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A helping hand for members of the British Chiropractic Association

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chiropractic-uk.co.uk Spring 2018 • Volume 32 • Number 1

PRESIDENT’S MESSAGEAge of changePage 5

FEATUREWorld Spine Care updatePages 24

CONFERENCESharing knowledge, having fun!Pages 11

REPORTX-ray game changePage 34

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CONTACT Spring 2018 • Volume 32 Issue 1 3

EDITORIAL

Progressing … positively

In this issue...

Positive is the one word that seems to come across in this issue, from the Student report to the Colleges’ report right the way to the

President’s message. 2018 certainly has got off to a great start

for chiropractic and the BCA. Following the Lancet publication our BCA President, Catherine Quinn, was on TV for the evening news discussing low back pain and the role that chiropractors can play. The PR Committee had organised media training for key spokespeople only a few weeks before and it was great to see those skills in use so soon.

At the time of writing we are gaining extensive print and radio coverage for our National Back Pain Barometer, highlighting our findings on regional differences in back pain. Please do keep an eye on your new patient numbers, as the number of searches on the Find a Chiropractor section of the BCA website always increases around Chiropractic Awareness Week.

You will read the first report from Dr Rhys Breckon the new Head of Chiropractic at WIOC. Several new faces have joined the team at WIOC and he outlines developments to the programme. The research at the CDTRU at WIOC appears to be leading the way in spine

function in sports and the resulting benefits of chiropractic. AECC UC School of Medical Ultrasound is also expanding and will be used as a UK training centre by Samsung for the latest advances in ultrasound technology. CBR research at AECC UC is being presented internationally with the latest research on lumbar spine biomechanics in mechanical back pain presented back in January, at the largest military hospital in the world.

The newest chiropractic programme at London South Bank University has been busy interviewing students for the first cohort this September. The programme has generated a lot of interest and prospective students are also attending open days with a view to commencing their training next year. The recruitment process for the Head of Programme is still taking place. We hope to bring you more information in the next issue.

The Student Report outlines the success of the BACS Conference where students from AECC UC, MCC and WIOC, as well as Osteopathy students were attending. The ECCE had its ENQA accreditation withdrawn in 2016. (ENQA is the European Association for Quality Assurance in Higher Education). It is heartening to read that chiropractic students attended the ENQA review of ECCE and gave the students perspective of the role

of ECCE in chiropractic education and the importance of ECCE accreditation.

The differences in GCC and ECCE accreditation over the last 20 years have been the source of many a debate in the chiropractic profession in the UK. In the next few weeks WIOC is hoping to be the first UK institution to be receiving a combined GCC and ECCE accreditation visit.

In 2017 BCA members saved £30,000 (yes £30,000) by using the BCA Privilege Scheme. When was the last time you had a look at saving some money for you and your family? Tim Button, BCA Membership Services Chair, outlines other opportunities for you to benefit from your BCA membership.

The BCA Spring Conference this year was a sell out again! Please make sure you have the date of the Autumn Conference in your diaries (13th-14th October) as this will undoubtedly be sold out too. If you haven’t attended a BCA Conference in a while do come along, you will be pleasantly surprised.

Rishi Loatey, Editor

CONTENTS

President’s message 5

Chief Executive’s message 6

News 8-9News from your Association, colleagues and the chiropractic world in general

Features 11-14, 16, 18, 20-21, 34

Spring ConferenceBCA PrivilegeBCA PlusInsight from IndiaThe X Ray Game Change

Special Interest 22-25, 26-27Acupuncture in clinical practiceWhat is PhotoBioModulation Therapy?

Colleges 28-31News from UK chiropractic colleges

Reports 32-33, 35, 36Student / New Graduate report Professional Standards CommitteeRoyal College of Chiropractors

Business & Finance 37, 38, 40-41

Brexit: Employment Law PredictionsManaging Probationary PeriodsFree business advice

Diary 42-43

Classifieds 44-47

For chiropractors, by chiropractors.

YEARS OF DESIGN

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MESSAGES

What an exciting five months we’ve had! Council has been working hard on a number of initiatives that will shape the future of the BCA. Research has shown that the most important factors members value from a membership association are that it promotes public awareness of chiropractic, gives you access to professional indemnity insurance and acts professionally with a positive attitude towards research.

In March Mark and I met with the Deputy Chief Allied Health Professions Officer from NHS England. This is further to work that has been undertaken across the profession to apply for AHP status for chiropractic. This meeting gave me the privilege of speaking for almost three hours on the wide range of educational and clinical standards that chiropractors are subject to. I was also able to speak about the potential impact that chiropractic could have on the provision of services to the UK for the leading cause of disability. We discussed the real meaning of evidence-based care and how reliance on RCTs alone does not lead to patient-centred care. NHS England, just like the BCA, values giving patients options on their care and allowing choice, whilst always looking to build our capacity of evidence via patient reported outcomes and experiences.

On March 21st, the Lancet released a ground-breaking series on Low back pain. The authorship included the presence of a number of Chiropractors which shows the huge value of the impact of funding for and conducting high quality research in the profession. As we demonstrated at the BCA Spring Conference inter-professional collaboration on unravelling the burden of MSK complaints on public health is the future and ensuring that back pain is well managed is vital. The principal messages from this series of papers were that in the West we are over medicalising low back pain and that we must avoid transferring this over medicalised approach to the developing world. There was continued support for conservative non-pharmacological care which has already emerged as the primary route in early treatment of LBP, an approach which matches specifically with what chiropractic delivers daily. Whilst we are immensely proud to see chiropractic involved at the forefront of such research and know that this is an endorsement of the package of care delivered by patient centred chiropractors, it is patients who benefit most. We must continue to demystify low back pain and encourage patients to take positive steps towards staying active and engaging in physical activity. I’d encourage you all to read this series and we send our congratulations

to Jan Hartvigsen and Alice Kongsted on their contribution to this series.

The Spring Conference, Chiropractic: Beyond the Spine was a great success and it was so lovely to meet many more of you over the weekend. The under-pinning theme of integration and collaboration is at the heart of providing patient centred care and this is what we do so well.

Over the next few months we want to hear from you. We will be moving our Council meetings around the country and holding an informal but hopefully informative meet and greet with those who can join us the evening before. We will be asking you questions and looking to gain feedback on two large projects which were announced at the Spring Conference. The first of these will be in Birmingham on the evening of May 1st and, if you can’t join us there, fear not we will be asking for your digital feedback too!

We are in the process of updating our Vision and Values document to ensure that we are clear on our identity which will form our strategic aims. This is our culture and with clear statements on what this is, decision making can always be held accountable. It becomes easy to make the right decision because you have a clear direction on which route to take.

We have begun to develop, with expert advice, proposals on how we can improve the governance of the BCA. Council wishes to see consistency and protection of corporate identity and will be consulting with you on the changes we would like to see in both our governing document, the Memorandum & Articles, and in the process surrounding Council terms. Standing for office is not something that should be taken lightly and I certainly don’t expect all of you to stand, but I’m sure that you all want to ensure that those who do represent you are doing so in line with correct, robust policies and procedures.

The BCA sits tantalisingly close to embracing an exciting age of change, integration and opportunity for its members. It will be my privilege to be President of this progressive and modern Association full of such passionate chiropractors.

Catherine Quinn, BCA President

Age of changePresident’s messageContact is produced by:

Trident Print, Lagpond Lane, Sutton Mandeville, Salisbury, Wilts SP3 5ND for the British Chiropractic Association,59 Castle Street, Reading, Berkshire RG1 7SNTel: 0118 950 5950 Fax: 0118 958 8946 [email protected]

Views expressed in this journal do not necessarily represent the policy of the Association, nor does publication of advertisements necessarily imply recommendation.

Contributions are welcomed. Editorial guidelines available from:[email protected] should be marked ‘for publication’ and addressed to:British Chiropractic Association,59 Castle Street, Reading, Berkshire RG1 7SNTel: 0118 950 5950 Fax: 0118 958 8946 [email protected]

The editorial board reserves the right to reject or edit contributions.Contact is published by the British Chiropractic Association and distributed free to all BCA Members, Associate Members, Provisional Members, Student Members and recognised collegesPrint run: 1,750 – published quarterlyBack issues: £1.50 inc. P & P for Members. £3.50 Overseas airmail

Advertising:Ann Goble, British Chiropractic Association,59 Castle Street, Reading, Berkshire RG1 7SNTel: 0118 950 5950 Fax: 0118 958 [email protected] payable to BCA.

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“The best way topredict your futureis to create it.”“In the Spring, I have counted 136 types of weather inside of 24 hours” – the words of Samuel Langhorne Clemens, better known as Mark Twain.

As I write this, with the rain hammering down outside but with the memory of a baking hot recent weekend and of being stranded in deep snow about a month ago,

Twain’s words seem remarkably apposite, particularly in this country where our national obsession with the weather is perhaps explained by its capricious propensity to seemingly follow no pattern whatsoever. Humans, hard-wired as we are to seek patterns in everything, find this endlessly entertaining and perfect fodder for chats at the bus stop.

It’s not just nature that surprises us of course. Without expressing any personal view on their desirability or otherwise I doubt that many of us, two years ago, would have correctly forecast the outcome of the EU referendum and the US Presidential election.

Of course not everything comes as a shock and, ironically enough, one of the significant things creating change this year comes as a result of our membership of the European Union. The snappily titled General Data Protection Regulation (GDPR) comes into force at the end of May.

Acting in the best interests of patients (including maintaining the integrity of their private information) comes naturally to Chiropractors but the complexity and breadth of the new rules has led to many people reviewing and updating their processes and systems. I was very pleased that the BCA was able to help by sourcing and making available, at a discounted price, a comprehensive training course on the subject; even more pleasing was that hundreds of members took up the opportunity to ensure that they were fully informed of their new responsibilities. It is, of course, a reflection of the standing of the BCA (and of its large number of members) that we were able to negotiate such a good deal.

That reputation also enables us to talk, with gravitas and import, to policy makers in government about the future direction of the Chiropractic profession. For example, Catherine Quinn and I recently had a meeting with the Department of Health

and Social Care about their consultation on the future of the Allied Health Professionals programme.

