Many people seek chiropractic care when their back goes out or their neck tightens up. But how does this form of care actually work? What are the benefits of receiving chiropractic care for nerve dysfunction compared with other healthcare options? Let’s take a look!
First, let’s discuss how the nervous system “works.” We have three divisions of the nervous system: the central, peripheral, and autonomic nervous systems. The central nervous system (CNS) includes the brain and spinal cord, and it’s essentially the main processing portion of the nervous system. The spinal cord is like a multi-lane highway that brings information to the brain for processing (sensory division) and returns information back to the toes, feet, legs, and upper extremities from which the information originated (motor division). For example, hiking on a mountain trail or simply walking requires constant input to and from the CNS so we can adjust our balance accordingly and not fall. These “sensory-motor pathways” are essential and allow us to complete our daily tasks in an efficient, safe manner as information is constantly bouncing back and forth between the brain and the rest of the body.
The peripheral nervous system (PNS) includes a similar sensory/motor “two-way street” system relaying information back and forth from our toes/feet/legs and fingers/hands/arms to the spinal cord (CNS). And if this isn’t complicated enough, we also have “reflexes” that, for example, allow us to QUICKLY pull our hand away from a hot stove to minimize burning our fingers.
Reflexes allow the information to “skip” the brain’s processing part so quicker reactions can occur. The autonomic nervous system (ANS) includes the sympathetic and parasympathetic divisions that basically “run” our automatic (organ) functions like breathing, heart rate, digestion, hormonal output, and more. There is constant communication between the ANS, PNS, and CNS that allow us to function in a normal, balanced way… unless something disrupts them.
There are obvious conditions that interfere with this communication process that include (but are not limited to) diabetes (with neuropathy), frost bitten or burned fingers, peripheral nerve damage from conditions like carpal/cubital tunnel syndromes, thoracic outlet syndrome, and/or pinched nerves in the neck, mid-back, low-back spinal regions, as well as conditions such as multiple sclerosis (MS), Guillain-Barre Syndrome, after a stroke (spinal cord or brain), and after trauma with resulting fractures where nerve, spinal cord, and/or brain damage can occur. These are “obvious” reasons for delayed or blocked neurotransmission.
There are many other less obvious injuries or conditions that can result in faulty neuromotor patterns and nerve transmission of which chiropractic services can benefit. The “subluxation complex” is a term some chiropractors use to describe the compromised nerve transmission that may occur if a nerve is compressed or irritated due to faulty bone or joint position along the nerve’s course. Reducing such nerve compression typically allows for a restoration of function. A good illustration of this is a patient who suffers from a herniated disk in the neck with numbness and tingling down the arm to the hand. The goal of treatment (for all healthcare professionals) is to remove the pinch of the nerve.
To realize this goal, doctors of chiropractic utilize spinal manipulation and mobilization in addition to other non-surgical, non-drug approaches that may include exercises, nutritional advice, home-care such as a cervical traction unit, and other anti-inflammatory measures (ice, modalities like low level and class IV laser, electric stimulation, pulsed magnetic field, and more). Given the minimal side-effect risks and well-reported benefits, it only makes sense to try chiropractic FIRST and if you’re not satisfied, your doctor will help you find the next level of care.
Peripheral neuropathy is a condition characterized by damaged nerve endings, most commonly in the feet and lower legs. Generally, a patient’s symptoms are initially localized to the digits and plantar aspect of the foot but over time can spread proximally to the distal third of the leg.
Most cases are related to diabetes which impacts between 60 to 70 percent of all patients with diabetes. This is because elevated blood sugars eventually damage the small blood vessels that provide nutrients to the nerves. Since the blood vessels cannot provide adequate nutrients to nerves, nerve injuries do not properly heal and regenerate. There are dozens of other causes of neuropathy including trauma as well as the side effects of prescription drugs.
Red/Near Infra-Red Light Treatment
Medical treatment for years has centered on pain management medicine to cover up the symptoms while the condition progresses. A much more natural, effective, non-invasive approach is the cutting-edge Ultimate Light. This painless approach employs a powerful system that focuses on healing the damaged nerve endings, rather than covering up the symptoms with dangerous drugs which can cause terrible side effects.
How Does It Work?
