ChiroMasterMind

Tags: Integrative Treatment Strategies, Class 4 Laser Therapy, General // Add Comment »

Ok here is a quick post before I leave for the NAALT (North American Association of Laser Therapy) Convention in West Palm Beach, Florida. Talking about and playing with therapy lasers all week. Now that is the definition of fun. I will be representing K-LaserUSA at the show. If you are going, make sure you stop by to say hello and I will even give you a laser treatment.

Knee pain can be complex to treat, especially with undetected trigger points causing unrelenting symptoms. The next time you have a patient with knee pain, make sure you evaluate the following muscles for trigger points. Some will be the actual culprits referring pain to the knee and others will be Kinetic Chain Dysfunction trigger points altering mechanical function of the joint. CHECK THEM ALL!

1. Vastus Medialis Obliques2. Vastus Lateralis

Is this a lot to check? Yes! Will it make the difference? Yes! So take the time to check them all. Once detected work out the knots either via laser, manual therapy, or ultrasound. Of course you probably know my favorites. Laser each TP with 150-200 Joules and then do manual trigger point therapy. Great combination.  Have fun.

Oh yeah and don’t forget to check the femur head for anterior rotation, the knee joint and fibular head as well as the L3 vertebrae and Si joint. But of course you already knew that, right?

Dr. Perry NickelstonVP Practice Development K-LaserUSA

Tags: Integrative Treatment Strategies, Practice Tips of the Day, General // Add Comment »

Law (noun); a statement of a scientific fact or phenomenon that is invariable under given conditions.

Success (noun); the achievement of something planned or attempted.

Law #2: Proper Training and Diagnosis.

A laser is only as good as the clinician behind its appication and the proper diagnosis. Point the best laser in the world at the wrong spot and you get minimal results at best. To obtain phenomenal success you MUST have sufficent training and knowledge of laser applications.

Unfortunately, after a sales rep hooks you in with a laser purchase their job is done. Their only priority is usually selling you a laser, meeting a sales quota, and keeping a job. Subsequent training usually involves showing you how to turn on the equipment and wishing you good luck. I see it all the time!

Using the different laser tips. Understanding the difference between CW and Modulation Laser Safety: review manual Laser Contraindications review manual: Eyes, do not treat thyroid, Cancers, Pregnancy, patients that have had a steroid shot within 7 days of treatment, patients that are taking photosensitive medication.

Risks of treatment Protocols: Presets, and Manual settings Techniques: Sweeping technique, and contact methodConditions: Go over different conditions with doctor and how to treat them.

How to treat Shoulder, Knee, Cervical, Wrist, and Low Back. Integrating muscle work into treatment (ART, MRT, TPT, MFR) Kinetic Chain assessment techniques Understanding chronic cases and secret problem areas to search for Biomechanical compensation syndromes (Avoid common treatment mistakes)

Available for support anytime via personal phone calls Understanding adjusting power settings and frequency changes Make sure your trainer is available for future consultations and continued support. Once trainers walk out the door after your purchase-they can be impossible to reach for help. Marketing, PR, patient education, reimbursement, and other value added material should be provided. Public relations and instructions on public speaking with “Patient Education Lectures”, “Open Clinic Nights” and “Lunch & Learn Programs.”

Tags: Class 4 Laser Therapy, General // Add Comment »

So the newest and hottest rage going in the world of low level laser therapy is it’s use in helping people to quit smoking. I’m sure you have heard all the radio commercials and seen all the print adds boasting high success rates. Should you get into this type of therapy? How successful is it? How does it work? All great questions that I will attempt to answer.

The laser stimulates acupuncture points in the ear, face and hand that release special hormones called “endorphins.” These endorphins are the body’s natural “feel good” hormones that are produced whenever someone smokes a cigarette. By stimulating a surge of endorphins the individual no longer has physical cravings for the addictive behavior.

There are 5 major nerves that innervate the ear. 

1.   Vagus Autonomic is a branch of the PNS

2.   Trigeminal Nerve goes to the facial muscles, nerves and bones

3.   Facial Nerve controls facial m uscles and taste.

4.   Cervical Plexus innervates head, neck and shoulder.

5.   Glossopharyngeal innervates the mouth and throat 

Laser auriculartherapy is applied to acupuncture points in the ear and meridian points of the body. It does not focus on the acupuncture meridians but on the use of the ear as a localized reflex technique that modulates the central nervous system and endocrine system.

