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Kinetic Chain Dysfunction

COMMON KINETIC DYSFUNCTIONS

There are three common kinetic chain dysfunctions you must be aware of to treat a patient effectively. These include the Lower Crossed Syndrome, Upper Crossed Syndrome, Pronation Distortion Syndrome.

LOWER CROSSED SYNDROME

A patient with lower crossed syndrome shows increased lumbar lordosis and an anterior pelvic tilt. There are muscles that are too tight and others that are too weak. The muscles that are too tight include gastrocnemius, soleus, hamstring complex, adductor complex, hip flexor complex (psoas, rectus femoris, tensor fascia latae), and the erector spinae. The muscles that are commonly weak or inhibited include posterior tibialis, anterior tibialis, gluteus maximus, gluteus medius, transverse abdominus, internal oblique, multifidus, and deep erector spinae. This pattern of tightness and weakness causes predictable patterns of joint dysfunctions, movement imbalances, and injury patterns.

Joint dysfunctions include:

• Subtalar joint • Proximal tibio-fibular joint

• Tibio-femoral joint • Iliofemoral joint

• Iliosacral joint • Sacroiliac joint

• Lumbar facet joint

Common movement dysfunctions include decreased stabilization of the lumbar spine characterized by excessive lumbar lordosis. This is caused by tightness in the hip flexors and lumbar extensors as well as weakness in the lower abdominals and lumbar stabilizers. Common injuries include hamstring strains, anterior knee pain, low back pain, sacroiliac pain, and hip pain.

Dr. Perry Nickelston, DC

www.k-laserusa.com

www.painlasercenter.com

1-866-595-7749 Ext. 102

 

Laser Dosage Calculation

Hey everyone! I will be out of town for a week on laser therapy training business. Filming an instructional DVD on clinical protocols for Class 4 lasers. Should be really cool! So don’t miss my posts too much. Just go through the past issues and learn from the beginning. In the meantime I hope this holds you over. Enjoy. :) Remember with laser therapy you are treating the PAIN associated with any injury!

Imagine an average sized apple. If you cut it in half, the surface area on one of the two halves is about 50 cm2.

Biostimulation occurs when 0.5-1 J/cm2 is delivered to tissue. (Let’s use 1)

Pain control requires 4-10 J/cm2 (Let’s use 5)

A superficial wound 3-4 cm large will require treating a total area of 50 cm2 to include a small amount of healthy surrounding tissue. Most wound protocols are programmed to deliver 2 watts with variable frequencies to stimulate a proper tissue response. (Average 1 watt) This delivers 1 Joule/second. We would need about 50 seconds to treat this area if it were a single cell layer. Wounds are multiple cell layers thick. Therefore, I usually would double the dose/treatment time for a wound of this size.

For example, I would treat this injury for 1.5 to 2 minutes maximum. You can extrapolate this same dose by imagining how many “apples” large each pain area is.

This same calculation works for deeper pain management. Let’s say you are working on the lumbar spine, treating an area four apples large. Therefore I need 200 cm2 X 5 Joules/cm2, or 1000 Joules. About half of the energy delivered penetrates below the dermis - we should multiply the dose by 2 to account for this. We need to deliver at least 2000 joules to the area for deep pain control. You can extrapolate this quick reference to treat larger areas.

Dr. Perry Nickelston

www.k-laserusa.com

www.painlasercenter.com 1-866-595-7749 Ext. 102

The Art of Networking (Don’t Make These Mistakes!)

Networking is the little known Secret Weapon of practice success. It is the most cost effective means to a referral based practice and creating ‘Raving Fans’.  In business, you don’t just want satisfied customer’s, you want ‘Raving Fans’. These are devoted patients who believe you are the BEST and ONLY doctor worth visiting. They would never consider leaving your practice and they tell everyone about your business.  

How do you create Raving Fans? One effective way is via networking. 70% of your business will come from some sort of networking. Word of mouth advertising is the key to long term practice growth and establishing a strong foundation for new patient acquisition.  Failing to develop this skill will negatively affect your financial future. Avoid these mistakes to ensure you don’t become just another doctor in town, or worse yet, a practice failure statistic. 

1.    You Don’t Have A ‘One-Liner.’
In most instances you have about 10-seconds to describe who you are and what you do. Failing to develop a powerful one-line description of your services can make or break first impressions.  Here is a good way to start. Take five pieces of paper. Assign one of the following sentences to the top of each sheet:

        *Who you are
        *What you do
        *Whom you do it for
        *How you do it
        *What happens as a result

Write down all the words, characteristics, ideas and phrases that pertain to each of these areas of your introduction. Have fun! Spend at least a few minutes on each sheet. The whole point of starting with this activity is to make your prospective patient feel you really understand what they are all about, and you’re there to solve their problem or fill their need.  Now it’s time to create the liner. An example might be: “I’m Dr. Xyz, and I renew people’s quality of life by eliminating pain with laser light.” I guarantee this will elicit a response. 

