ChiroMasterMind

There are do’s and don’ts for success in laser therapy. Satisfy these Ten Commandments and you will find your clinical success rates increase and patient satisfaction will soar to new heights. Now that is a pretty good deal. Here they are. Short, sweet, and to the point. Oh and if you don’t believe they are all important, try doing all ten and then take one away. Watch what happens. I dare you.

1. Proper Dosage- Yoy must get between 4J/cm2 – 10J/cm2 on tissue to have a therapeutic response. For instance 50cm2 deep tissue area will require up to 750J for proper response.

2. Wavelength-Determines penetration. For deep therapy stay in the IR (Invisible Red) range of 790-1000nm. Most common is the 800nm range. Wavelength is measured in nanometers. VR (visible red) in the 600nm range is too superficial for deep penetration. Don’t believe me, read a physics book. Get the right wavelength or results decrease.

3. Skin on skin-Laser must be in contact with the skin or exposed to skin surface. Adequate dosage cannot be obtained through objects like clothes, furniture, etc. Just use common sense. If it seems stupid, it usually is. Or better yet. Try it on skin and then through clothes. See which works.

4. Power-Higher power decreases treatment time and increases laser photon energy deeper into tissue. 500mW compared to 10,000mW is a big difference in dosage and penetration. Low powered lasers do work, but it takes longer for a session and longer to get results. (In my experience)

5. Proper Diagnosis-No laser in the world will help if you aim it at the wrong spot and simply chase pain. You should have an improvement within 3 visits or you are doing something wrong. Usually too low a dose or wrong diagnosis.

6. Nerve Root-Always treat the nerve root associated with any physical condition. For Example. Tendonitis in the elbow can be caused by nerve root adhesions which shorten the muscle and increase length tension relationships at the origin and insertion resulting in inflammation.

7. Treat Proximal to Distal-Always treat the spine first and then the peripheral area. You need to free up the lymphatics and nerves. This makes for a greater feedback mechanism of laser energy.

8. Treat enough times-Most conditions takes 3-6 visits with a high power laser and as much as 10-20 with a lower power laser. Depends on the dosage they get each session and if the diagnosis is correct. Tell the patient up front what the time frame is for healing.

9. Don’t over treat-Too much laser is just as bad as not enough. Just because you have higher power does not mean you kill the area with joules. Too much will inhibit cellular healing. You may get rid of pain, but ultimate healing is the goal. Follow the dosage rule above and you will be fine. Be wary of too much laser in one session and in one area.

10. Pick a Niche-Master a condition and become known as the “Guru’ of that injury and you will become so busy they will be turned away. For example: Be the ‘Shoulder Pain Laser Doctor’. Specialize or perish! Business 101.

Take time to learn the truth about lasers. Don’t even take my word for it. Research and see who is telling you the truth. Fancy brochures, pictures and sales tactics may make you buy a laser, BUT it will come back to haunt you and your patient’s when the results are poor. Reality speaks for itself by results!!

Dr. Perry Nickelston, DC

VP Practice Development, K-LaserUSA

1-866-595-7749 Ext. 102.

www.k-laserusa.com

Tags: Class 4 Laser Therapy, General, Integrative Treatment Strategies by Dr. Perry
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There are 6 hormones chiefly responsible for determining whether the food we eat ends up as muscle, fat or get burned as energy.  They are: insulin, glucagon, growth hormone, thyroid hormone, cortisol and epinephrine.    Over 90% of people who lose weight by caloric restriction return to their original weight within two years. This is because there is a weight-regulating center in your hypothalamus, which tries to maintain a constant body weight. (The hypothalamus and pituitary gland together represent the master endocrine gland of the body, controlling all of your hormonal responses.) It works like a thermostat by controlling your hunger level and your body’s metabolic rate. These effects are mediated by the nervous system and by hormones and enzymes involved in fat metabolism.   

If you want to change your body weight, or your body composition, you have to change the set point. The ratio of insulin to glucagon is perhaps the most important determinant of the set point. Both insulin and glucagon are produced by the pancreas, but have opposite effects. The concern of these hormones is blood sugar regulation. After eating a carbohydrate, it is digested and sent into the bloodstream as glucose. As blood glucose levels rise, so does the release of insulin, which is required to move glucose into muscle cells for use as energy or to be stored as glycogen. If blood sugar levels rise too quickly, a large insulin release results. When this occurs, some of the glucose can be converted and stored as fat instead of being stored as glycogen in liver & muscle.   

Glucagon is released when blood glucose levels become too low. This hormone prepares fat to be used for energy as well as muscle glycogen stores. The net result is to keep blood glucose levels normalized. By manipulation of the diet, you can regulate the insulin to glucagon ratio. .  Excess insulin cannot create muscle mass, but it will promote fat storage. It’s not the calories in sugar that make you fat – it’s the insulin response. READ THAT AGAIN!  When you eat carbohydrates they are digested and absorbed by the small intestine and transported directly to the liver via the portal vein. Essentially, all of the carbohydrates you eat are converted to glucose by the liver before being released into the bloodstream.

   This is why it is vitally important to detoxify and cleanse the liver before starting a weight reduction program. The liver must be functioning at 100% capacity to metabolize carbohydrates effectively. Fitness nutrition is NOT about how good you eat, it is all about WHAT nutrients your body can absorb to permit weight loss!

