The YMCA 2008 Race Series

Today, Bill Rodgers and I traveled to 5 YMCA's in Upstate New York to sign autographs (Bill signed) and promote the 5k race series that is coming up. It was great. People loved seeing him, he was as gracious as ever, and everyone had fun. This 5k race series will be a huge success, no doubt.

While Bill was here, visiting from Boston, I'd hoped he could meet my dad, Will Maggs, who continues to work full time at the age of 84. Yes, Bill Rodgers is a legend in this country and has won Boston 4 times and New York 4 times, but I wanted Bill to meet my father more than I wanted my father to meet Bill.

Values, respect, discipline, caring. This is what my father has taught me. Bill, although successful by everyone's standards, has not yet reached the success level of my father. So, it didn't happen this time, but hopefully will happen next time. Bill will be a better person if he gets to know my dad.

And, I'm blessed to call Will my dad. May I do half as much good in my life as he has in his. But, Bill, thanks so much for coming. In time, you, too, will be the best. But, it's because of your love for your daughters in addition to your running. Once they reach a certain age, they, too, will realize what a great dad you've been.

And, once you turn 84, you'll have the priviledge of being the best dad in the world. I'm sure your daughters will agree.

Biomechanical X-Ray Saga Continues

Just as I'm informed by a local insurance company that I should dramatically reduce the frequency of x-rays that we take on patients, I come across 2 magazine articles suggesting just the opposite. Of course, I have such strong feelings on this issue that I don't need the support of these articles, but to hear others endorse my position merely keeps the naysayers off balance.

My position; the industry wants me, and all others, to follow the guidelines of The American Academy of Radiology, which governs what and when to x-ray. The major flaw in this situation is that we, all Drs., are only supposed to take x-rays when we suspect disease. As in pathology. As in bone tumors.

This narrowed vision eliminates all possibilities for x-raying and understanding biomechanical issues. Now, for those who haven't read my work or listened to my message, I'm once again loudly saying, each and every human being has a unique set of biomechanics, and the standing x-ray is the number one tool to determine what those findings are. These findings will allow the trained eye to develop a corrective program, which will then reduce the likelihood of injuries and defer, to some degree, the onset of osteoarthritis.

This would save society billions of dollars. Every year. Not to mention the quality of life. So, you may ask, why isn't it being done? We live with a medical model health care industry, which waits for you to break, only treats the site of injury, and only sets as it's goal the elimination of symptoms. This is like sweeping the dirt under the carpet. Eventually, the floor underneath rots out, and the future is defined.

So, these two other articles talk about why chiropractors are preferred when examinations are done for low back pain, as we look for all kinds of things, and the only way we can look for these all kinds of things is with x-rays. On every patient. The next article writes about a chiropractor who was negligent in the care of a young man, as he never took the necessary x-rays to determine the details of his injury. The case settled for $125,000. prior to the trial.

And these are the two latest endorsements for my proclamation; everyone would do well to be fully examined, including at least 4 standing biomechanical x-rays, at some point in their lifetime. Especially if they want a clearer understanding of what to do to preserve their structure over the course of their future.

That usually includes just about everyone. Thanks.

Live Internet Radio

Well, week # 1 is in the bank. This show was used more as a test than anything else. We let very few people know we were doing it, just so we could make sure the technical side of it was all working. And, the good news is, it worked.

So, now our goal is to notify as many people as possible about this show, as Structural Management® should also be known as "the solution". There is a total void out there in the sportsmedicine world with regard to good answers for athlete's problems, and we offer much better solutions.

Join in on the show, via e mail or (soon to have) telephone call-in- capability to discuss, question, challenge or whatever moves you. But, regardless of what moves you, join us on Thursdays from 3-4 pm EST, and join in on the movement that is going to transform sportsmedicine world into a new way of doing business.

Stay on the roads, stay in the gyms, stay active, and life will be good. The key is, stay uninjured. With that being said, we know how difficult this can be with our current system.

And, that's why Structural Management® is the solution for the future.

Good Job Carl

We have a newspaper columnist in our city who sheriff's everything. As a community member, I know I don't have to worry about a thing, as Carl will keep an eye on teachers, Drs., police, politicians and anyone else who dares to stray from "legitimate". He just seems to catch everyone.

For years now, Carl has focused on the psychotherapy business. He's convinced that new psychological disorders are named for the sole purpose of creating some new (magical) medication to enhance bottom line profits. I'm not a psychotherapist, nor am I familiar with these medications, but I do believe patients are medicated first and talked to only as a last resort. This poor guy gets all kinds of letters blasting him, with justifications being thrown all over the place by those who are in on the take. There are days I really feel for the guy.

So, yesterday, he writes this new article on psychotherapy, a subject he hasn't touched in months with all the police and politician material that's always in abundance. He interviews this woman psychotherapist who opposes the standard protocols of medicating first. She believes in talking to patients. But, the interesting thing is, she describes the current, accepted, traditional system as being "medical model". Yes, this is the standard of care in the medical industry today.

So, I put somewhere on my "to do" list, call Carl. Tell him the psychotherapy industry is not the only profit oriented, ignorant department in medicine. Musculo-skeletal may even be worse. The so-called experts, the medics, and more specifically, the orthopedists, don't really know a whole lot about musculo-skeletal (from a biomechanically diagnostic and rehabilitative perspective). They are great surgeons (most of them), and they sure know how to inject cortisone, but beyond that, they're not much help. Yet, the public believes they are the wise men at the top of the mount.