2.    Networking Part Time.

Is there a time and place for networking? Yes, ANY time and ANY place. There is never a wrong time to make a new connection and meet potential patients. Networking is an attitude. Every time you go outside the office, be prepared to tell others who you are and what you do. The biggest obstacle to success is anonymity. If they don’t know about you, how can they come to see you? Learn to be approachable in life. You are not only a doctor; you are an entrepreneur who must master the art of marketing to set yourself apart from the competition.  Read a new marketing book every month and implement one unique strategy every day.

3.    Wish I Had My Card

NEVER leave your practice without business cards!  An effective card is arguably the most valuable tool you can have in building a business. For those just starting a practice, sometimes it’s the only tool. Nothing is worse than being in a situation where you say, ‘I wish I had my business cards with me.” When you give out cards, make sure you give out two at a time. People have a tendency to misplace cards, so give them a second chance to find you.  

Networking etiquette 101; don’t give out a card until someone gives you theirs first, they ask for one of yours, or you ask for theirs. Business cards should have some type of offer on the back. Use that space to promote your uniqueness. My most successful offer was a FREE Laser Therapy treatment. Get the best business card money can buy…It’s your image and it makes an impact every time you give one –either wow, positive, mediocre, or negative. When you give out your card, if someone doesn’t look at it and say “Nice card,” get it redone. 

4.    Taking Before Giving

Building relationships is about giving. Provide something for others before you try taking something for yourself.  It’s not about selling your services to everyone in the room. Hard selling will more than likely alienate half the room in the first 10-minutes. Network with an open attitude of learning something new about the people you meet. Express interest in them and I guarantee they will be more open to helping you. Engage in meaningful conversation, not simple fluff talk to pass time before handing them your card. People can sense when you are genuinely interested in them. Discover something that your probable customer considers valuable and give it away. It only needs to be information that will help him or her build their business so you can earn yours. 

5.    Too Much Too Soon

Building relationships via networking takes time. Don’t expect to get 20 new patients at your first event. Trust is a big factor in networking. Prospective customers need to know you truly care about their needs, before they decide to use your services. They don’t care how much you know, until they know how much you care. People buy people first. They don’t like to be sold, but they love to buy. People like and want to do business with their friends. True friendships don’t happen overnight, so be patient and enjoy the little moments until they start paying off. Trust me, they always do. Most people will begin the trust connection after three encounters. Your goal is three individual networking interactions with a new contact.  

6.    Desperation

Never network for new patients out of desperation. Being in a state of ‘lack’ permeates all of your actions and activities. People can smell desperation like a shark smells blood in the water. It is an automatic turn off, which can make you do things to compromise your integrity and character. Marketing is not something you do when business is slow; it’s something you do ALL the time so you never get slow. Plan on attending two networking events every month and incorporate this practice building action step into your monthly marketing calendar. You do have a marketing calendar don’t you? 

7.    Failure To Follow Up

Just because they have your card does not mean they are going to call. As a matter of fact they probably won’t. It’s a hard truth, but people don’t care about you or your business. They care about themselves. You MUST follow up with every contact in a timely manner with value added information. It’s called ‘Keep in Touch Marketing’ and it is an art form worth mastering.  At regular intervals contact your network via phone calls, e-mails, newsletters, e-zines, blog posts, special offers and information pertaining to their industry and yours. Investing targeted effort into cultivating your network will pay high dividends in the future. There are numerous software applications to help establish a systematic keep in touch system. A scrap piece of paper with notes won’t cut it in today’s world. 

Action Step: The 7 Best Places to Network 

1.     Chamber of Commerce business event after hours.

2.     Any networking club or business organization where solid contacts belong

3.     A civic organization (Rotary, Kiwanis, Elks, etc.)

4.     Charity events or community volunteer organizations

5.     Cultural events

6.     Your trade or professional association

7.     Private clubs (Golf country clubs, health clubs, spas) Networking is an art. And just like any artist, it takes repeated strokes on the canvas to reveal a masterpiece. Don’t get discouraged if you are shy or reserved. Remember that most people you meet are just as nervous as you are. It’s human nature to fear rejection. The easiest way to eliminate this fear is by ACTION. The more you do it, the better you become. Don’t take yourself too seriously…and make this an on-going life skill.   Network and prosper! 

