Orthotics and Biomechanics

by Timothy J. Maggs, DCIssue:August 2005
Chiropractic Products

The first step in helping anyone preserve their structure is to recommend custom-made orthotics

Chiropractors who have been in practice long enough quickly learn that the medical profession is doing nothing to endear itself to the aching public. The medical-model approach (looking for pathology) makes little sense to the lay public. The costly approach to solving the riddle of back pain (symptomatic relief) with many worthless tests just never feels quite right to any segment of the population. Ask employers how they like the current system, after paying such high workers’ compensation premiums for an aging, overweight, and out-of-shape workforce.

The sad fact is that no one in the medical community is looking at the patient from a biomechanical perspective. Human beings are architectural structures, yet it is virtually impossible for a person in our country to go into a medical office and ask his or her “specialist” for a personalized structural status report. Mechanics can tell you the status of any car you bring to them, and an engineer can quantify the value of a building or bridge. But try to find a doctor who can give a report on someone's structure, and you will probably have better luck finding a winning lottery ticket that’s been accidentally thrown away.

The Need for Biomechanics

Any human being who is seeking long-term wellness for their structure would do well to locate and work with a professional who can help them preserve their structure. “Preservation of the human structure” is a term not often heard in our current system, but it needs to be heard in an effort to reduce the amount of money currently spent on musculoskeletal breakdown, injuries, and symptoms in this country.

Appropriate Biomechanical Tests

The first test done on a patient should be a check of the patient’s foot type. It is well-established that there are three different foot types (low arch, medium arch, and high arch), and the running shoe industry has even gone so far as to make specific shoes for specific foot types. So wouldn’t it make sense for doctors to alert the patient as to their foot type? With a low arch/flat foot (or flat feet), a motion-control shoe is recommended. This is the foot type of 70%–80% of the population.

Those with a normal, medium arch (about 10% of the population) would benefit from a stability shoe.

A high medial arch, or a supinated foot, constitutes about 10% of the population, and it works best with a cushioned shoe, as a supinated foot typically will be rigid and more sensitive.

Two basic tests are performed when checking body-weight distribution and foot type. The first is to manually check standing arch height by getting down on your knee and inserting your middle and index fingers under the patient’s medial arch.

See Figure 1, a DC prepares a patient for a digital foot scan, which will yield digital images of the feet, as Figure 2 illustrates.

The second method for checking foot types and identifying weight-distribution imbalances is with a digital scan of the feet. With proper software, you will see the difference in the patient's weight, right versus left, and front versus back, and this visualization for the patient is extremely important when motivating the patient to take action. As you can see in Figures 1 and 2, digital scanning provides a wonderful visual.

The next test of concern is the Q angle of each knee. An increased Q angle is nothing more than a crooked hinge joint. The greater the imbalance, the greater the wear and tear on the knee. If neglected, over time, the likelihood for a knee replacement increases greatly.

Range of motion, muscle-tension tests, deep tendon reflexes, leg-length measurements, and spinal-compression tests are all part of biomechanical testing. In addition, and most importantly, standing biomechanical x-rays are taken on all patients, to rule out pathology and look for biomechanical findings.

Figure 4 shows a center of gravity check using lateral x-rays.

Figure 3 shows a center of gravity check using anteroposterior x-rays..

There are multiple biomechanical findings that we look for on x-rays. First of all, we check centers of gravity, both anteroposterior, as Figure 3 illustrates, and lateral in the neck and lower back, as Figure 4 illustrates. Second, we check for positional abnormalities, such as reversal of the normal cervical lordotic curve, rotation of the pelvis as seen on the anteroposterior lumbosacral, or rotation of the axis in relation to the atlas.

When biomechanical imbalances and joint dysfunction occur for a prolonged period of time, the degenerative process accelerates. Trauma, repetitive motion, structural imbalances, and joint fixations lead to an acceleration of joint degeneration. When degenerative changes are found on the x-ray, the practitioner should determine the history behind the degenerative change. For example, when C5 alone is going through degenerative changes, it is clearly a fixation due to abnormal stresses at that level. When a joint other than C5 or L5 undergoes degenerative changes prior to C5 or L5, it is due to prior traumas that have been unresolved. A joint left “locked” or subluxated for an extended period of time will produce a premature degeneration of that joint space.

Lifetime Preservation

No profession is out there selling “preservation” of the human frame. Yet, think of the savings in the health care field if we can help preserve everyone’s neuro-musculoskeletal system. And, this savings is based upon individuals proactively doing what they need to do to preserve their structure.

The first step in helping anyone to preserve their structure is to recommend custom-made orthotics. In my office, since we do Structural Management® exclusively, 95% of our patients are fitted for such orthotics at the beginning of their programs. Regardless of whether they are covered by insurance or not, patients understand the role custom-made orthotics play in their future. There are different reasons why these supports are recommended, and there are different types of custom-made orthotics that we need to understand.

First of all, any structural imbalances, centers-of-gravity imbalances, rotations, or dysfunction of joints need to begin correction with the fitting of custom-made orthotics. Un-less that medial arch is addressed so that it is bilaterally even, there will be an ongoing imbalance in the structure. As the aging process continues, premature degenerative changes will occur.

Figure 5 shows that foot imbalances can lead to postural imbalances throughout the body.

If the patient pronates, it becomes obvious why custom-made orthotics are needed, especially if right and left are different. The “crooked man” image (Figure 5) clearly shows why imbalances in the medial arches of the feet have exponential implications in the structure above. In this case, the left foot pronates, leading to compensation in the knee, hips, and shoulders. This imbalance will clearly lead to other imbalances and premature wear and tear of joints. This obviously sets the patient up for an increased vulnerability to injury.

When the patient presents with degenerative changes in any joints, the need for custom orthotics increases, as there is clear evidence that a certain joint has been under an increased level of stress for a prolonged period of time, and the outcome is premature degeneration.

Options for Orthotics

The podiatric and orthopedic professions recommend rigid, non weight-bearing orthotics to their patients. This type of orthotic addresses foot imbalances, but is not in any way designed to address the biomechanics above the ankle. A flexible orthotic, measured in the weight-bearing position, produces an orthotic more appropriate for the entire human structure. Additionally, shock-absorbing qualities in these orthotics are critically valuable to the longevity of the structure. As I tell my patients, “The more shock absorbed in the orthotic over the course of your lifetime, the less stress that goes up your structure.”

A rigid orthotic is designed for an imbalanced foot; however, it offers no shock absorption for the entire structure. These orthotics last an eternity, but their restriction of normal foot mobility, their overcompensation of joints and muscles above, and their absence of shock-absorbing qualities make flexible, weight-bearing orthotics preferable.

Scanning the Horizon

I use a digital scanning system, which educates the public that symptoms are not the issue; it’s biomechanical imbalances. In industry and sports—in most issues of postural health, for that matter— biomechanics is the key. The chiropractor is best suited to respond to these needs, but the chiropractor must be willing to “step up” outside the normal insurance guidelines to provide such help. In time, chiropractors will realize the benefits of this type of work.

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.

Back Pain: Solving the Riddle

by Timothy J. Maggs, DCIssue:May 2005
Chiropractic Products

Is it time to rethink our approach to back pain?

Pain sells. Pain has spawned an entire industry that brings in billions of dollars per year. From over-the-counter and prescription drugs to pain-management centers, many people are desperately looking for answers. Traditional medicine is ill-equipped at solving the pain riddle, because—as most chiropractors know—pain is a result, not a pathology. When pain gets its own diagnosis codes (724.1—thoracic pain, 724.2—lumbar low back pain), it is clear that those in charge might not know what is underlying.

While there are many varying viewpoints on back pain, it is important to recognize the vast difference between the conventional, medical approach and the viewpoint of this author. It is time that the entire health care community admits and recognizes the inadequacy of the current approach toward back pain.

Q: Why is back pain so prevalent?
Medical Approach: Every day, the spine and back muscles must maintain balance with weights whose load is magnified many times. When you lift something, your body acts as a lever—and the farther that item is from your spine, the greater the load is on your back. If you lift 10 pounds, that item may be 3 feet away from your spine. That translates to 30 pounds of weight that your spine has to carry. When you are sitting and leaning forward to use a computer, the load force of your upper body is two times greater than when you are standing upright.

Maggs: We are all architectural structures. As we age, the many contributing factors that dictate our Structural Fingerprint® , such as heredity, age, weight, height, condition, prior injuries, shoes, mattress, job, and diet, predispose all of us to imbalances, joint fixations, and muscle weaknesses. These defects, at some point, produce pain. Until we detect and correct these defects, we will never truly address the cause of back pain. If left unattended, degeneration of joints prevails.

Q: What is the best way to prevent back pain?
Medical Approach: The most important thing is to do what you always do. Most back pain results from changing your routine, which is why weekend warriors run into trouble. Taking an aspirin or an over-the-counter pain reliever before you exercise or lift things is sometimes recommended. Or have a cup of coffee; caffeine is thought to help prevent back pain.

Maggs: Back pain, first of all, is a result, not a condition. In most cases, back pain is the result of poor conditioning, coupled with other contributing factors. The best way to prevent back pain is to understand your Structural Fingerprint® , then make it a lifetime habit to work hard to improve and maintain your structural balance, joint mobility, and muscle flexibility. Americans cannot live a life of poor conditioning and think their structures will survive without notice.