That type of interaction and the many others we have within the healthcare arena enables the BCA to have an influence on changes that affect the profession as a whole and those which can affect the day to day work of individual chiropractors. It’s vital that we maintain and develop the strength and influence of the BCA. You will see developments working towards that aim over the coming weeks and months.

To return to my meteorological metaphor we may not be able to foresee every squall and cloud on the horizon (especially if they are no bigger than a man’s hand) but we may be able to influence and change the broader climate.

In fact, to quote a great American President (although it’s also attributed to the great Peter Drucker): “The best way to predict your future is to create it.”

Mark Rawden, Chief Executive Officer

CEO message

6 CONTACT Spring 2018 • Volume 32 Issue 1

MESSAGES

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NEWS


You may have seen BCA President, Catherine Quinn, on Channel 5 news on 22nd March discussing the Lancet report. You can see the video on the Members’ Facebook page www.facebook.com/ulrik.sandstrom/videos/1640895135996783/

We also received a lot of coverage from a joint press release made with Citroen.

This is just a small part of the work the BCA does to maintain the profile of Chiropractic, the British Chiropractic Association and its members every year. Keep an eye on the BCA Facebook page for details of larger stories when they land and you can view the BCA press office activity here: chiropractic-uk.co.uk/pr-and-social-media-reports/

The We Rock the Spectrum Kid’s Gym provides sensory-safe play for kids of all abilities including children with autism, special needs, as well as neurotypical development. Each gym features

ten pieces of therapeutic equipment which is specifically designed to work with many of the sensory processing issues that children on the spectrum face, while providing even neurotypical children with the sensory-diet necessary for improved learning and neurological development. For example, the zip line helps children with vestibular sensations and sensory feedback whilst allowing them to better develop upper-arm and core strength.

WIOC graduate and BCA Overseas Associate, Nashila Jaffer, is responsible for bringing the US franchise to Dubai. She has been a practising Chiropractor for the past 17 years hailing originally from the UK before moving to Dubai in 2009. She decided to change to a more children-focused career after she began working more with children with developmental delays and sensory processing issues. After discovering We Rock the Spectrum during a trip to the US and seeing how much her daughters enjoyed it, Nashila knew she had to bring this franchise to Dubai so other children could benefit from it.

Nashila said, “I was inspired by the whole idea; I loved how everything was designed to be inclusive from the play equipment they offered to the arts and crafts and the fitness classes. My motivation has always been my two girls and, as a mother, I am passionate about raising awareness and educating parents on the importance of movement for all kids to lead a healthy, active lifestyle.”

Conference winnerFollowing on from the Autumn 2017 conference, the BCA invited attendees to give their feedback to help structure the format and content of future conferences. Each respondent was given the chance to enter a prize draw. The winner was Carol Latto, member in Yorkshire. The prize was a free ticket to the recent Spring 2018 Conference.

Catch up from Dubai

NEWS


BCA meets ASAThe Advertising Standards Authority has offered to run a webinar for BCA members to look at aspects of advertising practices and compliance codes.The session will have the aim of helping members to understand how they can advertise within the guidelines outlined by the Committee of Advertising Practice (CAP).

The ASA is looking to BCA members to submit their questions regarding advertising practice and codes so that they can tailor the session to match member needs.

This is your opportunity to get questions answered, codes clarified and advertising practices requirements explained.

We already have some questions but will keep the survey open for another couple of weeks to make sure everyone gets the chance to give their input.

Submit your questions via this link: http://bit.ly/britchiroasa

Details of the webinar will be announced via In Touch and the BCA Members Facebook page when it has been arranged.

Going social There is a new public BCA Facebook page www.facebook.com/BritChiro/

We are taking it slowly as there are sceptic groups and negative individuals who delight in causing trouble on social media for organisations like the BCA but we hope to grow a following and share useful information for members of the public that are an extension of our website and Twitter feed.

Find the new page, like it and encourage your patients to like it too.

Meet the team

Starting on 1st May and continuing throughout the year, your BCA President, Catherine Quinn, CEO, Mark Rawden and members of Council will be travelling to different parts of the UK to meet

members as well as any other local chiropractors who want to attend too. The informal gatherings will be the opportunity to meet up with local colleagues as well as talk with the BCA leadership about the issues that are important to you. Catherine, Mark and the team will also be looking for feedback on proposals to the way the BCA runs including how Council is elected and the BCA Vision and Values.

So, watch out for dates and locations as they are released and join the team for a drink and a chat!

The first meet up is in Birmingham at the Hampton By Hilton, Birmingham City North, 98-104 Constitution Hill, Birmingham B19 3JT from 7.30pm on Tuesday May 1st.

BCA @ AECC UCCatherine Quinn and Tim Button had a great time on Wednesday as they attended the AECC UC stakeholders forum and heard about the developments they are making to their programmes, future plans and how their brand change has impacted on their culture. The BCA team had the opportunity to speak with around 100 students looking to practise in the UK and give them insight into how we are working to progress our profession, they all left with a brand new BCA T-shirt and reusable coffee cup!

Catherine said “From speaking to students they tell us that they want their Association to promote the profession, provide high quality insurance, support research and have a strong identity. I was pleased to be able to tell the AECC UC students about how the BCA provides each of these and was interested to hear about their vision for our profession. The AECC UC is committed to the patient-centred, evidence-informed care that the BCA promotes”

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Chiropractic:

Beyond the Spine Saturday 17 March 2018

Radisson Hotel, Heathrow

BCA Spring ConferenCe 2018

Spring 2018 Conference coincided with the return of the beast from the east bringing flurries of snow and cold conditions but nothing could deter a sell-out crowd from braving the weather and heading to Heathrow for Chiropractic: Beyond the Spine.

The room was full of motivated Chiropractors from across the country as well as Osteopaths, Physiotherapists and even a Strength and Conditioning coach! We all have our part to play

in sharing our knowledge and promoting patient centred care, so it was wonderful to see this truly collaborative event playing out.

“We all work on the same human race with the same anatomy and physiology. I came away full of interesting additions to my thinking and some great hands-on extremity techniques from the technique master class today. I couldn’t have asked for more!” Ulrik Sandstrøm

SpringConference

For healthcare to be ‘integrated’ it must be person-centred, coordinated and tailored to the needs of the individual and their environment. It means moving away from isolated thinking and disjointed decision making to a more holistic approach to healthcare, that puts the needs and experience of people at the centre of how care is organised and delivered. The support network of professionals within a patient’s journey can vary from a small group, maybe yourself and the GP, to a wide ranging multidisciplinary team. No matter what size that team is, it must function as an effective machine, focussed always on what is in the best interest of that patient.

Mark Charrette, a 1980 summa cum laude graduate of Palmer College of Chiropractic, is a frequent guest speaker at chiropractic colleges and has taught over 1,700 seminars worldwide on extremity adjusting, biomechanics, and spinal adjusting techniques. Dr Charrette delivered lively classes on Saturday followed up with a seminar on Sunday which emphasised a practical, hands-on approach to extremity adjusting.

Chiropractic:

Beyond the Spine

Saturday 17 March 2018




Starting our line-up of interdisciplinary speakers from outside chiropractic was Jarod Hall, a physical therapist from Fort Worth, Texas with a clinical focus on orthopaedics, therapeutic neuroscience education and implementation of exercise in the management of both chronic pain and athletic injuries. Jarod enlightened us with his views on how healthcare professionals’ beliefs about chronic low back pain have been shown to have an influence on patient beliefs.

There isn’t anything worth knowing about the hip and groin that Dr. James Moore doesn’t have a full grasp of ! Currently employed by the British Olympic Association where he is the Lead for Performance Services and the Manager of the Intensive Rehabilitation Unit at Bisham Abbey, James dispensed clinical pearls and prompted us to look at the mechanisms that lead to injuries in this region. Much like Dr Charrette earlier in the day he discussed the biomechanical chain of the lower limb and the importance of how the foot, ankle, knee and hip must all function together for the sake of the lower back.

Peter Dixon emphasised the need for Chiropractic education to be more widely available and for students at GCSE and A Level to be exposed to our profession when making choices on their further education and career.

Nicole Oliver is a seasoned speaker at many chiropractic conferences round the world where she reminds us each time of the neurology that underpins everything we do. Understanding the impact of what we do on our patients experience of pain helps us to maximise the anti-nociceptive effect of our care.

Dan Bernardin is new to the conference scene and shared with us his experience of working in the grey area between the two disciplines of Sports Therapy and Strength and Conditioning. His experience ranges from working voluntarily with Olympic level sprinters to academy and first team footballers. Currently Strength and Conditioning Coach at QPR Dan has previously worked with West Ham FC. He demonstrated the difference between specificity and simulation in designing an exercise programme for your patient based on their mode of injury.

Chiropractic:

Beyond the Spine Saturday 17 March 2018




Chiropractic:

Beyond the Spine





Dr Imtiaz Ahmad is also a QPR medical team member and is currently the Club Doctor there after having worked as a Sports Medicine doctor at Guy’s and St Thomas’ Hospital, The Football Association, Millwall FC and Tottenham Hotspur FC. Reflective communication was Dr Ahmad’s method of choice for encouraging change and improving the choices made by your patients. He very neatly showed how you could improve an exchange from being negative and cementing unhealthy behaviours to one which allowed the patient to be encouraged to improve their health.

After an AGM where we were very pleased to welcome a huge number of Full Members to our ranks, Simon Billings and Shoela Detsios each delivered talks which focussed on the need to think about nutrition and potential deficiencies in your patients. Simon discussed the importance of vitamin B12 and gave the delegates a simple to follow guide on to how to request tests both through the GP and privately and then how to act on this and treat the findings. Simon’s goal is that, not only are you aware

of these potential deficiencies in your patients, but that you are acting on this information and educating your patients. Shoela went on to discuss many of the other potential supplements that you might want to consider.

Sunday saw our sold-out Extremities Seminar held with Footlevelers where Dr Mark Charrette took a packed-out room through multiple protocols using the Deliberate Practise Method which saw us move seamlessly through each of the bones in the foot/ankle and hand/wrist! Dr Charrette entertained us all day and ensured that no one left without a firm grasp on how to treat the extremities. We are immensely grateful to Footlevelers for their huge amount of support in putting on this weekend and we look forward to working with them again.