_________________________________________ 

Dr. Perry Nickelston is a 1997 graduate of Palmer College of Chiropractic. He is Vice President of Practice Development for K-LaserUSA. Contact him at 1-866-595-7749 Ext. #2 , www.k-laserusa.com, or pnickelston@k-laserusa.com.

Laser Therapy Definitions

Below are ‘Key” Definitions when learning about Class 4 Laser Therapy. Remember to choose a laser based on physics and science, NOT fancy advertisements. Decide which laser is best for YOU and your desired clinical outcomes. Never purchase a laser based on price alone. Price is temporary, profits and patient results last forever! (If you have the right laser and proper training) Successful laser therapy is always contingent on an accurate diagnosis and proper application.

LIGHT: Light is a small spectrum of electromagnetic energy with wavelengths between 380 nanometers (nm) and 760nm in length. This spectrum of energy is visible to the naked eye.  

LASER: Light Amplification by Stimulated Emission of Radiation; refers to the specific qualities and methods by which lasers produce light. Originally theorized and defined by Albert Einstein in 1917, it was not produced until the 1950s. Laser light is Coherent, has a Monochromatic wavelength, is Collimated, and Polarized. These four characteristics differentiate lasers from LED & SLD light sources.

COLLIMATION: A property of light commonly associated with lasers and accomplished with focusing lenses where all the photons are traveling in the same direction.

COHERENCE: The photons within a laser beam are extremely well organized and directional. This means that all of the photons (energy) have waves that travel in unison – they are highly parallel with a specific wavelength. True laser systems focus all of their energy in one direction in a very concentrated line. A super-luminous diode, on the other hand, diffuses its energy in all directions with only a small percentage of the energy travelling in the direction of the treatment. A true laser system will deliver 90% more power to the treatment area than a super-luminous diode system of exactly the same power rating.

MONOCHROMATIC: Contains one specific wavelength of light (one specific color). It is an exclusive property of laser light, setting them apart from all other light sources. Because the wavelength of laser light determines its effect on tissue, the monochromatic property of laser light allows energy to be delivered to specific tissues in specific ways. Non-laser therapies such as LED’s (Light Emitting Diodes) are sufficient for superficial treatment (wounds), but are questionable on penetration for musculoskeletal conditions. Lasers penetrate deeper.  

 FREQUENCY: The frequency of light is inversely proportional to its wavelength, and is dependent upon the energy value of the individual photons being emitted. The higher the frequency, the higher the energy, and the shorter the wavelength.

WAVELENGTH: The property that differentiates different spectrums of energy within the electromagnetic spectrum of energy is wavelength. The wavelength of light is measured in billionths of a meter, or nanometers (nm). The energy of a wave is inversely proportional to its wavelength. In other words, the greater the energy, the shorter (smaller) the wavelength. Light of shorter wavelength carries greater the energy of the light. 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 infrared (IR) 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! Each photon contains energy and just as energy of the ocean comes to shore in waves of high and low energy the same is true of photons. Only with photons the energy is not measured by the height of the wave but the number of waves the photon carries. These waves are measured in two ways, the number of waves that will pass a given point in one second, or wavelength, the distance between one wave and the next.

POWER: Power = Energy / Time 1 Watt = 1 Joule / Second.It is important not to confuse power and energy, although they are closely related. Power is the rate at which energy is delivered, not an amount of energy itself. With simple algebra, you can turn the formula above around to solve for energy instead of power, and write:

Therapeutic Energy = Power (Watts) or Joules/sec x Time(sec).

 

POWER DENSITY: Power density is amount of power delivered per unit area. Power density indicates the degree of concentration of the laser output. It is expressed in Watts per square centimeter, or milliwatts per square centimeter, W/cm2 or mW/cm2. Some studies have concluded that the power density may be of even greater significance than the dose. Example: A laser’s output is 4 Watts, and it is illuminating a circle of 3 centimeter diameter. First find the area of the circle, 3.14 x 1.5 x 1.5 = 7 cm2. Then divide the power by the area, 4W / 7cm2 = 0.6 W/cm2.

ENERGY DENSITY: The energy density expresses the total amount of energy delivered per unit area, in Joules per square centimeter, J/cm2. The energy is measured in Joules, and is calculated by multiplying the power output of the laser times the amount of time elapsed during the laser treatment. (Energy = Power x Time, and the units are Joules = Watts x Seconds.) A 4 Watt continuous wave laser would deliver 240 Joules in one minute. (4 Watts x 60 seconds = 240 Joules) Then simply divide the total energy by the area to arrive at the energy density in Joules per centimeter squared.

PENETRATION: Penetration refers to the distance an energy wave travels into the tissue before it is absorbed and dissipated as heat or molecular vibration. Penetration is a physical and thermal phenomenon, not a therapeutic phenomenon. Penetration of laser light is dependent on the wavelength of the light. Lower wavelengths are absorbed by hemoglobin and melanin, and higher wavelengths are absorbed by water in the tissues.