   Glucagon is released several hours after a meal when blood sugar levels drop. Glucagon has the effect of reducing glucose for energy and stimulating breakdown of body fat and the use of fat for energy. Glucagon also stimulates the glycogen breakdown.The net result of glucagon is to raise the glucose levels back to normal and to signal the body to begin using fat for energy since it’s running low on carbs. This is how the body acts to regulate blood sugar levels. Insulin decreases blood sugar by moving glucose into the cells, stimulating glucose burning for energy and increasing glycogen stores by shifting the metabolism from carb-burning to fat-burning.   Remember, if insulin is present, fat burning is negative! This is why you only have high amounts if simple carbs after your workout. Because you carbed up AFTER the workout when it is most important and any further influx of carbs is going to leak out of a fully carbed up muscle and go to fat.

www.K-LaserUSA.com

1-866-595-7749 Ext. 102

Dr. Perry Nickelston, DC

VP Practice Development

Tags: General, Integrative Treatment Strategies, Practice Tips of the Day by Dr. Perry
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‘Oh the economy is so bad!’ ‘How can I afford to invest in new equipment with the economy?’ ‘Our business is suffering from the economy!’ ‘It’s too expensive to advertise now with the cost of living!’ EXCUSES ALL!

If you want to be rich, successful and happy you have got to get your mindset straight right now! Thinking like this will inhibit your progress and you will attract hardship and lack into your life if you are always negative. WEALTH is a state-of-mind. You can’t get it until you believe you can get it. This is not pollyana positive mental attitude stuff. This is a Law. The Law of Attraction. Ever heard of it? If you are successful then I know you have. if you are struggling and poor then I know you have not, or chose to ignore it in disbelief. Rich and successful doctors can duplicate their status in any economy, ‘Good or Bad!’

 The time to invest in new equipment, new marketing, new employees, etc., is when the competition is NOT. They are scared too do it! But not you. You realize that competition is tough and it is the time to strike out with focused direction, innovation, and desire. Burning desire to succeed. Pain never follows the economy. What does that mean? Even in a ‘so called recession’ people are still suffering and pain is a great motivator. What do you offer them that is unique and different from the competition?

So the next time you are feeling sorry for yourself and the state of the economy suck it up and realize that success is dependant on two things, YOU and ACTION!. You have to do something about it. So stop whining and start thriving.

Here are some hints to start.

1. Buy new progrrssive technology and offer it to your patients (Class 4 laser, Decompression)

2. Do more grassroots marketing to appeal to the human need for value and appreciation.

3. Spend 30-minutes a day reading positive material to improve your life.

4. Stop watching the news. Better yet the TV entirely.

5. Spend 30-minutes a day going over your goals. You do have them written down right. If not they are just wishes, not goals.

6. Call 5 old patients everyday and check up on them. YOU, not the staff.

7. Find a mentor and talk to them on a weekly basis to keep your head into success. Buy Think and Grow Rich by Napolean Hill and read it everyday. Success leaves clues. Follow the greats.

 8. Send out 5 ‘Thank You’ notes a day to exisiting patients to appreciate them.

Have fun and be the one who does not follow the recession crowd. It’s a shorter line to the front. Trust me.

Dr. Perry Nickelston, DC

www.k-laserusa.com

1-866-595-7749 Ext. 102

Tags: Integrative Treatment Strategies, Practice Tips of the Day by Dr. Perry
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If your low back pain patient is not responding to traditional therapy try to laser the Quadratus Lumborum bilaterally. I recommend 1500 joules per side for a total of 3000 joules a session. This amount of energy is necessary since 65% of this joule number is lost at the superficial layer of tissue. To reach the deeper tissue of the QL with adequate laser photon energy you need higher amounts of joules. Don’t believe me? Try it with lower dosages and then with my recommendation. See for yourself. Real world results speak for themselves. Ask the patient. They will tell you. Better yet, watch them get better before your eyes.

Make sure the patient is side lying to reach the muscle effectively. Pay close attention to he origin at the 12 rib and insertion on the iliac crest. Medial and lateral branches. Good luck and have fun. Patients will often notice an immediate decrease in pain. It usually take about three sessions for resolution of these points.

Dr. Perry

PS. Don’t forget to check satellite trigger points in the Gluteus Medius and Minimus! Always adjust POST laser. And NEVER neglect checking the bilateral psoas muscles. They are always involved with a QL problem. You can alternate laser applications and trigger point therapy from the QL to the psoas until resolved.

Dr. Perry Nickleston, DC

VP Practice Development, K-LaserUSA and Clinical Director of the Pain Laser Center, LLC in Ramsey, NJ

1-866-595-7749 Ext. #102

Tags: Class 4 Laser Therapy, General, Integrative Treatment Strategies by Dr. Perry
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Tags: Class 4 Laser Therapy, General, Integrative Treatment Strategies by Dr. Perry
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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: General, Integrative Treatment Strategies, Practice Tips of the Day by Dr. Perry
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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: Class 4 Laser Therapy, General, Integrative Treatment Strategies by Dr. Perry
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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: General, Integrative Treatment Strategies, Practice Tips of the Day by Dr. Perry
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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: General, Integrative Treatment Strategies, Practice Tips of the Day by Dr. Perry
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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: General, Integrative Treatment Strategies by Dr. Perry
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