FOR CHIROPRACTIC Dr

Issue 16 News and Views for Canada’s Chiropractors

A BOLD FUTURE FOR CHIROPRACTIC Dr. Jan Hartvigsen sees potential to address gaps in the healthcare system Page 34

Issue 16 | Canadian Chiropractic Association | 2018 1 TAKE A POSTURE BREAK AND ENHANCE YOUR HEALTH IN JUST THREE MINUTES A DAY!

2 Issue 16 | Canadian Chiropractic Association | 2018 ISSUE 16 BACK MATTERS COLUMNS 6 Message from the Chair

8 Message from the CEO

14 Advocacy: One Step Closer: Empowering Chiropractors to Issue Disability 5 Staying within the lines Tax Credits (DTC) Certificates 18 Message from the CBO

20 Researcher Spotlight: Dr. Carol Cancelliere

Clinical Value of Assessing Lumbar CHECK IT OUT 24 Segmental Stiffness 12 Celebrating 75 Years in Saskatchewan

16 Celebrating 60 Years and Beyond in New Brunswick

22 CCGI Student Ambassadors Take the Lead

Sports and the Convergence of Chiropractic 26 Looking Back: CCA National Convention 30 & Tradeshow

37 Connecting Canadian Chiropractors Through Podcasts

38 CCA Endorses: Schoolbags from Beckmann of Norway & NormalizerTM Posture Pillows

Professor Hartvigsen Sees A 34 Bold Future For Chiropractic 39 CCA Plus: Your CCA Perks!

Issue 16 | Canadian Chiropractic Association | 2018 3 CONTRIBUTORS

TRACY BERTRAM Ms. Bertram is the Executive Director of the Chiropractors’ Association of Saskatchewan. She graduated from the University of Saskatchewan in 1998 with a Bachelor of Commerce Degree (with Distinction), with majors in Health Care Administration and General Business. Issue 16, 2018 Ms. Bertram has almost 20 years of experience working within healthcare, government and with professional associations. She has held various positions with the Saskatchewan Ministry of Health, the Ministry of Social Services and the Regina Qu’Appelle Health Region. chiropractic.ca [email protected] DR. CAROL CANCELLIERE, DC, PHD Dr. Cancelliere is a CCRF Research Chair in Knowledge Translation in the Faculty of Health Sciences, BACK Matters™ is a publication University of Ontario Institute of Technology, and the project lead for the Canadian Chiropractic of the Canadian Chiropractic Guideline Initiative. The objectives of this program are to develop, adopt or adapt clinical practice guidelines relevant to musculoskeletal health and disability, and to engage in knowledge translation Association (CCA) and is activities and research. She is a CMCC graduate (2004) and practised for 10 years in Saskatchewan, published two times per year. British Columbia and Ontario. Carol received her PhD in Clinical Epidemiology and Health Care Research from the University of Toronto (2017). Her research program also focuses on concussion (management and prognosis) and spinal pain in the Canadian Armed Forces. She Copyright © 2018 Canadian has received competitive awards from major national and provincial funding agencies. Chiropractic Association. All DR. GAELAN CONNELL, BHK, DC rights reserved. The opinions Dr. Connell graduated from CMCC in 2014. He works in a multidisciplinary practice in expressed in this publication Vancouver, British Columbia, and is a knowledge broker with the Canadian Chiropractic are those of the authors and Guideline Initiative. He also works with the CCA as a policy advisor and is a former Student Canadian Chiropractic Association president. Dr. Connell is currently undertaking a master’s do not necessarily reflect degree at the University of British Columbia in Rehabilitation Sciences. He has a keen interest the opinions and policies of in knowledge translation and implementation science. He is also passionate about running and has completed several trail ultramarathons over the past year. the CCA. Advertisements shall not be considered an DR. GREG DUNN, DC endorsement, warranty or Dr. Greg Dunn graduated from CMCC in 1976. He had an active practice in Manitoba until June 1999. Dr. Dunn served on the Board of the Canadian Chiropractic Protective Association (CCPA) guarantee of the product(s) or from 1990 until his appointment of COO in September 1999. While serving on the CCPA Board, service(s) advertised, nor an Dr. Dunn became Chair of the Risk Management Committee. Dr. Dunn is also a national and international lecturer on the topic of risk and risk management. Currently, Dr. Dunn serves as endorsement by the CCA of the CEO of the CCPA. Dr. Dunn is a past president of the Manitoba Chiropractors’ Association the manufacturer, distributor, and a past president of the CCA. Dr. Dunn has been very active in community volunteer work. He co-chaired the 1992 Manitoba Summer Games, was a founding member and first Chairman supplier or advertiser of such of the Beautiful Plains Community Foundation Inc., and was the leading force in getting Canada product or service. Post to issue a centennial stamp commemorating one hundred years of chiropractic in Canada. No part of this publication DR. JAN HARTVIGSEN, DC, PHD may be reprinted without the Dr. Hartvigsen graduated from Palmer College of Chiropractic in 1989 and earned his PhD in clinical epidemiology in 2001. Dr. Hartvigsen has worked in several roles at the University of Southern editor’s written permission. Denmark (SDU) since 2006: professor and head of the Research Unit for Clinical Biomechanics at the Department of Sports Science and Clinical Biomechanics, leader of the Graduate Program for Physical Activity and Musculoskeletal Health, and co-founder of the Center for Muscle and Joint Health. In 2017, he won Researcher of the Year from the American Chiropractic Association and the Published by the CCA David Chapmann-Smith Honorary Award from the World Federation of Chiropractic. Editor: Ronda Parkes DR. KENT STUBER, DC, MSC [email protected] Dr. Kent Stuber works in private practice in Calgary, Alberta, and is Editor-In-Chief of the Journal of the Canadian Chiropractic Association. He is an Adjunct Professor at Canadian Memorial Chiropractic College and is currently working on a PhD, focusing on patient- Tel: 416-585-7902 centredness. Kent is a Best Practice Collaborator in Alberta for the CCGI and has published Toll Free: 1-877-222-9303 more than 30 articles in peer-reviewed journals. He is also a keen volunteer for youth sports, particularly the teams that his sons play for. Fax: 416-585-2970

Publications Mail DR. FRANCES LEBLANC, DC Dr. Frances LeBlanc is the CEO of the New Brunswick Chiropractors Association and Agreement No. 40036842 chiropractor in Moncton, NB. Frances completed a bachelor’s degree and graduate studies in psychology at the Université de Moncton. She later graduated from the Canadian Memorial Return undeliverable Chiropractic College and completed a master’s degree in Public Policy, Administration and Law at York University. Frances is currently enrolled in CAE and MBA programs. Frances is a Canadian addresses to: passionate health advocate with a special interest in models of care and integrative practices. 186 Spadina Ave, Suite 6, Frances continues to support the work of numerous organizations, including as Chair of the NB Coalition for Pay Equity, member of the NB Advisory Board of The Arthritis Society, and as a Toronto, Ontario M5T 3B2 best practice collaborator for the Canadian Chiropractic Guideline Initiative, among others.

DR. SHAWN THISTLE, DC Dr. Thistle is a practising chiropractor, educator, international speaker, knowledge- transfer leader, entrepreneur and medicolegal consultant. He is the Founder and CEO of RRS Education, a continuing education company providing weekly research reviews, informative seminars, and convenient online courses for chiropractors, physiotherapists, and osteopaths MIX Paper from worldwide. For 14 years, he has been a part-time faculty member at CMCC in the Orthopedics responsible sources Department. His skillsets are strengthened by his experience in expert medicolegal reporting C011603 in chiropractic malpractice cases.

4 Issue 16 | Canadian Chiropractic Association | 2018 Staying within the lines Keeping a professional mindset in your practice

BY DR. GREG DUNN, DC CEO, CANADIAN CHIROPRACTIC PROTECTIVE ASSOCIATION

s chiropractors, we all place Our DC, who thinks of himself as a great emphasis on high- a friend to his patients, recently Remember to keep these Aquality care for our patients. received several complaints. While the steps in mind: The Canadian Chiropractic Protective chiropractor was treating the patient, Association (CCPA) regularly speaks he noticed a concerning neurological • Update informed consent with DCs who are passionate about each symptom but did not re-evaluate it. with any change to the one of their patients’ well-being. But As the symptom worsened for the patient’s treatment, it’s still worth reminding ourselves patient, the DC realized he never did symptoms, diagnosis or what factors go into providing our baseline neurological testing despite health status, using the patients with the best care possible the patient’s presenting symptoms. most recent version of the and giving ourselves a refresher on our The DC also didn’t advise the patient CCPA form. Revisit informed consent after a prolonged basic, professional obligations. of possible differential diagnoses nor absence from care. the potential natural progression of In our conversations with DCs, her condition. As she progressed, she • Ensure you record all positive we sometimes see the chiropractors’ linked her worsening symptoms to the and negative exam findings. focus drifting from these professional treatment she had received. It turns out • Document differential obligations — becoming so eager to that her condition is a degenerative one diagnoses and share them build rapport with their patients that that usually progresses regardless of with the patient. they stray from the doctor-patient intervention. However, the patient feels • Document treatment plans relationship. One DC we spoke to the DC did not properly discharge his and reassessment schedules. recently told us he sees himself as obligations as a doctor. a friend to his patients and avoids • Keep thorough SOAP notes referring to himself as a doctor. It’s Practices like appropriately obtaining and document each patient great to build the kinds of relationships informed consent, re-evaluating interaction at the time it occurs. with patients that make them feel more changing symptoms and advising comfortable. However, remembering patients about differential diagnoses are our obligations and rights within the examples of our obligations as DCs and, doctor-patient relationship will allow us frankly, as healthcare providers. As I to strike a balance that makes us more often tell our members, “If you’ve done successful and able to manage risk in everything you’re supposed to do as a our practice. practitioner, you have the right to be wrong. But you don’t have the right to steps that a reasonable practitioner But what do we mean by a doctor-patient miss steps along the way.” should take. Only you can be the doctor relationship? What are our professional in the doctor-patient relationship. obligations and how do we keep this top Patients will appreciate a friendly, of mind as we become more comfortable approachable attitude from their And remember that CCPA is here to and build rapport with our patients? DC. But in the end, they expect speak to you about any concerns you Let’s take a look at a real-life example professionalism. And this means have. Our claims officers are here to to help answer these questions. ensuring you have taken the appropriate help, even if there’s not an emergency.

