ChiroMasterMind

Core Stability and Strength

Dr. Perry — Tue, 26 Jan 2010 09:40:25 +0000

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.

The lumbar spine can move quite a bit through flexion and extension but we know from experience to avoid repetition going the extremes, hanging out at one extreme or the other for prolonged periods, and to avoid high loads while trying to move through the lumbar spine.
Rotation at the lumbar spine is only supposed to contribute 13% of total spine rotation (Sahrmann, 2002), hence limiting rotation with training might be a good idea.
Lateral flexion occurs as well but limited. The total amount of lateral flexion allowed from L1-S1 is 27 degrees, while the thoracic spine is capable of contributing up to 75 degrees (Sahrmann, 2002). This also has a degree of rotation to it which again is not really designed to happen in the lumbar spine.

Think of the sports that require tremendous amounts of rotation. Golf and baseball (pitchers) come to mind. Two populations we see quite often with back pain. They get more than enough rotation and lateral flexion with every swing or throw so why add more? Throw out the stability ball crunches, superman exercise, crunches with a twist, side bending, etc. Teach them to resist these motions against a load, and how to maintain a stable spine through a golf swing or a pitch. Work on bird dogs, front and side planks, chops and lifts in tall kneeling and half kneeling, and don’t forget to deadlift.

Joe Heiler, PT

www.sportsrehabexpert.com

Perry Nickelston, DC

www.stopchasingpain.com

Customer Service

Dr. Perry — Sun, 17 Jan 2010 13:26:39 +0000

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

Laser Parameters: What Really Matters?

Dr. Perry — Mon, 11 Jan 2010 11:55:02 +0000

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.⁴Wavelengths 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

Who Invented Laser and How Does It Work?

Dr. Perry — Wed, 23 Dec 2009 13:27:04 +0000

First theorized by Albert Einstein in 1916, and invented by Theodore Maiman in 1960, the laser has become one of the most beneficial inventions used in modern society. In 1967, Dr. Endre Mester, a professor of surgery in Hungary, performed a revolutionary series of experiments that first documented the healing effect of lasers. Therapy lasers have been used and researched in Europe for over 30 years. The US Food and Drug Administration (FDA) approved the first low level Class III laser (LLLT) in 2002 and the first Class IV therapy laser in 2003. The most significant clinical and therapeutic difference between Class IV lasers and Class III is the Class IV can produce a primary biostimulative effect on deeper tissues while also producing substantial secondary and tertiary effects^.

Laser therapy aims to photo-biostimulate chemically damaged cells. This therapy actually excites the kinetic energy within cells by transmitting healing energy known as photons. The skin absorbs these photons via a photo-chemical effect, not photo-thermal; therefore it does not cause heat damage to the tissues. Once photons reach the cells of the body, they promote a cascade of cellular activities. It can ignite the production of enzymes, stimulate mitochondria, increase vasodilation and lymphatic drainage, ATP synthesis, and elevate collagen formation substances to prevent the formation of scar tissues. This is a critical step in reducing long term disabling chronic myofascial pain syndromes and joint hypermobility. Other formative cells are also positively influenced. One of the laser therapy’s many immune enhancing effects is an increase in the number of macrophages.

Dr. Perry Nickelston, DC

www.painlasercenter.com

What People Crave!

Dr. Perry — Tue, 01 Dec 2009 12:20:02 +0000

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

Power of Conversational Pause

Dr. Perry — Fri, 13 Nov 2009 15:17:08 +0000

Pause

If you find it hard to pause when making conversation, people can sometimes perceive it as you feeling lower-status. Too often, people rush to give an answer to a question or add comments into a conversation in fear that the other person may lose interest. It’s a silly fear and if people notice that you’re scared of that, they will instinctively assume that you are trying to impress them.

When it comes to building rapport that is NOT a good thing. Every now and then, you should pause:

· Before answering a question.

· While you are answering a question.

· While you are making comments.

· When you are telling stories.

Pausing:

1. Creates anticipation for your words.

2. Displays good status.

3. Demonstrates composure of mind.

4. Attracts people.

5. Makes your conversation sound so much more interesting.

Try it and you will see how powerful pausing really is. It can be the little difference in whether you get a patient or not.

Perry Nickelston, DC

www.stopchasingpain.com

Embrace Criticism

Dr. Perry — Wed, 28 Oct 2009 10:17:38 +0000

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

Secrets To Creating Success

Dr. Perry — Sun, 18 Oct 2009 11:48:11 +0000

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

Communicate with your Clients

Dr. Perry — Sat, 03 Oct 2009 09:32:01 +0000

The ability to communicate with another person effectively is a key to success. It shows value and respect. Here are several key ways to show professional conduct. They will notice.

1. YOU communicate to your clients if you have a change in your schedule. You take ownershp of any changes and don’t expect front desk or maagement to handle it for you.

2. YOU communcate to your clients if you are going on vacation, having another doctor cover your office, changing your schedule, your rates, etc. You take ownership.

3. If a client’s treatment session regimen is up, YOU MUST communicate this to them. If you are uncomfortable with speaking finances to them for some reason(You need to work on this). Value your services.

4. Ask for feedback from your clients periodically. Feedback is the breakfast of champions. My favorite way is to ask this way. “On a scale of 1-10 how would you rate your experience in our office?” (Now the most important part!) Ask this follow up question, “What would it take to make it a 10?” POWERFUL! …This gives you the actions you can now take.

Remember the cost of trying to find a new client is not cheap. It’s far less expensive and far more powerful to focus on internal marketing and use your existing clientele to help build your business.

Perry Nickelston, DC

www.painlasercenter.com

973-800-6570

Service Credo for Success

Dr. Perry — Sat, 26 Sep 2009 01:44:41 +0000

This list is inspired from the RITZ-CARLTON Credo Card of service. Apply these principles to your office. They know how to serve.

1. Build strong relationships with your patients for life.

2. Always be reponsive to the expressed and unexpresed wishes and needs of your patients.

3. Become empowered to create unique, memorable, and personal experiences for your patients.

4. Continuosly seek opportunities to innovate and improve your practice experience.

5. Own and immediately resolve problems.

6. Create a work environment of teamwork and lateral service so that the needs of your patients and others are met.

7. Make the opportunity to learn and grow. Never stop learning.

8. Involve staff in the planning of the work that affects them.

9. Always use a warm and sincere greeting.

10. Anticipate and fulfill each paitent’s need

11. Fond farewll. Give a warm good-bye and use their name.

12. Be proud of your profesional appearance, langage and behavior.

If you are stuck in practice, looking to get ahead, and you are looking to create loyal, raving fans, start with creating a culture that is special.

Dr. Perry Nickelston, DC