See you at our Autumn conference, booking open soon. It will take place on 13th and 14th October with a pre-conference seminar on the 12th all taking place at the Birmingham Hilton Metropole.

Chiropractic:

Beyond the Spine




@ChiropracticUK

@bcaconference

@bcaconferences

Chiropractic: it’s all about the patient

Speakers include Mike Stewart

(catch Mike’s pre-conference seminar on 12 October)

Jørgen JevneAlison Dantas

Donna Strachan

Come and join us at the BCA Go Social Flexible ticket options

Early bird rates until 31 August 2018

Saturday 13 – Sunday 14 OctoberHilton Birmingham Metropole

BCA AUTUMn ConferenCe 2018

Plain � lm x-rays or digital imaging

Address to send � lms or discs ONLY:Young Radiology, c/o MXD Ltd, Quill House, Charnham Lane,

Hungerford, Berkshire, RG17 0EY

All other correspondence, please:[email protected]

Doesn’t it just make sense to have a

DACBR report all your diagnostic images?

Young Radiology Kenneth J. Young

D.C., D.A.C.B.R, M.App.Sc. (Medical Imaging)

BCA Social

Members BCAMembersforum BCAConference

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Public BritChiro ChiropracticUK



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With so much change at the helm of the BCA there is an amazing amount of work being created to

help make the BCA the only association anybody would want to be part of.

We believe that Member Services is a key part of that strategy and needs a little reviving, ‘Tim style’. Forget everybody else, we just want the BCA to be the best association for its members. As a serving chiropractor and clinic owner for 15 years I have come across so many products and services that I need to help me be the best I can be. I do love to negotiate and barter with suppliers and what better way than to ask “what if I could give you access to the whole BCA membership? What deal could you do for me then?” Its simple really. We are the largest association in Europe and we need to start taking advantage of our buying power. I found that every company I have spoken to would like to offer us discounts, special rates and even to advertise with us. So why don’t we?

We have so many great discounts already with BCA Privilege and other suppliers but why not have even more and some extra special deals each month. In my research to see what we already provide I went through the BCA Privilege page and grabbed a few bargains on the way. I ordered some seriously cheap magazine discounts for the clinic, personal health insurance for me and my family, a cheap apple laptop, some discounted cinema tickets and super cheap access to Legoland for a family day out! I can’t believe that, in all the years I have been a member, I hadn’t really looked to see what is already there! So, the first thing that I have done in my new role as Member Services Chair was to call the company that provides us with all this access and get the low down

on how well its being used and what more they can offer. In 2017 we saved our members over £30,000 in total, with the biggest savings by far in discounts on cars, energy bills and holidays! We discussed a list of other general products and services that I felt members would be interested in and they will be added as they come in. I will announce them on Facebook but remember to check on the Members’ website regularly.

I have also looked at what discounts I’m really interested in as a chiropractor and am looking into medical supply companies and business services.

I am really proud to announce that we have negotiated, not only a 10% discount with the gold standard supplier of shockwave machines who created the famous EMS Swiss Dolorclast, but a host of other benefits too including free training, a free EMS support cushion and a most valuable free replacement head. Thank you EMS!

Not wishing to over promise and under deliver we have also negotiated a 10% discount with well-known medical supplier Physique who supply a wide range of goods that many of us benefit from and now we can get them just that bit cheaper!

I have many, many other things in the pipeline and I will be working hard to get the best I can for all our members in all areas of chiropractic interest. If you have any suggestions, contact me via the BCA office so I can investigate more ways to strengthen the BCA family. We are proud to be the BCA and we want to be the best in every detail. There is an exciting future coming for the BCA and this is just part of it but, in the meantime, I look forward to showering you all with gifts!

Tim ButtonChair, Member Services Committee

Member Services

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Telephone: 01733 646888 Email: [email protected]: www.hepag.org.uk

HePAG Health Professions Acupuncture Group

Western Medical Acupuncture, for the Benefi t of Pa� ents

HePAG Foundation Course

Save £80 on your course today!

Course Start Dates

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*Offer is for a limited time only - usual course price £575

PETERBOROUGH

- 12th May 2018- 11th August 2018

MANCHESTER

- 23rd June 2018- 24th November 2018

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- 7th July 2018

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- 5th September 2018

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HePAG provide Acupuncture foundation courses for Osteopaths, Chiropractors & Sports Therapists looking to add an effective and safe modality to their skill set.

By completing our 300 hour course, you will gain the in-depth understanding and knowledge necessary to safely administer acupuncture.

Over three weekends you will be introduced to the underlying concepts of western medical acupuncture, grounded in current research, clinical trials and case studies.

Within the offer price £495*, you still receive one year’s complimentary membership with HePAG worth £120.

RECOMMEND A FRIEND: If you recommend the HePAG Acupuncture Course to a friend you will both receive a £25 voucher of your choice when they successfully complete their course.


MSK conditions leading cause of disability

Insight from India;an update on the

World Spine Care Europe Project

The World Health Organisation’s most recent update on musculoskeletal disorders re-confirmed what many of us already know; the burden of disease MSK conditions create is enormous. They are the second largest contributor to disease worldwide and low back pain is the single leading cause of disability. BCA member, Nadine Harrison, tells us more.

Just imagine…

For many of us low back pain is the ‘bread and butter’ of our daily practise. Let’s all imagine you are one of your ‘typical’ patients; perhaps a labourer, whose had niggles on and off? He has seen a GP several times and they’ve

done their best but the painkillers only work for so long. His pain has worsened recently and is shooting down his leg. He fears he might need a couple of days off work and doesn’t want to rely on sick pay. He can’t play golf at the weekend like he used to and he so hopes he can make the holiday he booked in one month. His wife is very supportive and says she will drive him to the appointment thirty minutes away.

Now imagine you are a labourer in India. You sit on your haunches for hours each day chipping rock to make small stones for paving a set of stairs. You have back pain, just like another 1 billion people worldwide and, like many of them in developing countries, you can’t take a day off work as there is no sick pay. Your pay provides for your immediate and

extended family, food, clothing and school for your children. Your family is in your home village an hours bus ride away unable to help you and you will have to try to walk at least the hour from your place of work to your nearest health centre to register for an appointment and try to buy some painkillers.

On a MissionWorld Spine Care is on a mission to change this and instead create a reality where everyone has access to high quality care for MSK, particularly spinal conditions. Over the last year an amazing project in Mumbai, India has been set in motion. A collaboration between the Mahatma Gandhi Institute of Health Science (MGMUHS) Physiotherapy department and World Spine Care is taking place. Currently set within a hospital the Physiotherapy department has now adopted WSC protocols with the under-pinning values of sustainable, integrated, evidence-based care.

In November 2017 the WSC Europe team that


Please visit www.worldspinecare.org, find out about volunteering, or click donate. May we suggest the price of one of your treatments, in order to allow others to receive the same amazing care, you give every day? Thank you.

is managing and facilitating the MGMUHS/WSC collaboration, provided comprehensive WSC toolkit training and clinical education in primary spine care to Undergraduate and Masters level Physiotherapists. The aim is to assist them in their goal of taking high quality spine care, that is so needed, to their underserved communities. MGMUHS set up a community outreach day in the rural village of Tara where red flag screening of people suffering with pain and further advice and exercises were given. Important conversation were had with Orthopaedics team, Radiologists and Medical Doctors to facilitate collaboration between the professions for the benefit of the patients and improved running of the clinical services. It is a very exciting time. This work is helping to reach those who are currently underserved and very much in need.

Eye openingIt is a true privilege to work alongside our colleagues, in another country! We have so much to learn from each other and in turn better understand and serve the communities we work within. I am always fascinated by the cultural interpretations of pain. In India it is reported that patients described the severity of their pain based on their currency, the Rupee. One Rupee is 100 Paisa. A pain level of 50 Paisa out of 100 is, therefore, akin to a pain level of 5 out of 10 on a visual analogue score or similar. This example is just one of the many showing how key it is to understand a culture and the way in which our patients communicate in order to serve them best.

“Do a little bit of good where you are, it’s those little bits of good put together, that overwhelm the world” Desmond Tutu, WSC Ambassador.

We can all be of service in helping WSC achieve its vision. Small steps can have huge impact; education and resources provide outstanding clinicians who bring this care to their nation. Reducing the burden of disease will impact people’s personal lives; allow to them to better provide for and care for their families, bring more opportunity, greater health and wealth. This impact improves the socio-economic status of a region or country as a whole.

The next step is to equip the clinicians in India with an administrator to help with the running of the clinics. Ideally male, an administrator would then be able to accompany female clinicians to the rural clinic of Tara on a regular, permanent basis and start bringing much needed care to people in and around this location.

You can help! Why not get involved with WSC Europe’s ‘Spine Ride’?; a cycle event taking place in June from Bordeaux to Beziers. An amazing chance for adventure whilst raising good funds! Email [email protected].


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Acupuncture in clinical practice:Are therapists missing the point?IntroductionTraditional acupuncture practice has a rich history that embraces the idea of Taoism and the underlying concepts of Qi flow, Yin and Yang and Meridian theory that permeate Traditional Chinese Acupuncture (TCA). Whilst this valuable alternative perspective on health can offer insights to injury and disease management, its esoteric language can present as too “sandals and candles” for many clinicians who secure their clinical reasoning firmly upon anatomy and physiology. It is worth considering though that the concepts of TCA diagnosis and treatment are merely a part of a larger system of Observational Consensus Medicine. Whilst the terminology may seem odd, one should be clear on the belief that there is no “Chinese physiology” and “Western physiology” behind the explanation of any approach, there is just “physiology.” To

best understand the use of Western Medical Acupuncture (WMA), as opposed the TCA, as a clinical intervention in 2017, an understanding of its underlying mechanisms is essential. Then to obtain the full benefit of acupuncture as a treatment approach one must then consider the pathology of any given condition under treatment, to clinically reason the use of the modality.