Next, we have our primaries, who know next to nothing about musculo-skeletal. It's sometimes embarassing when a patient comes in and tells me they went to their primary, and the tests that were(n't) done and the treatment that was recommended. Pills for pain and "stop doing what you're doing" is all too common. Our final players in the game are physical therapists and chiropractors. For the most part, they do very few tests and use the elimination of symptoms as their goal, attempting to get the person feeling better asap....."Quit whining and get back to work".

No one FIXES the person. In psychotherapy or the musculo-skeletal world. I move "Call Carl" higher on my list. Tell him. Let him know our industry is also a profit center (at the expense of humanity) for the pharmaceutical and surgical companies.

As Dr. Bob Arnott says in his book, Wear and Tear, "Our medical profession would have nothing to offer for my sore hip until I needed a hip replacement". And, as the deceased Dr. George Sheehan, famous cardiologist in the running world said, "If you're injured, you'd be better off in the hands of a mechanic than a medical Dr. At least your problem would not be complicated by drugs, that in the end will do no good."

Yes, the medical model probably exists in other departments of medicine. But, being a reader of Carl Strock's column, and living in the biomechanics world, I know there are at least 2 departments in health care that need to burn the current rule book. We need to put the health of the patient back as our number one goal, not the health of some bottom line at the expense of the patient.

Life's Lessons

Dr. Robert Jarvik, inventor of the artificial heart, has been removed as pitchman for Lipitor, the best selling medication on the market. According to the report, Pfizer, the manufacturer of Lipitor, felt pressured to make this move as Dr. Jarvik's credentials have recently come under fire.

House Democrats said the ads could be misleading to consumers because Jarvik appeared to be giving medical advice, even though he is not licensed to practice medicine. While Jarvik holds a medical degree, he did not complete the certification requirements to practice medicine.
Democratic Reps. John Dingell and Bart Stupak said Monday the company made the right decision. "When consumers see and hear a doctor endorsing a medication, they expect the doctor is a credible individual with requisite knowledge of the drug," Stupak said.

Too frequently I read articles and get word back from patients how their therapist or health care provider warned them against some of the pro-active efforts we endorse, like flexible custom orthotics, proteolytic enzymes, chiropractic adjustments, cold laser therapy, etc.

I would like to ask Bart Stupak to tell the public that when a Dr., or any other healthcare authority voices an opinion on a possible course of action a patient is going to take, keep in mind this Dr. may not be intimately knowledgable about what they are saying. In fact, more often than not, they have little to no first hand experience regarding what they are saying.

And, as Norman Cousins said in his book, Anatomy of an Illness as Perceived by the Patient, "Be careful who you let make a proclamation of doom on you, as that may be the beginning of the end."

May all experts remain experts only in what they are experts at.

Shortcomings of Traditional Sportsmedicine

There are 4 basic flaws with today's sportsmedicine industry.

1. We wait until an athlete is injured before we do anything.
2. We only look at the site of injury.
3. Our treatment goals are "to eliminate symptoms".
4. We allow insurance guidelines to dictate what care is provided.

As athletes, we have much greater, more demanding and continual needs that should never be based only on symptoms nor governed by the insurance industry. Structural Management® guidelines are much more suited to the needs of athletes;

1. Examine biomechanics prior to season and make corrective recommendations.
2. Begin taking corrective measures immediately.
3. Never let symptoms be the call to action. The ultimate goal is maximum biomechanical improvements, and once that has been achieved, structural management and maintenance becomes a lifetime mission.

Today's message. Sleep well.

High School Athletes and Scoliosis

This past week, a female high school runner who is a patient of ours came into our office rather upset. She needed to talk. Evidently, the school nurse suggested the possibility of scoliosis, and the very thought of some deformity in her back was overwhelming to her.

Six months ago, when her mother brought her in to go through our Structural Fingerprint Exam® to uncover any structural imbalances or weaknesses, we looked at her in extreme detail to see how she faired. Look at the homepage under "Structural Fingerprint Exam®", and you'll see all the tests we put her through. This was one of those great cases where the mother "gets it", and wanted to have her daughter begin her running career safely, to see if there were any "structural issues" we should know about before she began.

For the past 6 months, we've been treating her accordingly, along with monitoring some of the other recommendations we made for her, and she has succeeded beautifully. She went to Disney in January and ran her first big race, and has continued running since. The joy her mom feels, being a marathoner herself, is, as they say, "priceless".

But, all of these successes became irrelevant, meaningless, as the school nurse examined her and said she might have scoliosis. Tears streamed down her face, and quickly, someone had to try and make sense of it all to her. "The school nurse is using very few tools to examine you, and can only screen you. When seeing so many kids, I'm sure one athlete just blends into the next, and any suggestion is only precautionary".

Within 5 minutes, we had her smiling again, because we pulled out her x-rays, and her spine was as straight as an arrow. "There is no scoliosis", I told her. I also told her I'd be happy to call the nurse and speak with her, which I did.

So, after all that, what is the moral of the story? First of all, from a structural point of view, our healthcare industry grades people as either having scoliosis or not having scoliosis. Black or white. Yet structural biomechanics is hardly black and white. There are unlimited shades of gray, but our medical model healthcare providers are thoroughly unfamiliar with the grays.

They are familiar with hearts and lungs and pancreas', but the percentage of high school kids with issues in these organs pales in comparison to the percentage of kids who have biomechanical issues at this age. The thought that so many kids have braces on their teeth, but their musculo-skeletal system is perfectly balanced is insane.

