Back for round 2- Ted and Fred’s Excellent Adventure Volume 2 is now available! In this CITV episode, Prof. Carrick discusses:
-( 00:34) Integrating into the medical community – how to build a relationship with other professionals within your healthcare community
-(9:35) Differential diagnose of a primary subluxation/joint position error that needs to be corrected from one that is a secondary/compensatory one that needs to be left alone.
-(23:37) And the most important question- what are the Patriots going to do without Tom Brady?!
We are so excited for this continued series and to keep bringing you these engaging conversations!
Thank you to everyone who has submitted their questions so far. If you would like to submit a question to Prof. Carrick, please fill out the form using the link below.
#Carricktrained #drcarrick #carrickinstitute #CITV #neurology #functionalneurology #chiropractors #physicians #physicaltherapists
– Hello, my name’s Dr. Freddy Garcia, and once again we’re joined by Professor Carrick. We’re doing volume two of Ted and Fred’s excellent adventure answering your guys’ questions that you submitted. Professor, what’s goin’ on?
– Good day, Freddy. It’s good to see you again.
– Listen, I have so many questions, so I wanna jump right into it. Can we do that?
– Yeah, let’s do it.
– Okay, so let me see. One that I saw that I liked is: all right, we have a scholar that wrote in and he said, I’m trying to get more integrated into the medical community to let them know what a clinical neuroscience approach is and what it can do. He noticed some similarities, and he goes, I guess neuro optometrists really see a lot of the same patients that we do. What are some of the recommendations that you have to integrate yourself into that community so there can be a symbiotic relationship? It’s actually a very common question. I found it interesting that they pointed out the neuro optometrist seeing a lot of the patients. I think that’s actually come to light in the last couple years, more people becoming aware of that. I gotta tell you, five years ago I didn’t really hear that many people talk about neuro optometry. It’s become very, at least, more in front of people in regards to how powerful that can be, and I agree that that’s a good tool and love the work they’re doing. What do you think? How do they become more integrated?
– Well, I can tell you what I did, and just historically speaking, if you’re doing the things that we do, oftentimes you’re outside of that mainstream, but one thing that definitely doesn’t work is telling people all about the things that you do or you’re qualified to do or telling stories, because people really don’t care about that, it could be crap, but what does make a difference if you want to be integrated is your patient outcomes. That makes a significant difference, so what I did, and years ago it was different: it wasn’t as fast, we didn’t have word-processing, there was no emails, it was letters, but every patient that I saw, I would send a thank you note to all of the people that were on their healthcare team. That’s something that everyone did, so that if you’re a specialist and you see someone and their general practitioner or the primary contact one, out of courtesy I would give them a copy of my narrative, and I wrote very good narratives, and they weren’t long narratives, and they weren’t, but they were exact, like patient came in with this and this. And I gave my examination, which was probably, to say this modestly, was better than anyone else had done. I was trained well to do a good physical exam and record it and interpret it, so that’s what I did. And then I gave them what I did, and boom! It wasn’t very long before almost every healthcare practitioner in my local area was getting five and six letters a week from me thanking them, and after a while I was just there. So I think the way to integrate if you’re not on staff at your hospital, and you probably should get out there and get into that community or attend rounds or go to your local university, but don’t try to sell yourself. If you’re a good guitar player, telling people about the history of guitars, how guitars sound really great, is not going to do something, but if you take that thing out and you start just strumming a few chords and you’re my gosh, this is amazing, that’s the way to do it. So it’s by outcomes because you can talk as much as you want about how great a functional neurological approach is in the treatment of concussion, but if you won’t be seeing one or two of them, doesn’t matter. You’ve got no credibility. So, look at the patients that you have and correspond. You don’t do a narrative report just when people ask you to do something, so keep it in there, have the appropriate releases for you to send to their patients, and that’s something that we’ve always done. So if you see Freddy Garcia, say who’s your family doctor? Who’s your dentist? Probably they have a psychiatrist as well. Look at all of these people, and then give the release form, so that people can send it out there, and then you send a copy of that release form with the narrative, and make sure it’s of quality. And learn to do that so that I would have by the time people would come in and leave my office, that letter would be in the mail, it would transcribed, it would be out. But also I videotaped people from the late ’70s, so that they’d have a copy of that videotape would be to referring doctor as well, so people could see what we’re doing. So integration means that you’ve got to show your work. You’re not going to refer to a surgeon, unless you’ve seen what that person has done. What are the outcomes? And this means more than a Facebook page or looking at somebody where you’ve got so many likes or dislikes, but really what happens, and what do people think about them. So I think that’s the best way. It certainly worked for me in a very short period of time. People will know that quality of your work as a consequence of the outcome, and that will speak to the nations, and that’s the real truth. In other words, you’re not talking about it, you’re doing it. You’re showing them your performance. That’s a sign you’ll be responsible as well. You will get mega referrals.
