March 2012

The Offi cial Publication of the American Chiropractic Association www.acatoday.org

Appealing Claims Denials | 18

CCoonnsseerrvvaattiivvee PPrriimmmaaaarrrryyyy CCaarree iinn CChhiropraccttiicc PPPrrraaaccctttiiccee || 24

Six Reasons to Employ Blood Panels| 30

25 Years Later:Why It Still Isn’t Over

Wilk v. AMA

| March 201228

Health & Wellness

Have you ever been to the Tour de France or watched it on TV? It’s one of the most intriguing sporting events on Earth. The sheer level of athletic performance, endurance and the will to win is like no other. What’s just as interesting is the

technology used to keep accurate time. The Tour has a fi eld of approximately 180 to 198 riders. Timing is kept at a high level of accuracy to ensure athletes’ performances are recorded properly. What technology company performs this critical task? MicroGate.

World-Class TechnologyBy Jay Greenstein, DC

Interestingly, this company has now entered the health and wellness industry, and formed a new corporation. Using its tim-ing technology, and combining it with optics used on the Hubble space telescope, it has created a new company called OptoGait. Dr. Peter Gorman, a doctor of chiropractic (DC) who has six U.S. patents on heart-rate monitor technology, is the president of Mi-croGate USA. He has worked tirelessly to help DCs enhance the profession and help us understand how leading-edge technology can grow our professional reputation and our practices.

“The fi nest human performance evaluators in the world will justify their opinions with precise objective evidence,” says Dr. Gorman. “The world stage is set for all chiropractors to vali-date their ability in injury prevention, injury recovery and sport enhancement. There is no rest until chiropractic receives its well-earned position in the global family of knowledge.”

Optical TechnologyThe technology essentially works as an optical measurement

system consisting of a transmitting bar and a receiving bar. Each of these bars contains 100 LEDs (1 cm resolution). The LEDs on the transmitting bar communicate continuously with those on the receiving bar. The system detects any interruptions or inconsistencies in communication between the bars and calcu-lates their duration. This makes it possible to make comparisons

among the performances of different patients or the same patient performing different moments. Starting from these fundamental data, the dedicated software makes it possible to obtain a series of parameters connected to the subject’s performance with the maximum accuracy and in real time.

OptoGait goes beyond the acquisition of numerical data. Thanks to small cameras that can be positioned as appropriate, it records images of the tests performed, synchronizing them per-fectly with the events measured numerically. This makes it pos-sible to enjoy the advantages of cross-analysis between numerical data and images. The optical image sequences and all the other data are saved in the database.

All data are displayed in real time through the software plat-form (affording instant decisions on treatment protocols) and paired with both lateral and sagittal video analysis. Data is stored over time, affording the clinician the ability to determine effec-tiveness of any treatment intervention. Injury prevention is en-hanced via objective data, showing increased asymmetrical ten-dencies before pain and neuro-biomechanical dysfunction set in. Chronic injuries are addressed via gait-empowered differentials, identifying the root cause of malingering problems. All aspects of dynamic motion are recorded to ensure your patient is func-tioning at his or her highest level.

29| March 2012www.acatoday.org

Typical, Basic Strategies of UseTreadmill gait evaluation: Have the patient walk at a slow

speed. Visually observe the parameters of the gait cycle in real time. The system will make left and right comparisons of contact time, fl ight time, swing, etc. As you increase your patient’s speed, the system will note if asymmetries are improving or worsening. When maximum effi ciency is realized, notate asymmetries and the treadmill’s speed. This effi cient “rhythm of gait” is a good starting point for clinical intervention. Footwear, orthotics, con-ditioning exercises, etc., may be employed to enhance patient symmetry. Pending the patient’s needs, gait protocols can be per-formed at any speed.

Floor Tests1. A basic step test can be evaluated for biomechanical effi -

ciency. Contact and fl ight time of each leg is evaluated for symmetry.

2. Standard squat jumps can be evaluated for maximum power. Pelvic angle can be noted instantly. Conditioning protocols can be based on this angle.

3. One-legged jumps, in any direction, are employed to com-pare left and right power. Knowing the patient’s overall power is only one aspect; symmetry is key to all rehabilita-tive programs.

4. Agility, left and right, is studied via simple ski tests. Left and right contact and fl ight times are easily compared. Ef-fective treatment ensures there is no favored side.

dysfunction, post surgical deconditioning and concussions, to name a few. Sub-clinical injuries can no longer hide; precise, effective treatment is ensured.

Actual Use and TestimonialsWhat do the leaders in sports chiropractic have to say about

this technology? Dr. Ted Forcum, offi cial U.S. Olympic Team chiropractor at the 2008 Beijing Olympics, past president of the ACA Council on Sports Injuries and Physical Fitness and president of the Back In Motion Sports Injuries Clinic, states, “This technology can identify lesions that the human eye and physical testing cannot. A competitive runner who is currently asymptomatic right post-ACL reconstruction came in for care. We did a Drift Protocol, which showed a signifi cant reduction in stability, power and vertical jump on the right. After a brief treatment we retested her, and her right drift stability mark-edly improved and her vertical jump increased from a greater than 25 percent defi cit to a 4 percent increase compared to the left. With these results, the patient stated, ‘This is fantastic. I know exactly why we are doing this treatment and what my goals are.’ That’s powerful!”

Dr. Forcum continues, “We tested 90 Western Hockey League athletes in a pre-season camp, we custom-designed test-ing for a soccer goalie coach, and we were able to use a variety of tests for an athlete to use as a marketing tool for National Football League scouts. I feel like I have just scratched the sur-face in OptoGait’s applications.”

World-renowned sports chiropractor and co-founder of FAKTR technique (www.faktr.com) Tom Hyde, DC, DACBSP, agrees. “With such a signifi cant emphasis on concussion man-agement, from pediatric to professional sports, we need innova-tive ways to evaluate these athletes in real time. This system allows us to do just that. I’ve seen remarkable concussion sen-sitivity and specifi city data that could not have otherwise been picked up by physical or neurologic exam on the fi eld of play! Doctors of chiropractic need to lead the way in injury manage-ment and prevention. This technology is part of our holy grail.”

J. Michael Flynn, DC, president of the World Federation of Chiropractic (www.wfc.org), who sits on the board of the Foun-dation for Chiropractic Progress (www.f4cp.org), concludes, “Concussion management, and pediatric sports safety in gen-eral, is an enormous opportunity for our profession. Having the latest technology at our disposal is critical to being the leader in sports health and wellness.”

So whether it’s OptoGait, or any other innovative technol-ogy that’s evidence-based, leading the way for neuro-biome-chanical evaluation, treatment and prevention is the chiroprac-tic profession’s destiny..The above tests are just a few of the many protocols that can

be performed to analyze patients and the variety of conditions that can cause deviations from the norm—neuro-biomechanical