Our Findings&

Recommended Action PlanFor

Mark Weaver

Andre A. Broussard, D.C. Broussard Clinic of Chiropractic, Inc.

6701 Aberdeen Avenue, Suite 7Lubbock, Texas 79424-1501

Phone: 806-796-0098

Date: 7/20/2010Name: DOB: 8/30/1959 Age: 50 Gender: Male

TestsLeft 12 sec. 30 sec

Right 10 sec.Left N/A sec. 25 sec

Right N/A sec.Left 13 sec. 96 sec.

Right 8 sec.28 sec. 136 sec.

Hip ROM Internal Rotation Left IR 45 ° 43 °

Right IR 50 ° External Rotation Left ER 50 ° 42 °

Right ER 40 °181 sec. 89 sec.

38% < 5% Flexion/extnesion ratio 85% < 100% RSB/extension endurance ratio 96% < 75% LSB/extension endurance ratio 93% < 75%

Percent of Normal

14%8%21%

Normative Data

Mark Weaver

Patient Result

One-Leg Stand (eyes closed)

203%

40%33%N/AN/A

116%119%95%

105%

Endurance Ratios RSB/LSB ratio

One-Leg Stand (eyes open)

Trunk Flexion Endurance

Side Bridge Endurance

Trunk Extension Endurance

Assessment and Prognosis

My assessment is that we have a very high confidence interval that our care is going to help!

First, please understand that time is necessary for healing and remember that you can feel better, without the condition being healed all the way.

First, here is a brief list of possible common reactions to the manipulative treatments: Studies have shown that patients undergoing spinal manipulative therapy reported a 66% chance of local discomfort, a 10% chance of fatigue, headache and pain outside the area of treatment, and a 5% chance of nausea, dizziness or other reactions. Any reaction is usually gone in 48 hours.

feeling better

feeling worse

Start

feeling better

feeling better

feeling better

feeling worse

feeling worse

feeling worse

Time

Recovery

Also, please understand that recurrences are to EXPECTED.

Short Term Prognosis

Prognosis Group 1: Immediate improvement on 1st adjustment; 84% chance that you will be “definitely improved” by the 4th visit.

Prognosis Group 2: Mild improvement on 1st adjustment; 63% chance of being “definitely improved” by the 4th visit.

Prognosis Group 3: No immediate improvement or have reaction after 1st adjustment; least favorable; only 30% chance of feeling “definitely improved” by the 4th visit.

If pain free by the 4th visit, you have 3 times the chance of being free of pain over the next 12 months.

 Long Term Prognosis

Based on your symptoms, medical history, examination findings, and considering the specific complicating factors, the long term prognosis is good, if I accepted your case. Over the years, I have helped many patients with the same or similar conditions with favorable results.

Plan & RecommendationsChiropractic Manipulative Therapy

Recommended by all of the most updated major back treatment guidelines, this form of therapy is something that many low back pain sufferers have not received early on.

This is a Major Recommendation in the United States Department of Health and Human Services National Guidelines Clearinghouse.

Manipulation is a form of treatment that dates to antiquity and has been practiced in some form in most cultures since that time. One of the first theories related to manipulation might be the statement attributed to Hippocrates: "Look to the spine as the cause of disease."

The treatment procedures produce a short-lasting (100-300 milliseconds), high velocity impulse into the body which produces many benefits. When joint structures are rapidly stretched in this manner, cavitation occurs internally and an audible "pop" may be heard. The effects of manipulation can be categorized as either mechanical or neurological. In fact, manipulation has been described "as mechanical treatment with reflex effects".

The mechanical effects are improved pain-free range of motion, relieving locked up joints, relieving disc problems, relieves adhesions and scar tissue from previous injury and/or degenerative changes and adaptive shortening of muscles, relieves deep muscles spasms, particularly one-sided muscle spasms.

The neurological effects are reduced pain, numbness, dizziness, improved posture, improved balance and coordination, as well as autonomic effects.

When you receive this type of treatment, we are affecting more than just your back or neck area. There are deep neurological stimulus-induced reflex changes. In other words, your nerves control everything in the body, and when there are neurological issues causing health problems, there is a good chance that chiropractic treatment can help.

