By: Alonzo M. Borja, DC, FICPA, Medical Examiner - US Dept of Transportation, all3sports Race Team Member
We live in the Metro Atlanta area which is the home of Life University - School of Chiropractic. Consequently, many of the graduates decide to make Atlanta their home. As an athlete, there is a high probability you may need Chiropractic services. With so many “DC’s” surrounding us, how can you make an educated decision in order to get the best treatment for your particular condition?
This blog intends to take the confusion out of this challenge by providing you the ammunition needed so you don’t get ripped off, under-treated, or over-treated. To be clear, I am a Doctor Chiropractic (DC) who graduated from “Life” in 1998. I remember distinctly where I was, who I was with and what I was doing when I got the call from the GA Board of Chiropractors congratulating me for becoming a licensed Doctor of Chiropractic: In my condominium pool with another Chiropractor having a few beers and cigars!
My background in the health field is what molded me to be who I am today as a healthcare provider. Between 2 generations, my family has produced 7 MD’s, 6 Nurses, 3 Chiropractors and a Special Needs teacher. My Father, a Cardiovascular Surgeon, instilled in me the importance of being the best in your field as well as treating each patient like a family member- with love and humor. My Mother, A registered Nurse, always displayed her loving and nurturing touch. I was also taught that money should NOT be the reason to be in the health field-if you give honest and thorough treatment financial rewards will come as a result.
So what is Chiropractic and what do they do?
DC’s are alternative Healthcare providers whose focus is on the spine and extremities (arms/legs etc). Some also niche their office, branch off from traditional chiropractic and corner a particular market. For example nutrition, weight loss, functional medicine etc. DC’s are able to perform and utilize the same techniques employed by Physical Therapists. I explain to my patients that their spine is intimately connected to the nervous system and when both are healthy - you are healthy. I emphasize the importance of freedom of movement of the Spinal and extra-spinal joints as well as the surrounding muscles. The primary method used to perform this goal is performed by manipulation - “The chiropractic adjustment”.
The scope of chiropractic is not limited to performing only manipulation on the spine or extremities. We can treat various symptoms utilizing Electric Stimulation (EMS), therapeutic ultrasound (US), microcurrent, deep moist heat and cryotherapy( ice), cupping, massage (and its diverse techniques - including ART and Graston), axial traction, exercises and stretches, mechanical traction etc. If your chiropractor does not “include” these options as part of your plan of action to heal your symptoms - walk away! They are essential for healing and prevention. Some clinics charge extra for the use of this equipment, I do not. However, it is OK to bill for each treatment modality if they are billing your health insurance. It is important to ask which therapies and how and when they will use them in regards to your treatment protocol.
The following is an explanation of the most popular used electric modalities:
- Electric Stimulation (EMS) - used to decrease pain and spasm
- Therapeutic Ultrasound (US)- for the reduction of inflammation
- Heat - increase blood flow and reduce tight muscle fibers
- Cold - reduce inflammation ( latest studies suggest that using ice may in fact prolong an injury by preventing blood flow therefore preventing the transport of healing elements and allowing for the stagnation of inflammatory agents). Compression appears to be more effective.
- Traction- ( not to be mistaken for a “roller table”). Axial traction is the long axis stretch of the spine at a predetermined weight in order to reduce the load on the joint, disc and nerve. Great for sciatic, and other pinched nerves producing pain down the arms or upper back. Many DC’s up charge for this service which may sometimes be greater than a normal office visit/treatment.
- Cox flexion distraction technique (AKA Cox Technic) - it is the Gold Standard for back and disc care and in fact the ONLY chiropractic technique ever awarded a grant from the NIH due to the effectiveness. Google it.
- Massage - most offices hire Licensed Massage therapists which will cost you around $60/hour. Make sure you ask before you receive - Swedish, deep, trigger point, therapeutic etc. Will they concentrate on problem areas or do their own routine? When getting a massage, make sure you communicate with the therapist in order to get a targeted, effective treatment. An effective chiropractor should themselves perform various types of massage to their patient and provide at least a few minutes of soft tissue work on your condition as the Skeleton and muscles are intimately attached and the movement of the bones will not react if the muscles are not addressed.
