How Aging Degenerates Tendons and Pragmatic Prevention Strategies

by Frank Bodnar, DC, MS
Ortho Molecular Products, Inc

In a perfect world we would stay forever young and be able to rebound quickly from biomechanical stress. Have you ever wondered why we begin to slow down? Is it all in our head? Is age ‘just a number’ as they say? After all we’re not completely fragile or helpless. We’ve seen our bodies respond with resilience before. Why now does it seem to take just a little bit longer to recover from the round of golf or weekend 5k run? While we joke about turning 40 and waking up stiff and achy, the truth is aging is a legitimate culprit. Aging is a multi-factorial process that unfortunately makes the glue that holds everything together weaker the older we get. 

The process of aging is a universal gradual decline that isn’t naturally pathological but is felt and seen in human performance and injury rates (1). Aging is a highly individual process due to genetic, lifestyle, injury history, past diseases and current co-morbidities. All of these factors can directly affect the individual aging process (2). One of the most common connective tissue injuries to walk into a chiropractor’s office are tendinopathies. The underlying pathology is largely due to the degeneration of the collagen fibers in the tendons of athletes, recreational athletes and those with repetitive tasks at work (3). We know age plays a key role in overuse injuries because studies have shown that older individuals have a greater frequency of tendon injuries than younger individuals, highly suggestive of a more degenerative role rather than an acute tissue injury mechanism (4,5). 

The aging of a tendon is a multi-factorial process that can include a variety of cellular and tissue mechanisms. The process of aging includes less vascular supply and degenerative changes of not only the collagen fibers but the non-collagenous matrix components of the tendons as well. These changes result in less collagen fibers that are less compliant, less resilient, less organized, less able to withstand cellular stress, a decreased ability to regenerate and have a much higher risk of failing under physical stress (6-10). 

Cellular Changes

In general, we associate aging with gray hair and wrinkles, but below the surface the cells responsible for producing collagen fibers, material for the extracellular matrix and literally make up the fabric of our tendons are undergoing a multitude of changes. On a cellular level tendon cells responsible for growth and repair, tenoblasts, transform into tenocytes which have less healing and regenerative capabilities (10). This transformation is a hallmark sign of tendon aging and results in the decreased density of tendon cells as well as less basement membrane, which protects and attaches tendons to surrounding tissues (11,12).  

Metabolic Changes

With increasing age there is also less metabolic overall metabolic activity of both tenoblasts and tenocytes, which results in a reduced ability of a tendon to repair itself. Tendon blood flow and the number of capillaries decrease with age as well (10). Blood vessels begin to become less elastic, more rigid and provide less arterial blood flow which causes less nutrients and oxygen to be delivered to cells, limiting their ability to repair and thrive (13,14). Inside the tenocytes the rough endoplasmic reticulum begins to decline in its capacity for protein synthesis, and a decrease in the number of mitochondria results in less overall ability to create energy from lipids and carbohydrates. The Krebs cycle, responsible for ATP production, also begins to shift its overall metabolic pathways from less aerobic to more anaerobic, which is highly inefficient, and energy production begins to slow and eventually shut down (10,11,15,16). 

Tissue Changes

Collagen turnover and collagen synthesis both decline with age and tendon cells lose their ability to divide and grow as quickly. As early as our mid-twenties we begin to see a decline in the amount of collagen production, and past forty may see production decline as much as 25%. But even more concerning to the health of a tendon is the decrease in the production of the surrounding extracellular matrix materials. The decline of proteoglycans and glycoproteins, which pull water into connective tissues, declines by about 70% which contributes to age-dependent stiffness and a loss in collagen fiber gliding capacity (1,11). Biological aging results in a decreased thickness, dehydration and ultimately less rebound capability of a tendon under stress and load. 

Although we don’t always feel these changes as they occur, we can definitely start to see them. If we were to take a tissue sample and examine it under a microscope, we would see that the aging tendon’s collagen fibers appear less organized, less bundled, and more fragmented. A tendon of an elderly individual appears more like a glob of frayed yarn compared to tendon of a teenager, which appears more like a well-organized cable that is capable of bearing high stress and maintaining tension under stress. 

Another tap of the zoom button on our microscope would also reveal that in those 40 and older we would see more tissue samples with an accumulation of lipids, glycosaminoglycans, and calcium deposits. Lipid deposition disrupts the fiber bundles and reduces tendon strength. Areas of reduced blood flow and maximal lipid deposition correlate with classic sites of tendon rupture (21). Sometimes fibrin and evidence of thrombus formation are apparent in surrounding blood vessels as well (10). The most common sites of these changes are in the Achilles, biceps brachii, anterior tibial, quadriceps and patellar tendons (22,23). 

Biomechanical Changes

The most severe biomechanical change of is decreased tensile strength, or the ability of something to resist being pulled apart (17). This decrease starts with the core protein of tendons, which is collagen. The mechanical property of collagen begins to decline due to an increase in collagen molecule crosslinking which makes the collagen fibrils very stiff and rigid (18). Unfortunately, there is no way to avoid or reverse this process and because of this collagen crosslinking is actually considered the best biomarker of aging. These mechanical adaptations result in a decreased ability to tolerate strain, load, elasticity, and maintain tensile strength (8,19,20). Less stress relaxation, mechanical recovery and creep (20), along with less elastin and proteoglycan matrix (10) make the older tendons weaker and more likely to tear or suffer from overuse injury when stressed and strained (1). 

Co-morbidities and Contributing External Factors

Apart from all of the cellular, metabolic, tissue quality and vascular changes of aging there are a multitude of external factors at play that can influence the rate of tendon degeneration that clinicians should be aware of. 

  • Research has shown that diabetes causes premature aging and degeneration. Collagen from 40-year-old diabetic has been found to be comparable to that of those close to 100 years of age (33). 

  • Nutritional deficiencies are also be associated with tendon degeneration. Protein is needed for the necessary amino acids of collagen and other proteins, and carbohydrates for the maintenance of the ground substance. Emerging evidence shows that specific collagen peptides may help with tendon repair as well (24,25), counteracting catabolic effects of tissue damage (25), enhance connective tissue remodeling (26,28) and enhancing clinical outcomes (27-31) especially when paired with specific exercise rehabilitation. 

  • Medications such as corticosteroids and fluoroquinolones are catabolic, especially at high levels and with chronic use because they inhibit the production of new collagen (9,38). 

  • Exercise and physical activity, or the lack of activity also stimulates specific responses in tendons. Exercise appears to have a beneficial effect on aging tendons (10,34), but of course individual caution should be used in terms of exercise type in those prone to tendon injury, or with past injury. Long-term exercise increases the mass, collagen content, cross-sectional area, tensile strength, weight-to-length ratio, and load-to-failure of tendon tissue (10,32,35–37). Exercise could reduce the rate of degeneration but may not completely prevent injury or degeneration. With one of the mechanisms of an aging tendon being poor blood supply a sedentary lifestyle will decrease circulation and result in less nutrients, oxygen and overall cellular health (21). 

In clinical practice, providing patients with sound nutritional and exercise advice are key preventative measures that can be taken to prevent age-related tendon degeneration and related symptoms. 

  • Daily stretching, mobility exercises, and compound multi-joint movements will help maintain range of motion and tissue compliance. 

  • Long warm-ups and cooling-down periods should also be part of the routine. The older an individual, the more gradual increase in intensity, shorter duration and less frequent bouts of exercise are recommended. 

  • Movements with strong impact, quick acceleration or quick deceleration movements, like sprinting and jumping should be avoided. Better alternatives would be swimming, rowing, cycling, walking and full body resistance exercises such as squats, deadlifts and presses would also be acceptable. 

  • Finally, as mentioned earlier nutrition also plays a key role in the aging process, and degeneration of tendons. The dietary reference intake (DRI) for an individual should be at least 0.8 g or protein per kilogram of body weight, which amounts to about 56 grams per day of protein for normal tissue repair and maintenance. Following a Mediterranean diet will provide sufficient macro and micronutrients that are not only essential to connective tissue synthesis, but anti-inflammatory (39,40) and demonstrate the ability to limit chronic inflammatory mechanisms (40). In order to maximize tendon strength and tissue healing additional vitamin C and magnesium, along with collagen peptides and mucopolysaccharides should be supplemented during acute injury, tissue regeneration and tissue remodeling as a patient undergoes physical rehab.


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So You Say You Want a Revolution?

“So You Say You Want a Revolution?”

“…well, you know…

…we all want to change the world.”

Jay Korsen wants a revolution in the chiropractic profession.  And we’ll discuss why he thinks one is necessary. He’s not the only one. It’s actually familiar language from a fringe of providers. So this blog isn’t about Jay Korsen, he’s just a symbol of the sentiment shared by a few. In this article I am going to refer to Jay by name. Keep in mind he’s just an archetype. He plays a character in a grand play. He even say’s all of his lines like he’s supposed to, with no ad libs.  Right out of the straight chiropractor playbook.

