Fall 2012 Logan Speaks

LOGAN SPEAKS FA L L 2012 |

Logan Speaks is produced by the offices of Institutional Advancement and Public Relations

4 Faculty Research Published in Preventive Medicine and Brain 6 The Educational Value of Evidence-Based Research 8 Marketing Motivation: The Science of Social Media 9 Did You Know?

10 Doctor to Doctor 12 Postgraduate Seminars

Examining the Factors that Fuel Performance Page 2 SCIENCE AND NATURE ALIGNED IN BALANCE

Examining the Factors that Fuel Performance

Dr. Laney Nelson Introduces Strategies for Treating the Summer Track and Field Athlete

For some athletes, overcoming hurdles is all part of the game. These young men and women calculate every stride and leap, vying to set a new record of achievement; and, in doing so, they transform a track and field into a testing site for human performance. When plagued by injury, they rely on a team of coaches, trainers and physicians to return them to the field before the brief season passes them by.

Consistency is critical if you are to treat the 100 to 200 athletes who compete at a weekend meet.”

Behind many of these runners, jumpers and throwers competing across Missouri stand members of Logan’s BIOFREEZE® Sports & Rehabilitation Center led by Director Laney Nelson, DC, Dr. Laney Nelson DACBSP, and Assistant Director Connie Hayes, DC. Dr. Nelson’s team dedicates its summers to track and field athletes, imparting protocols from Logan’s Master of Science in Sports Science and Rehabilitation.

But, Dr. Nelson says he and his colleagues have also learned lessons from these athletes as well.

According to Dr. Nelson, track and field athletes have no shortage of techniques they employ to enhance performance.

He says the Logan team is focused on developing strategies to help these athletes and their training staffs leverage their skill sets and achieve more predictable outcomes.

“When every second counts, we rely on these strategies to ensure we are thorough, efficient and effective,” Dr. Nelson added.

Dr. Nelson’s team uses acronyms to outline their strategies’ evaluation and treatment measures so they’re easily recalled when on the sidelines. The emergency acronym, referred to as ABPCDE, instructs the health team to assess the athlete’s airway, blood pressure, conscious level, disfigurement and then evaluate the diagnosis.

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LOGAN UNIVERSITY Logan University is a diverse and engaging community committed to excellence in health sciences, education and service, guided by integrity, commitment and passion.

M I S S ION

M I S S ION

“We have learned that track athletes have a tremendous amount of physical demand placed on them, which is complicated by small allocations of time to rest and heal between training and competitive events,” said Dr. Nelson, whose team has treated approximately 2,500 track and field athletes this summer. “When you’re on the sidelines working with these athletes, you’re a part of another kind of speed event—working to quickly and safely return these athletes back to the field.

His second strategy, focuses on treatment of the athlete, and accounts for the students’ educational and personal variations.

The acronym BSMFNOPQR=S helps students develop their clinical thinking and management. The letters remind the student to check: • Blood stabilization: Does treatment need to bring new blood into the area for chronic injuries or restrict blood if an acute condition?

• Muscle: What strategy will be used to treat the injured muscle sector?

• Fascial: What strategy or technique will manage fascial plane restrictions?

• Neurologic: What neurological level needs to be addressed from a manipulative standpoint?

• Orthopedic: What tests or signs are needed to validate the treatment and the outcome?

• Plan: How are we going to implement the strategy given our time constraints?

• Quietly Report: The heightened emotions associated with competitive events do not negate the need for correct documentation. When it is quiet, make sure you chart to the standard of care.

• Success: If you follow the strategy, then you can expect a successful outcome.

LOGAN COLLEGE OF CHIROPRACTIC Logan College of Chiropractic prepares students to become doctors of chiropractic who are superbly educated and clinically competent, practicing portal-of-entry chiropractic physicians. This mission is accomplished through our dedicated faculty, recognized for student-centered excellence; comprehensive science-driven, knowledge-based and information-facilitated curriculum; enhanced by community and public service. The institution is committed to the conduct of research and other scholarly activities.

SCIENCE AND NATURE ALIGNED IN BALANCE

Whether treating an injury or enhancing performance, Dr. Nelson advises his students and colleagues to apply a proven strategy to better manage patient outcomes.

Running the Risk of Overtraining Unlike contact sports where athletes must adapt and maneuver based on their opponents’ strategies, the track and field athletes perform on a linear plane.

“These athletes move in one repetitive direction, needing to rapidly reach their top speeds and angular velocity and then maintain it throughout the competition, as opposed to basketball or football players who change their directions and rates of speed throughout the game,” said Dr. Nelson. For example, the average football play or basketball exertion lasts 10-15 seconds; whereas, track events last from 12 seconds to minutes. “The combination of the dynamics of a track and field athlete and the condensed season often lead to overtraining.”

Dr. Nelson and his team instruct their athletes and respective coaching staffs to train at 80 percent of the athlete’s perceived capabilities. “By working with and helping to educate the coaching and training staffs, we’ve seen a sharp decline in stress fractures alone,” added Dr. Nelson.

When working with a track and field athlete, Dr. Nelson recommends practitioners: • Consider the lower extremity’s internal rotational speeds, as it relates to ground reaction forces.

• Assess the internal hip, tibia and talar speeds in regards to the pronation sequence.

• Test for abductor strength and speed by using a timed challenge.

• Perform Feiss’ line and measure talar drift, talar and navicular drops and glides.