The key discovery is that Red/Near Infra-Red Light actually stimulates the tissues of the body at the cellular level. The light energy penetrates the skin and is absorbed by the mitochondria of the cells. This energizes the mitochondria and accelerates healing of damaged nerves and surrounding tissues. It does this in part by increasing the oxygenation of injured tissue. In fact, regardless of what type of tissue that is involved, Red Light dramatically increases cellular function.
Before and After(s):
We know you’ve heard this before, but we’ll say it again – stretching is important and we all need to do it more often. Stretching isn’t just for athletes, runners, and people who do yoga. When it comes to maintaining joint and muscle health – it’s important for everyone. Here are a few reasons why:
Stretching Increases Your Flexibility and Mobility
Stretching regularly will lengthen your muscles, which improves flexibility and allows your body to move more freely. Many people often overlook the connection between injuries and a poor range of motion or a lack of flexibility. Simply put, if you want to avoid back pain or other common injuries, you need to stretch more.
Stretching Improves Your Posture
When muscles are tight, the alignment of your spine will suffer. It’s common to have a tight muscle on one side of your body but not the other, thus causing postural imbalance. Over time, poor posture can cause a number of different injuries so it’s important to work out those tight muscles before things get worse.
Stretching Reduces Stress
Taking the time to stretch and breathe every day is a great way to de-stress. Pain in your neck, shoulders, and back can also be caused by muscle tension as a result of stress. So, if you’re feeling burnt out, start a stretching routine and stick to it.
Stretching Keeps You Feeling Young
Did you know that as we get older, our muscles get shorter and tighter? If you’re not stretching every day, you’re not taking proper care of your aging body. Increasing your flexibility, range of motion, and stress levels will help you feel your best no matter what age.
Although both medication and chiropractic are utilized by neck pain sufferers, not everyone wants to or can take certain medications due to unwanted side effects. For those who aren’t sure what to do, wouldn’t it be nice if research was available that could answer the question posted above? Let’s take a look!
When people have neck pain, they have options as to where they can go for care. Many seek treatment from their primary care physician (PCP). The PCP’s approach to neck pain management usually results in a prescription that may include an anti-inflammatory drug (like ibuprofen or Naproxen), a muscle relaxant (like Flexeril / cyclobenzaprine), and/or a pain pill (like hydrocodone / Vicodin). The choice of which medication a PCP recommends hinges on the patient’s presentation, patient preference (driven from advertisements or prior experiences), and/or the PCP’s own preference.
Although it’s becoming increasingly common to have a PCP refer a neck pain patient for chiropractic care, this still does not happen for all neck pain patients in spite of strong research supporting the significant benefits of spinal manipulation to treat neck pain. One such study compared spinal manipulation, acupuncture, and anti-inflammatory medication with the objective of assessing the long-term benefits (at one year) of these three approaches in patients with chronic (>13 weeks) neck pain. The study randomly divided 115 patients into one of three groups that were all treated for nine weeks. Comparison at the one-year point showed that ONLY those who received spinal manipulation had maintained long-term benefits based on a review of seven main outcome measures. The study concludes that for patients with chronic neck pain, spinal manipulation was the ONLY treatment that maintained a significant long-term (one-year) benefit after nine weeks of treatment!
In a 2012 study published in medical journal The Annals of Internal Medicine, 272 acute or sub-acute neck pain patients received one of three treatment approaches: medication, exercise with advice from a health care practitioner, or chiropractic care. Participants were treated for twelve weeks, with outcomes assessed at 2, 4, 8, 12, 26, and 52 weeks. The patients in the chiropractic care and exercise groups significantly outperformed the medication group at the 26-week point AND had more than DOUBLE the likelihood of complete neck pain relief. However, at the one-year point, ONLY the chiropractic group continued to demonstrate long-term benefits! The significant benefits achieved from both exercise and chiropractic treatments when compared with medication make sense as both address the cause of neck pain as opposed to only masking the symptoms.
With results of these studies showing acute, subacute, as well as chronic neck pain responding BEST to chiropractic care, it only makes sense to TRY THIS FIRST!
Content Courtesy of Chiro-Trust.org. All Rights Reserved.
Most of us have suffered from back pain at one time or another. It often occurs after over-doing a physical task, like fall yard work, winter snow shoveling, working on the car, cleaning the house, and so on. But there are times when identifying the cause of back pain can be difficult or impossible. Let’s take a deeper look at where back pain can come from…
Though activity-related back pain is common, many times a direct link to over-use is not clear. Micro-traumatic events can accumulate and become painful when a certain threshold is exceeded. (Think of the old adage “The straw that broke the camel’s back.”)