The second moral of the story is that all high school athletes are examined medically (eyes, ears, nose and throat) while their biomechanics are grossly ignored. This has to change. We know too much now to let these young kids fly without a net in life, when they could easily go through a full exam and begin to make corrections before breakdowns occur.

Like our young runner friend, who clearly can't appreciate how good she really has it. She's paying now so she can pay considerably less later. And, someday, hopefully, she'll appropriately thank her mother.

This week's "new pill"

We recently had an article in our local newspaper about a chiropractor using manipulation under anesthesia. He works hand in hand with a radiologist and anesthesiologist in a local hospital, and this was a grand story of patients being "put under" before being aggressively adjusted. All to relieve pain.

As I read the article, I could just feel the enthusiasm in the writer's tone, looking at this as yet another breakthrough in modern medicine. And, the thought that these medical professionals would allow a chiropractor into their sanctuary and work side-by-side with them, almost more than one could bear. Wow, chiropractic must really be excited with such acceptance.

What the story fails to recognize is the lack of foresight and efficiency in our neuro-musculo-skeletal care that is provided to members of our communities. Once again, why does someone get to the point of such chronic, severe pain? The answer is simple; we encourage nothing and provide nothing in the area of management and maintenance of people's structures. Anything proactive, like chiropractic adjustments, massage therapy, physical therapy, custom orthotics, weight management, etc., is only recommended after the fact, never before.

There is a general assumption that everyone is "okay". Their structures are"okay". Ask any M.D. who has x-rays taken on patients backs, and they'll tell you most of them are "negative", meaning, the patient is "okay". But, looking closer, you'll learn the x-ray is negative for pathology, or disease, not biomechanics. Because the truth is, everyone is not okay. In fact, no one is okay. Everyone has biomechanical imbalances and issues. and these issues are the very precursors to structural breakdowns that lead to pain and disability.

So what's the moral of the story? Well, let's first congratulate the chiropractor who is working hand in hand with the medical community. For me, I never want to work in a hospital, as the very thought of that makes me quiver. The moral of the story is that acute, crisis care will always get headlines, as there is no excitement or newsworthiness in maintenance or health. How exciting is someone who doesn't hurt and lives a normal life?

Absence the glory and spotlight, I'll continue my mission to spread the word on Structural Management®, because the more people stay proactive and follow what we're teaching, the less they'll need to hire the "A" team who'll inject, x-ray and manipulate them.

This week's pill.

Void in the system

I had a young high school athlete come into our office yesterday, his mother being an RN, and he was referred by another family we've worked with for years. He had a severe strain/sprain injury of his shoulder, and had been to his pediatrician just the day before. His season is down to 3 games, and he needs to get back asap.

No real tests had been done by the pediatrician, and the recommendations were "rest and ice". Not horrible recommendations, but not "cutting edge"either. After all, no x-rays or other biomechanical tests were performed. So the mom asked me, "What are you going to do?". I told her we'll start by taking some x-rays of his mid-back and neck, to see if there are any underlying causes.

She then wanted to tell me that the pediatricians wouldn't give her a referral to our office and said absolutely don't let her son be adjusted by a chiropractor.

The pediatricians have minimal knowledge of musculo-skeletal injuries, what influencing factors contribute to them, and what corrective therapies, treatments and recommendations are needed to accelerate this athlete back to "game ready" (proven by their exam and recommendations). Yet, they actually believe they're doing right for the patient to make proclamations as they do. And, so many patients accept this.

I'm now working with the Director of all Wellness Programs for the state of New York's state employees. She is an employee of the Department of Health. The DOH has no category for musculo-skeletal. It's not even considered on their list of diseases, conditions, etc. This possilby provides us with the reasons why traditional healthcare only recommends ice and rest. Surely, it doesn't take 12 years of higher education to learn that recommendation. This category has been neglected by main stream medicine, and we're now bringing it to the forefront.

The director and I are now in the process of developing a pilot program, using state employees and Structural Management®, to address this crisis that both industry and sports suffers with (the breakdown of the musculo-skeletal system with no intervening testing or care until after-the-fact). The interest level and acceptance level by all employees, so far, has been extraordinary. Everyone is excited with the possibilities. This void can be filled.

And, if it is filled with a program like Structural Management®, a newsletter will have to be sent out, Express Mail, to all parents of young kids who believe every word their pediatrician says, even if it has to do with conditions they know little about. Parents will need to know there are answers. Better than "ice and rest", which is actually no answer at all.

In 1975, Dr. George Sheehan, the deceased running cardiologist who was a guru in his time, said so eloquently in his Book on Running;

“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."

The mission continues.

Broken System

Industry is a perfect controlled study that demonstrates the lunacy in our healthcare system today. Management wants to put the burden of health insurance on the workforce, while the workforce will scream eternally to keep costs on the backs of management. A modern day Hatfields and McCoys.

I've watched over the years, and have never understood why neither side will ever question the healthcare system by asking "Why do you cost so much?". It seems like an appropriate question. "Why have costs escalated so high? When might it stop? And, simply, how can they be lowered?"

This week in Sports Illustrated, this very topic jumps off the pages in Gary Smith's article Bitter Battle For The Old Guard, about Gene Upshaw, the 25 year Executive Director of the Player's Association. The flavor of this article is how retired NFL players are ignored, broken down and no one (The NFL Player's Association) cares.