Jay Korsen has a self published book, the pinnacle of expertise and authority.  He’s proud of his 2,500 followers on his “Chiropractor Cash Only Practice Facebook Page”. That facebook page is open for the whole world to read, making him a public figure that can be mentioned by name. I’m about to make Jay Korsen internet famous. I’m sure he’ll appreciate more followers on his page to pander to.  Maybe sell a few books. You’re welcome in advance, Jay.

Be careful what you ask for.  You might just get it.

And to make this blog entry a little more spicy, let’s play a game: Jay Korsen has something that could be considered potentially illegal on his website. First person to point it out gets a prize!

So what has mobilized him to take up arms in an epic battle of alternative healthcare supremacy? Here is a recent post from the revolutionary figure, Che’ Korsen.  He is commenting on video of a presenter at the WFC/ECU Convention (which happens every other year, not annually). The video can be seen HERE, and is obviously HEAVILY EDITED to convey some sort of context.


The researcher he is talking about is Jan Hartvigsen DC PhD. Jan was just coming off of an address to Members of the European Parliament in Brussels:

I tried to look up Jay Korsen’s address to Members of Parliament, or Members of Congress, or any equivalent. I couldn’t find any. But apparently he has spoken at Dynamic Essentials. I just don’t think that tent revival invented by Life University’s founder Sid Wiliams is on the same level. I’m not saying this to insult Jay Korsen. I’m establishing expertise here. Who’s the big dog, and who’s the little dog? The resume’s speak.

Jan Hartvigsen was one of the keynote speakers of the WFC/ECU 2019 Conference.  I was there. Jay Korsen wasn’t. Some people demand change of others from their computer screen.  Others show up in person and participate in change.

You can read a bio of Jan Hartvigsen HERE.

He was recently recognized as the leading researcher of musculoskeletal pain…  IN THE WORLD.

He was one of the authors on a team that published “The Lancet Low Back Series” in March of 2018.  

To not have read these papers, which are not only hugely impactful, but also a massive victory for chiropractic in general, should be absolutely criminal for anyone who would dare call themselves a chiropractor.  The full texts are available. The link is above. You aren’t worth the face paper you adjust on if you haven’t read them. That’s of course my personal opinion. But seriously. Read the series.

Like i’ve said, Jay Korsen is just a representation of a type of character in the profession. He has no clue who Jan Hartvigsen is, or of his work. That doesn’t matter. Jan is a “subluxation denier”. Lol. What a great way to dehumanize your opponents, whoever though that up (we know who, more on that later).

However it isn not just Jay getting after Jan Hartvigsen. I’m leaving the names readable on the following photos because the comments were made on an open to the public facebook thread. If you make comments such as these on an open thread, surely you don’t mind who knows you’ve said them. Even these are just small examples. There are too many examples to fit on one blog. And Jan is only one target of daily attacks on respectable professionals that “dare” to move the profession forward. Not criticisms mind you, those are everywhere. But attacks, on character, masculinity, you name it. Anything goes in the straight chiropractic revolution. Just as long as you support the team they will accept any behavior.


Now, never mind that the originator of this post, Deed Harrison, just happens to operate a company who’s whole financial business model depends on the idea that radiographic analysis is necessary for each and every patient. Never mind that same company’s non-profit arm donates tremendous amounts of money to Life University, one of the main actors in this play. Never mind these blatant conflicts of interest. Look the other way. Nah, this is totally about what’s best for the patient. Yes, “thank you Life University!” indeed.

So what is all of this kerfuffle about? It’s about The American Chiropractic Association’s adoption of the “Choosing Wisely” recommendations. And Life University’s rejection of them.  So what is Choosing Wisely? It is an initiative put forth by the American Board of Internal Medicine Foundation (ABIM) to:   

“Promote conversations between clinicians and patients by helping patients choose care that is:

  • Supported by evidence

  • Not duplicative of other tests or procedures already received

  • Free from harm

  • Truly necessary”

These are patient centered recommendations.  Based on the available high level evidence. While also respecting a clinicians personal experience. In other words, they adhere to Sackett’s 3 criteria for evidence based care. They are designed to help patients ask their doctors the right questions, and to help doctors guide those patients to proper care.  

Well, that sounds great!  So why do the revolutionaries feel the need to go bolshevik over Choosing Wisely?  Well for one, I’m fairly convinced that many chiropractors against the Choosing Wisely recommendations haven’t actually read them.  Second, their handlers and professional guru’s have told them to get angry about it, many of those same people and entities have money riding on the outcome. Of course it isn’t only about money. There is also an ideological battle at play here. But not many people are willing to fight a revolution for an ideology that isn’t helping them get a leg up in life, are they?

And for a bunch of “rebels” and “revolutionaries”, straight chiropractors sure are good at parroting the party line and staying in lock step with each other ideologically.  All the techniques and explanations for what a subluxation actually is are as varied as pebbles on a riverbed, but the language never changes. The behavior is quite predictable. They are essentially lemmings without a cliff. But Jay Korsen’s revolution might just provide the cliff they seem to be clamoring for.

So what does Choosing Wisely recommend to patients looking for care, and doctors who might recommend it?  5 things:

1. Do not obtain spinal imaging for patients with acute low-back pain during the six (6) weeks after onset in the absence of red flags.

2. Do not perform repeat imaging to monitor patients’ progress.

3. Avoid protracted use of passive or palliative physical therapeutic modalities for low-back pain disorders unless they support the goal(s) of an active treatment plan.

4. Do not provide long-term pain management without a psychosocial screening or assessment.

5. Do not prescribe lumbar supports or braces for the long-term treatment or prevention of low-back pain.

That’s it. Yes, Jan Hartvigsen and other researchers are the devil, Bobby Boucher!


Before we stray too far off the path, let’s get back to the HEAVILY EDITED video of Jan Hartvigsen that Jay Korsen would like to go Daniel Shay’s over.  (Shay’s rebellion? Keep up everyone.). Jan was discussing the rejection of Choosing Wisely by Life University in his talk, and in that HEAVILY EDITED video. When he said it was “rubbish”, he was saying that Life rejecting Choosing Wisely was rubbish.  The reasons were rubbish. He didn’t say subluxation was rubbish. That’s has been taken out of context.

So what did Life say that was rubbish according to Jan Hartvigsen?


(They’re not guidelines. They’re not guidelines. They’re not guidelines.)

Marietta, Georgia, February 11, 2019 – Life University (LIFE) is proud to have been one of the first chiropractic colleges to publicly denounce the ACA Choosing Wisely campaign. On September 19, 2017, LIFE’s President Dr. Rob Scott discussed the University’s opposition to the campaign in a publication of Today’s Chiropractic Leadership (TCL).

LIFE’s Doctor of Chiropractic program has long advocated for the continued necessity for radiographs for the purpose of identifying and correcting vertebral subluxation and for the efficacy and safety of delivering a chiropractic adjustment. From 2008-2010, LIFE contested a concern for over-utilization of x-rays by the CCE. In successfully advocating for the use of plain film radiographs, LIFE argued that in addition to the triggers for medical necessity, the presence of appropriate indicators for specific chiropractic techniques that rely on x-rays are applicable criteria for “chiropractic necessity” of radiographs if appropriately documented in a patient’s record.

As the ACA Choosing Wisely radiographic recommendations are only inclusive of triggers for medical necessity, LIFE strongly rejects these recommendations and any guideline, standard or criteria that limits the necessary and appropriate tools for a Doctor of Chiropractic to safely and efficaciously identify and correct vertebral subluxation.

Yes, that’s rubbish. And Jan Hartvigsen did something most are scared to do in today’s professional climate, he called it out.

Can a subluxation be reliably and predictably identified on xray? Let’s even make it easier: has anyone even agreed on a definition of subluxation yet? Or are we still doing that “you can define a subluxation any way you’d like” thing? It’s 2019. Wake me when a consensus happens. I read choose your own adventure books as a kid. I never thought I’d be living one as a healthcare professional in adulthood.

Do you need radiographs to safely and efficaciously deliver an adjustment?

A lot of these questions are answered HERE with this paper. This paper is also a must read. But I quoted a dagger of commentary from it below.

Once again we have Deed Harrison (reference 123) and his absolutely not biased, no conflict of interest whatsoever suggestion of “alternative X-ray guidelines” that recommend initial x-rays for every patient… while he also owns and sells a technique that, gasp, teaches initial x-rays for every patient. They call that the Hegelian Dialectic. You create the problem, and then you offer the solution. How people don’t call this man out on this conflict of interest absolutely baffles me.

