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Issue 16 | Canadian Chiropractic Association | 2018 1

BACK MATTERS

Issue 16

News and Views for Canada’s Chiropractors

FOR CHIROPRACTIC

A BOLD

FUTUREDr. Jan Hartvigsen sees

potential to address gaps in the healthcare system

Page 34

Issue 16 | Canadian Chiropractic Association | 20182

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COLUMNS

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6 Message from the Chair

8 Message from the CEO

14 Advocacy: One Step Closer: Empowering Chiropractors to Issue Disability Tax Credits (DTC) Certificates

18 Message from the CBO

20 Researcher Spotlight: Dr. Carol Cancelliere

ISSUE 16

BACK MATTERS

12 Celebrating 75 Years in Saskatchewan

16 Celebrating 60 Years and Beyond in New Brunswick

22 CCGI Student Ambassadors Take the Lead

26 Looking Back: CCA National Convention & Tradeshow

37 Connecting Canadian Chiropractors Through Podcasts

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

39 CCA Plus: Your CCA Perks!

Staying within the lines5

Professor Hartvigsen Sees A Bold Future For Chiropractic34

Sports and the Convergence of Chiropractic30

Clinical Value of Assessing Lumbar Segmental Stiffness24


Issue 16, 2018

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BACK Matters™ is a publication of the Canadian Chiropractic Association (CCA) and is published two times per year.

Copyright © 2018 Canadian Chiropractic Association. All rights reserved. The opinions expressed in this publication are those of the authors and do not necessarily reflect the opinions and policies of the CCA. Advertisements shall not be considered an endorsement, warranty or guarantee of the product(s) or service(s) advertised, nor an endorsement by the CCA of the manufacturer, distributor, supplier or advertiser of such product or service.

No part of this publication may be reprinted without the editor’s written permission.

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Editor: Ronda Parkes

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CONTRIBUTORS

DR. JAN HARTVIGSEN, DC, PHDDr. 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 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 David Chapmann-Smith Honorary Award from the World Federation of Chiropractic.

DR. SHAWN THISTLE, DCDr. 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 worldwide. For 14 years, he has been a part-time faculty member at CMCC in the Orthopedics Department. His skillsets are strengthened by his experience in expert medicolegal reporting in chiropractic malpractice cases.

DR. CAROL CANCELLIERE, DC, PHDDr. Cancelliere is a CCRF Research Chair in Knowledge Translation in the Faculty of Health Sciences, University of Ontario Institute of Technology, and the project lead for 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 activities and research. She is a CMCC graduate (2004) and practised for 10 years in Saskatchewan, 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 has received competitive awards from major national and provincial funding agencies.

DR. KENT STUBER, DC, MSCDr. 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-centredness. Kent is a Best Practice Collaborator in Alberta for the CCGI and has published 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.

DR. GAELAN CONNELL, BHK, DC Dr. Connell graduated from CMCC in 2014. He works in a multidisciplinary practice in Vancouver, British Columbia, and is a knowledge broker with the Canadian Chiropractic 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 degree at the University of British Columbia in Rehabilitation Sciences. He has a keen interest in knowledge translation and implementation science. He is also passionate about running and has completed several trail ultramarathons over the past year.

DR. GREG DUNN, DCDr. 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) from 1990 until his appointment of COO in September 1999. While serving on the CCPA Board, 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 the CEO of the CCPA. Dr. Dunn is a past president of the Manitoba Chiropractors’ Association 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 of the Beautiful Plains Community Foundation Inc., and was the leading force in getting Canada Post to issue a centennial stamp commemorating one hundred years of chiropractic in Canada.

DR. FRANCES LEBLANC, DCDr. Frances LeBlanc is the CEO of the New Brunswick Chiropractors Association and 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 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 passionate health advocate with a special interest in models of care and integrative practices. 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 best practice collaborator for the Canadian Chiropractic Guideline Initiative, among others.

TRACY BERTRAMMs. 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. 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.


As chiropractors, we all place a great emphasis on high-quality care for our patients.

The Canadian Chiropractic Protective Association (CCPA) regularly speaks with DCs who are passionate about each one of their patients’ well-being. But it’s still worth reminding ourselves what factors go into providing our patients with the best care possible and giving ourselves a refresher on our basic, professional obligations.

In our conversations with DCs, we sometimes see the chiropractors’ focus drifting from these professional obligations — becoming so eager to build rapport with their patients that they stray from the doctor-patient relationship. One DC we spoke to recently told us he sees himself as a friend to his patients and avoids referring to himself as a doctor. It’s great to build the kinds of relationships with patients that make them feel more comfortable. However, remembering our obligations and rights within the doctor-patient relationship will allow us to strike a balance that makes us more successful and able to manage risk in our practice.

But what do we mean by a doctor-patient relationship? What are our professional obligations and how do we keep this top of mind as we become more comfortable and build rapport with our patients? Let’s take a look at a real-life example to help answer these questions.

Our DC, who thinks of himself as a friend to his patients, recently received several complaints. While the chiropractor was treating the patient, he noticed a concerning neurological symptom but did not re-evaluate it. As the symptom worsened for the patient, the DC realized he never did baseline neurological testing despite the patient’s presenting symptoms. The DC also didn’t advise the patient of possible differential diagnoses nor the potential natural progression of her condition. As she progressed, she linked her worsening symptoms to the treatment she had received. It turns out that her condition is a degenerative one that usually progresses regardless of intervention. However, the patient feels the DC did not properly discharge his obligations as a doctor.

Practices like appropriately obtaining informed consent, re-evaluating changing symptoms and advising patients about differential diagnoses are examples of our obligations as DCs and, frankly, as healthcare providers. As I often tell our members, “If you’ve done everything you’re supposed to do as a practitioner, you have the right to be wrong. But you don’t have the right to miss steps along the way.”

Patients will appreciate a friendly, approachable attitude from their DC. But in the end, they expect professionalism. And this means ensuring you have taken the appropriate

steps that a reasonable practitioner should take. Only you can be the doctor in the doctor-patient relationship.

And remember that CCPA is here to speak to you about any concerns you have. Our claims officers are here to help, even if there’s not an emergency.

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

Remember to keep these steps in mind:• Update informed consent

with any change to the patient’s treatment, symptoms, diagnosis or health status, using the most recent version of the CCPA form. Revisit informed consent after a prolonged absence from care.

• Ensure you record all positive and negative exam findings.

• Document differential diagnoses and share them with the patient.

• Document treatment plans and reassessment schedules.

• Keep thorough SOAP notes and document each patient interaction at the time it occurs.

Staying within the linesKeeping a professional mindset in your practice


A board is only as good as the sum of its parts. I’m grateful to work with a team of amazing directors from across Canada and appreciative of the

opportunity to work closely with our new leadership team — First Vice Chair Dr. Debbie Wright and Second Vice Chair Dr. Judy Forrester.

Now for those of you who haven’t met me – a little bit about myself. I am a graduate of Northwestern Health Sciences University’s Chiropractic College. I returned to Manitoba shortly after graduation and, in 1998, established my multidisciplinary practice in south Winnipeg. I very quickly engaged with the Manitoba Chiropractors Association, working on various committees. Along the way, I developed a passion for providing chiropractic treatment for athletes, which has become a significant part of my professional work.

I had an extensive volunteer background before joining the CCA board. My primary focus was the regulation of chiropractic. I served in several regulatory capacities, including chair of the Manitoba Chiropractors Association Standards Committee for four years. I was a board member of the Canadian Chiropractic Examining Board for eight years, serving as chair from 2010-2013. I joined the CCA board as the Manitoba Director in 2013.

I’m excited about my new role. I wholeheartedly embrace our mission, vision and values, and how they support the needs of the almost 9,000 licensed Doctors of Chiropractic (DCs) and 10 provincial chiropractic associations.

The CCA began a transformation in 2012, complete with a new vision: ‘Chiropractors will be an integral part of every Canadian’s healthcare team by 2023.’

To achieve these outcomes, we will follow our strategic plan. And we will work tirelessly to bring value to you, our members.

Operationalizing the plan requires a hard-working, engaged and innovative staff. We are fortunate and appreciative to have a talented team led by our CEO, Ms. Alison Dantas.