– Professor Carrick, when you wrote those letters, did you ever have the clinicians give you a call or write you back and be like, hey can you explain this or this, or why did this happen? Did you ever have that happen, or did they just kind of accept it and go along with it?
– All the time. I’ve had it for different things. I had one guy who actually called me up just to tell me that he was a member of the AMA and they consider the chiropractors are quacks and boom. A year and a half later he became one of my best friends because I just kept on sending him stuff. After a while, he was like a white raft. He just had to refer because I was thanking him for referring even people he didn’t refer. So, it worked out well, but many of them would be, and I remember one fellow, he’s dead now, I just found out, but he was a really great OBGYN guy, and I would see I saw almost the entirety of these pregnant gals because they didn’t want them to take any drugs because they were pregnant, so they treated them at a higher level. Well, guess what. If you treat everyone as if they’re pregnant, man or a woman, then you’re going to do a better job. In other words, if you’re pregnant, then don’t eat this processed meat and don’t do this and don’t take this drug. Well, just pass it on. I remember him describing the sacroiliac joint movement, and saying I want to refer this person in. I think they have lots of anterior inferior glide of the sacrum on the ilium upon heel strike because they would read my notes and go, that’s just fantastic, and then of course they would see me because I would be in the labor and delivery and boom, and this is amazing, so they’d want to do that analysis, so they could come through, but all of the time. But again, you’re not going to write an epistle. You don’t want to write things like some people write things with references. According to Sam and Sam, the SI, who cares about this? What do they have? What did you find? And the typical things that people gloss over: blood pressure, blah blah blah blah, and then what did you do. So if you can get it into a nice narrative, like an elevator taught page, people will read that. They’re going to go right down to your clinical assessment, and, if it’s reasonable, it’s gonna work. When I first started doing this, I had no money. I used to go down to the Woolworths, and they had the typewriters that were out there, and you could check out when you’re going to buy them. I was really dirt poor, so I would get my paper and I would put it into the thing and I would type my letters for the first week or so, and then when I started making some money, I bought a typewriter, and then onwards. And it didn’t take too long before I could afford to have people type the letters, but at first I was just doing it by myself, none of this word-processing. You make a mistake. I think I spent more money on whiteout than I did on headrest paper.
– You know, and now clinicians do it even easier right? Because they can drag and dictate with the medical words, they can literally, you know talk through the computer and get that all written up pretty easily.
– Yeah, make it short though. Make it short.
– Yeah, no you’re right. That’s great. Let’s get another good question, I like this one, let me see where’d it go. All right, so this must come from a manual therapist, you know, we had questions come in from all different professions by the way. Acupuncture, athletic trainer, we had medical physicians, we had different education levels too. We had a couple PhDs, some people were new to us, some people have been with us for awhile, it was pretty neat to see all of these questions. This one’s a manual therapist and they asked, “Professor Carrick, how do you specifically, differentially, diagnose a joint positioner, or a primary joint positioner, which needs to be corrected from one that is secondary or compensatory and needs to be left alone?” And I think that’s an interesting question. What are you thoughts on that?