Auricular therapy points (AT) emerge only when there is pathology. These AT points correspond to anatomy and neurology. AT points have lower skin resistance and this is helpful in locating points. The ear contains tissue from all 3 germ layers from embryological development; endoderm, ectoderm, and mesoderm. Success rates can be very high depending on the type of laser you have for the procedure. For example: A 500 mW Invisible Red Laser with Wavelength of 820nm will give you different success rates than a 200mW Visible Red Laser with a Wavelength of 635 nm. The physics of the laser stimulation are totally different despite having the same doasge applied. It can be frustrating to learn a protocol because there are so many variations, and people will recommend their own lasers for use. Be careful where you go and what laser you use. All protocols are not the same. They can be hugely different. If you want to know my recommendations you may call me directly or e-mail me for the information.

 It is important for the patient to realize that Laser Therapy for addiction control can only be effective if they psychologically want to give up their addiction.  No amount of hormone stimulation can override their mental habitual cravings.  Laser therapy is not a quick fix program. There is a degree of self responsibility that comes with overcoming any addiction. It takes about 20-minutes for the procedure.

Dr. Perry Nickelston, DCVP Practice Development, K-Laser,USA

1-866-595-7749 Ext. 102

www.k-laserusa.com

pnickelston@k-laserusa.com

Tags: Integrative Treatment Strategies, Class 4 Laser Therapy, General // Add Comment »

Every great leader knows the value of a positive Attitude. In short ATTITUDE IS EVERYTHING! Talent is not enough to ensure success in chiropractic. There are a lot of very talented doctors who graduate from the top of their class, and yet they never become successful in business. Why? You would think that they of all people would be ensured of success. There are one of two reasons why. ONE: Zero business and communication skills TWO: Wrong attitude! Your attitude and your potential go hand in hand. Attitude is an inward feeling expressed by behavior. That is why an attitude can be seen without a word being said.

Attitude determines your ability to deal with people. The Stanford Research Institute says the money you make in any endeavor is determined only by 12.5% by knowledge and 87.5% by your ability to deal with people. Let’s do some math now.

87.5% people knowledge (attitude) + 12.5% product knowledge = Success

Where do you think you should be devoting your time after you graduate from school? Better yet, where should you be investing time WHILE still in school? Get ahead of the pack. The key to having a good attitude is the willingness to change. You are either the master or the victim of your attitude. It is a matter of personal choice. Who we are today is the result of choices we made yesterday. Tomorrow will become what we choose today. To change means to choose change. If you want to have a great attitude then make the following choices.

Choice #1: Evaluate Your Present Attitude-What is your starting point?
Choice #2: Write A Statement Of Purpose-Write specifically what you desire to accomplish, verbalize it everyday and take action!
Choice #3: Have The Desire To Change-Do you really want it?
Choice #4: Live One Day At A Time-Take it day by day and make subtle changes. The thought process will become a habit.
Choice #5: Change Your Thought Patterns-Thoughts become things. You are what you are because of your dominating thoughts.
Choice#6: Choose To Have The Right Attitude-You are the only one who can determine what you will think and how you will act.

The greatest battle you wage against failure occurs on the inside, not the outside. Every successful doctor in practice makes the following words a part of their vocabulary. Do it and you will too.

I can…I will…Expect the best… I know…I will make the time…Positively…I am confident…I do beleive…(promote) You…All things are possible.

Dr. Perry Nickelston, DC
VP Practice Development, K-LAser,USA
www.k-laserusa.com
1-866-595-7749 Ext. #102

Tags: Integrative Treatment Strategies, Practice Tips of the Day, General // Add Comment »

In one word, YES! Wavelength is critical to the success of your intended clinical application. Therapeutic lasers require deeper penetration to stimulate various tissue layers to promote optimal healing. Infrared wavelengths penetrate deeper by the laws of physics and science. Visible red lasers do not. Lets learn more.

The wavelength of light is measured in billionths of a meter, or nanometers (nm). The shorter the wavelength, the greater the energy carries. As wavelength becomes longer, the energy carried is less. Some wavelengths work better than others. Wavelength is the prime determinant of tissue penetration. 

