Remind your patients that we are looking at them as architectural structures

There are three kinds of chiropractors—those who don’t recognize the benefits of custom orthotics; those who recognize the benefits, but don’t know how to sell them; and those who recognize the benefits, and know how to get a patient to want and pay for them, even when insurance won’t cover the cost.

To become accomplished in this area, a chiropractor must first recognize the need for custom orthotics. The goal we have for all patients who begin care in our office is threefold: improve overall structural balance, increase joint mobility, and improve muscular flexibility. To accomplish these goals, several issues must be addressed.

The Calendar and the Scale
The first issue is time. The patient must recognize that chiropractic care is a process, not an act, and that time is needed. We generally begin with a 6-month time frame, but other chiropractors have no problem letting the patient know it can take 1 year or longer to reach maximum benefits.

The second issue is structural balance. No structure can have maximum balance unless the very foundation upon which it sits is addressed. In general, we estimate that 80% of the population pronates and 10% supinates, so at a minimum, 90% of the population requires some type of orthotic to ever hope to improve balance from the ankles up.

Reasoning in Triplicate
When explaining the need for orthotics to a patient, I offer three reasons. The first is to create a symmetrical foundation of the feet. I use a simple hand gesture to give the patient a visual understanding of arch support, or the lack thereof (cupped hand on table for arch support, flat palm for arch collapse).

The second reason is to provide shock absorption. If shock is being absorbed by the orthotic, that reduces the amount of shock that is being absorbed by the patient. Over the course of one’s lifetime, this should dramatically slow down the wear and tear of all joints in the body. There is also a reduced incidence of injuries due to this reduction of stress.¹

The third reason a patient would benefit from orthotics is to improve sensory-motor reflexes. Research shows that patients who wear flexible, custom-made orthotics have an improved sensory-motor reflex.² Once a doctor is aware of these reasons for orthotics, the task of making the patient see the benefits becomes much easier.

Report of Findings
In my report of findings (ROF), I’ve taken into consideration all of the biomechanical distortions found on our Structural Fingerprint™ Exam. The feet now become the starting point for corrective care. If the patient is currently in acute distress, the discomfort must be addressed before any corrective work can be done.

We begin the ROF by reminding the patient that we are looking at him as an architectural structure. The tests we’ve done, including the standing x-rays, show a wealth of information and provide a predictability of sorts as to the status of that structure. We remind the patient that 90% of society lives with imbalances in the feet. We explain that one of our goals is to improve balance of the body, and this can’t begin until we address the imbalance of the feet. We use custom-made, flexible orthotics to provide this support for improved balance.

I then explain to the patient that there are different philosophies regarding the manufacture of custom orthotics. Many in the podiatric and orthopedic professions recommend custom orthotics; however, they generally measure the foot in a nonweight-bearing position. They call this a neutral casting. I tell patients, “Just as we took your x-rays in a standing, weight-bearing position, we also want to see the state of your arches in a weight-bearing position.” This explanation makes perfect sense to patients, as they have just gone through standing x-rays; and typically, we’re the first ones who have ever suggested that weight-bearing plays a vital role in structural wellness.

Another difference, I explain to my patients, is that podiatrists and orthopedists often recommend a rigid orthotic. As I put my fist into a cupped hand sitting on top of the fist, I explain that a rigid orthotic reduces the needed mobility of the foot during the gait cycle, which only increases the compensation of movement above the ankles. I tell the patient that podiatrists and orthopedists are not considering any of the body’s biomechanics above the ankles, yet reduced foot mobility has serious implications for all weight-bearing structures. In addition, rigid orthotics provide no shock absorption; therefore, I know I offer a superior product (flexible orthotics) and a superior means of casting a patient more logically (weight-bearing).

I close by telling the patient that the normal fee for rigid orthotics in my area ranges from $300 to $500, and this is more expensive than the pair of flexible orthotics I’m recommending for them. So, I recommend a superior product at a less-expensive price.

Bundling Your Services
In retail sales, it’s much easier for a person to buy when all of the products are bundled into one package, with one cost. In our office, we bundle the cost of care (which includes the cost of all treatments and re-exams) and the cost of additional products (such as custom orthotics, muscle re-education, cervical pillows, nutritional supplements, and the Intracell Stick, a tool the patient uses to clean toxins out of muscles and encourage blood flow to muscles) into one cost. We then provide the patients with options as to how they pay for that package.

For example, if the total fee is $2,000, we will show patients what an up-front minus 10% charge would be, what a 6-month payment plan would be, and what a 12-month—at 8% interest—payment would be. This gives them the option to fit a payment plan into their budget.

In addition, when you bundle your services and products, patients are steered away from selecting or rejecting individual items from the list. Psychologically, they want the end result you’ve described to them, and they recognize that the total amount you’ve shown them is what it will cost to get to that end result.

This approach works extremely well with cash-paying patients, and it can also work with insurance patients. If a patient has insurance, the doctor can easily subtract the insurance coverage from the final balance of the amount that would be owed by the patient. If the insurance balance is unknown, let the patient know what it would cost if the patient were 100% responsible, and tell them it can only be better than that. Once the insurance payments are known, the patient’s responsibility can then be figured out. The doctor will always do better if a payment program is put into place for the patient.

Structural Satisfaction
Structural wellness is much needed but minimally recommended, yet patients truly want structural longevity. Once a doctor obtains structural reference points on the Structural Fingerprint Exam, a program can be set up to improve the patient’s balance, mobility, and flexibility.

Most changes begin with the feet. Custom-made orthotics should be recommended to nearly all patients. Then, a period of time long enough to make structural changes should be considered. I like 6 months, because that is a realistic time frame to make good structural improvements. Once that time frame goes by, a lifetime of management needs to be the goal. Many people don’t think they want to continue with the management of their structural care, but management is the only avenue to a lifetime of happiness and health, which is what all of us truly are seeking.

Our profession needs to look beyond the symptoms and address the structural imbalances that plague nearly everyone. Once we are able to do this, the chiropractic profession should become the profession of choice in dealing with all structural problems. That will certainly be a day to rejoice.

Timothy J. Maggs, DC, specializes in sports and industrial injury management and is a graduate of the National College of Chiropractic. He writes and speaks at numerous engagements. Maggs can be reached via email: runningdr@aol.com, or via his Web site: www.drtimmaggs.com.

References
1. Yochum TR, Barry MS. Bone marrow edema caused by altered pedal biomechanics. J Manip Physiol Ther. 1997;20(1):56-59.
2. Stude DE, Brink DK. Effects of nine holes of simulated golf and orthotic intervention on balance and proprioception in experienced golfers. J Manip Physiol Ther. 1997;20(9): 590-601.