TechniqueGary J. Miller, DC

Miller Family Chiropractic Center

MFCC 2018

Course Objectives1. Appreciate Old School Chiropractic and the field’s evolution.2. Understand the opportunity to focus the practice on "Acute

Care Chiropractic."3. Understand the "Nimmo" cross-fiber deep tissue technique and

how to apply it to the patient.4. Delve deeper into the bond that occurs between the DC and

patient before spinal manipulation.5. Review of the paravertebral and other muscle groups which

are benefited by the application of cross-fiber technique.6. Apply special chiropractic manipulation techniques that can

be applied immediately in the students' Monday morning practice.

MFCC 2018

Chiropractic History: 1984 - Present

• Cleveland Chiropractic, Dr. Carl Cleveland Sr.,Dr. Dorothea Towne, Dr. Ron Watkins, and Red Books

• The Rise and Fall of Chiropractic and the World of Insurance

• P/I, W/C, primary care insurance, P.P.O. insurance, and cash!

• Square reader• Yelp

MFCC 2018

Why Do We Adjust?

• Create “perfusion” allowing new biochemistry to flow into the region

• Metabolic cellular waste out-flow• Break up adhesions and decompress• Create restored and improved joint motion

MFCC 2018

Adhesions/Decompression• Patient has tight muscles, hypertonic, hyper-

contractile, due to both chronic trauma and acute trauma, postural trauma

• Chemicals become trapped in the soft tissue cells as metabolic wastes build up causing bio-chemical irritation

• Adhesions form within 4 days• Restricted motion• Negative cycle downward

MFCC 2018

MFCC 2018

Format Case History1. Age / Race2. Gender3. Weight4. Height5. Generalized Build6. Occupation

7. Exercise Habits8. Alcohol, Tobacco, Rx,

Cannabis, Supplements9. Metabolic Illness10. Family History of Spinal

Biomechanical Problems11. Personality Type

MFCC 2018

Their Story• Where it hurts• Why it hurts• How long it’s been hurting

My Questions

1. How am I going to approach the case?

2. Treatment program?3. Adjustment on the first day?4. Therapy?5. Refer it out?

MFCC 2018

MFCC 2018

Case History: “Mary Jo”

1. 58y/o / Caucasian2. Female3. 228 lbs.4. 5’ 8”5. Stocky, barrel chested6. Legal secretary7. No exercise

8. No tobacco/no cannabis/daily wine drinker

9. Mild diabetes10. Long family history of

low back pain11. Type A personality

with occasional TMJ flare-ups

MFCC 2018

Her Story: “Mary Jo”

This patient had a chief complaint of diffuse, bilateral, constant low back pain for 2 weeks after weeding the front yard. Radicular pain to the right, mid-thigh. All neurological tests were normal. No insurance. Cash patient.

MFCC 2018

My Questions

1. How am I going to approach the case?

2. Treatment program?3. Adjustment on the first day?4. Therapy?5. Refer it out?

MFCC 2018

MFCC 2018

“Promise”Rescue Cat

Cross-Fiber Work

• Golgi tendon organ and muscle spindle• Nimmo cross-fiber work: It takes time to development the necessary sensitivities

• Bob Sharpe taught• Byron Craygun taught• Me

MFCC 2018

MFCC 2018

Cervical Spine

• Review of cervical spine musculature and then the application of cross-fiber techniques

• Trapezius, suboccipital triangle, and erector spinae musculature

MFCC 2018

MFCC 2018

Case History: “Hilda”

1. 82y/o / Caucasian2. Female3. 98 lbs.4. 5’ (barely)5. Very fragile, fragile

spine6. Retired bookkeeper7. No exercise

8. Drinks a lot of beer (family of brewers)

9. Gall bladder removed 40 years ago

10. Extreme hyper-kyphotic senile spine

11. Supremely cantankerous with a big heart

MFCC 2018

Her Story: “Hilda”

“Everything hurts!” Patient for 30 years. Wants me to crack her like I’ve always cracked her. Wants to trade me beer for her office visit. Claims her entire spine hurts and wants me to miraculously fix it.

MFCC 2018

My Questions

1. How am I going to approach the case?

2. Treatment program?3. Adjustment on the first day?4. Therapy?5. Refer it out?

MFCC 2018

Components of a Great Spinal Manipulation1. Force – Body weight2. Speed – Hand speed and body drop3. Timing – The art and science has the element of

surprise4. Sensitivity – Cross-fiber work; range of motion

of patient; to the patient’s spirit; awareness of patient’s age and level of osteoarthritis

5. Getting all the slack out to the edge of the paraphysiological space

MFCC 2018

Connecting to the Patient

• Confidence and deep rooted belief in yourself and your technique

• Deep tissue cross-fiber work• Be the chiropractor you’d want to be

treated by• Vital that you gain the patient’s confidence

before adjusting or starting treatment• “Manos de ángel”

MFCC 2018

Giving Back to the CommunityChristie’s Place is a nonprofit social service organization in San Diego County that provides HIV/AIDS education, support and advocacy.

With funding from the Ryan White Care Act the Holistic AIDS Response Program (HARP) provides holistic services to those with HIV or AIDS.

MFCC 2018

Case History: “Nina”

1. 35y/o / Asian2. Female3. 410 lbs.4. 5’ 4”5. Morbidly obese,

amorphic6. Photographer and

marketing business7. No exercise

8. Both alcohol and cannabis regularly

9. Diabetes, considering gastric bypass

10. Family history of diabetes, hypertension, gall bladder disease, and obesity

11. Reserved

MFCC 2018

Her Story: “Nina”

She’s been told by every medical and chiropractic professional that her back pain is related to her weight. Doesn’t want any program(s) of care but instead says, “JUST ADJUST ME.”