Before looking ahead, I wanted to reflect on past leaders. We have been privileged to have had many leaders who demonstrated their dedication. They sacrificed time from their practices and families to help transform the CCA. I want to thank past Chairs Dr. John Corrigan, Dr. Jeff Warren, Dr. Robert David, and our most recent Chair Dr. David Peeace. I learned from each of them over the past five years and their insights will guide me.

Along with our board and leadership team, I look forward to supporting our advocacy efforts. These efforts help us forge stronger relationships with you, our members, and educate Canadians, government, the insurance industry, chiropractic academic programs, universities and researchers, and chiropractic stakeholder groups in Canada and around the world.

We are gaining ground and momentum is building. The CCA will continue to build favorable public perception of our profession and enhance the patient experience. We want Canadians to understand the value of chiropractic care and where we best fit within the healthcare system.

OUR TIME IS NOWDR. GERALD OLIN, DC

Chair, CCA Board of Directors

MESSAGE FROM THE CHAIR

• Build Favourable Public Perception

• Establish Chiropractic as a Healthcare Partner

• Enhance Patient Experience

• Demonstrate and Enhance Member Value

• Champion an Engaged Chiropractic Community

• Enhance Internal Management and Resources

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.

To achieve this vision, we are guided by our mission, values and strategies, including:


We will continue to champion an engaged chiropractic community and enhance member value. In April, we hosted our largest and most successful national convention in Calgary, Alberta. Our next national convention — scheduled for 2020 in Halifax, Nova Scotia — will build on those successes. We also plan to launch new initiatives that will assist you in your day-to-day practice and enhance member communication.

The CCA also supports the growth of our profession’s research capacity, having secured a research chair position at a major university in every province. In addition, we support the Canadian Chiropractic Research Foundation to ensure long-term sustainability and funding for chiropractic research. We must support chiropractic research initiatives and ensure the knowledge transfer of the most recent research, all of which will assist chiropractors to practice in an evidence-informed manner.

We will continue to establish chiropractic as a healthcare partner in Canada. Because of our advocacy efforts, the federal government invited us to be a signatory on the National Opioid Strategy. Our partnership in this initiative has brought tremendous opportunity. It has allowed us to collaborate with other healthcare professions and demonstrate the value of chiropractic as an upstream solution for the treatment of non-cancer, chronic MSK pain. We see a great opportunity for our profession to play a major role in helping Canadians live healthier lives.

But there are challenges ahead. In the past year, there has been a strong media focus on chiropractic. Most of the media attention has been negative, with a focus on regulatory issues that the media has identified as deficient.

I believe that now — more than ever — our profession will require our national and provincial associations to band together with provincial regulators. This is where my regulatory background can help. My experiences have shaped and defined the core values of what I believe would help us win the public’s trust and government support. As CCA Chair, I will continue to meet with regulators. My goal and message are simple: we must create an environment that allows for continued growth in chiropractic care.

The CCA is not advocating for changes to existing regulatory frameworks. Instead we want to see a more proactive and consistent application of regulations, especially related to misleading advertising and claims out of scope. Applying those regulations more consistently will prevent public perception in chiropractic from eroding further and will in turn boost patient trust and confidence in our profession.

Our vision is achievable. We can and should be an integral part of every Canadian’s healthcare team. We remain focused on the strategies that will help us achieve this vision. But we need your help. All of us must continue to learn and evolve. Patient trust and confidence is something that must be earned. The CCA board continues to challenge ourselves. I ask you to do the same. There is an opportunity for our profession. Let’s seize the opportunity before us. Our time is now.

Dr. Jaipaul ParmarDr. Jaipaul Parmar is a 2010 graduate of the University of Western States in Portland, Oregon, and practises in Vancouver, B.C. He is a strong believer in integrated healthcare and working with other health professionals to offer team approaches and solutions to patient needs. Having a patient-centered

approach to chiropractic healthcare is of utmost importance at his clinic, Alliance Wellness. The clinic offers almost all paramedical services in one location. Having served as the director on the British Columbia Chiropractic Association for the last six years, Dr. Parmar has gained a wealth of experience of the detailed operations of the provincial chiropractic association. He has also served the chiropractic community by volunteering with the Canadian Chiropractic Examining Board as an examiner and also as an opinion leader with the Canadian Chiropractic Guidelines Initiative (CCGI).

Dr. Clark MillsDr. Clark Mills is a registered chiropractor in Stony Plain, Alberta, about 15 minutes west of Edmonton on the beautiful Yellowhead Highway. He has practised in a multi-doctor facility for over 40 years and has been intimately engaged in institutional governance with a wide variety of provincial,

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 making, member/donor engagement, risk assessment and executive performance adjudication. Dr. Mills is married to Debi and they enjoy country living, travel, music, and — of course — their five grandchildren.

Dr. Catherine Bezeau Dr. Catherine Bezeau practises in Laval, Quebec, and received her chiropractic degree from the University of Quebec at Trois-Rivières (UQTR) in 2013. Dr. Bezeau participated in the chiropractic student association and the general student association at UQTR. She has been an active member of the World

Congress of Chiropractic Students, attending their congress in Dallas, Texas, Rio de Janeiro, Brazil, and Durban, South Africa. Dr. Bezeau works alongside two chiropractic colleagues at the Centre Chiropractique du Village. She has also been involved with the Association des chiropracticiens du Québec, joining their Board of Directors in 2017. In her spare time, she loves to spend time with her friends and family.

Dr. Heather Norman Dr. Heather Norman is a 1991 graduate of Palmer College of Chiropractic in Davenport, Iowa. She has been in private practice for 27 yrs and currently is the clinic director of a multidisciplinary practice in Burlington, Ontario. She is certified in Acupuncture and Trigenics, a myoneural release technique.

Dr. Norman has been a director on the OCA Board for 6 yrs and has a strong commitment to giving back to the profession. Supporting her community is also a priority and she has been involved with various boards and community organizations. She was honoured with the “Citizen of the Year” award in 2006. She enjoys traveling and golfing whenever possible.

NEW CCA BOARD MEMBERS


CHIROPRACTIC AND THE OPIOID CRISIS

MESSAGE FROM THE CEO

ALISON DANTAS CEO

Every day chiropractors help Canadians manage chronic pain. You work to diagnose the underlying cause. You recommend treatments to relieve 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.


For many Canadians, that experience is alien. When they suffered chronic neck or back pain, they asked for help and were handed an opioid prescription. The problem is that some of them became addicted. They needed opioids to manage their pain and make it through each day. As the number of addicted Canadians grew, it led to a worrying increase in overdoses and deaths from these

“powerful pain-relieving drugs.”

We have an opioid crisis that stretches from coast to coast. I believe chiropractors can help Canadians reduce their reliance on opioids. At first, the crisis was about addiction. Now the focus has shifted to pain and the need to provide safer alternatives to opioids. Chiropractic can help and I invite you to learn what we’re doing to ensure chiropractic care is part of the solution.

This September, I attended the Opioid Symposium in Ottawa. 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 was physically dependent on opioids. Without her opioid prescription, she said it was impossible for her to be the mother and grandmother that her family needed. She wanted non-opioid solutions that might lessen her dependence.

I also heard that when people can access non-pharmacological resources, it helps. But it only helps if they have access and for a lot of people who experience chronic pain it is difficult to pay out of pocket for health care.

That's why the Canadian Chiropractic Association took a leadership role in establishing the Coalition for Safe and Effective Pain Management (CSEPM). We've brought together 11 national associations to promote an interdisciplinary approach to pain management. We need to understand a patient’s path from pain to prescription. Only then we can show why practitioners and patients must consider chiropractic care a first-line treatment for acute and chronic musculoskeletal conditions. Then we can work to develop recommendations that the healthcare system can adopt.

But our work with CSEPM hasn’t stopped us from taking other immediate action. We know we can’t press pause on the crisis while we tinker with solutions. We wanted to put power in the hands of practitioners. The CCA is developing a referral and triage tool for prescribing professionals through the CCA’s Professional Practice Resources initiative.