The wavelength is very specific for cell absorption. In the IR (Infrared) spectrum, the longer wavelengths penetrate deeper and a greater percentage of the laser light will be transmitted in a forward direction. This means less scatter and better results!

 Laser therapy wavelengths vary from 630nm up to 1100nm depending on the manufacturer and your desired effect. The wavelength chosen for therapeutic laser must be capable of reaching its intended target.  Skin is permeable to light between 600nm and 1300nm. This is referred to as an ‘optical window”, and most light therapy is between these wavelengths.The wavelengths most commonly used for therapeutic purposes are 633 nm (HeNe lasers), 635 nm, 650 nm, 660 nm, 670nm (InGaAIP lasers), 780 nm, 820 nm, 830 nm (GaAIAs lasers), 904nm (GaAs lasers),  

Lasers that do not penetrate as deeply (630 - 740nm) are suitable for acupuncture point stimulation and wound healing but have not proven their clinical efficacy with deep musculoskeletal conditions. Infrared lasers (750 - 1500nm) penetrate deeper tissues and stimulate trigger points, ligaments, joint capsules, and intra-articular structures 

In my experience, Gallium-Aluminum-Arsinide (GaAlAs) lasers are effective over a wide therapeutic range and have very good depth of penetration. Laser treatment at more than one wavelength is likely to enhance results. Combining multiple wavelengths during the same session, one is likely to trigger additional biochemical/energetic pathways and a total higher dosage can be given.  CLINICAL PEARL:Ask your laser manufacturer what the wavelengths are and if the laser has multiple wavelengths from the same optical fiber. Very important to determine if you will need to purchase multiple wands and fibers. (Multiple wands can be EXPENSIVE) 

 Dr. Perry Nickelston, DC

VP Practice Development K-LaserUSA

Director of the Pain Laser Center, LLC in Ramsey, NJ

www.k-laserusa.com

www.painlasercenter.com

1-866-595-7749 Ext. #102

Tags: Class 4 Laser Therapy, General // Add Comment »

Ok Perry. What the heck are you talking about this time? You have officially lost your mind. Yes, while that is true, it still does not take away from the power of this question. What do I mean by this question? Let me tell you a story…

One of the most influential marketing consultants in sports had the job of turning around the dismal attendance at NY Nets basketball games. I mean, you could not give these tickets away and season ticket holders were not renewing in droves. They were losing millions! They had to find a way to get season ticket holders interested enough to open up a letter with new offers for the Nets upcoming season. Problem was, most fans were so disgusted with the team they just threw out the letters whenever they arrived in the mail. What to do? This consultant said, “I know, rubber chickens!” He sent full size rubber chickens via Fed-Ex to all season ticket holders and wrapped the season ticket offers around the leg of the chicken. Was that insane? YES. Was that outrageous? YES Did it work? YES. They were certainly curious and opened up the letters. Mission accomplished. 80% renewed for the season.

What is the moral of this story? You have to find your rubber chicken. What can you do that is crazy, outrageous and nuts in regards to marketing your services? Something that will get potential patients to take notice of you. Maybe you can have a Chiropractic Weenie Roast inviting families to attend. Sponsor a Hot Dog eating contest. Host a roller skating rink party-Skate for Your Spine. Sounds nuts? Good. Then it will probably work. Beats a newspaper ad anyday of the week. Get creative. If you don’t your competition will.

Dr. Perry Nickelston                                                                                           

VP Practice Development for K-LaserUSA

www.k-laserusa.com

1-866-595-7749 Ext. 102

www.painlasercenter.com

Tags: Integrative Treatment Strategies, Practice Tips of the Day, General // Add Comment »

At your core, there’s an incredible athlete. Lean and powerful. Strong, but still flexible. Use your core to transform your body—and your life, turn back the clock, speed up your metabolism, trim your waistline, build muscle, permanently rid yourself of nagging back pain and gain unlimited energy.  Sound good?  It can become a reality for your patient’s with a ” Core Regeneration Program!” 

So what is the core you say?  Good question. Lets start learning. 

The major muscles of your core include:

• Transverse Abdominis (TVA)-The deepest of the abdominal muscles, this lies under the obliques (muscles of your waist). It acts like a weight belt, wrapping around your spine for protection and stability.