The article reads, "Creeping along the sideline on a walker, bent at a 45-degree angle, was the alltime great Oilers running back Earl Campbell. Confused by foggy memory, neck locking up from damaged vertebrae, advancing on an artificial left hip was Hall of Fame Dallas Cowboys safety Mel Renfro........How had it come to this?........For three decades, from Pop Warner to retirement, they'd been groomed to spit at the pain, which was ever-increasing as the colliding bodies grew larger and faster, and they'd soldiered on in silence for years after they'd faded away. But then came the day when the consequence of all those head-ons, all that pounding on all that green pavement called astro-turf, demanded its reckoning. The mornings when they awoke and realized they could barely get up......or didn't even want to. The multiple knee and hip replacements, each one carving a year of recovery time out of their lives; the depression, vertigo, Alzheimer's and thoughts of suicide, which some doctors linked to the multiple concussions they'd suffered; the spiraling medical costs and the realization that neither their pension nor their disability plan--if they even qualified for it--could possibly keep pace, had combined to overwhelm them."

Wow. The end result of a broken system. This article wants to highlight the lack of concern the Player's Association has for it's retirees, while I only care to discuss a spoke out of that wheel, the physical condition of retired football players. Their futures have a backdrop of physical disability, pain and limitations, not the type of retirement anyone would aspire to have. The costs are overwhelming; emotional, physical, financial, relationships, employment, etc.

What is the solution? When does it begin? Success in any endeavor requires management. All athletes today, by default, learn the rules in taking care of themselves. Stretch, warm-up, lift weights and hope you don't break down. If you get hurt, well, we're not sure. Do you have a primary? Will they see you today? Or will it be the P.A.? Will they give you meds, a script for phyiscal therapy, a stint of chiropractic? No one really knows. There is no plan other than, we hope you don't get hurt. Maybe just take time off until the pain goes away.

The reason for such inefficiency and ignorance is that our injuries (Earl Campbell bent at a 45-degree angle, Mel Renfro's neck locking up from damaged vertebrae) are biomechanical injuries, yet we MUST deal with medical model healthcare providers. They don't do biomechanics. They don't know biomechanics. Even professional sports teams. And if the pros don't get it, what is the shot that our high school athletes or everyday athletes are going to get it.

Success at maintaining a healthy physical structure also requires management. It starts with a biomechanical exam and detection of the imbalances and faults. Correct those, now maintain these corrections throughout your lifetime. It's not about shots of cortisone, a short stint of physical therapy, surgeries after the injuries occur, early retirement due to broken down parts or retirements that leave you totally disabled.

The current system is broken, and the public must demand change! The answers are available, but don't call your primary and expect them to know. They, too, are victims of the problem. And certainly not the solution. We need biomechanics in our sports world to hope to help the middle and high school athletes of today not end up as a feature story in Sports Illustrated 40 years from now.

The famed comedian Lenny Bruce screamed at the judge as he was being dragged out of the courtroom, "Your honor, somebody needs to tell you when you're screwing up".

Ditto.

http://structuralmanagement.com/CPOYA/docs/highschool1.pdf

The website

Welcome to our new website. The simple goal of this website is to provide biomechanical information for the masses and make it available to them. We have many, many patients who have been eternally frustrated with their inability to find a Dr. who understood their problem. We gave reasonable and logical recommendations to help them solve their problem. The results are consistently pretty darned good.

Structural Management® is an alternative program for those athletes who are frustrated with the lack of knowledge their current Drs. have. In all honesty, you shouldn't get mad at your Drs. for their lack of knowledge, you should only get mad at your Drs. for not telling you they have no idea why you hurt, and have no clue what to do for it. Pathology based Drs. should readily admit they're unaware of biomechanics, but for some reason, that's not happening.

Well, we're here, and ready, willing and able to help. We'll take you by the hand and walk you through the maze of confusion, as we know the only reason you're even looking for help is that you want to get back to your sport and enjoy all it has to give.

So, bookmark our site, as we'll be bringing some life altering stuff, including case histories, live internet radio, daily stories and more, as our continual goal will be to help you get where you need to be without getting caught up in this healthcare mess that has been created.

Talk soon.

Injuries

Many have written, and many more will write, asking about injuries and what to do for them. I received a letter this morning, and most of them tell how they've seen chiropractors, orthopedists, physical therapists, etc. Simply put, most of these providers address only the site of injury, while Structural Management® Drs. begin with a full biomechanical exam that we call a Structural Fingerprint Exam® Please read the details on our website, then ask your questions. You'll find your questions are more detailed once you've learned a little bit more about biomechanics and Structural Management®.

High School Athletes and Structural Management®: The Future of Chiropractic Sportsmedicine

Click here to read this article that was published in The American Chiropractor August 2007.

The Importance of X-Rays in Today’s Chiropractic Practice

Click here to read this article that was published in the American Chiropractor April 2007.

The Structural Fingerprint™ Exam: Bill Rodgers

Click here to read this article published in The American Chiropractor, December 2006.

The Structural Management® Program

Click here to read this article that was published in The American Chiropractor January 2006

Orthotics for Everyone?

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

Whether to function under a medical or biomechanical model is your choice

This afternoon, I met with eight-time National Basketball Association all-star Michael Ray Richardson. Michael Ray is taking over the head coaching position of the Continental Basketball Association’s Albany Patroons, while I’ll be providing Structural Management® to the team. In our meeting, I was asked exactly what it is that I do:

“The traditional services provided by a team doctor are to wait until a player is injured, then make the best recommendations possible,” I answered. “That makes no sense, especially when there is a wealth of biomechanical information available on all players right now that will help to determine their unique weaknesses and imbalances. Once we determine each player’s weak spots through our Structural Fingerprint®™ Exam, we can then set up a good proactive program to get all the players doing things that will help their balance, joint mobility, and muscle flexibility. This will dramatically reduce injuries during the year.”