This initiative is part of our commitment to Health Canada’s Joint Statement of Action to Address the Opioid Crisis. To validate the referral tool, the CCA has contracted Ipsos — a market research company — to conduct focus groups with nurse practitioners, orthopedic surgeons, pharmacists, and medical doctors. The resources are aimed to improve inter-professional communication and coordination of care.

Chiropractic care can help reduce Canadians’ reliance on opioids. But it won't be easy. Especially since many physical and

psychological alternatives are often not accessible in primary care settings. And we certainly can’t do it without you. The work we're talking about requires research and research needs funding. Nothing will change unless we can show the effectiveness of non-pharmacological alternatives.

That’s why the Canadian Chiropractic Research Foundation is a critical partner in this work. Two of its four national research priorities stand out for me. Health Systems explores how including chiropractic care in an inter-professional approach affects patient outcomes. Clinical Science is about seeing how chiropractic management affects clinical outcomes. Through that research we can improve the lives of Canadians living with chronic pain. It is my hope that together we can get to the $1.5M goal that the CCRF has set to fund its first research project. Every dollar counts and you can give directly on the new CCRF website at www.canadianchiropracticresearchfoundation.ca

We must always remember that at the root of this issue are real people with pain. I hope that you’ll support us as we work to help people manage their pain more effectively. With the right data and funding, we can create community-based models that help you do what you do best. Help Canadians heal so they can get back to living their best lives.

Imagine this. A patient sits in a healthcare clinic waiting to visit their family doctor. Inside the office, they complain of chronic back pain. It started off small, they explain, but now the pain is interfering with their life, their work as a computer technician and their hobby as a woodworker. They need relief. Rather than prescribing an opioid, the doctor consults an inter-professional team and recommends a massage therapist. It helps but the pain persists. Now the doctor recommends a chiropractor.

The patient is nervous but open to the idea. The chiropractor listens, investigates and examines. And appointment by appointment, there is progress. The patient’s team of healthcare practitioners work together — reserving opioids as a last resort — to ensure the best outcome. Soon the patient’s pain subsides. They are grateful and return to work — able to sit intermittingly — and to their studio to start a new woodworking project. Only you can help us make this possible by disseminating the new tool we will be launching for referrals from primary care providers and by donating to research.

"We need to understand a patient’s path from pain to prescription. Only then we can show why practitioners and patients must consider chiropractic care a first-line treatment for acute and chronic musculoskeletal conditions."


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BY TRACY BERTRAM

This year marked the 75th Anniversary of the Chiropractors’ Association of Saskatchewan.

We’re proud of our long and storied history of chiropractic in Saskatchewan.

Saskatchewan is home to Canada’s first-known chiropractor, Dr. Almeda Haldeman, who practised in rural Saskatchewan. Her son, Dr. Joshua Haldeman, followed in her footsteps and was active in the profession in Saskatchewan in the early years. Joshua was also integral to the founding of the Dominion Council of Canadian Chiropractors (which later became the CCA) and the founding of the Canadian Memorial Chiropractic College (CMCC). His son, third-generation chiropractor Dr. Scott Haldeman, is an internationally known chiropractor and physician.

Following years of advocacy, The Chiropractic Act was passed in Saskatchewan in 1943, providing chiropractors with distinct legislation. Many other important milestones followed, including the ability for chiropractors to treat industrial and automobile injuries, securing coverage under Medicare for close to 40 years , the right to refer to specialists, the ability to apply for hospital privileges and, later, privileges in the health authority, and the ability to order diagnostic X-ray and ultrasound for MSK conditions covered by the provincial government. Quite a list of achievements!

Saskatchewan is also home to several other well-known chiropractic figures including Dr. David Cassidy, D.C. (non-practising CAS Life member) and Dr. Kirkaldy-Willis (Saskatchewan orthopedic surgeon). Drs. Cassidy and

Kirkaldy-Willis led important research in the mid-’80s, which resulted in publication of a five-year study on manipulation that had a dramatic effect

CELEBRATING 75 YEARS IN SASKATCHEWAN

SPOTLIGHT

The Chiropractors’ Association of Saskatchewan in 1945.

Dr. Almeda Haldeman is Canada’s first known chiropractor. She practised in Herbert, Saskatchewan.


on grassroot cooperation between the medical profession and chiropractors. Saskatchewan was also host to the conference on the findings of the Bone and Joint Decade 2000-2010 Task Force on Neck Pain and Its Associated Disorders in 2007.

As you can see, Saskatchewan has been at the forefront of chiropractic for decades with many pioneers from the early days right through to today, including CAS volunteers, board members and presidents. These pioneers gave their time, passion, and commitment to establish the profession in the province and beyond and continue to move it forward today. Members from Saskatchewan have been, and continue to be, active in leadership positions on national bodies including the CCA, CMCC, CCPA and Federation of Canadian Chiropractic, amongst others.

The 75th Anniversary was celebrated at the Annual General Meeting held Sept. 22 in Regina. The theme of the 75th Anniversary was Reflecting Back – Looking Forward

and the AGM was animated with history displays and items highlighting the last 75 years, some of which were donated by members. One hundred and thirty-five members attended the AGM meeting — 63 percent of the membership! — and the 75th Anniversary Celebration Banquet was well attended. The attendees were entertained by duelling pianos followed by a casino night. It was a great evening of celebration for the CAS, its members and special guests.

From 45 members in 1943 to our current membership of 215 practising members, the profession in Saskatchewan continues to grow and enjoy many of the privileges the founding members advocated and worked hard for. We look forward to what the next 75 years will bring in Saskatchewan!

Thirteen of the 30 past Presidents of the CAS reunited at the 75th Anniversary banquet celebration.

Dr. A.W. Johnstone was the first President of the CAS.


Our latest advocacy efforts reached a key stage on Oct. 18, when CCA Board Chair Dr. Gerald Olin presented our pre-budget submission — “Removing Barriers to Access and

Care. A Healthier Canada” — to Canada’s Standing Committee on Finance (FINA) in Winnipeg, Manitoba.

One of the two recommendations in our submission reads,

The invitation to meet for a pre-budget consultation means that the Committee reviewed our submission and found it of interest to their theme of “Economic Growth: Ensuring Canada’s Competitiveness.”

Our submission emphasized that removing barriers to chiropractic care, particularly for patients with osteoarthritis (OA), will reduce the pain and disability that keeps people from contributing to the workforce. In this way, access to chiropractic care creates stronger economic competitiveness in Canada.

We are confident that we made a compelling case for the amendment. After all, it is only reasonable that chiropractors — who are extensively trained to assess and diagnose back, neck and knee pain, and osteoarthritis — are added to the list of professionals who can legally assess disability in their patients and issue Disability Tax Credit (DTC) Certificates.

“Chiropractors have comparable qualifications to other health professionals already listed in the Income Tax Act who are authorized to determine eligibility for the Disability Tax Credit,” Dr. Olin said.

The current list of assessors includes medical doctors, audiologists, pathologists, occupational therapists, nurse practitioners, physiotherapists, optometrists and psychologists. These practitioners have the authority to certify that their patient suffers “severe and prolonged impairment.”

Not only does amending the Income Tax Act make sense, but it isn’t a difficult change to make. This change does not increase costs to taxpayers because the number of disabled Canadians who are eligible for the credit would remain the same. But it would make it more convenient for eligible Canadians to 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, chiropractors already have the authority to diagnose disability and make similar assessments for Workers’ Compensation and Motor Vehicle Accident rehabilitation.

Canadian Chiropractic Association CEO Alison Dantas has been lobbying the federal government for this change and is optimistic about the outcome. “This change will empower chiropractors and their most severe patients, enabling them to access resources they need to improve their quality of life without jumping through unnecessary hoops,” she said.

“I’m encouraged by the swell of support we’re seeing across the country.”

CHIROPRACTIC PATIENT ELIGIBILITY FOR DTC

Chiropractors regularly treat patients with disabilities, including those suffering from OA — the most common type of arthritis.1 Patients with OA often reach chronic disability that severely restricts basic daily tasks like dressing and walking, which are two items on the Canadian Revenue Agency (CRA) criteria for DTC eligibility.