– Well it’s a great question and it really depends upon where the joint dysfunction is. If it’s in the neck or the low back, or the elbow, or the knee, there’s different parameters. But let’s answer in a real, in a clinical reality, because oftentimes you just don’t know until you correct it and if you correct it and things go south, you probably should have left it alone. That’s the reality of these things. So when we look at joint dysfunction, everyone has one, and you’ll have to compare that joint dysfunction, especially in the neck, to what is happening in other parts of the body that are linked. And we see this primarily with the eyes. So that if I am really stiff for instance on the left side of my neck, I’m not going to be able to move my head to the right, I’m not going to be able to let go of that activity so that if we find that your, the relationship, or the gain of your neck movement is less than the gain of your eye movement, so if you follow a target and the eyes are moving, then there’s a very good probability that that neck is too tight for a variety of reasons. And it could be due to a dystonic relationship, or it could be due to a frontal lobe aberrancy, an integration that comes into the nasal ganglear. So, oftentimes what I do is, when I look and I find that there’s a joint dysfunction, and I say, “Boy, you know, this joint is tight, or it’s fixed, or we’ve got some spasticity of muscles, because it’s compensating. Because if you tilt your head, you’re gonna get dizzy.” Something like that. I would do something to provoke the symptoms and then I would see if could correct it with a non-joint sort of, a mechanism for instance if it’s a say a left frontal activity and you’ve got increased tension in the right side of your neck. I might want to do something complex with movements of the left arm. If that didn’t do it, it’s probably the joint, it’s probably not a cerebellipetal aspect of the frontal lobe. But at the end of the day, if you’ve never seen the patient before, you may have a hard time to know what is a primary or a secondary. And is with all things, if you address that and you find that things do well for them, then it probably was primary. If you address that and you find out the next day it comes back and it’s tight again, then it probably was a compensatory mechanism and you probably shouldn’t have gone there. There’s no sense of instance to manipulate a joint every other day or three times a week, if you’re doing that, then it’s probably secondary to something else that you’ve missed. So it’s a good window, with joint stimulations we like to look at the relationships of joints to brain, is something that I’ve done, you know, forever. The more proximal joints usually have a greater representation to brain than the more distal. Or to say differently, if you treat more distal joints, you’re gonna have less of an effect on brain function than more proximal joints, so it’s a little more forgiving in regards to that sort of effect. So if I’ve got a problem in the left side of my neck, I’ll oftentimes do a stimulation of the left wrist or the elbow just to see what happens in regards to brain activity. In other words, if their saccades towards the side of the fixation or the joint disturbance become worse when you manipulate an elbow then you probably don’t want to manipulate the neck in regards to that sort of effect. If you’ve seen the patient before and you know bio mechanically what they’re doing, it becomes pretty easy because if they have something that’s a new type of fixation or so then it’s probably a primary. In days gone by we would see patients that used to have travel cards and they’d go their doctor and they’d have a lesion of the level for instance of what they called their subluxation and sure enough, it was there. And I never got into the trap of going, “yeah, it’s C3 and I did the same.” And I would go like, “Why is this still here? This person’s had this travel card, it’s been good for three years, maybe there’s something else.” So I would search for something else and almost, I mean not all the time, but a good percentage of the time, I would find when I corrected something else that all of a sudden that lesion would just go away, I didn’t even have to do anything. So you’ll find out you’re right if you correct something and it goes away, then you knew it was the primary. If it comes back, it’s probably compensatory to something else. And sometimes with people, you’re gonna have some compensation that you need. So if I’ve got a trochlear nerve lesion, and I can’t move my eye down and in, then I’m gonna tilt my head to compensate for it and I’m gonna get a joint fixation. Well what are you gonna do? If you’ve got a frank lesion, they’re going to have to live with that and you’re going to have to do some things to enable them to do better. So you’re going to rehab those with for instance with an eyes closed mechanism. Give them exercises with the eyes closed so that they don’t become diplopic when they do it. And there’s all sorts of different variables. I don’t know if that answers things in a beneficial way to people, but it’s an honest way, cause you’ll make people worse when you do the wrong thing and you’ll make people better when you do the right thing. Sometimes it’s just a judgment call and your personal experience and your gut. So different tests of the neck makes it a little easier because you can look at movement of the head and seeing what the neck looks like or you can hold the head straight and then move the body to see how much is vestibular, how much is neck proprioceptive, and then you can do some different sort of techniques, we talked about snags the other day, there’s many people, if you’ve been doing this for awhile, you’ll find that you can affect the neck by manipulating the SI joint or by manipulating the foot or putting an orthotic or manipulating a knee or doing whatever. So in your armamentaria, there’s many things that you can do with experience that will let you know whether or not addressing a certain level is gonna have anything that’s gonna be lasting. If it comes back the next day or two days later, it probably wasn’t what you should have done.
