Issue: September 2004
This Upstate New York chiropractor creates the ultimate new patient exam and education model
Chiropractic care focused on treating symptoms alone amounts to a waste of time and expense, and represents a disservice to patients.
So believes Tim Maggs, DC, a solo practitioner in Schenectady, NY, who is making it his mission to harken the profession back to an embrace of the model it used in the days before chiropractors started patterning their thinking in the fashion of medical physicians and allowing themselves to be pushed around by insurance companies.
“With the way things are nowadays, if someone comes in for care without actual pain being present, the typical chiropractor more than likely doesn’t know what to do anymore,” Maggs asserts. “He’s been taught by the insurance industry and the medical community to use
Timothy J. Maggs, DC, explains the process of digital scanning to his patients.only the medical model, which entails diagnosing and treating based on symptoms.”
Not only that, says Maggs, but this is what patients themselves have been taught to expect. It is wrong, and needs to be corrected, he insists. “Consumers are of the understanding that they must ask for guidance regarding their health from their insurance company,” Maggs laments. “The insurance company never should be allowed to have a say in what a person does for his or her own health. Unfortunately, because the insurance company controls the money, that’s where people go for guidance. But what they’re taught is to not do anything about their health until after they’ve crashed. If you stop and think about it, you realize there’s no other aspect of life in which people function with that kind of self-imposed constraint.”
Use the Pyramid System
Both saddened and alarmed by all this, Maggs some years back put into motion a plan to recalibrate the thinking of the profession and the community. The centerpiece of that plan is his development of an approach to chiropractic care he calls Structural Management®.
“This is a program organized in the form of a pyramid,” he explains. “At the base of the pyramid is the Structural Fingerprint® exam. Above that are the familiar interventions of chiropractic along with a muscle management program and, further up, nutritional support.”
Climbing that pyramid, reaching the apex, patients find—at least in theory—that they have achieved optimal structural performance. In other words, they will have attained truly good health, Maggs suggests.
“My message, which I’m taking to sports, to industry, to the general population, and to the chiropractic profession is this: We can’t know what needs to be done for the individual until we first know where we’re starting from,” he says. “The only way we can learn what his or her structural distortions are is to take, if you will, a Structural Fingerprint® of the patient. This has nothing to do with symptoms, but everything to do with the ability to extract structural information to know where that person is relative to normal.
“Having that information, we can then create a proactive plan to work that individual toward normal. If the plan that is developed is a good one, after so many months the individual should be at a much more efficient—and far less vulnerable—state of health.”
The process of Structural Fingerprint®ing begins with the compilation of a thorough health history, followed by an evaluation of the feet.
“I also check the q-angles of the knees, range of motion, muscle tension, balance, imbalance, and leg length,” he adds. “Seventy-five percent of the information acquired during this Structural Fingerprint®ing process comes from a set of four standing x-rays we take. No other equipment is needed.”
The hardest part of the process is interpretation of the findings. “Many chiropractors have difficulty with this step because of their embrace of the medical model,” he says. “Rather than looking for symptoms, they have to instead look at things through the prism of what they learned in school—Ferguson’s gravity line, sacral base angle, and so forth.”
Explaining the findings in a cogent, impact-making manner to the patient is no less crucial because doing so then opens the door to the next step, the treatment phase, and induces in the patient a delightfully high level of compliance.
“Let’s say the patient is 42 years old,” Maggs hypothesizes. “Predictably, this person has another 43 to 48 years left on this planet. What’s he going to do to preserve and protect himself when he’s already starting to break down? If you tell the correct story to the patient, using the right terminologies and the simplest presentation, he is going to ask what can be done to preserve and protect himself. Once the patient asks that kind of question, you can correct his entire thinking about health,” shaking him loose of the indoctrination he’s received at the hands of the insurance industry all those years prior.
From there, the patient is primed to begin advanced conditioning, Maggs’s term for conventional chiropractic adjustment, rehabilitative exercises, orthotics, and more.
Get With the Program
The process of formulating this Structural Management® program spanned most of Maggs’s career as a chiropractor. “I started the process with a question: how do you articulate to the public the need for chiropractic care and for management of the entire structural system? When I entered practice in 1978, I believed that chiropractic was hugely valuable to people from all walks of life and at all ages. The problem was, I didn’t know how to articulate what I believed. It was extremely frustrating.”
His awareness of the problem became particularly acute after spending 4 years working with the New York Giants football team. It occurred to him in the course of that relationship that “almost no one involved in the players’ well-being truly understood the details of their structural needs,” he says.
At about this same time, Maggs took his nephew to meet the head strength coach of the Chicago Bulls basketball team, so that a conditioning program could be developed for the athletically gifted lad. “The coach spent an hour going through range-of-motion and various other details, in essence conducting a structural evaluation,” Maggs remembers witnessing. “It then really hit home to me that, as chiropractors, we have far more tools available to do exactly this kind of thing than does a professional strength-and-conditioning coach, and yet we’re not utilizing them.”
Soon afterward, Maggs began constructing a chiropractic version of that coach’s process. It took a number of years of experimentation and refinement, but eventually Maggs came up with what he is convinced amounts to a winning methodology.
“It’s now a program that would be perfectly appropriate in every chiropractic office in the world, and is something critically needed by sports, industry, an aging population, the pediatric population, and everything in between.”
Each year, Maggs conducts 25 seminars on Structural Management® to help colleagues learn how to integrate it within their own practices. However, there are some who find converting fully in one giant leap a sometimes impossibly daunting process because of its revolutionary nature, Maggs warns.