• External Obliques-These muscles are on the side and front of the abdomen, around your waist

• Internal Obliques-These muscles lie under the external obliques, running in the opposite direction.

• Pelvic Floor- These muscles are responsible for support of your internal organs and abdominal contents.

• Multifidus-Responsible for stabilizing the spine and pelvis directly prior to limb and trunk movement.

Why should you care about the core?
Core strength enhances your overall fitness level. Your body moves more efficiently and gracefully. You gain more power in athletic moves and other exertion. And you’re less prone to injury and muscle pain. When your core muscles are weak, other muscles compensate by doing work they’re not intended to, and you’re more likely to wind up with chronic debilitating back problems and injuries to the knee joint.

Weak core muscles contribute to all kinds of problems in the body, the most prevalent of which is lower back pain. By strengthening the muscles that help support the spine and improve posture, you can dramatically decrease the symptoms of lower back pain. Picture your spine as a column of soda cans stacked one on top of the other. If you wanted to keep that column standing up under stress, what do you think would work better: a “tenser” bandage (as is used for wrapping injured ankles) or Scotch tape? Sure the tape would keep the cans together but the cans wouldn’t receive a whole lot of support, would they?

When you strengthen the muscles of the core, you are in effect turning that Scotch tape into a nice, tight “tenser” bandage, increasing the amount of support that your spine gets. Core training also has the potential to greatly improve sports performance. The core is the one area of the body that will always give you a great return on your investment.

So how do I train my core muscles?
Exercises that work the abdominals and the lower back are the staples of core training. Also, exercises that target the stabilization and power-transfer duties of the core muscles are very effective.  Here is brief exposure to the beginning of core training.  (A personalized one-on-one program is designed for patients.)

The exercise is known as the Abdominal Sit-Up. It uses a sit-up-like movement but focuses directly on the abdominal muscles rather than the hip flexors (which a regular sit-up does). It is also very safe for your lower back. Another advantage it has over the standard crunch is that it targets the stretched (arched back) range of motion of the abs, which is totally missed in standard floor crunch.

How To Do It:

Lie on your back on the floor. Roll up a towel or mat and slip it underneath your lower back, just above the waistband (the size of the towel affects your body position during this movement - use a fairly large towel). Your knees should be bent about 90 degrees. Keep your feet close together and knees fairly wide apart. This prevents the hip flexors from having a direct line of pull, helping to minimize their involvement. Do not anchor your feet or have someone hold them down. This automatically activates the hip flexors. You will get the most out of this exercise by minimizing their involvement.The difficulty of this exercise depends on where you hold your hands. The hardest position is above your head at arms-length, then beside your head, then across your chest, then straight down between your legs or at your sides. You are now ready to begin. (Do 3 sets of 12-15 reps)

• Keeping your torso straight and stiff, start the sit-up by tightening your lower abs then lifting your upper body off the floor.

• As you continue up, imagine trying to push your face up against the ceiling (think up, not around).

• When you reach about 25 to 30 degrees above horizontal, hold there for a second or two and squeeze your abs hard.

• Keep your lower back in contact with the towel at all times and always maintain tension in the abs.

• Lower yourself down slowly and under control. Do not just drop back to the ground. The negative portion of this exercise is extremely effective. Take at least 3 seconds to lower down!

• Remember to adjust your arm position depending on the strength of your abs

If you were to ask me which muscle group in your entire body you could work to get the greatest benefits in the shortest amount of time, I would tell you without hesitation, “the core.” Strengthening the core can realize tremendous benefits to anyone regardless of his or her training experience and can do so very quickly.  Have fun with the exercise above.

Dr. Perry Nickelston, DC VP of Practice Development for K-laserUSA.www.painlasercenter.comwww.-k-laserusa.com

Tags: Integrative Treatment Strategies, General // Add Comment »

What do you do for a living? What is your profession? Most people will answer with the name of their job title; “I am a Chiropractor, I am an Accountant, I am a Painter.” Wrong! Wrong! Wrong!. You are a MARKETER first. You can’t BE a chiropractor unless you have a patient to care for. They have to be in your office for you to do that, get it? So stop trying to become a better doctor, that’s easy. Become a better marketing professional. That takes time, commitment and LOTS of failures. Here is a list of some of the marketing essentials you need to know and implement for lifeling practice and business success. So do it already…

Think outside the box. Have fun and enjoy.