Fueling Performance Even with the proper training and exercise regimens, track and field athletes must examine their diets if they are to reach their maximum performance levels.

Dr. Robert Davidson Robert Davidson, MS, PhD, assistant professor with Logan’s Master of Science in Nutrition and Human Performance, dedicates several trimesters of study covering the subject of nutrition and performance. He says athletes need strategies for maintaining their blood glucose levels and hydration.

“I was a track and field athlete who found my calling in nutrition when I learned that my college coaching staff at the time couldn’t answer my diet-related questions,” said Dr. Davidson. “Since my college track days, I’ve dedicated my career to educating others on the linkage between nutrition and performance, which is undeniable.”

Among the current literature, Dr. Davidson says, it’s been reported that when physical activity is conducted for less than 90 minutes, consider a carbohydrate source unnecessary.

However, physical endurance for longer than 90 minutes requires carbohydrates, which some athletes will consume via sports drinks or gels to maintain their blood glucose levels during competition.

“This is why you’ll often find triathletes, for example, packing baked potatoes on race day,” said Dr. Davidson. “It’s been reported that by maintaining blood glucose levels, athletes can lengthen their peak performance periods by one hour before they’ll hit fatigue.”

Dr. Davidson also emphasized hydration levels for track and field athletes, given they often spend two days out in the heat and sun competing. “For high school track athletes, I recommend mixing up

their water intake with an electrolytereplacement drink,” he says. “They could safely consume two sports drinks for every water bottle, so long as they are replacing electrolytes—needed to rehydrate quickly—and other key compounds and elements required to maintain thermal regulation, like sodium chloride, magnesium, calcium and zinc.

Be mindful that many sports drinks contain carbs, which are only needed if competing or training for periods longer than 90 minutes.”

When it comes to athletes’ home plates, Dr. Davidson advocates for consuming well-balanced meals with variation; complete protein sources to support muscle growth and regeneration; and iron-rich foods, such as red meat, for making blood cells with hemoglobin.

“Eating pasta before a game is great for carb-loading,” he said. “But, athletes should never cut out entire food groups from their everyday diet. The biggest difference between athletes’ diets compared to non-athletes’ is they are consuming more calories.”

We invite Logan alumni to contact Drs. Nelson and Hayes to make appointments on the Logan campus for assistance in setting up school site visits and learning more about assessment.

To learn more about Logan’s Master of Science in Nutrition and Human Performance, call 800-533-9210 or visit Logan online at www.logan.edu/future-students.

LOGAN SPEAKS FALL 2012

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Logan Faculty’s Research Published in Preventive Medicine and Brain Dr. Norman Kettner’s Greatest Research Honor … Thus Far Nearly seven years ago, Norman W. Kettner, DC, DACBR, chairperson of Logan’s Radiology Department, and his collaborative research team at the Massachusetts General Dr. Norman Kettner Hospital’s Athinoula A. Martinos Center for Biomedical Imaging initiated a series of studies. The studies represent part of the team’s long-term research trajectory: to map the functional and structural cortical neuroplastic reorganization related to the peripheral neuropathy of carpal tunnel syndrome (CTS). They have employed multiple

powerful neuroimaging methods, with robust analytical imaging paradigms, to render valuable insights into the abnormal cortical and subcortical processing arising from CTS and its accompanying chronic pain.

Recently, they completed another CTS study using magnetoencephalography (MEG) as the neuroimaging technique. Its findings included median nerve conduction deficit was associated with a delayed response time in the primary somatosensory cortex, altered cortical rhythms and maladaptive cortical neuroplasticity. The team then worked to publish its paper.

What happened next Dr. Kettner would describe as “the preeminent honor of my research career”—Brain, which boasts an impact factor of 9.4 and is considered one of the top neurology journals, accepted the paper titled “Spatiotemporal Mapping

Spatiotemporal Mapping Cortical Neuroplasticity in Carpal Tunnel Syndrome Rupali P. Dhond1*, Emily Ruzich1, Thomas Witzel1, Yumi Maeda1,4, Cristina Malatesta2, Leslie R. Morse3, Joseph Audette5, Matti Hamalainen1, Norman Kettner4, Vitaly Napadow1,4 1 Martinos Center for Biomedical Imaging, Dept. of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA. 2 Dept of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital, Medford, MA, USA 3 Dept of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA 4 Dept of Radiology, Logan College of Chiropractic/University Programs, Chesterfield, MO, 5 Dept of Pain Medicine, Harvard Vanguard Medical Associates, Atrius Health, Boston, MA, USA

SUMMARY Neuroimaging data demonstrate that carpal tunnel syndrome (CTS), a peripheral neuropathy, is accompanied by maladaptive central neuroplasticity. To further investigate this phenomenon, we collected magnetoencephalography data from 12 CTS patients and 12 healthy volunteers undergoing somatosensory stimulation of median nerve innervated digit 2, digit 3, and ulnar nerve innervated digit 5. Nerve conduction velocity and psychophysical data were acquired to determine if standard clinical measures correlated with brain response.

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SCIENCE AND NATURE ALIGNED IN BALANCE

Cortical Neuroplasticity in Carpal Tunnel Syndrome.”

According to Dr. Kettner, the published research has translational impact as it contributes to the understanding of the neurological mechanisms underlying central sensitization, a maladaptive neuroplastic state with enhanced nociceptive responsiveness and excitability. Central sensitization is fundamental in the conversion to and maintenance of chronic pain.