THERAPEUTIC WINDOW: Therapeutic laser light is primarily absorbed by the hemoglobin, melanin and water in human tissue. These three components each have a unique absorption curve that is dependent on the wavelength of the laser light. Hemoglobin and Melanin absorb more at the shorter wavelengths, around 630 nanometers. Water absorbs more of the laser light above approximately 960 nanometers. The three absorption curves have a relative minimum around 800 nanometers. Laser light in the range of 780nm to 810 nm penetrates the deepest into human tissue.

DUTY CYCLE: Duty cycle relates to the amount of time the light source is active, usually from 10% to 100%. A laser operating in continuous wave is running at 100% duty cycle. The modulation setting of K-Laser is a 50% duty cycle. Out of every second the light source would ‘On’ half of a second and ‘Off’ half of a second.

BIOMODULATION: Biomodulation is the process of changing the natural biochemical response of a cell or tissue within the normal range of its function, stimulating the cell’s innate metabolic capacity to respond to a stimulus. A cell can heal itself by this stimulation mechanism.

PHOTOBIOMODULATION: When biomodulation occurs from a photon transferring its energy to a chromophore it is referred to as photobiomodulation.

CHROMOPHORES: Chromophore literally means, “Color lover” (L. chromo = color; L. Phore = to seek out, to have an affinity for, to love). Chromophores are generally pigmented molecules that accept photons within living tissue. When the chromophore accepts a photon, it causes a biochemical change within an atom, molecule, cell or tissue. If this change increases cellular function, it is said to have activated the tissue. If this change decreased cellular function it is said to have inhibited the tissue. Biomodulation occurs in both cases.  

PHYSIOLOGICAL DOSE OF THERAPY: A Physiological Dose of any therapy is designed to stimulate production of, or provide to the body what it needs to normalize and heal itself through biomodulation. The symptomatic response to a physiological dose of therapy is dependent of the capacity of the patient’s body to respond to the therapy. The physiological dose of any treatment has specific advantages. • A physiological dose represents the body’s own response to a stimulus• A physiological dose generally improves the patient’s health. • A physiological dose will always be consistent for symptomatic response because it depends upon an interaction with the individual patient’s entire body system.

BIOLOGICAL AMPLIFICATION: When photobiomodulation occurs, the photon activates a chromophore, amino acid, nucleic acid, or molecule. Activation of a single enzyme molecule rapidly catalyzes thousands of other chemical reactions amplifying the signal to the cell. This is similar to the calcium regulated 2nd messenger cAMP cascade. Biological amplification explains how systemic, cellular, and clinical effects can occur almost instantaneously after exposure to light therapies.

DOSE: The term dose is an estimate of a therapy which produces a desired therapeutic action without harmful side effects. The therapeutic dose (safe and effective) range is defined by clinical evaluation of the response of a sufficient number of patients, generally 50 percent who improve without toxicity. The most important parameter in laser therapy is always the dose, often referred to as “fluence”. By dose (D) is meant the energy (E) of the light directed at a given unit of area (A) during a given session of therapy. The energy is measured in Joules (J), the area in cm2 and consequently, the dose in J/cm2.

 PULSED (TRUE) OR SUPER-PULSED: Lasers emit short, powerful burst of light at intervals. While depth of penetration is greater, pulsed Ga-As lasers have two disadvantages. First, because the width of the pulse is fixed and extremely short (no more than 200 billionths of a second) the average output power will be relatively low and treatment time will be much longer. Secondly, true pulsed laser diodes have a narrower therapeutic dosage range. The risk of an increase in pain post treatment is considerably greater.

PULSED (SIMULATED): In most modern therapeutic lasers, the pulsing is simulated by mechanically or electronically interrupting the output of a continuous beam laser. The pulse rate may be adjusted up or down without significantly affecting treatment time. This is accomplished by modulating pulse duration and/or the space between pulses. From research we know that pulsing has significant positive effects on pain relief. The body’s sensitivity to any steady stimulus diminishes over time. Varying the pulse rate helps to ensure a better response. Changing the rate to keep the body interested is far more important than strict adherence to continuous laser stimulation.

LASER DIODE: A semiconducting device which emits monochromatic non-ionizing radiation by a process of stimulated emission. A laser beam has a number of unique properties, such as coherence, polarization and directionality. Beams emitted by laser diodes are not, as is often stated, ‘straight’ and/or ‘parallel’. Unless manipulated with additional optical devices such as lenses, a laser diode’s beam is broadly divergent along one plane and narrowly divergent along the perpendicular plane, producing an elliptical cross-section.  