This series of articles will first explain the proposed underlying neurophysiological mechanisms of acupuncture and then proceed to explore its use as a clinically reasoned treatment approach.

The Path of Pain Any soft tissue injury to the body will trigger a local inflammatory response within the damaged tissues. Inflammation being the body’s generic response to any form of trauma is initiated regardless of the nature of the injury. The purpose of the inflammatory response being to eliminate the initial cause of cellular injury and the subsequent removal of damaged tissue and dead cell debris. It also exists to initiate repair of the damaged tissues and promote the healing process. Acute inflammation presents with five classical signs; pain, heat, redness, swelling and loss of function.

Following an initial insult the injured tissue creates a stimulation of the sensory receptors of small afferent nerve fibres of A delta (Aδ) and C axon size. These first order neurons ascend to synapse mainly in the superficial dorsal horn of the spinal cord. These first order neurons enter the spinal cord at the dorsal root entry zone, via the lateral division of the dorsal roots of the spinal nerves. It is here in the dorsal horn that they combine together to form the dorsolateral fasciculus (tract of Lissauer), which is present at all spinal cord levels. The first order neurons of Aδ fibre type enter lamina I (and V) and synapse primarily with second order neurons in lamina I and lamina V of the spinal cord grey matter. The first order neurons of C fibre type enter the spinal cord and synapse with lamina I cells and lamina II interneurons. The branches of the dorsolateral fasciculus then either ascend or descend one to

Traditional acupuncture pratice has a rich history


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three spinal cord levels within this tract, to terminate in their target laminae of the dorsal horn. It is there that they synapse either with second order neurons or interneurons. The axons of the second order neurons pass across the midline of the spinal cord to the contralateral side in the anterior white commissure, forming the spinothalamic tract (STT). The second order neurons stem from the dorsal horn and from here the pain signal progresses from the dorsal horn along the ascending STT. The STT transmits pain (and thermal and crude touch) to the contralateral ventral posterior lateral nucleus of the thalamus. Although the STT ends at the thalamus, as it ascends through the brainstem it also sends collateral connections to the reticular formation. When the STT reaches the thalamus it synapses with a third order neuron. The third order neurons are located within the ventral posterior lateral, the ventral posterior inferior and the intralaminar thalamic nuclei. From this level the signal then ascends from the thalamus onward via the fourth order neurons of the STT to synapse with fourth order neurons within the cortex. It is here that painful stimulus can be perceived at a conscious level. The projections of the fourth order neurons of the STT can be diffusely spread to the entire cerebral cortex. This tends to support the hypothesis that pain may affect the whole brain and “pain centres” are not necessarily discreetly located localised regions but rather a complex systemic network encompassing many neural structures (Stux and Hammerschlag, 2001). This is an example of one route by which pain may be experienced. If one considers this mechanism as a credible explanation for the transmission of painful stimuli and subsequently evaluates the proposed mechanisms for acupuncture, a cause and effect model for the clinically reasoned use of acupuncture can be implemented.

The Analgesia Mechanism of AcupunctureAn acupuncture needle inserted through the skin into the deeper myofascial structures activates the sensory receptor in the underlying muscle. Following initial insertion of the needle an inflammatory response is initiated and causes the release of a variety of chemicals, one such being

calcitonin gene related peptide (CGRP). CGRP is a potent vasodilator and causes a local increase in circulation which may lead to visual observation of the local phenomenon known as “weal” and “flare” which is similar to a histamine response. This response may cause a sensation of itchiness too in some individuals (White, Cummings, Filshie, 2008). The increase in circulation is also documented in deeper muscular tissues which is considered to support local tissue healing (Sandberg et al, 2003). The insertion of a needle is then often followed by some form of mechanical stimulus. This stimulus often takes the form of rotation of the needle in an alternating clockwise and anticlockwise manner. The response of the connective tissues to this action is termed mechanical transduction and is considered to be a beneficial component of acupuncture (Langevin et al, 2006). The local mechanical stimulus triggers impulses that transmits to the spinal cord type II and III muscle afferent nerves also known as small diameter myelinated afferents (Aδ). These cells synapse in the spinal cord with those of the anterolateral tract (ALT) which in turn communicates with three other areas. These areas, or more commonly termed “centres”, are the spinal cord, the midbrain and the pituitary hypothalamic complex. Within the spinal cord the arriving Aδ stimulus also transmits signals across collateral connections to intermediate endorphinergic cells which inhibit the substantia gelitinosa (SG) cell activity via the release of the endorphins, enkephalin or dynorphin but not β-endorphin. Spinal cord endorphins cause presynaptic inhibition of C fibres, preventing transmission of the pain signals from the C fibres entering the dorsal horn with the STT. Within the spinal cord the enkephalins and dynorphins that are released by intermediate cells block pain signals (Stux and Hammerschlag, 2001). This proposed mechanism of segmental analgesia is similar to that of Melzack and Wall’s (1965) original description, which discussed the collateral inhibition of pain by the release of γ-aminobutyric acid (GABA) as initialled by Aβ fibres.

The Aδ fibres entering the spinal cord also communicate with the mid-brain via the ALT. Ascending ALT

transmission stimulates cells within the periaquaductal grey (PAG) which release β-endorphin to excite the raphe nucleus located at the lower end of the medulla oblongata, triggering impulses along the dorsolteral tract (DLT) to release monoamines (M) (serotonin and noradrenalin) within the spinal cord. Postsynaptic inhibition is modulated via noradrenalin whist C fibres are presynaptically inhibited via serotonin stimulating further release of met-enkephalin. Noradrenalin has an analgesic effect throughout the spinal cord as its release is diffuse and non-specific in location. Either of the two monoamines released are capable of suppressing pain transmission (Stux and Hammerschlag, 2001). Imaging studies have also demonstrated that the limbic system plays an important role in acupuncture-induced analgesia (Wang et al. 2008). The ascending stimulus continues to terminate in the pituitary hypothalamic complex where it triggers the release of adrenocorticotropic hormone (ACTH) and β-endorphin into the circulation in equal measures. ACTH can then travel to the adrenal cortex where cortisol is subsequently released into the blood which produces anti-inflammatory effects (Stux and Hammerschlag, 2001). If acupuncture stimulus is particularly strong then analgesia can be facilitated through the mechanism of diffuse noxious inhibitory control (DNIC), where one pain may inhibit another (Filshie and White, 1998).


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Acupuncture Mechanism and Needle PlacementWhen acupuncture is performed in a region close to the site of pain there is a primary utilisation of the segmental circuits operating within the spinal cord whilst also bringing in cells from the midbrain and pituitary hypothalamic complex. When needles are placed in distal points much further away from the painful region, they activate the midbrain and pituitary hypothalamic complex without the benefit of segmental effects (Stux and Hammerschlag, 2001). Therefore, it may be generalised that local segmental needling usually gives more intensive analgesia than distal non-segmental needling does because it uses all three centres. Generally, the two kinds of needling (local and distal) are used together on each patient to enhance one another. This is often the case with traditional acupuncture where local and distal points on the same “channel” or “meridian” are utilised in the treatment of musculoskeletal pain. This then utilises the segmental and heterosegmental mechanisms as previously discussed. The segmental approach triggers inhibitory enkephalinergic cells in the spinal grey matter which are directly contacted by the Aδ primary afferents. The heterosegmental affect is brought

about by a neurohormonal mechanism involving the release of β-endorphin and by two descending neuronal mechanisms which are serotonergic and adrenergic. There is also considered to be some involvement of DNIC in the overall analgesic effect (White et al, 2008).

Beyond AnalgesiaAcupuncture has also been shown to induce a phenotypic switch of muscle macrophages. This causes a reduction in pro-inflammatory cells (M1 macrophages) and an increase in anti-inflammatory cells (M2 macrophages and IL-10), which reduces pain, swelling and inflammation in local tissue (da Silva et al. 2014). Wang et al. (2014) showed that acupuncture regulates opioid-containing macrophages and anti-nociceptive mediators in inflammatory pain, further supporting the interaction between acupuncture, pain and inflammation that speeds up healing and the recovery processes. Jeong et al. (2003) suggested that acupuncture treatment has an inhibitory effect on cytokine production since the elevated levels recorded in patients suffering from headaches were reduced to those of a healthy control group following acupuncture treatment. Although this research was specifically conducted in patients with chronic headache, it may be possible to apply these results to the general population.

Torress-Rosas et al. (2014) stated that sciatic nerve activation with electroacupuncture controls systemic inflammation by inducing vagal activation of aromatic L-amino acid decarboxylase, leading to the production of dopamine in the adrenal medulla. This can provide therapeutic advantages such as controlling inflammation in infectious and inflammatory disorders. This new research also goes some way to explain the biomechanical process initiated by electroacupuncture that influences sepsis.

Acupuncture is also thought to accelerate the initial inflammatory response to promote the secondary healing

responses in injury, and also help to control systemic inflammation in inflammatory and infectious disorders including sepsis.

Cost EffectiveAcupuncture performed by health professionals is a cost-effective way of delivering acupuncture since the only additional cost following training are the needles. Using the HePAG discount needles can cost as little as approximately £0.02 each (£2.11 per 100), and little, if any, additional treatment time is needed, meaning that there is either a minimal or no additional cost to the commissioner or service user. Acupuncture also provides an effective, cost-effective and evidence-based service for patients and maintains patient choice. Offering patient choice is a key objective of government (DoH 2011); offering acupuncture as part of existing services provides patient choice without any great cost to the NHS.

SafetyThere has been significant research in to the safety of acupuncture. MacPherson et al. (2001) made a survey of 34,407 acupuncture treatments, and reported no serious adverse events (i.e. ones requiring hospital admission). In total, there were 43 significant minor adverse events


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The Health Professions Acupuncture Group (HePAG)The Health Professions Acupuncture Group (HePAG) is the UK’s only professional body specifically for Osteopaths, Chiropractors and Sports Therapists practising Western Medical Acupuncture.

As the only UK association for acupuncture dedicated to a variety of allied health professionals, we are delighted to offer training, member benefits and representation to thousands of, so far unrecognised medical professionals.