Issue 16 | Canadian Chiropractic Association | 2018 5 MESSAGE FROM THE CHAIR

OUR TIME IS NOW

DR. GERALD OLIN, DC Chair, CCA Board of Directors

I am honoured to introduce myself as the new Chair of the CCA board. I look forward to working with all of you in the coming years.

board is only as good as the sum of its parts. I’m • Build Favourable Public Perception grateful to work with a team of amazing directors • Establish Chiropractic as a Healthcare Partner A from across Canada and appreciative of the opportunity to work closely with our new leadership team — • Enhance Patient Experience First Vice Chair Dr. Debbie Wright and Second Vice Chair Dr. Judy Forrester. • Demonstrate and Enhance Member Value

Now for those of you who haven’t met me – a little bit about • Champion an Engaged Chiropractic Community myself. I am a graduate of Northwestern Health Sciences • Enhance Internal Management and Resources University’s Chiropractic College. I returned to Manitoba shortly after graduation and, in 1998, established my multidisciplinary practice in south Winnipeg. I very quickly To achieve these outcomes, we will follow our strategic plan. engaged with the Manitoba Chiropractors Association, And we will work tirelessly to bring value to you, our members. working on various committees. Along the way, I developed a passion for providing chiropractic treatment for athletes, Operationalizing the plan requires a hard-working, engaged and which has become a significant part of my professional work. innovative staff. We are fortunate and appreciative to have a talented team led by our CEO, Ms. Alison Dantas. I had an extensive volunteer background before joining the CCA board. My primary focus was the regulation of Before looking ahead, I wanted to reflect on past leaders. chiropractic. I served in several regulatory capacities, We have been privileged to have had many leaders who including chair of the Manitoba Chiropractors Association demonstrated their dedication. They sacrificed time from their Standards Committee for four years. I was a board member of practices and families to help transform the CCA. I want to thank the Canadian Chiropractic Examining Board for eight years, past Chairs Dr. John Corrigan, Dr. Jeff Warren, Dr. Robert David, serving as chair from 2010-2013. I joined the CCA board as the and our most recent Chair Dr. David Peeace. I learned from each Manitoba Director in 2013. of them over the past five years and their insights will guide me.

I’m excited about my new role. I wholeheartedly embrace our Along with our board and leadership team, I look forward to mission, vision and values, and how they support the needs of supporting our advocacy efforts. These efforts help us forge the almost 9,000 licensed Doctors of Chiropractic (DCs) and stronger relationships with you, our members, and educate 10 provincial chiropractic associations. Canadians, government, the insurance industry, chiropractic academic programs, universities and researchers, and The CCA began a transformation in 2012, complete with a new chiropractic stakeholder groups in Canada and around the world. vision: ‘Chiropractors will be an integral part of every Canadian’s healthcare team by 2023.’ We are gaining ground and momentum is building. The CCA will continue to build favorable public perception of our profession To achieve this vision, we are guided by our and enhance the patient experience. We want Canadians to understand the value of chiropractic care and where we best fit mission, values and strategies, including: within the healthcare system.

6 Issue 16 | Canadian Chiropractic Association | 2018 We will continue to champion an engaged chiropractic community and enhance member value. In April, we hosted NEW CCA BOARD MEMBERS our largest and most successful national convention in Calgary, Dr. Jaipaul Parmar Alberta. Our next national convention — scheduled for 2020 in Dr. Jaipaul Parmar is a 2010 graduate of the Halifax, Nova Scotia — will build on those successes. We also plan University of Western States in Portland, to launch new initiatives that will assist you in your day-to-day Oregon, and practises in Vancouver, B.C. He practice and enhance member communication. is a strong believer in integrated healthcare and working with other health professionals to offer team approaches and solutions to The CCA also supports the growth of our profession’s research patient needs. Having a patient-centered capacity, having secured a research chair position at a major approach to chiropractic healthcare is of utmost importance university in every province. In addition, we support the at his clinic, Alliance Wellness. The clinic offers almost all Canadian Chiropractic Research Foundation to ensure long- paramedical services in one location. Having served as the director on the British Columbia Chiropractic Association for term sustainability and funding for chiropractic research. We the last six years, Dr. Parmar has gained a wealth of experience must support chiropractic research initiatives and ensure the of the detailed operations of the provincial chiropractic knowledge transfer of the most recent research, all of which will association. He has also served the chiropractic community assist chiropractors to practice in an evidence-informed manner. by volunteering with the Canadian Chiropractic Examining Board as an examiner and also as an opinion leader with the Canadian Chiropractic Guidelines Initiative (CCGI). We will continue to establish chiropractic as a healthcare partner in Canada. Because of our advocacy efforts, the federal government Dr. Clark Mills invited us to be a signatory on the National Opioid Strategy. Our Dr. Clark Mills is a registered chiropractor in partnership in this initiative has brought tremendous opportunity. Stony Plain, Alberta, about 15 minutes west It has allowed us to collaborate with other healthcare professions of Edmonton on the beautiful Yellowhead Highway. He has practised in a multi- and demonstrate the value of chiropractic as an upstream solution doctor facility for over 40 years and has for the treatment of non-cancer, chronic MSK pain. We see a great been intimately engaged in institutional opportunity for our profession to play a major role in helping governance with a wide variety of provincial, Canadians live healthier lives. national and international organizations. With a keen interest in organizational governance, Dr. Mills continues to expand his expertise in team building, strategic analysis and decision But there are challenges ahead. In the past year, there has been a making, member/donor engagement, risk assessment and strong media focus on chiropractic. Most of the media attention executive performance adjudication. Dr. Mills is married to has been negative, with a focus on regulatory issues that the Debi and they enjoy country living, travel, music, and — of course — their five grandchildren. media has identified as deficient. Dr. Catherine Bezeau I believe that now — more than ever — our profession will require Dr. Catherine Bezeau practises in Laval, our national and provincial associations to band together with Quebec, and received her chiropractic degree provincial regulators. This is where my regulatory background can from the University of Quebec at Trois-Rivières (UQTR) in 2013. Dr. Bezeau participated in help. My experiences have shaped and defined the core values of the chiropractic student association and the what I believe would help us win the public’s trust and government general student association at UQTR. She support. As CCA Chair, I will continue to meet with regulators. My has been an active member of the World goal and message are simple: we must create an environment that Congress of Chiropractic Students, attending their congress in Dallas, Texas, Rio de Janeiro, Brazil, and Durban, South Africa. allows for continued growth in chiropractic care. Dr. Bezeau works alongside two chiropractic colleagues at the Centre Chiropractique du Village. She has also been involved The CCA is not advocating for changes to existing regulatory with the Association des chiropracticiens du Québec, joining frameworks. Instead we want to see a more proactive and consistent their Board of Directors in 2017. In her spare time, she loves to spend time with her friends and family. application of regulations, especially related to misleading advertising and claims out of scope. Applying those regulations more consistently Dr. Heather Norman will prevent public perception in chiropractic from eroding further Dr. Heather Norman is a 1991 graduate of and will in turn boost patient trust and confidence in our profession. Palmer College of Chiropractic in Davenport, Iowa. She has been in private practice for Our vision is achievable. We can and should be an integral part 27 yrs and currently is the clinic director of a multidisciplinary practice in Burlington, of every Canadian’s healthcare team. We remain focused on the Ontario. She is certified in Acupuncture and strategies that will help us achieve this vision. But we need your Trigenics, a myoneural release technique. help. All of us must continue to learn and evolve. Patient trust Dr. Norman has been a director on the OCA Board for 6 yrs and confidence is something that must be earned. The CCA board and has a strong commitment to giving back to the profession. Supporting her community is also a priority and she has been continues to challenge ourselves. I ask you to do the same. There involved with various boards and community organizations. is an opportunity for our profession. Let’s seize the opportunity She was honoured with the “Citizen of the Year” award in 2006. before us. Our time is now. She enjoys traveling and golfing whenever possible.

Issue 16 | Canadian Chiropractic Association | 2018 7 MESSAGE FROM THE CEO

CHIROPRACTIC AND

ALISON DANTAS THE OPIOID CRISIS CEO

very day chiropractors help Canadians manage chronic pain. You work to diagnose the underlying cause. You recommend treatments to Erelieve that pain and prevent it from returning. Your hands help Canadians get back to their normal. That might be a father pushing his daughter on a playground swing. An athlete sprinting past the finish line after months plagued by injury. Or a mom returning to work after crippling neck pain forced her to take disability leave.