“That the government amend the Income Tax Act (1985), s. 118.4 (2), in order to add chiropractors to the list of practitioners eligible to assess disability and issue the Disability Tax Credit Certificate.”

ONE STEPCLOSER

ADVOCACY

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.


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

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 accessible, amending the Income Tax Act to provide chiropractors the authority to assess the disability in their patients breaks down an important barrier.

“Adding chiropractors to the Income Tax Act will increase accessibility for our patients,” Dr. Olin said. “It’s a simple but important step in improving the lives of Canadians dealing with pain. Having the support of The Arthritis Society and the Council of Canadians with Disabilities, further strengthened our position.”

WHAT YOU CAN DO

We need your help! For change to happen, the federal government must hear from chiropractors over the next few months before the 2019 Federal Budget is announced. This is an important, time-sensitive campaign. All it takes is a few clicks

to help chiropractors and patients from across the country to be heard. Please take a couple minutes to visit our website to submit a letter to your local Member of Parliament. With enough support, the federal government will include chiropractors as an assessor of the Disability Tax Credit. Your support can make a difference in the lives of Canadians. Together we can make it happen.

Sources:

1. The Arthritis Society, “About Osteoarthritis,” 2017.

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 and Technology, February, 2018. Retrieved from https://sencanada.ca.

3. The Arthritis Society, “About Osteoarthritis,” 2017.

4. National Surveillance of Osteoarthritis and Rheumatoid Arthritis in Canada, Results from the Canadian Chronic Disease Surveillance System, Public Health Agency of Canada, Ottawa, ON, October 26, 2017. Retrieved from http://www.arthritisalliance.ca.

WHY NOT CHIROPRACTORS?

VISITCHIROPRACTIC.CA/DISABILITY-TAX-CREDIT

TO SEND A LETTER TO YOUR LOCAL MP

CCA CEO Alison Dantas, Middle, and CBO Ronda Parkes, meet with Dr. Colin Carrie, MP for Oshawa about the DTC.


BY DR. FRANCES LEBLANC

This year marks the 60th year since the chiropractic profession 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 who dedicated time and expertise to the advancement of the profession. One such example is Dr. Glenn Johnston (Fredericton), who has been an NBCA member and practising chiropractor for 51 years. When first licensed in 1967, Dr. Johnston was one of very few practising chiropractors in the province. Early on, he embraced leadership — serving as NBCA President, CCA Director and CCA President, among other roles.

Dr. Johnston is but one example of the exceptional individuals who have served and continue to serve the NBCA. Dr. Norm Skjonsberg (Saint John) recently finished his 14th year as NBCA President and NBCA Registrar Dr. Carolyn Joy Levere (Oromocto) has served the NBCA Board for over 32 years. She was the recent recipient of the CCA Life Member Award in April 2018. The work of New Brunswick chiropractors never truly ends — caring for patients and communities alike.

Remarkably, if you look closely at the chiropractic profession in this province, it reveals a complex web of interconnectedness between chiropractors, families and their patients. The growth of the profession here can be largely attributed to a series of positive patient experiences. In fact, the early pioneers had a tremendous impact on the subsequent growth of the profession and inspired future generations of chiropractors. For example, a number of

families played an instrumental role in the profession’s development — including the Robichaud, Randall and Clark families, among others. Dr. Marie-Josée Robichaud (Moncton) describes fondly the unwavering passion and commitment of her father, Dr. Yves Robichaud, and two uncles to advance the profession in the Maritimes. That passion was also felt at home, resulting in 14 Robichaud relatives now practising chiropractic. Several others decided to pursue chiropractic as a career because they were once helped by one of these early pioneers.

Throughout our history, New Brunswick chiropractors have consistently demonstrated their willingness to collaborate and work together. This certainly is exhibited by the support shown among the close-knit community, but also beyond our chiropractic community with other healthcare team members. This is critical for a province who is consistently low in resources and capacity and especially true in rural areas.

CELEBRATING 60 YEARS AND BEYOND IN NEW BRUNSWICK

SPOTLIGHT


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 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 enhance access to care for New Brunswickers for generations to come.

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. Carolyn Joy Levere (right) with partner Andy (left).

Dr. Peter Magee (middle) receiving 35 years of practice award from Drs. Frank Mangoni (left) and Norm Skjonsberg (right).


MESSAGE FROM THE CBO

RONDA PARKES CHIEF BRAND OFFICER

Showcasing the difference chiropractic care can make

I t's important to show Canadians how chiropractic care can change pain. Educating Canadians about your work shows that chiropractors care and can make a difference.

In that respect, the last few months have been busy.

We implemented several high-profile initiatives to build favourable public perception. The results should make you proud. We put the profession’s best foot forward and communicated our message at a national level. Here’s a rundown of what you helped us accomplish.

First up was a partnership with the Ontario Chiropractic Association on a sponsored article in The Globe and Mail: “The Pain Problem.” The article was published on Oct. 15 to support the launch of our 2018 World Spine Day campaign on Oct. 16. In it, we explored the toll that muscle and joint pain is taking on Canadians. We showed how musculoskeletal pain can change the way we live. But we also provided hope. We highlighted how chiropractic care can improve quality of life without invasive treatments. And we reminded Canadians that many extended benefits programs cover chiropractic visits.

We also ran a print and digital campaign with ONtheGO Magazine — a lifestyle publication distributed across the Greater Toronto and Hamilton area – for the month of October. Billed as a magazine for commuters, ONtheGO offered us the chance to reach new audiences with our message. We encouraged people to learn about chiropractic care and download the Straighten Up Canada app on the App Store and Google Play Store.

Our full-page editorial, “Pain is Real and It’s Debilitating,” reached more than 300,000 people and appeared across from an ad promoting chiropractic care. The digital campaign included a series of five-second videos that appeared on screens in Toronto’s PATH (the underground commuter network and shopping complex) and were shown to more than 200,000 people that pass through the PATH each day. For one week, the video spots were also featured on a massive screen at one of the busiest intersections in the country — Yonge and Dundas Square. About 116,000 pedestrians pass through the intersection every day.

Since 2012, the World Chiropractic Federation has organized World Spine Day on behalf of the Global Alliance for Musculoskeletal Health. Its purpose is to “raise awareness of back pain and other spinal issues” and promote “physical activity, good posture, responsible lifting and healthy working conditions.” Because that aligns well with our mission, we have supported the worldwide campaign annually.

This year’s theme was Love Your Spine. With your support, we built a campaign to show Canadians why spinal health matters. The key component of the campaign was the Love Your Spine downloadable digital booklet. The 27-page document combined chiropractor-approved tips, information on chiropractic care and testimonials.

To promote the booklet, we created a series of digital ads. The ads ran for two weeks and offered the booklet for free. And we built a toolkit, including images, stats and more — making it easier for members to share and amplify. The result?

Posts by Canadians using the hashtags #WorldSpineDay and #LoveYourSpine made up almost a quarter of the global conversation. Almost 27,000 people visited chiropractic.ca to learn about the campaign. But what’s even better is that more than 1,100 Canadians shared their email address in exchange for the booklet.

You should see that as a massive success. I know we do. That’s 1,100 more people we can educate about the valuable work you do. More than one thousand people who have given us permission to continue a conversation about pain and pain management. We promise to learn as much as we can from these Canadians and share further insights with you.

Highlighting the millions of Canadians who benefit from chiropractic care ever year helps steady the profession’s reputation. Especially in the face of negative news coverage.

It’s almost 2019. Here at the CCA, we remain committed to our vision — chiropractors will be an integral part of every Canadian’s healthcare team by 2023. There are many ways to achieve that vision. But educating and engaging the public with effective and persuasive communications remains a key part of our strategy.

Recap of recent public awareness initiatives


Print Edition958,000 average weekday readers.

Digital Edition7.4 million monthly unique visitors.

THE CCA'S RECENT PUBLIC INITIATIVES TO SUPPORT CHIROPRACTIC

The Globe and Mail Chiropractic care

changes pain.Learn more at chiropractic.ca

Up to

85% of workers will experience low

back pain in their lifetime.

Pain changes everything.

Journal of Spinal Disorders.

