Dynamic Chiropractic

This article serves as a stark reminder to chiropractors about the pervasive issue of polypharmacy in the United States. Citing alarming statistics, it highlights that a vast majority of patients are likely taking multiple prescription or over-the-counter (OTC) drugs. Nearly two-thirds of adults have used a drug in the past week, and over a quarter of all medical visits result in five or more prescriptions. The problem is particularly severe among seniors, with nearly 90% taking at least one prescription medication, and it also affects children, with 20% on prescribed drugs. For chiropractors, this data is critically important. It means their patient base, regardless of age, is heavily medicated, increasing the risk of side effects and drug interactions. The author emphasizes that chiropractors are in a unique position to address this epidemic. Beyond offering non-drug healthcare that promotes true healing over symptom masking, they can act as vital patient advocates. By being aware of this reality, chiropractors can encourage patients to discuss de-prescribing with their medical doctors, helping to protect them from the dangers of unnecessary medication and reinforcing the value of a conservative, wellness-oriented approach to health.

This case study illustrates the effective chiropractic management of a complex post-surgical patient. A 52-year-old female presented with worsening neck and scapular pain six years after receiving a C5-C6 cervical disc replacement. Her situation was complicated by two factors: imaging confirmed a minor anterior migration of the prosthesis, and the specific implant had been recalled by the FDA due to this risk. While her surgeon suggested revision surgery to fuse the joint, the patient was strongly opposed to another operation. A thorough clinical evaluation revealed significant musculoskeletal dysfunction but no neurological deficits. Critically, direct cervical manipulation was contraindicated due to the implant's instability. The chiropractor developed a conservative treatment plan focusing on thoracic spine manipulation to address regional compensation, soft-tissue therapy for hypertonic neck muscles, and a progressive rehabilitation program to strengthen deep cervical stabilizers. After 11 visits, the patient reported an 80% improvement in pain and function, successfully avoiding revision surgery. The case highlights the valuable role chiropractors can play in managing patients with challenging post-surgical presentations, demonstrating the importance of careful clinical decision-making, adapting techniques when contraindications exist, and fostering collaborative care with surgical specialists.

Despite strong scientific evidence supporting chiropractic for low back pain, a significant awareness gap persists among the public. This article highlights the work of Dr. Christine Goertz, a distinguished chiropractor and researcher at Duke University School of Medicine, who is dedicated to closing this gap. Dr. Goertz has not only published landmark studies, including a highly cited trial in JAMA Network Open, but has also created clinical pathways at Duke Health that guide patients toward non-drug options like chiropractic as a first-line treatment. Her new book, "Take Your Back Back," is a direct effort to educate a mainstream audience. It aims to empower patients by debunking common myths about back pain, explaining the evidence for treatments like manual therapy, and providing a practical guide to advocating for better care. The book positions chiropractors as the right first call for low back pain. For practicing chiropractors, this book represents a rare, valuable resource: a patient-focused guide written by a highly credentialed researcher that validates their work in accessible language. It's a tool that can be used to educate skeptical patients and reinforce the value of a conservative-care-first approach.

This article focuses on the clinical progression from post-concussion syndrome (PCS) to post-traumatic stress disorder (PTSD) following a motor-vehicle accident (MVA). It explains that PCS, a form of mild traumatic brain injury (mTBI), can result from blunt-force trauma or acceleration-deceleration forces causing diffuse axonal injury, often without visible head trauma. PCS is diagnosed when concussion symptoms like headache, dizziness, and fatigue persist beyond two weeks, potentially accompanied by issues like photophobia, memory impairment, and irritability. The author emphasizes the significant symptom overlap between PCS and PTSD, including hyperarousal, sleep disturbances, and poor concentration, noting that the two conditions can co-occur and exacerbate one another. The prolonged recovery from physical MVA injuries can reinforce the "trauma memory" that contributes to PTSD. To aid in diagnosis and documentation, the article recommends clinical tools like the Acute Concussion Evaluation (ACE) and post-concussion questionnaires. It concludes by stressing the need for early identification and interprofessional co-management with neurologists and psychotherapists to address both the physical and psychosocial aspects of the patient's recovery, which is critical for achieving an effective outcome.

This article sounds an alarm about the calculated and sophisticated assault on independent chiropractic by corporate medicine. Driven by a relentless focus on return on investment (ROI), large healthcare corporations are acquiring chiropractic practices to use them as referral gateways for more profitable services like pain management and surgery. They lure chiropractors with high salaries and promises of future equity that rarely materialize, effectively turning practice owners into low-level associates with no control over patient care. These corporate systems limit chiropractic treatment to insurer-approved visit caps, prematurely ending care plans to funnel patients down the revenue-optimized pathway. A key competitive advantage for these corporations is their advanced information systems. Their medical EHR platforms are integrated business engines with automated referral, marketing, and reputation management capabilities, putting them 8-10 years ahead of the legacy software common in chiropractic. This technology allows them to systematically capture referrals at a scale independent practices cannot match. The author warns that this well-funded, data-driven strategy is designed to seize chiropractic's patients and revenue, fundamentally threatening the autonomy and patient-centered model of the independent chiropractor.

