RE: What do you provide for patients

February 4, 2010

,

Perhaps you are forgetting the quest fo the Educational Manual for Evidence Based Chiropractic that lasted ~ 6 years and was OFTEN assailed as an absurd use of our OBCE funds.

What your physiatrist may not be putting into his equation is practice rights. Oregon has a bill making its way to the legislators now limiting the use of manipulation only to those who have the same hours of training and experience required for a chiropractic license. They may NOT go out and take the latest 20-hour weekend course and show up for work on MOnday ready to adjustl It is due to be voted on in Jan of 2011. The evidence is there - in numerous forms - and continues to build.

What is your research project for this year?

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com

From: drpsnell@...Date: Wed, 3 Feb 2010 21:50:39 -0800Subject: RE: What do you provide for your patients

Herb I have the greatest respect for you. However, to answer your question "why should you care..." directly, perhaps you shouldn't, but the other DCs on this forum navigating the current environment of practice and planning for their future should. Why? The currency of the kingdom is research. The research says that manual therapy, manipulation and exercise combined work better than any of them alone. The Kaiser physiatrist in question is teaching the gatekeepers in your community how to view you and your colleagues. Kaiser is one of the only HMOs in the US that consistently runs in the black. Their model is frequently used as an example of some of the things that are right with managed care, whether you or I think so or not.Herb, this topic is of no interest to many of us on this forum who have panels into the 1000s. With decent care, most docs can maintain those practices with internal referrals. But for those that are building and have whole future ahead, the playing field is different than it was 45 years ago. Evidence based practice has changed things, for both MDs and for DCs. If MDs and DCs can't come together on this then as this physiatrist points out, they will refer, eventually to PTs who manipulate. In short Herb, this MD's opinion is the canary in the coal mine...and that's why we should listen. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports Medicine

Oregondcs From: hbf4747msnDate: Wed, 3 Feb 2010 20:31:56 -0800Subject: Re: What do you provide for your patients

Hi Dr. Snell,

Thank you for your informative post as to what current texts are available for patients' exercises. However when you cite the comments of a Kaiser physiatrist about our profession as being of significance we part company. D.C.s' are not MD's lapdogs waiting for a few words of approbation from them. I have practiced in the city of Keizer for about 45 years I've cared for thousands of patients and believe it or not nary a one of them was an MD referral. Philosophically chiropractic and all of the various methods under the medical umbrella are miles apart so why should I care at all as to this guys opinion.

Herb Freeman D.C.

What do you provide for your patients

The recent thread with someone asking what exercises to prescribe for LBP and the responses, or lack thereof was interesting. The field of exercise science in treatment of a variety of disorders is burgeoning with the new ACSM's Exercise is Medicine campaign as well as with the release of books such as Spark: The Revolutionary New Science of Exercise and the Brain by J. Ratey. Within our own field, chiropractors sadly continue to be slow to adopt this trend and to educate themselves in what the science supports. I work with a lot of personal trainers in town, and with several PTs. They regularly are surprised that I, a chiropractor, seem to be abreast of the literature in exercise science. I am regularly disappointed that so many of my colleagues, and even the recent grads, seem to barely have an understanding of what works and what doesn't when it comes to exercise. It's maddening to continue to get disc patients who have been prescribed "yoga" that includes forward bends, knees to chest and twisting poses and can't seem to get that pain down their leg get any better. It's frustrating to see abdominal hollowing exercises a la' Hodges work on transversus and the subsequent misinterpretation of the findings of those studies, continue to be spread as misinformation and thus creating more dysfunction in that patient. I wonder what is to become of our profession when we don't demonstrate to the public that we know more about how to treat their back pain than their trainer at the gym who has attended a McGill conference, a Gray conference, a Gray Cook conference and regularly tunes in to SportsRehabExpert.com. What do we have to offer in response? The latest practice income generating tips gleaned at the latest conference? This lack of understanding does not seem to be lost on our patients in my experience.What prompted me to write tonight was a communique I received today that was intended for Kaiser physicians. The following was written by a physiatrist and was intended to be a quick guide to appropriate referral for PCPs in the local Kaiser system. After giving a good (I feel) description of the pros and cons of manipulation therapy he states:"How does manipulation fit into the general musculoskeletal care continuum and how does it relate to our PT services? Manipulation as a form of treatment is legitimate, whether you consider the field of chiropractic so or not. If we had PTs that did manipulation we would not need to refer out to have this form of treatment. The down side of Chiropractic from our perspective in Physical Medicine, is that there is an over-reliance upon passive modalities of treatment like manipulation, heat, ultrasound and an under emphasis on currently accepted concepts of exercise therapy which flourish throughout sports medicine and rehabilitation in general. This then may leave the patient after a few visits feeling better but not fortifying them with education, strength and flexibility which are the foundation of prevention for recurrent spinal pain."I haven't participated in this forum for a while. It's interesting to spend a few days here again. If I'm too out of place here, I'll go away again. But I would be interested in finding out if DCs in this progressive state are tuning in to the changing times and positioning themselves to have cultural authority for ALL things concerning conservative management of the spine. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports Medicine