Q: What is the role of exercise?
Medical Approach: Aerobic exercise is most important, because there is no blood supply to the discs of the spine. You need motion to increase the diffusion of chemicals within the discs, to flush them with fresh oxygen and other nutrients, and remove the lactic acid that builds up, which causes pain. If you work at a desk, get up and walk around every 20 minutes. Yoga and other exercises that stretch back muscles are especially helpful because stretching these muscles makes them work better mechanically. Strength training is trickier because many people have bad form and wind up hurting their backs. But, with appropriate training, lifting weights can strengthen back muscles.

Maggs: Exercise is crucial for a healthy back; however, there is a specific role for exercise. It follows structural balance, joint mobility, and muscle flexibility. To attempt exercising—especially as we age—without first addressing these other factors will inevitably lead to back or other structural injuries. Once balance, mobility, and flexibility are present, exercise now becomes the gift of life for someone, as it truly creates a happier and healthier person. But you cannot do one without doing the rest; a great life requires all.

Q: How should back pain be treated?
Medical Approach: Back pain usually remedies itself in 3 to 5 days, but most people will have a recurrence of the same type. Pain relievers help, but you really need to stay active; bed rest should be avoided. If your back hurts, ice it to reduce inflammation. Acupuncture helps some people, possibly because back pain usually lasts only a few days, no matter what you do.

Maggs: Treating back pain has to stop being the goal. Usually, pain comes on as a result of ignorance with regard to proper conditioning. The health care community endorses waiting until back pain comes on, almost like it is some alien creature that needs to be killed any way that you can. As a society, we need to address this issue long before back pain presents itself. It all begins with better conditioning of the body, beginning with an understanding of a person’s unique structural needs.

Q: Should I see a physician?
Medical Approach: Most people only need to go if their pain lasts more than 3 weeks, but you should see a physician immediately if you are also suffering from leg pain, or have problems with erections or bowel or bladder function, since nerves in the back control them. X-rays rarely are useful because they do not show soft-tissue damage. A magnetic resonance imaging procedure may be warranted, but only after your physician has taken your health history and tested your reflexes and muscle strength.

Maggs: The answer is yes, but not necessarily for the back pain. Again, a structural plan should be created long before symptoms arise. The parameters that most conventional doctors function under (leg pain or problems with erections or bowel or bladder function) represent a relatively low percentage of back-pain sufferers. Those conditions that are a result of disc herniations causing nerve impingement are less than 1¼2 of 1% of all back-pain sufferers. X-rays are mandatory on a structural examination to determine the biomechanics of an individual. However, when back pain comes on, a patient should ask the question, “Why?” and then do whatever is necessary to find the answer and correct the underlying problem.

Q: How do shoes affect back pain?
Medical Approach: High heels can cause you to hyperextend your back—but if you already wear them, stick with it. Problems often occur with women who wear sneakers for their commute, then change into heels at work. When you change the mechanics of your footwear, you change the way your foot hits the ground, and that can stress the back.

Maggs: The feet are the most important component of the entire kinetic chain, as they are the foundation of the structure. Most people pronate or have flat feet, while a significant portion of the remaining population supinates, or have high arches. When structural balancing is the goal, the best results come when the medial arches of the feet are symmetrical.

In our office, we fit 95% of all patients with custom-made orthotics, as this is an important part of the master plan to help a person have a better life. An imbalance in the foot’s arch will aggravate weight-bearing joints in the body and never allow a person to realize maximum balance and maximum function of his or her structure. This predisposes one to a greater vulnerability to injury and an acceleration of degeneration in those joints under the most stress. Custom-made orthotics can be created to provide postural support, protection from heel-strike shock, and much-needed comfort.

Additionally, if people wear running or walking shoes, they can benefit from shoe-and-orthotic options that are available to the health care profession in a wide variety of styles.

Look for the Source
Pain is usually a result of not identifying the underlying imbalance. We, as a health care community, must stop treating pain as a condition. It is our job to motivate and educate the public to identify their unique structural qualities, and then to encourage them to continue keeping their structures working well for the rest of their lives. It is that simple. CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.

Philosophy: Preparing for Pregnancy

by Timothy J. Maggs, DCIssue:April 2005
Chiropractic Products

Benefits of adjusting women before pregnancy

As a father of four boys, I am clearly aware of the traditional approach to pregnancy and delivery in this country today. Having been a chiropractor for 26 years, I am also clearly aware of the unwritten rules that exist in working with pregnant women. As time has passed, the experiences from these two chapters of my life have merged and led me to a conclusion that should be offered to every potential mom out there.

Present Standard Care for the Pregnant Woman
As we all know, many pregnant women also suffer from a variety of neuromusculo-skeletal symptoms during pregnancy. It is well-assumed that the increase in weight, as well as how a woman carries herself due to this increase in weight, is reason enough to stress some muscles and joints, thus leading to symptoms.

The standard and accepted protocol has always been to do whatever testing you can do without exposing the patient to x-ray, and then work hard to reduce the symptoms to a tolerable level. This is all done with the hopes that the baby will be born before the symptoms become intolerable.

I have recently received several referrals from my wife’s obstetrician and gynocologist; and in speaking with his physician assistant, I get the sense that they feel “free” in a way, as though they “get” what the rest of the world does not. They have seen good results with chiropractic, and then feel the freedom and confidence to send some of their pregnant patients who are suffering from back pain to our office for help.

Procedural Shift

What this office did not understand is that I have changed my protocol with regard to pregnant women. I have taken a stand, and I am now unfolding my plan in an effort to change the way we work with pregnant women. First, there must be a general assumption out there that, prior to pregnancy, all women are structurally sound and physically in great shape. After all, there is no “prepregnancy” program that helps women prepare for this event—and it is an event.

For the past 26 years, we have been x-raying every new patient who comes into our office. The variances in sacral base angles, Ferguson’s gravity lines, disc integrities, and cervical lordoses have shown me that most people have significant structural imbalances; and this is prior to becoming pregnant. Aren’t we the professionals who believe that imbalances in the skeletal system produce abnormal irritation to the nervous system? And isn’t that detrimental to one’s health, especially one who is about to go through 9 months of pregnancy and then the delivery process? Doesn’t it make sense that we should seek more involvement with the woman prior to her getting pregnant than just offering some pain relief when the symptoms appear during pregnancy?

The Structural Fingerprint® Examination

This examination is ideal for any woman who is considering getting pregnant within the coming 12 months. The examination has nothing to do with symptoms, and it should be done while the patient is without symptoms. It begins with a consultation to determine if the patient has had any prior structural injuries, and what tests and treatments have been done. For the most part, the majority of patients have never been through any type of structural examination, and do not have recent standing x-rays that could be used for this evaluation.

The examination begins with an evaluation of the patient’s feet in the standing position to determine the foot type. Foot type is critical, as most people have abnormal medial arches, which produce abnormal weight-bearing throughout the other joints of their body. This certainly would impair the pregnancy process, as weight imbalances would only increase over the 9-month period. Range of motion, muscle compliance, leg length, and other tests are also performed. Standing x-rays should always be done to determine biomechanical defects that need to be improved and corrected. We recommend an A-P, lateral cervical, and L-S x-ray. The A-P cervical should include an open-mouth view.

Once all of this information is collected, then a corrective program can be designed. The goal, or objective, has to be more than just symptom relief. Assuming that the patient is a 24-year-old woman who hopes to become pregnant in the next 12 months, then the goals should be to:

• improve overall structural balance;
• improve joint mobility; and
• improve muscle flexibility.

Now, if the patient has one crest higher than the other and the measurement of the leg lengths is the same, then we need to check out what the foot types are. Typically, in a situation like this, you will find that the medial arch of the foot on the side of the low crest (as seen on x-ray) will be more pronated than the other arch. Obviously, custom-made orthotics would work well here.
If the sacral base angle is greater or lesser than normal, then a sudden increase in weight could produce structural problems. The same applies to Ferguson’s gravity line, which represents the center of gravity as seen from the side. On your later L-S x-ray, if the weight-bearing line is either anterior or posterior to normal, that means the weight of the body is going through areas that are unable to tolerate it, and the capacity of the lumbo-pelvic region is reduced. If this is the case and a woman hopes to become pregnant, predictably she will be more prone to back problems as well as potential delivery problems.

In our office, we set patients up on a 6-month program we call our Advanced Conditioning Program. This program includes 40 chiropractic visits, beginning with 3 times per week, and ending with once every 2 weeks. In addition, we recommend custom-made orthotics to 95% of all patients, as our goal is to improve and maintain structural balance over the course of one’s lifetime. This objective becomes much easier when the patient wears quality orthotics.

In addition to creating a symmetrical angle in the two medial arches, there is also a shock-absorption benefit when wearing certain types of custom orthotics. I tell my patients, “The more shock that is absorbed in the orthotic, the less that goes up through the body.” For a woman who is gaining weight each and every day for 9 months, this has to be a welcomed recommendation. In addition, the better condition a woman is in, the easier this journey will be. We recommend foundational-type exercises, such as core muscle, flexibility, cardio, and fitness-type exercises.