This article presents a compelling case study that underscores the importance of a thorough differential diagnosis for headaches. A 35-year-old female patient reported sharp headaches that occurred exclusively when she was watching movies in a theater. She also suffered from more frequent, dull cervicogenic headaches related to a past whiplash injury. Initial chiropractic treatment, including cervical manipulation, successfully resolved her general neck pain and the dull headaches, but the "theater headaches" stubbornly persisted. This prompted a referral to a colleague with a DABCI nutrition specialty. The key to the puzzle was uncovered through food sensitivity testing, which revealed allergies to gluten and corn. The specialist then connected this to the patient’s movie-going habit: consuming a large soda (with high-fructose corn syrup) and a large popcorn. When the patient attended a movie without eating popcorn or drinking a Coke, she remained completely headache-free. This case serves as a powerful clinical reminder that a patient can suffer from multiple types of headaches with distinct triggers. It highlights the necessity of looking beyond the musculoskeletal system and considering factors like diet and food sensitivities, demonstrating the value of specialization and collaboration within chiropractic practice.

This article explores piriformis syndrome as a prime example of myogenic pseudo-radiculopathy, where muscle dysfunction mimics nerve root compression symptoms. Patients often present with buttock and posterior thigh pain that resembles lumbar radiculopathy, yet the symptoms lack a consistent dermatomal pattern and are not associated with objective neurological deficits. The piriformis muscle, a deep hip rotator, can become overloaded due to altered hip mechanics or lumbopelvic instability, leading to myofascial trigger points that refer pain down the leg. A major diagnostic challenge is the frequent presence of incidental degenerative changes on lumbar imaging, which can misdirect clinicians toward spine-focused interventions. Key distinguishing features of piriformis syndrome include pain reproduction with hip movement or prolonged sitting and a poor response to spine-directed treatments. The article emphasizes that correctly identifying this condition is crucial, as it responds well to conservative, minimally invasive treatments like myofascial release, stretching, and stabilization exercises. By establishing this model in the lower extremity, the article sets the stage to introduce subscapularis syndrome as a parallel, yet often overlooked, cause of pseudo-radiculopathy in the upper extremity, urging a broader application of this diagnostic framework.

To improve efficiency, safety, and patient engagement, this article advocates for a systematic, 7-point checklist for daily patient visits. Drawing parallels to checklists in other industries, the author details a structured approach to each encounter. The seven points are: 1) Assess Pain using standardized tools like the Numeric Pain Rating Scale (NPRS) and the PEG scale. 2) Evaluate Improvement by asking about 12 primary indicators, including sleep quality and return to daily activities. 3) Inquire about Concurrent Care the patient may be receiving from other providers. 4) Outline the Plan to reinforce treatment goals and the visit schedule. 5) Check on Exercise, both prescribed and recreational, to ensure compliance and prevent harm. 6) Answer Any Questions, directly addressing a common patient complaint and demonstrating that the provider is listening. 7) Survey Satisfaction With Care to gather valuable feedback and strengthen the doctor-patient relationship. While this process may seem time-consuming, the author notes that not all points need extensive review at every visit. Implementing this checklist can streamline office flow, prevent critical omissions, and ultimately enhance the quality and effectiveness of care by ensuring a comprehensive and patient-centered approach.

This article provides a practical update on the Advance Beneficiary Notice (ABN) form, which has been revised by the Centers for Medicare & Medicaid Services (CMS) and is now valid through March 2029. The author clarifies the specific use of this crucial document in a chiropractic office. An ABN is required when a Medicare-covered service—specifically spinal manipulation (CMT)—is expected to be denied for not being medically necessary. When properly signed, the claim is submitted with a GA modifier, transferring financial responsibility to the patient. A common area of confusion is the use of ABNs for statutorily non-covered services like exams, therapies, or X-rays. While technically permissible, the author strongly advises against this practice because it can confuse patients, as Medicare never covers these services anyway. The recommended best practice is to use a separate "Medicare financial policy" or agreement for all non-covered services. This document clearly states that these services are never paid by Medicare and that the patient is always financially responsible. By reserving the ABN strictly for potentially non-covered spinal CMT, chiropractic offices can minimize patient confusion, enhance compliance, and align with the intended purpose of the form.

The current continuing-education (CE) system for chiropractors is fragmented, inefficient, and holding the profession back. While intended to ensure competence, it has devolved into a costly, box-checking exercise bogged down by regulatory roadblocks. The author highlights how the same educational program can face inconsistent approval processes across different states, not due to content quality but procedural issues. This duplication of reviews adds significant financial burdens on providers, which are ultimately passed on to clinicians. Perhaps most critically, the system discourages engagement with scientific literature by often refusing to grant credit for structured journal reviews, implicitly valuing lecture time over evidence-based learning. This contrasts sharply with medical CE systems, which are more centralized and predictable. The author proposes a modern approach: nationally approved courses should be broadly accepted without redundant state reviews, boards should have clear approval timelines, credit should be expanded to include research activities, and reporting systems should be interoperable. These reforms would strengthen professional standards by redirecting resources toward learning that truly improves patient care, ensuring the profession remains adaptive, evidence-informed, and trusted in a complex healthcare environment. The goal is competence, not just compliance.