There are other less well-identified causes of back pain. One is called referred pain. This can be caused by an irritated joint or soft tissue not necessarily located in the immediate area of the perceived pain. For example, pain in the leg can result from an injured facet joint, sacroiliac joint, and/or a disk tear (without nerve root pinch). This is called “sclertogenous pain.”
Internal organs can also cause back pain. This is called a “viscerosomatic response” (VSR). A classic example of this is when the right shoulder blade seems to be the source of pain when the gall bladder is inflamed. This pain can be located at or below the scapula next to the spine and the muscles in the area are in spasm and sensitive or painful to the touch. Also, VSR is often not worsened or changed by bending in different directions (unlike musculoskeletal / MSK pain). Without further testing, it’s easy to confuse this with a MSK or a “typical” back ache. Ultimately, a final diagnosis may require an abdominal ultrasound (CT, MRI scan, and other diagnostics are less frequently used).
Visceral pathology in the back pain patient presenting to chiropractors is reportedly rare, and according to one survey, only 5.3% of patients present with non-musculoskeletal complaints. Other common VSR pain patterns are as follows: Heart – left chest to left arm, mid-upper back, left jaw; Liver – right upper shoulder (front and back), right middle to low back, and just below the sternum; Appendix – right lower abdomen (may start as stomach pain); Small intestine – either side of the umbilicus and/or between it and the breast bone; Kidney – small of the back, upper tailbone, and/or groin area; Bladder – just above the pubic bone and/or bilateral buttocks; Ovaries – groin and/or umbilical area; and Colon – mid-abdominal and/or lower quadrants.
Another challenge to diagnosis is cancer in the spine, which can be primary or metastatic (from a different location). Thankfully, this is very rare. A history of unexplained weight loss, a past history of cancer, over age 50, nighttime sleep interruptions, and no response to usual back care may lead a doctor to recommend tests to determine if cancer is present in the spine.
Bottom line: When patients present with back pain, chiropractors have been trained to look for these less common but important causes of back pain. They get “suspicious” when the “usual” orthopedic tests do not convey the usual responses seen with mechanical back pain. In these cases, they work with primary care doctors to coordinate care to obtain prompt diagnostic testing and treatment.
We realize you have a choice in whom you consider for your health care provision and we sincerely appreciate your trust in choosing our service for those needs. If you, a friend, or family member requires care for back pain, we would be honored to render our services.
Review the latest news: Manipulation Helps Migraines
Coronary Artery Disease Linked to CTS
Therapeutic Tape Reduces LBP & Disability
What’s the Best Position for Shoulder Exercise?
Gyroscope Exercise for Upper Extremity Rehab
Skipping Breakfast Increases Diabetes Risk
Researchers from Harvard Medical School, Brigham & Women’s Hospital, and Palmer College of Chiropractic performed a systematic review of the effectiveness of SMT for migraine and concluded that: “Spinal manipulation may be an effective therapeutic technique to reduce migraine days and pain/intensity…We observed that spinal manipulation reduced migraine days as well as migraine pain/intensity.” Rist PM et al. The Impact of Spinal Manipulation on Migraine Pain and Disability: A Systematic Review and Meta-Analysis. Headache. 2019 Apr;59(4):532-542.
2. A systematic review of 47 randomized trials found that cervical manipulation is safe and effective:
3. Researchers have found that SMT may be a natural drug: “The mechanical stimuli provided through a cervical spinal manipulation may modify neuropeptide expression by immediately increasing the serum concentration of nociception-related (inhibiting) biomarkers.” Lohman EB et al. The immediate effects of cervical spine manipulation on pain and biochemical markers in females with acute non-specific mechanical neck pain: a randomized clinical trial. J Man Manip Ther. 2018 Dec 11:1-11.
4. “In patients with cervical radiculopathy, one session of thoracic manipulation may result in improvements in pain disability, cervical ROM, and deep neck flexor endurance.” Young IA et al. Immediate and Short-term Effects of Thoracic Spine Manipulation in Patients With Cervical Radiculopathy: A Randomized Controlled Trial. J Orthop Sports Phys Ther. 2019 May;49(5):299-309.