– Excellent. You know, one course, that I think a lot of scholars when they first come into us if they’re manual therapists, that they enjoy is our adjusting courses. We have a couple of faculty that are always very popular when you teach them and I think when they have that paradigm shift from adjusting things from a purely biomechanical perspective to a neuro biomechanical perspective, meaning we’re now taking into account the patient’s individual neurology, I think that blows away a lot of clinicians. When they have that shift, I think that is the beginning of them never being able to look at their patients in the same way again. I was lucky enough to go on tour with you when you were doing several adjusting courses a couple of years ago, was filming them, and I always tell this story of how there would be your, you’re showing these techniques on doctors, you know, 60, 80 doctors in a room. Everybody’s standing the whole time, and as soon as one doctor would get off the table, another one, even though in the middle of your lecture, would slide right onto the table because they wanted to be next to be adjusted by you. And what I think was most amazing to me was hearing it all with these manual therapists, who had been getting adjusted and doing passive work, active work, exercises, still had some sort of issue right? They would tell you about them. And then you would adjust them and the doctor would turn and be like, “you fixed this for me. What did you do?” I found that plenty that they had been adjusted and done all these thing lots of times. But you had a different approach you know? And you would adjust them and all of a sudden the doctor would kind of turn and I would be like, it was just amazing every time I saw those classes and saw you adjust that many people in a day.
– Yeah, it’s really good. I think, you know, we all have our skill sets, some are better with one thing or the other. But if you look at, like, at some of these basketball stars, the guy can go to the center line and pop them in, pop them in, pop them in. And then you look at other basketball players and they can’t do it. So if you did like a controlled study and you just took a bunch of basketball players that were elite basketball players, and you got them to throw from the center line, you might make a conclusion that it was not possible to do the thing that you just saw it done by Michael Jordan or somebody else. So, the techniques that I utilize are high velocity, low amplitude manipulative techniques. That’s what I do best so that’s what I like to do. And for some people, they may not have that dexterity. So when we teach people, it’s very interesting, a lot of people will look at manipulation and there will be big guys and they’ll muscle it in. Those are not good techniques. They may get a crack or a release or so but they can hurt people. We found for years, you know for about 20, 25 years, we used to give a technique award and every year, you know, again for a quarter of a century, a woman won that award because we would teach people how to do manipulations based upon their size and the patient size. Almost like when you play Judo or so, where you use the patient’s weight and stiffness against them or you’d use the subluxation against them. And then we would teach them how to do manipulations with their fingertips. Whether it be a low back or somebody that had had, you know, people would always say, “You know, no one’s been able to manipulate my low back.” And we’d show and just take a very and you’d hear this, the biggest crack they’d ever seen in life. It can be learned, but the technique that you would use in your size, is different than I would use or somebody next to you. So if you teach people how to fight with the joint enmity based upon their skills, you can increase their skill levels. So many times the outcomes that people get are because of a decreased skill, maybe it’s just not cool for them and that’s good to know so they can increase their training to become at a better level. Or just say, “Hey, I’m not good at that shoulder. So I’m gonna send you to this person that really is good. But I’m really super good at a knee or so.” and that’s about as humble as it is. But I know, what you’re talking about because when people come to a manipulation lecture, first of all, a lot of people get very surprised at these you know, neuro nerds that know all about this brain can manipulate like better than the rank and file as a consequence of experience and then all of a sudden when they have a manipulation, they’re dumbfounded because the consequences are different than what they’ve had before. So the techniques that we teach are very vibrant and probably more vibrant because we make them individual. So we don’t talk necessarily about, this is the line of drive, because it changes for each person. And once they can palpate it and understand it and then realize that, you know, if you find a problem on the left side of the neck and one on the right side, which one do you do? And you teach them a little subtle neurological localization that says it’s more probable that the left side is going to give you are greater cortical consequence than the right. And they do the left side, all of a sudden the relations that they get are markedly better because they might have gone on the right side first or so and that can make a significant difference. But manipulation is a skill, it’s an art form. You know, it’s you’re playing piano, we always like to give the relationship that you don’t hear too many, maybe, maybe Beethoven you could play like dun dun dun dun. You know, concerto for but realistically the greatest bang for your buck is being able to use different angulations of force and direction with your fingertips. If you don’t know it well, the only one you’re gonna hurt is gonna be yourself right? But if you know how to do it, your fingertips can have so much power. You know, I break boards with my fingertips. You know, I learned that when I was a young guy. So you get a lot of power, certainly, if you hit the board wrong you’re gonna not wish that you did it, same thing with the joints. So little people can do maximum force within an adjustment and not hurt anybody but themself, you know, basically. And they don’t if they’re trained.