VISIBLE RADIATION: Non-ionizing electromagnetic radiation within the wavelength band from 400 to 700 nanometers which is able to be ‘seen’ by the human eye.

RETRACING: From time to time, a patient will experience an increase in pain following treatment. It is NOT an adverse reaction, but indicates that the laser treatment is working. Patients will frequently observe improvement once this pain subsides which is usually within 24-hours. This is a normal process. Always advise the patient in advance of the possibility of the pain response. Otherwise, they may assume that the laser has caused them harm. If a patient experiences significant pain increase, suspend treatment for a few days.

Dr. Perry Nickelston, DCClinic Director of the Pain Laser Center in Ramsey, NJ and VP of Practice Development for K-laser,USA.www.painlasercenter.com

 www.k-laserusa.com

1-866-595-7749 Ext #102

Bodybuilding and Chiropractic: Identical Success Principles

How in the world is bodybuilding like chiropractic? What could they have in common? On the surface they may appear totally unrelated, but look a little deeper and it all makes sense. There are principles of success applicable to every venture in life, especially ones of self improvement. Below are 5 principles to guide you. Enjoy and let me know what you think and how your life, practice and body improves.

How does the principle of building this body make you a more successful doctor?

stop-it.JPG

Principle #1: KEEP A JOURNAL

Bodybuilders keep training journals to track reps, sets, pounds, and improvements, or lack of improvements. They set goals to attain and targets to hit. How can you hit a target you can’t even see? When they train for a bodybuilding competition, they know if they don’t ‘kick their own ass’ somebody else will!

You must keep a marketing journal. Track and set your goals for new patient’s, referrals, PVA’s and marketing events. Write in your joutnal everyday. Even when you don’t do anything! READ THAT AGAIN! When you don’t do anything. Why?  It stings to write down ‘nothing accomplished’ in a success journal. Now that is ‘kicking your own ass!’

Principle #2: NO PAIN, NO GAIN

Bodybuilders know that to go beyond expectations they have to knowingly put themselves into more pain. The pain of adding more weight, more intense training, strict dieting, more sets, reps, and days of lifting. You can’t simply rest on your past success. The body adapts and to make improvements you have to change your approach, go to failure, and increase your intensity. Put yourself in more PAIN.

You must step outside of your ‘comfort zone’ and do things that you find ‘painful’. Go out and market yourself more, learn public speaking, ask for referrals everyday and try new things in your office to create ‘Raving Fans.’ Everything in life you desire lies just outside your comfort zone. YES, you are going to fail! But that is the key to success. Fail and change your approach until you get the desired results.

Principle #3: COMMITMENT

Bodybuilding is not for the weak of heart. It is tough, grueling, and a lifelong commitment to self improvement. It takes sacrifice of time, energy, personal life (sometimes), and continuous learning and adaptation. Oh people may ‘workout’ a few days a week, but that is NOT bodybuilding. True bodybuilders never lose focus of their objective and when they are not in the gym, they are visualizing themselves working out. It is their primary focus.

Starting a new chiropractic practice is not for the faint of heart either. It takes a passion, for what you do. There will be sacrifices of your personal life, time and energy. But you must also keep focused on your desired outcome. You must live and breathe your office until it succeeds. The Law of Attaction’ -You become what you think about. So think about your office 24/7. Never rest on your past success because the competition is always trying to improve.

Principle #4: VISUALIZATION

Bodybuilders see their physique in their minds of how it will appear. They manifest their body by seeing it in their minds first and then applying action steps to create it. The key here is ACTION. You can visualize all you want, but if you don’t actually get your ass into the gym to workout, then there is now way you can build that body. Before every workout they visualize completing the sets and reps. Lifing that new heavy weight goal they set. They do it before they do it! Get it? Envision success or envision failure, either way you will be right!

You must visualize your day every morning before you step outside the door. Picture yourself adjusting patient’s, getting new patient’s, meeting a new contact, booking a speaking event or hitting a new PVA record. Take 15-minutes every morning to lay out your ’successful’ day in the mind. Don’t even think about turning on that TV either! Stary away from negative outside influences until you clear your mindset first.

Principle #5: SELF CONFIDENCE

Bodybuilders know that self belief and self confidence are the keys to success. You must believe you can achieve your goal. You become what you believe! Funny thing is, when your physique begins to change and you obtain succees your confidence natrually increases. The Law of Manifestation’. You create your own destiny by the choices you make (or don’t make) and your attitude towards the world.