“In CTS, as with many chronic disorders, an underlying mind-body interaction is operational, which becomes associated with a state of maladaptive cortical reorganization,” said Dr. Kettner. “The maladaptive neuroplastic responses in CTS are biopsychosocial and evolve from the abnormal afferent processing associated with median nerve injury (paresthesia, persistent nociception, referred pain), along with disturbances in cognition (fear memory, hypervigilance) and affect (pathological anxiety, catastrophization).”

One of the most unexpected findings from the research, according to Dr. Kettner, was

In carpal tunnel subjects, but not healthy volunteers, sensory nerve conduction velocity for digit 2 and digit 3 was slower than digit 5.

However, somatosensory M20 latencies for digits 2 and 3 were significantly longer than those of digit 5. The extent of the M20 delay for median innervated digit 2 was positively correlated with decreasing nerve conduction velocity and increasing pain severity.

Thus, slower peripheral nerve conduction in carpal tunnel syndrome corresponds to greater delays in the first somatosensory cortical response. Furthermore, spectral analysis demonstrated weaker poststimulus beta event related desynchronization and earlier and shorter event related synchronization in carpal tunnel subjects. The extent of the decreased event related synchronization for median innervated digits was positively correlated with paresthesia severity.

We propose that ongoing paresthesias in median nerve innervated digits render their corresponding sensorimotor cortical areas “busy” thus reducing their capacity to process external stimulation. Finally, carpal tunnel subjects demonstrated a smaller cortical source separation for digit 2 and digit 3 in comparison with healthy volunteers. This supports our hypothesis that ongoing paresthesias promote blurring of median nerve innervated digit representations via Hebbian plasticity mechanisms.

In summary, this study reveals significant correlation between the clinical severity of carpal tunnel syndrome (CTS) and the latency of the early M20 as well as the strength of long-latency beta oscillations. These temporal MEG measures are novel markers of neuroplasticity in carpal tunnel syndrome and could be used to study central changes that may occur following clinical intervention.

the slower peripheral nerve conduction velocity in CTS, correlated with decreasing response time in the primary somatosensory cortex. “The delayed peripheral nerve transmission resulted in delayed response in the primary somatosensory cortex,” added Dr. Kettner. “This cortical delay suggests that more complex cortical processing may be required in CTS compared to healthy controls. In addition, the delay in cortical response correlated with the intensity of the CTS metrics for pain and paresthesia suggesting this increased afferent traffic was slowing the cortical somatosensory response to external inputs.”

Dr. Kettner says another focus of the team’s ongoing research is to characterize the central neural correlates of CTS patients in response to acupuncture stimuli. This work has revealed clinical and neuroimaging evidence for beneficial neuroplastic reorganization that stems from the intervention of acupuncture in CTS patients.

“Our work has added to the growing recognition that diverse mechanisms may drive beneficial neuroplastic reorganization in the brain, including neural stimulation, physical activity, cognitive and motor learning and environmental enrichment,” said Dr. Kettner. “This therapeutic approach constitutes a new, safe and effective armamentarium for clinicians who employ neurorehabilitation in patient care.”

As Dr. Kettner looks toward the future, he says the new MEG data used in the Brain study may serve as primary outcome measures in future interventions for CTS or other chronic pain syndromes.

Dr. Cheryl Hawk’s Research Lands in Preventive Medicine According to Harvard Medical School faculty and Harvard Health Publications, good health means more than treating illnesses when they occur—it means achieving and maintaining a healthy weight, getting optimal nutrition, exercising and staying fit, and taking steps to prevent disease.

If Cheryl Hawk, DC, could add one more to that list, there’s no doubt she would include complementary and alternative health care.

For more than 35 years, Dr. Hawk, director of clinical research at Logan College of Chiropractic/University Programs, has been deeply involved in wellness promotion and disease prevention and its role in today’s chiropractic model. At Logan, her research has centered on developing ways to integrate mainstream prevention and health promotion practices into chiropractic.

“For us, these findings reinforce the theoretical basis of chiropractic, as well as other complementary and alternative health care practices,” she said. “However, it could come as a surprise to those not familiar with complementary and alternative health care practices as well as mainstream health care providers.”

Dr. Cheryl Hawk

Earlier this year, Dr. Hawk earned the honor of being published in Preventive Medicine— one of the highest ranking medical journals—for her research on the potential role of complementary and alternative health care providers in chronic disease prevention and health promotion. Dr. Hawk said the published research is significant for many reasons, but perhaps one of the more noteworthy reasons is that it reaches thousands of readers outside of the chiropractic industry.

“Complementary and alternative health care is almost always viewed as a treatment for conditions, and very seldom in the context of wellness, disease prevention and health promotion,” she said. “We wanted to use the National Health Interview Survey (NHIS) data to explore the idea that people do use complementary and alternative health care for wellness, not just for treating conditions.”

Abstract Potential role of complementary and alternative health care providers in chronic disease prevention and health promotion: An analysis of National Health Interview Survey

SURVEY DATA Objective: To make a preliminary assessment of the potential role of the most frequently used licensed or certified United States complementary and alternative medicine (CAM) providers in chronic disease prevention and health promotion.

Method: This was a secondary analysis of the 2007 United States National Health Interview Survey (NHIS), the most recent to include CAM use. The Adult Core Sample, Person and Adult Complementary and Alternative Medicine data files were included. NHIS complete survey design structure (strata, cluster and survey weights) was applied in generating national population estimates for CAM usage.

