, hip rolls and more. Plus, some doctors even suggest having the patient do ice compresses. This option can also be beneficial in temporarily relieving pain since the area will numb.

Additional procedures
While there are many common procedures chiropractors perform, there are other non-standard methods that have also been known the ease back pain. Acupuncture is said to encourage healing of the body and better organ function. It is done by placing tiny needles on certain pressure points.

In addition, other non-standard procedures include massage, heat treatments and water exercises, to name a few.

Chiropractic Marketing Online With Google AdWords

Google AdWords can be a very effective tool for chiropractic marketing online. There are various benefits to using this highly targeted search medium. This form of advertising is essential in getting you page one results, bringing your practice to the forefront in what is often a very crowded field.

What are Google AdWords?

Google AdWords are the advertisements you see, the sponsored links, when you run a search using their search engine. The ads usually appear on the side or top of the page. They can be fairly simple, using text, or more complex as they may incorporate logos, images and videos. These ads can be especially helpful for chiropractic marketing online. The primary reason for this has to do with how they work.

How it Works

Although the Internet is international, you can use it very effectively for local advertising. Thus, for local chiropractic marketing online, Google AdWords can be quite effective because it allows you to target a specific geographic area.

Additionally, your advertisement is keyword sensitive. When someone puts in your designated keywords (ex... Los Angeles chiropractor) and they are searching from the geographic area you've designated, your ad will come up.

For chiropractors, Google AdWords can be an efficient method of connecting with potential clients. The fact that the search is targeted, linking you with people who are looking for your services, makes it an important online marketing device.

Cost of Google AdWords

One selling point regarding Google AdWords for chiropractic marketing online is there is no minimum charge. Ads are billed at a pay-per-click-rate, which means you're charged whenever someone clicks on your advertisement and goes to your site. Thus, at the very least your ad has to create interest before you are charged for it.

You decide how much you are willing to pay each day. Thus, you're able to set your advertising budget in advance. Google gives its customers a host of tools that they can use to determine costs, keywords and what type of ad they should run.

Marketing for Success

If you're thinking of engaging in chiropractic marketing online, Google AdWords can be one way to capture people's attention and get them to your site quickly and efficiently. Do your research, scope out your geographic area, research keywords and decide what type of advertisement will work best for you. This pay-per-click medium can be an effective way for you to utilize the power of the Internet and the millions who use it.