Blog, Chirosecure Live Event November 6, 2023

Chiropractic Malpractice Insurance – Are You Talking Subluxation?

Click here to download the transcript.

Disclaimer: The following is an actual transcript. We do our best to make sure the transcript is as accurate as possible, however, it may contain spelling or grammatical errors.  We suggest you watch the video while reading the transcript.


Hi, I am Dr. Mark Studin, and first, I’d like to thank ChiroSecure for giving me the opportunity to share with you. Today I’m gonna do something that’s quite different. I’m not gonna be teaching from slides. I’m not gonna be talking all about research and even though probably just a little bit. But what I want to do is share with you what I’ve learned over the last 11 years because I am about utilization.

I am about seeing what has moved the needle in our industry because. I want to help more people. And to me that’s what it’s about. It’s if a tree falls in a forest and no one hears it, did he really fall? If you can help a whole lot of people, but no one comes in, did you really help? A whole lot of people?

Click here for the best Chiropractic Malpractice Insurance?

The analogy might be a little bit off, but you understand what I’m saying. So my journey started, and I’ve talked about this before, my journey started many years ago while I was practicing. I was seeing a lot of people and it was great, but you know what? Why was I seeing a lot of people?

I was president of my state organization and that really had nothing to do with it. I just was really good at BSing and got a lot of votes. I was good at rhetoric that probably had more to do with it, and I attended a lot of seminars that were religious and fervor. But actually short on the evidence in the literature.

But truthfully, we didn’t have a lot of evidence in the literature then. There wasn’t a lot of literature because I’m out since the early eighties. I went to school through from 78 to 81, and there was very little to no evidence, almost none. So as time evolved, we’ve evolved. And when you evolve, you look at, for me, the valuable final statistic is numbers.

So it all came to a, a crescendo when my wife got ill in 2008, she had cancer, and I’ve talked about this before. She had kidney cancer. She’s doing great now, but it was a five-year odyssey of which she’s had four surgeries. And we went from coast to coast, north to south to find the right doctors. And when I needed to find the right doctor, and by the way, this is extremely germane to chiropractic.

Get a Quick Quote and See What You Can Save

So when I went to find the right doctor. I went from, I’m in New York. I went from Boston to New York, to Philly to Washington, realizing that if you can’t find the right doctor in that corridor, and I needed a urologist, a kidney a kidney surgeon, that you’re in trouble because it probably doesn’t exist because some of the best healthcare is in that corridor in the world.

And I finally found the right one in New York City and Columbia Hospital, Columbia Presbyterian, and I called to make an appointment and they said. It’ll be six months to get her an appointment. I said, she’ll be dead by that. I said six months, I’m sorry. We have patients coming in from Africa, from Asia, from South America, from Europe, from all over the world, and the doctors only got two hands.

What can we do? So I said, okay and then I said, but she’ll be dead. This says I’m sorry. There’s nothing we could do. There’s only so many hours in a day. Click, they Huang up. I’m not the smartest person in the world, but I am the most persistent person you will ever meet and. I got on the phone and who do I know?

Other department chairman, politicians, you name it I worked it. It was, I was, it was life and death here. So I finally got an appointment in three weeks. And to make a long story short, we got in, got an appointment, and she’s doing well and she had her surgeries and she’s doing well.

But going through that, we had to do the same thing with the geneticist, with hematologist. We had to go to Harvard up in Boston. We, I went to USC in California, uc, Irvine in Southern California. We went all over the map to get the right people, and every time, how do you get an appointment?

Going through that five year process, I said, why don’t people run after chiropractors the way I was running after those surgeons? We’re not. Life and death is a rule, but when people’s lives are upside down because they can’t function. You know what? They can’t function. They don’t have a life.

Their life is really and truly upside down. So I started with academia and I’m saying, why did I run after that surgeon? He had the best credentials, went to the best schools, went to the best postdoctoral credentials. The best. The best. And it fit and it worked. And I’m not stupid. I know, you, you’ll learn more, you’re better.

It’s really an easy equation. So in chiropractic, we didn’t have that. So then I reached out to Harvard and found a neuroradiologist. I reached out to the State University of New York and Stony Brook and found a neurosurgeon. I reached out to Albert Einstein College of Medicine and found a double boarded vascular neurologist, and we put on courses

That were taught by those entities, but it wasn’t enough. So then I went to the State University of New York at Buffalo Jacob School of Medicine and Biomedical Sciences and got those courses credentialed and that, that was a huge process. And it’s still an ongoing issue and battle to stay there, but it took years to get it approved for chiropractors to get medical school academic, AMA category one CMA credits.