Dr. Hawk collaborated with Dr. Harrison Ndetan from the Parker Research Institute in Dallas, Texas, and Dr. Marion Willard Evans Jr. from Texas Chiropractic College in Pasadena, Texas. Dr. Hawk said while many others in the past had used the NHIS data set, she and her co-authors were the first to conduct their particular analysis.

Results: Chiropractic or osteopathic manipulation (8.4%) and massage (8.1%) were most commonly used; acupuncture was used by 1.4% and naturopathy by 0.3% of respondents. Substantial proportions of respondents reported using CAM for wellness and disease prevention, and informed their medical physician of use.

Fifty-four percent were overweight or obese, 22.0% physically inactive, and 17.4% smokers; 18.0% reported hypertension, 19.6% high cholesterol, and 9.1% prediabetes or diabetes.

Their findings showed that many respondents do not use complementary and alternative health care to treat specific conditions; rather, a substantial number of complementary and alternative health care users take advantage of it for wellness, improved energy and improved immune function.

Conclusion: CAM users present with risk factors, which are priority public health issues. This implies a need to train CAM providers in evidence-based health promotion counseling. CAM encounters may provide opportunities to coordinate health promotion and prevention messages with patients’ primary care providers.

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The Educational Value of Evidence-Based Research While the team discovered improved movement times in participants with neck pain who received spinal manipulation therapy, their research also revealed something else.

John Ellis (left) and Jonathan Emlet

When Jonathan Emlet and John Ellis graduate from Logan College of Chiropractic/University Programs, they’ll have something that most

“Going into the study, I had an idea that we would find the chiropractic adjustment to have a significant effect on movement times in symptomatic participants, but we also found a significant change in movement times with non-symptomatic participants,” said Emlet. “I enjoyed working on a topic that is relatively untouched in the chiropractic research realm and knowing our study’s findings could have a positive impact on the profession.”

“There’s something very gratifying about knowing firsthand what I’m doing is effective,” said Ellis. “When I graduate, I can adjust with confidence knowing the technique works because I helped to validate its benefits through research.”

Student Research at Logan

of their peers don’t—published research as well as an award from the Association of Chiropractic Colleges and Research Agenda Conference (ACC-RAC).

Dr. Kevin Ward

Along with Dr. Kevin Ward, who graduated from Logan in August 2011, Emlet and Ellis volunteered their time to continue an ongoing line of research into the effects of spinal manipulation therapy on Fitts’ Law Performance.

Building on research that Dean of Logan’s Research Division Dr. Rodger Tepe conducted in 2010, their objective was to determine whether or not chiropractic adjustments had any effect on reaction times of participants both with and without neck pain.

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SCIENCE AND NATURE ALIGNED IN BALANCE

The abstract, “A Single Blind Randomized Controlled Trial of the Effects of Spinal Manipulative Therapy on Fitts’ Law Performance in Participants With and Without Neck Pain,” was published in the Journal of Chiropractic Education. The full research manuscript has been submitted to the Journal of Manipulative and Physiological Therapeutics for peer review.

While the hard work and determination of Emlet, Ellis and Dr. Ward is reflected in their abstract’s publication and recognition at ACC-RAC, they offer accolades to Dr. Tepe for his mentorship and for creating an inviting and collaborative environment for student research to occur.

“One of the reasons why I chose Logan was the institution’s emphasis on research,” Emlet said. “As soon as I began the doctorate program, I got in contact with Dr. Tepe and let him know that I was interested in conducting research, and that I was willing to begin as soon as possible.”

Ellis agreed.

“We came prepared to research and presented ourselves as people who wanted to do this study to further chiropractic,” he said. “I think Logan’s faculty is pleased to see the outstanding research projects performed by Logan students.”

For years, Logan has offered educational curricula designed to teach students about research in both the classroom setting and in their senior research projects. At any given time, there can be as many as 80 different student research projects taking place at Logan on topics ranging from the effects of chiropractic care on head and neck conditions to balance and fall prevention to treatment and prevention of sports injuries.

The institution boasts one of the highest numbers of required student research hours and is one of the few chiropractic colleges with an Evidence-Based Journal Club, created to teach students how to be consumers of research and critically evaluate scientific journal articles.

“What students learn hands-on by doing their own literature reviews and their own experimental projects, like a clinical trial, is invaluable,” said Dr. Tepe. “The big initiative here at Logan Dr. Rodger Tepe is to do an outstanding job of educating students so they become lifelong learners.”

patients and validated his care to other health providers.

“Last month, I met with a neurologist, and I was telling him how chiropractic care can be beneficial for some patients with cervicogenic vertigo,” Dr. Ward said.

“He was skeptical, so I told him about our study at Logan. He said it was the first time chiropractic care had ever been explained scientifically.”

Dr. Tepe was not surprised by the neurologist’s response:

“We’re in the business of changing the perception of chiropractic through research on several levels. We want our students to be informationliterate, evidence-informed, evidencebased practitioners. The mission of the research division at Logan is to design, conduct, present and publish studies that investigate the efficacy, safety and our cost-effectiveness of chiropractic intervention on musculoskeletal conditions in diverse populations.”

Dr. Rodger Tepe, Dean of Logan’s Research Division

Research in Practice

The Fitts’ Law research study demonstrates that a single cervical manipulation resulted in dramatic improvement in sensory motor coordination, speed and accuracy in participants with and without neck pain.