For instance, there are published studies that have looked at chiropractic type treatments helping:

Neck Pain

Headache

Dizziness

Vision Problems

Hearing Problems

Ear Ache

Inner Ear Infections

Allergies

Shoulder Problems

Arm Problems

Tennis Elbow

Carpal Tunnel Syndrome

Mid Back Pain

Asthma

Bronchitis

High Blood Pressure

Stomach Problems

Indigestion

Heartburn

Gastritis

Ulcers

Irritable Bowel

Constipation, Diarrhea

Menstrual Cramps

Hip Pain

Numbness in the Legs

Knee Pain

Ankle Pain

Foot Pain

ExcercisesCat / Camel / Flexion / Extension Cycles

This helps warm the spine up for the exercises. This is intended as a motion exercise and not a stretch, so the emphasis is on motion rather than ‘pushing’ at the end ranges.

Perform 5-6 cycles. If you have sciatica, you may

experience some increased pain during the flexion phase. Use pain to guide the suitable pain-free range of motion.

Birddog, Beginner’s

The starting position is on the hands and knees with the hands under the shoulders and the knees directly under the hips.

Practice raising an arm up as shown, then the other arm, then one leg and then the other.

Hold for two SLOW breaths. Goal: 5 reps with each arm and 5 reps with each leg, twice daily.

Curl-Up, Beginner’s

Lay on your back with the hands supporting the low back area. Do not flatten the back to the floor. The hands can be adjusted to minimize pain if needed.

One leg is bent with the knee flexed to 90 degrees while the other leg remains relaxed on the floor/bed. The focus of the lift is on the upper torso. Only lift to the point between the shoulder blades.

Leave the elbows on the floor while elevating the head and shoulders a short distance off the floor.

Do not bend/flex your neck. No neck motion should occur, either chin poking or chin tucking. Goal: Holding for two SLOW breaths. Do 5 reps with right knee bent, and 5 reps with left knee bent. Twice daily.

Side Bridge, Beginner

Begin with the knees and hips flexed (a) and moving into the side-bridge with an unfolding of the legs, all the time keeping a braced neutral (straight like white arrow on picture) spine (b)

Straighten out your torso (upper body) by lifting the pelvis off of the floor/bed a few inches.

If you need to, you can pull down on the shoulder a little to help stabilize the shoulder.

Cat / Camel / Flexion / Extension Cycles

This helps warm the spine up for the exercises. This is intended as a motion exercise and not a stretch, so the emphasis is on motion rather than ‘pushing’ at the end ranges.

Perform 5-6 cycles. If you have sciatica, you may

experience some increased pain during the flexion phase. Use pain to guide the suitable pain-free range of motion.

Birddog, Beginner’s

The starting position is on the hands and knees with the hands under the shoulders and the knees directly under the hips.

Practice raising an arm up as shown, then the other arm, then one leg and then the other.

Hold for two SLOW breaths. Goal: 5 reps with each arm and 5 reps with each leg, twice daily.

Curl-Up, Beginner’s

Lay on your back with the hands supporting the low back area. Do not flatten the back to the floor. The hands can be adjusted to minimize pain if needed.

One leg is bent with the knee flexed to 90 degrees while the other leg remains relaxed on the floor/bed. The focus of the lift is on the upper torso. Only lift to the point between the shoulder blades.

Leave the elbows on the floor while elevating the head and shoulders a short distance off the floor.

Do not bend/flex your neck. No neck motion should occur, either chin poking or chin tucking. Goal: Holding for two SLOW breaths. Do 5 reps with right knee bent, and 5 reps with left knee bent. Twice daily.

Side Bridge, Beginner

Begin with the knees and hips flexed (a) and moving into the side-bridge with an unfolding of the legs, all the time keeping a braced neutral (straight like white arrow on picture) spine (b)

Straighten out your torso (upper body) by lifting the pelvis off of the floor/bed a few inches.

If you need to, you can pull down on the shoulder a little to help stabilize the shoulder.

