The Most Overlooked Source of Back Pain: Fatty Infiltration of the Multifidus

Your back hurts, and no one can figure out why. It can be incredibly frustrating when you've had x-rays, MRI's and more doctors visits than you care to remember.

Well, there is a very common source of back pain that is often overlooked. It's impossible to see on X-rays and often overlooked on MRI.

What is the most overlooked source of back pain?

Fatty infiltration of the multifidus. If you have a patient that has an MRI, first of all, take a look at those pictures. Don't just look at the report. Furthermore, take a good look at those axial slices when you go down to L4-L5-S1. You will see the multifidus in what I call it the channels or gutters directly posterior to the lamina. The multifidus there should look like a beautiful marble sized steak and then on the outside should be superficial fat, which is white. If you cannot tell the difference between what is the fat and what is the muscle tissue- then you have fatty infiltration of the multifidus.

This is very important because very few docs are talking to their patients about that right now. But if there is deconditioning and fatty infiltration of the musculature, it is going to result in needed more than one or two adjustments to get where they want to be. They are genuinely deconditioned, so it helps you set better expectations for your patients.

The pain occurs in this area because essentially they are unstable. Normal movement patterns will place a tremendous amount of stress and strain on the facets, discs, and all other supporting structures when the muscles are deconditioned. Those other structures aren't designed to handle the extra load and will often fail- thus resulting in pain.

This is also relevant information to know if that patient is exploring a surgical intervention such as a laminectomy or decompression. How well do you think that's going to hold together? Probably not very well.

One more questions, do you think spinal injections are miraculously going to take care of 50 years of degenerative change? I don't think so!

So, I would encourage you to be different, be better. A lot of physicians are not looking at those axial pictures, and if you are, you probably haven't checked out the integrity of the multifidus lately. I would encourage you to do so for next patient that comes in that has an MRI. Look at those actual pictures. Take a look at multifidus and see what you think about the integrity of the muscle and set a better expectation for the recovery of your patient. Your practice is where they should be if they have this challenge. Establishing proper motion with adjustments, gapping the facets, getting movement into the disc and improving the multifidus through exercise and rehab is typically a great start to a successful plan of care.

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Social Media Tips for Chiropractors: How to Easily Create Compelling Content

You know that publishing and producing top quality content online on platforms such as Facebook, LinkedIn, Instagram, and your website is imperative to driving interest and patients into your practice. But for a lot of docs, it can be exceptionally challenging to keep up with content production. Sound familiar?

I know a lot of people who have a Facebook page's for their practice that goes dormant for weeks at a time. So I wanted to break down how you can take one piece of content and split it into a variety of different parts that you can utilize throughout weeks or months in your practice.

Let's start at the top and walk through how each piece works and how you can utilize them to get more influence, and ultimately more eyeballs on your social media content.

Creating Compelling Chiropractic Content for Social Media

It all starts with a piece of smart material. What is "smart" content? It's a topic that you would feel comfortable talking about for five to ten minutes if I put you on the spot right now and started filming. Maybe it is disc herniation, ergonomics, spinal curves, etc. We each have our own topics that we just know inside and out.

This topic will be your pillar piece of content from which everything else is created. Here's the catch (isn't there always a catch?). The best way to make this process work is to take your pillar topic, or smart content, and create a 5-10 minute of you discussing it. I know, a lot of docs have challenges shooting video. So if you have any questions comment down below. But here's what you can do, and why you should start with a video.

Once you shoot a video, all of your other content can actually be distilled down from that initial video. While shoot your video be sure to paint a clear picture and talk about the topic confidently. Once you do, you can have that video transcribed into text. That creates an excellent blog post. Then guess what? You can post a picture of the video on Instagram, a link to the blog on Facebook and much more.

Depending on the topic you also may have just created a brand new patient education piece for your practice. The options and opportunities are endless.

For instance, take a still image from you speaking during the video. Now you have a beautiful picture. Well, when you combine some of the text of the blog and the images self what do you have? You have an excellent social media post that you can publish on Facebook and LinkedIn.

And don't forget about that audio. If you rip the sound, you have a podcast episode already in the bag!.

And finally off of that video 5 to 10 minutes. You can break down a 60-second piece of it and then have that as a story on your Facebook or on your Instagram page.

If this sounds interesting to you but your concerned about not having enough time I encourage you to check out The Smart Chiropractor. We automate this entire process and provide a done for you social media solution for your practice!

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A Chiropractor’s Guide to Pay Per Click (PPC) Advertising

PPC (pay per click) or "Google" advertising is an important part of a holistic approach to marketing. These campaigns aren't designed to necessarily build your brand (which is also crucial), but rather convert people who are looking for your service.

In other words, if someone types "your town chiropractor" into Google, and your listing pops up first (THAT'S THE AD!), then it is quite likely they will click to learn more.

DOWNLOAD THE CHIROPRACTORS GUIDE TO PPC ADVERTISING HERE!

Below is a transcript of Matt Adams from Empirical360 and I discussing PPC advertising for chiropractors and their new guide to help make it easy.