Hotmail: Powerful Free email with security by Microsoft. Get it now.

February 4, 2010

,

Perhaps you are forgetting the quest fo the Educational Manual for Evidence Based Chiropractic that lasted ~ 6 years and was OFTEN assailed as an absurd use of our OBCE funds.

What your physiatrist may not be putting into his equation is practice rights. Oregon has a bill making its way to the legislators now limiting the use of manipulation only to those who have the same hours of training and experience required for a chiropractic license. They may NOT go out and take the latest 20-hour weekend course and show up for work on MOnday ready to adjustl It is due to be voted on in Jan of 2011. The evidence is there - in numerous forms - and continues to build.

What is your research project for this year?

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com

From: drpsnell@...Date: Wed, 3 Feb 2010 21:50:39 -0800Subject: RE: What do you provide for your patients

Herb I have the greatest respect for you. However, to answer your question "why should you care..." directly, perhaps you shouldn't, but the other DCs on this forum navigating the current environment of practice and planning for their future should. Why? The currency of the kingdom is research. The research says that manual therapy, manipulation and exercise combined work better than any of them alone. The Kaiser physiatrist in question is teaching the gatekeepers in your community how to view you and your colleagues. Kaiser is one of the only HMOs in the US that consistently runs in the black. Their model is frequently used as an example of some of the things that are right with managed care, whether you or I think so or not.Herb, this topic is of no interest to many of us on this forum who have panels into the 1000s. With decent care, most docs can maintain those practices with internal referrals. But for those that are building and have whole future ahead, the playing field is different than it was 45 years ago. Evidence based practice has changed things, for both MDs and for DCs. If MDs and DCs can't come together on this then as this physiatrist points out, they will refer, eventually to PTs who manipulate. In short Herb, this MD's opinion is the canary in the coal mine...and that's why we should listen. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports Medicine

Oregondcs From: hbf4747msnDate: Wed, 3 Feb 2010 20:31:56 -0800Subject: Re: What do you provide for your patients

Hi Dr. Snell,

Thank you for your informative post as to what current texts are available for patients' exercises. However when you cite the comments of a Kaiser physiatrist about our profession as being of significance we part company. D.C.s' are not MD's lapdogs waiting for a few words of approbation from them. I have practiced in the city of Keizer for about 45 years I've cared for thousands of patients and believe it or not nary a one of them was an MD referral. Philosophically chiropractic and all of the various methods under the medical umbrella are miles apart so why should I care at all as to this guys opinion.

Herb Freeman D.C.