When a program like this is provided to a patient, this certainly does not totally eliminate the possibility of back pain, hip pain, or sciatica; however, it certainly reduces the likelihood. If a patient does become symptomatic during pregnancy, I can assure you they will respond much quicker and better if that they have already gone through the Advanced Conditioning Program.

Marketing This Concept

You need to have a procedure that will help to detect structural imbalances and defects, and then a report that will allow you to articulate the message to the patient.

The Structural Management® Program is one program available to doctors that will help them build their confidence in working with nonsymptomatic patients and then managing these patients through a structural-correction program. Once this confidence is in place, then release the hounds.

Obviously, one great resource is the obstetrician and gynecologist offices in your community. I have found that most of these offices have physician assistants, and they might be the more appropriate personnel with whom to meet. With whoever you get to meet, simply be prepared to inform them that women enter pregnancy with no knowledge of their structural wellness or integrity.

As a chiropractor who works with pregnant women, it is extremely difficult to only see women after they are pregnant. Second, having to work on someone without having the benefit of seeing their structural x-rays puts everyone at a disadvantage. Third, the care provided is almost too little, too late. No one wants to see a pregnant woman suffer needlessly. So, the goal is to hold an educational class, at the gynecologist’s office if possible, for those women who want to be more prepared physically for their next delivery.

Once you set this up, conveying the message is usually pretty easy. A PowerPoint presentation or flip charts can easily show the range of imbalances seen on many low-back x-rays, and the goal is to improve these imbalances before the pregnancy occurs.

This concept also can flourish by informing your current patients. Many of them are intimately connected—either through work, being related to, or knowing—with moms-to-be. Encourage these contacts to have the young woman set up a consultation in your office, and then give her a one-on-one presentation. I have found that the smaller the group, the more personalized the consult can be. Seldom will someone walk out of this consult without making an appointment for an examination.

Conclusion

As you can see, this approach requires energy and improved skills to get the message out there, and then to sell the program once the patient comes in. However, the alternative is to continue to function under the current medical model of care rules, which only address musculo-skeletal issues after an acute onset or chronic return of symptoms. Once you become proficient in this preonset approach, and begin informing your community of the tremendous services you now provide, the world becomes your oyster—and chiropractic moves one step closer to becoming mainstream. CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.

Under Structural Management®

By Dr. Tim Maggs
March 3, 2005
National Indoor Track & Field Meet--New York City

Shaker High School boys team (upstate New York) misses the national 4 x 800 relay record by 6/10ths of a second. 6 weeks prior, 2 of the 4 members couldn’t run because of injuries. Due to some persistence and good injury management, I’m sure “Pre” was smiling down on these guys.

Sports Physicals

Eighteen months ago, I contacted the National Federation of High School Athletics in Indianapolis. The president of the organization, Jerry Diehl, was kind enough to take my call. “Mr. Diehl, my name is Dr. Tim Maggs, and I work with many middle and high school athletes. After many years in a sportsmedicine practice, I’ve come to a conclusion, and I hope you’ll find some interest in my conclusion. There’s a crisis within this group of athletes. Structural exams are non-existent in middle and high school sports. School physicals, which are mandatory for participation, for the most part consist of tests ranging from eyes, ears, nose and throat to scoliosis “screening” and vaccination verification. No one is looking at joint mobility, structural imbalances or postural distortions. Their biomechanics are virtually ignored, yet that’s where most sports injuries occur.”

There was a pause, maybe even a little sigh, before Mr. Diehl said, “You know Dr., you hit a nerve. We know this void exists, yet we don’t know what to do about it. In fact, we’ve even gotten to the point where we call it a ‘hey you physical’. If the kid looks when the Dr. says “Hey you”, he or she passes”.

I was surprised by his answer. No, I was thrilled with his answer. Someone other than me is acknowledging the problem. I need more people out there recognizing this huge void, and the thought that someone of Mr. Diehl’s stature would get it was great. I’ve said for years that doctors don’t have to be experts in biomechanics, but just tell the truth. Tell the truth that most docs in our system don’t understand biomechanics, yet it’s critically important for athletes to find someone who does. Every athlete alive would improve under the guidance of a biomechanics expert, as well as learn how to preserve their structures over the course of their lifetime.

I’ve found parents to be the most receptive to this message, as they inherently want the best for their kids. Look at what’s happened to orthodontia over the past 20 years. Parents would rather stick bamboo shoots under their fingernails than not have their kids wear braces. Even though there’s very little health crisis with crooked teeth.

Yet, if they knew a “hey you” physical was all that was done in the schools, there’d be an uproar. My goal is to alert them of the absence of good structural evaluations, then figure out how to provide them with the “expert” who can perform such tests. My plan is often met with resistance by some, but I know parents care. And if I can just get the message out to them, they’ll help to make things change. The importance of this effort would have far reaching implications, from injury prevention while in high school sports to delaying joint and muscle degeneration as these kids reach middle age.

“Well, Mr. Diehl, I think I have an answer”.

And with that response, the long and arduous process of attempting to change the establishment began.

A “Concerned Parent’s” Search

Two years ago, I was the guest speaker at a coaches’ night for a local high school. My message was the same as always, kids need structural, biomechanical exams before the season begins. Don’t treat injuries with symptomatic relief. We need to think in terms of structural management.

Two months ago, I received a call from a mother who had attended that meeting. Her son, a member of the Shaker 4 x 800 indoor relay team, was suffering with severe low back pain and unable to run. Unfortunately, the timing of this injury couldn’t have been worse. A 4 year athletic scholarship was at stake. So the mom made an appointment with our office and we did our Structural Fingerprint™ Exam on him, trying to find the imbalances that were causing his pain. The imbalances were obvious and his corrective program started immediately. Our corrective program includes many different components, determined by the structural issues we find on the patient’s exam and x-rays.

What I didn’t know at the time was this 4 x 8 relay team was vying for national attention, as their times were seriously challenging the national record of 7:42 indoors. Within a couple weeks after meeting this runner, two of his teammates came in to undergo their Structural Fingerprint™ Exam. One was suffering with hip pains while the other hadn’t run in 6 weeks due to knee pain. Fortunately, youth responds quickly, especially when you can isolate the exact cause of the symptoms. As expected, all of these guys responded very well.

Without really knowing the talent level I was working with, I wake up one morning and read that Shaker High School boy’s 4 x 8 relay team comes in 2nd place to another national powerhouse team, while both of them break the national record. One of the young men who hadn’t run in 6 weeks due to knee pain runs a 1:57.4. I told him “I’m glad you didn’t ask me if you could run, I would have told you no.” He laughed. I cringed.

So, they go out again on March 3rd, and miss the national indoor mark by 6/10ths of a second. All of them run between 1:54.7 and 1:57.4. And, most importantly, all of them felt great. No dings, no pulls, no excuses. Nothing but excitement heading into the outdoor season. Youth, optimism and success, the formula for guaranteed happiness. For me, helping them reach the starting line in one piece, that’s my excitement.

Keep an eye out for our Concerned Parents of Young Athletes Program. Until biomechanics is available to all middle and high school athletes in this country, I won’t quit the mission. Have a great month.

Overutilization or Utilization?

by Timothy J. Maggs, DCIssue: March 2005
Chiropractic Products

Are you providing the necessary treatment and recommendations for maximum care

In today’s insurance community, the word “overutilization” is frequently used. Many doctors have learned that overtreating or over-recommending is tantamount to stealing or abuse of the patient, and fear encourages many doctors to recommend less, despite what they believe.

Within many of these doctors lies a frustration that permeates every cell in their bodies. Staying within the guidelines of the insurance industry—using the medical model as the standard of care—will typically lead to limited, or failed, results.

Despite current trends, we know that many Americans suffer from chronic back, neck, hip, and other joint pains that will continue to degenerate at an accelerated basis. The currently accepted model of care in no way provides solutions to these problems. Most low back pains are due to mechanical causes,1 yet we live under a pathology-oriented system that fails to detect or correct musculoskeletal imbalances, weaknesses, or injuries.

More important is the fact that very few physicians are providing the level or quality of care needed to correct the many biomechanical problems that exist today. Most practitioners are drawing a circle around the site of pain, doing localized testing for pathology, and then treating to eliminate any pain that exists. This is what insurance reimburses for, and this is what the public expects. This methodology certainly leads to a more costly and ineffective approach to treating neuromusculoskeletal traumas and degeneration.

Success at the Tour de France

For the past 6 years, Lance Armstrong has competed in the Tour de France. His teams have been cared for by Jeff Spencer, DC. Spencer has worked diligently to keep all of these riders alive, well, and able to participate.

Despite the difficult circumstances and stresses associated with the Tour, Spencer has been able to perform the near impossible: Except for one rider with a broken arm, he has helped every team member become a Tour finisher during the 6 years he has been there. What an incredible accomplishment, especially since only one other team reached that accomplishment this year. The obvious next question: “What did he do to achieve such results?”

Key to Success

Some chiropractors will want to know what chiropractic technique he used, as though that was the difference. Others will assume that all of these riders are professionals and, therefore, were in better shape and should not have had any problems. On the contrary. The demands of this event probably surpass the demands of any other sporting event; 22 days of heavy competition, ranging from 2 to 6 hours a day of competing, not to mention the mental and physical preparation needed on a daily basis. And Spencer helped them stay healthy and competitive, year after year. The simple answer to how he accomplished that feat is the concept of utilization.