Dr. Perry Nickelston, DC

1-866-595-7749 Ext. #102

www.k-laserusa.com

www.painlasercenter.com

Tags: Integrative Treatment Strategies, Practice Tips of the Day, General // Add Comment »

“I can’t close my bra in the back.” “The pain in my shoulder is terrible when I turn on it in bed at night. “It hurts like hell when I try to put on my T-shirt.” “The pain starts in my shoulder and goes down my arm to the elbow.” “The pain is so bad, that I can’t workout without pain.”  “Just thinking about exercise makes my shoulder hurt Doc!”

These are typical of the things I hear from patients consulting me about shoulder pain. Most ailments afflicting the shoulder have a gradual, often imperceptible onset. We keep thinking it’s going to get better, but our range of motion decreases progressively because of our natural avoidance of moving into pain. Muscles and tendons shorten, joints tighten and movements are more limited, until daily activities become so difficult we finally have to scream for help.

The shoulder is not a biomechanically efficient joint, nor is it one single joint. The head of the upper arm bone (humerus) sits rather insecurely in an extremely shallow cup at the outer upper angle of the shoulder blade (scapula) called the glenoid fossa. Essentially, it is held in place by the muscles and ligaments attached to it. Extreme movements in any direction, but particularly overhead and/or to the back, subject those tethers to stretching which eventually results in slight tearing of ligaments and tendons. The body attempts to protect these structures and sets up a reaction called inflammation. The inflammatory response is associated with swelling due to increased blood flow, further restricting motion and increasing pain.

MOST COMMON INJURIES FOR PEOPLE WHO EXERCISE

Rotator Cuff Injury. Tears in the rotator cuff can result from the progressive worsening of tendonitis, repetitive strain through overuse, or trauma- especially as a result of athletics. The gradual tearing of the rotator cuff is a process similar to a shirt wearing out- it gets more and more threadbare until the edges fray or a hole appears. This sort of rotator cuff injury can be difficult to repair surgically, and conservative treatment under the direction of a professional is often the best course of action.  A “clean” tear to the rotator cuff (due to trauma) can often be repaired surgically. Whether or not surgery is indicated, Sports Medicine treatment will almost certainly be involved in all stages of recovery.

Bursitis/Tendonitis go hand-in-hand. Inflamed bursa sacs and muscle tendons may become thickened and reduce the “free” space in the joint, thus restricting movement. In extreme cases some of the bursa sacs can be removed surgically; otherwise, the therapeutic approach to treating bursitis and tendonitis is similar.

Impingement refers to a condition, sometimes painful, in which the shoulder joint lacks enough room to function properly. Structural impingement is a “built-in” organic condition, e.g., a bone spur in the shoulder joint. This situation is usually the result of years of tendonitis, rotator cuff injuries, and wear-and-tear. It is important to note that structural impingement usually requires surgical intervention.Functional impingements often result from repetitive motion situations (such as pressing movements overhead with weight training). Stretching and rotator cuff exercises, along with proper CORE muscle balance training, can help prevent and alleviate functional impingement.

Trigger Points are “knotted” up muscles in the shoulder that cause significant debilitating pain and restricted movement.  The most effective treatment for these points is aggressive Orthopedic Sports Massage.      

TRAINING SECRETS   ********    TRAINING SECRETS

Balance your upper body workouts

A good way to avoid shoulder injuries is to make sure your upper body strength sessions are balanced. This means that every push or press exercise must be balanced with a pull or row exercise. Too many athletes and weight trainers focus on developing the ‘mirror muscles’, the upper trapezius, anterior deltoid and pectorals. As a consequence, the ‘non-mirror muscles’, lower trapezius, rhomboids, latissimus dorsi and rear deltoid, are underdeveloped. This leads to a muscular imbalance about the shoulder, which results in poor scapular stabilization. since the non-mirror muscles are the ones that work to stabilize the scapula. In addition, over-developed mirror muscles can lead to a round-shouldered posture, which incorrectly places the scapula up and forward. Redressing this imbalance is very important for the prevention and rehabilitation of shoulder impingement injuries

