To start a nutritional sports/athletic niche, learn to bundle your products and services into one care package for the patient

In business, we all value time and energy. Trying to maximize them is key to success at any endeavor, including chiropractic practice. It takes a lot to see your practice as a business that sells products in the marketplace. Many fear “diluting the message of chiropractic” and are apprehensive when it comes to selling products in the office. One thing must be realized: The adjustment is a product—a very powerful one at that—but it is no different than, say, recommending Omega-3 fatty acids. I concede, however, that soul-searching is required by some on this.

Personally, I cannot tell you all of the things I experienced to achieve a needed metamorphosis. I found that I needed to reidentify myself as a person, not merely as a chiropractor. I threw off the shackles the “identity” had me locked in (I am a chiropractor) and found out that instead of being locked in (even to a mode of practicing one way), I was free to explore other options. One of those options was to leave the profession entirely, but this is a discussion for another time and topic. I am engaged in a niche sports chiropractic practice where we deal with nutritional issues quite frequently.

One of the questions most frequently asked by patients active in a sports lifestyle is how they should eat or what nutritional supplements they should be taking. The list of products can be endless. Although you or I may not be experts in the field of nutrition, you can take a common-sense approach to nutrition just like you have in other areas of practice.

I’d like to convey the idea of repositioning yourself in the community as a doctor who provides products and services, among them nutritional supplements and counseling. I feel the best market for this is a sports chiropractic practice, because supplements have intrinsic value to the sports model and are relatively easy to implement. Also, you do not have to have exhaustive knowledge of nutrition to see the kind of results that will motivate both you and your patients. Success relies heavily upon your ability to assimilate and disseminate information well.

Let me lay the groundwork for establishing a practice conducive to a sports mentality in the doctor and patient. Having been in a strict “subluxation/neurology- based” practice for almost 20 years before my hyperspace jump into a “biomechanical/structural”-based practice, I bring a fresh perspective and understanding of what is needed to market yourself in that direction.

Establish a Sports Chiropractic Practice
Start out by taking small steps; remember that marketing is key. Not only do you need to know what you are selling but you also need to know to whom you are selling. For instance, marketing your practice as a geriatric practice without taking Medicare would be foolish. It would be equally foolish to position yourself as a sports chiropractor without products and language relevant to success in that niche. You also need to know the mechanism of the products (including your adjustment) and their effectiveness on your patients’ conditions. It is crucial to know when it is appropriate to recommend a particular step or product in the patients’ care plan.

I suggest that you start out with basic ideas and tools as you work toward a fully functioning sports chiropractic practice. You can do the following with relative ease: measure the foot type; recommend appropriate running/sports shoes; give the initial exam a unique name (in our office, we call the initial exam The Structural Fingerprint Exam™); and direct them to footwear product guides with a chart on which manufacturer makes which shoe for each respective arch type, such as pronated, supinated, or neutral.

The bottom line is that for everything you recommend—whether it is orthotics and adjustments or nutrition and soft-tissue management—at some point, you are going to have to address the strategy of that component. One component that needs to be added to the sports-minded patients’ care plan is nutrition. Runners, weight lifters, and the garden-variety athlete have similar needs. You are trying to affect muscle regeneration, function, flexibility, and endurance. Specific nutrition may be required, and some special-needs cases will present themselves, but overall nutritional recommendations you make should be simple.

Architectural Versus Neurological
To move to a sports chiropractic niche practice, you must re-evaluate your emphasis and patient education. I think it is nearly impossible to have a nervous system-based practice and rely heavily on the subluxation model, while trying to appropriately serve the needs of the sports- minded/athlete patients. For them to understand what you are doing and stay competitive in their respective venues, they need to see chiropractic from another perspective, and so do you. Teach it from a ground-up structural/biomechanical point of view. This is something patients can see, feel, touch, and grasp a lot easier than trying to comprehend the nervous system. Products (including that pivotal spinal adjustment) are essential.

Remember, the athlete’s mind is steeped in somewhat of a different psychology. They are mindful of the buildup and breakdown toll on their bodies by the respective activities they do. As the clinician, you need to be prepared not only from a chiropractic model, but also from a nutritional model. Introducing the appropriate nutritional product and recommending what to eat and when fall under the category of marketing as well as clinical. Remember, you are dealing with a niche market—a captive audience, so to speak. And, while you may believe that they are an “easy sell,” you must be aware of this reality: Spinal adjustments as a stand-alone care package are not the only product they want or need. Learn to bundle your products and services into one care package for the patient.

Also, don’t forget to network. Local gyms, running clubs, and, of course, high school sports programs are great places to start. Set up a meeting with the athletic director of an area high school. Tell him or her why you are the best doctor available to screen the school’s athletes for potential injuries. Inform him or her that you have a program for total structural balance and function.

Nutritional Supplementation: What and When?
Change is a hard-won spoil in the “war on running a good business,” but it is necessary. The idea of it is daunting to many of us. However, people who are successful in business and stay in it for the long run have learned that change is the difference between success and failure.

Just do it. Like anything else in business, you need to blow it a few times before you succeed. The Nutrition Guideline Food Guide for Marathoners, 3rd Edition, and The Cyclists Food Guide, both by Nancy Clark, MS, RD, are very good. These books will give you a good outline of the important foods and their impact on athletes.

Get under regular chiropractic care immediately. Cleave yourself to an athlete in some way, shape, or form; or at least get serious about an exercise/stretching program. Being fit is good for your own health. Besides, a person wants to go to a doctor who they believe is successful and looks it. Get into shape for the health aspect.