We aim to represent our members with Law Makers, the Public, NHS and Private Health Insurers.The Health Professions Acupuncture Group (HePAG) promotes the integration of evidence-based

acupuncture into a holistic treatment programme for the benefit of the patient. Acupuncture is a safe treatment when administered by a competent HePAG-registered health professional.

(including nausea, fainting, dizziness, vomiting, increased symptoms and bruising). This equates to only 0.12% (1.2 per 1000), which is an extremely low figure even in comparison to other treatments regarded as very safe, such as medication.

Figures on serious adverse events associated with acupuncture were published by White (2006). This research combined data from the above studies with further reports, and included 4,441,103 treatments in total. White (2006) reported 11 serious adverse events. More common were mild adverse events such as tiredness and bruising, which both occurred in 3% of treatments. Further evidence of the safety of acupuncture has been provided by Xu S. et al. (2013), who stated that four recent surveys of acupuncture safety among regulated, qualified practitioners confirmed that serious adverse events after acupuncture are uncommon. These surveys covered more than three million acupuncture treatments in total; there were no deaths or permanent disabilities, and all patients who suffered an adverse event fully recovered.

The more common adverse events are exceptionally minor in nature and pose very little risk to the patient. More significant adverse events are extremely rare. The Association endorses acupuncture as an exceptionally safe treatment, when practised by a HePAG member.

Application and TrainingThe range of musculoskeletal and sports injures that research has shown to benefit from acupuncture include; plantar fascial pain, medial tibial stress syndrome, acute and chronic low back pain, patellofemoral pain, shoulder pain, neck pain, headaches and migraine. From a clinically reasoned perspective however the potential exists for it to be used for the treatment of any myofascial pain and dysfunction. WMA is a practise that has its philosophies firmly based in anatomy and physiological principles. This therefore means that providing a prerequisite knowledge

of anatomy and physiology are in place (i.e. graduate sports therapist, osteopath, chiropractor, Dr, nurse, physiotherapist etc.) a foundation level of WMA can be taught as an accelerated protocol over a few months with a little as six contact days. This is the type of acupuncture that is most commonly employed by Chartered Physiotherapists and other manual therapists clinically at all levels, from treating sedentary individuals to elite Olympic athletes.

Jonathan HobbsMCSP MSc FHEAHePAG Director and Accredited Tutor

To find out more call 01787 881475 or email [email protected] www.technologytamed.com/GDPR

Practical, affordable help.

Designed for chiropractors the toolkit gives you step by step guidance on what you need to do. For example:

Stage 1: Introduction to GDPR slide presentation

Stage 2: Information systems audit, lawful basis for processing

Stage 3: Data retention policies, data subject access request procedures, Data Protection Officers

Stage 4: Data privacy policy, data breach procedure

Checklists, templates, email support.

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What is PhotoBioModulation Therapy?

Photobiomodulation therapy is defined as a form of light therapy that utilizes non-ionizing light sources, including lasers, light emitting diodes, and/or broadband light, in the visible (400 – 700

nm) and near-infrared (700 – 1100 nm) electromagnetic spectrum. It is a nonthermal process involving endogenous chromophores eliciting photophysical (i.e., linear and nonlinear) and photochemical events at various biological scales. This process results in beneficial therapeutic outcomes including but not limited to the alleviation of pain or inflammation, immunomodulation, and promotion

TOP 7 Biological Effects of Laser TherapyPain Reduction Photobomodulation has various mechanisms that promote pain relief1. Some of these include increasing serotonin levels which impact nerve transmission and mood2, increased beta endorphins which decrease pain at receptor sites3, and increased nitric oxide levels which normalize impulse transmission in nerve cells4. Pain inducing bradykinin levels are also reduced by laser therapy5.

Anti-InflammationGenerally, injured tissue responds to laser therapy by influencing mitochondrial metabolism and enhancing ATP production11. Specifically, it helps stimulate vasodilation12 and improve temperature modulation13 while enhancing lymphocyte responses12 in the injured area. Other mechanisms include reduction of Interleukin-1 production which impacts the inflammatory cascade13 and stabilization of the cellular membranes14. Additionally, free radicals are mitigated with enhanced levels of Superoxide Dismutase (SOD)14. These changes all contribute to improve the body’s ability to move through the inflammatory phase of healing more quickly.

Accelerated Tissue Repair and Cell GrowthWound healing has been the area where most traditional laser therapeutic studies have focused. Research supports that tissue repair is enhanced by laser’s ability to enhance leukocyte Infiltration15, increase macrophage activity16, and increase neovascularization17. Photobiomodulation also increases fibroblast proliferation18, keratinocyte proliferation22, and early epithelialization19. While these factors help tissue repair, new tissue growth is aided by increased levels of growth factor20 which

leads to greater wound tensile strength21. The improved oxidative environment created by these changes helps improve the quality of scar tissue and reduces the number of adhesions23.

Improved Vascular ActivityLaser light not only increases the perfusion of blood to injured tissue by increasing the amount of free NO in the area which causes vasodilatation and enhances oxygenation24 but it also aides in the formation of new capillaries via Neovascularization25. This hastens the healing process and helps with rapid wound closure.

Analgesic Effect/ Trigger Points and Acupuncture PointsLaser therapy helps decrease pain at muscle trigger and acupuncture points. Same day reduction of pain from laser treatment can be related to laser’s ability to block the depolarization of A delta and C-Fiber afferent nerves26 which slows the afferent signal transmission from peripheral nociceptors27. Prolonged relief from photobiomodulation can be explained by normalizing resting membrane potentials in nerve cells. Injury or prolonged trauma can impair the resting potential of nerve cells leading to a lower threshold for pain. Laser treatment has shown to increase the resting potential closer to the norm of ~70Mv28.

Improved Nerve Function/ HealingSeveral factors can impact injured nerves ability to heal. Slow recovery of function to damaged nerve tissue may result in numbness and impaired sensation in the limbs. Laser therapy accelerates nerve cell regeneration via increased axonal sprouting and nerve cell regeneration29. Several studies have shown that laser’s positive effects on nerve repair can have a dramatic effect on pain relief29.

1 (Hode & Turner 2007; Faegapani et al 2008)2 Cassone et al 1993; Walker 1983; Cassone et al 19903 Montesinos 1988; Labajos 1988; Cramond et al 19944 Mrowiec 19975 Jimbo et al 19986 Enhancement of ATP (Friedman & Lubart 1911; Cui et

al 2002; Casanassima et al 1984)7 Stimulation of Vasodilatation (NO) (Gladwin & Shiva 2009)8 Reduction in Interkeukin-1 (Albertini et al 2005)9 Stabilization of the Cellular Membrane (Greco et al 2001)10 Acceleration of Leukocytic Activity (Greguss et al 1978)11 Increase Prostaglandin Synthesis (Abiko et al 2000;

Harada et al 2004)12 Enhanced Lymphocyte Response (Karu 1991)13 Temperature Modulation (Kurokawa et al 1991; Maeda

1990)14 Enhanced Superoxide Dismutase SOD levels (Eichler et

al 2003; Eichler et al 2005)15 Karu 199116 Bansal et al 2003; Qin et al 1992; Bolton et al 199017 Gladwin & Shiva 200918 Cagnie et al 2003; Abrahamse & Hawkins 200619 Bayat et al 200520 Benayahu et al 2005; Abrahamse et al 200821 Mester et al 196722 Graves et al 199023 Prevention of Abdominal Adhesions and Healing

Skin After Peritoniectomy Using Low Level Laser. Authors: Mara L.C.D. Teixeira PT, MsC, Leonardo S. Vasconcellos MD, PhD, Tharcisio G. Oliveira MD, MsC, Andy Petroianu MD, PhD, Luiz R. Alberti MD, PhD. Published: September 28, 2015. DOI:10.1002/lsm.22423

24 Mrowiec 199725 Gladwin & Shiva 200926 Wakabayashi 199327 Kawatani et al 199328 Blom et al 200029 Anders et al 1993; El-Ani et al 2009; Anders et al 2005

of wound healing and tissue regeneration.1 The term photobiomodulation (PBM) therapy is now being used by researchers and practitioners instead of terms such as low level laser therapy (LLLT), cold laser, or laser therapy.2

The fundamental principles that underpin photobiomodulation (PBM) therapy, as currently understood in the scientific literature, are relatively straightforward. There is consensus that the application of a therapeutic dose of light to impaired or dysfunctional tissue leads to a cellular response mediated by mitochondrial mechanisms that reduce pain and inflammation and speed healing.3


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Five Things to Know about PBM TherapyClinicians are using laser therapy more often than ever before to help reduce pain and inflammation related to many common conditions. Thousands of doctors and patients have experienced the power of laser therapy and are familiar with its therapeutic effects, but for those who aren’t, here are 5 things everyone should know about it:

1 It reduces pain and inflammation without side effectsLaser therapy uses a process called photobiomodulation. Photons enter the tissue and interact with the cytochrome c complex within mitochondria. This interaction triggers a biological cascade of events that leads to an increase in cellular metabolism and a decrease in both pain and inflammation. Unlike medications, laser therapy reduces pain without undesirable side effects. It is also important to point out that patients report long-lasting pain relief. While the number of treatments required may vary depending on the acuity of the condition, many patients experience lasting relief after only a couple treatments.

2 Can be used for acute and chronic conditionsWhen treating acute conditions with laser therapy, it is particularly effective when it is administered as soon as possible following injury (assuming there is no active hemorrhaging). The faster the inflammation is reduced and the healing process can begin, the better. In the case of acute injury, laser therapy helps restore the body to normal function quicker. With chronic conditions, laser therapy is used most often to help combat persistent pain and inflammation.

3 Treatments can be customized for each situationLasers that have larger power ranges offer versatile treatment options. A laser that can be set to operate from 0.5 W all the way up to 25 W, allows the clinician flexibility to treat low and slow or at maximum output. The availability of multiple treatment heads offers additional flexibility for the clinician. It is helpful to have several delivery options to ensure the delivery method is appropriately matched to the situation. For instance, when treating over bony prominences, an off-contact treatment method is advisable. However, when treating deep-tissue structures, such as a hamstring, an on-contact massage ball attachment is best to reduce reflection and scattering, and also encourage deeper penetration by displacing excess fluids. Different sized treatment heads can also be advantageous for administering treatments that require varying levels of precision.