5. “Patients with acute and chronic back pain reported statistically significant improvements in patient-reported outcomes four weeks after initiating chiropractic care.”
Gedin F et al. Patient-reported improvements of pain, disability, and health-related quality of life following chiropractic care for back pain – A national observational study in Sweden. J Bodyw Mov Ther. 2019 Apr;23(2):241-246.
6. “Patients presenting with nonspecific ear fullness may have TMD.”
Lee SY et al. Clinical implications of magnetic resonance imaging in temporomandibular disorders patients presenting ear fullness. Laryngoscope. 2018 Jul;128(7):1692-1698.
7. A 14-year study of 70,622 patients with coronary artery disease (CAD) and 70,622 patients without CAD found: “A significant positive correlation was observed between CAD and a previous diagnosis of carpal tunnel syndrome.”
Editor’s note- no surprise since CTS also results from ischemia (via nerve compression or tension)
Chang YC, Chiang JH, Lay IS, Lee YC. Increased Risk of Coronary Artery Disease in People with a Previous Diagnosis of Carpal Tunnel Syndrome: A Nationwide Retrospective Population-Based Case-Control Study. Biomed Res Int. 2019;2019:3171925. Published 2019 Mar 3.
8. “The cervicothoracic differentiation test (CTDT) is a specific test with significant diagnostic utility to identify individuals who will experience immediate pain relief following thoracic manipulation. The CTDT should be considered during the clinical decision-making process when treating individuals with neck pain.”
Swanson BT et al. Reliability and diagnostic accuracy of cervicothoracic differentiation testing and regional unloading for identifying improvement after thoracic manipulation in individuals with neck pain. Musculoskelet Sci Pract. 2019 Feb;39:80-90.
9. “Results showed that a Kamath and Stothard carpal tunnel questionnaire (CTQ) score:
10. Neurosurgical Focus Journal: “The Timed Up and Go (TUG) test is a quick and easily applicable tool that reliably measures objective functional impairment in patients with lumbar spine stenosis.”
Stienen MN et al. Objective functional assessment using the “Timed Up and Go” test in patients with lumbar spinal stenosis. Neurosurg Focus. 2019 May 1;46(5):E4. doi: 10.3171/2019.2.FOCUS18618.
11. “Posterior interosseous nerve syndrome is a compressive neuropathy of the posterior interosseous nerve which innervates the extensor compartment of the forearm. It usually has an insidious onset, often presenting with weakness in finger and thumb extension. However, there should be preservation in wrist extension due to the radial nerve innervated extensor carpi radialis longus. It is often self-limiting and resolves with conservative measures.”
12. Who moved L4? A new study has shown greater accuracy in spinal enumeration when the spinal level at the landmark of the iliac crests was identified as L3 (or L3/4), as opposed to the conventional landmark rule that the spinal level of the palpated iliac crests is L4. Cooperstein R et al. Would adopting a revised landmark rule for the spinal level of the iliac crests improve the accuracy of lumbar level identification? Can Chiropr Assoc. 2019 Apr;63(1):26-35.
13. In a cumulative review of more than 1 million acupuncture treatments, the risk of a serious adverse event with acupuncture was estimated to be 0.05 per 10,000 treatments. Most common side effects were bleeding at the needle site and localized needling pain. Similar findings were also reported in 229,230 patients with more than 2 million visits.
Mao JJ et al. Acupuncture for Chronic Low Back Pain: Recommendations to Medicare/Medicaid from the Society for Acupuncture Research. J Altern Complement Med. 2019 Mar 30.
14. “In patients with LBP, KinesioTape (KT) with or without tension reduces pain three days after its application. Additionally, when applied with tension, it improves disability.”
KT was positioned in the form of “I” over the erector spinae muscles bilaterally. The tape was applied with the participants seated, with the spine in anatomical position for the application of the anchor, which was positioned in the sacral region without tension. The participants were then asked to perform trunk flexion and rotation to the opposite side to the application of the tape with a slight stretch of approximately 10 to 15%, which was then repeated on the opposite side. The tape was fixed with tension from the posterior superior iliac spine to T12 with a final anchor point fixed directly above T12.
Macedo LB et al. Kinesio Taping reduces pain and improves disability in low back pain patients: a randomised controlled trial. Physiotherapy. 2019 Mar;105(1):65-75.