”Alternate X-ray guidelines for the chiropractic profession have also been proposed [123]…

…These guidelines have not been considered in the summary provided in Table11 because:

1) they make the initial assumption that spinal X-rays are required for a chiropractor to provide optimal management of the patient;

2) all available high quality evidence and peer-reviewed imaging guidelines do not support the routine use of spinal imaging for spinal conditions;

3) to the best of our knowledge, the guidelines in question have not been published in a peer-reviewed journal; and

4) the guidelines do not adequately consider the well-established evidence for the potential risks of spinal X-rays, as presented in this and other review papers [84553].”

But never let the evidence get in the way of what you and your father built over the decades. When someone challenges your castle, a new set of “alternative research” and “guidelines” is the boiling oil at the castle walls you need! Wait, if they have the castle, who are the revolutionaries again? Just like Life’s defense that medically necessary isn’t the same as chiropractic-ally. Wordsmithing that any resident of the white house would love.

Honestly, I don’t blame Deed Harrison. He has built a life, an income, and a reputation on his stance. As far as human nature goes, you know there is a lot of ego and personal self worth built into this idea. It’s the only reason we know his name. He is deeply dug into his trench. He’s not coming out. No amount of evidence to the contrary will change that. That’s not what a scientist does. Or a person of the evidence who puts the patients interest before his/her own. But it is what Deed does. Enough that he doesn't mind joking about it either:


The irony here though is that Life doesn’t ACTUALLY believe this.  Or at least they don’t walk their talk. They don’t believe X-ray is chiropractically necessary for the location and correction of vertebral subluxation. Otherwise they wouldn’t put their name on a humanitarian mission that does not xray all of its patients prior to treatment.  Are these patients less worthy of the high standard of care that Life states is so necessary? Or is this conditional? As in, a conditional political statement to appease donors and supporters?


What about pregnant patients? They are being adjusted in droves. Yet pregnancy is a relative contraindication for radiography in chiropractic practice. The dosage of radiation is not necessarily harmful to the fetus. So if the radiographs are necessary for proper care, do organizations like Life University advocate x-raying pregnant patients? If they don’t, are the radiographs actually as necessary as they claim?

I believe as of writing there are 19 accredited chiropractic colleges in the USA.  Of those, the two Life colleges and Sherman college appear to be the only ones “denouncing” Choosing Wisely.  And to even call Sherman’s response a “denouncement” is liberal, as their response was a well crafted political statement that basically says “According to Christopher Kent, Christopher Kent says subluxation analysis via x-ray is necessary, for more see this paper written by Christopher Kent. Sincerely, Cristopher Kent.”  But perhaps we should reserve a different place and time for discussing Christopher Kent’s stranglehold on straight chiropractors and his genius misuse of the word “evidence based”.

So that’s almost 16% of chiropractic education. Give or take a percentage or two of course.  Ballpark figures but certainly no mandate. If x-ray analysis is so fundamentally necessary to the practice of chiropractic, why are only 16% of US campuses teaching it and/or advocating for it?  There are 46 institutions in the world. That puts chiropractic necessity of X-ray analysis at 6.5%. How necessary is it? What’s really going on here? I’m sure it’s a massive conspiracy. Name your boogeyman. Big pharma, medipractors, vaccines. Straights have plenty of boogeymen. They love a good boogeyman story. It is never their own inability to get their act together.

I think doing a history and physical examination are necessary.  You should too if you are a healthcare provider with a license. I guarantee that 100% of the institutions are teaching history and physical examination. I think the adjustment is necessary for the chiropractor to know. 100% of the institutions are teaching that.  At 6.5% to 16%, how necessary is xray analysis of vertebral subluxation looking?

Who is Life appeasing anyways with this “denouncement”?  Sponsors and donors? The party line? This is about money, not patient outcomes. If it was about outcomes, show me the studies.  Not the biased studies. Not the anecdotal stories. The evidence. All you have to do is look at the sponsors and donors to know what’s up. It’s a Subluxation Industrial Complex.

And what about the practitioners?  The sad truth is that xrays are quite often used as a sales tool in practice, not a diagnostic tool.  As part of technique? Sure. Is part of some techniques using the X-rays to sell the care? Yes. Is that wrong? It sure has some ethical quandaries, no doubt.

“ you say you’ve got a real solution?...”

“...We’d all love to see your plan…”

Oh Jay.  What would you do with your revolution?  What’s the plan? I’d imagine most chiros of this ilk want what their brethren had in the late 1800’s and early 1900’s; the power to just do whatever they wanted, however they wanted, say whatever they want to say, and answer to no one.  Sound’s idealistic.

You know, I’d like to float down the Columbia river, like Lewis & Clark, discovering the new mysteries of the west. But there are dams holding back the river now, and cities, and nearly all of the natives and wildlife are gone. Technology and information can help me get from St. Louis to the Pacific Ocean much more effectively than a life threatening overland trek in moccasins. Lewis & Clark already did that. In other words, it isn’t the 1800’s anymore.  And times have changed. We aren’t going back. And you’re not BJ Palmer. Keep up or get out of the way. We have new frontiers to conquer. Primarily a worldwide epidemic in musculoskeletal pain that is BEGGING for a professional class of experts to step in and solve. It is ours if we want it. If we can cut the crap and own it.

I believe the happiest world for many straight chiropractic is one where every DC has his or her own little island, and literally no outside contact.  No regulations. No bosses. No “the man” keeping them down. And no peers to have to answer to. Many of them practice like that right now as it is! Don’t tell me what to do, don’t tell me what to think. I will care for people however I want with what I believe, and that won’t change. That is not appropriate. How good is it for a patient to see a provider who has walled themselves off from the established evidence in their field? How bad is it for a patient to never know what they are going to get, from one island to another. That’s one of the reasons Choosing Wisely is an important step in a progressive process.

So what would come of Jay Korsen’s revolution?  Spinology sounds like an equitable outcome. In fact, examples of the revolutionary outcome already exist. In latin american communities there are plenty of “sobadores”, modern day unregulated bone setters.  Working out of back rooms of homes and sheds and making house calls. But if you think you are going to maintain access to payors and keep the good graces of the public and regulators, as well as not have to maintain the evidence based standards that are expected of providers, you’re going to have a bad time with this revolution. Some folks only get away with it now because in many places we still regulate ourselves. But we don’t do a good job of it often, so even that privilege is due to sunset eventually.

“Separate and Distinct” was an excellent legal defense when it was needed. But to think any sort of alternative regressive regulation that will allow you to do whatever you’d like as a doctor is going to come your way 100 years later is a pipe dream.

The interesting twist here is that to entertain this fantasy land of unfettered plenary right to do whatever you want with your “practice members”, you’d also have to show that your service is completely innocuous and absolutely safe. Oh like reiki for example. Or Feldenkrais. The argument that x-rays are absolutely necessary for the safety and efficacy of care isn’t going to help you with that. You can’t have your cake and eat it too. Either play the evidence game and play it right, or consider the esteemed career path of shamanism. There’s a market for it revolutionaries. You can have it.

Jay, and all of the “Jay’s” are just being played by their handlers. Where did Jay get his his HIGHLY EDITED version of Jan’s Hartvigsen’s talk? Who filmed it? Even then, who HEAVILY EDITED it out of context and then released it for mass consumption? And for what purpose? The Jay’s get to carve out a nice career caring for people, and that is noble. Not everyone is perfectly evidence based. Nor do they need to be. They just need to be open to improving their craft and changing as the information changes over time. I really don’t think the way the Jay’s treat people is the problem. I have an issue with their rhetoric and divisiveness.

The real problem is their handlers. The Subluxation Industrial Complex. Or as Cyrus Lerner wrote in his unpublished “Lerner Report” on the chiropractic profession, there is a secret in chiropractic; And a long time ago the leaders and influencers figured out this secret… You can make $5 caring for a patient, or you can make $500 telling someone else how to care for patients. The gurus. They’re the problem. And their money insulates them from retribution.

Mass dissemination of divisive chiropractic information. Enter the “News Staff” of an online rag called The Chronicle of Chiropractic.  They jumped in on the rhetoric too. The Chronicle of Chiropractic is just about the greatest collection of biased subluxation based rubbish ever collected in the history of the profession.  And to add further insult to injury, this chronicle is digital only, so it can’t even serve the purpose of most of the worthless rags the world over, as emergency relief when you’re stranded on the pot without tissue paper, and in need something for a wipe.

Robbed of even that utility, we are further insulted by this chronicle with its lack of journalistic integrity,  writing hack articles about colleagues under the anonymous name of “News Staff”. Not signing an author’s name to its articles gives you a pretty good idea of the level of integrity we’re dealing with here. I am most surely NOT saying they are ultimately responsible for disseminating this information. But they are certainly taking part in it for their own benefit.