His response was one that every sports-minded chiropractor would love to receive: “I need to set up a meeting with Kiki Vanderweghe and get this program into the Denver Nuggets’ locker room.” Now, for those who don’t know, the Denver Nuggets are a National Basketball Association team, and Kiki Vanderweghe is its general manager.

I can’t imagine any fewer words a chiropractor could say that would get a response as electrifying as that. If chiropractic had the ability to excite key people in sports and industry the same way I happened to in this conversation, we certainly would be in loftier positions in the health care food chain and would be seeing a whole lot more than 6%–8% of the population.

The response from Michael Ray is the same one we get from almost all parties we now meet. The need for Structural Management® is critical, yet it is absent in our modern-day health care system. The medical model is everywhere, despite the fact that everyone would love to learn how to preserve their structures so they can enjoy their lives injury free.

Where to Begin?
I’ve written quite a bit about the need for chiropractors to stop functioning under the medical model of care, especially if we want to fully realize this profession’s potential in our lifetime. Adjustments should not replace pills. Adjustments should be a spoke in the wheel of the necessary tools to keep a person healthier. Our profession truly needs to learn how to articulate this message to our community, because if we do, we will be busier than we have ever wanted to be.

Just last week, I was the guest speaker at a sports information night at one of the larger local high schools. Approximately 800 parents were present. I emphatically told them of the void in good-quality structural care for middle- and high-school athletes in this country. These kids go through medical tests (eyes, ears, nose, and throat) to determine if they are healthy enough to go into the weight rooms and participate in their sports.

The response was overwhelming. I ended the talk telling the parents that their school is now endorsing our Structural Management® Program, and it all begins with our Structural Fingerprint® Exam. This exam consists of a foot exam for foot type; a knee exam for Q angle; range of motion, stressing the key joints of the body; muscle tests, and standing x-rays of the neck and low back. The final test is a digital scan of the feet to determine if the body weight is evenly distributed right versus left. This information is invaluable for determining where the vulnerable and weak spots are on an athlete. We invited parents to fill out an application, and then we would contact them to set up this exam for their children. Within 24 hours, we heard from more than 30 families.

The exams were set up, and the appreciation by the parents was exactly what we’d hoped for. These parents have begged to have someone tell them something that makes sense regarding the injuries their children are suffering. Most of the kids examined have foot imbalances, knee imbalances, and many biomechanical abnormalities that will certainly predispose them to a greater likelihood of injuries, as well as a greater vulnerability to degenerative changes as they age.

How to Use the Test Information
In our office, we offer two products: The Structural Fingerprint® Exam and The Advanced Conditioning™ Program. A patient can purchase either one or both of these programs, but there is no obligation to purchase both. We encourage people to go through the examination, because understanding their structural status is invaluable in many ways, whether they elect to do anything about it or not. Once we have this information, we then design a plan tailored to their needs.

The very beginning of this plan includes the use of custom-made, stabilizing orthotics. Our goal in this program is to improve structural balance, joint mobility, and muscle flexibility. Many doctors use pain and symptoms as their benchmark; however, that superficial goal provides an artificial “correction” to the patient, as most people believe if the pain is gone, they’re healthy.

Most imbalances begin in the feet. We’ve found that approximately 80% of the population pronates (flat foot) with one or both feet. Either way, this produces a postural distortion pattern every time the patient stands up. We’ve also found that 10% of the population has reasonably normal arches, while the final 10% has supinated, or high, arches. This doesn’t take into consideration any of the other biomechanical measurements we look at on our exam, such as Ferguson’s gravity line, the sacral base angle, pelvic balance on the A-P L-S x-ray, femur heights, the cervical lordosis, the atlanto-axial relationship, or the integrity of the disc spaces. Each and every one of these measurements is impacted by the integrity of the medial arches of the feet.

Pronation. This, theoretically, will produce an increased Q angle, but not always. In fact, sometimes we’ll find an increased Q angle with a supinated foot. However, in most cases, the center of gravity going through the knee is abnormal when the medial arch pronates. The human body is a compensating architectural structure, and pronation begins the very “shifts” that accelerate wear and tear at many levels of the structure. Custom-made orthotics begin the balancing process that all structures need to go through.

Normal arches. Many doctors think this is a ticket for dismissing a patient, as “nothing is wrong.” Au contraire. Keep in mind that this patient, if he or she is lucky enough, will go through the aging process, and two factors will influence his or her future.

The first factor is that medial arches of the feet weaken and fall as time goes on. When patients tell you their feet are growing, keep in mind that their medial arches are simply falling. As they fall, the biomechanics of the structure will go through negative changes. Imbalances accelerate degenerative changes, and falling arches will only pour fuel on that fire. Why wait for that to happen? Purchasing custom-made, stabilizing orthotics is a nominal fee to protect against this, and people are desperately looking for this information.

Second, the shock-absorbing qualities of the orthotic reduce the wear and tear going up through the structure. Over the course of one’s lifetime, this is huge.

Supination. These high, rigid arches have very little shock absorption for the structure. It becomes critically important to incorporate some shock absorption into shoes to protect against the acceleration of degenerative changes, and addressing this issue on the front end is always more cost-efficient and logical than addressing it on the back end.

