ChiroMasterMind

One of the questions I get asked most frequently about the Functional Movement Screen is how I implement it into my evaluation procedure and what type of system I use based on the results. Well, I decided to give everyone an inside peek at my thought process whenever I have a new client coming in for the FMS. My perspective will be from a Sports Medicine point of view, but it can apply to any fitness professional. The thought process of gathering information is what you want to duplicate. The FMS is a system for movement evaluation, but it is also a process for gathering information about what your client should and should not do when exercising.For those unfamiliar with the FMS, here is a brief overview. The (FMS) Functional Movement Screen is exactly what is implies; a screening for movement. It was created by Gray Cook, PT and Lee Burton, Phd. to look deeper into movement patterns, particularly dysfunctional movement of the body. It consists of seven movements; Deep Squat,  Hurdle Step, In-line lunge, Shoulder Mobility, Active Straight Leg Raise, Trunk Stability Push-up, Rotary Stability. There is a scoring system of a possible 21 point perfect screen. These seven tests are designed to be used on a client who is NOT in pain. If someone experiences pain during a screening, it should be discontinued and further evaluation by a health professional is recommended to diagnose the cause. Why should the screening be stopped with pain? Movement patterns will be altered because a patient will compensate for pain and results may be skewed. Health professionals can utilize a more detailed evaluation to look at dysfunctional movement via the (SFMA) Selective Functional Movement Assessment, created by Gray Cook, Phil Plisky and Kyle Kiesel. This assessment is used to discover where the non-painful dysfunctional movement pattern exists that is causing the pain.  You can visit www.functionalmovement.com to locate a healthcare provider in your area who is trained in the SFMA. Working directly with a healthcare professional who understands the primary role of movement is in the best interest of your client. They understand the ‘lingo’ and also work directly with you as a fitness professional in restoring proper function.

Tags: General by Dr. Perry
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When determining how to apply laser therapy there are a few key factors to consider.

 Laser Power Power affects penetration, dosage, and treatment time. More power offers deeper penetration, higher therapeutic dosages, and decreased treatment times. Lasers are classified by power. Class 3 ‘cold lasers’ are at maximum power output of 500mw from a single laser source. Class 4 lasers are anything over 500mw.You cannot make up for insufficient power by increasing treatment time. Depth of tissue penetration will not increase with more application time if you have insufficient power. Positive results require more than increasing time.                                         65% of laser energy is absorbed in the skin and subcutaneous tissue layers with the following having a high affinity for absorption:• Hemoglobin in blood

• Melanin in skin, hair, moles, etc

.• Water (present in all biological tissue)In order to overcome these factors one must start with large quantities of energy to reach the deeper target cells and myofascial structures with a required dose.

Optimal Dosage

Dosage is the single most important parameter for a successful outcome in laser therapy. Too little, or too much energy produces no effect. There is an ‘Optimum Window’ of therapeutic dosage. The matter of correct dosage is very complicated, since a number of factors must be taken into account including laser wavelength, power density, type of tissue, condition of tissue, acuteness or chronicity of the problem, skin pigmentation, treatment technique, and depth of target tissue.  

The primary factors in laser therapy that determine dosage is power and time.  DOSAGE = Power x Time While power is the amount of energy measured at the source of the beam, dosage is the amount of energy delivered to the skin and target tissue. Dosage may also be referred to as energy density or fluence. Its unit of measure is the Joule (J). Current industry dosage application requires 1- 4 J/cm2 for superficial, and 4-10J/cm2 for deeper conditions.   Therefore, a 50cm² deep tissue area may require up to 750J for maximum effect. 

 Optimal Wavelength

Light characteristics are determined by its placement along The Electromagnetic Spectrum.  Wavelength is calculated in nanometers (nm). The ideal range for therapeutic lasers is along the Invisible Red (IR) spectrum of 790-970 nm. IR beams penetrate deeper into the body for increased effects on cellular tissue.  Wavelengths in the Visible Red (VR) 600’s nm spectrum are ideal for superficial conditions and limited in deep penetration. Wavelengths above a 1000nm lose therapeutic value and crossover into surgical laser applications. Deep therapy applications such as spinal stenosis, disc herniations, hip derangements, trigger points of spinal intrinsic stabilizer muscles and neuropathic conditions are inherently more responsive to the Invisible Red (IR) wavelength. 