Dr. Ward, who practices at Taschler Spine and Rehab in Fairfax, Va., said knowing that he’s providing evidence-based care, as supported by the latest literature, has increased his confidence with

Ellis said the most valuable learning experience he gained was understanding the process of creating a research project and seeing it through from start to finish. “I’ve

never had anything published, and I’m now at an institution where that is really encouraged,” he said. “I enjoy being able to crunch the numbers to see if we’re getting the results we need. That’s fun for me, and the results were amazing— better than we expected.”

For Emlet, learning the importance of conducting meaningful research that builds on previous studies and supports future investigations has been most beneficial.

“The information that has been derived from this study can be used in future research on the effects of chiropractic adjustments,” he said. “It can also give us a better understanding of how chiropractic aids the body in maintaining homeostasis.”

Dr. Ward plans to apply his research skills in generating case studies from his own patient experiences, leveraging these studies as a basis for more extensive research, such as clinical trials. As chiropractors strive to return their patients to full function as rapidly as possible, Dr. Ward maintains that research is key to this mission and can guide the most effective clinical practices.

Emlet and Ellis are continuing Fitts’ Law research and the effect of chiropractic adjustments under Dr. Tepe’s mentorship.

Building on the most recent award-winning study, this Logan faculty and student research team is conducting a new investigation that will examine the effects of multiple adjustments in a repeated measures design.

At Logan’s 2012 Homecoming, the Logan College Alumni Association presented the Logan Senior Research Project Award to students John Ellis, Jonathan Emlet and (now Dr.) Kevin Ward. The three honorees shared a $2,000 award.

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Did You Know

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Excerpts The American Chiropractic Association ACA Pledges to Continue Patient Access Fight as Health Reform Law Upheld

When the U.S. Supreme Court ruled the Patient Protection and Affordable Care Act as constitutional, it preserved Section 2706.

The ACA advocated for the inclusion of this provision in the legislation, which establishes a “provider non-discrimination provision” applicable to all Employee Retirement Income Security Act (ERISA) health care plans, including self-insured, multi-state plans that are not subject to provider-friendly state laws.

“Regardless of how you feel about this legislation in general, Section 2706 has to be recognized as an historic first for the chiropractic profession. We now have a federal law applicable to ERISA plans that makes it illegal for insurance companies to discriminate against doctors of chiropractic and other providers based on the provider’s license or scope of practice,” said ACA President Keith Overland, DC. “While the fight to fully level the playing field for doctors of chiropractic in our health care system goes on, the non-discrimination provision, when it is fully implemented, will extend the availability of chiropractic services to several million employees at large, national firms that operate in multiple states.

In an effort to keep you informed about recent news and industry changes that may affect the profession and your practice, we’ve collected the following news briefs from various trade publications and news articles. We hope you find this synopsis beneficial.

The majority of the law’s key provisions, including the provider non-discrimination provision and the individual mandate, are scheduled to take effect no later than 2014.

The Court’s ruling also confirms all 50 states must establish “state insurance exchanges” where eligible consumers can shop some insurance plans’ prices and benefits, as specified by federal government guidelines. According to the ACA’s news release, “safeguarding significant ‘state flexibility’ is seen as one way to ensure that consumers have access to the services provided by doctors of chiropractic and that state laws favoring consumer choice of provider remain applicable, for the most part, in the state exchange environment.”

Chiropractic Economics Research Supports Chiropractic’s Effectiveness

Including evidence-based health care approaches, like chiropractic, in valuebased health plans may advance cost and clinical effectiveness, according to findings from recent research titled “A HospitalBased Standardized Spine Care Pathway: Report of a Multidisciplinary, EvidenceBased Process.”

In the study, the 402 low-back pain patients treated exclusively by doctors of chiropractic at Jordan Hospital in Plymouth, Mass., achieved successful clinical outcomes in an average of 5.2 visits at the low cost of $302 per case, while maintaining satisfaction rates above 95 percent. In addition, self-reported pain and disability scores were reduced by about 70 percent over the course of just a few weeks.

“As employers expand their approach to implementing value-based plans, these additional findings increasingly demonstrate the potential value that inclusion of chiropractic services may provide,” said Bruce Sherman, MD, FCCP, FACOEM, former medical director, Whirlpool Corporation and contributing author of Outcomes-Based Contracting™: The Value-Based Approach for Optimal Health with Chiropractic Services.

HealthCare Medicine Institute

A collaborative investigation between researchers from the University of Maryland School of Medicine and the Shanghai University of Traditional Chinese Medicine concluded: “Recent clinical trial and systematic review results clearly show acupuncture to be more beneficial than conventional standard care for many pain conditions….” As published in Medical Acupuncture, the review notes that “basic science research has identified several mechanisms by which acupuncture exerts its effectiveness in the treatment of pathological conditions.”

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Doctor Doctor TO

Logan College of Chiropractic/ University Programs and the Logan Alumni Association have partnered to sponsor Doctor to Dr. Ralph Barrale Doctor, a practice tips section featuring effective practice management methods from successful DCs. Doctor to Doctor is spearheaded by Dr. Ralph Barrale, vice president of chiropractic affairs and dean of postgraduate education.

If you would like to submit a practice tip to Doctor to Doctor, please contact Dr. Barrale at 800-782-3344, or e-mail your tip to tower@logan.edu.

This installment of Doctor to Doctor features information from Dr. David Heitmann, a December 2007 Logan DC graduate and an April 2008 graduate of Logan’s Master of Science in Sports Science and Rehabilitation.