4 Treatments Feel GoodOne common question related to laser therapy is, “What does it feel like?” Depending on the laser, it can create little to no sensation or it can create a gentle, soothing warmth. Many patients receiving Laser Therapy treatments report enjoying the experience, especially when a massage-ball treatment head is used to deliver what is often referred to as a “laser massage.” Patients receiving treatments with higher-power lasers also frequently report a rapid decrease in pain. For someone suffering from chronic pain, this effect can be particularly pronounced.

5 Treatments Are FastWith certain Class IV lasers, treatments are quick, usually 5-10 minutes depending on the size, depth, and acuteness of the condition being treated. High-power lasers are able to deliver a lot of energy in a small amount of time, so therapeutic dosages are achieved quickly. For people with packed schedules, patients and clinicians alike, fast and effective treatments are a must.

For further information on LightForce™ Therapy Lasers contact: Dorian Cook, [email protected], UK Office – 01646 603878.

The primary target (chromophore) for the process is the cytochrome c complex which is found in the inner membrane of the cell mitochondria. Cytochrome c is a vital component of the electron transport chain that drives cellular metabolism. As light is absorbed, cytochrome c is stimulated, leading to increased production of adenosine triphosphate (ATP), the molecule that facilitates energy transfer within the cell. In addition to ATP, laser stimulation also produces free nitric oxide and reactive oxygen species. Nitric oxide is a powerful vasodilator and an important cellular signalling molecule involved in many physiological processes. Reactive oxygen species have been shown to affect many important physiological signalling pathways including the inflammatory response. In concert, the production of these signalling molecules has been shown to induce growth factor production, to increase cell proliferation and motility, and to promote extracellular matrix deposition and pro-survival pathways. Outside the cell, nitric oxide signalling drives vasodilation which improves microcirculation in the damaged tissue, delivering oxygen, vital sugars, proteins, and salts while removing wastes.4

You may have heard the terms “Cold Laser” or “Low-Level Laser Therapy (LLLT)” before. In general, such terms refer to “treatment using irradiation with light of low power intensity so that the effects are a response to the light and not due to heat.”5 Many of the terms used to commonly describe this process do not ideally reflect the mechanisms of action involved. They also don’t adequately distinguish this type of therapy from the other laser-based therapies that rely on heating tissue to achieve an effect. This lack of clarity has led to significant confusion and a need for better nomenclature.

In September 2014, the North American Association for Light Therapy (NAALT) and the World Association for Laser Therapy (WALT) convened to discuss this issue, and as a result of their efforts, the term “Photobiomodulation Therapy” was added to the MeSH database. This term more accurately reflects the process and better distinguishes it “from the popular use of light-based devices for simple heating of tissues…or other applications of light energy that rely on thermal effects for all or part of their mechanism of action.”6

1 Anders JJ, Lanzafame RJ, Arany PR. Low-level light/laser therapy versus

photo-biomodulation therapy. Photomedicine and Laser Surgery. 2015; 33(4): 183-184.

2 Frydrych. The Evolution of Photobiomodulation link3 Karu TI. Low power laser therapy. In: Vo-Dinh T, editor. Biomedical

Photonics Handbook. Boca Raton (FL) CRC Press; 2003: 48-1-48-25.4 Hamblin MR, Demidova TN. Mechanisms of low level light therapy. Proc.

of SPIE. 2006; 6140: 612001-1-12.5 Ncbi.nlm.nih.gov. Low-Level Light Therapy – MeSH –

NCBI. 2016. Available at: http://www.ncbi.nlm.nih.gov/mesh/?term=photobiomodulation. Accessed February 25, 2016.

6 Anders J, Lanzafame R, Arany P. Low-Level Light/Laser Therapy Versus Photobiomodulation Therapy. Photomedicine and Laser Surgery. 2015;33(4):183-184. doi:10.1089/pho.2015.9848.


COLLEGES

What an exhilarating start to 2018! We’re enjoying a welcome moment to take stock

of what seems to be, even now, a very positive and energetic beginning to the year for AECC University College.

We start with some delightful news for our on-site Chiropractic Clinic, which received the Clinical Management Quality Mark award (CMQM) for 2018 – 2022, bestowed by The Royal College of Chiropractors (RCC), which recognises excellence with regard to operating within a structured and managed clinical environment. This accolade compliments the Patient Partnership Quality Mark award (PPQM) received in 2016. I would like to thank Dr Neil Osborne our Director of Clinic and all of his team as the RCC’s recognition through both of these quality marks is a testament to the efforts of the Clinic’s academic and professional services staff, who have all worked extremely hard and contributed to these achievements.

To add further to our celebrations, we acknowledge the expertise of our academic staff as the British Medical Journal (BMJ) featured a new systematic review citing several publications authored by a number of our academic staff. The study looked at manual therapy as an intervention for unsettled, distressed and excessively crying infants and its publication validates AECC University College as being at the forefront in the field of paediatric

with AFC Bournemouth, the premier league club who have been partners with us since 2013. We’ve provided support to the club’s first team, development squad and youth team over the years as their official performance rehabilitation partners through our specialist equipment and facilities ensuring the ‘Cherries’ are in safe hands.

Sadly, one long-lasting relationship which will soon be coming to an end is that with Associate Professor, Dr Joyce Miller, who we bid farewell to as she embarks on her retirement. Joyce has made an exceptional impact, nationally and internationally, on

News from AECC UC

research relevant to chiropractic practise. Our academic staff take a responsible approach to providing evidence-based solutions to prevalent health issues affecting our communities.

In January we kicked-off with a number of high-profile partnerships. Our School of Medical Ultrasound partnered with MIS Healthcare and world-leading provider Samsung enabling us to enhance and maintain our delivery of first-class diagnostic ultrasound education, clinical training and care. Twelve state-of-the-art imaging systems arrived on campus to be housed in our Ultrasound Clinic where the equipment will prove advantageous to our students, patients and the wider University College, strengthening our learning environments through the use of the latest technology. MIS Healthcare and Samsung will also utilise our School of Medical Ultrasound as a UK test-bed and training centre for the latest advancements in new technology. We also saw the renewal of our partnership

Joyce Miller at work at AECC


COLLEGES

Research at AECCAn overview of the work carried out by our new Centre for Biomechanics Research (CBR) was presented by Dr Alex Breen at the Walter Reed National Military Medical Centre in Washington DC in January. The seminar was about the Centre’s work into the individualised biomechanics of the lumbar spine to help with the diagnosis of nonspecific back pain. This was part of a series of visits funded by a Travelling Fellowship awarded by the UK Society for Back Pain Research.

Walter Reed is the world’s largest military hospital and one particular focus for research in its Biomechanics Lab is the rehabilitation of lower limb amputees. It has recently turned its attention to the biomechanics of back pain in this population which Alex’s PhD work addressed. However the work of the CBR goes wider and the audience was also presented with results of studies of the prevention of disc swelling in astronauts for the European Space Agency and a new method for determining the loads on the individual segments of the lumbar spine using quantitative fluoroscopy and MRI. We were very fortunate to have received grant support that has allowed us to engage with expert groups in multidisciplinary settings across the world and enhance the multidisciplinary focus of AECC University

College. It also allowed us to receive important inputs from a range of experts at meetings and conferences starting with the 9th Interdisciplinary World Congress on Low Back and Pelvic Girdle Pain in Singapore in November 2016, and including Odense, Antwerp, Oslo, Orlando and Berlin. All this has led to new collaborations with research centres at Cardiff, Exeter and Aalborg Universities.

In early February Dave Newell, Research Director of the University College, gave a seminar to the Primary Care and Population Science Research Group at University of Southampton. He presented a description of the modern chiropractic profession, the evidence underpinning conservative care as provided by the profession for musculoskeletal pain conditions such

as low back pain. He also outlined plans for a five-year research programme at the University of Southampton exploring models of chiropractic care delivery that may enable the profession to help support the substantial MSK burden within primary care. This project, funded by the Chiropractic Research Council, involves funding not only for Dave Newell but further PhDs to support this work.

Dr Stewart Cotterill, Head of School Health, Wellbeing and Performance, has a book out titled Psychology of Performance which is part of the new Routledge Psychology of Everything series. The School is currently working on research projects and once these are further developed we’ll be displaying the research on our website so do frequently check for updates.

the institution, our students and the chiropractic profession, particularly around her special interest area in the care of children. Aurélie Marchand, Lecturer in Clinical Science, stepped into Joyce Miller’s position in January as Lead Tutor on our postgraduate MSc Advanced Professional Practice (MSc APP) Paediatric Musculoskeletal Health course. We’ll be sad to see Joyce go. Aurélie will truly bring her own experience, enthusiasm and ideas to our MSc APP pathway. We wish Joyce all the best in her retirement, thank her for her dedication over the 20 years with us and we plan to keep in touch. Discover more about our postgraduate courses, including our brand new MSc APP Musculoskeletal Neuroscience (subject to validation) at www.aecc.ac.uk/pg/

Medicine. In June, for those sports-minded health professionals, Dr Alan K. Sokoloff presents Successful Integration of the Health Professional in Sports Medicine. Don’t forget discounts are available to AECC University College alumni and students, ECU and RCC members. To book and find out more information, visit our website: www.aecc.ac.uk/cpd/

Finally we’re working on introducing a new, bigger and better Alumni Reunion event, which will be much more of a showcase of our fantastic University College and a celebration for our wider alumni. This year’s Reunion will take place on Saturday 15th September so save the date and we’ll look forward to welcoming you to beautiful Bournemouth.