The Chronicle of Chiropractic shares an address that can be connected to one Matthew McCoy.  He does not sign his name as the author of the “News Staff” pieces. There are many ways to connect this chronicle to Matthew McCoy however.  And with the public notoriety he has assumed by selling products on the same page, we can mention him by name.  It can be safely assumed that The Chiropractic Chronicles is the work of public figure Matthew McCoy, hiding behind the title of “News Staff”. And no, there is no actual news staff listed on the site.  Even names the authors of its fake news pieces. McCoy is the Alex Jones of chiropractic journalism.

Although I might check to see if there’s a middle school nearby the chronicles “sprawling headquarters”.  With the quality of the writing displayed, there might be a beginners composition class there that is, in fact, the “News Staff”.

The Chronicles regularly labels chiropractors who pose questions about subluxation based practice as “subluxation deniers”.  It calls groups that think critically about our profession “Anti subluxation hate groups”. The Chronicle weaponizes language to score points on the internet. It tries to relate critical thinking chiropractors to flat earthers, in the greatest display of psychological projection i’ve ever seen. Attempting to fervently hold on to philosophical and practice approaches of the early 1900’s isn’t backwards thinking at all, but allowing current evidence to help guide clinical decision making is TOTALLY flat earthy.  Makes sense.

I myself am proud to have been labeled a RABID subluxation denier.  That’s like a level up. I wish they had plaques for sale with the honor engraved on them.  I would give the “News Staff” my own hard earned money! With the amount of ads Matthew McCoy has put up on the chronicle page, I get the feeling they could use the cash.


There is also a “subluxation deniers” facebook page.  Of course completely anonymous, but these things aren’t hard to figure out.  I have some news I have to break to the straights who think subluxation denier is a pejorative; it’s actually a badge of honor.  The Chronicle itself has for a long time been the laughing stock of the profession.

It delights me when i think of the “News Staff” reviewing their web traffic, possibly gleaning joy from some good readership numbers, not realizing it is mostly evidence based DCs going to their page for a good laugh.  And how much money the sponsors must be throwing away in the process.

“ ask me for a contribution…”

“...we’re all doing what we can…”

Speaking of sponsors.  The “News Staff” makes a habit in their articles of naming the names of chiropractors.  Labeling them “subluxation deniers” and members of hate groups, as if they are unfolding some vast conspiracy in true expose fashion.  In reality, their hit pieces look more like Geraldo Rivera opening Al Capone’s vault… There was a three legged cat in there and some empty bottles.  Quite anticlimactic, but the anticipation was priceless! And I’m sure it sells a lot of McCoy press products. At least the “news staff” has refrained from their old gambit of writing a hit piece on a colleague, and then asking for donations at the end of the article.  If that isn’t divide then pander, I don’t know what is.

And that is the whole schtick we see from this “Subluxation Industrial Complex”.  Put it on a t-shirt…

Divide and Pander.

So if the “News Staff” is going to name names, lets name some names too, shall we?  Who sponsors the chronicle? On the right margin there are a few ads:

- “Wellness & the Chiropractic Lifestyle” book by Matthew McCoy - Selling books on the traffic that the “News Staff” (that surely isn’t McCoy himself) gets from writing hit pieces on other professionals.

- “On Purpose” - Christopher Kent.  Remember Kent wrote the denouncement of Choosing Wisely for Sherman college? The one where Kent quotes Kent research to come to Kent’s conclusions?

The irony is that McCoy used to go on screeds and rants about conspiracies within the profession. If anyone has conspired ever at all to do anything in this profession, it’s these two chiropractic celebrities.  The Subluxation Industrial Complex. These guys need subluxation in this profession in order to pay their bills. If we changed the word to “floofingtons” tomorrow, nothing else but the word, they might go out of business overnight. That’s how invested they are, in a word.

So you can see their desire to prop the idea up at all costs. Including trying to put a hit piece out on one of the most top notch researchers our profession has. Oh yeah, and these guys are “researchers” too. They sure do have plenty of opinions of how you should treat patients, but between the two of them it has probably been decades since they’ve been in a therapeutic relationship as a doctor.

- Chirofutures - Another McCoy Company.

- Mind Virus - Marc Swerdlick DC AKA “The Dark Lord”.  The dark lord has a dark shadow, and it’s rare that you won’t find McCoy in it.

- Vertebral Subluxation Research - Another McCoy enterprise.  

- Foundation for Vertebral Subluxation - Kent and McCoy.  Abbott and Costello. Sonny and Cher. Peanut butter and Jelly.  Jazzy Jeff and the Fresh Prince. So happy together.

- Chiropractic is - Steve Tullius DC.  One of the best DCs at pouring over low quality research, squinting at it real hard, and convincing himself it legitimizes his personal outlooks of the profession.  Chiropractic is…? It is what Tullius tells you he thinks it is. He puts on an autism megaconference that somehow counts as continuing education for chiropractors. With speakers like deregistered former MD Andrew Wakefield on the stage.  Oh PS, Straights TOTALLY hate MDs, unless they happen to support their beliefs. Then it’s all a big party.

That sure are a lot of McCoy enterprises that the Chiropractic Chronicles props up. Doncha think?

So, lets just put the baby to rest on the WFC video posted by the “News Staff” of the chronicle, and circulated around social media:  It is so HEAVILY EDITED that it is taken out of context completely. This is dishonest and deliberate.

Someone is using this video to foment discontent.  And if you bought into it, you’re a sucker. Someone needs you to be a sucker, to keep up this fight.  Who needs to do this? Who profits? Who’s playing you for the sake of the “sacred trust”?  Oh I wouldn’t want to say. You’ve all played Clue before. You can connect the dots. Professor Plum in the kitchen with a wrench.

There are people out there that keep up these divides intentionally.  And they profit off of it. They bank on you not understanding the nuance. Not understanding the evidence. Not actually reading. They bank off of your fears. Why wouldn’t you want a revolution against THAT instead of against well intentioned and well respected researchers?

Straight chiropractors, no one wants to fight you. You’re some pretty cool people, except the fundamentalist jerks like the one’s who compared evidence based chiros to pedophiles who are going to steal your children. (Ask me about that one off line). We WANT you to win. We really do. Who wouldn't want what you claim to be true? All that ails mankind , helped, managed and even prevented, with a calculated crack of their spine. One cause to everything, one cure. So awesome! But you have to deserve the win. No one is going to give it to you. And if you can’t prove your win, the least you could do is stop taking your ball and going home.

“...but if you want money for minds that hate…”
“...all I can tell you brother is you have to wait…”

When in fact, if all the different types of chiropractors in the world sat down in a room together and broke bread, and we discussed what we actually AGREE upon, we would find much common ground.  We’d find amazing people. We’d even find geniuses and a momentum that we could use to improve the world around us, AND our future as a profession. But some people won’t get THEIR money if we all agree. They won’t get their fame. They won’t be able to cement their name on this profession for time immemorial. My gripe isn’t with all of the lovely providers in this profession, regardless of stance. It isn’t about “straights” as a whole. We all know there are only a few bad apples in the bunch. The overwhelming majority of us could truly enjoy a profession together, doing amazing work, sans an absurdly loud group of fundamentalists enabled by social media. The people are good. The system is broken. The gurus suck.

“5% of you are cultists, 5% of you are freaks. And the rest of you, keep your mouths shut” - George P. McAndrews, Wilk Trial lead attorney.

Our practices, no matter how big they are and how many people we see in them, it’s still a small number on a macro scale. Just a drop in the bucket in a world of suffering. On a macro scale, there is a worldwide epidemic due to musculoskeletal related pain. 7.5 billion people on the planet, and an epidemic that needs help. Straight chiropractors pejoratively call that a “narrow scope”. While they are practicing on each of their fantasy islands to small audiences and small utilization rates (relatively speaking), peacocking around as if they are practicing some “wide scope”. An imaginary scope of practice is always wider than one based in reality.

Once again, the massaging of the language is absolutely impressive. But they’ve massaged the language into near irrelevance of the profession. Yes, there will always be a sub population of people who seek sectarian medicine. Is that what chiropractic “is”? Because that is what some people seem resigned to, on their little islands, begging to be left alone. While others want to play collaboratively, on a bigger stage, to put our talents on display contributing to solutions for much bigger world problems.

What this battle comes down to is two ideologies, do you put the “sacred trust” of the profession ahead of the “patient’s trust” of the community at large? It is very apparent to me that there are some bad actors in our profession who absolutely place the profession before the people it serves. They will fight to dismantle anything that gets in the way of that, of their personal ideologies, and the financial machine built up around it. As a health care provider, behaving in ways that are contrary to the evidence, when the evidence is strong, is not patient centered. It is doctor centered. It is practice centered. It is unacceptable.