You control your practice destiny and success. You must believe and ‘know’ you are the best doctor to help people live healthy life. Think about how many people will suffer if you don’t get out there and teach them the value of chiropractic. You believe in it-now make them believe it too! They don’t know what you know. How can you fault anyone for not seeing the value if you don’t show it to them. Take your confidence and self belief out into the world. Don’t sit in your office WAITING for ’stuff’ to happen. You make it happen.

 Apply these principles to your life and see the world change. For anything in your life to change, YOU must change first. To get motivated and see these principles first hand, go to the video store and rent the movie ‘PUMPING IRON’ with Arnold Schwarzenneger. If that does not motivate you, then you must be dead. Who knows, maybe you will get the body you always wanted PLUS your dream practice!

Dr. Perry Nickelston, DC

Clinic Director of the Pain Laser Center in Ramsey, NJ and VP of Practice Development for K-laser,USA.

www.painlasercenter.com

www.k-laserusa.com

1-866-595-7749 Ext #102

Niche Marketing: A Business Model

The quickest way to get on the “fast track” to a struggling practice and becoming another statistic is to market your services to the masses. Why? We know chiropractic can help everyone and that’s how most doctors promote it. But, by having a clearly defined model of the kinds of patients you want, your marketing strategy becomes clearer and more cost effective. That’s the name of the game.

You need to be business smart and marketing savvy to thrive in a competitive industry. There are certain strategies to help you decide how to spend your marketing time, energy and money to increase the percentage of ideal patients and ideal referrals. You can still treat whoever comes into your clinic, but if you build your practice with patients you enjoy taking care of, you’ll have more fun, be more productive and be able to handle more volume.

 The truth is that when you narrow whom you market to (niche), three magical things happen.

  1. Your service becomes more desirable. People want to buy stuff that’s made just for them…that solves their unique problems.
  2. Your name spreads rapidly. People in groups talk! If you’re good and you provide services for a specific niche, your name will travel fast.
  3. It becomes easier and less expensive to prospect. Most niches have a list of members or list of people. Instead of spending money on mass marketing, you can spend the money on getting your message to just the right people in your niche who want to hear your message.

The following are several questions that you should ask yourself when choosing your niche.

 Question #1: Can you easily and affordably contact the niche?

Question #2: Can the niche afford your product or service?

Question #3: Does your technique lend itself certain types of people? Ex. (Kids, elderly, sports)

So how do you niche a niche? That’s easy. Here’s how. You already have a niche that is called chiropractic. Now you niche this niche. What do I mean? Become an expert on one problem or treatment, and promote yourself as the expert. An example might be shoulder injuries.  Simply advertise and promote yourself as the go to doctor for shoulder pain. Become the “Shoulder Guru”.  Since your market is shoulder pain, find out where that market hangs out and promote there. Examples might include gyms, sporting events, tennis clubs, golf courses, etc.

You will get more than enough patients to build a practice from the specialty alone, and word of mouth referrals will spread quickly. Why? Because your niche patient base hangs out with other people who have similar likes, and they usually have the same problems. Before you know it, you will have more patients than you can handle. Then you can promote those niche patients on the benefits of chiropractic for other problems.  

 Here are several suggestions for determining your niche.·       

Personal characteristics, like age, size, gender·       

Types of conditions (Back, shoulder, neck)·       

Occupations, hobbies, or common interests·       

Acute or wellness care patients 

You may come up with other aspects of ideal patients that are important to you.  Get a clear picture of ideal patients that meet your criteria. Pick out six of your favorite patients. Which categories do they fall into? It’s a pretty safe bet that is where you are going to focus your marketing energy. We are always more successful when we enjoy what we do. Why not make your chances of success greater by creating a practice environment that is enjoyable to be in every day?

 When focusing in on a market niche, it’s imperative to speak their language. In other words, you should understand the market’s “hot buttons” and be prepared to communicate with the target market.  “Hot buttons” are the emotional triggers that inspire a patient to take action. You must appeal to their emotional desire to improve the quality of their lives before you can ever hope to turn them into lifelong chiropractic advocates. It’s the “WIIFM Syndrome:  What’s in it for me?”

Once they know you have what they want, not so much what they need; they will become your patients. Most experienced doctors recognize the value of targeting a market. But when you target a broad audience, you’re only targeting people who CAN use your product or service. You have to narrow your focus if you want to target patients who WILL use your product or service. A well defined, small niche market can separate you from competition. Other start-up offices are likely to overlook this strategy, giving you the opportunity to build the type of practice you dreamed always dreamed of.  

Dr. Perry Nickelston, DC is a 1997 graduate from Palmer College of Chiropractic. He operates four laser therapy centers in New Jersey and is Vice President of Practice Development and Product Integration for K-Laser, USA. He can be reached via his website www.painlasercenter.com or 1-866-595-7749 Ext. 2. 