“It’s easy to be in your practice and stay within your comfort zone,” he says. “Structural Management® on the other hand requires you to get out of your comfort zone. Because it can be so hard to exit that comfort zone, I’ve designed Structural Management® in a programmatic form that can be adopted in easy steps. You can take certain aspects of it and implement those immediately, then add the others later as your confidence grows.”
In the program, a favorite therapy equipment to use is the stick-like object for improving warm-up prior to activity and accelerating recovery once the activity is completed. The application for this program is in sports, industry, and the general population. Maggs first used it on the New York Giants while also teaching them how to use it on themselves for all types of reasons. “This program works on repetitively used muscles that accumulate toxins and become shortened and vulnerable to injury due to excess use,” Maggs says. “Two hours of my 12-hour seminar are on this program, and DC’s are absolutely thrilled once they begin using it in their offices.”
Stripped of the Structural Management® component, Maggs’s Schenectady practice (50% cash based, 30% insurance, and the remainder a mix of workers’ compensation and the New York state version of personal injury) is pretty much a plain-vanilla operation. His office is relatively small, about 800 sq ft, into which are packed a pair of adjusting rooms, an x-ray suite, and a reception area.
However, Maggs has found the somewhat cramped quarters much to his liking. He says a compact facility abets efficiency and, if nothing else, his is an ultraefficient office.
“People very seldom wait to get into the adjusting rooms because we’re so on top of things,” he notes. It’s also a less expensive office to run. “Small size means small overhead,” he offers. “These days, given the market realities, you have to be conservative in what you spend every month.”
Even so, Maggs finds his practice outgrowing its current digs. A move to a larger site appears inevitable.
“I want to work with major employers,” he says. “To do that, I’m going to have to take on one or two associates. That, in turn, will make it necessary to have a larger office. Nothing’s firm on this yet, but one of the hospitals in this area has asked me to consider moving in with them. They don’t have programs for industrial injury and sports injury, but are of the belief that chiropractic would be ideal as the basis for those particular offerings. They see how well chiropractic is accepted by the medical community out on the West Coast, so they think the time is right to do the same here on the East Coast.”
Market My Words
As for marketing, Maggs is no fan of advertising in outlets such as newspapers and phone books. “That type of advertising motivates a response only from those people with a preconceived and completely misinformed notion of what’s going to happen when they visit a chiropractor,” he grouses.
The preferred form of marketing for Maggs is lecturing at local hospitals and service clubs, as well as getting involved one-on-one with sports coaches and corporate human-resources managers. “My most effective marketing tool is talk,” he tells. “All I need to make it work is access to people.”
For a stretch of 3 years that ended in 2003, Maggs had exactly that—access to people and the ability to talk to them via radio. “I did a Thursday afternoon show called Sports Medicine Hour. It was broadcast from a local college station that could be heard over the air and on the Internet, so it had a pretty sizable audience. I had to quit the show because I became so busy with my practice and all the things related to community health reeducation.”
Another outlet Maggs has for his message is consumer magazines. Each month, he writes a sports medicine column for about a dozen regional publications catering to runners.
“The most recent piece I wrote was about Structural Management®,” he says. “Within a matter of just a day or two after the column was published and began hitting subscribers’ mailboxes, I’d already received 35 inquiries from around the country, readers wanting to know who in their locales could perform a structural evaluation.”
Maggs says he plans to continue refining his Structural Management® program and, at the same time, build a national network of doctors trained in its use.
“My goal is for every community to one day have someone there who performs structural evaluations,” he says. “The participants in this network will be equipped to educate their communities and motivate them to take action with regard to their personal health.
“Don’t tell me there’s no market for this kind of network. There most certainly is. You go out to any company, have the right presentation, have the right program in place to be able to process people, and you can be busier than you’d ever want to be the rest of your life. I know I am.”
Born to Run
Tim Maggs, DC, is a natural-born optimist. That, however, puts him in the minority, since most people are innately the opposite.
Still, in his view, chiropractors not prone to an upbeat outlook can nonetheless learn to adopt that frame of mind.
“It takes work, but it’s worth the effort,” he assures. “Patients love to be in an office where the chiropractor has a positive view. And you’ll be able to accomplish a lot more in life while enjoying yourself along the way.”
Optimism lies at the heart of a chiropractic methodology for which the Schenectady, NY, practitioner has garnered considerable renown in recent years.
Most of that approach to care, called Structural Management®, concerns itself with the health of the body. Now, Maggs is toiling on an extension of it to address the health of the emotions.
“We know that we have to exercise to get physically in shape, but hardly anyone really talks about conditioning and strengthening our mental attitudes,” he says.
A great way to strengthen the mind while doing the same for the body is the sport of running, suggests Maggs, himself an enthusiast since his youth.
But it was in 1976, an Olympics year, that Maggs’s current keen interest in serious amateur running bolted out of the starting block. By 1987, Maggs had competed in 13 major events, including the Boston Marathon.
Then, tragedy. A day after his run through historic Beantown, Maggs developed a problem with calf pulls. “For the next 8 years, I couldn’t handle anything longer than a 3-mile run,” he says.
His running days were anything but over, though. Using a muscle management program he and two other practitioners developed (and which today is a component of his Structural Management® approach to chiropractic), Maggs restored himself to a level of functionality sufficiently high that he was once more able to run marathons.
In 2001, Maggs again qualified for the Boston Marathon. He’s run two more long-distance events since then. Maggs—married and the father of four sons who range in age from 15 to 1—hopes to run in many more contests yet to come, and more than likely will. —RS