And we did that. All of a sudden the needle started to move and it started to move. It started to move with lawyers because now in Voir dire or Dalbert or Shrek or Fry admissibility hearings and an expert hearing, they were able to get these doctors credentialed so that they could testify and it worked.

But MDSs it, it was almost better because. We went from lowly technicians that below of the physical therapist because they controlled the physical therapist to that of a peer. A peer where we have the same postdoctoral credentials they do because it’s from the same institution with the umbrella of the A-C-C-M-E, the accreditation council from the med medical education.

So it’s the same . Credentialing entity. And as a result of that, it really started to work and it was great, but we hit a roadblock. We just hit a roadblock. And the question is, why did we hit the roadblock? We hit the roadblock for two reasons. Number one, we use the term manipulation, interchangeable with adjustment.

That’s a big problem. Hey, are you a physical therapist? They manipulate you an osteopath. They manipulate. We hit roadblocks. So language created load roadblocks, and through the evidence in the literature, there is a huge difference between a manipulation and a chiropractic spinal adjustment. The spinal adjustment affects central segmental motor control, meaning brain control.

It affects the CNS. Manipulation often does not, or quantumly less to the point where a research article in Ontario Canada came out a few years ago, which shows that chiropractic has a 313% better outcome for secondary disability than physical therapists. And a 250% approximately better outcome for primary disability than physical therapy because the joint mobilizations do not affect

The the central nervous system change actually called central segmenter modal control. And that’s because of the deep paraspinal muscles and the facets the nociceptors and the facets and the different neurological elements in the joint capsule. Meaning the Pisidian core muscles, the root affinity, core muscles and nociceptors there as well as gogi tendon apparatus.

And the those you will find also, again in the deep paraspinal muscles, which is the goldy tendon apparatus, which both feed into the lateral lo and up through the spinal with the lama tract, through the periaqueductal gray area, hits the thalmus. Goes to the prefrontal cortex, the somatosensory cortex, the somato motor cortex, that’s all afer and then efer.

It changes everything. So it matters tremendously. But the medical community didn’t really care. They didn’t care. So when we changed that language, it didn’t move the needle. It actually helped the attorneys in court because it took the . The question away from the defense. Are you a physical therapist?

Are you an osteopath? It took those arguments away and it helped stage the ground for the better outcomes in research. But it didn’t break the last barrier. And it took me many years up until recently actually, to understand how to break that last barrier. And I go back to 1962.

Helping to understand, excuse me, how to break down that last barrier. And 1962 comes from a doctor in California today, whose name is Leonard Fay. Now all of you should know Leonard Fay, and it should be a household name because Len actually, we owe him a tremendous set of gratitude. A tremendous set of gratitude because without him setting the foundation for moving forward, we might not know where to look.

He was the originator of the five components of the vertebral subluxation, which yes, is theory, its supposition. However, research has validated almost everything Len came out with in 1962. Len was in he went to London. And he heard a seminar on spinal biomechanics and neurological treatment and aberration with aben with spinal patho, biomechanics or abpi, Arin, spinal biomechanics.

And Len, who I actually spoke to in his early nineties I spoke to him, I believe he’s in his early nineties, might be in his late eighties. I spoke to him at length last week. We spoke for 45 minutes and he told me when he heard that one presentation, there was a six story library in London. And remember, there are no computers then that we were readily accessible.

There’s no Googling anything. No Google Scholar, no PubMed. He had to go to the books. See, he went to this library that had a tremendously large anatomy section. He went and he read and he learned and he came up with and invented the five components of the subluxation complex. Now, Joe Felicia, who is a very dear friend of mine, who is no longer with us, actually took that and ran with one segment of that, which is spinal aberrant rotation, aberrant misplacement kinesio pathology, as they call it, change in movement of the vertebra.

Joe ran with just one of those, leaving the other four off the table and it was an issue. So Len, from the sixties and seventies before Dr. Felicia came in, went around from chiropractic school to try to teach this, and he got thrown out in Blackball because he changed the status quo.

Len changed the status quo and he actually flew out to a seminar I did about eight or nine years ago, and he said to me, and I really didn’t know who he was then. He said, mark, don’t be afraid to change the status quo as you evolve if it helps chiropractic and it helps the people we serve. And it was a powerful message.

And he told me the same thing last week and last week. He wanted to talk about extra spinal problems when correcting the spine didn’t work, clavicles, pelvis knees and ankles. He was really anxious to share that with me and move on. But if we go where with back backpedal just a little bit. We look at the referrals that we’ve gotten as a result of credentials and changing our language a little bit.

