July 2002

Clinical Biomechanics of Posture (CBP®)

and Rehabilitation Protocols

by Jason Haas, DC

            Dr. Jason Haas graduated from Life Chiropractic College West. He participated as a CBP® student club officer and instructor throughout his chiropractic education. He successfully passed the CBP® Club Certification in June of 1997 and passed the CBP® Technique Certification, making him a Distinguished Fellow of Clinical Biomechanics of Posture®. He is originally from Colorado where he attended undergraduate school at the University of Colorado at Boulder. His association with CBP® began at Life University in Georgia where he was Student Club President and Vice President. He has co-authored the Cervical Rehabilitation text with Drs. Don and Deed Harrison and has been a contributing author to research papers on the Thoracic Spine Normal Model, reliability studies, and a clinical control trial showing the efficacy of CBP® protocols. He is currently the International Chiropractic Association representative by proxy for the state of Wyoming. Dr. Haas is currently working with CBP® researchers in Wyoming and Nevada to further the knowledge of the human spine and advance chiropractic principles.

Rehabilitation has traditionally relied on functional outcomes to determine effectiveness. This has led many practitioners to believe that if a person has a stronger muscle following an exercise program or their original complaint has subsided then they have been rehabilitated. Thus they may then discontinue care because the person is ‘Better.’ This thinking is only injurious to the patient as their structural alignment has been ignored. It is, after all, the patient who we are attempting to help, isn’t it?

      Because the human neuromuscular and skeletal systems are completely reliant on one another to determine proper function, it has been estimated that 90% of the nervous system is geared towards control of the musculoskeletal system. Thus, it would appear that “functional” rehab focuses on the correction of the end point, the muscle, and not the starting point the nervous system in the spinal column.             In my opinion, this leads to patient care that is severely lacking in quality.    It should be well understood to any first year chiropractic student, medical student, bricklayer, or aerospace engineer that structure dictates function.             This is true regardless of the field of study. However, for some reason, in applying this knowledge in clinical healthcare for human beings, something is lost in the translation. Why is it so difficult to see that unless the structure of the spinal column and the nervous system inside is as close to biomechanical normal position as possible, the function of said human being will not be optimal? Why do chiropractors continually have their claims cut? How can statements be made such as the following quote from a medical care review group dated 5/13/02 concerning an accident victim and the doctors request for compensation for care?

            “The reviewer certifies that the indicated number of treatments/visits (30) for the following reason(s): ...30 visits to ostensibly correct a kyphotic neck.  

            The D.C. cites some articles that supposedly support his/her position. This reviewer disagrees with the conclusion drawn by D.C. These studies are not widely accepted and are not substantiated with other studies replicating the results or supposed results. There is no conclusive evidence that a natural kyphotic cervical curve (reversed cervical lordotic curve) can be reversed by chiropractic manipulation. In many people the reversed cervical curve is normal and natural to them. Trying to reverse that curve could be detrimental. The ICD code for headache could be a valid code for 2 to 4 visits. But not 30. ICD-9 code is appropriate for up to 12 visits as a maximum but not 30 visits. The D.C. does not use the ICD-9 code for nonallopathic lesion (739.1) which would be appropriate as doctors of chiropractic resolve them.

            Based upon documentation, the requested 30 visits is excessive and is not supported. The previous certification for 5 visits and the present certification for 7 additional visits (for a total of 12 visits over a 6 week course) is approiate and supported. The decision is based upon documentation, national community standards and the following references: Chiropractic standards of practice and quality of care, Vear HJ, Gaithersberg, MD, 1992, Aspen Publishers and Guidelines for chiropractic quality assurance and practice parameters, The proceedings of the Mercy Center Consensus Conference, Gaithersberg, MD, 1993.

            The reviewer applied the following criteria in reaching the following decision: Reviewer Qualifications: This review has been provided by a licensed chiropractor in active practice for over twenty years. This reviewer is a board eligible chiropractic orthopedist and is a member of their state Chiropractic Association and the American Chiropractic Association. This reviewer specializes in disability evaluation, industrial.”

            The preceding statement is the criteria used by many insurance companies to deny the chiropractic care of patients. Our reviewer is a “Board eligible chiropractic orthopedist” and a member of the ACA. Why do the vast majority of IMEs claim to be “Chiropractic Orthopedists,” “DACBRs,” and/or ACA members? The answer is that the ACA (as indicated in the title: DACBO — Diplomat of the American Chiropractic Board of Orthopedists) has sponsored, sanctioned, and given prestige to these weekend seminar modules as something far beyond what the education entails. Since the ACA created these monsters, it is now up to the ACA to come up with some requirements to limit these insurance prostitutes who cut our claims. Some IME standards like those used in Oklahoma might be a good start for the ACA.

            To return to our patient with a cervical kyphosis, this reviewer cut off the patient’s benefits at 12 visits for a kyphotic cervical curve! Thus patients who cannot afford cash chiropractic care are being denied rehabilitation of their spinal disorders. Other than the additional weekend seminars, this reviewer does not have the qualifications or advanced degrees to make statements such as kyphotic cervical curves are normal. There is Index Medicus literature, published from within the profession and from non-chiropractors, that strongly supports the necessity of a lordotic cervical curve to prevent pain and dysfunction.

            Additionally, rehabilitation protocols and normal spinal models, published by CBP® researchers in widely accepted journals such as Spine, Clinical Biomechanics, the Archives of Physical Medicine and Rehabilitation, the Journal of Spinal Disorders, and the European Spine Journal, have shown the necessity for a cervical and a lumbar lordosis. In four recent CBP® Clinical Control Trials, it has been reported that at least 72 visits are needed on average to restore a cervical kyphosis and/or lumbar hypo-lordosis to as near normal as humanly possible.

            The reason that these ignorant reviewers are able to propagate this substandard amount of care is because there seems to be no outcry from chiropractors who clinically apply CBP® or claim to apply these techniques. We, as a profession, are the only ones who can change this method of thinking. All practitioners of structural methods should begin their own clinical trials for the effectiveness of their care. Chiropractic schools must use the vast number of patients, seen on a daily basis in their college clinics, to complete clinical controlled trials investigating the effectiveness of structural rehab (such as CBP® protocols). Additionally, it is my opinion that individual chiropractors must confront chiropractors in their communities with this current CBP® information.

            All chiropractors should be encouraged to learn the most current understanding of the care of the upright human frame and apply this understanding in their own practice. CBP® Nonprofit has completed this high quality research for the good of the profession and IME’s, who support ACA claims that subluxation is a figment of the imagination of chiropractors, must be reeducated in the CBP® reality. If you, as a chiropractor, cannot begin to support this profession and give to it the recognition of correcting subluxation and being compensated for it, then please contribute to a group who will.

            If you are a reviewer for a case and you knowingly deny a claim in the face of overwhelming evidence, then how can you sleep at night knowing patients’ nervous systems are not functioning to optimum because you won’t allow chiropractors to correct their structure? Please do everything you can as a student, doctor, faculty, or college president to change this gross misunderstanding of what chiropractic is and why it is necessary for the reduction and prevention of disease.

            For a complete list of CBP® references, all of which are available from the individual publishers, please see Dr. Sang Harrison’s Research Corner article in this issue.