 Proper Diagnostic Procedures

Simply treating the symptomatic area will not give you maximum clinical results in laser therapy. It is vitally important to treat the underlying kinetic chain referral and compensation patterns which contributed to the problem. High power deep tissue laser allows you to treat many of these contributing areas with proper dosage during a single therapy session.  The key is to address dysfunctional painful (DP) patterns in combination with the dysfunctional non-painful (DN). By utilizing special evaluation procedures from the SFMA™ (Selective Functional Movement Assessment), created by Gray Cook, MSPT, OCS, CSCS and Kyle Kiesel, PT, PhD, ATC, CSCS you can implement an integrated model to address regional interdependence to locate the non-painful dysfunctional areas.   What you will typically find with chronic back pain sufferers is involvement with ankle, hip and thoracic spine hypo-mobility combined with knee, pelvic and lumbar instability. 

Tags: General by Dr. Perry
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Fascia is the most overlooked system in the human body when it comes to rehabilitation, pre-habilitation, and the recovery phase of athletics or injury. Fascia is the missing element to unleashing one’s potential. Currently the traditional medical system treats every other system except the fascial system when an athlete gets injured or when treating chronic pain. Although there are several forms of work that specifically address fascia, most people are unaware of the different types of fascial work that can be done to facilitate healing, optimize performance, and provide the answers to many questions when it comes to dealing with chronic pain.  What is Fascia?

Fascia is a specialized system of the body (connective tissue) which plays a critical role in the support of our bodies. Fascia is a very dense connective tissue which envelops every muscle, bone, nerve, artery, and vein as well as all of our internal organs. It is an intricate, 3-D web that supports your organs and joints from head to toe and acts as a shock absorber to the body. The fascial system is actually one structure that exists from head to toe without interruption. When there is tightening or restriction in one place, you can feel pain and dysfunction in another seemingly unrelated location. Most people stretch the painful area with little lasting results, while neglecting to stretch the actual site of dysfunction. Always stretching and never improving!

Perry Nickelston, DC

www.stopchasingpain.com

Tags: General by Dr. Perry
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Here is a posting from my good friend Joe Heiler, PT. A brilliant clinician. Enjoy.

Core stability and core strength are terms that are often used interchangeably when speaking about training the trunk musculature and spinal stabilization. The fact is that they are quite different. Training for core stability requires resisting motion at the lumbar spine through activation of the abdominal musculature as a whole. Training for core strength allows for motions to occur through the lumbar spine in an attempt to work the abdominal or back musculature, often in an isolated fashion.   Looking at the functional anatomy of the lumbar spine, it does allow for movement in all three planes of motion but overall it is quite limited.

Tags: General by Dr. Perry
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Focus on great customer service.  When people are making more decisions than ever about what to do with their hard-earned dollar, you must convince them that getting rid of their ‘personal’ chiropractic care is not an option. Notice the word ‘personal.’ The more your care is personalized and customized, the more of a necessity it becomes. Focus on doing the ‘little things’ to make it even more personal: phone calls, regular and informative e-mails, periodic assessments and care plan goal setting, 100% focused attention during each session (PTC-Present Time Consciousness), educational handouts, etc. Give them an experience worth remembering. What motivates them to talk about your services to others? Wow them so they want to talk about you.

Perry Nickelston, DC

www.stopchasingpain.com

Tags: General by Dr. Perry
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When determining how to apply laser therapy for back pain there are a few key factors to consider. This is taken from my article published in Advance Physical Therapy Magazine this month.

Laser PowerPower affects penetration, dosage, and treatment time. More power offers deeper penetration, higher therapeutic dosages, and decreased treatment times. Lasers are classified by power. Class 3 ‘cold lasers’ are at maximum power output of 500mw from a single laser source. Class 4 lasers are anything over 500mw.You cannot make up for insufficient power by increasing treatment time. Depth of tissue penetration will not increase with more application time if you have insufficient power. Positive results require more than increasing time.                                         

65% of laser energy is absorbed in the skin and subcutaneous tissue layers with the following having a high affinity for absorption:

Hemoglobin in blood

Melanin in skin, hair, moles, etc.

Water (present in all biological tissue)

In order to overcome these factors one must start with large quantities of energy to reach the deeper target cells and myofascial structures with a required dose.

