Lancaster Back and Joint Clinic helps athletes react quicker and compete better

Pictured from left are Diran Lancaster, DC, Kellie Timberlake-Lancaster, DC, 8-time world- champion cowboy Roy Cooper, and 7-time world-champion cowboy Larry Mahan.

Few sports are as brutal to the body as rodeo. Participants occasionally end up trampled by an angry bull—1,500 pounds of USDA prime mean, as thrown riders sometimes say. And getting bucked 15 feet into the air by a snorting, kicking equine none too fond of passengers is par for the course.

But though they endure enormous punishment for the sake of their sport, rodeo cowboys count themselves fortunate if they find themselves in or near the town of Decatur, Tex. That’s where Diran Lancaster, DC, works his wonders to help put those bronco-busted and bull-whipped athletes back atop their wildly unstable mounts and get them once more riding at their best.

Lancaster has been aiding rodeo stars and “wannabes” for more than a decade now. What’s surprising about his cases, though, is that it’s not—as you’d expect—the guys thrown off the horses and bulls who most frequently need chiropractic attention. Instead, it’s the ropers—men and women competing to see who can lasso and hog-tie a calf or adult steer the fastest. Roping is technically less jarring to the body than bronco or bull riding. Nevertheless, ropers suffer musculoskeletal injuries aplenty.

“The biggest source of problems for ropers is actually riding in their cars and trucks from one rodeo to the next,” Lancaster says. “They might travel a thousand miles in a single weekend, and from that they develop chronic low back pain, chronic neck pain, and other complaints.”

Increasingly, Lancaster’s rodeo patients are coming to him beforehand, in preparation for their events.

“When I first started working with rodeo cowboys, they usually saw me only after an injury,” he says. “Now, more than anything else, they come to get their body loosened up so they can react quicker, compete better, and, when they do become injured, to recover faster.”

A Box of Viable Techniques
Lancaster, with his wife, Kellie Timberlake-Lancaster, DC, operates Lancaster Back and Joint Clinic, a two-office practice that sees upward of 800 patients per month—only a comparative few of which are rodeo athletes.

“We treat all types of athletes, but also nonathletes,” says Lancaster, who is among a small cadre of Texas chiropractors certified in neuromuscular re-education.

Pictured in the back row are Kellie Timberlake-Lancaster, DC; Elizabeth Gaston, RMT; Heather Williams, RMT; Chrystal Romines, RMT; and Denise Selby, clinic director. In the front row are Diran Lancaster, DC, and Jay Daniel, director of physical medicine and rehabilitation.

Kellie Timberlake-Lancaster is the area’s lone female chiropractor (a distinction that gives Lancaster Back and Joint Clinic an edge in efforts to attract patients who prefer to be under the care of a woman). She is also a big believer in the role proper nutrition plays in musculoskeletal performance.

Adjusting techniques employed by the couple include diversified, activator, and Leander, with a smidgen of Thompson thrown in for good measure. Lancaster also has a few moves he’s developed on his own over the years for anterior work and the adjusting of rib heads.

“My hobby is fly fishing, and I’ve got a tackle-box full of lures,” Lancaster says. “Every one of those lures will catch a fish—provided, that is, the right one is cast in front of the right fish at the right time. Chiropractic is the same way. Every adjusting technique is a good one. You just have to make sure you use the right one on the right patient at the right time.”

Many of the patients seen by the Lancasters prefer to tender cash. About 30% of revenues currently derive from that form of payment. The remainder comes from a mix of insurances that varies by office.

“Our office in the town of Bowie is 30% managed care and 30% Medicare, while our Decatur clinic is 50% managed care and 10% Medicare,” says Timberlake-Lancaster, adding that the two sites together collect roughly 10% of their income from personal injury and workers’ compensation payouts.

The Lancasters insist they’re not actively pressing for more cash cases and less insurance; the mix they now have works just fine.