Jeff: Hey what's up everybody Jeff Langmaid here and I am talking with Matt Adams from Empirical 360 today. We're going to discuss some PPC advertising and how you can maximize your results. Today they've just released a guide specifically for a chiropractor's, and that's what we're going to dive into. So Matt, who is this guide for?

Who is the Chiropractors Guide to SEO for?

Matt: It's dual purpose. It's specifically for a chiropractor-number one. But number two, it's for chiropractors who might have an agency relationship or for chiropractors that don't have an agency relationship but want to get into PPC marketing. If you have an agency, then it might offer some checks and balances to make sure that they're doing their job. If you're a chiropractor that's not doing PPC right now, this can be extremely beneficial regarding how to set up a PPC campaign and do it in the right way to actually monetize and get some new patients coming in a pool.

I've worked in healthcare marketing for quite some time, and chiropractic has been a significant portion of that. Coming to work for Empirical 360 as their director of client access, I really see a market in need. Chiropractors are great physicians who actually want to treat and make people feel better. I want to help them actually find patients and get them into their practice.

Jeff: And as we break this down in a moment step by step just recap for anybody that didn't check out the previous videos. What's PPC advertising in a nutshell?

Matt: So PPC advertising is a pay per click. Basically, it's when you use a search term in Google, like for example "chiropractor near me" and the first four results that come up are going to be advertisements. That's a chiropractor who is in PPC marketing. They're actually bidding on those words and queries so that their site can come up and a consumer can find them when they actually need them.

Jeff: Well let's dive in and take a look.

Matt: So basically this is going to be a step by step guide to PPC marketing. And again we didn't want to make this overly technical. We want it to be professional enough so that you know you're going to do things the right way and you get the point behind it is. But we want to drill things down enough to a fundamental standpoint so you can actually get to understand it.

Anybody who wants to be found on Google they're going to be using pay per click typically. So moving on down the line here we kind of get into the genesis of a campaign which is your keyword selection strategy. And you know there's a couple of things that we get into that are going to be for things that you want to avoid and things that you want to do. We talk about the keyword planner in there.

PPC Keyword Selection

Jeff: The keyword selection is absolutely essential. I mean it's really where everything else stems from. What's the biggest misstep you see chiropractors taking regarding keyword selection?

Matt: It's really leaving things too broad. If you're going to start with a campaign, we always recommend starting small. In most markets when it comes to PPC for chiropractic, depending upon the size of your demographic area, the overall budget may be 500 to 1000 dollars per month.

Also, don't use terms that are super broad. Because you may be lumped in with interventional pain management for example, which could drive up your cost. Just focus on people who are looking for chiropractic care.

Jeff: It's almost like reverse engineering what people are searching for. If you are the answer to what they're looking for, that helps in every aspect of your marketing. Number one, you don't need to feel cheesy or corny trying to sell them on something. If an individual is looking for a service that you offer, and you're there when they're seeking, then it's a perfect match.

Segmenting Your Audience When Marketing Chiropractic

Matt: This probably is this is legitimately one of the most important things in setting up a PPC campaign When you segment an account the right way it's done by device. If you have a campaign that is specifically for "chiropractor near me" and you realize that is performing particularly well on mobile then you can cut out some of the budgets for your other campaigns and funnel a bigger budget back into what's performing the best. That helps your cost per click go down. It's going to help the actual cost per lead go down as well, and you should be getting more new patients because you're using the money the right way.

Jeff: That's great. That's important because a lot of times it's overlooked. Being able to understand if something is converting better on a mobile vs. desktop is essential because it helps you gain efficiency.

That's a key component for anybody that's out there already involved in PPC advertising. Is your agency fine-tuning your campaigns?

Matt: Yeah. It's like a kind of like the stock market and diversifying your portfolio right. If you don't have that diversification in your average portfolio, you're not going to be able to allocate things the right way. So this is this is paramount. If you read this here, spend all your time on it.

Jeff: Then it comes to writing the actual ad copy.

Matt: In particular I want to talk about relevance. So if you're going to use something like spinal decompression, your advertising copy needs to be related explicitly to the efficacy of the treatment.

All About Ad Copy

Having relevant ad copy is going to increase your quality score on Google, and thereby you're going to get a lower cost per click lower cost per lead and more new patients coming in.

Jeff: Any time I think about copyrighting it's good to be creative but not good to be too cute. In other words, you can be creative with how you structure your copy and how you talk about it. But be direct, it's not the time to get drastically esoteric. You have to be able to lead the person from "I'm looking for this" to taking action.

Let's talk about landing pages. When we're talking about landing pages, if you have ad copy that related explicitly to spinal decompression, you really want somebody to fall at the landing page that talks about spinal compression and breaks it down. They see the spinal decompression apparatus. They see a patient that's actually getting spinal decompression. They know a testimonial about a patient that benefited from spinal decompression, and then they've got a form to be able to contact you right there dead center. So they can actually communicate with you and engage.

And once you get those landing pages of what some of the next steps as far as optimizing so optimization?

Matt: So let's say for example somebody search for "chiropractic university." You probably don't want somebody to click on your advertisement if they've searched for "chiropractor university." So you need to go back into your account and add a negative keyword which will exclude it from being shown. So this is done on an ongoing basis as dealing with competitors. So if somebody was searching for a specific chiropractor, you want to exclude that particular chiropractor as a negative,e so that you can refine your strategy within Google ads.