I applaud Jan Hartvigsen for displaying the courage to say what needs to be said to offer leadership in this arena. Despite where the money goes and where the money flows. We are starved for leaders who will confront these difficult issues with truth and a modicum of bravery.

So be careful when you ask for revolution.  Because you just might get it. More specifically.  There might not be a revolution at all. The evidence informed side of the profession might just tell you they’re going out for a pack of smokes one day, and never come back.  (Credit Greg Kawchuk for that one - also said at WFC/ECU 2019)


Chiropractic, One Big Unhappy Family;  Better Together or Apart?

Notice one of the authors Jay?  Jan Hartvigsen. This revolution will not be televised. I was wondering though, aren’t revolutions typically situations where “the little guy” overthrows “the big guy”?  Yet all this time straight chiropractors say their way is THE way? The real chiropractic? The right way to do it? And they’re the underdog at the same time?  You’ve gotta make up your mind, are you the truth or the victim? This is an archetypical story that plays out over and over throughout history. I’ll get my popcorn.  You’re all playing your part in the production swimmingly. The truth is the victim! The grand conspiracy! Tin Foil hats for sale via The Chiropractic Chronicle website. All proceeds go to…?


Jay, and everyone else on social media who loves to say “get out of MY profession” to your evidence based colleagues, the time approaches where you may not have to say that anymore. I think we will both be happy. I think it will be alright.

The patient trust comes before the sacred trust. Always. All opinions are my own. All facts are not. No sponsors were pandered to in the production of this blog.

“...dont you know its gonna be…”




Student Chronicles - 12/2/18

Periodically I will respond to some of the numerous questions I get from students. Sometimes they ask more sensitive and harder hitting questions that will require me to blank out names and protect identities so that we can discuss issues that are important to students without repercussions. All responses are my own opinions. And I hold every right to change my opinions over time with further insight and education.

Speaking of education, this entry revolves around that same subject. Chiropractic college education. Question is long, so the response is long. All feedback is welcome.


Question from Student:

“I have been listening to the (FTCA) podcast a lot (and I love it, thanks so much for doing it!) and the main thing I hear over and over is that students aren't being taught to think critically or clinically. They are either taught a ton of scientific facts, heavy philosophy, or a ton of techniques but not being a master of anything. I hear over and over that there is a lack of systems in school to clinically assess someone and that you and others believe that the profession needs to start becoming more systematic.

I agree with everything above. I am a XXXXX chiropractic college student and we definitely get a lot of science here and we do really well on our first boards test but we seem to struggle with our later boards that are more clinical.

I have had 3 teachers that work here tell me in a one on one conversation that they think XXXXX is drifting away from what chiropractic should be and that we are getting caught up in becoming primary care docs, PT's, and scientists rather than proficient adjustors. That is pretty disheartening to hear from the staff of a school that you thought was going to prepare you the best for your future career.

I have been struggling to know what I should do as a student to become a good chiropractor when and before I graduate. I struggle with this especially because one of those three teachers that I mentioned before told me that if they had to redo their education somewhere now-a-days that they would do it at another school that wasn't XXXXX.

I don't see the point in leaving XXXXX to go to another school because I am just now finishing my 1st year and I might as well finish the basic sciences here at XXXXX before I go somewhere else... but should I go somewhere else once I pass my 1st part of boards?

I met a student from ZZZZZ chiropractic college that says they see a patient every week starting at trimester 1. Another friend of mine is at YYYYY chiropractic college and seems to be much more clinically aware than I am and we have an equal amount of schooling.

I want to do something before it is too late but I don't really know what to do. To make this questions more difficult another 1 of the three teachers told me that a doc who jumps to learning clinical stuff before they have a solid foundation in the basic sciences won't be as good as they could be but if you are just a pure scientist who dabbles in clinic practice then you won't really be a good clinician because a lot of the job is just figuring it out as you go. So where is the balance and how/where do I get it?

I am not against learning science but if the science is not going to help me be a better clinician then I really don't care to learn it. This trimester we did Head and neck anatomy, neurophysiology and neuroanatomy and I really liked a lot of neurophys and neuroanatomy but I didn't find a lot of clinical pearls in Head and Neck anatomy. For instance, we just finished a lecture about the layers and names of TEETH OF ALL THINGS and during that lecture I was replaying the many times from the podcast that I hear you and others say that students just learn a bunch of facts that aren't really helpful and then they get thrown out into the job market and struggle.

I know I am going to struggle when I graduate either way, but I want to prepare for it now.

I also want to know if I am wanting to run before I can walk. If I have that attitude and I just need to chill out because everything will be okay in the end then I would like to hear that too.”


Thank you for listening to the podcast.  I started it to begin conversations out loud that I felt were going on quietly in the profession.  So many of us tend to graduate and then go off and practice on islands. We do that for many reasons, and not all of them are good.  And some of them are downright detrimental to ourselves, our professions, and most importantly our patients.

Systems, or having solid systems in place in your practice, was a very strong theme in season one of the podcast.  Think of your practice system as a practice “philosophy”. In reality, that’s what chiropractic philosophy serves as; a system for how to deliver care to people.  There is really no chiropractic philosophy. There is a philosophy of chiropractic, and if you want to break it down, in truth there are thousands of different philosophies of chiropractic.  One for each and every disparate doctor on their own island doing their own thing.

We have to be very careful when criticizing our educational institutions.  I for one am not an educator. I don’t and never have taught at a chiropractic college.  Most of us haven’t. They are a completely different entity with completely different responsibilities to the world, compared to the boots on the ground patient care world most clinicians live in.  They have different masters to answer to. They also have alumni to answer to, but that might be a completely different story in itself. So I am not always comfortable discussing what a chiropractic school “should” do, or how they “should” change. All things can improve though, and there’s no doubt room at our educational institutions for improvement as well.

We do know that there are some really good chiropractic colleges out there, there are quite a few in the middle, and then a few more at the end of the spectrum that just do not produce a quality product on the average.  Not the product we would want as a whole representing the profession. Everyone seems to be afraid to say that. And then to add another layer to that, the great schools can also produce horrible clinicians, and the less than favorable colleges can also produce great clinicians.

So I say, it is not a correlation equals causation argument.  The school you go to isn;t nearly as integral of an issue on the outcome of your future success. I say it’s much more dependent upon the person matriculating in the program. The student.  They are responsible for their own success. Yes, a school can sort of nudge you one way or another, it does have some importance. But overall, if a student has the makeup to be a winner, all things being equal, they have a better chance of winning.  And the opposite for a student who is not, regardless of the college.

Here’s the thing about chiropractic colleges:  Their job isn’t to help you be successful in chiropractic practice.  You are paying them to matriculate you through a program that will prepare you to pass your boards and make you legally competent to practice within the profession of chiropractic.  Anything else is gravy. Hopefully they teach you how to operate in the profession. Introduce you to ideas. Stoke your passions. But they don’t make you successful It’s that simple. There’s no “Harvard of chiropractic” where everyone who graduates wins. Even Harvard has its “unsuccessful” graduates.

So when you see the colleges focusing on certain topics, it should be taken with reflection that those are the things that will be potentially tested on in a board environment.  They teach the things that will keep you legal and keep you from harming the public. They by no means need to formally introduce the concept of clinical MASTERY into your education.  And when you discuss systems, you are discussing steps towards mastery. That happens after school.

First of all, they cannot teach mastery.  Mastery is a journey that takes time. It takes a long time. Experienced DCs, throughout the span of time, get a good chuckle out of the fresh DC graduate’s The ones who think that now they have a diploma and a license, that they know all there is to know and are completely as equal clinically as an experienced DC.  Your college can only teach you competency, and then initiate you into the profession with a nice push out the door and hopes that you make the best of it you can.

So let’s talk about the adjustment.  You would think that the college would have the impetus to make adjusting proficiency the most important topic in the education, since chiropractors bank on it so much as a therapy.  But with the thought process laid out above in mind, the reality is that the colleges don’t need to do any such thing. They need you to pass the adjusting portion of the boards, AND not hurt anyone in the process.  Mastery of the technique itself is up to you. And it will take time, a long time, to reach it. Some faster than others of course. And that goes for any technique or approach.

One thing that students may not consider is that colleges have to present a program that prepares all students from all states, provinces, and jurisdictions, to be able to practice in their states.  So while some states may have pretty straightforward requirements for practice, preparing a student to practice in states like Oregon, for example, require extra focus on meeting those needs. Oregon has quite a wide scope of practice, compared to its neighbor Washington, which is relatively narrow.  The school has to prepare both students equally.