Haymo ThielPrincipal, AECC

As often in life, as one door closes, another opens. As part of our continued institutional development, growth and expansion there will be delivery of more courses to complement our existing offering and we will be recruiting for a Head of School position, responsible for the strategic leadership and management of the School of Chiropractic. Keep an eye on our website and other relevant sites for more details about opportunities for joining our team. As always we have a packed schedule of CPD seminars planned to take place throughout the year. In April we are welcoming Dr Ed Cambridge, who has studied with Professor McGill for the past six years while completing his PhD, with his seminar on Building the Ultimate Back; From Rehabilitation to Performance. Then in May Dr Rebecca Furlano hosts a two day Introduction to Functional


COLLEGES

There are changes taking place at the WIOC at USW. After 18 years at WIOC Mark Webster has recently resigned from his post as Academic Subject Manager Head

of Chiropractic Academic Programme which he has held for the past two years. I speak on behalf of the Chiropractic team in thanking Mark for his service, contribution to the programme and friendship over the years. As the new Academic Subject Manager Head of Chiropractic I look forward to taking the programme into a new direction with cross

faculty collaborations, external partnerships, technology advancement to enhance the student experience and supporting staff development and progression. As the Head of the academic programme I have been working closely with Dr David Byfield (Head of The Welsh Institute of Chiropractic 2005-2016 and currently Head of Clinical Services and Clinic Training), on the Validation and Re-accreditation documents as well as the GCC Annual Monitoring report. I would like to take this opportunity to thank both David and Steph Davey for their support and contributions in producing these documents during this transition period.

Dr Alister Du Rose, who joined the team in 2017, is the new Course Leader and will be managing the day-to-day running of the programme in addition to developing his research activity. Alister continues his focus on spinal biomechanics (the topic of his PhD thesis) where he has been awarded the position of Visiting Research Fellow at the Centre for Biomechanics Research (AECC University College) which will ensure he can continue his work in this area. Since joining the Welsh Institute of Chiropractic he has expanded his interests into other areas, developing a research stream in the field of chiropractic education

alongside David Byfield and Danny Clegg and working closely with Professor Peter McCarthy on various projects that include the supervision of a Canadian PhD student who is investigating the topic of jurisprudence within the chiropractic profession.

The technology development for the programme will be led by Dr Danny Clegg who has spent the current academic year implementing new learning and assessment technologies across the course and has recently coordinated Chiropractic focus group research projects with Alister Du Rose. Danny and Alister are also working on a number of potential publications as a result of these focus groups and are currently in the long and arduous phase of transcribing and analysing this data assisted by the head of the University Education cognate group. Along with David Byfield, Danny and Alister have also integrated a new video feedback system for staff and students to use for the purpose of enhancing the teaching and learning environment.

Dr Leon Yandle is the newest member of staff and will be leading in the development of Clinical Imaging and Diagnosis with Dr Alf Turner DACBR, Neuro-Orthopedics with Annabel Kier and will lead on student engagement and welfare on the Chiropractic programme. Leon is currently investigating movements and muscle activation patterns that optimise joint mechanics, with the use of imaging techniques.

The Clinical Services Unit continues to grow particularly in relation to diagnostic ultrasound clinic placements under the supervision of Dr Roger Denton and Alison McBride. Alf Turner continues to oversee and expand the operation along with his role in radiology. Roger and Alison are developing US protocols to measure subcutaneous fat. This will enable the team to develop self-referral body composition scans. There is a lot of interest from athletes regarding training outcomes which we can determine using DXA scans. This approach is completely non-invasive and we are engaging with Sport Wales to measure their athletes when they attend for their biannual DXA and correlate the results from the two assessments. DXA referrals are increasing as the awareness of osteoporosis and the use of the osteoporosis risk assessment on all patients kicks in. The students and clinical staff are much more familiar with the process and the follow up. Angela Sims is providing support for students who have questions about the justification for DXA. We feel that as a public health issue osteoporosis awareness is an important clinical issue for our patients and we have successfully embedded protocols to engage both students and patients. Our relationship with the National Osteoporotic Society is growing as we are participate in their advisory group meetings as an active partner. As part of our ongoing commitment to quality care we are going to audit 100 patient files from the clinic and look at the incidence of osteoporosis risk factors and the follow up protocols. We plan to submit this inspection survey as

News fromWIOC

David Byfield, Lucy Owen (BBC Wales presenter), Professor Mike Stone and Dr Roger Denton


COLLEGES

Research report2018 is rolling on with an invitation for Bianca and me to address the Sport Faculty of RCC. We both attended and presented a few ideas from which we have two new areas of sport to consider and potentially three new collaborators. The sports research is starting to become interesting and is developing a life of its own. Recently, we have even been introduced within FICS as “the best chiropractic sports research group anywhere”. Although this is arguable, it is nice to know that people outside the UK are realising we are doing some research that might have a positive benefit on the way Chiropractors are viewed in sports.

The cervical spine in rugby work (headed by Bianca Zeitsman) is moving to the next stage, testing efficacy of interventions. A number of organisations are looking at this area since we announced what we were doing. World Rugby is looking at a neck prehab protocol so we are now looking at the best way to test this properly using a controlled trial. We have recently had an offer of help from the London Broncos and are currently looking for a further comparable squad.

Niall Tilley who leads on the boxing theme has now made links with the Northern Irish amateur boxing elite and hopefully this can convert into some data on the effects of boxing on cervical spine function to add to the IABA data. We are also working with a US company on some interesting technology that aims to enable detection of punch type, number and rate, which could be a great coaching tool for the future. Such tools will have the added advantage of allowing us to start quantifying how chiropractic care effects the boxing characteristics that count!

Dan Morgan (who leads on the football theme) presented at the BACS conference. We now have data back from the second premiership football academy regarding our predicting lower limb injury based on functional movement and other tests. The data looks a little too good at present which always begs the question “what have we done wrong?”. This is now being slowly constructed into a publication so we can get some critical review.

We have a new PhD student, Brian Glieberson (CMCC Canada) with Alister DuRose and me as supervisors.

Until next time,

Peter W McCarthy• @CTDRU • www.facebook.com/ctdru.usw

• http://ctdru.research.southwales.ac.uk/Remember to also check out the journal Chiropractic and Manual Therapies regularly, it’s on-line and free to access!

a poster at the upcoming National Osteoporosis Society Conference in Birmingham in December 2018. Our new x-ray installation has finally been approved by our RPA and we are able to continue our radiography service which was discontinued in December 2017. I would like to thank the Faculty for their financial support to replace our equipment.

We also want to welcome a group of newly appointed clinic supervisors, Bianca Zeitsman, Elisabeth Angier, Rhia Edwards, Hannah Burke and Bronwen Henley who have commenced their roles in supporting student clinician training, bringing a wealth of experience to WIOC.

David Byfield recently met with a group of surgeons led by Mr Paul Edwards, Mr Ian Mackie and Mr Dave Baker to discuss expanding our current hospital placement programme at Prince Charles Hospital into another health board providing additional opportunities for our students and staff. This is a particularly exciting development as we are also going to discuss adding chiropractic care to an enhanced back pain service.

David Byfield attended the first of many stakeholder meetings with the newly formed Health Education and Improvement Wales (HEIW) which will become a statutory body with the responsibility of coordinating health education and workforce planning in Wales. The Chair is keen to widen access and include other professions in the discussions which is a good opportunity for WIOC and USW.

WIOC is preparing for a GCC re-approval exercise. Documents have been submitted to show that we have met the newly published Educational Standards (GCC 2017). We will be the first institution to be judged against these standards and discussions are underway with the GCC and ECCE to conduct a combined accreditation visit. If this takes place, we will be part of the first combined event in the UK with GCC and ECCE working together which is an exciting and forward thinking development. Credit goes to Penny Bance (GCC) and Ken Vall (ECCE) for working together to develop this risk based approach to chiropractic accreditation.

WIOC also held an evening CPD event which included talks from David Byfield (MSK evidence update), Dr Roger Denton (Diagnostic Ultrasound common conditions) and Professor Mike Stone (osteoporosis and pre-menopausal women).

European Chiropractors’ Union President Oystein Ogre presented the WIOC with an acknowledgement of 20 years of outstanding service to the chiropractic profession in Europe at the BCA/WIOC 2017 Autumn Conference gala evening.

Rhys BreckonHead of Chiropractic, Welsh Institute of Chiropractic

David ByfieldHead of Clinical Services and Clinic Training, Welsh Institute of Chiropractic

REPORTS


The future of the profession was being shaped on Saturday 3rd of February at WIOC, University of South Wales. This year a small group of volunteers worked hard for several months to bring an

unforgettable experience to those at the British Association of Chiropractic Students (BACS) conference.

Those attending included worldwide WCCS delegates, our osteopathy student neighbours from Swansea and chiropractic students from AECC UC, McTimoney and WIOC. We also had the pleasure of hosting representatives from 10 different international organisations and companies as well as two chiropractic charities. The theme of BACS 2018 was Progressive Positivity. The future of chiropractic is bright but only with a progressive and positive mentality can the profession move forward and upward. This is the BACS vision and was manifested by the fantastic talks and demonstrations during the conference.

We heard from the BCA’s very own Dan Morgan who inspired many with his demonstration and explanation of functional assessment. We were also introduced to functional medicine, also known as integrative medicine and the importance of prevention and not cure. We engaged with and experienced movement and how ancient cultures and ways of life may hold the key to a healthy and fulfilling life. We heard about practising in a multi-disciplinary environment and how chiropractors can succeed and grow in this setting. We witnessed the influence of the subconscious mind and how harnessing this in our approach can help us become better clinicians and bring the best for our patients. We realised the importance of looking after our own health because a healthy chiropractor means a healthy patient. Finally we had a first-hand glimpse into functional neurology and how sympathetic dominance is important to consider in our future practise.

As the organisers we wanted to make this a fun, entertaining and interactive event. Students were fired up

Student/New Graduate reportBritish Association of Chiropractic Students Conference 2018

BACS Organisers: Tharsan Sellathurai, Jon Shurr, Dr Vicky John, Jannes Gick

REPORTS


Behind the scenesMy colleague Tharsan Sellathurai and I witnessed first-hand what goes on behind scenes to ensure the highest quality of chiropractic education in the UK. In January we travelled to the ENQA Higher Education review of the European Council on Chiropractic Education (ECCE) which accredits 10 chiropractic institutions around the world; eight in Europe and two in South Africa. Accreditation from ECCE is important for many students as it means that graduating from their institution facilitates their mobility as a qualified chiropractor.