Dr. Heitmann owns Integrated Sport and Spine Clinic of Madison, Wis. Dr. Heitmann shared this article with Logan College of Chiropractic/University Programs for publication in Logan Speaks. Logan claims no copyright interest in Dr. Heitmann’s work.

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How to Grow Your Practice …

On a Low Budget David Heitmann, DC, MS Integrated Sport and Spine Clinic of Madison, Wis. Dr. David Heitmann (at left) with a patient.

I started small … really small.

When I graduated from Logan, I purchased a building with duplex space. I rented the duplex space I didn’t need and allocated the upstairs real estate to my practice and home, dedicating 700 square feet to my practice and 150 square feet to living space. This is not a typo, I said 150 square feet for living.

At the time, the space well suited my life.

When I first opened my practice, there were no official ends to the work day. If I didn’t have a patient, I would leave. With little money to spend on a marketing campaign, I relied on myself to connect with people oneon-one. Going to networking- or businessrelated events and meeting with business owners became my job when I wasn’t treating patients.

I later refined my “pounding the pavement” approach and developed what I call a keyperson marketing strategy. My goal: Connect with every business owner in town. I knew if I could personally meet with our town’s business leadership and educate them on the value of referring their employees and friends to my practice, I would increase my new patient reach exponentially while managing my investment of time and dollars.

SCIENCE AND NATURE ALIGNED IN BALANCE

For complementary businesses such as massage therapy providers and shoe stores, I would visit their businesses, spend time building personal relationships with the owners and representatives, and share information about how my services could help to grow their businesses. I never made the conversation about me.

To Communicate, You Must Differentiate In my town, there are more than 100 chiropractors. For me to spend any time or money on advertising and other communication tactics, I had to differentiate myself as a doctor, or I’d find myself lost in the crowd.

Lucky for me, I had a competitive advantage—my Master of Science Degree in Sports Science and Rehabilitation from Logan. When I communicated with prospective patients and referral sources, I leveraged my expertise and practice focus on sports medicine.

I also submitted to the recommendations of author Chuck Mefford in his book “Brandformation,” which advises readers to audit how your competitors are advertising and positioning themselves and do something

A Publication of Logan College of Chiropractic/University Programs for Alumni, Students, Employees and Friends of the College

completely different. For example, many of the doctors in my town advertise the techniques they use. I take a different approach, even if I employ the same technique, because I question how this information persuades a patient to seek my care.

Yet, in my four years now practicing chiropractic and sports medicine, I’ve found the cheapest form of advertising is simply talking with people. I also use my new 6,000-squarefoot clinic, which is a bit larger than my first office space—by 5,300 square feet exactly—to communicate my sports science and rehab focus. In my waiting room, you’ll see jerseys, helmets and other sports paraphernalia on my walls. If I’m involved in a charitable endeavor, the event’s marketing materials are also prominently displayed.

Long-term Gains I don’t subscribe to short-term marketing initiatives designed to get one person in the door. My focus is always on the long-term strategy, which relies on personal relationships.

My Master of Science Degree in Sports Science and Rehabilitation from Logan allows me to treat athletes on the field. What better way to reach athletes, their coaches and trainers than by stepping out of my office and getting on the field, which is exactly what I did.

Game Plan: Market Saturation My master’s degree allows me to treat athletes on the field. What better way to reach athletes, their coaches and trainers than by stepping out of my office and getting on the field, which is exactly what I did.

It took four years, but my willingness to show up for practice and provide support for our community’s athletes has now led to my role as the official medical provider for eight local teams. For these teams, my staff and I design their warm-up and cool-down routines, provide on-site support at competitions to triage injuries, and manage concussion screenings and post-concussion care.

As the teams’ medical director, the community is reminded of my expertise and practice focus, and I also enjoy crosspromotional opportunities with the athletic organizations.

Instead of spending a day at an off-site marketing event, I take the time to get to know my patients while they’re in my office. Our conversations go beyond their health needs and goals to what’s going on in their personal lives. When patients enjoy a positive experience, they will refer their family and friends, which doesn’t cost me any advertising dollars.

In fact, because of my patient relationships, I began earning referrals from medical doctors (MDs). As my patients returned to their MDs excited about the progress we made, these doctors called a meeting with me to learn more about my practice and its offerings. Now, I co-treat patients with many of our town’s local MDs. We open lines of communication by reporting findings and treatment plans, so our patients can benefit from coordinated care.

My support for patients regardless of their insurance status has also led to another opportunity—contracting with federally assisted, qualified hospitals and managing rehabilitation for a community clinic and its 22,000 patients.

While I’ve enjoyed great success with these marketing strategies, I admit this approach is no silver bullet. It demands hard work, determination and a great investment of time to execute. Looking back, I’ve spent very little in terms of money to establish such a valuable reputation in my community, allowing me to build a practice I no longer have to call home.

LOGAN SPEAKS Fall 2012 Logan Speaks is published three times a year: Winter, Summer and Fall.

