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By John Maltby, DC
No matter what you think of BJ Palmer, he seems to have been on to something. In 1938, the public’s view of Chiropractic was at an all-time high. Now, with the most recent Gallup Poll numbers, it appears that we have hit an unprecedented low. The truth about the 2016 Gallup Poll, those touting it’s value are hiding is shown clearly in the infographic below. So what is it BJ knew in 1938 which we may learn from today?
Written by John Maltby, DC and David Marcarian, MA
In a recent webinar and blog post, a well-respected individual in injury evaluation, highly recommended replacing Range of Motion Assessment as an outcomes measure with subjective-objective evaluations (e.g. Oswestry). Apparently, he has not seen the latest edition of the AMA’s book “The Practical Guide to Range of Motion Assessment,” where the DynaROM is presented as the new gold standard. This device is not only one of the most important technological breakthroughs in 30 years but significantly improves the validity of range of motion measures. To suggest in this evidence-based world that we opt for subjective report over objective data, as this author did, is a poor decision considering the increasing demand by insurers, courts and the public for healthcare providers to support their clinical decisions with objective data. John Gerhardt, MD, the inventor of modern range of motion technology, determined that range of motion, when augmented by simultaneous measurement of muscle guarding, significantly increased the sensitivity and specificity of range of motion measures. Clinically, he found 70% of his patients with muscle guarding and pain demonstrated normal range of motion values. The DynaROM quickly and easily presents muscle guarding in an objective, quantitative manner and the process is familiar as it’s simply performing range of motion measures with ECG electrodes attached to measure the muscle guarding component.
By Jeri Anderson, DC and John Maltby, DC
Can you imagine a world where IME’s and insurers no longer control patient care? With US Patent 9,808,172 B2, there’s no need to imagine. The newly patented DynaROM Motion EMG is the Gold Standard per the AMA Medical Text on Range of Motion Assessment and has been named “the lie detector for back pain” by prestigious attorneys for its ability to detect the presence or absence of soft tissue injury.
The DynaROM technology is actually quite simple; it combines wireless dual inclinometry with EKG technology to simultaneously measure range of motion and muscle guarding. It’s commonly known that muscle guarding is the body's natural defense in response to pain in motion; so, when you measure these two together, the results become significantly more sensitive to soft tissue injury and symptom magnification. This is because a significant percentage of the population has normal range of motion yet show muscle guarding and pain. A fitting example is the yoga instructor involved in a rear end MVA: they had excellent range of motion prior to the MVA and won’t be considered abnormal post MVA. When the muscle guarding component is measured alongside ROM, their normal ROM now becomes an abnormal DynaROM, as their muscle guarding is exposed, and injury is clear.
Is it Ethical to Utilize the MyoVision for Public Screenings to Determine Potential Spinal Disorders?
By David Marcarian, MA
You can't argue with success. B.J. Palmer promoted the NCM throughout the profession and DCs were becoming very well known, to a large degree because of technology. According to former President of the International Chiropractic Association, John Maltby, DC, "If B.J. were alive, he would be using the MyoVision on every patient." John is not wrong. Visit the clinic at Palmer College and the first thing you'll see are devices, like the Electroencephalo-neuromentimpograph. He knew the power of objective data even in 1924!
There were those that did not like "how" it was presented, but all recognized conceptually, that it worked. It was significantly better than palpatory findings alone.
So what does this all have to do with the Gallup Poll? B.J. was ahead of his time: He listened. He heard that science was trumping belief systems and we needed to "tech up."
It is my opinion that one of the main reasons we have not broken through the 5% ceiling and the reason the public perceives us as less credible than medical doctors, is that we don't provide objective data. Many of us don't even understand what it is! When I asked a group of students what objective data they gather on patients, they said "Oswestry." Oswestry is fine, but doesn't the patient input influence the results? In other words, if you have a heart issue, does the cardiologist rely on your subjective report to determine if you have a problem? Of course not. They do an EKG.
Even your auto mechanic understands the importance of objective data. Do you question the need for service when they show your wheels are out of alignment on a computer screen?