8 Issue 16 | Canadian Chiropractic Association | 2018 For many Canadians, that experience is alien. When they suffered psychological alternatives are often not accessible in primary chronic neck or back pain, they asked for help and were handed care settings. And we certainly can’t do it without you. The an opioid prescription. The problem is that some of them became work we're talking about requires research and research addicted. They needed opioids to manage their pain and make it needs funding. Nothing will change unless we can show the through each day. As the number of addicted Canadians grew, it effectiveness of non-pharmacological alternatives. led to a worrying increase in overdoses and deaths from these “powerful pain-relieving drugs.” "We need to understand a patient’s We have an opioid crisis that stretches from coast to coast. path from pain to prescription. I believe chiropractors can help Canadians reduce their reliance Only then we can show why on opioids. At first, the crisis was about addiction. Now the focus has shifted to pain and the need to provide safer alternatives to practitioners and patients must opioids. Chiropractic can help and I invite you to learn what we’re consider chiropractic care a first- doing to ensure chiropractic care is part of the solution. line treatment for acute and chronic This September, I attended the Opioid Symposium in Ottawa. musculoskeletal conditions." I heard Canadians asking for non-pharmacological options to manage pain. I remember one woman in particular. She was a mother and grandmother with osteoarthritis and she That’s why the Canadian Chiropractic Research Foundation is was physically dependent on opioids. Without her opioid a critical partner in this work. Two of its four national research prescription, she said it was impossible for her to be the mother priorities stand out for me. Health Systems explores how and grandmother that her family needed. She wanted non-opioid including chiropractic care in an inter-professional approach solutions that might lessen her dependence. affects patient outcomes. Clinical Science is about seeing how chiropractic management affects clinical outcomes. Through I also heard that when people can access non-pharmacological that research we can improve the lives of Canadians living with resources, it helps. But it only helps if they have access and for a chronic pain. It is my hope that together we can get to the $1.5M lot of people who experience chronic pain it is difficult to pay out of goal that the CCRF has set to fund its first research project. Every pocket for health care. dollar counts and you can give directly on the new CCRF website at www.canadianchiropracticresearchfoundation.ca That's why the Canadian Chiropractic Association took a leadership role in establishing the Coalition for Safe and Effective Pain We must always remember that at the root of this issue are real Management (CSEPM). We've brought together 11 national people with pain. I hope that you’ll support us as we work to associations to promote an interdisciplinary approach to pain help people manage their pain more effectively. With the right management. We need to understand a patient’s path from pain to data and funding, we can create community-based models that prescription. Only then we can show why practitioners and patients help you do what you do best. Help Canadians heal so they can must consider chiropractic care a first-line treatment for acute and get back to living their best lives. chronic musculoskeletal conditions. Then we can work to develop recommendations that the healthcare system can adopt. Imagine this. A patient sits in a healthcare clinic waiting to visit their family doctor. Inside the office, they complain of chronic But our work with CSEPM hasn’t stopped us from taking other back pain. It started off small, they explain, but now the pain is immediate action. We know we can’t press pause on the crisis interfering with their life, their work as a computer technician while we tinker with solutions. We wanted to put power in the and their hobby as a woodworker. They need relief. Rather than hands of practitioners. The CCA is developing a referral and triage prescribing an opioid, the doctor consults an inter-professional tool for prescribing professionals through the CCA’s Professional team and recommends a massage therapist. It helps but the Practice Resources initiative. pain persists. Now the doctor recommends a chiropractor.

This initiative is part of our commitment to Health Canada’s The patient is nervous but open to the idea. The chiropractor Joint Statement of Action to Address the Opioid Crisis. To listens, investigates and examines. And appointment by validate the referral tool, the CCA has contracted Ipsos — a appointment, there is progress. The patient’s team of market research company — to conduct focus groups with nurse healthcare practitioners work together — reserving opioids as practitioners, orthopedic surgeons, pharmacists, and medical a last resort — to ensure the best outcome. Soon the patient’s doctors. The resources are aimed to improve inter-professional pain subsides. They are grateful and return to work — able communication and coordination of care. to sit intermittingly — and to their studio to start a new woodworking project. Only you can help us make this possible Chiropractic care can help reduce Canadians’ reliance on opioids. by disseminating the new tool we will be launching for referrals But it won't be easy. Especially since many physical and from primary care providers and by donating to research.

Issue 16 | Canadian Chiropractic Association | 2018 9 NEW LOOK NEW FEATURES NEW PRODUCTS NOW INTRODUCING A WIDER RANGER OF TAPES AND ANALGESICS CCA PLUS PARTNER

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10 Issue 16 | Canadian Chiropractic Association | 2018

CCA_2pg-FINAL.indd 2-3 2018-10-12 3:44 PM NEW LOOK NEW FEATURES NEW PRODUCTS NOW INTRODUCING A WIDER RANGER OF TAPES AND ANALGESICS CCA PLUS PARTNER

Issue 16 | Canadian Chiropractic Association | 2018 11

CCA_2pg-FINAL.indd 2-3 2018-10-12 3:44 PM SPOTLIGHT

CELEBRATING 75 YEARS IN SASKATCHEWAN

The Chiropractors’ Association of Saskatchewan in 1945.

BY TRACY BERTRAM Following years of advocacy, Kirkaldy-Willis led important research The Chiropractic Act was passed in in the mid-’80s, which resulted in his year marked the 75th Saskatchewan in 1943, providing publication of a five-year study on Anniversary of the Chiropractors’ chiropractors with distinct legislation. manipulation that had a dramatic effect TAssociation of Saskatchewan. Many other important milestones We’re proud of our long and storied followed, including the ability for history of chiropractic in Saskatchewan. chiropractors to treat industrial and automobile injuries, securing coverage Saskatchewan is home to Canada’s under Medicare for close to 40 years , the first-known chiropractor, Dr. Almeda right to refer to specialists, the ability to Haldeman, who practised in rural apply for hospital privileges and, later, Saskatchewan. Her son, Dr. Joshua privileges in the health authority, and Haldeman, followed in her footsteps the ability to order diagnostic X-ray and and was active in the profession in ultrasound for MSK conditions covered Saskatchewan in the early years. Joshua by the provincial government. Quite a was also integral to the founding of list of achievements! the Dominion Council of Canadian Chiropractors (which later became Saskatchewan is also home to several the CCA) and the founding of the Canadian other well-known chiropractic figures Memorial Chiropractic College (CMCC). including Dr. David Cassidy, D.C. His son, third-generation chiropractor (non-practising CAS Life member) Dr. Almeda Haldeman is Canada’s first Dr. Scott Haldeman, is an internationally and Dr. Kirkaldy-Willis (Saskatchewan known chiropractor. She practised in known chiropractor and physician. orthopedic surgeon). Drs. Cassidy and Herbert, Saskatchewan.

12 Issue 16 | Canadian Chiropractic Association | 2018 Thirteen of the 30 past Presidents of the CAS reunited at the 75th Anniversary banquet celebration.

on grassroot cooperation between the The 75th Anniversary was celebrated at the and the AGM was animated with medical profession and chiropractors. Annual General Meeting held Sept. 22 in history displays and items highlighting Saskatchewan was also host to the Regina. The theme of the 75th Anniversary the last 75 years, some of which were conference on the findings of the was Reflecting Back – Looking Forward donated by members. One hundred Bone and Joint Decade 2000-2010 Task and thirty-five members attended Force on Neck Pain and Its Associated the AGM meeting — 63 percent of Disorders in 2007. the membership! — and the 75th Anniversary Celebration Banquet was As you can see, Saskatchewan has well attended. The attendees were been at the forefront of chiropractic entertained by duelling pianos followed for decades with many pioneers from by a casino night. It was a great evening the early days right through to today, of celebration for the CAS, its members including CAS volunteers, board members and special guests. and presidents. These pioneers gave their time, passion, and commitment From 45 members in 1943 to to establish the profession in the our current membership of 215 province and beyond and continue to practising members, the profession move it forward today. Members from in Saskatchewan continues to grow Saskatchewan have been, and continue and enjoy many of the privileges the to be, active in leadership positions founding members advocated and on national bodies including the CCA, worked hard for. We look forward to CMCC, CCPA and Federation of Canadian Dr. A.W. Johnstone was the first what the next 75 years will bring in Chiropractic, amongst others. President of the CAS. Saskatchewan!

Issue 16 | Canadian Chiropractic Association | 2018 13 ADVOCACY ONE STEP CLOSER Empowering Chiropractors to Issue Disability Tax Credits (DTC) Certificates

CCA CEO Alison Dantas visited Ottawa to lobby for Chiropractors to be allowed to certify patients for DTC.

ur latest advocacy efforts reached a key stage on Oct. 18, The current list of assessors includes medical doctors, when CCA Board Chair Dr. Gerald Olin presented our pre- audiologists, pathologists, occupational therapists, O budget submission — “Removing Barriers to Access and nurse practitioners, physiotherapists, optometrists and Care. A Healthier Canada” — to Canada’s Standing Committee on psychologists. These practitioners have the authority to certify Finance (FINA) in Winnipeg, Manitoba. that their patient suffers “severe and prolonged impairment.”

One of the two recommendations in our submission reads, Not only does amending the Income Tax Act make sense, but it isn’t a difficult change to make. This change does not increase “That the government amend the Income Tax Act costs to taxpayers because the number of disabled Canadians (1985), s. 118.4 (2), in order to add chiropractors to who are eligible for the credit would remain the same. But the list of practitioners eligible to assess disability it would make it more convenient for eligible Canadians to and issue the Disability Tax Credit Certificate.” access the credit. In fact, this amendment may decrease public spending in provinces where additional doctor visits to get certified will cost taxpayers. At the provincial level, The invitation to meet for a pre-budget consultation means chiropractors already have the authority to diagnose disability that the Committee reviewed our submission and found it and make similar assessments for Workers’ Compensation of interest to their theme of “Economic Growth: Ensuring and Motor Vehicle Accident rehabilitation. Canada’s Competitiveness.” Canadian Chiropractic Association CEO Alison Dantas has Our submission emphasized that removing barriers to been lobbying the federal government for this change and chiropractic care, particularly for patients with osteoarthritis is optimistic about the outcome. “This change will empower (OA), will reduce the pain and disability that keeps people from chiropractors and their most severe patients, enabling them contributing to the workforce. In this way, access to chiropractic to access resources they need to improve their quality of life care creates stronger economic competitiveness in Canada. without jumping through unnecessary hoops,” she said. “I’m encouraged by the swell of support we’re seeing across We are confident that we made a compelling case for the the country.” amendment. After all, it is only reasonable that chiropractors — who are extensively trained to assess and diagnose back, neck CHIROPRACTIC PATIENT ELIGIBILITY FOR DTC and knee pain, and osteoarthritis — are added to the list of professionals who can legally assess disability in their patients Chiropractors regularly treat patients with disabilities, and issue Disability Tax Credit (DTC) Certificates. including those suffering from OA — the most common type of arthritis.1 Patients with OA often reach chronic disability that “Chiropractors have comparable qualifications to other health severely restricts basic daily tasks like dressing and walking, professionals already listed in the Income Tax Act who are authorized which are two items on the Canadian Revenue Agency (CRA) to determine eligibility for the Disability Tax Credit,” Dr. Olin said. criteria for DTC eligibility.