What do you provide for your patients

The recent thread with someone asking what exercises to prescribe for LBP and the responses, or lack thereof was interesting. The field of exercise science in treatment of a variety of disorders is burgeoning with the new ACSM's Exercise is Medicine campaign as well as with the release of books such as Spark: The Revolutionary New Science of Exercise and the Brain by J. Ratey. Within our own field, chiropractors sadly continue to be slow to adopt this trend and to educate themselves in what the science supports. I work with a lot of personal trainers in town, and with several PTs. They regularly are surprised that I, a chiropractor, seem to be abreast of the literature in exercise science. I am regularly disappointed that so many of my colleagues, and even the recent grads, seem to barely have an understanding of what works and what doesn't when it comes to exercise. It's maddening to continue to get disc patients who have been prescribed "yoga" that includes forward bends, knees to chest and twisting poses and can't seem to get that pain down their leg get any better. It's frustrating to see abdominal hollowing exercises a la' Hodges work on transversus and the subsequent misinterpretation of the findings of those studies, continue to be spread as misinformation and thus creating more dysfunction in that patient. I wonder what is to become of our profession when we don't demonstrate to the public that we know more about how to treat their back pain than their trainer at the gym who has attended a McGill conference, a Gray conference, a Gray Cook conference and regularly tunes in to SportsRehabExpert.com. What do we have to offer in response? The latest practice income generating tips gleaned at the latest conference? This lack of understanding does not seem to be lost on our patients in my experience.What prompted me to write tonight was a communique I received today that was intended for Kaiser physicians. The following was written by a physiatrist and was intended to be a quick guide to appropriate referral for PCPs in the local Kaiser system. After giving a good (I feel) description of the pros and cons of manipulation therapy he states:"How does manipulation fit into the general musculoskeletal care continuum and how does it relate to our PT services? Manipulation as a form of treatment is legitimate, whether you consider the field of chiropractic so or not. If we had PTs that did manipulation we would not need to refer out to have this form of treatment. The down side of Chiropractic from our perspective in Physical Medicine, is that there is an over-reliance upon passive modalities of treatment like manipulation, heat, ultrasound and an under emphasis on currently accepted concepts of exercise therapy which flourish throughout sports medicine and rehabilitation in general. This then may leave the patient after a few visits feeling better but not fortifying them with education, strength and flexibility which are the foundation of prevention for recurrent spinal pain."I haven't participated in this forum for a while. It's interesting to spend a few days here again. If I'm too out of place here, I'll go away again. But I would be interested in finding out if DCs in this progressive state are tuning in to the changing times and positioning themselves to have cultural authority for ALL things concerning conservative management of the spine. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports Medicine

Hotmail: Powerful Free email with security by Microsoft. Get it now.

February 4, 2010

That would be wonderful! Although, I think we (as a state) should really try to differentiate professions ie "look, you want to manipulate the spine, you go to chiro school or become an Osteopath. Period. Our identity suffers folks. When everyone can do Everything, how the heck is this good for anyone? Believe it or not YES, we should also have some limits to our scope that would be better provided by other specialties ex. accupuncture amongst others.

ph Medlin D.C.Spine Tree Chiropractic1607 NE Alberta StPDX, OR 97211503-788-6800

What do you provide for your patients

The recent thread with someone asking what exercises to prescribe for LBP and the responses, or lack thereof was interesting. The field of exercise science in treatment of a variety of disorders is burgeoning with the new ACSM's Exercise is Medicine campaign as well as with the release of books such as Spark: The Revolutionary New Science of Exercise and the Brain by J. Ratey. Within our own field, chiropractors sadly continue to be slow to adopt this trend and to educate themselves in what the science supports. I work with a lot of personal trainers in town, and with several PTs. They regularly are surprised that I, a chiropractor, seem to be abreast of the literature in exercise science. I am regularly disappointed that so many of my colleagues, and even the recent grads, seem to barely have an understanding of what works and what doesn't when it comes to exercise. It's maddening to continue to get disc patients who have been prescribed "yoga" that includes forward bends, knees to chest and twisting poses and can't seem to get that pain down their leg get any better. It's frustrating to see abdominal hollowing exercises a la' Hodges work on transversus and the subsequent misinterpretation of the findings of those studies, continue to be spread as misinformation and thus creating more dysfunction in that patient. I wonder what is to become of our profession whe n we don't demonstrate to the public that we know more about how to treat their back pain than their trainer at the gym who has attended a McGill conference, a Gray conference, a Gray Cook conference and regularly tunes in to SportsRehabExpert.com. What do we have to offer in response? The latest practice income generating tips gleaned at the latest conference? This lack of understanding does not seem to be lost on our patients in my experience.What prompted me to write tonight was a communique I received today that was intended for Kaiser physicians. The following was written by a physiatrist and was intended to be a quick guide to appropriate referral for PCPs in the local Kaiser system. After giving a good (I feel) description of the pros and cons of manipulation therapy he states:"How does manipulation fit into the general musculoskeletal care continuum and how does it relate to our PT services? Manipulation as a form of treatment is legitimate, whether you consider the field of chiropractic so or not. If we had PTs that did manipulation we would not need to refer out to have this form of treatment. The down side of Chiropractic from our perspective in Physical Medicine, is that there is an over-reliance upon passive modalities of treatment like manipulation, heat, ultrasound and an under emphasis on currently accepted concepts of exercise therapy which flourish throughout sports medicine and rehabilitation in general. This then may leave the patient after a few visits feeling better but not fortifying them with education, strength and flexibility which are the foundation of prevention for recurrent spinal pain."I haven't participated in this forum for a while. It's interesting to spend a few days here again. If I'm too out of place here, I'll go away again. But I would be interested in finding out if DCs in this progressive state are tuning in to the changing times and positioning themselves to have cultural au thority for ALL things concerning conservative management of the spine. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports Medicine