Regardless of foot type, custom-made, stabilizing orthotics are the very beginning of the preservation process of everyone’s structure. The key is for the doctor to learn how to articulate this message to all patients, despite the fact that insurance will seldom cover the cost of the orthotic. Ninety-five percent of all patients in our office are fitted with custom-made orthotics as part of their program, and our area economically is no better off than most other areas in the country. It’s purely a matter of confidence and desire on the part of the doctor as to how much they’re willing to help the patient over the course of his or her lifetime.

Many chiropractors want to argue the fact that our profession should function under medical-model guidelines. Certainly, that system is already in place and available if those are your parameters. However, another “pain reliever” who wears a stethoscope around his or her neck is not what the world needs. Industry, sports, pediatrics, and geriatrics are all begging for someone, anyone, to teach them how to preserve their structures and protect against injuries. The medical-model approach will never be able to do that.

Structural Management® is the key; custom-made, stabilizing orthotics are a tool; and chiropractors are the most qualified to provide this level of care. It’s all about choice and how you want to help your community. And, should I meet with the Denver Nuggets’ Vanderweghe, this may be the entry into pro sports that will provide many more chiropractors with respected roles in pro organizations. 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.

Improving the Chiropractic Posture

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

We need to do the proper testing, make the proper recommendations, and be willing to manage the patient to a higher level of health

Some 20 years ago, I enjoyed a book titled, “Winning Through Intimidation,” by Robert J. Ringer. Ringer was a realtor who faced many tough experiences in his quest for success.

He was never told about closings from which he should have received a commission; he would receive a pittance of the commission he thought he would receive; and he was always treated with little respect when he tried to carve out a place for himself at the table of life. If I didn’t know better, I might have thought Ringer was a chiropractor.

Ringer did the unthinkable: He enhanced and improved his posture. He developed a business card the size of a birthday card. On the front was a picture of the Earth. Each card cost $5, and that was back in the 1970s, but he figured it was worth it, as this started the process of people treating him with more respect.

He then decided that ultimate posture could be attained if he, too, had a lawyer representing him at closings. It was his position that an unwritten “lawyer-to-lawyer code” said they would never, under any circumstances, disrespect each other in any business matter. So, at each and every meeting and closing, Ringer would show up with a lawyer.

Finally, when money started coming in the way it was supposed to, Ringer purchased a private jet to travel to and from projects from afar, never missing even the smallest meeting. He would transport buyers and sellers, and represent himself as the key person in all of his transactions. In essence, he wanted everyone to see him as indispensable and absolutely necessary for any sale to take place. Once he achieved this, commissions became an afterthought.

The Posture of Chiropractic

Needless to say, the state of chiropractic can be directly measured by the 6%–8% of the US population that uses chiropractic. Simply put, this is just unacceptable. However, if chiropractic is to ever grow from this point, we need to be brutally honest as to why we have not grown during the past decades.

Yes, we can all agree we have much going against us. In this country, we live in a medical-model system. Whoever can provide the best and quickest pain relief is going to make the most money. Even though this is the lowest standard of care any human can ask for, this is the way it is. Patient expectations, poor insurance reimbursements, and medical marketing and advertising make it very difficult to change the way the system works. We all graduated with the hope we would help correct the cause of problems, but once in practice, we soon realized that if we enjoy the art of eating, we had better defer to the system that exists out there. And, slowly, we became people we didn’t like, respect, or understand. We’re reduced to marketing our adjustment as a better and quicker way to relieve pain. Oh, my.

So, when we talk posture, it becomes extremely difficult to walk tall, act authoritatively, and pretend that we are the “experts” when it’s hard to even get paid for what we do. But, posture is the key to it all, and somehow, the profession needs to redesign its postural profile to reach newer and higher levels. How and where does that start?

Improving the Chiropractic Posture

The first step in improving our posture is to clearly define who we are and what we do. With a clearer definition, it becomes easier to recognize who our market is and the value we bring to this market. We can’t hope that our community will fully understand who we are and what our product is all about using only the previous knowledge they’ve learned. Much of that knowledge is incorrect or learned through inappropriate sources.

We must rewrite the information our community is getting, and it all begins with us defining more clearly who we are and what we do. Once our value is better recognized, then we just need to get the message out there. With the improved response we get from members in our community, we will feed our inner selves, making our belief system grow even stronger.

In chiropractic, we have created many subspecialties. This subspecialty idea will help dictate who our market should be and what our job description is. We need to simplify the definition of who we are and what we do. If we can’t tell it in three lines or less and make an impact, then we will never get the public to understand. The people in our market are going 100 miles an hour in life and are constantly bombarded with advertising and marketing stimuli from all directions. We need to be clear and simple.

For example, in my particular case, I specialize in Structural Management®. My goals are to:
help people get a status report of their structure (Structural Fingerprint®™ exam);
develop a proactive “plan” that is based on much more than symptoms (much like the orthodontist) for them to biomechanically improve to their maximum level (our Advanced Conditioning™ Program), which will reduce the vulnerability of injury; slow down the degeneration process (wear and tear or rotting); and improve structural balance, joint mobility, and muscle flexibility; and
help people manage that improvement for the rest of their lives.

With this simple explanation, most people are intrigued, as no one has ever suggested to them that they can delay degeneration. No one has ever suggested that a “plan” can be created just for them. Most people are interested because this message is not based on symptoms, crisis/pain management, or surgery. It is based on universal information—imbalances increase the likelihood of injury and accelerate the degenerative process. A statement like this will move people to consider your care.