“We want to be able to offer both types of payment arrangements,” says Lancaster. “Patients who have insurance with a chiropractic benefit want to be able to utilize it; they tend to go elsewhere or to have psychological difficulty getting well if you tell them, ‘No, sorry, you can’t use your insurance here because we only accept cash.’ ”

Separate Influences Draw Lancasters to Chiropractic Kellie Timberlake-Lancaster, DC, is the daughter of Dallas-based chiropractor Bill Timberlake, DC, past-president of the Texas Chiropractic Association. He was at the helm of that organization when legislation was passed some years ago to compel insurance companies doing business in the state to reimburse for chiropractic services. She says it was he who inspired her to become a chiropractor. “I never considered any other profession but this,” says Dallas-born Timberlake-Lancaster. Her husband, Diran Lancaster, DC, was born in Lubbock, Tex, but was raised mostly in the Lone Star State town of Bowie, where their practice’s flagship office is located. Lancaster was drawn to a career in chiropractic after sustaining a chronic injury to his shoulder while playing football at Texas Tech University and then subsequently experiencing symptomatic relief at the hands of a DC. “My injury wouldn’t respond to any allopathic medical treatments,” he says. “I was complaining about that one day in the gym, and a local chiropractor who happened to be there overheard me. He invited me to come by his office. I figured, why not? So I went to see him and was able to get relief.” Lancaster credits the mobility gains he derived from chiropractic treatment in 1990 with helping him to not only make a speedy return to his sports but also to go on that year to become state champion and national collegiate silver medalist in Olympic weight lifting. “At the time, I was an undergraduate working toward a degree in exercise physiology and thinking about a career in physical therapy or perhaps something else in health care,” he says. “But my personal experience with chiropractic convinced me to instead make that my career choice.”

Out of Room
The Lancasters have been in practice together since 1993. That is the same year Diran Lancaster completed his training at Parker College of Chiropractic in Dallas, where the couple met (Timberlake-Lancaster graduated from there in 1992). In 2001, with the opening of the second office, the couple gave up their habit of working side by side. Now, they’re apart, with Lancaster exclusively manning the Decatur site and Timberlake-Lancaster solely at Bowie.

Back in the days when the Lancasters were under a single roof, new patients were assigned for initial intake to whichever doctor had an opening (unless a patient asked for one of them specifically, or if the other’s expertise was more appropriate for the indications presented).

“We each developed our own niches,” says Timberlake-Lancaster. “Dr Diran is gifted with athletes, so the acute sports injuries usually went to him. On the other hand, elderly women loved coming to see me because I liked sharing recipes.” Kidding aside, the women—and many men, too—sought Timberlake-Lancaster for her skill in handling chronic pain.

The reason the Lancasters opened that second office was because of growth.

“We were out of room in our Bowie office,” says Timberlake-Lancaster, explaining that she and Lancaster started with a 1,500-square-foot space that was later expanded to 2,200 square feet with the addition of a rehab room. “We figured we had two choices: either expand the Bowie office again, or add a second clinic.”

They opted for the latter after a demographic analysis revealed that many of their patients lived in or near the town of Decatur, about 30 miles away. The Lancasters felt an office there would relieve the crowding at Bowie and, owing to the convenience of location, attract plenty of new Decatur patients.

Ironically, Decatur is where the Lancasters expected originally to open their first office. It didn’t work out that way due to an unavailability of space in Decatur—and to a golden opportunity in Bowie real estate.

“By setting up shop in Bowie, we were able to start out in practice owning the building,” says Lancaster.

That was no easy feat. The Lancasters were turned down by 14 different lenders before at last finding a bank willing to finance their dream. And they likely would have been denied by that one, too, except that a well-connected rival chiropractor in town used his influence to persuade bank officials to grant the Lancasters a mortgage.

“You could call that friendly competition,” says Lancaster, who discloses that the other bankers rejected his applications for want of collateral (“I owned an old pickup truck and a dog, and that was about it”) compounded by his carrying of significant debt in the form of tuition loans.

Adding a Surgeon to the Mix
While the bank financing was enough to buy the office, the Lancasters at the time had barely enough capital to outfit it.

“We started with nothing snazzy—just a couple of adjusting tables, a few pieces of therapy equipment, and our hands,” Lancaster remembers.

On the plus side of the ledger, the rural nature of the Bowie market played to the Lancasters’ financial advantage. The cost of living—and, by extension, the cost of doing business—was cheaper there than in the big cities, so the clinic had an easier time launching and sustaining itself.

Kellie Timberlake-Lancaster, DC, demonstrates her technique on a patient.

During the years the Lancasters worked in one location, the practice was purely chiropractic-focused. Since adding the second office, they’ve gone multidisciplinary. Now, at both locations, they have massage therapists who provide services on a near-daily basis. And, once every other week, an orthopedic surgeon from Presbyterian Hospital of Dallas drives out to the Decatur office to see Lancaster patients.