Hotmail: Powerful Free email with security by Microsoft. Get it now.

February 4, 2010

Assuming the question was not rhetorical, our clinic is currently finishing its 5 year participation in the NIH funded dose response of manipulation for chronic LBP. Dr. Chaser, Dr. Haines and I will also be involved in the upcoming NIH study investigating manipulation for neck pain and headaches along with several of our other colleagues on the list here. In addition, I hope to take the professional film work I had done of "McGill's Big 3" stabilizing exercises last year and format it into a DVD form that can serve as an adjunct to primary care management of discogenic LBP. It would take care in primary care environment, be an outcomes study, and would be randomized and double blinded. Thanks as always for your work as well Sunny! W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center

3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956

drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports MedicineFrom: skrndc1@...To: drpsnell@...; Subject: RE: What do you provide for patientsDate: Thu, 4 Feb 2010 10:22:39 -0800

,

Perhaps you are forgetting the quest fo the Educational Manual for Evidence Based Chiropractic that lasted ~ 6 years and was OFTEN assailed as an absurd use of our OBCE funds.

What your physiatrist may not be putting into his equation is practice rights. Oregon has a bill making its way to the legislators now limiting the use of manipulation only to those who have the same hours of training and experience required for a chiropractic license. They may NOT go out and take the latest 20-hour weekend course and show up for work on MOnday ready to adjustl It is due to be voted on in Jan of 2011. The evidence is there - in numerous forms - and continues to build.

What is your research project for this year?

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com

From: drpsnell@...Date: Wed, 3 Feb 2010 21:50:39 -0800Subject: RE: What do you provide for your patients

Herb I have the greatest respect for you. However, to answer your question "why should you care..." directly, perhaps you shouldn't, but the other DCs on this forum navigating the current environment of practice and planning for their future should. Why? The currency of the kingdom is research. The research says that manual therapy, manipulation and exercise combined work better than any of them alone. The Kaiser physiatrist in question is teaching the gatekeepers in your community how to view you and your colleagues. Kaiser is one of the only HMOs in the US that consistently runs in the black. Their model is frequently used as an example of some of the things that are right with managed care, whether you or I think so or not.Herb, this topic is of no interest to many of us on this forum who have panels into the 1000s. With decent care, most docs can maintain those practices with internal referrals. But for those that are building and have whole future ahead, the playing field is different than it was 45 years ago. Evidence based practice has changed things, for both MDs and for DCs. If MDs and DCs can't come together on this then as this physiatrist points out, they will refer, eventually to PTs who manipulate. In short Herb, this MD's opinion is the canary in the coal mine...and that's why we should listen. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports Medicine

Oregondcs From: hbf4747msnDate: Wed, 3 Feb 2010 20:31:56 -0800Subject: Re: What do you provide for your patients

Hi Dr. Snell,

Thank you for your informative post as to what current texts are available for patients' exercises. However when you cite the comments of a Kaiser physiatrist about our profession as being of significance we part company. D.C.s' are not MD's lapdogs waiting for a few words of approbation from them. I have practiced in the city of Keizer for about 45 years I've cared for thousands of patients and believe it or not nary a one of them was an MD referral. Philosophically chiropractic and all of the various methods under the medical umbrella are miles apart so why should I care at all as to this guys opinion.

Herb Freeman D.C.