OntheGo Magazine

27,000 people visited chiropractic.ca

1,100 Canadians shared their email address

2018 World Spine Day Campaign

#LOVEYOURSPINE

2018

Yonge and Dundas Square116,000 walking traffic per day.

Toronto PATH screensDaily Audience 100,000

5 second video spot

324,000 readers from 120,000 distributed copies


Dr. Carol Cancelliere, a clinical epidemiologist, started as the new CCGI Project Lead in March 2018. Soon after, she was appointed as the CCRF’s newest Research Chair in Knowledge

Translation at University of Ontario Institute of Technology.

Dr. Cancelliere’s research focuses on the development of evidence-based guidelines and knowledge-translation tools. She practised as a chiropractor for 10 years in Saskatchewan, British Columbia and Ontario before becoming a full-time researcher. Her primary drive remains delivering optimum patient care.

BRINGING ATTENTION TO THE GAPS IN PATIENT CARE CHIROPRACTORS CAN FILL

As a researcher, Dr. Cancelliere sees huge opportunities for chiropractors to fill a major gap in today’s patient care. “There is a large, unmet need in the world — disability related to spinal disorders — and chiropractors can absolutely take a central role in meeting that need.”

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.

CREATING A NEW GUIDELINE

Together, Dr. Cancelliere’s team is working on a new guideline that addresses disability related to spinal disorders. “This guideline is very important as low back pain is a leading cause of disability worldwide. Chiropractors need to take a lead on addressing this issue,” she said.

Although still in planning stages, her team is working with EuroSpine — the Spine Society of Europe — on a joint proposal for this guideline development.

INCREASING EVIDENCE-BASED GUIDELINE ADOPTION

Part of Dr. Cancelliere’s work is focused on developing guideline-implementation toolkits. Her team is starting with three toolkits — focusing on concussion, headache and lumbar spinal stenosis.

Guideline Implementation Toolkit Development

1. The toolkits will be developed using the knowledge-to-action framework.

2. This approach involves building a comprehensive research team for the effective transfer of research findings into practice.

3. Carol’s team will include end users such as representative Canadian chiropractors and their patients, a knowledge-translation expert, and a professor in education who specializes in optimizing information delivery based on how people learn and the sociology behind learning.

Researcher Spotlight:

Dr. Carol Cancelliere

RESEARCH FOUNDATION


The knowledge-to-action framework allows for a proper needs assessment, identifying what and how to transfer knowledge to chiropractors and their patients. “You can’t just give guidelines to

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.

Once the toolkits are developed, they plan to test the guidelines with a small sample of chiropractors. In the final phase, they will measure the effectiveness of the guideline implementation (on a broad scale) by asking key questions such as:

• Did chiropractors actually get the tools that they needed?

• Did they actually learn from the tools?

• What were the barriers to using the tools?

• Did the tools actually impact the patient (did patients improve?)

COLLABORATION WITH HER TEAMDr. Cancelliere was quick to point out that none of her work would be possible without her team, the CCGI, and a lot of mentors along the way. “Everybody’s dedication inspires me.

We all work in a really collaborative spirit. We work under a shared vision that caring for patients means using evidence, but also working collaboratively. Even though we may disagree about things or have different opinions, that’s always the spirit we work under.”

She thinks that chiropractors have great, unique potential to fill the growing gap in today’s MSK patient care. She believes that collaboration across the healthcare system, and other sectors, and practising according to evidence are necessary for the chiropractic profession to bridge this gap. “People need 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 to continue to demonstrate our care through evidence.”

OUR DONORS MAKE THE DIFFERENCE

A big thank you to the CCGI and the donors who fund Dr. Cancelliere’s work. You are making a huge difference, supporting research that improves the lives of people living with musculoskeletal pain and disability.

“People need 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 to continue to demonstrate our care through evidence.”

Life Without the Burden of MSK Pain and DisabilityThere 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 atcanadianchiropracticresearchfoundation.ca


BY DR. GAELAN CONNELL & HEATHER OWENS

Supporting the uptake of evidence-informed practice at the national and international level is one of the key aims of the Canadian Chiropractic Guideline Initiative (CCGI). And

there are encouraging signs that change is happening. Students and new graduates can act as key change agents and influencers. They can lead the way in affecting long-term, durable uptake of evidence-informed practice. Partnering with tomorrow's leaders will help ensure that the implementation of best practices becomes the norm for the chiropractic profession.

As Dr. Michele Maiers wrote in The Journal of the Canadian Chiropractic Association1, students have a crucial role to play:

“The future of any profession is in the hands of its students 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 today is predicated on how well contemporary chiropractic leadership engages millennials now. This requires active engagement, thoughtfully and purposefully leveraging millennial qualities, skills, and vision within professional committees, work groups, and professional networks.”

With this in mind, CCGI is pleased to announce the launch of a new chiropractic student ambassador program in Canada and the U.S.

We are delighted to be partnering with nine student ambassadors from the Canadian Memorial Chiropractic College (Dan Nighswander, Kevin Fox-Chen, Puneet Shoker,

CCGI STUDENT AMBASSADORS

New program to promote evidence-informed practice

The purpose of the program is to:

1. Support the dissemination of best-practice resources and latest evidence in musculoskeletal health to chiropractic students;

2. Promote the integration of evidence-informed practice into the chiropractic curriculum;

3. Engage student leaders in the creation and development of knowledge-translation strategies specifically adapted for students and recent graduates; and

4. Obtain student perspectives and feedback to tailor CCGI resources and increase uptake.


Register now for winter and spring classesacupuncturecanada.org | 416-752-3988

TRAINING & CERTIFICATIONFOR CHIROPRACTORS AND OTHER HEALTHCARE PROFESSIONALS

Visit our website for additional courses, dates and locations.

ACUPUNCTURE—CORE PROGRAM (AA1)

DRY NEEDLING (LEVEL 1)

WINTER START SPRING START SPRING START

REGISTRATION DEADLINE Dec. 15, 2018 Feb. 15, 2019 Jan. 29, 2019

ONLINE TRAINING STARTS Jan. 2019 Mar. 2019 Feb. 2019

ONSITE LOCATIONS Calgary, Toronto London, Winnipeg Halifax, Toronto, Vancouver

IMPROVE TREATMENT OUTCOMES & GROW

YOUR PRACTICE• Practical hands-on workshops taught in small groups

• Convenient locations across Canada • Combined with online learning

ACUPUNCTURE & DRY NEEDLING PROGRAMS

Josh Thomas, Riaz Mohammed, Madison Baile, Mack Gingerich, Tory Clay and Vivian Wang) and three ambassadors from the University of Quebec at Trois-Rivières (Janny Mathieu, Philippe Parent-

Simard and Justin Roy). We are also very pleased to be partnering with three students from Northwestern Health Sciences University (Taran Barett, Colton Maclean, and Sylvianne Poirier). All of our student ambassadors have completed a short training module and orientation session to familiarize themselves with their role.

What will CCGI student ambassadors be doing? Our new team members will meet online every two months to identify opportunities for a) dissemination of best-practice resources within their respective programs, and b) supporting the use of CCGI materials within course content (i.e., clinical education, rehabilitation, diagnosis, etc.). They will also represent CCGI at school events, share resources and answer questions about clinical-practice guidelines and best practices. For example, one of our stakeholders, the Ordre des chiropraticiens du Québec generously offered CCGI and student ambassadors a booth during the OCQ-UQTR Joint Convention - 25th Anniversary of the Chiropractic Program in Trois-Rivières, Qué., from Sept. 27-29. We are also looking forward to partnering with our ambassadors in the creation of new resources such as a best-practice toolkit for students and new graduates.

CCGI develops evidence-based, clinical-practice guidelines and best-practice recommendations and facilitates their dissemination and implementation within the chiropractic profession. We work with chiropractors across Canada, provincial associations, regulatory bodies, educational institutions, and – of course – students! To learn more, please visit us at www.chiroguidelines.org.

Contact Dr. Gaelan Connell, CCGI Knowledge Broker ([email protected]), to learn more about CCGI and their student ambassador program.