When I took my car to my auto alignment specialist, you can imagine my surprise when I heard him speaking chiropractic lingo when it came to my car! But I learned something very important: When I saw my car's "health" on a computer screen, I didn't question whether or not I would "engage" in care for my car. I just said, "fix it." Considering he was the one to use scientific tools to determine the problem, I instantly recognized him as the expert with the right skills and credibility needed to fix it.
Do you see how this applies to us in Chiropractic?
Surface EMG 2.0: Paraspinal Scanning sEMG now is reproducible, has solid control group research studies, and is "the EKG For Spinal Health."
Not sure? Listen to a prospective patient's unscripted response.
At this screening, 8/10 individuals had never been adjusted. After correctly identifying issues via the E-Scan system, all 8 were adjusted for their first time.
And for those who want to really help patients? DynaROM Motion sEMG is making DCs the first choice of PI Attorneys.
In the days before DynaROM, attorneys preferred working with MDs over DCs specifically because of the results of the above Gallup Poll. Now, with the evidence-based model ruling the courtroom as well, the doctor with the best data wins. DynaROM Motion sEMG can prove injury and pain with Normal ROM, normal MRI and when every other measure fails.
You're the experts on Soft Tissue Injury. You are a natural at not only diagnosis, but treatment as well. All you have to do is to prove it. DynaROM Motion sEMG provides the proof.
- It is dirty. There are SO many games which need to be played.
- Attorneys will never refer to us anyhow.
- Who wants to deal with the stress of being deposed?
- The income from PI is so much greater, that I would not know what to do with the added income!
- It is a violation of my philosophical orientation, as I want only patients who want to see me for wellness.
Time for a wake up call!
Why is PI perceived as a "dirty game"? Because it has always required we do things which we know are unethical for the purpose of obtaining patients. Some pay for a list of DMV accident records. Some spend time and money taking attorneys to dinner. There are all kinds of "tricks". The best trick of all, is to have tools which prove your value to attorneys. This way you don't have to chase them down, but they chase you down.
Change the game from opinion vs opinion to data vs. opinion.
Attorneys tell me all the time, that they prefer to work with MD's over DCs. I started to ask. "Clearly the public perception is that the MD has more credibility over the DC" is what I heard. Is this the case for the DC armed with objective data? Not at all. As a matter of fact, doctors that used to fear being before a jury or even in a deposition now gladly accept such challenges, as they have their trusty DynaROM Data to protect them and their patients.
Focus on the data, and opinion means nothing. Literally.
Dr. Richard Merritt, a DC from Lakeland, FL decided to challenge the State. He contacted all the experts on the technology in the Chiropractic Profession, and the only to respond was David Marcarian, inventor of the MyoVision.
The task was daunting: How would David Marcarian and Dr. Richard Merritt prevail against all odds? As is typical, everyone underestimated the knowledge of those from our profession:
According to Judge Cleavinger: "this technology has been shown to be useful in the evaluation of spine pain in much the same way EKG’s have become indispensable for chest pain evaluation”.
The insurers and the State of Florida failed to convince the Superior Court to overturn the decision, and apparently the Supreme Court rejected their appeal.
The impact this case has had on Chiropractic patients throughout the United States has been monumental, leading to a major win for the Dream Team.
Prior to this case, insurers could successfully argue that normal range of motion findings were justification to cut off care, even when the doctor placed in his or her notes that the patient experienced pain and muscle guarding.
With the patented DynaROM Motion sEMG technology, the ability to measure muscle guarding is a game changer, giving patients with normal ROM the right to maintain care.
The “legal game” of PI isn’t what it used to be, thanks to the dedicated efforts of a chiropractic “Dream Team” that fought the courtroom battles - and rewrote the rules.
Personal injury cases are a “love-it or leave-it” experience for many chiropractors. High on the list of objections is losing to the opposing side’s “medical experts,” whose opinions have historically held more weight in court.
But, it’s the facts that matter, says John K. Maltby, DC, FICA, FICAC(H), practicing in Blythe, CA. “When expert testimony relies primarily on the status of the expert, and is not based on solid data, it is purely opinion and nothing more,” says Dr. Maltby. “Data is indisputable and it easily wins over the status or rank of those offering medical opinions.”