What do you provide for your patients

The recent thread with someone asking what exercises to prescribe for LBP and the responses, or lack thereof was interesting. The field of exercise science in treatment of a variety of disorders is burgeoning with the new ACSM's Exercise is Medicine campaign as well as with the release of books such as Spark: The Revolutionary New Science of Exercise and the Brain by J. Ratey. Within our own field, chiropractors sadly continue to be slow to adopt this trend and to educate themselves in what the science supports. I work with a lot of personal trainers in town, and with several PTs. They regularly are surprised that I, a chiropractor, seem to be abreast of the literature in exercise science. I am regularly disappointed that so many of my colleagues, and even the recent grads, seem to barely have an understanding of what works and what doesn't when it comes to exercise. It's maddening to continue to get disc patients who have been prescribed "yoga" that includes forward bends, knees to chest and twisting poses and can't seem to get that pain down their leg get any better. It's frustrating to see abdominal hollowing exercises a la' Hodges work on transversus and the subsequent misinterpretation of the findings of those studies, continue to be spread as misinformation and thus creating more dysfunction in that patient. I wonder what is to become of our profession when we don't demonstrate to the public that we know more about how to treat their back pain than their trainer at the gym who has attended a McGill conference, a Gray conference, a Gray Cook conference and regularly tunes in to SportsRehabExpert.com. What do we have to offer in response? The latest practice income generating tips gleaned at the latest conference? This lack of understanding does not seem to be lost on our patients in my experience.What prompted me to write tonight was a communique I received today that was intended for Kaiser physicians. The following was written by a physiatrist and was intended to be a quick guide to appropriate referral for PCPs in the local Kaiser system. After giving a good (I feel) description of the pros and cons of manipulation therapy he states:"How does manipulation fit into the general musculoskeletal care continuum and how does it relate to our PT services? Manipulation as a form of treatment is legitimate, whether you consider the field of chiropractic so or not. If we had PTs that did manipulation we would not need to refer out to have this form of treatment. The down side of Chiropractic from our perspective in Physical Medicine, is that there is an over-reliance upon passive modalities of treatment like manipulation, heat, ultrasound and an under emphasis on currently accepted concepts of exercise therapy which flourish throughout sports medicine and rehabilitation in general. This then may leave the patient after a few visits feeling better but not fortifying them with education, strength and flexibility which are the foundation of prevention for recurrent spinal pain."I haven't participated in this forum for a while. It's interesting to spend a few days here again. If I'm too out of place here, I'll go away again. But I would be interested in finding out if DCs in this progressive state are tuning in to the changing times and positioning themselves to have cultural authority for ALL things concerning conservative management of the spine. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports Medicine

Hotmail: Powerful Free email with security by Microsoft. Get it now.

February 4, 2010

Assuming the question was not rhetorical, our clinic is currently finishing its 5 year participation in the NIH funded dose response of manipulation for chronic LBP. Dr. Chaser, Dr. Haines and I will also be involved in the upcoming NIH study investigating manipulation for neck pain and headaches along with several of our other colleagues on the list here. In addition, I hope to take the professional film work I had done of "McGill's Big 3" stabilizing exercises last year and format it into a DVD form that can serve as an adjunct to primary care management of discogenic LBP. It would take care in primary care environment, be an outcomes study, and would be randomized and double blinded. Thanks as always for your work as well Sunny! W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center

3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956

drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports MedicineFrom: skrndc1@...To: drpsnell@...; Subject: RE: What do you provide for patientsDate: Thu, 4 Feb 2010 10:22:39 -0800

,

Perhaps you are forgetting the quest fo the Educational Manual for Evidence Based Chiropractic that lasted ~ 6 years and was OFTEN assailed as an absurd use of our OBCE funds.

What your physiatrist may not be putting into his equation is practice rights. Oregon has a bill making its way to the legislators now limiting the use of manipulation only to those who have the same hours of training and experience required for a chiropractic license. They may NOT go out and take the latest 20-hour weekend course and show up for work on MOnday ready to adjustl It is due to be voted on in Jan of 2011. The evidence is there - in numerous forms - and continues to build.

What is your research project for this year?