15. “Friction massage of the pronator teres muscle helps restore ROM of the forearm supination and immediately increases supinator muscle strength. This technique can be used as an intervention method to improve muscle strength in patients with limited supination ROM.
16. “In patients with chronic low back pain, adding connective tissue manipulation to standard care shows superiority… for improving pain, increasing spinal mobility, and well-being.”
Celenay ST et al. Adding connective tissue manipulation to physiotherapy for chronic low back pain improves pain, mobility, and well-being: a randomized controlled trial. J Exerc Rehabil. 2019 Apr 26;15(2):308-315.
17. Tennis elbow and golfer’s elbow are associated with decreased eccentric peak torque of shoulder external rotators and abductors compared with those of healthy athletes. This tends to decrease the external stability of the shoulder joint and put high stress on the distal joints of the upper kinetic chain.
Nabil BA et al. The Impact of Tennis and Golfer’s Elbow on Shoulder External Rotators and Abductors Peak Torque. J Sport Rehabil. 2019 Apr 29:1-24.
18. “Due to the significant effects of the “gyroscopic device” mediated exercise on grip strength, wrist and shoulder strength and proprioception, and performance of the upper extremity, use of the exercise (three sessions per week over 8 weeks) can be recommended for subjects with impingement syndrome or tennis elbow impairment in measured variables.”
GyroballBabaei-Mobarakeh M et al. Effects of eight-week “gyroscopic device” mediated resistance training exercise on participants with impingement syndrome or tennis elbow. J Bodyw Mov Ther. 2018 Oct;22(4):1013-1021.
19. Researchers sought to determine the most appropriate posture for early infraspinatus strengthening. “The activity of the infraspinatus can be increased gradually during rehabilitation by beginning in the supine position, which assures low activity of the upper trapezius and biceps brachii. Exercise with the shoulder adducted in the supine position can strengthen the infraspinatus gradually and avoid compensatory mobility.”
Sasaki Set al. Electromyographic analysis of infraspinatus and scapular muscles during external shoulder rotation with different weight loads and positions. J Orthop Sci. 2019 Jan;24(1):75-80.
20. JAMA weighs in on the benefits of a low-carb diet such as Atkins and keto: “In the short-term, if a person (is significantly overweight), almost anything that would cause weight loss would be beneficial,” “In the long-term, it’s a different story. Virtually anyone who wants to lower their risk of a variety of ailments, including cardiovascular disease and multiple types of cancer should consume more, not fewer, carbs, as long as they’re good carbs, i.e., fiber-rich whole grains, legumes, fruits, and vegetables.”
Rubin R. High-Fiber Diet Might Protect Against Range of Conditions. JAMA. Published online April 17, 2019.
21. A large review of nearly 100,000 people found that skipping breakfast led to higher rates of type II diabetes:
Some may consider gardening a sport. It may not be a competitive sport (unless you’re competing with your neighbor for who can grow the biggest tomato), but nonetheless; it requires physical activity to perform and therefore may be considered a “sport” to serious enthusiasts. Digging, pulling weeds, adding mulch, and raking can all make you feel like you’ve had a workout at the gym, so it’s essential to use the following safety precautions to prevent injuries.
SAFETY TIP #1 - WARM UP
Take a few minutes to warm up the muscles you’ll be using. Do a short, brisk walk and then lightly stretch your shoulders, back, legs, arms, and wrists. If you need inspiration, consider these two stretches:
Wrist Flexor Stretch
Corner Pectoral Stretch
SAFETY TIP #2 – USE CORRECT POSTURE
Back pain is a common ailment in gardeners, so be mindful of your posture at all times, whether you’re standing or kneeling. When lifting, bend at your knees and keep your back straight. Imagine that your spine has been strapped to a broomstick. Do not bend at your waist or twist your torso. Keep the load you are carrying close to your body.
SAFETY TIP #3 – SWITCH UP YOUR TASKS
Vary your tasks often so that you are not holding the same position for prolonged periods. Walk around and stretch a little in between tasks to help prevent stiffness and improve your circulation.
SAFETY TIP #4 – USE THE RIGHT TOOLS
If you’re using a rake that is too short for your height, you’ll be forced to bend over excessively and cause yourself some back pain. If you need to bend down frequently, consider purchasing kneepads or a mat.