14 Issue 16 | Canadian Chiropractic Association | 2018 Osteoarthritis patients may visit their chiropractors more often than any other practitioner, and for extended periods of time. Their chiropractor would be the most familiar with their level of pain, and know whether their disability is getting better or worse.

WHY THE TIME TO LOBBY FOR THE AMENDMENT IS NOW

“Fewer than 40 per cent of the over 1.8 million adults who report qualifying disabilities are claiming the credit,” according to Breaking Down Barriers: A critical analysis of the Disability Tax Credit and the Registered Disability Savings Plan.2 “Moreover, the credit is claimed in roughly equal numbers by men and women; yet over 56 per cent of those reporting severe and very severe disabilities in the Canadian Survey on Disability are women.”

Women are more likely to develop OA than men,3 and the gender difference in prevalence of OA in Canadian women increases significantly with age.4 CCA CEO Alison Dantas, Middle, and CBO Ronda Parkes, meet with Dr. Colin Carrie, MP for Oshawa about the DTC. This demographic represents many chiropractic patients in Canada, and as the government works to overhaul the DTC program and make the process of receiving certification more to help chiropractors and patients from across the country to be accessible, amending the Income Tax Act to provide chiropractors heard. Please take a couple minutes to visit our website to submit the authority to assess the disability in their patients breaks a letter to your local Member of Parliament. With enough support, down an important barrier. the federal government will include chiropractors as an assessor of the Disability Tax Credit. Your support can make a difference in “Adding chiropractors to the Income Tax Act will increase the lives of Canadians. Together we can make it happen. accessibility for our patients,” Dr. Olin said. “It’s a simple but Sources: important step in improving the lives of Canadians dealing with pain. Having the support of The Arthritis Society and the Council 1. The Arthritis Society, “About Osteoarthritis,” 2017. of Canadians with Disabilities, further strengthened our position.” 2. Eggleton, Hon. Art, Petitclerc, Hon. Chantal, Seidman, Hon. Judith. Breaking Down Barriers: A critical analysis of the Disability Tax Credit and the Registered Disability Savings Plan, the Standing Senate Committee on Social Affairs, Science WHAT YOU CAN DO and Technology, February, 2018. Retrieved from https://sencanada.ca. 3. The Arthritis Society, “About Osteoarthritis,” 2017. We need your help! For change to happen, the federal 4. National Surveillance of Osteoarthritis and Rheumatoid Arthritis in Canada, government must hear from chiropractors over the next few Results from the Canadian Chronic Disease Surveillance System, Public months before the 2019 Federal Budget is announced. This is an Health Agency of Canada, Ottawa, ON, October 26, 2017. Retrieved from http://www.arthritisalliance.ca. important, time-sensitive campaign. All it takes is a few clicks

WHY NOT CHIROPRACTORS?

VISIT CHIROPRACTIC.CA/DISABILITY-TAX-CREDIT TO SEND A LETTER TO YOUR LOCAL MP

Issue 16 | Canadian Chiropractic Association | 2018 15 SPOTLIGHT CELEBRATING 60 YEARS AND BEYOND IN NEW BRUNSWICK

BY DR. FRANCES LEBLANC

his year marks the 60th year since the chiropractic profession T was first legislated in New Brunswick in 1958. The New Brunswick Chiropractors Association (NBCA) is proud to celebrate the profound work of the profession’s pioneers and members over its history.

Chiropractic in New Brunswick had humble beginnings, with only a handful of dedicated chiropractors who worked to establish it as an ethical, regulated health profession. Those pioneers recognized early that formalizing processes and adopting best practices would allow the profession to gain legitimacy and credibility.

For decades, the NBCA sustained its operations due to the selflessness of volunteer members families played an who dedicated time and expertise to the advancement of instrumental role the profession. One such example is Dr. Glenn Johnston in the profession’s (Fredericton), who has been an NBCA member and practising development — chiropractor for 51 years. When first licensed in 1967, including the Robichaud, Dr. Johnston was one of very few practising chiropractors in the Randall and Clark province. Early on, he embraced leadership — serving as NBCA families, among President, CCA Director and CCA President, among other roles. others. Dr. Marie-Josée Robichaud (Moncton) Dr. Johnston is but one example of the exceptional individuals describes fondly the who have served and continue to serve the NBCA. Dr. Norm unwavering passion Skjonsberg (Saint John) recently finished his 14th year as and commitment of NBCA President and NBCA Registrar Dr. Carolyn Joy Levere her father, Dr. Yves (Oromocto) has served the NBCA Board for over 32 years. She Robichaud, and two uncles to advance the profession in the was the recent recipient of the CCA Life Member Award in Maritimes. That passion was also felt at home, resulting in April 2018. The work of New Brunswick chiropractors never 14 Robichaud relatives now practising chiropractic. Several truly ends — caring for patients and communities alike. others decided to pursue chiropractic as a career because they were once helped by one of these early pioneers. Remarkably, if you look closely at the chiropractic profession in this province, it reveals a complex web of Throughout our history, New Brunswick chiropractors have interconnectedness between chiropractors, families and consistently demonstrated their willingness to collaborate their patients. The growth of the profession here can be and work together. This certainly is exhibited by the support largely attributed to a series of positive patient experiences. shown among the close-knit community, but also beyond our In fact, the early pioneers had a tremendous impact on the chiropractic community with other healthcare team members. subsequent growth of the profession and inspired future This is critical for a province who is consistently low in generations of chiropractors. For example, a number of resources and capacity and especially true in rural areas.

16 Issue 16 | Canadian Chiropractic Association | 2018 Drs. Sarah Williams, Rachelle Coates and Allyshia Daley.

Drs. Marc LeBlanc (left) and François LeBlanc (right). Dr. Norm Skjonsberg (left) after a presentation to Saint John students.

Dr. Guildor Poitras (Grand Falls) shares that part of his success has come from building trust among other providers in his community. “It’s important to work with others and recognize our limits.” This sentiment is also shared by Drs. Matthew and Sarah Williams (Fredericton) who work diligently to foster new opportunities for collaboration and integration, notably with primary care providers in their areas. These collaborative efforts are further solidified by the commitment to evidence-based practice and the work of Dr. Jeff Hebert, CCRF-NBRHF Musculoskeletal Health Research Chair at the University of New Brunswick.

The NBCA is committed to working with their growing and engaged membership to improve the health and wellness of Dr. Carolyn Joy Levere (right) with partner Andy (left). New Brunswickers by supporting and promoting excellence in chiropractic practice and patient care. “In New Brunswick, chiropractors distinguish themselves by their diagnostic and manipulative skills,” said Dr. Michel LeBlanc, “which is why thousands of New Brunswickers rely on our care every year.” The NBCA believes that chiropractors have an important role to play in maintaining and enhancing the health of New Brunswickers, providing a safe and effective non-pharmacological option for pain management and to help restore function.

After 60 years, New Brunswick chiropractors can be proud of what has been accomplished. Celebrating this anniversary at the Atlantic Chiropractic Convention and Tradeshow in late October was a highlight! The NBCA is confident that together we can further Dr. Peter Magee (middle) receiving 35 years of practice award from Drs. Frank Mangoni (left) and Norm Skjonsberg (right). enhance access to care for New Brunswickers for generations to come.

Issue 16 | Canadian Chiropractic Association | 2018 17 MESSAGE FROM THE CBO Showcasing the difference chiropractic RONDA PARKES care can make CHIEF BRAND OFFICER Recap of recent public awareness initiatives

t's important to show Canadians how chiropractic care Since 2012, the World Chiropractic Federation has organized can change pain. Educating Canadians about your work World Spine Day on behalf of the Global Alliance for I shows that chiropractors care and can make a difference. Musculoskeletal Health. Its purpose is to “raise awareness In that respect, the last few months have been busy. of back pain and other spinal issues” and promote “physical activity, good posture, responsible lifting and healthy working We implemented several high-profile initiatives to build conditions.” Because that aligns well with our mission, we have favourable public perception. The results should make supported the worldwide campaign annually. you proud. We put the profession’s best foot forward and communicated our message at a national level. Here’s a This year’s theme was Love Your Spine. With your support, rundown of what you helped us accomplish. we built a campaign to show Canadians why spinal health matters. The key component of the campaign was the First up was a partnership with the Ontario Chiropractic Love Your Spine downloadable digital booklet. The 27-page Association on a sponsored article in The Globe and Mail: document combined chiropractor-approved tips, information “The Pain Problem.” The article was published on Oct. 15 to on chiropractic care and testimonials. support the launch of our 2018 World Spine Day campaign on Oct. 16. In it, we explored the toll that muscle and joint pain To promote the booklet, we created a series of digital ads. The ads is taking on Canadians. We showed how musculoskeletal pain ran for two weeks and offered the booklet for free. And we built a can change the way we live. But we also provided hope. We toolkit, including images, stats and more — making it easier for highlighted how chiropractic care can improve quality of life members to share and amplify. The result? without invasive treatments. And we reminded Canadians that many extended benefits programs cover chiropractic visits. Posts by Canadians using the hashtags #WorldSpineDay and #LoveYourSpine made up almost a quarter of the global We also ran a print and digital campaign with ONtheGO conversation. Almost 27,000 people visited chiropractic.ca to learn Magazine — a lifestyle publication distributed across the about the campaign. But what’s even better is that more than 1,100 Greater Toronto and Hamilton area – for the month of Canadians shared their email address in exchange for the booklet. October. Billed as a magazine for commuters, ONtheGO offered us the chance to reach new audiences with our You should see that as a massive success. I know we do. That’s message. We encouraged people to learn about chiropractic 1,100 more people we can educate about the valuable work you do. care and download the Straighten Up Canada app on the App More than one thousand people who have given us permission to Store and Google Play Store. continue a conversation about pain and pain management. We promise to learn as much as we can from these Canadians and Our full-page editorial, “Pain is Real and It’s Debilitating,” share further insights with you. reached more than 300,000 people and appeared across from an ad promoting chiropractic care. The digital campaign Highlighting the millions of Canadians who benefit from included a series of five-second videos that appeared on chiropractic care ever year helps steady the profession’s screens in Toronto’s PATH (the underground commuter reputation. Especially in the face of negative news coverage. network and shopping complex) and were shown to more than 200,000 people that pass through the PATH each day. For one It’s almost 2019. Here at the CCA, we remain committed to our week, the video spots were also featured on a massive screen vision — chiropractors will be an integral part of every Canadian’s at one of the busiest intersections in the country — Yonge and healthcare team by 2023. There are many ways to achieve that Dundas Square. About 116,000 pedestrians pass through the vision. But educating and engaging the public with effective and intersection every day. persuasive communications remains a key part of our strategy.