Sunny

Sunny Kierstyn, RN DC Fibromyalgia Care Center of Oregon 2677 Willakenzie Road, 7CEugene, Oregon, 97401541- 654-0850; Fx; 541- 654-0834www.drsunnykierstyn.com

From: drpsnell@...Date: Wed, 3 Feb 2010 21:50:39 -0800Subject: RE: What do you provide for your patients

Herb I have the greatest respect for you. However, to answer your question "why should you care..." directly, perhaps you shouldn't, but the other DCs on this forum navigating the current environment of practice and planning for their future should. Why? The currency of the kingdom is research. The research says that manual therapy, manipulation and exercise combined work better than any of them alone. The Kaiser physiatrist in question is teaching the gatekeepers in your community how to view you and your colleagues. Kaiser is one of the only HMOs in the US that consistently runs in the black. Their model is frequently used as an example of some of the things that are right with managed care, whether you or I think so or not.Herb, this topic is of no interest to many of us on this forum who have panels into the 1000s. With decent care, most docs can maintain those practices with internal referrals. But for those that are building and have whole future ahead, the playing field is different than it was 45 years ago. Evidence based practice has changed things, for both MDs and for DCs. If MDs and DCs can't come together on this then as this physiatrist points out, they will refer, eventually to PTs who manipulate. In short Herb, this MD's opinion is the canary in the coal mine...and that's why we should listen. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports Medicine

Oregondcs From: hbf4747msnDate: Wed, 3 Feb 2010 20:31:56 -0800Subject: Re: What do you provide for your patients

Hi Dr. Snell,

Thank you for your informative post as to what current texts are available for patients' exercises. However when you cite the comments of a Kaiser physiatrist about our profession as being of significance we part company. D.C.s' are not MD's lapdogs waiting for a few words of approbation from them. I have practiced in the city of Keizer for about 45 years I've cared for thousands of patients and believe it or not nary a one of them was an MD referral. Philosophically chiropractic and all of the various methods under the medical umbrella are miles apart so why should I care at all as to this guys opinion.

Herb Freeman D.C.

What do you provide for your patients

The recent thread with someone asking what exercises to prescribe for LBP and the responses, or lack thereof was interesting. The field of exercise science in treatment of a variety of disorders is burgeoning with the new ACSM's Exercise is Medicine campaign as well as with the release of books such as Spark: The Revolutionary New Science of Exercise and the Brain by J. Ratey. Within our own field, chiropractors sadly continue to be slow to adopt this trend and to educate themselves in what the science supports. I work with a lot of personal trainers in town, and with several PTs. They regularly are surprised that I, a chiropractor, seem to be abreast of the literature in exercise science. I am regularly disappointed that so many of my colleagues, and even the recent grads, seem to barely have an understanding of what works and what doesn't when it comes to exercise. It's maddening to continue to get disc patients who have been prescribed "yoga" that includes forward bends, knees to chest and twisting poses and can't seem to get that pain down their leg get any better. It's frustrating to see abdominal hollowing exercises a la' Hodges work on transversus and the subsequent misinterpretation of the findings of those studies, continue to be spread as misinformation and thus creating more dysfunction in that patient. I wonder what is to become of our profession when we don't demonstrate to the public that we know more about how to treat their back pain than their trainer at the gym who has attended a McGill conference, a Gray conference, a Gray Cook conference and regularly tunes in to SportsRehabExpert.com. What do we have to offer in response? The latest practice income generating tips gleaned at the latest conference? This lack of understanding does not seem to be lost on our patients in my experience.What prompted me to write tonight was a communique I received today that was intended for Kaiser physicians. The following was written by a physiatrist and was intended to be a quick guide to appropriate referral for PCPs in the local Kaiser system. After giving a good (I feel) description of the pros and cons of manipulation therapy he states:"How does manipulation fit into the general musculoskeletal care continuum and how does it relate to our PT services? Manipulation as a form of treatment is legitimate, whether you consider the field of chiropractic so or not. If we had PTs that did manipulation we would not need to refer out to have this form of treatment. The down side of Chiropractic from our perspective in Physical Medicine, is that there is an over-reliance upon passive modalities of treatment like manipulation, heat, ultrasound and an under emphasis on currently accepted concepts of exercise therapy which flourish throughout sports medicine and rehabilitation in general. This then may leave the patient after a few visits feeling better but not fortifying them with education, strength and flexibility which are the foundation of prevention for recurrent spinal pain."I haven't participated in this forum for a while. It's interesting to spend a few days here again. If I'm too out of place here, I'll go away again. But I would be interested in finding out if DCs in this progressive state are tuning in to the changing times and positioning themselves to have cultural authority for ALL things concerning conservative management of the spine. W. Snell, D.C. Director, Solutions Sports & Spine, Inc at Hawthorne Wellness Center 3942 SE Hawthorne Blvd. Portland, OR 97214 Ph. 503-235-5484 Fax 503-235-3956 drpsnell.chiroweb.comwww.fixyourownback.comMember American College of Sports Medicine

Hotmail: Powerful Free email with security by Microsoft. Get it now.