– Professor Carrick, it’s funny that you mentioned Michael Jordan earlier, which is you know, a GOAT, one of the greatest of all time for basketball. Somebody asked a question about another person that I would consider a GOAT and I guess they must know that you are a New England Patriots fan.
– I remember a few years ago we were at an ISTN, the international symposium for clinical neuroscience and we had a Super Bowl party and that was the greatest Super Bowl I’ve ever seen. Patriots versus the Falcons right?
– That comeback was amazing. I don’t think I’ll ever see a better Super Bowl than that. Its the most exciting thing I’ve ever seen in football. But they have a question. They said, “Professor Carrick, what are your Patriots gonna do now that Tom Brady is history?” And because he has a new team, he’s left the Patriots, he’s now with the Tampa Bay Buccaneers. Or I like to call them the Tampa Bay Patriots now. And so what are they gonna do? What’s gonna happen?
– That’s an easy answer. They’re gonna win. Because they’re a team and you’re gonna see some amazing things with Belichick. And I was a Patriots fan when the Patriots were the worst team in the league. You know back in ’79 and the early 80’s and things, a high school team could’ve beat the Patriots. And then everyone hates them because they’re so good. That’s what happens when you get good, people hate you. So Brady, you know, is the best of all time, but he really, he became the best because of some great players that allowed him to become the best. So lets see who can catch him. I mean, let me tell you, have you seen that guy drill a ball? I mean he’s gonna go right through those, some of those Buccaneers. You know, way at the back, I don’t know, they’re gonna have to retrain them all. We’ll see, but I did try to get season tickets which you can’t get just anyways so. But Patriots are gonna win, I mean that’s what’s gonna happen. And maybe Tampa will too, we’ll see.
– Well I just saw a thing a couple days ago that in like right now the Tampa Bay Buccaneers gear is outselling everybody else and that specifically Brady’s gear, has sold more than like ever before so people are really excited about him coming down and then there’s a lot of free agents who are trying to get to the team because they know that he’s a good quarterback, he’s a smart quarterback, and he distributes the ball well and I think the reason receivers like him, because if you watch Brady play, he throws passes, but he never puts his receivers in vulnerable positions. He throws the ball low when he has to. And so I think it’s going to be really interesting to watch over the next couple years, I do hope to catch a game and we should make that a trip. You know? That’d be great.
– Let me tell ya, it’s gonna be close, and the good thing is, you know, I always have the, you know, the Sunday package, and you don’t need it now! Because Tampa’s local so it’s all gonna be televised. I mean and it’s gonna be pretty amazing. But let’s hope we have a season. We’ll see, you know, with all of this stuff that’s coming up. We’ll see. And you know, for all athletes, hockey, basketball, what are they doing? I mean you can sit there in your basement and you can throw, but this is an entirely different world. How are these players gonna do? Maybe they’ll do better. Maybe taking that time off and developing their own, we’ll see right? We don’t know what’s gonna happen. Hopefully our world will heal and come back. But I don’t know, you know, what’s happening here at our local sports teams but that’s part of it right? And I think the whole consequence of the team translates to the things that we’re talking about by immersing ourselves in the community, being an essential part of it. If you’re doing good, if you’re the Tom Brady, you can go anywhere and people are gonna want to catch your ball. And with what we do, if you’re good at what you’re doing, people make notice, really really quickly. And just as some people, believe it or not, don’t like Tom Brady cause he’s so good, there’ll be some people that may not like some of our colleagues that are just so good as a consequence. But the majority of people want to catch that ball. So team playing, what a perfect example. Watch the Patriots because they are a team. And you watch what Belichick does with it one guy’s out, they got other guys that are gonna come in. He’ll have a different strategy, it’s not gonna be the same ballgame that they’re gonna play. You watch! It’s gonna be amazing.
– Yeah, I do admire Belichick as a head coach. I think he’s genius. I think he’s the GOAT when it comes to coaching. And I’m actually exited to see how he’s gonna adapt. I do think he’s short on talent. But his genius in coaching is I believe undeniable.
– There you go.
– So we’ll see. All right professor I think that’ll do for this volume of Ted and Fred’s excellent adventure. I have some more questions for you but I think we’re gonna meet later today and we’ll do some more questions then. Is that fair?
– Yeah, sure. That’d be great.
– All right, we’ll catch you later professor. Thank you.
– Yeah. Buhbye