Law of Success

The Power of Expectation

Have you ever hit a plateau in your personal of business life? Not growing, not moving forward, everything is just average. It’s time to get off it and get on with it.

 The ten greatest two-letter words are: If it is to be it is up to me!So how do you get on with it. By changing the questions you are asking yourself. 

Questions are the laser beams of human consciousness. When the right questions are asked, their power can cut through any obstacle or challenge. What is the difference between average success and ultra success? Quite simply, successful people have developed the habit of asking better questions, and as a result, get better responses. Quality questions create a quality life. You need to burn this idea into your brain, because it’s as important as anything you will ever learn.

 Remember, it’s not only the questions you ask, but the questions you fail to ask that shapes your destiny. 

What questions are you currently asking yourself? In business, we should ask the right questions regarding what kind of patients we want: PI, cash family, etc. This shapes our marketing and our focus. This determines our strategic planning, which determines our budget, and our action plan. When we work on relationships, our questions are focused on potential challenges and the avoidance of conflict early on in the relationship. 

All human progress is preceded by new questions. What new questions could you ask yourself today which will give you the new answers that can improve your life today and tomorrow? Remember, ask and you shall recieve. If you ask a terrible question, you’ll get a terrible answer. Your brain is ready to serve you, and whatever question you give it, it will surely give you an answer. Rather you like it or not! Lousy questions yield lousy answers. Why am I always screwing up? Why am I such a…?

Useful questions yield useful answers, which build our self esteem and self confidence.  New answers come from new questions. If you are in a situation or have a challenge you’ve wrestled with for some time, try asking some new questions and listening for new answers. New questions yield brilliant new answers. 

The Hot Pen MethodThe hot pen method of goal setting consists of the following guidelines:

  • Blank paper
  • Ink pen
  • An absolute private place
  • Comfortable surroundings
  • No external stimuli such as TV, radio, or other people
  • Write as fast as you can, anything and everything that pops into your head
  • No judgement or analysis

Prior to getting started, consider these two questions:

  1. If you knew you couldn’t fail, what would you be, do, have or become?
  2. If money were no object, what would you be, do, have or become?
  3. Write goals for every area of your life:
    • Spiritual, family, personal, financial, community, social, career, physical

Once again, don’t think too much, just write. Don’t evaluate, judge, or get practical, or logical. Don’t try to figure it out or conform to your perceived reality. JUST WRITE. If you find you can’yt think of anything or find it difficult, it’s because you have stopped dreaming. You’ve gotten too smart, too logical, too negative, too realistic …too grown up. Or maybe, just given up. If you have the ability to conceive, you can achieve with belief.

Dr. Perry Nickelston

www.painlasercenter.com

www.k-laserusa.com

1-866-595-7749 Ext. 102

VP of Practice Development for K-laser, USA and Clinic Director of The Pain Laser Center in Ramsey, NJ. 

Greatest Day, My Idol, and Success

“For me life is continuously being hungry. The meaning of life is not simply to exist, to survive, but to move ahead, to go up, to achieve, to conquer.” -Arnold Schwarzenegger

“I knew I was a winner back in the late sixties. I knew I was destined for great things. People will say that kind of thinking is totally immodest. I agree. Modesty is not a word that applies to me in any way - I hope it never will.” -Arnold Schwarzenegger

Great words from a lifelong inspiration. As you all know by know, I attended the Arnold Bodybuilding Classic in Columbus, Ohio recently. During this fitness extravaganza I had the honor of meeting my childhood inspiration and idol, Mr. Arnold Schwarzenegger. What a thrill!! I am still flying high from that one. His autobiography changed my life and inspired me to become successful in bodybuilding and life.

He is the textbook ‘American Dream.’ Coming to America with no money, a heavy foreign accent, dreams of greatness and a drive to succeed. Failure was not an option for him. He has become a Governor, film star, bodybuilding legend, and inspiration to millions.

So it always irritates me to hear doctors in our profession moan and groan about how ‘tough it is to make it today.’ How  their practice is slow, they can’t afford to do this or that (my personal favorite), or ‘that’ will never work in my office excuse. You can succeed with the right mindset, mental attitude, goal setting system, action plan, and the right attitude. Oh yes and actually getting off your a** and making it happen, that is called ACTION! Dream all you want, but it won’t happen until YOU make it happen.

When I educate doctors about Class 4 laser therapy and why it is essential for their pratice success, I hear every excuse in the book why they can’t do it. “I can’t afford it (bull), I don’t need it, I don’t think my patient’s will pay cash for it (bull-cash practices and wealth are a mindset), and my favorite ‘it’s too expensive!’ What? Price is temporary doctors, profit and helping people get well is forever! Get over yourself and your fears. Take action and make it happen! The only way life is going to change and get better is if YOU change! Not the economy, not the world, not your patient’s, but YOU! You are the catalyst for success in your own life.