Utilization is the art and science of providing the necessary treatment and recommendations, whatever they may be, to attain the goal of finishing the race. Many traditionalists may consider three treatments a day as overutilization, but I would be surprised if anyone associated with the US Postal Team would ever complain about the frequency of treatment that Spencer provided every rider on the team.

Now, let us bring the utilization concept back to our community. Can any of us make the same claim that Spencer can make? Can any of us say that all of our patients have been treated and educated to the level that they are all completing their race, whatever their race is (job, athletic competition, or getting through the day without pain)? Can any of us even begin to make this claim? I don’t think so—not under the current guidelines that exist today.

We must stop using the medical model guidelines when attempting to address biomechanical wellness. We need to begin comparing the needed care for biomechanical wellness to those guidelines in keeping people in shape. It is a conditioning issue—a mobility and flexibility issue. It is not about pathology.

Below is a list of ways that chiropractors and patients alike can begin to redefine the necessary steps in staying healthy and active, even into their later years. It is all about utilization of whatever is needed to get there.

1. Buy shoes appropriate for your foot type. There are three different foot types (pronator, neutral, and supinator), and there are three different shoe types (motion control, stability, and cushioned). Make sure your patients know what they need.
2. Get flexible, custom-made orthotics. Full-body biomechanics is the most critical piece of the puzzle for all people who want to stay injury-free. Custom-made orthotic support, combined with chiropractic care, can help restore postural integrity to the entire body. This minor investment will begin the process, and it is painless.
3. Do not wait until you are broken. We have been programmed to wait until we are sick or injured. Most doctors are unable to do anything for you unless you are sick or injured. But, for better results, you must change that thinking. Structural wellness comes with Structural Management®. Just as you do with your car, your teeth, and your finances, managing your structure will provide a wonderful return on investment.
4. Do not ask your insurance company for directions. Again, we have all been taught to first ask what our insurance company will cover before we make our health care decisions. Do you think Spencer checked with the health insurance company for the US Postal Team? No, he did not care what they thought. His decisions were based on a goal much higher than the insurance carrier’s guidelines—just as yours and mine should be with our patients. Healthy activity throughout life is the most valuable ability anyone has. Do not lose sight of that.
5. Manage your muscles better. Listen to them, and aid them in better warm-ups and more complete recoveries. They will either make or break your future, as muscles are a big part of everything we do.
6. Structural or biomechanical imbalances and distortions are the cause of most injuries. Again, the reason many x-ray reports come back negative from your doctor (“negative,” meaning there is nothing wrong) is because medical x-rays look for pathology or fractures, and in most cases these are not the causes of injuries.
7. Biomechanics exists above the ankles. Society has come to grips with the fact that podiatrists understand the biomechanics of the feet; however, no one is acknowledging the fact that biomechanics exists throughout the body. If it was acknowledged, then chiropractors would be the “go-to professionals” for everyone, rather than physical therapists (who get referrals from orthopedists who do not know what to do with most injuries).
8. Standing structural x-rays are mandatory; 75% of the information received when structurally examining someone comes from standing x-rays. They must be taken to rule out pathology, determine biomechanical faults, and teach the patient.
9. Only a biomechanics doctor can detect biomechanical imbalances and distortions. You cannot go to traditional physicians and hope they will provide biomechanical information. They know nothing about it. They are trained to look for and treat disease, or pathology. In the absence of pathology and symptoms, you would be better off in the hands of an engineer.Only a biomechanics doctor can help correct biomechanical imbalances and distortions. Structural imbalances, fixations, and distortions can improve dramatically, but you must work with someone skilled in locating and correcting them. In many cases, these defects have existed for a long time; so time is needed, just as with most orthodontia work, to make the necessary changes and improve the overall structural balance, joint mobility, and muscle flexibility. CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.
Reference
1. Jarvik JG, Deyo RA. Diagnostic evaluation of low back pain with emphasis on imaging. Ann Int Med. 2002; 137:586-597.

Philosophy: Chiropractic to the Mainstream

by Timothy J. Maggs, DCIssue: February 2005
Chiropractic Products

Establishing a clear identity can increase your number of patients

Timothy J. Maggs, DC

As I began my first treatment on a 47-year-old male patient with low back pain, he asked me whether he could bring his x-rays to an orthopedist for a second opinion. This was after his first consultation, when I learned his pain had been ongoing for 10 years and was getting worse.

He would tell me how, on multiple occasions upon visiting his orthopedist, each time the doctor would say, “I’m sorry, but there is nothing I can do.” This was after my Structural Fingerprint®™ Exam, when I included the lower back and structural x-rays, and explained the ill-effects of abnormal weightbearing, the reason certain joints had already begun degenerating, and predictably, where his future was headed if he did not begin to rehabilitatively address these issues.

I spent some time explaining how the current health industry virtually ignores structural wellness and focuses more on testing and therapy, primarily consisting of pharmaceuticals and surgeries. I told him that physicians generally wait until you are broken, perform pathology-oriented tests that are typically negative, and then do whatever it takes to kill the pain.

No one is teaching the public how to preserve their structures. If you are age 47, and significant degeneration is already being seen on an x-ray, what does your future hold if you do not begin to address this issue? How do you expect to reach age 85 or 90 with a prayer of good health if you are having a hard time today?

The patient set up his first appointment for our 6-month program, which included 40 chiropractic adjustments with ultrasound, custom orthotics for all his shoes, a custom-designed exercise program to encourage and maintain mobility in the joints of his spine, and our muscle management program to improve and maintain muscle flexibility.

Religion of Modern Health Care

Chiropractors currently see less than 10% of society. The other 90% have either had a negative experience with chiropractors, or are the recipients of much of the misinformation that is so prevalent. This usually prevents them from finding a good one.

While the chiropractic profession has balanced at or around that 10% number, other health care workers continue to see the vast majority of society. So, if we as a profession ever hope to begin merging into the mainstream, we need to better understand what is involved. For example, how is it that a reasonably intelligent patient will ask someone multiple times over the years for an answer, without getting one; then will ultimately find someone who not only has an answer, but who makes sense? This usually leads a reasonably intelligent patient to want to check with the first person again, which does not make much sense.

So, how can these actions be explained? The reason is simple. Modern medicine has become like a religion to most people. Once a person is born in this country, everything they read, hear, see, and are taught tells them that modern medicine is the big brother for good health. The public is taught to live an enjoyable life, and when a crisis occurs, they should visit their family doctor. As far as types of treatment, everything they read, hear, see, and are taught tells them that modern medicine, in the form of pharmaceuticals, is the correct treatment of choice. If the condition is beyond pharmaceuticals, then surgery is often required. And, if either of these two are not the “solution,” then psychotherapy may be needed.

In the past 20 years—out of necessity—modern medicine has had to accept the growth of alternative health care into our society. The perception of the masses, however, is that “alternative medicine” is unfounded evidence presented by some fringe groups who have discovered some magical formula out back in their garage. This perception is encouraged by those in control of health care, as it allows modern medicine to continue in their authoritative role. However, alternative care is growing, as those members of society who have the ability to make their own choices based on reason and logic are fully aware that the methodology behind medicine is both illogical and inadequate, and the treatments provided are, for the most part, detrimental to society. Therefore, alternative medicine will continue to grow, but we cannot hope the authorities of modern medicine will embrace the benefits. If they do, they will risk losing the much-fought-for turf they currently control.

So, the religion of modern health care keeps many people robotically deciding who to go to and what to buy. Regardless of the logic we present, this mission of going mainstream is not a simple reeducation issue. It is much deeper and broader than that.

Chiropractic House-Cleaning

Now it is time for chiropractors to look in the mirror. Until we glare deeply into our own eyes, we will never right a wrong. Any successful company has a chairman, a board of directors, and a mission statement. There are good managers, and communication is paramount for the many daily details that occur. Simply put, the chiropractic profession has none of this. Thirteen percent of those in our profession belong to one of multiple national organizations. Yes, there are many fine leaders in our profession, but we have too many factions with different messages going out to the public. We oftentimes do not know our own identity, yet we hope the public gets it.

In addition, we have ridden the subluxation message in hopes that the public would understand and want to live happily “subluxation-free” ever after. It is time we put that phrase to bed, and never use it again; at least not publicly. Remember, those we are trying to bring into our offices are parishioners of modern medicine. These people do not want to investigate on their own and make informed decisions. They make decisions based on what others tell them, such as their medical doctors, commercials, billboards, and magazine articles. Most of these sources are promoting modern medicine and their ideals.

As a profession, we need to be more unified in our protocols and recommendations. Whereas one chiropractor will tell a patient to use chiropractic as a pain reliever, another will say they need chiropractic care regularly for the rest of their life. This is confusing to the public. A patient recently came into my office who had received treatment from another chiropractor for several years. The patient had read an article in Sports Illustrated about a 42-year-old water polo player who played Olympic-caliber water polo without ever being injured. The article stated further that the player’s father was a chiropractor, and that the athlete attributed his noninjury success to having been adjusted regularly throughout his life. So, this patient asked his former chiropractor if he could come in on a regular basis with the hopes of not getting injured. Keep in mind, however, that the patient had repeated episodes of lower back pain. The chiropractor discouraged him, explaining that it was not necessary.