“Having an orthopedic surgeon working in our office has been great for our patients who can’t manage the long trip to Dallas for the kind of presurgical and postsurgical care that’s otherwise available only in a city that size,” says Lancaster. “Patients still have to go to Dallas for the actual surgery, but at least they’re spared all the before-and-after travel.”

The surgeon is spine specialist Bernie McCaskill, MD. He’s an old friend of Timberlake-Lancaster’s father, Bill Timberlake, DC (who’s still in practice in Dallas). Says Lancaster, “Dr Kellie’s dad often referred to Dr McCaskill. When we went into practice, we also began referring to him. We liked that he was a very conservative doctor whose approach was to employ surgery only when absolutely necessary.”

The Lancasters refer to McCaskill patients who are nonresponsive to chiropractic care or whose initial evaluation indicates right off the bat that orthopedic intervention is necessary. Even so, McCaskill’s practice remains completely separate from Lancaster Back and Joint Clinic.

“He pays rent, and that’s all,” says Lancaster.

You’ve Got Email
Right from the start, the Lancasters made a habit of offering services that other chiropractors didn’t. “For example, one doctor in the area accepted insurance but made it the patient’s responsibility to submit the claim. So we told our patients not to worry, that we’d fill out the claims paperwork for them and handle it from there,” Lancaster says.

The Lancasters even went so far as to pick up patients whose lack of reliable transportation prevented them from coming to the office.

Seeing little merit in using paid advertising to attract patients, the couple prefers building their case volume through referrals.

“The best advertising is to get somebody well; if you do that, people will tell their friends and family, many of which will come see you,” says Lancaster.

The duo helps keep the clinic’s referral machinery well-oiled by periodically issuing email blasts. These are short but informative text messages sent to every patient who has a home or office computer (or a certain type of cell phone) and a connection to the Internet.

“It’s inexpensive and a great way to communicate with patients,” says Timberlake-Lancaster. “The email blasts I send out focus on wellness topics. As an example, I’ve written about recurrent back pain and the role poor nutrition plays in that process. I include pointers on what to eat, what not to eat, supplementation, and so forth.”

New patients are culled as well, via appreciation activities the clinic conducts once each quarter. During one of these, the Lancasters and their staff recently visited a local high school, where they treated teachers to massage therapy, chiropractic education, and nutritional counseling.

“It was an opportunity to do something nice for the teachers, but also to provide them with information about chiropractic in general and about us specifically,” says Timberlake-Lancaster.

The Lancasters also generate interest in their practice through their community involvement. A short time ago, the two offices served as drop-off points for contributions of canned food and electric fans that subsequently were distributed to a local mission serving the needy.

“This was a patient-appreciation-day activity where services were provided to established patients in exchange for donated items,” says Lancaster, adding that this type of endeavor is “a way to show support for our community, to let people know that we’re part of things, that we’re here, and that we care.”

Family Values
Annually, the Lancasters set goals regarding the number of patients they will see. Their current target is to bring in 60 fresh cases per month. If they achieve that goal, they can expect to be very busy during the 31¼2 days the offices are open each week.

When the Decatur office first opened, Lancaster was there from 7 am to noon and then from 2 pm to 6 pm every weekday, plus from 9 am to noon on Saturdays. “I pared it back when I realized those hours were preventing me from taking care of more important things, like helping my oldest son, Pierce, with basketball, Little League and fishing.”

Pierce is now 8. The couple have one other child, a boy, Dane, 2.

“We know our kids won’t stay little like this very long—the moment is fleeting—and Dr Diran and I have decided we’re not going to miss out on any of it,” says Timberlake-Lancaster. “We have thriving clinical practices and are blissfully happy in them, but we’re not about to sacrifice our family for that.”

Even so, the Lancasters are toying with the idea of constructing a larger building in Bowie to accommodate further growth. Nothing’s definite yet, but if they opt for it, a new home for Lancaster Back and Joint Clinic will almost certainly feature state-of-the-art equipment throughout. Don’t expect, though, to see a hay-bale-lined arena out back with pens, chutes, and other rodeo paraphernalia. Those things won’t be necessary to attract cowboys in desperate need of quality musculoskeletal care. CP

Rich Smith is a contributing writer for Chiropractic Products.