Below is a picture of me with Arnold. After the photo I am putting down Attitude Action Steps you can take right now to change your life. I give these to the doctors who tell me they can’t afford to invest in Class 4 K-laser. Opens their eyes to say the least! Open yours now.

arnold.jpg


1. Admit it’s no one’s fault but yours. (Success and failures)

2. Understand you always have (had) a choice.

3. If you think you are successful. You are. If you think you are not. You’re not.

4. Study the thoughts and writings of successful people (Like me, lol)

5. Help others without expectation or measuring. 6. Think about your winning and losing words to yourself.

7. Celebrate victory and defeat. We learn more from our failures. T0 succeed you have to play!

7.5 Study 30-minutes everyday your list of goals and action plan for wealth. Read positive!

Have fun! Make it happen NOW. Nobody else is going to do it for you.

Dr. Perry Nickelston, DC VP PRactice Development for K-laser, USA

www.k-laserusa.com

www.painlasercenter.com

1-866-595-7749 Ext. 102

Arnold Expo 2.0

The feedback from my first post regarding the Arnold Expo was so positive that I decided to add some additional photos from the day. Listed below are some pictures that speak for themselves. These are some the competitors who stood out from the crowd. Any doctor into fitness and treating athletes should go to this event. Especially if you treat athletes with laser therapy like me. They are a perfect match. Listed below the pictures will be my tip of the week. Enjoy.

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How can Class 4 laser expand my practice?

Your patient base opens dramatically because of lasers ability to help so many types of conditions. What other modality could you use to help the pain associated with cuts, burns, wounds, scars, post surgery pain, post joint replacement surgery, skin conditions and soft tissue tears? When these people get better, they tell everybody. It’s a therapy that sells itself. Better yet, your satisfied patient’s sell it for you. No expensive advertisement can come close to that practice building power. 

I don’t think people will pay cash for laser treatment.

If you go in with that attitude, then no they won’t. If you don’t put a value on your services, somebody else will. Most doctors are not successful because of self created mental barriers. They predispose themselves to failure. Wealth is a state of mind.  People will pay for results; they pay for what they want, not for what they need. Read that again until it sinks in your brain. Make them want it! Make them believe they can’t afford NOT to do it. Nobody needs to pay $600 for an Xbox 360, they simply want to. That’s marketing! All you need now is the right laser to back up your marketing.

Dr. Perry Nickelston

www.k-laserusa.com

www.painlasercenter.com

1-866-595-7749 Ext. 102

Class 4 Laser Myths Exposed!

“Class 4 Laser Myths Exposed!”
Don’t believe the hype, believe the science.
 

Myth #1: They Are Too Expensive

Compared to what? The most expensive laser you can purchase is one that fails to deliver results! Class 4 lasers manufactured by a reputable company deliver results; it’s all based in the science of therapeutic dosage. The #1 cause of failure in laser therapy treatment is insufficient dosage. Inadequate power is the primary factor in low dosage. Class 3 lasers have lower power, so penetration is decreased and success rates decline. Higher power means less treatment time and less stress on the laser diodes, adding to the life of the laser. Class 3 lasers require multiple laser heads adding to the bottom line expense of the laser. Advertising laser therapy and not getting results is EXPENSIVE! You only have one chance to impress a patient, make sure you have the Class IV power to back it up.  

Myth #2: You Can Burn A Patient

Yes, if you are a complete idiot! You can also burn a patient with ultrasound and muscle stimulation if you use them incorrectly. A properly trained physician or clinician will never burn a patient. This is why you should receive your laser training from a qualified clinician, not a sales rep. You have to be present during treatments (PTC)-Present Time Consciousness, with no distractions; devoting your time to the patient. Treatment times are significantly reduced with Class 4 lasers so the risk of injury is miniscule. Proper training is essential.

Myth #3: They Are Too Costly To Maintain

Any medical equipment used incorrectly can be costly to maintain. Proper training is essential for the life of laser equipment. What is more costly, a cheap “bargain” laser that breaks every few months or durable high end models with proven performance and results? Don’t make a purchase decision on price alone. Price is temporary, profit is forever. Look at the fine print on laser manufacturer warranties. Make sure you have a lifetime warranty on your laser diodes. If a product is good, the dealer will have no doubts about selling it on sale-or-return basis, with written confirmation of this.

Dr. Perry Nickelston, DC VP Practice Devlopment for K-Laser USA and Director of The Pain Laser Center in Ramsey, NJ. 1-866-595-7749 Ext 102

www.k-laserusa.com

www.painlasercenter.com