February 4, 2010

Can we get an update/information as to what the bill says, intends or

if it is indeed happening? To my knowledge the signature gathering has stopped:

‘Oregon

has a bill making its way to the legislators now limiting the use of manipulation

only to those who have the same hours of training and experience required for a

chiropractic license.’

s. fuchs dc

From:

[mailto: ] On Behalf Of Snell

Sent: Thursday, February 04, 2010

12:48 PM

oregon dc listserve

Subject: RE: What

do you provide for patients

Assuming the question was not rhetorical, our clinic

is currently finishing its 5 year participation in the NIH funded dose response

of manipulation for chronic LBP. Dr. Chaser, Dr. Haines and I will also

be involved in the upcoming NIH study investigating manipulation for neck pain

and headaches along with several of our other colleagues on the list

here. In addition, I hope to take the professional film work I had done

of " McGill's Big 3 " stabilizing exercises last year and format it

into a DVD form that can serve as an adjunct to primary care management of

discogenic LBP. It would take care in primary care environment, be an

outcomes study, and would be randomized and double blinded. Thanks as

always for your work as well Sunny!

W. Snell, D.C.

Director, Solutions Sports &

Spine, Inc

at Hawthorne

Wellness Center

3942 SE Hawthorne Blvd.

Portland, OR

97214

Ph. 503-235-5484

Fax 503-235-3956

drpsnell.chiroweb.com

www.fixyourownback.com

Member American College

of Sports Medicine

From: skrndc1msn

drpsnellhotmail;

Subject: RE: What do you provide for patients

Date: Thu, 4 Feb 2010 10:22:39 -0800

,

Perhaps you are forgetting the quest fo the Educational Manual for

Evidence Based Chiropractic that lasted ~ 6 years and was OFTEN assailed as an

absurd use of our OBCE funds.

What your physiatrist may not be putting into his equation is practice

rights. Oregon

has a bill making its way to the legislators now limiting the use of

manipulation only to those who have the same hours of training and experience

required for a chiropractic license. They may NOT go out and take

the latest 20-hour weekend course and show up for work on MOnday

ready to adjustl It is due to be voted on in Jan of 2011. The

evidence is there - in numerous forms - and continues to build.

What is your research project for this year?

Sunny

Sunny Kierstyn, RN DC

Fibromyalgia Care

Center of Oregon

2677 Willakenzie Road, 7C

Eugene, Oregon,

97401

541- 654-0850; Fx; 541- 654-0834

www.drsunnykierstyn.com

From: drpsnellhotmail

Date: Wed, 3 Feb 2010 21:50:39 -0800

Subject: RE: What do you provide for your patients

Herb I have the greatest

respect for you. However, to answer your question " why should you

care... " directly, perhaps you shouldn't, but the other DCs on this forum

navigating the current environment of practice and planning for their future

should. Why? The currency of the kingdom is research. The research says

that manual therapy, manipulation and exercise combined work better than any of

them alone. The Kaiser physiatrist in question is teaching the

gatekeepers in your community how to view you and your colleagues. Kaiser

is one of the only HMOs in the US

that consistently runs in the black. Their model is frequently used as an

example of some of the things that are right with managed care, whether you or

I think so or not.

Herb, this topic is of no interest to many of us on this forum who have panels

into the 1000s. With decent care, most docs can maintain those practices

with internal referrals. But for those that are building and have whole future

ahead, the playing field is different than it was 45 years ago. Evidence

based practice has changed things, for both MDs and for DCs. If MDs and

DCs can't come together on this then as this physiatrist points out, they will

refer, eventually to PTs who manipulate. In short Herb, this MD's opinion is

the canary in the coal mine...and that's why we should listen.