18 Issue 16 | Canadian Chiropractic Association | 2018 THE CCA'S RECENT PUBLIC INITIATIVES TO SUPPORT CHIROPRACTIC

Up to 85% of workers will experience low back pain in their lifetime. Pain changes everything. The OntheGo Globe Magazine and Mail Chiropractic care changes pain.

Learn more at chiropractic.ca

Journal of Spinal Disorders.

Print Edition 324,000 readers from 120,000 958,000 average weekday readers. distributed copies Digital Edition 7.4 million monthly unique visitors.

2018

2018 World 5 second #LOVEYOURSPINE Spine Day video spot Campaign

27,000 people visited chiropractic.ca Yonge and Dundas Square 1,100 Canadians shared their 116,000 walking traffic per day. email address Toronto PATH screens Daily Audience 100,000

Issue 16 | Canadian Chiropractic Association | 2018 19 RESEARCH FOUNDATION

Researcher Spotlight: Dr. Carol Cancelliere

r. Carol Cancelliere, a clinical epidemiologist, started as the new CCGI Project Lead in March 2018. Soon after, she was Guideline Implementation Dappointed as the CCRF’s newest Research Chair in Knowledge Translation at University of Ontario Institute of Technology. Toolkit Development 1. The toolkits will be developed using Dr. Cancelliere’s research focuses on the development of the knowledge-to-action framework. evidence-based guidelines and knowledge-translation tools. She practised as a chiropractor for 10 years in Saskatchewan, British 2. This approach involves building a Columbia and Ontario before becoming a full-time researcher. comprehensive research team for the Her primary drive remains delivering optimum patient care. effective transfer of research findings into practice. BRINGING ATTENTION TO THE GAPS IN PATIENT CARE CHIROPRACTORS CAN FILL 3. Carol’s team will include end users such as representative Canadian chiropractors and As a researcher, Dr. Cancelliere sees huge opportunities their patients, a knowledge-translation for chiropractors to fill a major gap in today’s patient care. expert, and a professor in education “There is a large, unmet need in the world — disability related who specializes in optimizing information to spinal disorders — and chiropractors can absolutely take a delivery based on how people learn and central role in meeting that need.” the sociology behind learning.

She and her team are trying to demonstrate what is possible, moving the needle for chiropractic’s application with patients suffering disabilities related to spinal disorders. Although still in planning stages, her team is working with EuroSpine — the Spine Society of Europe — on a joint CREATING A NEW GUIDELINE proposal for this guideline development.

Together, Dr. Cancelliere’s team is working on a new guideline INCREASING EVIDENCE-BASED GUIDELINE ADOPTION that addresses disability related to spinal disorders. “This guideline is very important as low back pain is a leading cause Part of Dr. Cancelliere’s work is focused on developing guideline- of disability worldwide. Chiropractors need to take a lead on implementation toolkits. Her team is starting with three toolkits — addressing this issue,” she said. focusing on concussion, headache and lumbar spinal stenosis.

20 Issue 16 | Canadian Chiropractic Association | 2018 The knowledge-to-action framework allows for We all work in a really collaborative spirit. We work under a shared a proper needs assessment, identifying what and vision that caring for patients means using evidence, but also how to transfer knowledge to chiropractors and working collaboratively. Even though we may disagree about things their patients. “You can’t just give guidelines to or have different opinions, that’s always the spirit we work under.” chiropractors and expect them to read and use them. They’re too long, too technical and it can be hard to isolate the information you need,” Dr. Cancelliere said. “People need to know what this profession has to offer and what we can do. That’s why Once the toolkits are developed, they plan to test the guidelines consistency is important and that’s why we with a small sample of chiropractors. In the final phase, they will need to continue to demonstrate our care measure the effectiveness of the guideline implementation through evidence.” (on a broad scale) by asking key questions such as:

• Did chiropractors actually get the tools She thinks that chiropractors have great, unique potential to that they needed? fill the growing gap in today’s MSK patient care. She believes that collaboration across the healthcare system, and other • Did they actually learn from the tools? sectors, and practising according to evidence are necessary for the chiropractic profession to bridge this gap. “People need • What were the barriers to using the tools? to know what this profession has to offer and what we can do. That’s why consistency is important and that’s why we need • Did the tools actually impact the patient to continue to demonstrate our care through evidence.” (did patients improve?) OUR DONORS MAKE THE DIFFERENCE COLLABORATION WITH HER TEAM A big thank you to the CCGI and the donors who fund Dr. Cancelliere was quick to point out that none of her work Dr. Cancelliere’s work. You are making a huge difference, would be possible without her team, the CCGI, and a lot of mentors supporting research that improves the lives of people living along the way. “Everybody’s dedication inspires me. with musculoskeletal pain and disability.

Life Without the Burden of MSK Pain and Disability

There is a growing crisis in healthcare — disability related to spinal disorders. Eighty per cent of workers will experience an episode of back pain in their lifetime.

Chiropractors can play a central part in addressing this epidemic. But, we need the research and evidence- based tools to demonstrate what we can do.

Help us fund this vital research.

Sign-up for a One-Time, Monthly or Annual Donation at canadianchiropracticresearchfoundation.ca

Issue 16 | Canadian Chiropractic Association | 2018 21 CCGI STUDENT AMBASSADORS New program to promote evidence-informed practice

BY DR. GAELAN CONNELL & HEATHER OWENS The purpose of the program is to:

upporting the uptake of evidence-informed practice at the 1. Support the dissemination of best-practice national and international level is one of the key aims of resources and latest evidence in musculoskeletal Sthe Canadian Chiropractic Guideline Initiative (CCGI). And health to chiropractic students; there are encouraging signs that change is happening. Students and new graduates can act as key change agents and influencers. 2. Promote the integration of evidence-informed They can lead the way in affecting long-term, durable uptake practice into the chiropractic curriculum; of evidence-informed practice. Partnering with tomorrow's leaders will help ensure that the implementation of best practices 3. Engage student leaders in the creation and becomes the norm for the chiropractic profession. development of knowledge-translation strategies specifically adapted for students and recent The Journal of the Canadian As Dr. Michele Maiers wrote in graduates; and Chiropractic Association1, students have a crucial role to play: 4. Obtain student perspectives and feedback to “The future of any profession is in the hands of its students tailor CCGI resources and increase uptake. and early career practitioners. The millennial generation of chiropractors embodies attributes that are uniquely suited to the evolving landscape of 21st century healthcare…. How we adapt to transformational change taking place in healthcare With this in mind, CCGI is pleased to announce the launch of a new today is predicated on how well contemporary chiropractic chiropractic student ambassador program in Canada and the U.S. leadership engages millennials now. This requires active engagement, thoughtfully and purposefully leveraging We are delighted to be partnering with nine student millennial qualities, skills, and vision within professional ambassadors from the Canadian Memorial Chiropractic committees, work groups, and professional networks.” College (Dan Nighswander, Kevin Fox-Chen, Puneet Shoker,

22 Issue 16 | Canadian Chiropractic Association | 2018 Josh Thomas, Riaz Mohammed, Madison Baile, "The future of any profession is in Mack Gingerich, Tory Clay and Vivian Wang) and three ambassadors from the University of Quebec the hands of its students and early at Trois-Rivières (Janny Mathieu, Philippe Parent- career practitioners. The millennial Simard and Justin Roy). We are also very pleased to be partnering with three students from Northwestern Health Sciences University generation of chiropractors embodies (Taran Barett, Colton Maclean, and Sylvianne Poirier). All of our student ambassadors have completed a short training module and attributes that are uniquely suited orientation session to familiarize themselves with their role. to the evolving landscape of 21st

What will CCGI student ambassadors be doing? Our new century healthcare." team members will meet online every two months to identify opportunities for a) dissemination of best-practice resources CCGI develops evidence-based, clinical-practice guidelines within their respective programs, and b) supporting the use of and best-practice recommendations and facilitates their CCGI materials within course content (i.e., clinical education, dissemination and implementation within the chiropractic rehabilitation, diagnosis, etc.). They will also represent CCGI profession. We work with chiropractors across Canada, at school events, share resources and answer questions about provincial associations, regulatory bodies, educational clinical-practice guidelines and best practices. For example, institutions, and – of course – students! To learn more, one of our stakeholders, the Ordre des chiropraticiens du please visit us at www.chiroguidelines.org. Québec generously offered CCGI and student ambassadors a booth during the OCQ-UQTR Joint Convention - 25th Contact Dr. Gaelan Connell, CCGI Knowledge Broker Anniversary of the Chiropractic Program in Trois-Rivières, ([email protected]), to learn more about CCGI and their Qué., from Sept. 27-29. We are also looking forward to student ambassador program. partnering with our ambassadors in the creation of new References resources such as a best-practice toolkit for students 1. Maiers, M (2017) Our future in the hands of Millennials. JCCA 2017 Dec; 61(3): and new graduates. 212–217

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Issue 16 | Canadian Chiropractic Association | 2018 23 RESEARCH FEATURE CLINICAL VALUE OF ASSESSING LUMBAR SEGMENTAL STIFFNESS Research review of manual and instrumented methods

BY DR. SHAWN THISTLE

s chiropractors, we treat many patients dealing with low back pain. About 90 per cent of cases involving lower A back pain (LBP) are thought to involve mechanical issues. Because the exact mechanical source of LBP is often unclear, clinicians may use their physical examination findings to classify patients into presumed homogenous LBP subgroups, with the goal of optimizing treatment outcomes. These groups hopefully help us determine appropriate treatments to relieve pain and restore mobility and proper function. But there are many factors that make manual segmental spinal stiffness assessment (MSSA) unreliable.