SAFETY TIP #5 –DRINK WATER
Staying hydrated should always be a priority, and it’s especially important when you’re out in the sun doing physical activity. Have a drink of water at least every 15-20 minutes.
If you feel any pain after a day of gardening, apply ice to the affected area. If you still have discomfort after 24- 48 hours, give us a call to schedule a check-up. Happy Gardening!
Previously, we discussed how herniated disks can resorb all by themselves, especially large herniated disks. But what about a damaged nerve—can it self-repair too?
First, it’s important to realize that damage can occur when enough pressure is applied to any living tissue. The anatomy of our nerves includes many micro-structures such as the blood vessels that bring needed oxygen to the several layers of the nerve. If the nerve is deprived of oxygen long enough, there can be damage to its infrastructure, similar to a heart attack damaging the heart muscle.
A pinched nerve results in symptoms that include numbness, tingling, weakness, and in some cases, burning sensations. There are three stages of nerve damage that can be simplified into mild, moderate, and severe, and the ability for nerves to regenerate depends largely on the amount of damage and the length of time that has passed before treatment is sought out.
Generally speaking, it has been well reported that the nerves that make up the peripheral nervous system (the nerves outside of the brain and spinal cord) have the ability to regenerate, while those within the central nervous system (CNS) generally do not. However, there is hope. Researchers have begun to identify the molecular mechanisms that can promote axon regeneration in CNS injuries. Much of the knowledge and insight derived from these studies comes from the experimental use of fruit flies, as is referred to as “Drosophila models of axonal regrowth.”
The activation of an important receptor (called “insulin-like growth factor 1 receptor or IGF-1R) appears to be an essential step for axonal regeneration to occur in adult CNS neurons. Studies utilizing Insulin-like Growth Factor-1 (IGF-1) as a form of treatment in animal models after a brain injury found IGF-1 to be “neuroprotective” in the early stages of brain injury, and blood levels are often elevated soon after an injury.
In a study of 45 patients who suffered traumatic spinal cord injuries, researchers detected higher levels of IGF-1 blood serum levels in those who had clinically documented neurological resolution as compared to lower levels that were found in those who did not have neurological remission.
Unfortunately, researchers need to identify some of the missing pieces of the CNS-injury recovery puzzle before a consistent and predictable outcome can be expected for people who have sustained a serious spinal cord injury.
Doctors of chiropractic are trained to identify injuries to peripheral nerves as well as to the spinal cord and they can also work closely with other experts who manage the more significant neurological injuries, all in the quest of getting you back on the road to as much recovery as possible!
"The Opioid Crisis for Athletes: A Case for Chiropractic Disrupting the Cycle of Pain, Prescriptions and Addiction."
No matter what the sport, athletes suffer injuries. This can happen in a second, such as a high ankle sprain during a football tackle, or gradually, such as a rotator cuff irritation in golf, baseball, tennis or other sports. Regardless of the cause, athletes pursue numerous treatments to prevent injury, reduce pain and improve their range of motion including rest, ice, chiropractic care, physical therapy, and, unfortunately, opioids and other medications. With the latter, this can lead to a vicious cycle of aggravating the injury and then consuming more opioids repeatedly until the athlete is permanently injured and/or addicted to the medication.
The below eBook offers an overview of opioid misuse among athletes and how the pressure to perform can cycle to drug addiction quickly and as early on as high school. We will also explore how chiropractic care can prevent this pattern by helping athletes prevent injuries and perform at their best without the risks associated with opioids.
Have you ever had neck or back pain and considered Chiropractic but feared you’d be required to commit to a long term plan?
You are not alone.
Even though there is plenty of research backing up Chiropractic, some patients just can’t afford the time or expense of long-term, corrective care.
That is why we now offer “pay per visit” Chiropractic for your neck pain or back pain.
This means you can call and come in on the same day and provided that there are no contraindications, get exactly what you want; an adjustment without pressure to keep coming back over and over again.
As a matter of fact, this mainstream approach is featured on www.Chiro-Trust.org… one of the most visited online back pain information websites in the country.
So, if you, your spouse, or a friend is complaining of aches and pains, rest assured that you can come in and get the care you want and can afford.
Give us a call at 772-286-5277. We’ll take good care of you.
Cliff Atwell, B.S., D.C.