References

1. Maiers, M (2017) Our future in the hands of Millennials. JCCA 2017 Dec; 61(3): 212–217

"The future of any profession is in the hands of its students and early career practitioners. The millennial generation of chiropractors embodies attributes that are uniquely suited to the evolving landscape of 21st century healthcare."


BY DR. SHAWN THISTLE

A s chiropractors, we treat many patients dealing with low back pain. About 90 per cent of cases involving lower 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 have been invented, but are (currently) only available for clinical research purposes. In their recent narrative review paper, “The clinical value of assessing lumbar posteroanterior segmental stiffness – a narrative review of manual and instrumented methods” (published in Physical Medicine and Rehabilitation), Drs. Arnold Wong and Greg Kawchuk discussed the evidence behind both manual and instrumented segmental lumbar stiffness assessments. They also summarized the evidence linking LBP and PA spinal stiffness, as quantified by instrumented spinal stiffness-testing devices.

When a patient visits a chiropractor seeking relief of lower back pain, a common method of manual assessment is to apply posterior-anterior (PA) force to a prone patient’s spine, with 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 resistance indicates low spinal stiffness. The challenge is that the reliability of manual assessments is considered poor due to factors attributed to the patient, examiner and the environment.

PATIENT-RELATED FACTORS AFFECTING RELIABILITYPatient muscle tone can affect the measurement. We may ask patients to “relax their trunk and hold their breath,” but their ability to do so consistently can affect measurements. A patient’s weight and gender may also complicate the assessment.

EXAMINER-RELATED FACTORS AFFECTING RELIABILITYSeveral examiner-related factors may also affect reliability, beginning with vision. Where a clinician looks can affect their perception of stiffness. It is therefore recommended that clinicians and researchers keep their eyes fixed during manual assessments. In addition, using a thumb-tip technique to measure MSSA consistently yields lower perceived stiffness magnitude compared to using a pisiform contact. Adopting standard hand placements and using a metronome to regulate the frequency and speed of loading could theoretically improve reliability. It is also implied that clinicians should apply the same techniques consistently in their practice. The clinical reliability of MSSA also decreases because some clinicians palpate overall displacement of examined segments and others perceive spinal stiffness based on the “end-feel” of PA motion results.

ENVIRONMENT-RELATED FACTORS AFFECTING RELIABILITYThe authors also assert that rigid or padded surfaces can affect the assessment, especially instrumented assessments. They have recommended standardizing testing surfaces to increase reliability.

It should be noted that unfortunately, while these recommendations have been made to rectify potential issues affecting reliability of spinal stiffness measurement, the utility of these recommendations remains unclear and require further research.

Research review of manual and instrumented methods

CLINICAL VALUE OF ASSESSING LUMBAR SEGMENTAL STIFFNESS

RESEARCH FEATURE


SPINAL STIFFNESS ANALYSIS VIA INSTRUMENTED METHODS IN RESEARCH SETTINGSAnother important issue raised in this review concerns how spinal stiffness is measured via instrumented methods. The process used in research settings is inconsistent across various laboratories, preventing direct comparison across studies.

To counter the effect of external patient and environmental factors on instrumented MSSA, the authors have made the following recommendations:

1. Voluntary trunk muscle activity is minimal;2. Lung volume is at the functional residual capacity;3. Ribcage and pelvis are not constrained;4. The patient’s posture is neutral; and5. Standardization of the testing surface (soft vs. hard)

and loading parameters (i.e. frequency, speed, force).

The authors propose that gender, weight and disc degeneration should also be considered.

RELATION BETWEEN SEGMENTAL SPINAL STIFFNESS AND LOWER BACK PAIN

Mechanical LBP is thought to be associated with aberrant/impaired intervertebral joint motion or function and a relationship between lower back pain and spinal stiffness has been demonstrated. But those studies did not estimate the correlation between absolute segmental spinal stiffness values and the corresponding LBP intensity.

Other laboratories have shown no major difference in average PA segmental lumbar stiffness values between symptomatic and asymptomatic individuals and have failed to demonstrate bivariate correlation between PA lumbar stiffness and LBP severity/chronicity before spinal manipulative (SMT) treatment. Unfortunately, this latter finding may have been affected by inconsistent manual loading parameters during the mechanically-assisted spinal stiffness tests.

Collectively, the existing evidence suggests that lumbar PA stiffness generally decreases as LBP subsides in some, but not all, individuals suffering from LBP. The lack of consistency is likely secondary to the heterogeneity, and non-specificity of LBP symptoms.

The authors also asked whether a baseline assessment is necessary to predict lower back pain outcomes. Such an assessment could become a useful component of a clinical prediction rule for LBP patients,

with the goal of individually directing treatment choices to achieve the best patient outcomes. This is an area where further research on spinal stiffness measurement could really impact patient care in terms of applying appropriate treatment techniques to patients more likely to positively respond.

There are studies where more reliable instrumented spinal stiffness measurement technology was used to predict clinical outcomes. Those studies demonstrated that some patients with lower back pain may benefit from spinal manipulation. Unfortunately, more large-scale study is required before we can apply this finding more broadly.

Even though the evidence suggests that PA segmental lumbar stiffness is related to lower back pain, there is a complex mixture of factors – including but not limited to: age, gender, psychological and neuromuscular factors – that can complicate the assessment and diagnosis. Unfortunately, no studies have been conducted to quantify how much these psychological factors may modulate the relationship between PA stiffness and LBP.

The authors of this review paper synthesized the best and most current literature and provided pragmatic recommendations for improving the reliability/accuracy of manual segmental spinal stiffness assessment (MSSA). Because of MSSA’s low reliability,

they advocate for the use of instrument-assisted postero-anterior spinal stiffness measurement technology in clinical and research settings. The use of such technology has shown that a reduction in PA segmental spinal stiffness is associated with alleviation of LBP in some populations, which is certainly promising. The authors also stated that some of the variance of this relationship is

mediated by demographic, psychological and neuromuscular factors, which may need to be accounted for and controlled in research and clinical settings. Future research should endeavor to establish normative lumbar stiffness values in asymptomatic individuals, to enable recognition of aberrant spinal stiffness values in symptomatic patients.

Dr. Shawn Thistle is the founder and CEO of RRS Education, a company which provides weekly Research Reviews and evidence-based online courses and seminars to help busy clinicians review and integrate current research into their patient care. For more information, visit rrseducation.com.

Access to RRS Education’s weekly Research Reviews is a CCA member benefit, available to those who register through the member’s only section of chiropractic.ca and on the chiropractium app.


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.

CCANCT’18

A Better Approach to Pain ManagementChiropractic Care Changes Pain

April 27 – 29, 2018 Calgary, Alberta

Scott Stratten

Dr. David Peeace and Alison Dantas


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!

Dr. Geoff Outerbridge

Dr. Greg Kawchuk

Dr. Jason Busse


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 visitchiropractic.ca/2018cca-national-convention

Dr. Gord McMorland, Dr. Deborah Kopansky-Giles, Dr. Christie Newton and Dr. Alban Merepeza

Dr. Carlo Ammendolia

Issue 16 | Canadian Chiropractic Association | 2018 29Dr. André Bussières James Cunningham

Olympic sprinter Andre De Grasse and Dr. Alban Merepeza


I t was his love of soccer that set Dr. Gerald Olin on his path to the chiropractic profession. Two seemingly unrelated practices converged when he began

experiencing migraine headaches during his first year of university. It was the summer of 1990 and he was working for the Winnipeg Fury professional soccer team.

The migraines continued without successful treatment until Olin was advised to see a chiropractor who helped him manage his pain. This piqued his interest, so he borrowed a book on chiropractic from the University of Winnipeg resource centre to better understand the profession. Becoming a chiropractor was suddenly a very real option for him after completing his undergraduate degree.

In 1991, Olin was offered the Assistant General Manager position with the Nova Scotia Clippers in Halifax. But he

decided to stay in Winnipeg as the Assistant General Manager for the team he had come to know and love — The Winnipeg Fury — even though they were in last place in the now defunct Canadian Soccer League (CSL).

It was a fateful decision. In 1992, the Winnipeg Fury won the CSL Championship by defeating the Vancouver 86ers in goals aggregate (3-1) after a two-game series. Dr. Olin, along with the team staff and players, have since been inducted into the Manitoba Sports Hall of Fame for their work during the ’92 season.

