Building a secondary profit center with orthotics to benefit your patients and practice

Building a successful profit center of adjunct products can be easy if you implement this trade secret: carry only the products you believe in. It does not matter whether you offer nutritional analysis and supplements, weight management products and counseling, cervical pillows, cold packs, postural supports, or orthotics. If you believe a product or service benefits your patients, you can better communicate to patients how the product or service enhances their chiropractic care. The better the communication, the more likely your success will be. The result is a healthier patient and a financially healthier practice.

Finding Stable Ground

Certain types of custom-made orthotics can fit into every chiropractor’s treatment goal: structural stabilization. Orthotics that are specifically designed to stabilize the spine and pelvis—hence the entire body—are more often used by chiropractors for stabilization than to treat foot pain.¹ Therefore, it can be a valuable profit generator for practices.

Figure 1. Patient with low back pain most commonly presents with pelvic unleveling

Creating a symmetrical foundation is crucial because even a 3% difference from one side to the other contributes to the serial distortion that transmits through the lower extremity, which results in pelvic unleveling.² This pertains to the excessively supinated (high-arched) foot³ as well as the more common pronated (low-arched) foot (Figure 1).

Body stabilizing orthotics help correct abnormal foot position and motion by supporting the arches of the foot in a more normal weight-bearing position to reduce the dynamic stress and strain on the foot, ankle, knee, hip, and spine.⁴ Offer orthotics that support the three arches of the foot: anterior transverse arch, medial longitudinal arch, and the lateral longitudinal arch.

Orthotics can also be used to reduce pain. The most common condition chiropractors treat is acute low back pain, and as a general rule, we often take anterior-posterior (A-P) and lateral X-rays of the lumbosacral spine. The most common structural presentation seen on the A-P film is an unlevel pelvis coupled with rotational patterns of the pelvis. This is so common that, according to my observation and the responses from my seminar attendees, more than 80% of low back pain patients present pelvic unleveling (Figure 1). If serial distortion, which starts in the foot/ankle complex and contributes to unleveling, is not addressed, then pelvic leveling and structural stability will not be reached—even if the symptoms abate.

Ora Friberg, MD, a Finnish orthopedist, presented a study in Spine showing that 75.4% of patients with low back pain had a leg length inequality (LLI) of 5 mm or greater.⁶ An unlevel pelvis is always accompanied by muscle imbalance (Figure 1).7 Based on my clinical examinations and patient history, I concluded that only 5% to 10% of LLIs are caused by a true anatomical short leg. The most common cause of pelvic unleveling is a biomechanical aberration in the foot/ankle complex, knee, hip, and/or pelvis. Nearly all of these aberrations can be corrected or controlled using stabilizing orthotics.

A survey⁷ by the American Chiropractic Association reports that the average chiropractor sees 26 new patients per month. If only half of those patients were examined for and showed indications of foot deficiencies and spinal-pelvic instability correctable with orthotics, you could easily calculate your net profit (Table 1).

Active Assistance

As treatment plans move from passive care, adjustments, and unassisted physiotherapy modalities, toward active care—adjustments and conditioning and work hardening exercise programs, added focus is placed on increasing structural integrity in addition to decreasing acute and chronic pain. Check the five target areas that indicate signs of structural asymmetries (Figure 2) and clinically address any problems to help the patient achieve structural stability. These areas are used in an evaluation of gait, shoes, and feet. Have the patient walk toward you and check for in-toeing or out-toeing. Look at both knees to see whether they rotate inward. Examine the Achilles tendon at the back of both legs—they should be parallel to the floor, not bowed. Checking the medial arches can detect flexible pas planus. Finally, examine the patient’s shoes for signs of uneven wear.

Figure 2. Five target areas for spotting structural imbalance.

Ask patients about problems in their ankles, knees, and hips. Objective evidence obtained through observation and functional testing supports the need for care and reassures patients that you have considered every possibility.

Explain to your patients that a 5- to 10-minute adjustment is usually insufficient to overcome long-term osseous malalignments, soft tissue imbalances, postural faults, and counterproductive lifestyle habits. The patient’s body grows accustomed to experiencing these conditions as normal. After the adjustment, the body wants to return to the malaligned state. Flexible orthotics provide correction between adjustments to help train the body into structural alignment.

Your CA can be helpful in fitting and selecting the best orthotics for your patient. To determine the best support for structural alignment, make sure the patient has orthotic support no matter what kind of shoes they wear. A combination order of one pair of full-length (for lace-up shoes) and another pait of 3/4-length (for dress shoes) orthotics should be ordered.

Finally, support your recommendation with plenty of patient educational material. A simple display with sample orthotics and brochures goes a long way in helping patients understand its value. Patient-geared audio and video tapes explaining orthotics as enhancements to chiropractic care provide an introduction to open the door to question-and-answer sessions.

When you know the products will benefit your patients, your profit center focus moves from just selling to confidence-backed recommendations and patient education.

About the Author

William M. Austin, DC, CCSP, CCRD, has developed practices in Connecticut and Arizona. He serves on the postgraduate faculties of Northwestern College of Chiropractic and Cleveland Chiropractic College. He can be reached at 800-553-4860, ext 3108.

References

1. Jacobs GE, Hulbert JR. Northwestern College of Chiropractic (NWCC), Summary of Market Research Findings: Surveys of Chiropractors and Patients. Bloomington, Minn: NWCC; 1997.

2. Blake RL, Ferguson HJ. Correlation between limb length discrepancy and asymmetrical rearfoot position. Journal of the American Podiatric Medical Association. 1993;83(11):625–633.

3. Carpintero P, Entrenas R, Gonzalez I, Garcia E, Mesa M. Spine. 1994;19(11):625–633.

4. Wu K. Foot Orthoses: Principles and Clinical Applications. Baltimore: Williams & Wilkins; 1990:97.

5. Friberg O. Clinical symptoms and biomechanics of lumbar spine and hip joint in leg length inequality. Spine. 1983;8(6):997.

6. Kendall HO, Kendall FP, Boynton DA. Posture and Pain. Malabar,Fla: Krieger Publishing Co; 1985:113.

7. Goertz CH. Summary of the 1997 ACA Statistical Survey on Chiropractic Practice. Journal of the American Chiropractic Association. 1998;11:32.