To eliminate this subjectivity, various instrumented spinal stiffness-testing devices with superior reliability EXAMINER-RELATED FACTORS AFFECTING RELIABILITY have been invented, but are (currently) only available Several examiner-related factors may also affect reliability, for clinical research purposes. In their recent narrative beginning with vision. Where a clinician looks can affect their review paper, “The clinical value of assessing lumbar perception of stiffness. It is therefore recommended that posteroanterior segmental stiffness – a narrative review of clinicians and researchers keep their eyes fixed during manual manual and instrumented methods” (published in Physical assessments. In addition, using a thumb-tip technique to Medicine and Rehabilitation), Drs. Arnold Wong and Greg measure MSSA consistently yields lower perceived stiffness Kawchuk discussed the evidence behind both manual and magnitude compared to using a pisiform contact. Adopting instrumented segmental lumbar stiffness assessments. standard hand placements and using a metronome to regulate They also summarized the evidence linking LBP and PA the frequency and speed of loading could theoretically spinal stiffness, as quantified by instrumented spinal improve reliability. It is also implied that clinicians should stiffness-testing devices. apply the same techniques consistently in their practice. The clinical reliability of MSSA also decreases because some When a patient visits a chiropractor seeking relief of lower clinicians palpate overall displacement of examined segments back pain, a common method of manual assessment is to apply and others perceive spinal stiffness based on the “end-feel” posterior-anterior (PA) force to a prone patient’s spine, with of PA motion results. the goal of evaluating stiffness and/or to reproduce the patient’s pain. If the patient displays high resistance, they are said to have high spinal stiffness (or, hypomobility). Conversely, low ENVIRONMENT-RELATED FACTORS AFFECTING RELIABILITY resistance indicates low spinal stiffness. The challenge is that The authors also assert that rigid or padded surfaces can the reliability of manual assessments is considered poor due to affect the assessment, especially instrumented assessments. factors attributed to the patient, examiner and the environment. They have recommended standardizing testing surfaces to increase reliability.

PATIENT-RELATED FACTORS AFFECTING RELIABILITY It should be noted that unfortunately, while these Patient muscle tone can affect the measurement. We may ask recommendations have been made to rectify potential issues patients to “relax their trunk and hold their breath,” but their affecting reliability of spinal stiffness measurement, the ability to do so consistently can affect measurements. A patient’s utility of these recommendations remains unclear and weight and gender may also complicate the assessment. require further research.

24 Issue 16 | Canadian Chiropractic Association | 2018 SPINAL STIFFNESS ANALYSIS VIA INSTRUMENTED with the goal of individually directing treatment METHODS IN RESEARCH SETTINGS choices to achieve the best patient outcomes. Another important issue raised in this review concerns how This is an area where further research on spinal spinal stiffness is measured via instrumented methods. The stiffness measurement could really impact patient process used in research settings is inconsistent across various care in terms of applying appropriate treatment laboratories, preventing direct comparison across studies. techniques to patients more likely to positively respond.

To counter the effect of external patient and environmental There are studies where more reliable instrumented spinal stiffness factors on instrumented MSSA, the authors have made the measurement technology was used to predict clinical outcomes. following recommendations: Those studies demonstrated that some patients with lower back pain may benefit from spinal manipulation. Unfortunately, more large- 1. Voluntary trunk muscle activity is minimal; scale study is required before we can apply this finding more broadly. 2. Lung volume is at the functional residual capacity; 3. Ribcage and pelvis are not constrained; Even though the evidence suggests that PA segmental lumbar 4. The patient’s posture is neutral; and stiffness is related to lower back pain, there is a complex 5. Standardization of the testing surface (soft vs. hard) mixture of factors – including but not limited to: age, gender, and loading parameters (i.e. frequency, speed, force). psychological and neuromuscular factors – that can complicate the assessment and diagnosis. Unfortunately, no studies have The authors propose that gender, weight and disc degeneration been conducted to quantify how much these psychological factors should also be considered. may modulate the relationship between PA stiffness and LBP.

RELATION BETWEEN SEGMENTAL SPINAL STIFFNESS The authors of this review paper synthesized the best and most AND LOWER BACK PAIN current literature and provided pragmatic recommendations for improving the reliability/accuracy of manual segmental spinal Mechanical LBP is thought to be associated with aberrant/ stiffness assessment (MSSA). Because of MSSA’s low reliability, impaired intervertebral they advocate for the use joint motion or function of instrument-assisted and a relationship between postero-anterior spinal lower back pain and stiffness measurement spinal stiffness has been technology in clinical and demonstrated. But those research settings. The use studies did not estimate of such technology has the correlation between shown that a reduction absolute segmental spinal in PA segmental spinal stiffness values and the stiffness is associated corresponding with alleviation of LBP in LBP intensity. some populations, which is certainly promising. Other laboratories have The authors also stated shown no major difference that some of the variance in average PA segmental of this relationship is lumbar stiffness values between symptomatic and asymptomatic mediated by demographic, psychological and neuromuscular individuals and have failed to demonstrate bivariate correlation factors, which may need to be accounted for and controlled in between PA lumbar stiffness and LBP severity/chronicity before research and clinical settings. Future research should endeavor spinal manipulative (SMT) treatment. Unfortunately, this latter to establish normative lumbar stiffness values in asymptomatic finding may have been affected by inconsistent manual loading individuals, to enable recognition of aberrant spinal stiffness parameters during the mechanically-assisted spinal stiffness tests. values in symptomatic patients.

Collectively, the existing evidence suggests that lumbar PA stiffness Dr. Shawn Thistle is the founder and CEO of RRS Education, a company generally decreases as LBP subsides in some, but not all, individuals which provides weekly Research Reviews and evidence-based online courses suffering from LBP. The lack of consistency is likely secondary to the and seminars to help busy clinicians review and integrate current research heterogeneity, and non-specificity of LBP symptoms. into their patient care. For more information, visit rrseducation.com.

The authors also asked whether a baseline assessment is necessary to Access to RRS Education’s weekly Research Reviews is a CCA member predict lower back pain outcomes. Such an assessment could become benefit, available to those who register through the member’s only a useful component of a clinical prediction rule for LBP patients, section of chiropractic.ca and on the chiropractium app.

Issue 16 | Canadian Chiropractic Association | 2018 25 Scott Stratten

CCA A Better Approach to Pain Management NCT’18 Chiropractic Care Changes Pain

April 27 – 29, 2018 Calgary, Alberta

Thank you to everyone that attended NCT’18. It is with your enthusiasm that we had an even bigger and better NCT, and we look forward to continuing to grow in Halifax in 2020. The CCA National Convention & Tradeshow continues to be Canada’s largest chiropractic show, bringing together clinicians, researchers, stakeholders and exhibitors.

26 Issue 16 | Canadian Chiropractic Association | 2018 Dr. David Peeace and Alison Dantas Dr. Geoff Outerbridge

Dr. Greg Kawchuk

This year, we explored the important theme of A Better Approach to Pain Management – Chiropractic Care Changes Pain. In addition to meeting some of the best exhibitors in North America on our tradeshow floor, attendees had the opportunity to take part in Workshops, Intensive, Breakout and Keynote sessions, a Chiropractic Assistant (CA) focused business management educational stream, as well as social and networking events.

The signature social event of the 2018 CCA National Convention & Tradeshow took place on the evening of Saturday, April 28 in the Grand Hall at Ranchman’s Cookhouse and Dancehall. Our guests dusted off their favourite sparkly accessories and dancing boots to join other convention attendees at this spectacular evening that celebrated the chiropractic profession in Canada.

This event-packed weekend brought our profession together for inspiration, passion, networking, knowledge transfer and some fun! Thank you for helping us make the CCA National Convention and Tradeshow the most celebrated chiropractic event of 2018!

Issue 16 | Canadian Chiropractic Association | 2018 27 Dr. Jason Busse Dr. Gord McMorland, Dr. Deborah Kopansky-Giles, Dr. Christie Newton and Dr. Alban Merepeza

At the NCT 2018 Denim and Diamond’s event, attendees bid to see their chiropractic colleagues ride Ranchman’s mechanical bull! Together we raised over $25,000 dollars for Chiropractic Research!

Wow! What an amazing few days. It is an honour to have hosted so many leaders in the chiropractic profession in Calgary. Special thank you to our sponsors, staff, volunteers and our VIP members who made it happen. We’ll see you in Halifax in 2020!