We still have roadblocks and the credential,

having the medical credentials in joint providership with chiropractic credentials. And we do that through Cleveland University Kansas City College of Chiropractic, and Dr. Carl Cleveland, who is a very forward thinker in our industry. We look at the roadblocks. Even with the roadblocks, we’ve attained an additional 1.8 million referrals in 49 states over the last 11 years.

That number should be a lot higher, and my goal is to tap into the medical community. I don’t wanna be a medical doctor. I don’t wanna give drugs. I don’t wanna do surgery. I don’t need to. All I need is these, it’s all I need. I don’t want to do any of those things. But medicine’s utilization is 99% of the population where chiropractics utilization is still 7%.

Someone will tell you, 10, 12, 11, 9, I don’t believe it. Not for one second. Not for a second. And I’ve read some recent research articles which actually validated what I’ve been saying. We cycle up and down. We can’t break through number one. There’s not enough of us that’s about to change.

And I’ll share with that in a minute, but how come we’re not, and by the way, my doctors who’ve I’ve trained with advanced credentials and using appropriate language and I started the language change about two and a half to three years ago. , and I’m looking at the word subluxation. So when I work and by the way, I grew up in a subluxation based environment.

I saw 650 visits a week doing it. I don’t suggest anyone see that many patients by themselves. I’ve got a new hip surgery on both my hands, both my shoulders, two compression fractures. I lost two and a half inches a night. And a lot of things hurt. So I don’t say we take our toll. ’cause every time you, you give an adjustment, it takes its toll on your body.

So when we look at all of that and we look at language and subluxation, when you speak to a medical doctor, you know what you say, oh, there’s a subluxation there, there’s a vertical subluxation complex there. They say to themselves, how do I know this? Because I’ve asked them, when I say the word subluxation, what do you think?

I. And if they’re really, if they’re polite, they say we look at subluxation differently, and it’s not quite how you look at it. So when you say that, there’s a huge disconnect that’s being polite. Now, when I go to my family members who are medical doctors and very close friends, they tell me the truth.

Mark, when you say subluxation, I think you’re an idiot. That’s what I say to myself, you’re an idiot. You don’t understand what language means. You don’t understand anatomy. You’ve made up your own definition of something that we in the medical community have been looking at, for over a hundred years.

And I’m dying to say we’ve been doing it for over a hundred years too. How come yours is right and mine’s wrong. The bottom line folks, theirs is better and ours is worse because they see 99% of the profession and we see 7% of the profession. They don’t want to tap into me, I want to tap into them.

So what I started doing is tinkering around with biomechanical pathology. I wanted to call it neuro biomechanical pathology, but Dr. Capari down in Georgia yelled at me and said, it’s too complicated. Keep it simple, because every single medical doctor knows what biomechanical pathology is. They know it’s in line with non-specific back pain.

They have no solution for it. They have no clue what to do with it. None whatsoever. Zero. They know it’s a problem and they can recognize that, and it’s got a relatively high level iic D 10 value ICD elevens in Europe already. It’s coming here shortly, but it’s got a relatively high IICD 10 value, and when you’re treating that, it really works with all of the other sequela codes.

With respect to strength, sprain injury to nerve root or a myriad of, or anything else that can emanate from the spine or from the spine. It becomes pathological and it works. And all of a sudden we started throwing out there the term biomechanical pathology. Now all, you know when you see a counter on a dial and it goes up 1, 2, 3 that’s what we have with those referrals.

The 1.8 plus million I. As soon as we started tinkering with that language, that dial started to spin a whole lot faster, a whole lot faster. We’ve broken some of the barriers by changing some of the language. It doesn’t change anything about chiropractic. If you wanna hold on to the language and hold on to everything you’ve ever believed in with a religious fervor, you’re not gonna evolve.

You’re gonna become extinct like the dinosaurs. Yeah, there’s a certain group of people doing very well in our industry extremely well by holding onto that, but the majority are not. And I’m not suggesting we remove the language of subluxation from our lexicon. It should be taught in every chiropractic college.

It should be taught in tandem with biomechanical pathology because that’s what it’s, and there are ways, as evidenced in the literature. To quantify that biomechanical pathology, there are ways to do that now. I personally would rather see three times the amount of, you know what, we have so few chiropractors in our industry.

We should have waiting list practices. Everyone just like that. That surgeon, the urologist that my wife ran after. How come people can get into a chiropractic office like that? When you want to get to a surgeon’s office, you can wait weeks, or in my case, months. How come? How come? Because there’s a great need.

Right now the need is changing, and I can tell you that the doctors that I’ve trained, almost all of them have one common denominator. They can’t get an associate. Associates fees are going up. Folks. We’re talking well into the six figures. They’re going up right outta school. Guess what? The schools are gonna be pressured shortly because it’s gonna be a great place to earn a living where four or five years ago, an associate couldn’t earn $65,000 outta school.

