Last year, I invited Dr. Leonard Faye to conduct a chiropractic technique seminar for the 70+ doctors in my organization. He is a pioneer in motion palpation and studied under Dr. Henri Gillet in Europe. The seminar was a great fit for my doctors who practice at The Joint locations throughout Southern California and we are always seeking ways to provide faster, safer, and more effective care. Dr. Faye referred me to a 2016 study that provides a measure of redemption for the very commonly used motion palpation techniques. I hope you find my short review of this study helpful!
Double blind studies of motion palpation have shown poor interexaminer reliability in the assessment vertebral subluxation. Simply stated, researchers had 2 experienced chiropractors examine the same patients at each of the 26 spinal levels using motion palpation; the 2 chiropractors could not reliably agree on which spinal levels were stiff or not stiff. This has been a thorn in the side of motion palpation and chiropractic in general as most chiropractors use some sort of motion palpation in the spinal analysis of their patients. The implications of poor interexaminer reliability are that patients visiting multiple chiropractors would probably receive a different diagnosis at each one they visited. The chiropractor claims to offer diagnosis and correction of vertebral subluxation, the location of which no two chiropractors can agree upon! This lack of consistency is problematic for a profession that has struggled to gain respect in the healthcare industry.
There is good news though. Cooperstein and Young (2016) recently revisited some of those studies and asked a different question. Instead of asking if two examiners could agree if each specific spinal level was stiff or not stiff, they asked if two examiners could simply agree on the “stiffest spinal site” or “SSS” within the sections of the spine. For example, they asked themselves if the chiropractors could agree upon the stiffest site in the cervical region, the stiffest site in the thoracic region, and the stiffest site in the lumbar region. They found that the chiropractors could in fact reliably agree on the the stiffest site in each of the three regions. Furthermore, they found that when the examiners were more confident in their findings, they had a greater the level of agreement. Keep in mind that each examiner was blinded from the other’s results.
What does this mean for the practicing chiropractor? When examining a patient, the chiropractor using motion palpation might ask the same amended question the researchers asked. Abandon the level by level method of stiff or not stiff, moving or not moving, fixated or not fixated, out or in, and instead ask, “Is this the stiffest spinal site in the region?”; direct the force of the adjustment to those areas. When chiropractors use techniques that have good interexaminer reliability, consistency of care is improved, greater results can be expected, and the validity of chiropractic is strengthened.
Cooperstein, R., & Young, M. (2016) The reliability of spinal motion palpation determination of the location of the stiffest spinal site is influenced by confidence ratings: a secondary analysis of three studies. Chiropractic & Manual Therapies. 24:50
These words are often murmured by chiropractors and others to demean me and other affordable chiropractors. I was able to help one of my patients, Gloria, in just a handful of visits with a condition called Trigeminal Neuralgia. This condition is also called the “suicide disease” because of its severe lancinating pain across the face that can be triggered by even the slightest breeze. Upon interviewing her, I asked if she had considered suicide and she responded affirmatively. What was a chiropractic visit worth to her? One million dollars? More? Worker’s Compensation managed to come up with a number; benefits for a death are three hundred twenty thousand dollars for an individual with three or more dependents. Using my experience and advanced chiropractic techniques, I was able to eliminate Gloria’s pain in 4 visits. Am I worth eighty thousand dollars per visit? Maybe. Of course I’m being facetious but it raises the question of how to price chiropractic.
You get what you pay for! This is the maxim often used by people who are in disbelief that there are great deals or great value in the marketplace. I want to challenge your belief; the marketplace knows you think this way and markets to your beliefs. It’s called “the psychology of perceived value”. They know that you are thinking, “pay more, get more” so they price their services accordingly to fit your belief system. In other words, they price their services higher so you will think you are getting more (you don’t); you are an unwitting pawn in their branding game. Their plan is to move into a wealthy community with plenty of good insurance and overcharge because, “these people can afford it”. Then they get to work on fluffing up their branding to “differentiate” themselves from their competitors and increase perceived value. This hurts the chiropractic profession by pricing ninety percent of people out of the market. That huge majority of the population never gets to experience chiropractic. This is a shortsighted and selfish approach and is definitely not the serving attitude of a health care professional.
Chiropractic has been historically expensive because prices have been based on what an insurance company is willing to pay, and then some. Chiros typically add all kinds of gimmicky services to a visit in order to stack the bill higher(into the hundreds of dollars) until the insurance company finally pushes back and says, “No mas!”. Two hundred dollars, is that the value of a chiropractic visit? Now, if you don’t have insurance, the chiropractor will graciously…ahem… give you a cash price which is some amount discounted off of the artificially created insurance price. One hundred dollars? Fifty dollars? Forty? Even at forty dollars, can the average person afford a forty dollar visit? Perhaps. But what if they need multiple visits, what about wellness and maintenance visits?
Now, I was able to help Gloria quite rapidly and continue to help others rapidly, but chiropractic is a process; all healing takes time. The greatest results come when patients are regular, consistent, and proactive. I priced ChiroCore not on perceived value or even true value(what’s the value to Gloria?) but on a) what the average person can afford to pay for regular adjustments b) how many people I can comfortably(for both of us) and effectively see in a day c) what provides me a reasonable and comfortable lifestyle in my community. In founding over fifty affordable and convenient practices at The Joint franchises in California, I developed efficient systems that lower costs and overhead to meet my price target and truly serve. I am obsessed with creating value for my patients and in giving them the most effective, expert care in the most straightforward and honest manner possible. I can help you. Book an appointment today!
I want to challenge your beliefs about pain. These 5 counterintuitive concepts may seem hard to believe but stick with me. Challenge number 1) pain is not purely physical/structural. It’s not just “a disc” or “a muscle” 2) pain is not processed in the part of the body where you “feel” it; it is processed in the brain and nervous system 3) Your brain responds to pain through your EXPERIENCE, your thoughts, fears, stresses, and feelings. 4) The nervous system can get locked in an “overprotective”, hypersensitive state where it overreacts to normal stimuli. 5) Here is the great news! The brain and nervous system are malleable like “putty”; the hypersensitive programming can be reversed. There is hope! You do not have to wait for the latest health-damaging pills or surgery. I have developed unique, safe, and effective chiropractic techniques that can help you address your pain from a different angle, reprogram your nervous system, and start “turning down the volume” on your symptoms no matter how they started or how long they’ve lasted. The only way to find out how much of a difference these techniques can make in your life is to get started and see what happens; that is exactly what I am here to help you do. Book an appointment today!