Optimal Dosage

Dosage is the single most important parameter for a successful outcome in laser therapy. Too little, or too much energy produces no effect. There is an ‘Optimum Window’ of therapeutic dosage. The matter of correct dosage is very complicated, since a number of factors must be taken into account including laser wavelength, power density, type of tissue, condition of tissue, acuteness or chronicity of the problem, skin pigmentation, treatment technique, and depth of target tissue.  

The primary factors in laser therapy that determine dosage is power and time.  DOSAGE = Power x Time While power is the amount of energy measured at the source of the beam, dosage is the amount of energy delivered to the skin and target tissue. Dosage may also be referred to as energy density or fluence. Its unit of measure is the Joule (J). Current industry dosage application requires 1- 4 J/cm2 for superficial, and 4-10J/cm2 for deeper conditions. ³   Therefore, a 50cm² deep tissue area may require up to 750J for maximum effect. 

Optimal Wavelength

Light characteristics are determined by its placement along The Electromagnetic Spectrum.  Wavelength is calculated in nanometers (nm). The ideal range for therapeutic lasers is along the Invisible Red (IR) spectrum of 790-970 nm. IR beams penetrate deeper into the body for increased effects on cellular tissue.  Wavelengths in the Visible Red (VR) 600’s nm spectrum are ideal for superficial conditions and limited in deep penetration.⁴ Wavelengths above a 1000nm lose therapeutic value and crossover into surgical laser applications. Deep therapy applications such as spinal stenosis, disc herniations, hip derangements, trigger points of spinal intrinsic stabilizer muscles and neuropathic conditions are inherently more responsive to the Invisible Red (IR) wavelength.

Perry Nickelston, DC

www.painlasercenter.com

Tags: General by Dr. Perry
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Some of the primary needs in life are food, shelter, and clothing. Most people already have fulfilled these needs. They have replaced these needs with desires of which their greatest is to feel appreciated. Following appreciation, they desire-and demand-respect. Simply stated, people want to feel important. Make them feel important by showing manners. Address them as Mr. or Ms. until you get their permission to do otherwise. Return their phone calls promptly. Respect their time and don’t keep them waiting long for an appointment. Say thank-you. It’s the small things that matter most.

Life is a sale. And the path to success at both living and selling is the same. Serve your patients with the passion you have for chiropractic, but always remember you are a business first. To help people you must first attract them to your services. Take the time and continue learning how to become a better you. I guarantee it will bring you more rewards in practice and in life.

Perry Nickelston, DC

www.stopchasingpain.com

Tags: General by Dr. Perry
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· When you are telling stories.

Tags: Practice Tips of the Day, General by Dr. Perry
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Are you serious Dr. Perry? Yep! That’s right. Feedback is the breakfast of champions. Ask your patients what you can do better to assist them; ask your employees how you can be a better boss. Embrace the feedback and be open and willing to improve based on what you hear. If you ask for advice and never change behaviors, this system will not work. It’s amazing how your entire life can change from asking a better question. If you don’t like the answers you are getting, that’s too bad. Get over it! More often than not, the intensity of your reaction will help prioritize the areas which need the most work.

Everything in life you desire, lies just outside your comfort zone. So get out there and start stepping!

Perry Nickelston, DC

www.stopchasingpain.com

973-800-6570

Tags: Practice Tips of the Day, General by Dr. Perry
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Here are some tips taken from one of my favorite books, ‘The One Minute Entrepreneur’ by Ken Blanchard. Check it out today. Fantastic advice…plain and simple!

Part #1: Building a Firm Foundation.

• Be guided by values such as integrity, love, honesty, and purposeful work, because they’ll be the foundation your life is built on.
• Write your values down and read them everyday.
• Associate with people you admire and can learn from.
• Keep a notebook of the wisdom you read, hear, and learn.
• You never need to cheat to win.
• What is right is more  important than who is right.

Part #2 Growing in Knowledge

• You’ll be the same year after year except for the people you meet and the books you read.
• You can get what you want in life if you help other people get what they want.
• Lead with your ears.
• Success occurs when opportunity and preparation meet.
• It’s not who you know that counts; it’s who knows you and what they think of you.
• When you feel moments impacting your destiny, seize the opportunity.

Next time we will cover ‘Learning the Craft’ and ‘Catching the Business Bug’.

Perry Nickelston, DC

www.stopchasingpain.com

973-800-6570

Tags: General by Dr. Perry
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