Next, we need to raise the level of responsibility to the patient. Much of health care today is increasing liability protection at the expense of good will or helping the patient. And the public feels this separation every day. A profession with the courage to increase the responsibility—similar to the doctors of yesterday—will inevitably be viewed with much greater respect.

We need to do the proper testing, make the proper recommendations, and be willing to painstakingly manage the patient to a higher level of health. The current system is a superficial, test-oriented, symptom-relief system, and this will help no society have a better future. This superficial help also will minimize the quality and depth of a relationship between a doctor and his patient.

Proper Testing

We must be aware of the pain, and care about the pain, but look beyond the pain. In my office, we want people to come in when they are asymptomatic, as full physical testing can be done then. If the patient is in pain, we need to rule out pathology and start him on a pain-relief program. We never know how long that will take, but the patient understands that, when the pain is improved, we will determine what corrective program is necessary.

To rule out pathology, determine biomechanical faults, and show patients what their problems are, standing x-rays are mandatory. This information cannot be determined without them. If a correct explanation is given to the patient, rare is the patient who will not go through this testing. To let a patient talk a doctor out of taking x-rays adds to our weak posture.

Full structural testing should complement the x-rays. These tests include foot type, Q angle, joint range of motion, leg lengths, muscle strength and compliance, nerve testing, and any other tests a doctor feels is necessary. But the bottom line is, any treatment given without doing the preliminary testing will only add to our weakness.

Making Proper Recommendations

Most people in this country have never gone through a complete biomechanical exam; therefore, they live in a state of deferred maintenance. Chiropractors have slipped into the category of making a subluxation a pathology, and our goal, unfortunately, is to remove this pathology. However, it doesn’t take much intelligence to know that a subluxation at T12–L1 is always directly influenced by any abnormality in the arches of the feet. If we do not correct the imbalance in the feet, this architectural structure will never have a corrected T12–L1 motor unit.

Therefore, custom-made orthotics are mandatory for long-term wellness of this patient. What I’ve come to learn is that just about every patient who comes to my office has multiple foot, knee, hip, low-back, midback or upper-back imbalances that will be directly improved with the addition of custom orthotics to their “plan”—especially over the patient’s lifetime. In fact, 95% of all patients in my office are fitted with custom-made orthotics at the beginning of their plan.

Also, time is a crucial component of biomechanical improvement. If an orthodontist needs 3 years to help improve the alignment of a 12-year-old’s teeth (despite the fact there are no movable joints, and the teeth are not weight-bearing), then how on earth can we hope to improve overall balance, joint mobility, and muscle flexibility on 12 visits per year? The answer is, we can’t.

So our posture in the community goes way up when we begin recommending something that makes sense. A conditioning program that includes spinal adjustments, extremity adjustments, rehabilitative exercises, custom-made orthotics, weight management, nutritional supplements, and whatever else is needed will always make patients feel as though they are going to “the best.” Six months is the minimum time frame any of us should ever recommend to a patient for corrective care.

I know that conditioning is the only way to prepare for a marathon. The thought that someone will get their back to function better—especially when we know the aging process is a detrimental contributing factor—without getting in better shape is absurd. Time is mandatory for any level of improved conditioning.

Managing the Patient

This skill requires confidence, communication, management skills, problem-solving skills, and true concern for the long-term wellness of the patient. Our profession would do well to provide these ongoing courses to all chiropractors, as this is what the public is looking for. Our posture will dramatically improve when we improve in these categories.

When I tell patients something they don’t want to hear (such as telling them they’re not doing a good job at keeping their appointments), and that if they don’t improve they can’t expect the best results, this tells patients I’m not out to just be their friend; I’m out for their well-being. This is what patients want and need.

There is much room for posture improvement in our profession. We need to focus more on the above issues than on improved clinical knowledge, as the art and science of chiropractic that we all learned is more than enough to make you the best doctor in your community. However, we need to spend much more time on becoming better healers, so we can learn better how to relate to and answer the many needs of an ailing public. 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.

What About the Kids?

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

Structural exams must be performed on child athletes

In the mid-1990s, I spent 4 years working in the New York Giants’ strength department with Al Miller, their head strength coach at the time. During those years, I also spent some time working with Coach Al Vermeil in the Chicago Bulls’ strength department. Coach Miller has gone to the Super Bowl five times, and Coach Vermeil won six championships with the Bulls, so we can assume that these two coaches know something about conditioning.

Together, the two of them developed a conditioning program (Figure 1). This conditioning pyramid has at its base six categories: aerobic conditioning, anaerobic capacity, core strength, joint mobility, strength endurance, and body composition. These six categories represent the very foundation of conditioning, and it is mandatory for all players to begin their conditioning at this level.

Figure 1: The conditioning pyramid that coaches Al Vermeil and Al Miller created represent the very foundation of conditioning.

When a player joins either of these teams, either through the draft, free agency, or a trade, he is required to prove himself in these six categories before he can enter the weight room. Every athlete on these teams must be able to pass certain tests in these categories before they can introduce weight to their structure. Miller and Vermeil both proclaim that this is the beginning of injury prevention.

Middle School/High School Standards

In most states, all student athletes are required by law to complete testing before they can participate in sports for the year. Although this sounds very protective and appropriate, it in fact is thoroughly inadequate. The standard exam (Figure 2, page 32) required by each state is a medical exam—starting with the eyes, ears, nose, and throat—and ends with a paltry structural exam, the performance of the Adam’s Test for scoliosis. The corresponding line for scoliosis says, “Scoliosis: positive_________ negative_________,” as though scoliosis is the only condition worthy of notice in the spine.