Do something else. Because unfortunately, there’s a calling, but there’s the economics of it also. There’s need out there that’s not being fulfilled, and in part it’s because of the changes. That we’ve effectuated regarding credentials and language and tying into that 99% because the medical community needs us tremendously.

Folks. They need us, they don’t know what to do. But one of my cousins is a PhD in medical sociology and he does research for big pharma. He actually studies the utilization of drugs. For big pharma and he was working. He’s working on new types of drug classes, and these are opiates, let me rephrase that.

These are serious pain management drugs without opiate issues. So when you look at why the medical community right now is starting to even consider us, they want to get rid of the opiate issue. But big pharma has come up with other pain solutions. No opiates. Now there, I’m sure there’s gonna be other side effects of that, and I’m sure the next generation will have to deal with that.

But right now we’ve got a window to walk right in and grab those referrals and grab them. And yes, it’s about pain. Am I suggesting you only treat pain? No. That’s your choice. Hey, I’ve had patients who’ve lost their hearing, who are asthmatic, who had eczemas, who had breach babies. . I’m not suggesting you treat any of those except if you want to and it’s within your scope, that’s your choice.

But if they don’t come into your office, you don’t have anyone to treat. And the reality is the gateway to the majority of those other maladies are through people coming in with pain and then you educate them any way you choose. There is so much evidence in the literature coming down, folks so much.

It’s become so easy to explain all this stuff. I. It’s just easy when I sit in a meeting with neurosurgeons and neurologists and vascular neurologists and orthopedist, and neuroradiologist. I’m have, I’m a peer with them and the majority of the time I’m teaching them, I’m actually teaching them about their specialty and the minutiae of their specialty.

Hey, I don’t know how to cut. That’s not what I do. I don’t know how to give anesthesia. That’s not what I do. I know how to better identify that lesion for them to know where to cut, when to cut, when not to cut, and when to refer out for conservative care. And that’s what they want to know. They’re missing it.

They don’t understand if it’s not fractured tumor infection or herniation. It’s a nonspecific back pain. You gotta give ’em drugs. No, those Medrol dose packs are useless. Those muscle relaxers are useless. All of those things. It’s not even a bandaid usually. It doesn’t even touch the problem. They’re looking for issues, and there is a growing sect of neurosurgeons who won’t even see a patient unless they see the chiropractor first and use an analytic on them to determine, and there are tools to give us analytics of where the primary lesion is.

Right now the best tool in the industry is something called Verta, S-Y-M-V-E-R-T-A. Go look it up. If it’s an analytic tool that’ll tell you where the primary lesion is, when to adjust, when not to adjust. Because if you’re relying on motion palpation or static palpation, that has failed intra and interrater reliability, and this is all based upon an X-ray, which has zero negative effect for diagnostic x-rays that we take.

I’ve had con, we’ve had seminars on that before and we’ve talked about that at ad nauseum. But it will tell you in a highly predictive, reproducible environment, when to, when not to adjust where to where not to, but again, folks, it’s barriers, credentials. Language. You’ve gotta work with people who, it’s if you’re talking to someone in a different language from a different country, it’s not gonna work.

They’re gonna say You’re an idiot. Maybe not to your face, but in their mind that’s what they’re thinking. But you’re not using accepted terminology. Subluxation is a great term, philosophically. It’s wonderful. It’s real. Biomechanical pathology or neuro biomechanical pathology is the exact same thing.

It’s accepted. It works, and it’s filling offices in an honest and an ethical environment. Use it interchangeably, teach it, but communicate a little bit differently and start understanding your audiences and what their needs are because they got what you want. You have the solution to what they need and that will help.

But listen, I know this isn’t gonna be the most popular conversation I’ve ever had, and that’s okay. I’m not about being popular. I’m about filling your offices. That’s all I care about. I have no skin in your game other than I want chiropractic to win because then people win. That’s my only skin in the game.

So are you willing to evolve to the future in a drugless environment, no drugs, no surgery where it’s not indicated using your hands or anything else within your scope to help the masses of people. And that’s all I care about. Hey folks, I’m Dr. Mark Studin. I’d like to thank you so much for the time to allow me to share this with you.

I’m Dr. Mark Studin. I’d like to thank ChiroSecure for the opportunity. To share this information and to give me a an uncensored and unfettered forum for the betterment of chiropractic. I look so forward to seeing you next time. Thank you and have a great day.



Click here for the best Chiropractic Malpractice Insurance?



Get a Quick Quote and See What You Can Save