Integrating Complementary
and Alternative Medicine
into a Chiropractic Practice
Geoff Lecovin, D.C., N.D., L.Ac., CSCS
Education/Training
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BS Human Biology (1989 LACC)
DC (1990 LACC)
MS Nutrition (1992 University of Bridgeport)
MS Acupuncture (1994 Bastyr University)
ND (1994 Bastyr University)
CSCS (2006 NSCA)
CES/PES (2007 NASM)
What is CAM?
Complementary and Alternative therapies that
have been shown to be safe and effective.
(NIH)
e.g. naturopathic medicine, acupuncture,
manipulation, guided imagery, supplementation
Naturopathic Medicine
Naturopathic Medicine
 Four-year
graduate level naturopathic
medical school
 Holistic and nontoxic approaches
emphasizing prevention and wellness
 Professional board exams to be
licensed as a primary care general
practice physician
Philosophy of Naturopathic
Medicine
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Do no harm
Find the cause
Treat the whole person
The healing power of nature
Prevention
Scope of Practice (WA)
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Nutrition and food science
Supplements
Physical modalities/manual therapy
Minor office procedures
Homeopathy
Botanical medicines/nutritional supplements
Hygiene and immunization
Contraceptive devices
Common diagnostic procedures
Counseling and hypnosis
Intramuscular and intravenous therapies
Prescription drugs (all legend/limited controlled substances)
Diagnostic procedures (e.g. lab, imaging, etc.)
Naturopathic Patient Demographics
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Pain/sports injuries/auto & work injuries
Family practice
Obesity
Cardiovascular disease/hypertension/diabetes
Wellness
NHRT, depression, ADD/ADHD, women’s/men’s
health, pediatrics, oncology, fertility
Naturopathic physicians are currently licensed
in these states:
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Alaska
Arizona
California
Connecticut
District of Columbia
Hawaii
Kansas
Maine
Montana
New Hampshire
Oregon
Utah
Vermont
Washington
US Territories: Puerto Rico and Virgin Islands
Acupuncture
Acupuncture
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Traditional Chinese Medicine (TCM)
Neuro-anatomic acupuncture (“dry needling”)
TCM
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The practice of acupuncture dates back nearly
5000 years, where it began in China and other
Asian countries.
Over the course of its development, ancient
practitioners developed concepts and systems
reflecting the religious, medical and cultural
beliefs of their time.
Neuro-Anatomic Explanations
for Acupuncture
Lesions created by inserting sterile needles in the soft tissue activate
the body’s main systems:
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Nervous
Cardiovascular
Endocrine
Immune
This promotes homeostasis and stimulates healing.
(Yun-tao Ma, Mila Ma, Zang Hee Cho, Biomedical Acupuncture)
Effects of Dry Needling
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Strengthen tendons & ligaments by inducing local
inflammatory reactions
Stimulates GTO & muscle spindles inducing muscle
relaxation
Mechanically disrupts trigger points
Treats overactive motor points
Provides blood & growth factors, which can increase
circulation, disrupt micro-scars and repair tissue
Alters neural control via neurotransmitters
Stimulates neural reflex mechanisms
Chiropractic, Manual
Therapies and Exercise
Beyond chiropractic help
Kinetic Chain
Kinetic Chain
Muscular
Articular
Neural
Muscle Imbalance/Joint dysfunction
(upper & lower crossed syndromes)
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Altered reciprocal inhibition
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Synergistic dominance
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Myofascial dysfunction
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Arthrokinetic dysfunction
Manual Therapy
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Spinal and extremity manipulation
Mulligan techniques
Soft tissue manipulation
-NMR
-Soft tissue release
-Gua Sha
-Active isolated stretching
Modalities
Exercise
Corrective Exercise Protocol
(NASM)
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Inhibit- self myofascial release with foam
rollers
Lengthen- stretching
Activate- isolated intramuscular strengthening
Integrate- full body intermuscular movements
NASM Exercise Model
Case Study:
An Integrative Approach
Triad of Health
Psychological
Biochemical
Structural
History
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28 y/o female Caucasian presents with
headaches 3-5x/wk that started during high
school and have progressively worsened. They
are 3-6/10 (10 being worst). Massage,
chiropractic and heat are temporarily palliative.
Stress and working on the computer are
provocative. History of minor rear-end collision
in high school. Symptoms worsen during
menses. Other complaints include low energy
and difficulty losing weight.
Review of Systems
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General – NAD, A&O x 3, overweight
EENT, cardiovascular, respiratory, gastrointestinal,
genitourinary and neurological are unremarkable
Musculoskeletal - neck pain & headaches
Skin - eczema
Psychiatric - high stress job
Endocrine - heavy menses
Hematologic - history of anemia
Allergy/immunologic - seasonal allergies
PMhx/Family hx/Social hx
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PMhx - unremarkable
Family hx - mother has hypothyroidism
Social hx - single; non-smoker; light drinker
Occupation - Microsoft software engineer
Sleep – poor (5-6 hrs interrupted)
Exercise – occasional yoga
Diet - high refined carbohydrate/fast foods;
often skips breakfast and/or lunch
Examination/Diagnostic Testing
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Vitals (Ht 5’4”; Wt 137 lb; BP 90/68; P 77
Eyes - 20/20 vision
Head and neck - normocephaly. No thyromegaly.