How many of us perform pelvic or rectal exams in our daily practice?  Seriously, it is practically no one (there are a few though). In chiropractic college, in oregon, they taught the requirement, because there was a requirement, that would meet the needs of all 50 states and canada.  Except one, California. Asterisk for those students planning to practice in the golden state. Even though I am nearly positive absolutely zero california chiropractors perform rectal or pelvic examinations, that states requirement was DOUBLE everyone elses.  So the school had to make those resources available to student to meet the requirement.

To you, and many students, what the college does can seem absurd.  It seems that it has nothing to do with you. And it would seem absurd if it didn’t directly benefit you.  Or directly benefit what you think are the most important things you need to know to succeed in practice.

So let’s break some of these down.  Students are taught “a ton of scientific facts, heavy philosophy, or ton of techniques without being a master of anything.”  Well, that’s right. The scientific facts are absolutely required. And if you are going to build a healthcare profession that gains respect, the clinicians are going to have to be built upon a foundation of science.

Heavy philosophy is a bone of contention.  I think historically that has been the vehicle to help the student apply what they were learning.  Should the colleges teach a philosophy? Well they have to because it’s on the boards for one. Second, students do need a system for interpreting the education and then to begin practicing to apply it.  “Chiropractic philosophy” has been the vehicle for that. The debate is for many of us, is that necessary anymore? I don’t think that debate will fit this article.

The irony of chiropractic colleges I find is that in order to allow more “philosophical” content on their campuses, they cling to an idea some of them term “academic freedom”.  They have to allow academic freedom on their campuses in order for students to explore different ideas as they form their professional journey towards mastery. The irony here is that when it comes to “chiropractic philosophy”, there is no academic freedom on that subject allowed.  It is rigid, dogmatic, and not to be questioned or obfuscated. So yeah, there’s a big logical crevice that needs to be navigated there. It’s one of the elephants in the room.

The same idea applies to teaching tons of techniques without a mastery of any of them.  It’s exploratory. Introductory. This is why I personally, PERSONALLY think that chiropractors on the whole should have nothing to say whatsoever when it comes to vaccinations.  Just a cursory introductory course in immunology does not make one expert enough on a subject to guide health care and public health decision making. Your few courses in physiological therapeutics will not make you an expert in rehab.  Your few courses in soft tissue work will not make you an expert manual therapist. Your few courses on history taking will not make you a master interviewer.

Your professors that say your school is “drifting away from what chiropractic should be”...  

…”should be”...  That is extremely subjective.  The truth is they feel it is drifting away from what THEY THINK chiropractic should be.  Chiropractic, like many professions, should be and is is liquid. It has to be open to change.  Unfortunately it is not as liquid as other professions, which can leave it stuck in the mud of the past, feel outdated, and have difficulty with change.  But it does change. If it didn’t, it wouldn’t be a profession, it would just be an application of a technique. And we’d be technicians. Not doctors. Your professors are giving personal opinions.  Take them as that.

“I have had 3 teachers that work here tell me in a one on one conversation that they think National is drifting away from what Chiropractic should be and that we are getting caught up in becoming primary care docs, PT's, and scientists rather than proficient adjustors…” - GOOD!!!  Good for your college. Chiropractic is a profession, not a procedure. The colleges should be educating the profession and all of its professionals. Not just clinicians. That means it has to cover a wide array of subjects. And yes, adjusting is still an important tool in the chiropractors tool bag, but it is not everything.  And let’s be very very honest here, you aren’t going to learn to be a good adjuster in school. Just not going to happen. Not even proficient. Consistent practice and experience does that. Could the school provide experiences? Practice opportunities? Sure. But not the years it would take. Because it’s just a hard truth, some things take time.

Yes, you need a scientific foundation before applying clinical approaches.  There is no way around that. Will you “use” every single aspect of your scientific education in your clinical life?  No, of course not. But without a foundation to stand on, based on science and reason, it is quite possible you will fall for anything.

There are very few “pure scientists” in our profession.  And that’s bad. But most of us should endeavor to be scientist-practitioners.  Clinicians well studied in science and research based subjects, possibly even participating in research projects when possible, but primarily clinicians.  For a professor to even intimate to a student that if you focus too much on the sciences you won't be a clinician, that should be a damned crime. It’s an opinion.  But if I was a college president I’d be hauling that professor into my office for a discussion. It’s just not true.

However it is true that if you don’t come out of school well balanced and well actuated, you are going to have some challenges.  But I know for a fact some professors say, in essence “don’t worry so much about that science stuff, just get through it.” Another elephant in the room.  And usually a hint you might be at a school coming to struggle. The irony is, you and these professors seem to think you are at a bad school, based on what the school is teaching.  I say from experience you might be at a bad school because of these professors. Let’s not make it because of you too.

“A lot of this job is figuring it out as you go.”  Yeah, that’s called practice. That’s called pursuing mastery.  And without a solid foundation you will be a lost ship without a rudder, ready to sign on to any guru’s program who can promise you easy success, just as long as you do exactly as they say and they do, and the credit card is on file.

“I am not against learning science, but if the science is not going to help me be a better clinician then I really don’t care to learn it.”  I take it back, you might be part of the problem as well. The science WILL help you be a better clinician. There’s no way around that. Is it going to make you a better day 1 out of school adjuster?  No. Is it going to fill your practice because it gives you an edge in marketing? No. But it will make you a better clinician far and above the fold.

I am getting the impression that there is an instant gratification element to how you are approaching your educational process.  These are the most important 4 years of your career. And I’m not trying to get down on you, but once you started to question the importance of head and neck anatomy…  Well im starting to get a little pissed. You aren’t supposed to get clinical pearls out of every aspect of your education. But how could you appreciate a clinical pearl, without a foundation to draw on it from?  You are waaaaaay too early on this journey to understand how your education builds on itself and doubles back and revisits items in year 3, that you learned in year one.

Do you think if a medical center asked you to come to their docs and do a lecture on vertebral artery dissections, that an anatomical understanding of head and neck anatomy won’t be important?  To digest what another professional says about the subject? To identify nonsense. You would have no clue as to what is or isn’t nonsense, without the understanding itself.

Yes, students learn a lot of facts.  Teeth is somewhat absurd. But someone is going to get a teeth question on the boards somewhere.  Also, someone somewhere who was paying attention on that day is going to invent a device that helps with neck and TMJ pain derived from tooth related dysfunction.  Some of my peers have created new approaches and ideas, from the same program as me, and I didn’t even see it. It’s like I wasn’t there on that day when they talked about XXXXX.  Now Dr. XXXXX has a million dollar XXXXX business. It’s not all for you and your clinical pearls.

Where the colleges fall short, and my main point in regards to the podcast, is the colleges do a poor job telling you, the student these things.  Some of you are destined to be absolute brilliant minds in the profession. Let’s be honest here, some of you are mental potatoes and i’m shocked a few are in practice.  And then there’s the middle. The huge middle. Colleges have to play to all of them. So there’s no place for the brilliant, of any subject, in chiropractic college. It will never be enough.  The potatoes, they end up sort of taking care of themselves.

Professor Stu McGill endeavors to create MASTERS in the treatment of the low back through his course series.  Stu will say one of the ironies of clinical science is the idea that the only way for a test to be valid is for it to be reliable/reproducible.  But in order for a test to be reproducible, a master must be able to do it, as well as the middle, AND the potatoes. How valuable is that in giving outstanding feedback clinically?  What if a test gave a master exceptional information, but the middle and the potatoes couldn’t generate equal result? Science would say that test is not valid… Mastery is not the subject matter of chiropractic colleges.  You have to regress to the mean.

So it’s not about you, or me, or any of us individuals on the whole.  Colleges have to educate everyone. The problem I have with the colleges is that they don’t tell you.  They don’t say “hey guess what, you’re paying us to teach you to pass the boards, be legal, and maybe pique your interests in some various topics.  But you’re not going to use all of it, you’re not going to like all of it, you’re not going to always see how any of it applies, and by the way it has nothing to do with making you successful in your actual career.  You’re just here to get permission to have a career. Education is for a time period, mastery is for a lifetime.”

Students struggle because many of them think that what they learned in school was “it”.  And then they stop. And then when the results are bad, they blame the school or the profession, but not themselves.  And then they hire gurus to teach them easy ways to fix it.

Look, I’m not down on the profession.  I love the profession. I think some people who choose it have some personality traits that attract them to the profession.  Just like other professions. Except one of them is expedience. I think some people choose chiropractic as a profession out of expedience.  We’ve been told its easy. Easy money. Easy schools to get into. Easy living. And then the real world walks up and kicks you in the shins.  Nothing worth doing and doing well is easy. Potatoes are easy. Masters choose the hard road.