When the patient came into my office, we x-rayed him and performed standard tests. He had a reduced range of motion in his lower back with muscle spasms. On x-ray, there was advanced degenerative changes, and the patient was only 45 years old. How on earth could anyone tell this patient that he should not be doing proactive, rehabilitative activities so he might have a better life? Well, that is only my opinion, but it just goes to show the diversity in what we are telling our patients.

Getting Chiropractic Into Mainstream

We must do five things to accelerate the inclusion of chiropractic into the mainstream. They include:

1. Decide on a logical, unified message. I believe that the structural wellness approach is a great one, as it attracts everyone’s interests. When I lecture to 20 people, it is not just 10% who are interested; it is 90%. Everyone has a structure, and no one wants to age prematurely or become inactive early in life due to disabilities. Most people want to preserve their structures, but no one is showing them how to do it.
2. Decide on a logical, unified in-office procedure. We have got to get away from the medical model of care, which is all symptom-based, and embrace the biomechanical model. In essence, what is needed is a protocol that makes sense and encourages the public to understand and use chiropractic for a lifetime. With this protocol, you would encourage members of your community to get structurally evaluated just as most people have their teeth cleaned on a regular basis. This is not an easy transition, as a chiropractor’s communication, management, and people skills need to greatly improve. Currently, many of the procedures being used in offices are influenced by the insurance industry. This has to stop.
3. Train all chiropractors to become better ambassadors to get this message out through public speaking, writing, and all forms of communication. These skills are imperative, as confidence grows as these skills improve. Many in our profession cannot even communicate a good message on a one-on-one basis. A small profession with mixed messages, and members with low self-esteem and little confidence, is hardly the army needed to take the profession into the mainstream.
4. Pool our resources, and create one group to mastermind the advertising and marketing campaign of this message. My experience has shown me that too many influential people look at chiropractic as a bogus profession. Until we begin to invest in reshaping these opinions, this profession’s future could be left in the hands of the misinformed.
5. Continue research studies that are practical and make sense to the public. We spend countless dollars and energy on research studies to fit into the current health care community, and many of these studies will never make a difference in anyone’s life.

These are just a few of the areas that need to be “discovered” for the good of mankind, and can make a huge impact on the direction our health care system takes in the coming decades. We need to get away from the medical model of care and get back to the “pay now or pay later” approach. Society would love to pay now, but no one is showing them how. Also, it will give chiropractic a clear identity that will surely increase the number of people who want to use our services.

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.

Philosophy: Chiropractic to the Mainstream

by Timothy J. Maggs, DCIssue: February 2005
Chiropractic Products

Establishing a clear identity can increase your number of patients

As I began my first treatment on a 47-year-old male patient with low back pain, he asked me whether he could bring his x-rays to an orthopedist for a second opinion. This was after his first consultation, when I learned his pain had been ongoing for 10 years and was getting worse.

He would tell me how, on multiple occasions upon visiting his orthopedist, each time the doctor would say, “I’m sorry, but there is nothing I can do.” This was after my Structural Fingerprint®™ Exam, when I included the lower back and structural x-rays, and explained the ill-effects of abnormal weightbearing, the reason certain joints had already begun degenerating, and predictably, where his future was headed if he did not begin to rehabilitatively address these issues.

I spent some time explaining how the current health industry virtually ignores structural wellness and focuses more on testing and therapy, primarily consisting of pharmaceuticals and surgeries. I told him that physicians generally wait until you are broken, perform pathology-oriented tests that are typically negative, and then do whatever it takes to kill the pain.

No one is teaching the public how to preserve their structures. If you are age 47, and significant degeneration is already being seen on an x-ray, what does your future hold if you do not begin to address this issue? How do you expect to reach age 85 or 90 with a prayer of good health if you are having a hard time today?

The patient set up his first appointment for our 6-month program, which included 40 chiropractic adjustments with ultrasound, custom orthotics for all his shoes, a custom-designed exercise program to encourage and maintain mobility in the joints of his spine, and our muscle management program to improve and maintain muscle flexibility.

Religion of Modern Health Care

Chiropractors currently see less than 10% of society. The other 90% have either had a negative experience with chiropractors, or are the recipients of much of the misinformation that is so prevalent. This usually prevents them from finding a good one.

While the chiropractic profession has balanced at or around that 10% number, other health care workers continue to see the vast majority of society. So, if we as a profession ever hope to begin merging into the mainstream, we need to better understand what is involved. For example, how is it that a reasonably intelligent patient will ask someone multiple times over the years for an answer, without getting one; then will ultimately find someone who not only has an answer, but who makes sense? This usually leads a reasonably intelligent patient to want to check with the first person again, which does not make much sense.

So, how can these actions be explained? The reason is simple. Modern medicine has become like a religion to most people. Once a person is born in this country, everything they read, hear, see, and are taught tells them that modern medicine is the big brother for good health. The public is taught to live an enjoyable life, and when a crisis occurs, they should visit their family doctor. As far as types of treatment, everything they read, hear, see, and are taught tells them that modern medicine, in the form of pharmaceuticals, is the correct treatment of choice. If the condition is beyond pharmaceuticals, then surgery is often required. And, if either of these two are not the “solution,” then psychotherapy may be needed.

In the past 20 years—out of necessity—modern medicine has had to accept the growth of alternative health care into our society. The perception of the masses, however, is that “alternative medicine” is unfounded evidence presented by some fringe groups who have discovered some magical formula out back in their garage. This perception is encouraged by those in control of health care, as it allows modern medicine to continue in their authoritative role. However, alternative care is growing, as those members of society who have the ability to make their own choices based on reason and logic are fully aware that the methodology behind medicine is both illogical and inadequate, and the treatments provided are, for the most part, detrimental to society. Therefore, alternative medicine will continue to grow, but we cannot hope the authorities of modern medicine will embrace the benefits. If they do, they will risk losing the much-fought-for turf they currently control.

So, the religion of modern health care keeps many people robotically deciding who to go to and what to buy. Regardless of the logic we present, this mission of going mainstream is not a simple reeducation issue. It is much deeper and broader than that.

Chiropractic House-Cleaning

Now it is time for chiropractors to look in the mirror. Until we glare deeply into our own eyes, we will never right a wrong. Any successful company has a chairman, a board of directors, and a mission statement. There are good managers, and communication is paramount for the many daily details that occur. Simply put, the chiropractic profession has none of this. Thirteen percent of those in our profession belong to one of multiple national organizations. Yes, there are many fine leaders in our profession, but we have too many factions with different messages going out to the public. We oftentimes do not know our own identity, yet we hope the public gets it.

In addition, we have ridden the subluxation message in hopes that the public would understand and want to live happily “subluxation-free” ever after. It is time we put that phrase to bed, and never use it again; at least not publicly. Remember, those we are trying to bring into our offices are parishioners of modern medicine. These people do not want to investigate on their own and make informed decisions. They make decisions based on what others tell them, such as their medical doctors, commercials, billboards, and magazine articles. Most of these sources are promoting modern medicine and their ideals.

As a profession, we need to be more unified in our protocols and recommendations. Whereas one chiropractor will tell a patient to use chiropractic as a pain reliever, another will say they need chiropractic care regularly for the rest of their life. This is confusing to the public. A patient recently came into my office who had received treatment from another chiropractor for several years. The patient had read an article in Sports Illustrated about a 42-year-old water polo player who played Olympic-caliber water polo without ever being injured. The article stated further that the player’s father was a chiropractor, and that the athlete attributed his noninjury success to having been adjusted regularly throughout his life. So, this patient asked his former chiropractor if he could come in on a regular basis with the hopes of not getting injured. Keep in mind, however, that the patient had repeated episodes of lower back pain. The chiropractor discouraged him, explaining that it was not necessary.

When the patient came into my office, we x-rayed him and performed standard tests. He had a reduced range of motion in his lower back with muscle spasms. On x-ray, there was advanced degenerative changes, and the patient was only 45 years old. How on earth could anyone tell this patient that he should not be doing proactive, rehabilitative activities so he might have a better life? Well, that is only my opinion, but it just goes to show the diversity in what we are telling our patients.

Getting Chiropractic Into Mainstream

1. We must do five things to accelerate the inclusion of chiropractic into the mainstream. They include:
2. Decide on a logical, unified message. I believe that the structural wellness approach is a great one, as it attracts everyone’s interests. When I lecture to 20 people, it is not just 10% who are interested; it is 90%. Everyone has a structure, and no one wants to age prematurely or become inactive early in life due to disabilities. Most people want to preserve their structures, but no one is showing them how to do it.
3. Decide on a logical, unified in-office procedure. We have got to get away from the medical model of care, which is all symptom-based, and embrace the biomechanical model. In essence, what is needed is a protocol that makes sense and encourages the public to understand and use chiropractic for a lifetime. With this protocol, you would encourage members of your community to get structurally evaluated just as most people have their teeth cleaned on a regular basis. This is not an easy transition, as a chiropractor’s communication, management, and people skills need to greatly improve. Currently, many of the procedures being used in offices are influenced by the insurance industry. This has to stop.
4. Train all chiropractors to become better ambassadors to get this message out through public speaking, writing, and all forms of communication. These skills are imperative, as confidence grows as these skills improve. Many in our profession cannot even communicate a good message on a one-on-one basis. A small profession with mixed messages, and members with low self-esteem and little confidence, is hardly the army needed to take the profession into the mainstream.
5. Pool our resources, and create one group to mastermind the advertising and marketing campaign of this message. My experience has shown me that too many influential people look at chiropractic as a bogus profession. Until we begin to invest in reshaping these opinions, this profession’s future could be left in the hands of the misinformed.Continue research studies that are practical and make sense to the public. We spend countless dollars and energy on research studies to fit into the current health care community, and many of these studies will never make a difference in anyone’s life.