W. Snell, D.C.

Director, Solutions Sports &

Spine, Inc

at Hawthorne

Wellness Center

3942 SE Hawthorne Blvd.

Portland, OR

97214

Ph. 503-235-5484

Fax 503-235-3956

drpsnell.chiroweb.com

www.fixyourownback.com

Member American College

of Sports Medicine

Oregondcs

From: hbf4747msn

Date: Wed, 3 Feb 2010 20:31:56 -0800

Subject: Re: What do you provide for your patients

Hi Dr. Snell,

Thank you

for your informative post as to what current texts are available for patients'

exercises. However when you cite the comments of a Kaiser physiatrist about our

profession as being of significance we part company. D.C.s' are not MD's

lapdogs waiting for a few words of approbation from them. I have practiced

in the city of Keizer

for about 45 years I've cared for thousands of patients and believe it or not

nary a one of them was an MD referral. Philosophically chiropractic and

all of the various methods under the medical umbrella are miles apart so why

should I care at all as to this guys opinion.

Herb Freeman D.C.

What do you provide for your patients

The recent thread with

someone asking what exercises to prescribe for LBP and the responses, or lack

thereof was interesting. The field of exercise science in treatment of a

variety of disorders is burgeoning with the new ACSM's Exercise is Medicine

campaign as well as with the release of books such as Spark:

The Revolutionary New Science of Exercise and the Brain by

J. Ratey. Within our own field, chiropractors sadly continue to be

slow to adopt this trend and to educate themselves in what the science

supports. I work with a lot of personal trainers in town, and with

several PTs. They regularly are surprised that I, a chiropractor, seem to be

abreast of the literature in exercise science. I am regularly

disappointed that so many of my colleagues, and even the recent grads, seem to

barely have an understanding of what works and what doesn't when it comes to

exercise. It's maddening to continue to get disc patients who have been

prescribed " yoga " that includes forward bends, knees to chest and

twisting poses and can't seem to get that pain down their leg get any

better. It's frustrating to see abdominal hollowing exercises a la' Hodges

work on transversus and the subsequent misinterpretation of the findings of

those studies, continue to be spread as misinformation and thus creating more

dysfunction in that patient. I wonder what is to become of our profession

when we don't demonstrate to the public that we know more about how to treat

their back pain than their trainer at the gym who has attended a McGill

conference, a Gray conference, a Gray Cook conference and regularly tunes

in to SportsRehabExpert.com. What do we have to offer in

response? The latest practice income generating tips gleaned at the

latest conference? This lack of understanding does not seem to be lost

on our patients in my experience.

What prompted me to write tonight was a communique I received today that was

intended for Kaiser physicians. The following was written by a

physiatrist and was intended to be a quick guide to appropriate referral for

PCPs in the local Kaiser system. After giving a good (I feel) description

of the pros and cons of manipulation therapy he states:

" How does manipulation fit into the general musculoskeletal care continuum

and how does it relate to our PT services? Manipulation as a form of

treatment is legitimate, whether you consider the field of chiropractic so or

not. If we had PTs that did manipulation we would not need to refer out

to have this form of treatment. The down side of Chiropractic from our

perspective in Physical Medicine, is that there is an over-reliance upon

passive modalities of treatment like manipulation, heat, ultrasound and an

under emphasis on currently accepted concepts of exercise therapy which

flourish throughout sports medicine and rehabilitation in general. This

then may leave the patient after a few visits feeling better but not fortifying

them with education, strength and flexibility which are the foundation of

prevention for recurrent spinal pain. "

I haven't participated in this forum for a while. It's interesting to spend a

few days here again. If I'm too out of place here, I'll go away again.

But I would be interested in finding out if DCs in this progressive state are

tuning in to the changing times and positioning themselves to have cultural

authority for ALL things concerning conservative management of the spine.

W. Snell, D.C.

Director, Solutions Sports &

Spine, Inc

at Hawthorne

Wellness Center

3942 SE Hawthorne Blvd.

Portland, OR

97214

Ph. 503-235-5484

Fax 503-235-3956

drpsnell.chiroweb.com

www.fixyourownback.com

Member American College

of Sports Medicine

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February 4, 2010