“I know I am going to struggle when I graduate either way, but I want to prepare for it now.” - Well you are prepared, by admitting it.  And as well, you cant prepare for it, because you just have to experience it. You can read book after book about your first kiss, or anything that you don’t actually own until you do it.  I suppose you can take a kissing class, practice kissing the back of your hand. But it’s not until you do it, fumble with it, realize you’re actually not very good, get feedback, and practice and practice…  and have some PASSION for it (even the foundations), then you will approach mastery. Confidence.

“I also want to know if I am wanting to run before I can walk. If I have that attitude and I just need to chill out because everything will be okay in the end then I would like to hear that too.” - Yes.  You need to chill out. That’s easy. Don’t go jumping schools and looking for greener grass elsewhere. You will find the same gripes no matter where you go. Each college does it a little different. They all have their shortcomings and their strengths.  They all produce great DCs, and potatoes. It’s not the schools… It’s what you put in and get out of it. They will not complete you.

I’m sorry to say it, maybe i’m becoming an old fart.  But sometimes you just have to sit down, listen, do your work, enroll yourself in being part of the process and not work outside it, and admit that some things take time.  Patience grasshopper. You have a lot you have to learn, learn it and discover for yourself where your passions within that lie, and go after them vigorously…

Bobby Maybee DC

The Problem with Educating Patients - By Chris Chippendale DC

"I find new patients frustrating. All they want to talk about is their pain. Why don't they get that there's more to health than being pain-free?"

“It’s so annoying that people only think of us as ‘back doctors’ ”

If you're a chiropractor, you've probably had thoughts like this cross your mind at some point. And you've probably spent a good deal of time trying to come up with a way to explain the other benefits to chiropractic to your patients, or why they shouldn't just focus on their pain.

You just need to find the right metaphor, the right script, or the right mentor to teach you how to explain chiropractic so your patients "get it"... right?

Saving You from Documentation Disasters, An Interview with Dr. Gregg Friedman

Dr. Noah Volz has volunteered the content he produced from his DC2Be Podcast. He did great work while he endeavored to discover all he could about chiropractic as a student. Although most likely an exercise entered upon for his own benefit/learning, the content he produced was also quite valuable, so we will be sharing it here. Enjoy!

Saving You from Documentation Disasters, An Interview with Dr. Gregg Friedman

By Noah Volz

Getting in Front of a Complaint - by Chris Chippendale DC

None of us like getting complaints. Hopefully they’re pretty rare, but they’re inevitable in clinical practice. Whether it’s something whispered to the front desk, an off-hand comment to our face, or - worst of all - a bad online review, negative comments have a way of ruining our day. Nevermind the fact that all the other patients that day were enthusiastic, positive and making great progress, that one complaint is probably all you’ll think about when you get home.


Not only that, but you’ll probably have a good case of l’espirit de l’escalier (French for “staircase wit”, or thinking of the perfect reply too late). “I should have said this, that would have shown them!” I’ve been there, it’s not a fun way to spend an evening.


Whilst there’s no simple quick fix for ruminating all night over a complaint, a better use of your energy would be to ask yourself “What could I have done to prevent this?” If your immediate reaction is “Nothing, they’re just unreasonable” - which I totally get - you might want to think a bit harder.

The Nordic Maintenance Care Program, a Long Journey That Is Starting to Bear Fruit! - Andreas Eklund, MSc(Chiro), PhD

The Nordic Maintenance Care Program, a Long Journey That Is Starting to Bear Fruit! - Andreas Eklund, MSc(Chiro), PhD

Maintenance Care (MC) has been around for a long time within the chiropractic profession and has become an issue of great debate and conflict. Headed by Professor Charlotte Lebouf-Yde a serious research effort was made to study the procedure. Over the past decade a series of publications under the name the Nordic Maintenance Care Program has been published [1-11].  The purpose of the program has been to identify indications for care, treatment content, frequency of care and to understand the clinical reasoning process among chiropractors in the Scandinavian countries.

Introduction to the FTCA Research Committee

Here is a brief introduction of the FTCA Research Committee and an update on some of the projects they are working on for FTCA members!



The FTCA research committee, Dale Thompson as chair, desires to help bridge gaps between the chiropractor and their patients, the public, healthcare providers, and researchers. We plan to produce monthly “newsletters” for the website which provides a list of the top 10 published research papers in the last 30 days.

We want to organize a student poster presentation for our annual conferences. These may be formal or informal projects. Awards will be given to the best presentations. We plan to produce brochures that members can give to patients on a specific condition. Wall posters that can be used to help educate the patient. Posters that provide more doctor centered information to help the FTCA member understand the condition and help guide their treatments.  A brief summary of pertinent research and educational materials on a topic that can be given to other healthcare providers. Media products that members can use on their web pages or for the purpose of public education.

A few other possible future projects include being an avenue to help connect researchers with the appropriate clinicians when they wish to conduct clinically-based research. Also, a publication of a differential diagnosis for “red flags”. Hopefully these projects will help The FTCA member to better transfer research into everyday clinical use.

Dale Thompson DC,
Research Committee Chair

Introduction to the FTCA Political Action Committee

Please take time to read the following introduction from Jonathan Parham DC, the Chair of the FTCA Political Action Committee.  A lot of people are very excited to see what may come out of this committee.  Myself, as the founder of the FTCA, all I could really hope for was that their actions will encourage someone, anyone to be involved in their professions political activities in any way possible.  Get out there and represent.  I promise you good things will happen.

Bobby Maybee DC

Introduction to the Critical Thinking Committee​​​​​​​

The FTCA has moved in a new direction recently.  That new direction is the creation of committees who will work for the benefit of the members of the FTCA and the chiropractic profession as a whole.  Each of these committees will be undertaking tasks and producing content that they themselves have felt is important to FTCA members.  They are all volunteer, they are using their own resourcefulness to accomplish these goals.  And they have my utter thanks and gratitude for stepping up.  This letter is an introduction to your CRITICAL THINKING COMMITTEE.  Having a foundation of critical thinking skills is a hallmark necessity for a Forward Thinking chiropractor.

Injury Prevention Tips for Our Troops - Dino Pappas DC

Dr Pappas was generous enough to share a slideshow he has prepared in regards to our tactical athletes, our troops.  This presentation is not placed behind a membership wall so that as many people can access it as possible.  The FTCA does hold dearly the conviction that our active duty soldiers, and veterans, receive the highest quality care possible.  It is our hope and the hope of Dr. Pappas that this presentation contributes to that conviction.

Reconciling Order and Chaos in the Chiropractic Profession

Reconciling Order and Chaos in the Chiropractic Profession

Last night I attended a lecture from Dr. Jordan Peterson, a PHD and Clinical Psychologist. Some of you are aware of him through numerous avenues and through his recent thrust into politically divided spheres. Not the point right now.  This post is focused on his lectures and his clinical perspective specifically.

He recently wrote a book "12 Rules of Life, and Antidote to Chaos", which yes, '12 rules' is kind of a cliche, however the depth he goes into in "An antidote to chaos" is not. It is a deep book.

At Forward KC I gave a brief lecture styled after that book. I called it "10 Rules to Chiropractic Life" (Because 10 rules are better than 12).  I recommend the Peterson book, I learned a lot about our profession and even ourselves in FTCA through the book, the ideas, and last nights lecture.

Lets combine that with an anonymous survey Kevin Christie and I just recently did. A survey where the NUMBER ONE AND NUMBER TWO RESULTS absolutely shocked me. The question was essentially "What do you fear the most?' 

Number one response to the question was something akin to responses like fearing how "the other side of the profession is ruining it" or "we dont have any respect because of the straights" "MDs not respecting us" "DPTs encroaching on our territory" and a multitude of these types of answers that can be summed up as "other people ruining it all for me"

Well, this completely contradicts the points that Dr. Peterson makes in "12 Rules..." and makes in general in lecture and elsewhere. First and foremost... "Other people" cannot ruin your thing for you. And that same sentiment goes for straights who feel that "mixers" or nontraditional chiropractors mess up their paradigm.  To me so many people were blaming the crux of all the professions problem on the wrong thing.  Outside themselves.  The bigger problems, and the ones you can tangible do something about, rest on the inside and directly around us.  

Dr. Peterson writes about the concepts of Order and Chaos in his book. A lot of times he's referring to the political spectrum, but I saw immediately how this fit into the chiropractic spectrum. Representatives of Chaos within our profession tend to be the "straights". They favor less rule, they favor less organization, they favor less evidence also less science. They favor less answers and more "freedom" to act as they feel fit. They essentially like to act as if they are molding from a lump of clay. They like to take from nothing (Universal intelligence or quantum? Language they use) and make something. 