These are just a few of the areas that need to be “discovered” for the good of mankind, and can make a huge impact on the direction our health care system takes in the coming decades. We need to get away from the medical model of care and get back to the “pay now or pay later” approach. Society would love to pay now, but no one is showing them how. Also, it will give chiropractic a clear identity that will surely increase the number of people who want to use our services. CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements.

Up and Running

by Timothy J. Maggs, DCOrthotics Advisor
Issue: January 2005

The first step toward peak conditioning for any athlete is the body’s foundation—the feet

Timothy J. Maggs, DC

Anyone familiar with the running world will recognize the name George Sheehan, MD. He was a tremendous writer, philosopher, runner, and cardiologist who passed away in 1993 in his mid 70s.

During his illustrious career, Sheehan wrote of his many experiences and had the ability to articulate his feelings and emotions better than most. He wrote what all of us thought and felt, but just seemed to say it better.

Sheehan’s running career after college was halted and not considered again until he was 45 years old, when his desire to get back into the sport he loved sent him back to the roads. However, what he experienced was a series of physical breakdowns. From his writings, it is clear Sheehan suffered not only from his injuries, but also from the frustrations of not finding reasonable answers.

“When I began running, I was an educated specialist who concentrated on one area of the body. I was an expert who relied on other experts for advice. Serious running led swiftly to a series of foot, leg, knee, and low back injuries that threatened to end my newfound happiness back on the roads.

“I went dutifully to my specialist friends and found, to my surprise, that they were of little help. They were preoccupied with giving relief to my aching foot, my swollen knee, and my throbbing sciatic nerve. They treated the effect, not the cause. And, when I resumed running, back came my misery and pain. Clearly, I needed someone more sophisticated, some superspecialist. I had not gone high enough on the specialist ladder to find the wise man to help me. I soon discovered, there was no such wise man.”1

Little did Sheehan know there was a wise man. Little did he realize there was someone out there who could make sense of all he was going through and provide him with information needed to get back and stay back. Sheehan needed Structural Management®.

As he continued his journey to find happiness on the roads and solutions to his injuries, Sheehan learned what most are never able to find. He ran right up until his death, and that was only due to his persistence to find answers.

I receive hundreds of emails every month from athletes around the country, all of them looking for answers to their injuries, just like Sheehan. Most of them have gone down the path of conventional medicine, and many of them end up doing a search on Google or Yahoo for a superspecialist. Some end up at my site; others, who knows?

I often reflect back to Sheehan, as his pearls of wisdom would be advanced thinking today. In sports medicine and medicine, not to mention care for the masses, the methodology is based on the medical model of care. Sheehan wrote: “I am a cardiologist, but my relationship to sports medicine has been as an athlete rather than a doctor. What I have experienced as a runner and what judgment I have been able to bring to this experience as a physician has convinced me that traditional medicine is not dealing adequately with athletes’ problems.

“In more than 10 years as a distance runner, I have experienced almost every injury of the foot, leg, knee, thigh, and back. During this time, the medical profession has only been able to provide me with symptomatic relief.”1

Structural Balance
The reason Sheehan wrestled with his medical care was because his desire to run exceeded his loyalty to medicine. He could see firsthand that athletes, and all people for that matter, could not get credible or logical care for their structural injuries. What medicine was offering just did not make sense. So, he looked and looked, desperate at times, and at some point in his life, reached peace, as he found some form of solution.

“The human body is a marvelous instrument. When in perfect alignment and balance, there is almost no feat of endurance the body cannot handle, even on a regular basis. However, structural imbalance of even minor degrees can result in incapacitating injuries and persistent disabilities.”

The Starting Point
As with any structure, the foundation is the key to the overall balance. To address any musculoskeletal issues, the feet must be considered. Knowing that 80% of the population pronate, 10% supinate, and 10% are normal should encourage any health care provider to first look at the feet when addressing neuromusculoskeletal problems.

“It wasn’t until I came under the care of a podiatrist that I was able to run for prolonged periods and be free of foot, leg, and knee difficulties.

“This convinced me that no matter what an athlete’s problem is, we should look first to the feet as the source of the problem. The foot is an architectural marvel—an engineering masterpiece that has 26 bones, four times as many ligaments, and an intricate number of tendons that act as guy ropes or slings for the arches.”1

Sheehan evidently improved greatly with the introduction of orthotics in his shoes. What he was never able to do was combine the use of custom-made orthotics with structural correction. He never had the opportunity of having his biomechanics above his ankles examined. If he had been provided this, he certainly would have minimized all his years of complaining. And, had he been examined prior to any of his breakdown, he might have even eliminated all of his heartbreak and frustration, having to look for that superspecialist.

If Sheehan were alive today, there is no doubt he would be an advocate of structural examinations and corrections. He would be a vocal proponent of this approach to all athletes. In 1975, Sheehan had the guts to tell it like it was. Here we are, 29 years later, and his words still ring true.

“I cannot emphasize too strongly that most athletic injuries are structural, almost architectural, not medical. You would be better off in the hands of an engineer than a medical doctor when this type of injury occurs. At least you would not have your problem complicated by medication that in the long run will do no good. What the runner needs is to be restored to structural balance.”

The Structural Fingerprint® Exam
This exam begins with the feet and considers structural balance, joint mobility, and overall flexibility. The feet dictate the course of action taken. If there are imbalances, areas of increased wear and tear, and chronic injuries that do not respond to care, custom-made orthotics are indicated.

Secondly, the type of custom-made orthotic is important. There are at least two benefits that should be considered with custom-made orthotics: 1) symmetry of the medial arches; and 2) shock absorption. With rigid orthotics, shock absorption and normal foot mobility cannot happen. Flexible orthotics are preferred when full biomechanics are considered.

With this comprehensive exam, it does not matter if patients have symptoms or not. The goal is to evaluate athletes, employees, and people in general long before symptoms occur. Why should we have to wait for people to break down before we see them? And, why should our only goal be to get them out of pain? Our current standards of care are inadequate, and until we re-educate our communities to get structurally evaluated and proactively work to improve, we can never hope to reduce the current suffering that exists out there.

The standards should be maximum structural function, not just the relief of symptoms. This can only happen with structural exams before injuries occur, and the willingness to rehabilitatively improve distortions, even in the absence of symptoms. For this to ever happen, re-education can never stop.

On a final note, the Chicago Bulls, as well as many other professional teams, have all players fitted for custom orthotics at the beginning of each season. Do you think they know something the rest of us don’t know? CP

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements. Maggs can be reached via email . or via his Web site:www.drtimmaggs.com.

Reference
1. Sheehan G. Dr. Sheehan on Running. Mountain View, Calif: World Publications; 1975:204.

My Newest Favorite Color - Yellow

© 2004 By Dr. Tim Maggs

One year ago, while chatting with my favorite 3 year old on the planet, Timmy Maggs, jr., he told me his favorite color was blue. I looked at him with a little amazement, and said, “T, I don’t even know what my favorite color is. How do you know yours”? Without hesitation, Timmy said, “It’s orange”. Oookay.

Early on in this year’s Tour de France, wearyellow.com caught my interest. After all, I’d read Lance’s 2 books, It’s Not About the Bike and Every Second Counts. Both electrified my internal juices, as here was a human being who went right to the edge. I can’t imagine anyone getting closer……..and coming back.

When his surgeon, an elderly, bow-tied fellow, was asked what he told Lance after getting all test results back, “I told Lance he had a 20% chance to live. Actually, he had a 0% chance, but I had to give him some hope”.

Whoa.

And, here we had Lance Armstrong once again riding in the Tour de France. It was almost surreal, maybe even unreal, like 1 plus 1 = 7. Just didn’t make sense. Now, as Lance tries for not 1, not 2, not 3, 4, or 5 victories, but number 6, he stands up in front of the world and asks for something. Not for him, not for his profit. He asks for donations to the very industry that brought him back from death row, the American Cancer Society.

Let me say right here, I’ve been a tad skeptical of the ACS for most of my life. I just can’t get by the fact that so many Americans lead very unhealthy lives, and most marketing done out there is about unhealthy foods, unhealthy lifestyles, and then all the different drugs, surgeries and radiations that can rid you of reminders that you’re doing the wrong thing. So, for 25 years, I’ve ignored all requests by the ACS.

But, when wearyellow.com was advertised during the Tour, I couldn’t connect soon enough. I couldn’t order enough yellow bracelets fast enough to show and proclaim my support for Lance. My personal feelings for the ACS were insignificant, irrelevant. There was nowhere in my mind that my feelings could even begin to entertain having an opinion on this thing. Lance had returned from his journey, had come back and was on the verge of doing something no other human being had ever done, and I was now being asked to either support it or turn the channel.