MFCC 2018

My Questions

1. How am I going to approach the case?

2. Treatment program?3. Adjustment on the first day?4. Therapy?5. Refer it out?

MFCC 2018

Dan J. Murphy, DC, DABCO

• Cavitation• Drop table• Activator• Etc…. Everything you are doing!!

All result in high threshold Golgi tendon organ discharge.

MFCC 2018

MFCC 2018

Bikes of a Sort

Thoracic and Lumbar Spine

• Review of paravertebral musculature and the application of cross-fiber technique

• P/A adjusting vs. dorsal anterior adjusting and when to use each

• Gluteus medius and gluteus minimus

MFCC 2018

MFCC 2018

If everyone looked like thiswe would have nothing to do.

Case History: “Lou”

1. 42y/o / Caucasian2. Male3. 325 lbs.4. 6’ 2”5. Body builder6. Sells nutritional

supplements

7. Constantly weight lifting, no cardio

8. No recreational alcohol or drugs

9. Some anabolic steroids10. No family history of

back or neck problems11. Total non-believer

MFCC 2018

His Story: “Lou”

During initial office visit claims no one has ever been able to adjust him and is angry that his girlfriend is wasting his time and money.

No real pain. Feels tightness between his scapula and his low back. Feels tight especially when squatting or lunging.

MFCC 2018

My Questions

1. How am I going to approach the case?

2. Treatment program?3. Adjustment on the first day?4. Therapy?5. Refer it out?

MFCC 2018

Scoliosis• Anterior dorsals?

• Posterior dorsals?

MFCC 2018

MFCC 2018

Case History: “Susie”

1. 40y/o / Asian2. Female3. 118 lbs.4. 5’5. Very athletic physique6. Dance instructor7. Dances 8-12/hrs. day

8. Occasional wine drinker

9. No metabolic illness10. No family history of

back or neck problems11. Bubbly personality

MFCC 2018

Her Story: “Susie”

Presents with mild low back and cervical spine pain after returning home from France on a 12-hour flight. Has a 14-month old baby.

Likes to be adjusted 1-2 times/month. Refers a ton of patients.

MFCC 2018

My Questions

1. How am I going to approach the case?

2. Treatment program?3. Adjustment on the first day?4. Therapy?5. Refer it out?

MFCC 2018

Osteoarthritis & Congenital Abnormalities

• Hair patches at the cervicothoracic junction and lumbosacral region (Hypertrichosis)

• Side posture with leg extended• Port wine stain in the suboccipital region

MFCC 2018

MFCC 2018

Core Strengthening

Specialty Techniques

MFCC 2018

Specialty Techniques

• TMJ technique• Pubic Symphysis technique• Ankle mortise technique• Temporalis work• Sinus technique• Scoliosis adjusting

MFCC 2018

TMJ TechniqueMedial Pterygoid Muscle Function• Given that the origin is on the medial side of the

lateral pterygoid plate and the insertion is from the internal surface of the ramus of the mandible down to the angle of the mandible, its functions include:oElevation of the mandible (closes the jaw)oMinor contribution to protrusion of the mandibleoAssistance in masticationoExcursion of the mandible; contralateral excursion

occurs with unilateral contractionMFCC 2018

TMJ Technique

MFCC 2018

Case History: “Pam”

1. 28y/o / Hispanic2. Female3. 165 lbs.4. 5’ 5”5. Medium stature and

physique6. Mobile dog groomer

7. No exercise8. Daily beer drinker and

cannabis user9. No metabolic illness10. Low back pain on and

off since high school11. Mellow personality

MFCC 2018

Her Story: “Pam”Wants immediate relief because she has two Saint Bernards to wash that afternoon.

Mobile dog grooming has caused her to have lots of low L.B.P. The pain is isolated at L5-S1 with extreme splinting spasm bilaterally. No radiculopathy. This most recent flare-up has been constant for the last two weeks. Taking 800 mgs of Advil every six hours.

MFCC 2018

My Questions

1. How am I going to approach the case?

2. Treatment program?3. Adjustment on the first day?4. Therapy?5. Refer it out?

MFCC 2018

Specialty Technique Add-ons

• Cox table work• Physical therapies

• Hydrocollator packs, intersegmental traction, interferential electrical muscle stimulation

• Voice modulation and slow movement pre-adjustment

• Suboccipital triangle/migraines• SPANISH!!

MFCC 2018

Basic Spanish Terms• How do you say? – Cómo se dice?• Where is your pain? – Dónde está tu dolor?• Are you better? – Estás major?

MFCC 2018

• Neck – El cuello• Waist – La cintura• Hip – La cadera• Arm – El brazo• Hand – El mano

• Fingers – Los dedos• Heel – El talón• Knee – La rudilla• Thoracic – Espina dorsal• Lumbars – Los lumbars

• Vaya con Dios – Go with G-d

$400 Days• Acute care• Maintenance care• New patients• Geriatric care

• Athletic injury care• TMJ• Physical therapy only• “Miracle Adjustment”

MFCC 2018

Low Overhead / High Profit Margin

Overhead Amt. = Cost to Treat Each Patient# of Office Visits

MFCC 2018

State: Cobb chiropractors’ health care fraud funded ‘lavish lifestyle’Ben Brasch - The Atlanta Journal-ConstitutionThursday, October 12, 2017

How do we change the negative public perception of chiropractic?

MFCC 2018

MFCC 2018

It’s an amazing healing artWhen done well!!

You have a huge opportunityTo make a huge impact!

MFCC 2018

Speaking of GIFT…

MFCC 2018