Logan Board of Trustees Steven C. Roberts, JD, LLM Chair of the Board Debra L. Hoffman, DC Vice Chair of the Board Logan Board Members Rachel Storch Akrongold, JD Cynthia L. Baudendistel Anthony C. Bilott, DC Richard M. Bruns, DC Christophe Dean, DC Paul Henry, DC Carmen Jacoby Hutchcraft, DC Charles G. Kim, MBA Rick A. McMichael, DC Mark O. Reeve, DC Robert J. Stearley Rodney Williams, DC Logan Administration George A. Goodman, DC, FICC President Laura McLaughlin, MA, JD General Counsel Boyd Bradshaw, EdD Vice President of Enrollment Management Carl W. Saubert, IV, PhD Vice President of Academic Affairs Sharon Kehrer, MBA Vice President, Administrative Affairs Patricia Marcella, MBA Chief Financial Officer Ralph Barrale, DC Vice President of Chiropractic Affairs Patricia C. Jones Vice President, Institutional Advancement Elizabeth A. Goodman, DC, PhD Dean of University Programs James Paine, MEd Dean of Student Services Logan Speaks is produced by the offices of Institutional Advancement and Public Relations. Reader comments can be sent to the editor via e-mail at tower@logan.edu.

Thomas F. Keller Associate Vice President Office of Public Relations Logan Speaks Editor LOGAN SPEAKS Logan College of Chiropractic/ University Programs 1851 Schoettler Road, PO Box 1065 Chesterfield, MO 63006-1065 tower@logan.edu www.logan.edu 1-800-782-3344, Ext. 2401

FPO LOGAN SPEAKS FALL 2012

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Marketing Motivation Motivation Marketing

The Science of Social Media Using web-based technology as a marketing tool for your practice

by Jennifer Reynolds-Reed, Director of Health Centers Marketing

What’s a “tweet”?

What’s a “tweet”?

Do I need to be on LinkedIn? Do I need to be How do I start a blog?

on LinkedIn? How I startmethods a blog?

While traditionaldo marketing

are still important, social media tactics Whileyou traditional marketing methods allow to provide information on are still important, social media tactics various platforms as a way to engage allowcustomers, you to provide information with fans and, in manyon variouspatients. platforms as a way to engage cases, with customers, fans and, in many cases, patients.

Not every social media platform may make sense for you or your practice.

Not everythere socialare media However, sitesplatform that canmay help you make sense for you or your practice. connect with potential patients as well as However,communication there are sites that help you maintain withcan current connect with potential patientsand as well as patients.

When used correctly maintain communication withbecurrent consistently, social media can a patients.

When used correctly and valuable marketing tool for your business. consistently, social media can be a valuable marketing for your business.

In this issue of Logantool Speaks, we explore the objectives of several key (and free) In thismedia issue of Logan Speaks, we explore social platforms. the objectives of several key (and free) social media platforms.

Facebook: a social networking website that allows you to create Facebook: a social networking a page and post information website that allows you to create Opportunity: Whether you have a a page and post information

personal Facebook account or not, Opportunity: Whether you Facebook have a page consider creating a separate personal FacebookWhen account not, for your business. youorencourage consider creating a separate Facebook page your patients and community supporters to for your business.

When you encourage “like” your page, the information that you youron patients and community supporters to post your Facebook page will “like” your page, the in information automatically appear your fans’ that you post on your Facebook newsfeed.

Facebook is apage greatwill way to automatically appear in your interact with your patients onfans’ a more newsfeed.level Facebook is a great way to personal and demonstrate customer interactbeyond with your on a office. more Use service the patients walls of your personal level and customer your Facebook pagedemonstrate to link to positive service beyond the walls of your office.post Use news about the chiropractic industry; your Facebook page to link to positive information about your practice or photos news about the chiropractic industry; (perhaps by introducing a new hire or post informationanabout your or photos promoting event); or practice share a daily (perhaps by introducing a new hire or health or “Did You Know” tip. promoting an event); or share a daily health or “Did You Know” tip.

88

SCIENCE SCIENCE AND AND NATURE NATURE ALIGNED ALIGNED IN IN BALANCE BALANCE

Twitter: a social media site that Twitter: a social media site that allows you to read, write or share allows you to read, write or share information in 140 characters or less, information in 140 characters or less, otherwise known as a “tweet” otherwise known as a “tweet” Opportunity: Take advantage Opportunity: Take platform advantage of this social media for timeof this social media platform for timesensitive announcements, updates or sensitive announcements, or reminders for your patientsupdates and members reminders for your patients and members of the community. Like Facebook, Twitter of theyou community.

Facebook, your Twitter gives a platformLike for conveying gives you a platform for conveying brand and driving awareness of youryour brand and practice.

It’sdriving also a awareness great way of your practice.

It’s also a great wayyour to gather to gather information about information about your followers, theiron followers, their interests and the word interests and the word on the street. the street. Here are some examples of tweets that can help market your practice: Here are complimentary some examplesadjustments of tweets “Providing that can help market your practice: today at the Maplewood Community Center” or “Our office is open until 9 “Providing complimentary tonight.”

Additionally, use of adjustments today atTwitter’s the hashtags on subjects (for example, Maplewood Community Center.” #carpaltunnelsyndrome) support specific condition communications.

“Our office is open until 9 tonight.”

LinkedIn: a business-oriented

Additionally, Twitter’s usesite of that allows social networking hashtags on subjects (for example, you to post a professional profile of #carpaltunnelsyndrome) yourself or your business support condition-specific communications.

Opportunity: LinkedIn promotes networking with patients and professionals LinkedIn: a business-oriented in your community or industry. By creating networking siteresume) that allows a profilesocial (similar to an online for you to post a professional profile of yourself or your practice, you can network yourself or your business with people in your industry; promote news or updates about your practice; create Opportunity: LinkedIn promotes dialogue among a group; or recruit networking with patients and professionals employees.