Multiple times, I went online to order 100 bracelets for friends and patients, but it just wouldn’t go through. I tried and tried, but it didn’t happen. Universal law states that human beings want more of what they can’t have, and this law proved truer than true here. After repeated failures, I accepted the fact I would try tomorrow.

As my family arrived home that evening from a brief shopping trip, my oldest son John walked in and said, “Dad, I bought this for you”. I couldn’t believe it when he pulled out of his bag a yellow bracelet. At that moment in time, the most important thing on my mind was being given to me by my oldest son, an act that gave exponential meaning to me. I’ve got a mountain bike I was given 15 years ago by a friend for helping him, and I’ve got a mandolin given to me by my father for my 50th birthday, and these two gifts are virtually my only “real” possessions in my life. Now, I have a yellow bracelet from my son.

Life truly is a crapshoot. None of us know from one second to the next what’s coming down our road. All of us wish we could design our future, create the perfect scenario, but that’s not how it happens. Later today, tomorrow, and the rest of life is nothing more than a wish.

Here’s what I now know from the trials and tribulations that I’ve gone through in my life. I’ve never been to the edge like Lance has. I’ve never experienced the pain of losing a child. I’ve never been told I’ll never walk again. I have gone through some rough spots, but none you can’t come back from. Yet, those rough spots have been my gift. I’ve learned more from them than from any of my successes.

Lance has been consistently challenged by many for his drug use. The problem here is that his critics overlooked the resolve a person develops when they’ve been so down and out, there’s no where else to go. Some of the media ignores the depths, they only look at what might sell. Pathetic. But, knowing that life is such a relative experience, having nothing gives you a fire in your belly, an energy that can’t be measured by any medical tests. It doesn’t make sense to the masses who haven’t been there. However, in my own way, I’ve been there, and without a doubt, Lance has been there. So, when he powered up L’Alp d'Huez, and passed Ivan Basso, this wasn’t drugs in action, this was life in action. This was a person who’s been to the bottom of life, and given another chance. This was the life everyone should beg for, but most fear. Lance handled this year’s Tour the same way he handled his cancer, one pedal at a time.

When a friend asked, “What’s that band for”?, I answered, “For Lance Armstong’s Cancer Fund”. He responded, “You buy into the Cancer Research”? I said, “No, but I buy into Lance”. He responded, “Yeah, but he’s a druggy”. I responded, “Yeah, but I don’t judge”. The questioning stopped, as it should have.

Yellow, my newest, favorite color. Have a great month!

The Life of a Patient

© June 2004
By Dr. Tim Maggs

It was just about one year ago, July 1, 2003, that both Kobe Bryant and I spent the day on an operating table having our torn meniscus in our knees operated on. For me, it was the first time I'd ever been admitted into a hospital. For Kobe, it was the hangover from a night gone bad. Probably the only day Kobe Bryant wished he was Tim Maggs.

But, that's not the point. The point is, I was a patient for a day, and boy I loved it. I was so unfamiliar with being "the issue". My aches and whoas were everyone elses' concern for this one day, and I just couldn't enjoy it enough. "Can I get you a glass of juice?". "Are you comfortable enough?". Foreign territory for me.

I clearly remember laying on the operating table on this virgin voyage, and the surgeon saying, "just pretend you're winning Boston". I laughed, told him I'd already used that dream to get me to this point, and that was it. Lights out. For about 3 hours. When I awoke, I was somewhere with a bunch of people busily running around. I felt like a hunk of ground beef thawing on the counter. Now, don't think I'm complaining. I was still laying down, which is unnatural for me in my life, and still feeling pretty good, as a result of whatever they gave me.

As I began thawing a little quicker, all of a sudden, they were forced to have to deal with me. "Are you okay? Can I get you anything?". I still can't believe that somewhere between walking into the hospital that morning and this nurse asking me these questions, someone cut open my knee and cut out the "bad guy", beginning my recovery back to freedom. Wow, this wasn't bad. I used to feel for those people going through surgery. Forget that. I'm going to be looking for reasons to get under that knife. But, getting a little ahead of myself, I still hadn't come down from the drugs, and the 6 weeks of no running hadn't even begun. So, I decided to slow down before asking about my second surgery.

Colonoscopy Time

I love my brother-in-law, Dr. Peter Purcell. The only down side to Pete is, he wants everyone to get a colonoscopy. Pete's a gastro-guy. Well, I must have forgotten my enjoyable trip through knee surgery as I cancelled at least 3 appointments for my first colonoscopy. Let me tell you, the heat was on me to get one, from family to friends. Once you hit 50, it's a lot easier to just give it up and sign on the dotted line.

So, May 13, I walked into the hospital under entirely different circumstances. My thoughts immediately went back to Kobe. I wondered, if Kobe were going through a colonoscopy today, I can guarantee you he wouldn't have been charged with anything last night, except loitering---on his toilet. He never would have bothered anyone else. My smile was probably a little out of place for the average guy getting his first scope, but I also thought of my prior night, with my 4 year old getting everyone worked up, my 10 month old screaming wildly, and Trudy and my older boys just doing damage control while I sat helplessly preparing for my scope. For those who haven't taken this trip yet, don't let anyone tell you how bad it is. It's really a breeze.

I can still remember after one of my Boston finishes, my running partner Doug Griset and I shared sink and toilet for at least an hour. The prep for this scope involved no one else. The toilet was all mine. Most runners have been well beyond "the night before a colonoscopy".

The next day, I was right back into being the patient. "Are you comfortable? Can I get you anything?". The good stuff just didn't end. As they had me robed, on my side looking at the monitor to witness that I had a colon, Pete walked in and said, "Welcome to my world". He was so happy I was there, as he's been such a part of my world for years. I don't know if I said it or thought it, but "Pete, be kind" were words that flashed through my brain.

As I awoke about an hour later, realizing I got to watch nothing on that monitor, word came back to me that everything was perfect. No problems. I don't know if that good feeling I was experiencing was the fact I was healthy or the fact I was the patient. I didn't care. Both were good as far as I was concerned.

And, when Pete told me, "We won't need to see you again for another 5 years", I wondered if it was time to consider a vasectomy. Oh well..I'll keep you posted.

My final note, all kidding aside, is to get your colonoscopy sooner rather than later. Knowledge is power. Until then, have a great month.

Sciatic Pain - No Cure? Please!

© 2003 By Dr. Tim Maggs

I recently spoke with a runner who’s suffering with a severe case of sciatica. The pain got so bad she couldn’t sleep at night. I asked my usual question, “So what’s causing it and what are you doing for it?”, but her response was one I hadn’t heard yet. “I looked up a bunch of info on the internet, and evidently there is no cure for it”.

What is Sciatica

This misunderstood condition is proven by her finding that there is no cure. To understand sciatica, it’s important to understand some simple anatomy. The sciatic nerve exits the low back and travels down through the butt and down the back of the thigh. It continues down to the lower leg, but for the most part, all symptoms remain in the butt and back of the thigh. It is the largest nerve of the body, approximately the size of one’s little finger.

When that nerve gets pinched or becomes inflamed, it hurts. And, although I’ve never had the condition myself, I can only tell you it’s one of the more painful conditions that patients come in with. The first goal for anyone suffering with this condition is to locate the sight of irritation on the nerve. So, to ever say there is no cure for the condition borders on lunacy, since there are so many different causes.

The most common cause of inflammation of the sciatic nerve is due to injuries, restricted motion in the lumbar spine or abnormal weight-bearing, or weight distribution, in the low back (detected on standing, low back x-ray). This will produce an added stress on the sciatic nerve causing the pain. The second most obvious cause of the condition is tightening of the piriformis muscle, which is a muscle that runs straight across the butt. All of us have 2 piriformis muscles, and usually only one will go into a spastic state at a time. If you think of your muscles in the low back and butt as wires holding up a flag pole, when the pole leans one way, the wire on the opposite side tightens, and that’s what happens to us.

Now, there are other causes for this condition, but none are as common as the two causes above. Despite that fact, I had a patient come in about 15 years ago with sciatic pain, and on x-raying the low back, we found an abdominal aortic aneurysm that put him into surgery within 2 days. Whether the aneurysm was in any way directly or indirectly causing the sciatic pain is unknown, but doing a thorough work-up saved this patient’s life.

Determining the Cause

Most sciatic conditions are due to long term conditions. Structural imbalances place too much stress for too long a time on one or more areas of the low back, and the sciatic nerve gets pinched. The easiest way to find out what’s causing it is to have a structural, or biomechanical exam done. This consists of a foot exam, leg lengths, low back range of motion and a variety of other structural tests. The most conclusive test is the standing low back x-ray (front and side-view), because that shows the unique structural positioning and condition of the vertebrae and disc spaces. The most important findings are the sacral base angle, the weight bearing gravity line and the quality of the disc spaces. (For more information on any of these, feel free to e mail me).

Correction

In most cases, once the exact cause is learned, proper treatment, home recommendations and exercises can be determined. Since most of us stand or walk or run a lot of the time, symptoms may take longer than normal unless we eliminate the majority of these from our schedule.