Cat / Camel / Flexion / Extension Cycles

This helps warm the spine up for the exercises. This is intended as a motion exercise and not a stretch, so the emphasis is on motion rather than ‘pushing’ at the end ranges.

Perform 5-6 cycles. If you have sciatica, you may

experience some increased pain during the flexion phase. Use pain to guide the suitable pain-free range of motion.

Birddog, Beginner’s

The starting position is on the hands and knees with the hands under the shoulders and the knees directly under the hips.

Practice raising an arm up as shown, then the other arm, then one leg and then the other.

Hold for two SLOW breaths. Goal: 5 reps with each arm and 5 reps with each leg, twice daily.

Curl-Up, Beginner’s

Lay on your back with the hands supporting the low back area. Do not flatten the back to the floor. The hands can be adjusted to minimize pain if needed.

One leg is bent with the knee flexed to 90 degrees while the other leg remains relaxed on the floor/bed. The focus of the lift is on the upper torso. Only lift to the point between the shoulder blades.

Leave the elbows on the floor while elevating the head and shoulders a short distance off the floor.

Do not bend/flex your neck. No neck motion should occur, either chin poking or chin tucking. Goal: Holding for two SLOW breaths. Do 5 reps with right knee bent, and 5 reps with left knee bent. Twice daily.

Side Bridge, Beginner

Begin with the knees and hips flexed (a) and moving into the side-bridge with an unfolding of the legs, all the time keeping a braced neutral (straight like white arrow on picture) spine (b)

Straighten out your torso (upper body) by lifting the pelvis off of the floor/bed a few inches.

If you need to, you can pull down on the shoulder a little to help stabilize the shoulder.

Excercises

Proteins

Vegetable

Fruit

Wheats & Grains

Sweetners

Carbohydrates

Fats

Milk Products

Nutritional Recommendations

The Page Fundamental Diet Plan

Foods to eat, and food not to eat

Liquids

Eat small amounts more frequently

Phase I

Phase II

Total 6 weeks (healing cycle of the body)

Specific Recommendations & Goals

Visits Week CareMinimum Benchmarks

M T W T F

12 4

•Chiropractic manipulation

•Ice for any pain and flare ups.

•Physical therapy exercises

•Nutritional recommendations

• 20-30% symptom intensity reduction.

• 6 point improvement on ADL questionnaire.

• 20-30% improvement on exams

X X X

Progress Exam

Consequences If Left Un-treated Or Under-treated

If left untreated, this problem, being structural, and biomechanical, will tend to decay over time due to the uneven compressive stresses to the spine and pelvic structures. The pain will most likely continue, and may progressively intensify as the disorder decays.

Symptom care only will mask over symptoms while the disease process remains unchanged or progressively gets worse for lack of proper attention. Symptom management is not recommended.

Recent medical studies show that if appropriately cared for, your chance of recurrence is only 3 out of 10 (30%). If un-treated, or under-treated, your chances of it coming back are 8 out of 10 (84%).

Financial Report Specific Service(s) Service Fee BC/BS* Total Fees

8 Chiropractic Manipulation 98941 3-4 Regions $47.00 $29.82 $238.568 Extremity Manipulation 98943 $27.00 $13.50 $108.001 Re-exams 99213 $62.00 $56.52 $56.52

Total $403.08*Contract Allowable

BlueCross/BlueShieldWal-Mart - No Coverage

Estimated Out of Pocket Expense$403.08

Payment Options#1 Pay visit by visit

$43.32 Regular visits$99.84 Reexam plus Rx

$403.08 Total paid visit by visit

#2 One Time Prepayment10% Administrative Discount

$40.31 Savings$362.77 Total Prepaid (Escrow)

Office Policies and Benefits

Referrals

Time/Appointment Scheduling M.A.P.

Office Hours

Missed Appointments

Office Policies and Benefits

Terminating Your Care

Injuries

Durable Medical Equipment and Nutritional Supplies

Dr. Broussard’s Spine Class

Go to CajunChiro.net and click on SpineClass

Disclosure & Consent

Fractures

Disc injuries

Dislocations

Sprains

Increased symptoms and pain or

No improvement of symptoms or pain