In a recent $1MM soft tissue case, the patient was referred to Dr. Maltby for evaluation of her injuries using dynamic (active) range of motion analysis that simultaneously documents muscle guarding through the use of attached-electrode sEMG (DynaROM Motion sEMG). These two measures, when performed and graphed simultaneously, have been shown to be significantly more sensitive in proving soft tissue injury than endpoint ROM testing alone (Geisser, 2004). The exam results clearly indicated muscle guarding, validating the patient's injuries (Ambroz, 2000). And, according to the American Medical Association (AMA), muscle guarding is classified as a 5-8% functional impairment. (AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition)
This case, and others like it, have dramatically changed med-legal strategies and outcomes for DCs and their injured patients. Armed with new technology and objective data, chiropractors can now refute the most highly-credentialed medical expert’s opinion. “When evidence and technology are applied, and data are presented, it will always trump opinion,” says Dr. Jaeger. “And when you enter the med-legal arena, submitting the highest level of peer-reviewed evidence is what wins.” In the process, the value and status of chiropractic care is elevated in the eyes of the public, as well as in the medical and legal communities.
Dynamic range of motion testing, in combination with sEMG for measuring muscle guarding, has helped win a series of major PI cases for chiropractors and their patients.
The Merritt vs. DOH case lead to reimbursement for such testing under CPT Codes 96002 and 96004, and established admissibility of the DynaROM Motion sEMG instrument and data in all cases thus far. The reimbursement rate for these codes is five times higher than the reimbursement rate for endpoint ROM testing, without consuming additional time.
If you are still on the fence about handling PI cases, consider this: even “cash” patients are routine one day and injured the next. But the new ammunition provided by dynamic range of motion studies gives you the power to succeed.
Remember, when credibility and respect are high, so are referrals. Dr. Jaeger has this advice for DCs: “We now have the tools to make PI objective and evidence-based, so get on board and get it done! The rewards for your patients' health and your practice are invaluable."
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Dr. Fraley has more than 17 years experience working with personal injury and injured-worker cases, and has testified in court on behalf of these patients. He is a frequent guest speaker on chiropractic topics for the Washington State Association of Justice, and is a featured speaker for MyoVision.
email@example.com | 509-764-1836
Dr. Jaeger holds adjunct faculty positions at four chiropractic colleges, and was awarded the 2014 Chiropractic Biophysics™ Researcher of the Year Award for the Advancement of Chiropractic Science. He also holds the 2015 CBP™ Chiropractor of the Year Award, and applies his extensive clinical experience to his treatment of injured patients.
firstname.lastname@example.org | 702-396-4993
Dr. Maltby is a respected expert witness and two-term past-President of the International Chiropractors Association (ICA). He also served as ICA Chairman of the Board, and was ICA’s Chiropractor of the Year in 2007. Dr. Maltby has represented the ICA on the Board of Directors of the World Federation of Chiropractic.
NASA-Trained Researcher and inventor of high-tech biometric instrumentation, including the patented Wireless DynaROM Motion sEMG System which graphs muscle guarding and ROM simultaneously. This technology has established chiropractors as the leading experts in soft tissue injury. Upcoming CE Seminars can be viewed at www.myovision.com or by emailing email@example.com.
- Geisser, ME, Ranavaya, M, Haig, AJ, Roth, RS, Zucker, R, Ambroz, C, Caruse, M, A Meta-Analytic Review of Surface Electromyography Among Persons with Lower Back Pain and Normal, Healthy Controls. Journal of Pain, November 2005; Vol. 6, No. 11; pages 711 to 726.
- Ambroz C, Scott A, Ambroz A, Talbott EO. Chronic low back pain assessment using surface electromyography. J Occup Environ Med 2000;42:660-9.
- American Medical Association: Guides to the evaluation of permanent impairment, 5th edition.
- Richard W. Merritt, DC vs. Department of Health and The Florida Insurance Council. (Case No. 04-1149RX).
Designer of the MyoVision and experienced expert witness.