Get on some basic nutritional products yourself: antioxidants, omega-3 fatty acids (fish oil), and vitamins C, E, and B. In our office, we offer patients whole-food supplements and we take them as well. You need to use at least some of the products you offer (including your “one of a kind” adjustment that you get from your colleague down the street) to your patients.

Whatever products you have to sell to your patients, do not hesitate to display them out front. While patients are sitting in the waiting room, they will begin to get the idea that you are different and that they may be asked to consider purchasing products. This sets the stage for a more compliant patient. Most people are smart enough to expect to pay for products on their own and not rely on insurance to pick up the tab. This way, when their insurance does in fact run out, they will be less likely to balk when they are asked to pay for their care. They are already used to paying for things in your office, and since you have learned to position the adjustment as a product along with the muscle tools, rehab, custom orthotics, and nutritional supplements, it is less likely to be a problem. All this creates needed cash flow and primes you for the possibility of an all-cash practice.

Nutritional Needs of the Athletic Patient
The following list of nutritional products can be made available to your patients. You will find suggestions as to when it is an appropriate time to introduce them into your patients’ care packages. One of the ways you can do this in a professional and authoritative way is to consider hooking up with a company to create custom blends of different products. The company we use makes the products that are geared toward what your specific understanding is and what you find your patients’ needs to be. They know their business and will hold your hand throughout the process.

In the case of custom blends, you create your own labels and then slap them on the bottles. Here is where you create the position-of-strength image that you need in sports/nutrition chiropractic: a doctor that has his own line of products. Before you do this, however, you need to spend some time reading up and mixing and matching. Establish some cases in which you have been able to repeat the results. Other companies are out there that will slap your label on their product for a fee.

Here are some of the custom-blended nutritional products we use in the office, as well as what they do and when I think it is best to use them:

Bromelain: This is a general name for a family of sulfhydryl proteolytic enzymes commercially obtained from the stem of the pineapple plant.

Some of bromelain’s actions include: inhibition of platelet aggregation, anti-inflammatory action, digestive assistance, enhanced wound healing, and cardiovascular and circulatory improvement. Bromelain is well-absorbed orally, and it has been demonstrated to be a safe and effective supplement.

Bromelain helps in the treatment of inflammation and soft-tissue injuries. It is a protein, easily metabolized and non-toxic. It can be taken anywhere between 200–2000 mg with no side effects and no tolerance buildup. It enhances the absorption of and improves the action of other substances when they are administered in combination. In our office, we have created a custom-blend product of 600 mgs of bromelain and 250 mgs of suma. This is a natural anti-inflammatory and rapid fiber developer. Suma has long been recognized as effective in rapid fiber development. It can be used at any time in the patients’ care plan, preferably after acute care has ended and they are back on an exercise/workout routine

Calcium/magnesium: These are two critically important minerals for normal muscle function. With muscle injuries, either from overuse or trauma, the relaxation/contraction mechanism is disrupted, producing abnormal muscle function and a delayed recovery. Also, a noncompliant muscle will have chronically contracted fibers, unable to fully relax. Calcium/magnesium supports and promotes the normal relaxation and contractability of a muscle and its fibers.

Calcium is essential for muscle activity because it causes the actin and proactin fibers of muscle to contract. The little channels, called t-tubules, draw the electrical activity, in the form of calcium and magnesium, into the depths of the muscle fiber to facilitate this. (Calcium causes the contraction, and magnesium the relaxation.) Without the calcium, no muscle contractions can occur. It is important to have a calcium/magnesium product available that is easily absorbed and easily flushed out of the muscles. We combine 500 mg of calcium carbonate, citrate, and amino acid chelate with 250 mg of magnesium oxide, citrate, and amino acid chelate to accomplish this in our product. We also add the following catalysts and buffers: Vitamin D, boron, and betaine hydrochloride.

Calcium/magnesium can be used at any time in the patient’s care plan, provided there are no contraindications or interactions with medications. It is preferable to use it in conjunction with a muscle-cleansing tool once the patient is out of acute care.

Glucosamine HCL joint formula: Glucosamine is an amino sugar that is naturally produced in humans. It is easily used by the body, and when taken orally, it has an absorption rate of almost 90%. Glucosamine is a basic building block in the production of proteoglycans, hyaluronic acid, and glycosaminoglycans, all of which are the foundation of tendons, ligaments and cartilage.

Glucosamine comes from shellfish because of the abundance of the cellulose-like biopolymer called chitin. Supposedly, glucosamine derived from shellfish is purified and therefore should not cause a hypersensitive reaction in individuals with shellfish allergies. Glucosamine provides anti-inflammatory activity and has been shown to increase proteoglycans, facilitating joint repair. It helps to thicken synovial fluid and make it more elastic.

There are no known toxicity levels that make this product a safer alternative to medicine. Dosage varies from 500–2000 mgs, but the most common dosage is 500 mgs, three times per day. The product we use is a custom blend combination of 1,500 mgs glucosamine HCL, 5 mgs trans-resveratrol and 450 mgs Cox-II inhibitor herbal blend: Feverfew leaf extract, hops, standardized extract, and turmeric rhizome. Trans-resveratrol, found in red wine, has been found to have anti-aging properties. It is best used after acute care and during rehabilitative care, provided no suspected shellfish allergies or other contraindications exist. It is preferable for patients with advanced joint degeneration or severe injuries to joints, or for patients who regularly undergo repetitive traumatic activities. CP

John Michael Gentile, DC, practices in Latham, New York. Contact him at drjohn@logical.net.