Ask yourormost trusted in your community industry.

Bypatients creating to write a solid recommendation for you a profile (similar to an online resume) foror your practice on practice, your LinkedIn profile. yourself or your you can network Testimonials are a great third-party with people in your industry; promote news validation your your work.practice; create or updatesofabout dialogue among a group; or recruit employees. Ask your most trusted patients to write a recommendation for you or your practice on your LinkedIn profile.

Testimonials are a great third-party validation of your work.

YouTube: YouTube:a avideo-hosting video-hostingsite sitethat

allows registered users to upload that allows registered users to and share upload andvideos share videos

Opportunity: Opportunity: IfIf you you don’t don’t have have the the budget budget to to hire hire aa professional professional production production company, company, one one alternative alternative solution solution isis YouTube, YouTube, which which allows allows you you to to create create and and upload upload videos videos to to its its site site as as well well as as various various social social networks networks and and websites. websites. While While YouTube YouTube can can be be aa catch-all catch-all for for anyone anyone and and anything, anything, itit does does have have advantages advantages for for businesses. Consider Consider making making aa compelling compelling businesses. video that that showcases showcases your your practice practice and and video staff, demonstrates demonstrates aa chiropractic chiropractic staff, technique, or or highlights highlights aa patient patient success success technique, story. A A video video can can also also offer offer aa more more visual visual story. description of of your your brand brand and and values. values. description

Blog: Blog: an an online online journal journal where where entries entries appear appear in in aa reverse reverse chronological chronological order order Opportunity: Opportunity: Blogging Blogging provides provides an an opportunity opportunity to to communicate communicate with with your your patients patients about about common common points points of of interest. interest.

You You don’t don’t necessarily necessarily need need to to be be the the world’s world’s best best writer writer to to maintain maintain aa blog. blog. As As aa chiropractor, chiropractor, keep keep your your audience audience interested interested in in topics topics that that relate relate to to their their health health and and body body or or offer offer thought-provoking thought-provoking comments comments on on timely timely news news articles. articles. Make Make sure sure you you keep keep your your readers readers engaged engaged by by asking asking questions questions or or encouraging encouraging their their feedback. feedback.

Their Their comments comments may may inspire inspire aa new new blog blog topic topic or or conversation conversation you you may may not not have considered. considered. have When communicating communicating with with your your clients clients When via Facebook, Facebook, Twitter Twitter or or even even aa blog, blog, be be via mindful of of your your patients’ patients’ privacy, privacy, especially especially mindful when they they start start aa conversation conversation about about aa when personal health health concern. concern. You You might might want want personal to suggest suggest discussing discussing over the matter over the to the phone phone or in person. or in person.

Finally, once once you you commit commit to to using using aa social social Finally, media site site or or application, application, make make sure sure you you media keep itit updated updated with with fresh fresh content content without without keep overposting. Outdated Outdated information information and and overposting. overposting might might deter deter patients patients and and overposting readers from from coming coming back. back. Social Social media media readers experts recommend recommend aa maximum maximum of of four four experts tweets per per day day and and no no more more than than three three to to tweets four posts posts per per week week on on Facebook.

Facebook. four

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LOGAN SPEAKS A PUBLICATION OF LOGAN COLLEGE OF CHIROPRACTIC UNIVERSITY PROGRAMS 1851 Schoettler Road, PO Box 1065 Chesterfield, MO 63006-1065

RETURN SERVICE REQUESTED

Postgraduate Seminars All programs on campus unless otherwise stated

August 25-26

Chiropractic Assistant Certification Program Session #12 Review and Final Exam Instructor: Courtney ZindrickLehmen, DC

August – December 2012

September 15-16

October 27-28

December 1-2

Biomechanics, Biomechanical Distortions and Corrections

Basic Acupuncture #2 Instructor: Zev Myerowitz, DC, Dipl.Ac.(NCCAOM), Lac.

Biomechanics, Biomechanical Distortions & Corrections

Instructor: Howard F. Loomis, Jr., DC, FIACA Location: Paducah, KY

Insurance Consultant/Peer Review #1

Instructor: Howard F. Loomis, Jr., DC, FIACA

Instructor: Mario Fucinari, DC, CCSP®, MCS-P

Basic Acupuncture #3

September 22-23

Whole Food Nutrition #1

November 10-11

Instructor: Joseph Olejak, DC

September 8-9

Unique Options for Enhancing Your Practice

Logan Basic Technique #4

October 6-7

Multiple Instructors

Instructor: Patrick Montgomery, DC

Basic Acupuncture #1

Structural Management

Instructor: Zev Myerowitz, DC, Dip.Ac.(NCCAOM), Lac.

Instructor: Tim Maggs, DC

October 20-21

Whole Food Nutrition #2 Instructor: Joseph Olejak, DC

SCIENCE AND NATURE ALIGNED IN BALANCE

November 17-18

Instructor: Zev Myerowitz, DC, Dipl.Ac (NCCAOM), Lac.

December 8-9

Insurance Consultant/Peer Review #3 Instructor: Mario Fucinari, DC, MCS-P

Whole Food Nutrition #3 Instructor: Joseph Olejak, DC

December 15-16

Insurance Consultant/Peer Review #2

Whole Food Nutrition #4

Instructor: Mario Fucinari, DC, CCSP®, MCS-P

Instructor: Joseph Olejak, DC