Limit your range of movement, and take it easy

Often this means avoiding certain ranges of motion where the shoulder joint sub-acromial space is compressed the most. The impingement zone to avoid is between 70 and 120 degrees of shoulder abduction (when you move the arm laterally away from the side of the body). To start training the non-mirror muscles, begin with the seated row, because the shoulder joint is not abducted in this exercise. Once the pain is completely gone, then introduce the overhead exercises such as pull ups and lat pull downs. You should be even more careful when it comes to the mirror-muscle exercises. I would avoid lateral raises, upright rows and shoulder presses completely for a while. However, incline bench press with arm abducted to 45 degrees would be a good choice to start again. Slowly build up to the normal bench-press range as strength improves.

Correct scapula positioning when performing exercises

The correct position for the scapula (shoulder blade) is back and rotated down. Essentially, this means maintaining a good ‘military posture’, with shoulders back and chest out. A round-shouldered or hunched posture is to be avoided at all times. To achieve the correct position, you need to use your rhomboids, mid and lower trapezius muscles to retract the shoulder and pull the scapula down.

When you perform any upper body weight training exercise, always get into the habit of starting with good upper body posture and pinching the shoulder blades together. You should feel that the scapula is a solid platform which keeps the shoulder correctly positioned while you perform the exercise. As mentioned last issue, a good way to learn the correct position is during the seated row exercise by keeping your scapula back and down while you move your arms. During the exercise, you should feel that the rhomboids and trapezius muscles are statically contracting to hold the scapula in place, and the latissimus is working to perform the movement. Once you have the feel for maintained scapula stability during the seated row, try to achieve it during all upper-body exercises. What you might find is that exercises such as the press up or front raise, where the shoulder may become impinged, will not be painful if you stabilise your scapula correctly. In effect, by using the scapular muscles you can achieve better shoulder mechanics and avoid injury.

Correct scapular stability is difficult to learn and demands a great deal of practice and concentration during your training sessions. You first need to understand what the correct position is, and often this requires a professional to guide you. Instruction and observation can help you achieve and maintain the correct shoulder position.

Avoid too many consecutive training days

The more consecutive training days you have, the higher your chances of getting hurt.  Consecutive days are counted as follows: if you train on Monday, Tuesday, Wednesday, and Friday, you are training on three consecutive days each week (Friday doesn’t count because it has a rest day before and after it). Studies show that reducing the number of consecutive days lowers the risk of injury. This means that if you train for one hour every day from Monday through Friday (five consecutive days), you could reduce your risk by completing 75- minute workouts on four days per week (Monday, Wednesday, Friday, and Saturday, for example). Your total training time (and gain in fitness) would be the same in each case, but the second strategy would reduce your consecutive days from five to two, giving you much more average recovery time between sessions and a lower risk of injury.

PROPER Stretching

Stretching to increase flexibility should never be done prior to training or competition, but instead done during ‘down’ times in the week. This is because of the suppression of the ‘stretch reflex’ that takes place during sustained passive stretching of muscle tissue (i.e., repeated holds of 20-30 seconds). If one were to do rapid forceful movements such as lifting weights straight after such passive stretching, there would be an increased chance of muscle and tendon tears. For flexibility every muscle needs to be stretched three to four times at 20-30 seconds each, and repeated three to four times per week. The best way to learn how to stretch the above areas is to be taught by a sports physiotherapist, sports conditionist or personal trainer. It is important not to stretch the ligaments of the shoulder, which in due time can cause laxity of the joint and potential instability.

If you have a shoulder injury and would like to try to treat yourself, please remember:

It would be wise to visit a Sports Medicine Specialist to rule out structural damage first, via X-rays, CT-Scan, US Scan or MRI, particularly if your shoulder joint experiences sharp catching pains, locking sensations, clunks, pins and needles or numbness, looseness or laxity, or the history of the injury was in any way traumatic, involving body contact or a fall.  The length of time it took to develop your problem will give you some indicator of how long you will need to persist with correcting the faults before the results will be felt. Don’t forget, that the pain is often only the tip of the iceberg, directing you to the real issue.

Dr. Perry Nickelston, DC VP of Practice Development for K-laserUSA.

www.painlasercenter.com

www.-k-laserusa.com

1-866-595-7749 Ext. 102

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