The irony here is that if chaos is on a far left of a scale, they must always make SOMETHING out of that NOTHING, so they have the proclivity to create order out of their chaos, up to a limit. That limit appears to be within their specific belief system. That is why the 33 principles is so important to them, Before that, any level of chaos is warranted. But it stops once it meets the Hadrians wall of the 33 principles. Then there is a political refusal to cross that line.

Progressive chiropractors (mixers) tend to favor more order, more rules, more legislation, more regulatory intervention, more science. They tend to be agents of order in the profession. The irony here is that as they do that, many within their own ranks destroy that order or hierarchy, and then try to create their own "chaos". Usually in the form of trying to create new seminar series', new explanations or newly wrapped explanations for old concepts. 

However, they only create chaos up to the line they meet with their ethos, which is science. OR at least biological plausibility. Just as straights will create order until they meet the 33 principles, progressives will create chaos up until they violate the lines of science (most of the time).

Take for example, from our progressive end of the scale, "Pain Science". The Biopsychosocial concept of pain has been talked about and researched for decades.  Leonard Faye has been involved with it for 30, 40, 50 years.  Craig Liebenson has written about it in his texts. Waddell wrote about it. We've had it on scientific record for decades. Yet what have we found? New "Pain Science" gurus have sprung up talking about the new concept and idea of pain science. Its not new!

There are multiple examples of this, but it would be difficult to cite them without making reference to specific names of specific people who made this move to create chaos in the orderly side of the profession. Even if for personal gain or notoriety.

However, is creating Order out of chaos bad for straights? Is creating chaos out of order bad for progressives? Not entirely. It is known that too much order can lead to tyranny. It is known that to much chaos can lead to absolute destruction. In our case, the straights are CORRECT to fight against too much order. The progressives are RIGHT to fight against too much disorder in our profession.

On many levels... BOTH SIDES ARE RIGHT!

Now theres another dichotomy working as well in this battle. Straights represent the "old way of doing things", progressives represent "the new way of doing things" Now the roles of order and chaos are flipped. Straights represent the ORDER of doing it as things were designed and not changing the status quo. Progressives represent a new disorder to them of chopping down their old ways and building anew. 

Its really a fascinating mix we have going on here. Both sides essentially play multiple roles in the battle between order and chaos. Most of the players doing it completely subconsciously. Most people dont entirely do this because of money motivations or ethical considerations as we might assume, they actually do it (based on Peterson's interpretation of the data) based in their own personality temperment.

You are on any side of this battle because of who you are. What you believe to a core. I personally believe you can argue anything with anyone in this world. You can debate, you can rationalize, you can appeal to emotion. However, once you begin to discuss core beliefs or ideologies, you can no longer argue, because that is what the person IS, and that will never change and they will defend it to the grave.

Peterson was asked in his lecture, paraphrasing "So how does one side win the battle over the other?"

They dont. THEY DONT. Both sides are essential to one another. To maintain balance. It is an existential tug of war where, if you do it right, everything comes out okay in the wash. That is where we find ourselves. Straights NEED progressives. Progressives NEED straights.

Or as Peterson put it, we all think politically "If we as democrats could just get rid of those republicans, we would have the utopia we've always clamored for", or vice versa. But thats not how it works. Its a checks and balances. The USA has voted 50/50 essentially for these two parties over the last 20 years. It doesn't matter in an overall sense. Politically, if you wish your opponent would "disappear", you're really wishing half the population would disappear? Friends, families, loved ones, colleagues?

The same goes for chiropractic. 

If progressives were successful in removing every single "straight" from the profession, would it make for a better profession? You might think yes, but of course the answer is no. And vice versa. They need each other. Otherwise they teeter towards the tyranny that would choke this profession to non existence with too much order. Or they would evaporate completely with no structure and complete chaos/disorder.

We always say, an entrance exam sure would fix all of our problems. It might or might not. Maybe an entrance exam that focused on personality profiles, sure. Profile types that tend to become straight in thinking, and types that become progressive in thinking (Research project idea for any out there willing to tackle it!). So yes, you could eliminate half the profession based on core values, but would you want to?

Peterson outlines in more ancient marriages the symbolism was meant to show that a man and a woman, when married, entered into a relationship with a third "higher ideal". And depending on your culture that higher ideal could be many things, God, Jesus, Yahweh, Truth, etc. Whatever it was. And then the man and the woman, through marriage worked together to uphold that higher ideal. Thats why people stand under an arch when married, or under a candle, or at an alter. Its a triumvirate. A team of push and pull to work towards an ideal. Checks and balances with an end goal in mind.

Is it the same nowadays? Well thats a different cultural discussion. I'm an online "ordained minister" and Ive married close to a dozen couples. Almost all of them are shocked at the symbolism of the ceremony I expose them too during their marriage. Man would do man stuff, woman would do woman stuff, and for better or worse even that has dissolved from our culture. My point being, not to make cultural commentary, that even us as chiropractors have lost that relationship in our marriage of both sides with a "higher ideal".

The straights do straight things, the mixers do mixer things, and never to they interrelate. And neither of them are focused properly on the higher ideal.

Does that mean we need unity? NO!! The husband and the wife argue. Thats what they do. They constantly battle on how they do things the right way or the wrong way, and they compromise, oriented towards the higher ideals.

What we need are higher ideals!!!

Now, the straights will tell you that we already have higher ideals, the chiropractic principles. Nope sorry, we are telling you, those no longer apply (or maybe never did) as the higher ideals of the profession, as a whole. It is not accepted.

The progressives will tell you the higher ideal is science. Nope, that too is wrong. NOt that science doesn't play an important role in helping us understand the world around us and how we should act within it, it is not a higher ideal for how people should behave. It is merely a powerful tool.

We need, as Peterson stated last night in his lecture, better language towards each other, more specific spelling out of roles. We need to identify the the times and moments we spend the most time TOGETHER, and make those moments as peaceful as possible. While still maintaining our individuality. We dont need "unity" as so many people seem to define it these days, where we all get along and there are no problems. We need better communication and higher ideals to pursue together.

On that note, subluxation. Stay or go? It most certainly is a very POOR way of communicating. To our partners, to the professional public, and on some levels the way it is used, to the general public. Its akin to asking your spouse how they're doing and they say "fine". What the hell does fine mean? WE may have accepted subluxation as lexicon, but it is a BAD lexicon because it has no solid definition. Accepting subluxation as lexicon as we have is akin to just letting your spouses "fine" comment go on. Ignore it, she said she was fine, she must be fine whatever that means, not my issue.

So ive addressed "unity" and ive addressed "subluxation", whats next? How do we make our marriage better?

We sit down together, use better language towards each other. We recognize that we need each other and no one is going anywhere. We demand more from each other. We would want our spouse to be ethical. We would want our spouse to be fair. We would want our spouse to be the best they could be. Because, as Peterson stated, you could win an argument, and your spouse lose, but then youd be married to a loser, and what would that make you?

If we treat our professional relationship as a marriage, and people come to this table honestly, we could win as a whole. If one of the spouses is irreconcilable, then the only logical next thing is divorce. Real talk.

This is not a unity message. I hope people can see the subtle difference between the rainbows and unicorns stylized "unity" that seems to be tossed around these days, and a stable functional marriage or relationship.  Billy Demoss is the equivelent to your spouse chewing with their mouth open at dinner. I dont have to accept that. But me n Billy do have to come to an agreement on a much higher ideal, one that allows me to tell him to quit chewing with his mouth open, or bop him on his bald head and say "knock it off", or one that encourages me to just let it go, so we can get to that higher place together. 

So I apologize if I have very little tolerance for poorly formed "unity" messages. We need better language, we need to do better, together. Neither of us are going anywhere, so don't let that other side own you. Dont be afraid, be involved. And remember as an FTCA member, you ARE an agent of order, but chaos has a place and deserves some respect. Not unity. Just respect.

p.s.  And I know that the relationship between the two sides of this profession is not a marriage.  Its called a metaphor.  Its probably closer linked to a family situation.  We are two brothers or sisters that have to live in the same house together, but really can't stand each other.  That doesn't matter.  The chores still have to get done, we still have to go to all the big celebrations together, we still have to get good grades and take care of each other and our neighborhoods.  Whether we like each other or not, we are bonded, and we might as well suck it up and try to make something good of it.  That takes two to tango however...

Fireside Chat 4/30/18

This fireside chat is hopefully one of many.  These videos are for members, by members.  FTCA Members hang out and shoot the breeze.  We never know what might happen!  There is no agenda.  There is no script.  The format that worked today was that a post is made in the facebook group, and whoever shows up, shows up!  As you can see, some people roll in and some people roll out.

In this episode I am joined by Gregg Friedman DC, and then Blake Kalkstein DC takes us for a ride.  Then at the end Kurt Kippenberger DC jumps on the call to chill.

Now our first fireside chat should be available to all...