Jeff: That's that's a really really crucial point, especially when we talk about the competition on some of the large pain management groups and some of the large surgery groups. These are people that have bottomless pockets that can dump a ton of money into their online advertising that you just can't compete with for dollar for dollar. It's challenging.

Matt: Well the other piece of that puzzle is that it's not just that big pocket competitors that you're worried about. You're actually worried about Google as well because Google's job let's not forget 92 percent of Google's revenue comes from paid search. They are getting paid billions and billions of dollars for their advertising and the Google ad platform. If you don't put checks and balances in place and you don't have those negative keywords, you're not doing things based upon the exact match, and you don't actually set in a budget.

Jeff: That's very very very well said.

Dynamic Call Tracking with PPC Advertising

Matt: Also, we use a particular platform that enables dynamic call tracking. If you have a consumer that has reached a landing page, then we have a unique phone number that we can attribute back to the actual advertisement. So that call tracking data we want to pump back in to see that this particular campaign is doing really well-generating calls for you. So when the drive is doing really really well the next step is to say. All right. Perfect. This is working great. We've got the right recipe. Let's go ahead and funnel more of our budget into that campaign, and we should expect to yield the same results. So it's rinsed and repeat.

Jeff: Love it. That has been a complete breakdown of the entire chiropractic pay per click guide.

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Chiropractic Clinical Series: 4 Keys to Reading a Spine MRI

Welcome to a new clinical series designed for practicing chiropractors! Today we are talking about the four essential tools that you need to have command knowledge of within your imaging software. We'll go through them one by one.

The four essential tools are- measurement, contrast, magnification, and scout lines. The four tools will get you 98 percent of the information that you need when looking at a spine MRI. I highly encourage working with your radiologist for the complete read. But knowing your way around an MRI will save you from getting super anxious, and you could eliminate a lot of that anxiety by doing a few simple things.

Number one; make sure that you are opening up in your software. Do NOT use "whatever" software comes on the disc. That is a recipe for disaster because all the software is slightly different. Two software packages make viewing images really easy. If you are a PC person, then check out Radiant Viewer. If you are a Mac person than OSIRX is the best tool on the market. They have a free version and a paid version. If you're not a radiologist, then the free version is going to be absolutely perfect for you.

When you open up, you're software you should anticipate seeing, on the left-hand side of the screen, all of the different images that you have lined up in your queue. So whatever's on that disk will show up on the left-hand side.

You should already see the scout lines. Most imaging software including OSIRX WILL allow those scout lens to come up automatically. They just rectify one image or plane against the other. As you scroll the scout lines will then move following where you are. So scout lines are essential only to understanding and rectifying left versus right, up versus down,n and what segment you're at.

The other three measurement contrast in magnification are all located in the same area in almost every software package you open up. All you have to do is go to the middle at the top, and you will see the cluster of tools that you are looking for. And typically, they're pretty obvious. Your magnification is usually the little magnifying glass. Measurement seems like a bit of measuring tape, and then your contrast.

The measurement tool allows you to drag and drop to measure the distance between two items. Very important when you're measuring canal space. You can see how that happens right there.

The magnification tool is the little magnifying glass. This allows you to get in really detailed or pull back out of the picture can be used in conjunction with your measurement tool.

Contrast allows you to brighten or darken the images on the screen. Thankfully we no longer are at the whim of a single "hard" film but can manipulate the contrast from the comfort of our own home.

So, wrapping up. Be sure to download your own software package. OSIRX is a great MRI viewer for Mac and Radiant Viewer for PC. Make sure that you are not at the whim of different software for every disk that you put in or it will be inefficient and confusing.

Don't just rely on the report. I know we can do better. I think we all should be looking at the imaging because we have the luxury of seeing the patient. The radiologist does not typically see the patient. We, as chiropractors, are able to see the functional aspects of what they're going through and correlating that with the images. It's our job to delineate what matters, what doesn't matter and give our patients the best course of action.

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Creating an Irresistible Call to Action on Your Chiropractic Website

Is your website converting new patients as it should be?

And I mean that earnestly. If somebody is typing in your town, chiropractor and your website comes up; it is very likely that they are looking for a chiropractor and will become a new patient!

So my question to you is- does your website represent what you want them to do, the next step they need to take? And that really comes down to your call to action. In marketing, when you see "CTA," all that means is call to action. Let's go one step deeper.

Your call to action is what are you asking for. What do you want the person that visits your website to do? If you want your site to drive new patients, then your call to action needs to invite them to call your office and learn more. You need to dive deep on these type of things because I know there's a lot of chiropractors out there that have the headline of their website (their call to action) that's esoteric and/or generatic and doesn't give a clear direction.

When marketing, you need to be as crystal clear. You need to distill your message down and be as clear as possible. Describe the next step for the visitor to take.

Click over to your website. Check out the call to action or the headline and ask yourself if you are providing a clear direction for your visitors. If it's unclear, then I can tell you right now your website is not converting as well as it should be.

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