The next year, Olin graduated with his Bachelor of Science degree. Recognizing the emerging role for chiropractic care in sports medicine, he moved to Minneapolis to attend the Doctor of Chiropractic program at Northwestern Health Sciences University in Minnesota. It was there that he met his future wife, and fellow Winnipegger, Dr. Kerri Brooker.

DR. GERALD OLIN'S TREK FROM STUDENT TO SPORTS TEAM CHIROPRACTOR

SPORTSAND THE CONVERGENCE OF

CHIROPRACTIC

CLINICAL FEATURE

Mike Stobe/National Hockey League/Getty Images


For his externship, Dr. Olin moved to Phoenix, Arizona, while his fiancé completed her chiropractic education in Minneapolis. During this time, the NHL’s Winnipeg Jets had moved to Arizona and become the Coyotes. Olin didn’t have any involvement with the Jets during that time, but he did work with two Arizona pro indoor and outdoor soccer teams.

Feeling the pull to return to their hometown, Olin and Brooker moved back to Winnipeg and opened the T.E.A.M. Chiropractic Family Wellness Centre.

“Working with another chiropractor is extremely beneficial. It provides for the opportunity to consult with each other on individual cases,” Olin said. “My wife works part time. We have two kids, so she will work a couple days a week for half days. She will also work after hours to see my patients when I am away on travel for the Canadian Chiropractic Association or for sports — making it an especially busy time for her in our office during the recent NHL Playoffs. I can’t begin to describe how appreciative I am of her support, which allows me the opportunity to participate in so many of the things I love and enjoy being a part of.”

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 chiropractor for the Winnipeg Blue Bombers (CFL), the Manitoba

Moose (American Hockey League) and the Winnipeg Jets. And he serves on many sports and professional boards and committees.

The role of a chiropractor on a professional sports team’s staff is to provide musculoskeletal (MSK) expertise as part of an interdisciplinary team focused on the performance of elite athletes. The early promotion of chiropractic in sports can be traced to the athletes themselves who sought treatment and realized how a chiropractor could help speed the recovery from injuries and assist in achieving optimal physical health and performance.

“Elite athletes are very aware of their bodies,” Olin said. “They notice the subtleties of proper bio-mechanics for their specific sport and they can identify and see the benefits of chiropractic care. Sports organizations see the need for an interdisciplinary approach — to have a team of people who provide care for the athletes. We want to see our athletes succeed. We want the teams that they play for to succeed. We all want what is in the best interest of the individual athlete, and we are going to work together to ensure the players have every resource available to them that is necessary to enhance and improve their performance.”

Dr. Olin pointed out that neck, mid back and low back pain are the most common ailments he treats for the Jets, but it isn’t unusual

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

Dr. Gerald Olin and Don Cherry during 2018 Stanley Cup playoffs.


for players to have extremity injuries and pain. His treatments usually consist of adjustments and myofascial treatments.

The need for chiropractic care can be intense during the NHL Playoffs. Last season, Olin travelled with the team in what became an enjoyable five-week pattern of “non game day, then game day, followed by a non game day, then game day.”

“On non game days there were treatments available to the players,” he said. “On game days, there were multiple times open to provide treatments — including morning skates, during the three hours prior to game time when you prep at the arena and players arrive, and treatments during the game when something arose [which doesn’t happen frequently], and then post-game as well.”

Dr. Olin also has experience working with another interdisciplinary team whose patients are very different from hockey or football players. He serves as the Manitoba Chiropractic Association’s liaison to the chiropractic program at Winnipeg’s Mount Carmel Clinic.

Mount Carmel’s patients include people from low-income neighbourhoods, members of the LGBT community, new immigrants, teens and the homeless. Mount Carmel’s chiropractor, Dr. Audrey Toth, joins a variety of other healthcare providers on an interdisciplinary team that uses a process of cross-referrals to ensure patients receive the care they need.

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 interesting connections that I have recognized from the pro sports side and Mount Carmel Clinic,” he said, “is both have interdisciplinary care approaches. 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. At Mount Carmel Clinic, they do the exact same thing.”

Dr. Olin’s experiences with the interdisciplinary models used by the Jets and Mount Carmel Clinic have given him a unique perspective on the future of the chiropractic profession and have informed his goals as CCA Board Chair.

“One of my hopes for the next one to two years is to work with healthcare providers from other professions that I have developed strong relationships with, and who are also involved with their national associations. I want to connect our associations, so we can work together in a way that results in change, and to the level where we actually see that change. I would like to see a time where it becomes commonplace for chiropractors who desire to work in interdisciplinary settings to have those opportunities.”

Olin knows there will always be individual clinical practices but recognizes there is no downside to integrating chiropractic into healthcare teams and interdisciplinary clinical settings.

“We are starting to see more chiropractors providing MSK expertise as part of healthcare teams, and the evidence suggests that this team-based approach to care is beneficial for our patients, and a great opportunity for our profession.”

Dr. Olin at the NHL Global Series in Helsinki, Finland.

“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."


• It’s a simple, easy-to-use tool that allows you to stay connected with your colleagues from coast to coast;

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• Offers a suite of tools to maximize your member experience with the CCA.

Leading Chiropractic Content At Your Fingertips!

CHIROPRACTIUM IS A New Members-Only App offered as an enhancement to your CCA Membership

Prefer the web? Chiropractium is also available online at www.chiropractium.ca


RESEARCH FEATURE

PROFESSOR HARTVIGSEN SEES A BOLD FUTURE FOR CHIROPRACTIC But there are challenges both in the profession and the healthcare system


A recent series published in the prestigious medical journal The Lancet attracted worldwide attention to the growing epidemic of low back pain (LBP). It examined how

healthcare systems are failing patients by providing treatments that are ineffective, or worse, leaving people in poorer health than before they sought care.

The first paper in the series was titled “What low back pain is and why we need to pay attention.” It presented sobering statistics on the prevalence and burden of LBP and produced a grim global outlook based on the inadequacy attention to prevention of LBP disability and inadequate treatment.

Delving into the complexity of LBP causes, the authors emphasized that rarely can the nociceptive source be identified in the individual patient. This is further complicated by contributions of biopsychosocial and social factors, comorbidities and genetics. Along with individual pain processing, these elements make LBP a challenging condition to treat.1

The second paper, “Prevention and treatment of low back 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 guidelines and made recommendations, none of which supported pharmacology, imaging, spinal injections or surgery as first-line treatment.

Instead the authors promoted solutions that “focused implementation of best practice, the redesign of clinical pathways, integrated health and occupational care, changes to payment systems and legislation, and public health and prevention strategies.”2 However, the lack of robust research prevented them from recommending wide-spread implementation.

The final article — “Low back pain: a call for action” — spotlighted the immediate need for international public health policy makers to make LBP a priority to ease the future burden.3

We spoke with one of the series’ authors, world-renowned musculoskeletal (MSK) expert and researcher Professor Jan Hartvigsen, PhD, about the impact of its publication on the chiropractic profession.

Hartvigsen’s professional and research experience are impressive. Not only was he a lead in the creation of the series, but he also serves on The Lancet Low Back Pain Series Working Group’s Steering Committee, as well as heading both the Research Unit for Clinical Biomechanics and the Graduate Program for Physical Activity and Musculoskeletal Health at the PhD School in the Faculty of Health Sciences at University of Southern Denmark (USD). He is also Senior Researcher at the Nordic Institute of Chiropractic and Clinical Biomechanics and was recently appointed Adjunct Professor at UOIT-CMCC Center for Disability Prevention.

Hartvigsen called for a transformation in our healthcare system so that pharmacological treatment, imaging, spinal injections and surgery are not the first-line treatments for LBP patients.

“Much of the problem is in the way we have designed our healthcare systems,” he said. “It is not well-designed to deliver therapies like chiropractic. It is geared toward pharmacological treatment, invasive procedure, high-tech stuff.”

Hartvigsen illustrated how high rates of imaging can be detrimental to LBP patients.