To view our full photo gallery visit chiropractic.ca/2018cca-national-convention

Dr. Carlo Ammendolia

28 Issue 16 | Canadian Chiropractic Association | 2018 Olympic sprinter Andre De Grasse Issue 16 | Canadian Chiropractic Association | 2018 29 and Dr. Alban Merepeza Dr. André Bussières James Cunningham CLINICAL FEATURE

SPORTS

AND THE CONVERGENCE OF

CHIROPRACTIC

Mike Stobe/National Hockey League/Getty Images DR. GERALD OLIN'S TREK FROM STUDENT TO SPORTS TEAM CHIROPRACTOR

t was his love of soccer that set Dr. Gerald Olin on his decided to stay in Winnipeg as the Assistant General Manager path to the chiropractic profession. Two seemingly for the team he had come to know and love — The Winnipeg I unrelated practices converged when he began Fury — even though they were in last place in the now defunct experiencing migraine headaches during his first year of Canadian Soccer League (CSL). university. It was the summer of 1990 and he was working for the Winnipeg Fury professional soccer team. It was a fateful decision. In 1992, the Winnipeg Fury won the CSL Championship by defeating the Vancouver 86ers in goals aggregate The migraines continued without successful treatment until (3-1) after a two-game series. Dr. Olin, along with the team staff Olin was advised to see a chiropractor who helped him manage and players, have since been inducted into the Manitoba Sports his pain. This piqued his interest, so he borrowed a book on Hall of Fame for their work during the ’92 season. chiropractic from the University of Winnipeg resource centre to better understand the profession. Becoming a chiropractor The next year, Olin graduated with his Bachelor of Science was suddenly a very real option for him after completing his degree. Recognizing the emerging role for chiropractic care undergraduate degree. in sports medicine, he moved to Minneapolis to attend the Doctor of Chiropractic program at Northwestern Health In 1991, Olin was offered the Assistant General Manager Sciences University in Minnesota. It was there that he met position with the Nova Scotia Clippers in Halifax. But he his future wife, and fellow Winnipegger, Dr. Kerri Brooker.

30 Issue 16 | Canadian Chiropractic Association | 2018 Dr. Gerald Olin and Don Cherry during 2018 Stanley Cup playoffs.

Members of the Winnipeg Jets medical staff and former NHLer Dr. Gerald Olin and Madison Bowey of the Washington Capitals. Teemu Selanee, third from left.

For his externship, Dr. Olin moved to Phoenix, Arizona, Moose (American Hockey League) and the Winnipeg Jets. And he while his fiancé completed her chiropractic education in serves on many sports and professional boards and committees. Minneapolis. During this time, the NHL’s Winnipeg Jets had moved to Arizona and become the Coyotes. Olin didn’t have The role of a chiropractor on a professional sports team’s staff any involvement with the Jets during that time, but he did is to provide musculoskeletal (MSK) expertise as part of an work with two Arizona pro indoor and outdoor soccer teams. interdisciplinary team focused on the performance of elite athletes. The early promotion of chiropractic in sports can be traced to the Feeling the pull to return to their hometown, Olin and Brooker athletes themselves who sought treatment and realized how a moved back to Winnipeg and opened the T.E.A.M. Chiropractic chiropractor could help speed the recovery from injuries and assist Family Wellness Centre. in achieving optimal physical health and performance.

“Working with another chiropractor is extremely beneficial. “Elite athletes are very aware of their bodies,” Olin said. It provides for the opportunity to consult with each other on “They notice the subtleties of proper bio-mechanics for their individual cases,” Olin said. “My wife works part time. We have specific sport and they can identify and see the benefits of two kids, so she will work a couple days a week for half days. She chiropractic care. Sports organizations see the need for an will also work after hours to see my patients when I am away on interdisciplinary approach — to have a team of people who travel for the Canadian Chiropractic Association or for sports — provide care for the athletes. We want to see our athletes making it an especially busy time for her in our office during the succeed. We want the teams that they play for to succeed. recent NHL Playoffs. I can’t begin to describe how appreciative I We all want what is in the best interest of the individual am of her support, which allows me the opportunity to participate athlete, and we are going to work together to ensure the in so many of the things I love and enjoy being a part of.” players have every resource available to them that is necessary to enhance and improve their performance.” To say that Dr. Olin is busy is an understatement. In addition to his parenting duties, he treats patients in his clinic and serves as team Dr. Olin pointed out that neck, mid back and low back pain are the chiropractor for the Winnipeg Blue Bombers (CFL), the Manitoba most common ailments he treats for the Jets, but it isn’t unusual

Issue 16 | Canadian Chiropractic Association | 2018 31 Olin sees the success of the chiropractic program at Mount Carmel as indicative of opportunities for the profession to become an integral part of the solution to the opioid crisis in Canada. According to Olin, many of Mount Carmel’s patients are part of a population of Canadians who are at a higher risk for opioid addiction. And data collected since the clinic began by chiropractic researcher Dr. Steven Passmore has revealed very encouraging results on the chiropractic program’s positive effects in patient pain management and a notable reduction in opioid prescriptions.

“ONE OF THE BEAUTIES IN PRO SPORTS IS THAT AS TEAM CHIROPRACTOR, I AM CHARGED WITH CO-MANAGING THE CARE OF AN ATHLETE WITH OTHER HEALTHCARE PROVIDERS ON THE TEAM."

“One of the interesting connections that I have recognized from the pro sports side and Mount Carmel Clinic,” he said, Dr. Olin at the NHL Global Series in Helsinki, Finland. “is both have interdisciplinary care approaches. One of the beauties in pro sports is that as team chiropractor, I am for players to have extremity injuries and pain. His treatments charged with co-managing the care of an athlete with other usually consist of adjustments and myofascial treatments. healthcare providers on the team. At Mount Carmel Clinic, they do the exact same thing.” The need for chiropractic care can be intense during the NHL Playoffs. Last season, Olin travelled with the team in what Dr. Olin’s experiences with the interdisciplinary models used became an enjoyable five-week pattern of “non game day, by the Jets and Mount Carmel Clinic have given him a unique then game day, followed by a non game day, then game day.” perspective on the future of the chiropractic profession and have informed his goals as CCA Board Chair. “On non game days there were treatments available to the players,” he said. “On game days, there were multiple times open to provide “One of my hopes for the next one to two years is to work treatments — including morning skates, during the three hours with healthcare providers from other professions that I prior to game time when you prep at the arena and players arrive, have developed strong relationships with, and who are also and treatments during the game when something arose [which involved with their national associations. I want to connect doesn’t happen frequently], and then post-game as well.” our associations, so we can work together in a way that results in change, and to the level where we actually see that change. Dr. Olin also has experience working with another I would like to see a time where it becomes commonplace for interdisciplinary team whose patients are very different from chiropractors who desire to work in interdisciplinary settings hockey or football players. He serves as the Manitoba Chiropractic to have those opportunities.” Association’s liaison to the chiropractic program at Winnipeg’s Mount Carmel Clinic. Olin knows there will always be individual clinical practices but recognizes there is no downside to integrating chiropractic Mount Carmel’s patients include people from low-income into healthcare teams and interdisciplinary clinical settings. neighbourhoods, members of the LGBT community, new immigrants, teens and the homeless. Mount Carmel’s “We are starting to see more chiropractors providing MSK chiropractor, Dr. Audrey Toth, joins a variety of other healthcare expertise as part of healthcare teams, and the evidence providers on an interdisciplinary team that uses a process of suggests that this team-based approach to care is beneficial cross-referrals to ensure patients receive the care they need. for our patients, and a great opportunity for our profession.”

32 Issue 16 | Canadian Chiropractic Association | 2018 Leading Chiropractic Content At Your Fingertips! CHIROPRACTIUM IS A New Members-Only App offered as an enhancement to your CCA Membership

• It’s a simple, easy-to-use tool that allows you to stay connected with your colleagues from coast to coast; • Provides tools to enhance your interactions with patients; • Offers a full range of resources to optimize your practice; • Provides content and resources on best-in-class evidence-informed practice principles; and, • Offers a suite of tools to maximize your member experience with the CCA.

Prefer the web? Chiropractium is also available online at www.chiropractium.ca Issue 16 | Canadian Chiropractic Association | 2018 33 RESEARCH FEATURE

PROFESSOR HARTVIGSEN SEES A BOLD FUTURE FOR CHIROPRACTIC

But there are challenges both in the profession and the healthcare system

34 Issue 16 | Canadian Chiropractic Association | 2018 recent series published in the prestigious medical journal Hartvigsen called for a transformation in our The Lancet attracted worldwide attention to the growing healthcare system so that pharmacological A epidemic of low back pain (LBP). It examined how treatment, imaging, spinal injections and surgery healthcare systems are failing patients by providing treatments are not the first-line treatments for LBP patients. that are ineffective, or worse, leaving people in poorer health than before they sought care. “Much of the problem is in the way we have designed our healthcare systems,” he said. “It is not well-designed to deliver The first paper in the series was titled “What low back pain is and therapies like chiropractic. It is geared toward pharmacological why we need to pay attention.” It presented sobering statistics treatment, invasive procedure, high-tech stuff.” on the prevalence and burden of LBP and produced a grim global outlook based on the inadequacy attention to prevention of LBP Hartvigsen illustrated how high rates of imaging can be disability and inadequate treatment. detrimental to LBP patients.

Delving into the complexity of LBP causes, the authors “We cannot relate imaging findings to the patient’s emphasized that rarely can the nociceptive source be symptoms,” he said. “Studies have convincingly shown that identified in the individual patient. This is further imaging can be iatrogenic in back-pain patients. We scare complicated by contributions of biopsychosocial and social people by telling them that something is wrong with their factors, comorbidities and genetics. Along with individual backs when they may be completely normal. The high rates pain processing, these elements make LBP a challenging of imaging are partially to blame for the high surgery rates. A condition to treat.1 surgeon may take something out that has nothing to do with the patient’s pain, which may explain the ineffectiveness of The second paper, “Prevention and treatment of low back some forms of surgery for back pain.” pain: evidence, challenges, and promising directions,” argued for more robust LBP evidence and research on prevention. The authors also collated the most current global practice “Much of the problem is in the way guidelines and made recommendations, none of which we have designed our healthcare supported pharmacology, imaging, spinal injections or surgery as first-line treatment. systems,” he said. [ ... ] It is geared toward pharmacological Instead the authors promoted solutions that “focused implementation of best practice, the redesign of clinical pathways, treatment, invasive procedure, integrated health and occupational care, changes to payment high-tech stuff.” systems and legislation, and public health and prevention strategies.”2 However, the lack of robust research prevented them from recommending wide-spread implementation. How can we decrease the rates of imaging, pharmacology, injections and surgery? The final article — “Low back pain: a call for action” — spotlighted the immediate need for international public health “It is a question of leadership. We need courageous leaders policy makers to make LBP a priority to ease the future burden.3 who have the guts to go in and change the system and restrict access to MRIs, but that is not going to be popular to a politician. We spoke with one of the series’ authors, world-renowned However, we need to put science into action, there is no way musculoskeletal (MSK) expert and researcher Professor Jan around it. Studies, even randomized trials, show that people who Hartvigsen, PhD, about the impact of its publication on the have imaging in the absence of a clear indication for back pain chiropractic profession. have a worse prognosis than those who do not.”