ENT - tender frontal and maxillary sinuses
Cardio/Pulm/Abdomen - unremarkable
Skin - dry
Cervical X-ray – loss of cervical lordosis
Blood work - TSH 5.3; D3 22; Ferritin 20
- CBC and Chem within normal limits
Assessment
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Chronic tension headaches
Hypothyroid
Overweight
Iron deficiency
Vitamin D deficiency
Insomnia
Naturopathic Treatment
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Dietary modification
Supplement prescription
Armour thyroid
Systematic relaxation/guided imagery/breathing
home exercises
A Balanced Approach to Diet
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Focus on fueling the body with nutrient dense, antiinflammatory foods that satisfy energy requirements
Optimize nutrients
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Shift balance of omega-3:omega-6 fats
Change carbohydrate sources to fruits and vegetables (low
glycemic load)
Incorporate lean protein sources with every meal and snack
Increase phytonutrients and water
(In other cases, it might be indicated to identify potential food
sensitivities through food elimination/challenge)
Healthy Plate
Broccoli
Cabbage
Carrots
Cauliflower
Dark green leafy
veggies (e.g.
Spinach, kale,
chard, Brussels
sprouts etc.)
Green beans
Peppers
Tomatoes
Starch
Non-starchy
veggies
Corn
Peas
Potatoes
Pumpkin
Squash
Sweet potatoes
Yams
(Brown/wild rice, oats,
Quinoa)
Protein
+ healthy
fats,
including:
Avocado
Nuts and seeds
Olive & Canola oil
Beans & lentils
Beef (grass fed)
Poultry (w/o skin)
Dairy (Yogurt)
Eggs
Fish
Nuts & nut butters
The Power of Color
RED (anthocyanins, lycopenes) - strawberries, cranberries, raspberries, cherries, grapes,
beets, peppers, water melon, pomegranates, apples, onions, pink grapefruit
ORANGE-YELLOW (beta carotene, lutein, zeaxanthin) - carrots, sweet potatoes,
yellow potatoes, orange, mangoes, cantaloupe, pumpkin, squash, apricots, corn,
banana, turmeric, ginger
GREEN (beta carotene, lutein)- spinach, chard, kale, avocado, asparagus, artichokes,
broccoli. Brussels sprouts, cabbage, green tea
BLUE-PURPLE (anthocyanins)- blueberries, blackberries, grapes, red wine, eggplant
WHITE- garlic, onion, cauliflower
BLACK/BROWN- Coffee, dark chocolate, nuts, stout beer
The Color Code. James A. Joseph, Ph.D., Daniel A. Nadeau, M.D., Anne Underwood
Supplements (Thorne)/Prescriptions
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Multiple with iron
Iron - 20 mg qd
Vitamin D - 2000 IU qd
Fish oil (Nordic Naturals) - 1000 mg tid
L-Tryptophan - 1000 mg at bed time
Armour Thyroid (Rx) - 60 mg away from iron and
multiple
TSH to be re-tested after 1 month
Ferritin and D3 to be re-tested after 12 weeks
Acupuncture Treatment
1. Symptomatic points - local trigger points
2. Paravertebral points - cervical and thoracic
3. Homeostatic points – facial, upper
extremity and shoulder region
Chiropractic Treatment
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Soft tissue release/NMR to address shortened
muscles (upper crossed syndrome)
Spinal manipulation to cervical/thoracic/lumbar
areas of segmental dysfunction
Headache SNAGS (Mulligan)
Home corrective exercises
Home Corrective Exercises
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Self-myofascial release with tennis balls and
foam rollers
Static stretches
Isolated strengthening - scaption, deep neck
flexors
Integrated movements - squat to row
Outcome
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Patient was seen two times per week for one month
Headache frequency was reduced to once per week
Sleep, energy and feeling of wellbeing were improved
Skin hydration improved
TSH after one month decreased to 2.1 (thyroid Rx was refilled
for 6 additional months)
Frequency of visits reduced to once qo wk for four more visits,
at which time headaches were minimal
Exercise progressed from corrective to strength training 2x/wk,
+ yoga 1-2 x/wk
At 12 weeks, headaches were infrequent. Vitamin D level was 52
and Ferritin level was 68
Next follow-up was scheduled for 3 months
Recommended Resources
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Certifications: NASM - CES and PES
Seminars:
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NMR training with Peter Levy, DC
Mulligan technique
Hands on Seminars – trigger point therapy
Gaby/Wright – medical nutrition
Stuart Taws – soft tissue release
Stuart McGill, PhD (books and seminars)
Books:
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Natural Hormonal Enhancement – Rob Faigin
Good Calorie, Bad Calorie – Gary Taubs
The Gunn Approach to Pain – Chan Gunn
Acupuncture, Trigger Points and Musculoskeletal Pain – Peter Baldry
Trigger point manuals, Travell and Simons
Biomedical Acupuncture, Yun-tao Ma, Mila Ma, Zang Hee Cho
New Rules of Lifting, Schuler and Cosgrove
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Internet: www.vitasearch.com, www.nutraingredients.com
Dr. Geoff Lecovin
Evergreen Integrative Medicine
www.eimed.com
geofflecovin@hotmail.com