“We cannot relate imaging findings to the patient’s symptoms,” he said. “Studies have convincingly shown that imaging can be iatrogenic in back-pain patients. We scare people by telling them that something is wrong with their backs when they may be completely normal. The high rates of imaging are partially to blame for the high surgery rates. A surgeon may take something out that has nothing to do with the patient’s pain, which may explain the ineffectiveness of some forms of surgery for back pain.”

How can we decrease the rates of imaging, pharmacology, injections and surgery?

“It is a question of leadership. We need courageous leaders 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. However, we need to put science into action, there is no way around it. Studies, even randomized trials, show that people who have imaging in the absence of a clear indication for back pain have a worse prognosis than those who do not.”

How can those in political and public-health sectors, healthcare professionals, and policy makers deny the evidence that current treatment for LBP is not only ineffective, but harming people’s health? The research at the core of The Lancet series provides proof that the system must change to provide patients with better outcomes and reduce the burden of LBP.

Since treating LBP is such a substantial component to chiropractic practice, Hartvigsen believes the profession is well positioned to be part of the solution, but only if the profession decides it’s really ready.

“Much of the problem is in the way we have designed our healthcare systems,” he said. [ ... ] It is geared toward pharmacological treatment, invasive procedure, high-tech stuff.”


“The utility and effectiveness of invasive procedures are being questioned across the board, and these are not treatments that chiropractors deliver,” Hartvigsen said. “The interventions that chiropractors use and recommend are exercise, various forms of manual treatment, patient education — these are the approaches that are now being universally recommended. It is a time of opportunity.”

But Hartvigsen believes discord within the profession hampers the potential capacity chiropractors could occupy in a remodelled healthcare system.

“Many chiropractors are practising in relative isolation outside of mainstream healthcare,” he said. “I think that many chiropractors like it that way. Many are not interested in becoming part of the big healthcare machine.”

“[But] 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. That is very difficult for chiropractors because historically we have been very suspicious of other healthcare professions, many times for good reason. There is a tremendous amount of baggage, friction and bias between chiropractors and other healthcare professions. Chiropractors need to work to overcome that.”

“It’s not only about persuading the other people,” Hartvigsen added. “Chiropractors need to look in the mirror and ask themselves if they are really prepared to take on this challenge. I think many are.”

Hartvigsen also pointed to disagreement about fundamental beliefs within the profession as an impediment to wider acceptance from other healthcare providers.

“There is confusion about what chiropractic is and what the treatments are among other healthcare providers,” he said. “And to be honest, there is that confusion amongst chiropractors

too. We don’t speak with one voice. Medical doctors don’t speak with one voice either, but they do not question that the foundation of medical practice is evidence. Chiropractors need to embrace an evidence-based approach because we bring something very valuable to the table.”

Hartvigsen said the response to The Lancet series has been “overwhelming.” The papers are ranked by Altmetric as being among the top five per cent of all research output ever scored across fields and disciplines. According to The Lancet Media Department, there has now been more than 15 million tweets about the series, many using the hashtag #LowBackPain.

“I spent weeks speaking to journalists from all over the world,’ Hartvigsen said. “It is not every day a Dane is interviewed live on Brazilian radio or makes front page on an Italian newspaper. [The Lancet] papers [alone] are not going to change the world, but it was a very big microphone to speak into.”

References

1. “What low back pain is and why we need to pay attention,” Jan Hartvigsen, Mark J Hancock, Alice Kongsted, Quinette Louw, Manuela L Ferreira, Stéphane Genevay, Damian Hoy, Jaro Karppinen, Glenn Pransky, Joachim Sieper, Rob J Smeets, Martin Underwood on behalf of the Lancet Low Back Pain Series Working Group, The Lancet, Vol. 391, No. 10137, March 21, 2018

2. “Prevention and treatment of low back pain: evidence, challenges, and promising 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, 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

3. “Low back pain: a call for action,” Rachelle Buchbinder, Maurits van Tulder, Birgitta Öberg, Lucíola Menezes Costa, Anthony Woolf, Mark Schoene, Peter Croft on behalf of the Lancet Low Back Pain Series Working Group, The Lancet, Vol. 391, No. 10137, March 21, 2018

READ THE LANCET ARTICLES ONLINE Open access and free of charge

thelancet.com

“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.”


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

Dr. Kent Stuber and Dr. Gaelan Connell have co-hosted the Canadian Chiropractic Guidelines Initiative Podcast since August 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 — 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

have included researchers, clinicians and advocates from provincial associations, as well as chiropractors.

“We are trying to have a well-rounded approach because there is tremendous value in hearing stories from all those involved in chiropractic,” Connell said.

Stuber and Connell have published articles in several peer-reviewed scientific journals. And both are dedicated to promoting evidence-based best practices within the Canadian chiropractic profession. This combination made them the perfect fit for The CCGI Podcast. Their show educates chiropractors about getting involved in research, understanding clinical guidelines, building an evidence-informed practice and more.

The show sprouted from discussions about unique ways to reach clinicians and emphasize the importance of guidelines and evidence in practice.

“We had originally thought of doing videos,” Connell said. “But we were quickly told by everyone around us that we had faces for radio, so maybe we should try a podcast instead.”

A podcast can be downloaded or streamed online — at the listener’s convenience — and this flexibility is vital for a practising chiropractor. “We know that creating change requires a multi-faceted approach and a podcast is meeting people where they are at,” Connell said.

Stuber agreed. “A lot of chiropractors and healthcare professionals have busy lives. Trying to squeeze in a little extra learning, and a little extra entertainment, can be done with a podcast.”

Stuber also sees the podcast as a way to combat what he described as the “isolation” that can happen to chiropractors. “Even if you haven’t spoken to another chiropractor in months, you can listen

to us chatting with somebody, and hopefully that can reduce some of that isolation.”

Connell also wanted to highlight how the podcast helps to show researchers in a different light.

“It’s easy to forget that researchers are people,” he said. “They have families and lives and many of them started out as clinicians or have trained as clinicians. They publish their work so it can make an impact on their colleagues throughout Canada and the world. So, if we can highlight that human element to the research then that makes it more relatable to the listener.”

The response to the podcast has been great. It had more than 4,000 listens in the year since its launch and has a five-star rating on iTunes.

“When I go to conferences and conventions,” Connell said, “people 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 are chiropractors who I have never met before, so it is nice to know that we are reaching a wide audience.”

Stuber and Connell attribute much of the podcast’s success to their chemistry. “It’s such an easy relationship, the back and forth,” Stuber said. “Despite having a fairly large age gap between the two of us.”

“I am much younger,” Stuber said.

At that point, Connell laughed.

CONNECTING CANADIAN CHIROPRACTORS THROUGH PODCASTS

The CCGI Podcast can be found at chiropractic.ca/guidelines-best-practice/podcasts or on iTunes, Pocket Casts and Google Podcasts.

Dr. Kent Stuber Dr. Gaelan Connell


T he CCA is proud to announce that we have endorsed Beckmann of Norway, makers of 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.

Kids wear their backpacks often, but improper use and heavy weight can affect posture. At Beckmann, they believe that each child should have an appropriately sized backpack. And they emphasize showing children how to 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 to make “heavy loads feel easy to carry.”

Find retailers in Canada at beckmannofnorway.com

T he Canadian Chiropractic Association is pleased to announce our newest affiliate 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.

Schoolbags from Beckmann of Norway

Posture Pillows

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For more information, contact:

Omega Posture Systems Inc.1-800-665-4839

omegaposture.com


CCA PERKS

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+CCAPLUSCCA Plus is the Canadian Chiropractic Association’s exclusive member benefit program. It offers a range of products and services uniquely tailored to meet the professional and personal interests and needs of members at preferred CCA rates.

RESEARCH

• Research Review Service Education

• The Cochrane Library

• The Journal of the Canadian Chiropractic Association

GROUP INSURANCE

• Morneau Shepell

• The Personal Insurance Company

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• Vitality Depot

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Visit chiropractic.ca and use your member log in to view your CCA perks.

THE MOST CELEBRATED CHIROPRACTIC EVENT OF 2020

IS COMING TO HALIFAX!

CCANCT’20

NATIONALCONVENTION& TRADESHOW

MAY 1 – 3 • 2020

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