- Graston technique should be Googled as well and is an important treatment for many conditions associated with trauma or overuse syndrome (hips, IT, glutes, etc)
- Exercises and stretches - should always be factored in when recovering from an injury or pain syndrome. Sometimes there is an avoidance of certain activities until you heal and many times there is an addition of various activities in order to promote healing. Does the office have rehab equipment ( bands, balls, bikes, treadmills, machines for strength, wobble boards, etc)?
First Impression of the office
I am reminded by many conversations with my patients that the first impression they have as they walk into an office is a make or break. Cleanliness, up to date orderly furniture, a friendly and neat assistant with a cheerful greeting and lastly your introduction to the Doctor usually sets the stage for the overall experience. I’ve been told on countless occasions from patients who have been to other DC’s that they KNEW that the “other guy” was in it only for the money the minute they walked in the door. Trust your instinct and walk away.
Do your research
In the age of technology, google searching can be helpful for the reviews. If the clinic has stellar ratings and 4+ stars disregard the one or 2 negative reviews, they are probably haters or high maintenance patients who didn’t feel fulfilled. Going to the website can give you valuable insight to the practice as well as information on the type of care you will receive.
Paying through insurance vs. out-of-pocket
Money, and the amount you have to dish out for your care is the next topic. If you have health insurance make sure you are informed of the benefits before you go back into the examination room. Beware of the office manager who tells you not to worry about it - “you’re covered”. Make sure it is explained thoroughly. You may also want to verify yourself before making the first appointment. Unfortunately, Insurance benefits aren’t what they used to be and many of us have high deductibles. If that is the case then you may want to avoid giving your insurance card and inquiring about their cash price. BIG WARNING…….If you are a traumatic injury, pain patient or just want to enjoy the benefits of Chiropractic for general health/athletic performance as this can dictate the number of times you may need to be treated and thus affect the amount of money you pay for treatment.
Cash option chiropractors can be a little sketchy and in line with a mall jewelry sales person who has their trusty calculator in their pocket. They like to tell you that for your condition will require anywhere from 5-12 months of care and convince you that a lump sum would be the best benefit. Then they whip out the calculator and give a discount if you pay it all up front. I have a hard time telling someone you need ½ to a full year of treatment. These types of practices used the same treatment plan and protocol for every condition regardless of the individual and their chief complaint. 9/10 times the ONLY treatment you will receive on this “bargain of a deal” will be feeling like cattle with everyone getting the same kind of adjustment whether its a headache or a bunion.
The other cash option (which is what my office uses) is the cash price per treatment. Examinations can range from $50 to $200, Xrays from $50 to $200 and the treatment from $20-$100. When utilizing this means of payment you have more control. My prices are as follows: exam $145 without X-rays/ $195 with X-rays, afterwards $60 per treatment. Make sure you will be treated on the same day as the examination. As crazy as it sounds, I hear the stories of severe pain patients going to a DC, getting an exam/X-rays and then being told to come back in a day or two for treatment. NO SIR! I want it NOW!
There is a disturbing rise in the number of Offices offering LOW LOW LOW prices in par with The Joint Chiropractic offices. These clinics will only do a quick adjustment and convince you of the need for an extensive care plan spanning months. Additionally, The Joint doesn’t pay their DC’s well and as a result their DC turnover is high. They love to pluck them out of school with no experience, so you are pretty much a crash test dummy. None of The Joints have Xray machines either. Not absolutely necessary but definitely nice to know the option is there for potentially serious conditions.
Beware of the DC who demands that you get Xrays before they treat you.
- Many conditions don’t need Xrays
- If you had Xrays taken previously you should be able to use them if they were done within 4-5 years.
I have successfully treated hundreds of thousands of patients and utilized Xrays in about 25-30%. But it is important to communicate the reason for taking or not taking. Family history, acute versus chronic, past history, mechanism of injury, symptomology etc. are all factors in the X-ray decision making.
Expectations for duration of treatment
I touched upon the number of treatments needed (care plan/Plan of care) for various conditions. No condition needs months and months of treatment! If you are providing the RIGHT type of Chiropractic treatment coupled with all of the options included within your scope of practice, positive results should be felt almost immediately. I tell my patients by the 3-5 visit they should feel 50% better and by the 8th visit almost completely healed. However, if relief is not felt in that time frame, It is important to discuss a possible referral to a specialist or for advanced imaging (MRI/CT scan). Please let me emphasize the above sentence, “...coupled with all of the options included within your scope…” - when you provide all the tools available in your healing arsenal during each visit, then the chances of getting better faster is multiplied considerably.
You are the boss.