In the case of a degenerative joint, the condition may take a little longer, since the inflammation is due to a lack of motion within the joint as well as a compromise of the amount of space for the nerve to exit the joint. But, with proper treatment and home recommendations, symptoms and the condition can be improved greatly.

Treatments

A good approach to treating all conditions would start with ice treatments to the low back, since the majority of sciatic problems originate there. Secondly, the tennis ball technique on the hip muscles will greatly help to relax the piriformis muscle, thus reducing the stress on the sciatic nerve. Stretching this area could also help to take pressure off the nerve.

If custom orthotics are needed, they almost become a must, since the imbalance in the feet will continue the stress on the low back until corrected. And, as written about in prior articles, the orthotic should be flexible for the foot and fitted in a standing position.

Finally, with regard to training, running should only resume once all symptoms are gone. This may sound harsh, but sciatic problems can last a lifetime, and the only way to get rid of them and keep them gone is to “get rid of them” before you run. So, ice, treatment if needed, orthotics if needed and patience will get most runners back the soonest and keep them back the longest.

Dr. George Sheehan The Greatest Visionary Ever

© 2003 Dr. Tim Maggs

Many runners have gruesome stories of injuries and their nasty “quest back” to running. Me included. It took me 8 years to solve my condition, and I’m supposedly a specialist in sports injuries. Getting injured is one thing, but trying to find a doctor who knows about the injury is another. Today’s industry is so focused on illness, pathology and disease that it’s virtually impossible to find a doctor who understands the importance of structure and the architecture of an athlete. Yet, structure is the key when talking about most running injuries. Just yesterday, I had a runner with low back pain come in and tell me he’s been to 2 chiropractors and 4 orthopedists over the past 6 years, and none of them have yet to tell him what his injury is. Well, none of them have done a structural exam on him either, and he’s still injured. What a surprise.

In 2001, the New England Journal of Medicine published an article on low back pain, stating that 85% of the time it was near impossible to detect the exact cause of low back pain. Therefore, pain killers and anti-inflammatories were the best that could be done. In 2002, the Annals of Internal Medicine did another story on low back pain and imaging, and stated that less than 3% of all low back pains were due to pathology (disease), and 97% were due to mechanical distortions.

Well, if this is the case, (and it is), then why are our pathological doctors suggesting they are the experts on mechanical disorders, which they know nothing about? The very thought that 28 years ago, Dr. George Sheehan wrote his thoughts on running injuries loud and clear in his book, Dr. Sheehan on Running, pleases me to no end.

Over 2 years ago, I wrote an article on building a national sports doctor network. That dream is becoming more of a reality everyday. My vision of having a structural specialist in every community in this country is getting closer. When this day arrives, the overwhelming incidence of injury in runners will go down drastically, as well as the costs that are spent on needless tests looking for pathology and symptomatic treatments that hide the real cause. Race directors, get ready. When this day arrives, you’re the ones who will have to handle the massive crowds. What a great day that will be.

And, to think, Sheehan knew all of this back then. What a genius.

“When I began running, I was an educated specialist who concentrated on one area of the body. I was an expert who relied on other experts for advice. I soon needed it. Although my ancestors could run forever, my limits were quickly reached. Serious running led swiftly to a series of foot, leg, knee and low back injuries that threatened to end my new found happiness on the roads.

I went dutifully to my specialist friends and found to my surprise that they were of little help. They were pre-occupied with giving relief to my aching foot, my swollen knee and my throbbing sciatic nerve. They treated the effect, not the cause. And, when I resumed running, back came my misery and pain. Clearly, I needed someone more sophisticated, some super-specialist.

I had not gone high enough on the specialist ladder to find the wise man to help me. I soon discovered, there was no such wise man.”

“I am a cardiologist, but my relationship to sportsmedicine has been as an athlete rather than a doctor. What I have experienced as a runner-and what judgment I have been able to bring to this experience as a physician-has convinced me that traditional medicine isn’t dealing adequately with athlete problems.

In more than 10 years as a distance runner, I have experienced almost every injury of the foot, leg, knee, thigh and back. During this time, the medical profession has only been able to provide me with symptomatic relief.

It wasn’t until I came under the care of a podiatrist that I was able to run for prolonged periods and be free of foot, leg, and knee difficulties.”

“This convinced me that no matter what an athlete’s problem is, we should look first to the feet as the source of the problem. The foot is an architectural marvel-an engineering masterpiece that has 26 bones, four times as many ligaments, and an intricate number of tendons that act as guy ropes or slings for the arches.

When these components are perfectly balanced, the foot can handle almost any amount of work. However, even a minute deviation from normal can cause adjustments that will eventually produce injury either in the foot, or in its supporting muscles and tendons, or even in the structures above.”

“The human body is a marvelous instrument. When in perfect alignment and balance, there is almost no feat of endurance the body cannot handle even on a regular basis. However, structural imbalance of even minor degrees can result in incapacitating injuries and persistent disabilities.

Prevention and treatment of musculo-skeletal injuries in the athlete, therefore, rests in the establishment of the structural balance and architectural integrity of the body-and its re-establishment should injury occur.”

 “I cannot emphasize too strongly that most athletic injuries are structural, almost architectural, not medical. You would almost be better off in the hands of an engineer than a medical doctor when this type of injury occurs.

At least you would not have your problem complicated by medication that in the long run will do no good. What the runner needs is to be restored to structural balance.”

If George were here today, I’d assure him his vision is alive and well.

Are You Centered? (Physically, that is)

© 2003 by Dr. Tim Maggs

Who would ever think you'd waste your time reading an article on you and your "center of gravity"? I ask you as I ask myself, who'd ever think I'd spend time writing an article on "center of gravity"?

Well, the more I travel in life, the more I try to hone in on those issues that really, really make a difference. You know, the one's that you really have to pay attention to. Not some of those worthless laws or rules that have no value in life. There comes a time in life when you want to focus on those rules that matter. And, after all is said and done, this is one of them.

Osteoarthritis

In a December issue of Time Magazine, the cover story was all about arthritis, the new epidemic and how it's being recognized earlier in people. Of all the arthritis' out there, osteoarthritis, or wear and tear arthritis, is the most prevalent. The story went into detail about the new and advanced treatments available today. In order of usage, the list went from drugs to surgery to exercise to alternatives. You can only imagine the short list provided under exercise (if you move your arthritic joint, it will hurt less---PLEASE!!) and alternatives.

What the list failed to address at all was the importance of posture, balance, gravity and structural defects. As with any structure, imbalances accelerate degeneration or wear and tear. But, in our pathology-based world that treats everything pharmaceutically, "posture" has no shot of making the short list of treatments. But, let me tell you why it should be number 1.

Pay Now or Pay Later

How on earth can the industry sell the package that we don't have to do anything about potential degeneration until we've begun to degenerate. You mean to tell me, there's NOTHING we can do to prevent it. Time Magazine didn't give anything preventative, but I can assure you of this, there is a ton we can do.

Let's look at the simple issue---What causes osteoarthritis? It's the fixation or locking of a joint put under abnormal stress for a prolonged period of time, and then Wolf's Law kicks in. Wolf's Law simply states that any bone under stress, given time, attracts calcium salts to innately fuse it to the surrounding bones as a protective measure to resolve the weakness or stress. So, whatever part of your structure is the recipient of abnormal stress, due to an imbalanced center of gravity, will be the site of attraction for calcium salts, or..osteoarthritis.

This is not a pathological or pharmaceutical issue. People with osteoarthritis should not be going to their doctors to get drugs or look for a miracle cure. It's a biomechanical issue that will require a re-education of the body to re-establish mobility in the joints and balance in the structure. And, this takes time. In my office, we usually consider a period of 6-9-12 months, depending on the age, condition and status of the patient.

The Structural Fingerprint® Exam

It all begins with a status report of the structure. Center of gravity is a finding on the visual standing test as well as the standing x-rays, both front to back and side to side. Center of gravity is critical for normal function and normal wear and tear of the musculo-skeletal system. With imbalances, there will always be an accelerated degeneration. So, the first step is to locate sites of imbalances, fixation or weakness.

This is done through a series of physical tests, such as range of motion of a specific area, muscle tightness in that area and ultimately, standing x-rays, which provide 75% of all biomechanical information needed. The first x-ray shown is the front to back view of the low back, and shows the alignment of the spine with the pubic joint (lies in the front of the pelvis). The second x-ray shows the center of gravity from the side view. A line drawn from the center of the 3rd bone in your low back (lumbar spine) down to the front 1/3 of your sacral base will show you if your weight bearing is ahead of or behind the area designed to handle the weight in your body.

If either of these gravity lines are off center, you know there will be an increased stress and an acceleration of breakdown in whatever joints are under the most stress. So, with running, it's an easy formula----balance and correct centers of gravity make it the perfect sport. But, with imbalances, running slowly adds to the degenerative process that is taking place.

Simple Answer

The simple solution is to go through a complete biomechanical exam, and then be willing to do the corrective measures recommended. To ignore this approach and subscribe to the current system of waiting until the degeneration produces symptoms is insane. We've come too far as a society to allow such lunacy.

It may be difficult to find the person to perform this exam, but in time, each and every community will have someone you can look to. Until then, feel free to contact my office for some suggestions.