Figure 2: The standard student-athlete school exam required by each state is a medical exam—starting with the eyes, ears, nose, and throat—and ends with a paltry structural exam.

The child who passes this test is then put through demanding conditioning, training, and participating in his or her respective sport. Children as young as middle-school age are entering the weight room these days to begin their long journey of conditioning. Added to the fact that no one performs any type of thorough structural exam on these children is the issue of proper guidance in the weight room.

While with the Giants, I witnessed Coach Miller individually bark out individual commands to each and every player, based on the accumulation of knowledge the team had gained during the prep phase with each athlete. At our local middle and high schools, either the coach, a gym teacher, a parent—or no one—watches our kids. With the competitive nature of youth and their desire to show how strong they are, it doesn’t seem illogical that improper weight work will occur.

The startling truth is that coaches, gym teachers, and parents are putting our children through a demanding amount of physical stress with no prior knowledge of their structural conditions. In many cases, these workouts are inappropriately supervised. The immediate fear is that children might get injured while participating in these activities. This matter is complicated by one of the two following protocols that will take place if an injury does occur:

1. The trainer will evaluate the child and make recommendations, and, if the condition is severe enough, refer the child to the local orthopedist or to the child’s primary health care provider. At this point, the child is caught in the loop of seeing doctors and therapists who have no idea of biomechanics, the cause of the injury, the degree of the injury, or the course of action that should take place.
2. The trainer, who is overwhelmed with too many responsibilities, will make a simple recommendation, ignoring the need for further, appropriate follow-up.

The long-term concern is that degeneration of the human frame is caused by imbalances in the structure, which, over time, become fixated joints. Eventually, this young person becomes an adult with an accelerated degenerative process that is taking place in his or her body. Of course, our health care industry has made it almost commonplace for aging athletes to require some level of care for their aching, worn-out joints. These treatments range from medications (such as anti-inflammatories, corticosteroids, and hyaluronic injections) to surgeries (such as arthroscopic, bone fusion, and joint replacement). Not only do they provide answers once the joints have worn beyond a certain point, but this has become a tremendously profitable industry.

And this is OK with everyone? Personally, I am outraged at the collective negligence that is allowed in the supposed protection of our pediatric population today. It is ignorance (lack of appropriate examination), followed by more ignorance (not recognizing the importance of strategic and safe conditioning), followed by ultimate ignorance (waiting for a person to rot out and then provide radically expensive crisis care).

The National Federation of High School Sports

Approximately 1 year ago, I contacted Jerry Diehl, president of the National Federation of High School Sports, and told him about the critical void that existed in our middle and high school conditioning programs. After a brief pause, he stated that the federation is aware of the void, but is unaware of how to address it.

I have continued my dialogue with Mr Diehl in an effort to solve this crisis. Structural exams must be performed on all children wishing to participate in sports today, prior to the beginning of the season. Structural exams can be performed without x-rays, until the child turns 12 years old, when appropriate standing x-rays need to be taken.

The Structural Fingerprint®™ Exam

This exam detects structural imbalances, weaknesses, and distortion patterns. It is ideally performed on nonsymptomatic patients; however, it can also be performed on the injured. As many of our young athletes are under the age of 12, structural x-rays should only be considered if they are clinically warranted. Once a child reaches age 12, standing structural x-rays need to be taken to determine the starting point for that child.

The x-rays provide 75% of the information needed. They allow the examiner to determine biomechanical distortions and imbalances, as well as many other possible findings. Assuming that the examiner knows how to biomechanically interpret the information on the x-rays, this information contributes greatly to the conditioning recommendations for this child. In addition to the exam and x-rays, examination of the feet and knees is crucial.

Foot and Knee Exam

Most children will pronate (have flat feet) prior to age 7 or 8. Once a child is past age 8, the medial arch he or she presents with is considered to be the arch he or she will live with. Since the majority of the population pronates, the odds are high that there will be some possible pronation involvement. Prior to age 12, custom-made orthotics should be considered, as body balance and efficient joint mobility is the prevailing goal. Once a child reaches age 12, a complete examination should take place, including x-rays, and the child should use adult orthotics for the shoes.

Figure 3: With regard to the knee, an evaluation of the Q angle will inform the examiner about the balance of this hinge joint.

With regard to the knee, an evaluation of the Q angle (Figure 3, page 34) will inform the examiner about the balance of this hinge joint. This angle represents the angle formed by the quadriceps tendon as it travels over the patella and then attaches to the tibial tubercle. In the textbook case, pronation of the corresponding foot will often produce an increase of this angle. Unfortunately, an increased Q angle can also not be textbook, showing positive when least expected and negative when expected. Therefore, it must be examined—both knees on all patients—to know the status of this test.

Research has shown an associated increase of many knee injuries when an increased Q angle is present, and the addition of custom-made orthotics to the equation will reduce the stress in the knee caused by the imbalance. If all active children could receive this evaluation and the supportive care needed, the number of injuries in youth sports would be drastically reduced. The amount of future joint degeneration would also be reduced, altering the course of many people’s lives. This approach might also put a dent in the profitability of modern medicine.

It is incumbent on all of us to demand a change in the way kids enter the sports arena. Structural exams should become mandatory, and the standards used by coaches Miller and Vermeil should also be used for the thousands of young athletes today. Until we raise the bar and demand such a change, it is unlikely anyone will see to it that this happens.

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.

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.