Hartvigsen’s professional and research experience are How can those in political and public-health sectors, healthcare impressive. Not only was he a lead in the creation of the professionals, and policy makers deny the evidence that current series, but he also serves on The Lancet Low Back Pain Series treatment for LBP is not only ineffective, but harming people’s Working Group’s Steering Committee, as well as heading both health? The research at the core of The Lancet series provides the Research Unit for Clinical Biomechanics and the Graduate proof that the system must change to provide patients with Program for Physical Activity and Musculoskeletal Health at better outcomes and reduce the burden of LBP. the PhD School in the Faculty of Health Sciences at University of Southern Denmark (USD). He is also Senior Researcher at Since treating LBP is such a substantial component to the Nordic Institute of Chiropractic and Clinical Biomechanics chiropractic practice, Hartvigsen believes the profession is well and was recently appointed Adjunct Professor at UOIT-CMCC positioned to be part of the solution, but only if the profession Center for Disability Prevention. decides it’s really ready.

Issue 16 | Canadian Chiropractic Association | 2018 35 “If chiropractors really want to be part of the solution, they need to integrate more into healthcare systems. That means invariably giving up some autonomy.”

“The utility and effectiveness of invasive procedures too. We don’t speak with one voice. Medical doctors don’t are being questioned across the board, and these are not speak with one voice either, but they do not question that the treatments that chiropractors deliver,” Hartvigsen said. foundation of medical practice is evidence. Chiropractors need “The interventions that chiropractors use and recommend to embrace an evidence-based approach because we bring are exercise, various forms of manual treatment, patient something very valuable to the table.” education — these are the approaches that are now being universally recommended. It is a time of opportunity.” Hartvigsen said the response to The Lancet series has been “overwhelming.” The papers are ranked by Altmetric as being But Hartvigsen believes discord within the profession hampers among the top five per cent of all research output ever scored the potential capacity chiropractors could occupy in a remodelled across fields and disciplines. According to The Lancet Media healthcare system. Department, there has now been more than 15 million tweets about the series, many using the hashtag #LowBackPain. “Many chiropractors are practising in relative isolation outside of mainstream healthcare,” he said. “I think that “I spent weeks speaking to journalists from all over the world,’ many chiropractors like it that way. Many are not interested in Hartvigsen said. “It is not every day a Dane is interviewed live on becoming part of the big healthcare machine.” Brazilian radio or makes front page on an Italian newspaper. [The Lancet] papers [alone] are not going to change the world, “[But] if chiropractors really want to be part of the solution, but it was a very big microphone to speak into.” they need to integrate more into healthcare systems. That means invariably giving up some autonomy. That is very difficult for chiropractors because historically we have been thelancet.com very suspicious of other healthcare professions, many times for good reason. There is a tremendous amount of baggage, READ THE LANCET ARTICLES ONLINE friction and bias between chiropractors and other healthcare Open access and free of charge professions. Chiropractors need to work to overcome that.”

“It’s not only about persuading the other people,” Hartvigsen References

added. “Chiropractors need to look in the mirror and ask 1. “What low back pain is and why we need to pay attention,” Jan Hartvigsen, themselves if they are really prepared to take on this challenge. I Mark J Hancock, Alice Kongsted, Quinette Louw, Manuela L Ferreira, Stéphane Genevay, Damian Hoy, Jaro Karppinen, Glenn Pransky, Joachim Sieper, Rob think many are.” J Smeets, Martin Underwood on behalf of the Lancet Low Back Pain Series Working Group, The Lancet, Vol. 391, No. 10137, March 21, 2018

Hartvigsen also pointed to disagreement about fundamental 2. “Prevention and treatment of low back pain: evidence, challenges, and promising beliefs within the profession as an impediment to wider directions,” Nadine E Foster, Johannes R Anema, Dan Cherkin, Roger Chou, Steven P Cohen, Douglas P Gross, Paulo H Ferreira, Julie M Fritz, Bart W Koes, Wilco Peul, acceptance from other healthcare providers. Judith A Turner, Chris G Maher on behalf of the Lancet Low Back Pain Series Working Group, The Lancet, Vol. 391, No. 10137, March 21, 2018

“There is confusion about what chiropractic is and what the 3. “Low back pain: a call for action,” Rachelle Buchbinder, Maurits van Tulder, Birgitta Öberg, Lucíola Menezes Costa, Anthony Woolf, Mark Schoene, Peter treatments are among other healthcare providers,” he said. Croft on behalf of the Lancet Low Back Pain Series Working Group, The Lancet, “And to be honest, there is that confusion amongst chiropractors Vol. 391, No. 10137, March 21, 2018

36 Issue 16 | Canadian Chiropractic Association | 2018 CONNECTING CANADIAN CHIROPRACTORS THROUGH PODCASTS

Show uses online medium to reach chiropractors across the country and discuss important topics

r. Kent Stuber and Dr. Gaelan Connell have co-hosted the Canadian Chiropractic Guidelines Initiative Podcast since DAugust 2017, but they didn’t meet in person until last spring’s National Convention & Tradeshow conference in Calgary.

Luckily, the co-hosts — who live in different provinces — Dr. Kent Stuber Dr. Gaelan Connell developed a good online rapport. Together, they provide interesting, lively discussions with experts on matters important to Canadian chiropractors at least once a month. Their guests to us chatting with somebody, and hopefully that can reduce have included researchers, clinicians and advocates from some of that isolation.” provincial associations, as well as chiropractors. Connell also wanted to highlight how the podcast helps to show “We are trying to have a well-rounded approach because there researchers in a different light. is tremendous value in hearing stories from all those involved in chiropractic,” Connell said. “It’s easy to forget that researchers are people,” he said. “They have families and lives and many of them started out as clinicians Stuber and Connell have published articles in several peer- or have trained as clinicians. They publish their work so it can reviewed scientific journals. And both are dedicated to promoting make an impact on their colleagues throughout Canada and the evidence-based best practices within the Canadian chiropractic world. So, if we can highlight that human element to the research profession. This combination made them the perfect fit for The then that makes it more relatable to the listener.” CCGI Podcast. Their show educates chiropractors about getting involved in research, understanding clinical guidelines, building The response to the podcast has been great. It had more than an evidence-informed practice and more. 4,000 listens in the year since its launch and has a five-star rating on iTunes. The show sprouted from discussions about unique ways to reach clinicians and emphasize the importance of guidelines and “When I go to conferences and conventions,” Connell said, “people evidence in practice. come up to me and say, ‘I listen to the podcast while I cook dinner, or I listen to the show while I’m running, and I’m enjoying it.’ And these “We had originally thought of doing videos,” Connell said. “But are chiropractors who I have never met before, so it is nice to know we were quickly told by everyone around us that we had faces for that we are reaching a wide audience.” radio, so maybe we should try a podcast instead.” Stuber and Connell attribute much of the podcast’s success A podcast can be downloaded or streamed online — at the to their chemistry. “It’s such an easy relationship, the back listener’s convenience — and this flexibility is vital for a and forth,” Stuber said. “Despite having a fairly large age gap practising chiropractor. “We know that creating change requires between the two of us.” a multi-faceted approach and a podcast is meeting people where they are at,” Connell said. “I am much younger,” Stuber said.

Stuber agreed. “A lot of chiropractors and healthcare professionals At that point, Connell laughed. have busy lives. Trying to squeeze in a little extra learning, and a little extra entertainment, can be done with a podcast.” The CCGI Podcast can be found at Stuber also sees the podcast as a way to combat what he described chiropractic.ca/guidelines-best-practice/podcasts as the “isolation” that can happen to chiropractors. “Even if you or on iTunes, Pocket Casts and Google Podcasts. haven’t spoken to another chiropractor in months, you can listen

Issue 16 | Canadian Chiropractic Association | 2018 37 CCA ENDORSES

Kids wear their backpacks often, but improper use and heavy weight can affect posture. At Beckmann, they Schoolbags believe that each child should have an appropriately sized backpack. And they emphasize showing children how to from Beckmann properly adjust their schoolbag to avoid poor posture. At Beckmann, they work to ensure each backpack has good weight distribution, using chest and lap straps of Norway to make “heavy loads feel easy to carry.” he CCA is proud to announce that we have Find retailers in Canada at beckmannofnorway.com endorsed Beckmann of Norway, makers of T the “original ergonomic schoolbag.” Founded in 1946, Beckmann designs children’s backpacks with a twist. Each one is reviewed and tested in collaboration with physiotherapists and chiropractors.

he Canadian Chiropractic Association is pleased to announce our newest affiliate T partner, Omega Postures Systems Inc., and their Normalizer™ Posture Pillow. Omega Posture Systems Inc., a Canadian company, has been dedicated to serving chiropractic since 1983. Designed by a chiropractor and backed by 35 years of clinical experience, the Normalizer™ Posture Pillow was designed to contour the normal curvature of the neck. Its unique construction helps maintain the head and neck in proper relationship to each other. The Normalizer™ Posture Pillow gently supports the neck, providing a comfortable and restful night’s sleep. Designed to reduce stress and give the body the rest it needs. ™

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Issue 16 | Canadian Chiropractic Association | 2018 39 THE MOST CELEBRATED CHIROPRACTIC EVENT OF 2020 IS COMING TO HALIFAX!

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