The ENQA panel consisted of four prominent professionals in the field of education who were assigned the task of gaining the perspective of students of the ECCE’s role in education. We emphasised that, for many students, ECCE accreditation is often the determining factor when choosing which institution to attend because many students from Europe want to return to their home country to practise. For many UK students it is additionally a sure sign of the quality of education at that institution.

We also took this review as an opportunity to promote the high-quality education we have been receiving in the UK something that is important as the panel felt that chiropractic has seemed to isolate itself in the past but this is changing as chiropractic education becomes more integrated into the programme of established universities. The profession itself has a wider reach as well with the help of good spokesmen and spokeswomen making their voices heard.

by WIOC’s very own 3rd year student, Kelsey Patterson, with her crowd-rousing music performances and games. The whole experience, including lights, sound, and atmosphere was taken to the next level by our production team led by our 1st year student colleague Jannes Gick.

As organisers, we want to thank all those students who attended BACS and who made it such a special event. We hope that the next generation of chiropractors is excited and ready to take on their role.

The future of chiropractic will be decided by YOUR hands.

Jon Shurr, Final Year WIOC Student


The dust has settled, you’ve registered with the Health and Safety Executive (HSE) and there’s a pile of legislative papers entitled IRR17 and IRMER18 that you need to get your head around. So, what actually has changed? Carl Irwin, Chair of the Imaging Standards Committee, takes members through the changes.

Essentially regulations for those using any form of ionising radiation have changed and, as chiropractors, we are

required to adopt these. The focus is on accountability, training, safety and protection; chiropractors need to know the part they will need to play.

Firstly, under IRR17, if you didn’t register yourself as an employer of ionising radiation by 6th Feb 2018 you are now committing an offence. You are also required to keep your registration updated if there are any changes to your circumstances.

Secondly, IRR17 also requires you to provide specific documentation when requested by the HSE so we suggest you put together an x-ray file for the relevant documents and records. Keep this somewhere accessible in your x-ray room so it is at hand in case of an HSE inspection as they can now do spot checks and potentially prosecute if you are not complying with the new legislation.

Our responsibilities regarding IRMER18 are summarised in section 2 of their legislation. Before their x-ray examination we will need to provide patients with information

The X Ray Game Change

on the risks versus the benefits of radiation exposure. If an exposure incident occurs it needs to be recorded and investigated immediately. It is recommended you speak to your MPE/ RPAQ should this occur. If a carer or assistance is needed to help a patient during exposure you need to have suitable radiation protection for them to wear and separate justification and dose limits apply to them under IRMER18, again contact your MPE/RPA. You must maintain an accurate log of patient details, including date of birth and sex, your exposure factors and their exposure index. These are subject to mandatory audits. We also recommend you speak to your MPE/RPS before updating or purchasing new equipment so they can check you will be complying with the new legislation.

Taking into account IRR17 and IRMER18 your x-ray file will ultimately need to include;• A radiation safety policy / criterion for x-ray• A copy of a patient info document on x-ray (see Royal

College of Radiologists)• An up to date radiation risk assessment, normally the one

done on installation/unless units been modified, then speak to MPE/RPA

• Current local rules (displayed and on file)• Employers x-ray procedures for IMRER (x ray technique)• Individual staff training records for all your team

members even reception team and your cleaner (induction training and radiation protection courses etc)

• Documentation of an appointed Medical Physics Expert (was the Radiation Protection Adviser (RPA))

• Radiation Safety Check documents by your MPE (every three years)

• Printed copy of your HSE registration

• A background radiation/ radon gas review (contact your RPA/MPE for advice)

• Evidence of regular quality control testing of your x-ray equipment (eg light beam diaphragm alignment, output/ flat field assessment)

• Radiation dosimetry reports• Annual service documents for x ray

unit and processor.As chiropractors it is our

responsibility to comply and to be seen complying with this new legislation, not just from a safety view point but for maintaining the high public profile and relationship we have, as BCA chiropractors, have with our patients and other professions. Attending a radiation protection course or spending time at your clinic with your MPE/RPA is worth the investment. They will help you understand the legislation, get everything in place for your file and update your procedures where necessary. The BCA imaging standards committee is there to help too and they can me contacted through the BCA office [email protected]

Carl Irwin BSc (Chiro) DC DCRR MRCoC


REPORTS

BCA Council invited the current Professional Standards Committee (Bronwen Henley,

Warren Dickinson, John Williamson, a layperson to join us soon and me) to serve just prior to the last BCA Election. We were provided with Terms of Engagement, the BCA Code of Conduct and Disciplinary Procedure for review and encouraged to pursue development of a Quality Agenda.

Briefly stated, the PSC will: • Advise BCA Council on

professional standards and ethical issues

• Advise members on proactive risk management

• Maintain and develop codes

of conduct and disciplinary procedure

• Maintain guidelines on professional behaviour (including conduct on social media, conduct of Council and committee members during and after office)

• Develop a Quality Agenda promoting highest ethical standards and provide advice to members via Council on clinical governance

• Refer breaches of conduct to the Disciplinary Committee

• Report to Council quarterly.The committee has met

regularly via Skype. We liaise with the BCA Office, Council, President and Executive as necessary.

The GDPR presented itself as an urgent matter for our attention and I am pleased we were able to recommend Technology Tamed and Croner as appropriate companies to develop the GDPR Tool Kit and provide GDPR advice respectively. The PSC encourages BCA members to take advantage of these arrangements and to also familiarize themselves with the ICO documents regarding GDPR which are available online.

We are actively reviewing the BCA Code of Conduct and Disciplinary Procedure and developing the Quality Agenda in respect of the Terms of Engagement looking to current BCA advice, Quality Standards of the Royal College of

Chiropractors and, of course, the GCC Code.

Please contact me or any of the committee members with any concerns or suggestions regarding professional standards. You can make initial contact via the BCA Office [email protected]

Jeff Shurr, Chair PSC

Professional Standards Committee

MRI Scanning Services Affordable and Responsive Scanning

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Our Open Upright MRI scanner provides a cost effective solution for diagnostic imaging for healthcare professionals and patients.

We accept referrals from healthcare professionals who are registered with a public healthcare regulatory body. To find out more visit our website or call us.


REPORTS

Competency-based membershipThe RCC’s Specialist Faculties are making good progress with defining and documenting skills and competencies for ‘specialism’, particularly in the areas of Sport and Paediatrics. As their important documents develop, specific curricula and corresponding educational resources will emerge for each faculty enabling chiropractors to develop their special interests and pursue membership of the RCC’s specialist faculties in a more structured manner.

New online learning resourcesThe RCC Pain Faculty’s new Understanding and Managing Psychosocial Barriers in MSK Conditions learning programme will be launched in April. The programme, which will be in three parts, is designed for clinicians who are working with patients who present with pain, and who will benefit from understanding how non-physical factors can provide barriers to their patients’ recovery, and how to manage them. Details to follow.

Health promotionOur recent AGM & Winter Conference highlighted the RCC’s intentions to encourage chiropractors to engage with a public health agenda and we are now embarking on a programme to:• Help chiropractors recognise the importance of their public health

role;• Help chiropractors enhance their knowledge and skills in providing

advice and support to patients in key areas of public health through provision of information, guidance and training;

• Help chiropractors measure and recognise the impact they can have in key areas of public health.

To take this work forward, we will be exploring the possibility of launching an RCC Public Health Promotion & Wellbeing Society with a view to establishing a new Specialist Faculty in due course. We are already actively engaging with the Royal Society for Public Health and have had an initial meeting with representatives of Public Health England to outline our intentions.

RCC Summer ConferenceOur second Summer Conference will take place in Birmingham on Saturday 2nd June 2018. Following a PRT Trainers workshop in the morning ( for current and aspiring PRT Trainers), we have a fantastic line-up of international speakers for the afternoon session, including Professors Jan Hartvigsen, Simon French and Bruce Walker. The conference is free to RCC members, with tickets for the optional evening barbecue available for sale.

Rob FinchChief Executivee [email protected] t +44 (0)118 946 9727 w www.rcc-uk.org

fb.com/royalcollegeofchiropractors

Royal College of ChiropractorsRCC activities in the year ahead will, perhaps more than ever, highlight how RCC membership complements membership of your Professional Association.

RCC CPD EventsRocktape functional movement taping level 128 April 2018 • 09:00Venue: Musgrove Park Academy, Musgrove Park Hospital, Taunton TA1 5DACollege Member Fee: £130.00 Non-College-Member Fee: £160.00

GDPR Workshop – What will the new regulations mean for clinics?2 May 2018 • 18:30Venue: The Mount Somerset Hotel and Spa, Lower Henlade, Taunton TA3 5NBCollege Member Fee: £20.00 Non-College-Member Fee: £45.00

Using communication skills to enhance therapeutic outcomes9 May 2018 • 18:30Holiday Inn Maidstone-Sevenoaks, London Road, Wrotham Heath, Sevenoaks, Kent TN15 7RSCollege Member Fee: £35.00 Non-College-Member Fee: £55.00

Soft tissue shoulder pathology16 May 2018 • 18:30Venue: Holiday Inn, The Coldra, Newport NP18 2YGCollege Member Fee: £35.00 Non-College-Member Fee: £50.00

RCC Summer Conference 20182 June 2018 • 10:00Venue: The Studio, 7 Cannon Street, Birmingham B2 5EPFree to Members

Interpretation of spine MRI and x rays: Consigning the ‘radiology report’ to room 101! 6 June 2018 • 18:30Venue: Holiday Inn Taunton Jct 25, M5, Deane Gate Avenue, Taunton TA1 2UACollege Member Fee: £35.00 Non-College-Member Fee: £50.00

Empowering your patients: helping your patients achieve their desired healthcare outcomes13 June 2018 • 18:30Venue: Education Centre, Queen Alexandra Hospital, Cosham, Portsmouth, PO6 3LYCollege Member Fee: £35.00 Non-College-Member Fee: £50.00

Pregnancy and Paediatrics Symposium 201823 June 2018 • 09:00Venue: Holiday Inn London Gatwick Airport, Povey Cross Road, Gatwick RH6 0BACollege Member Fee: £245.00 Pregnancy & Paediatrics Faculty Member Fee: £215.00 Non-College-Member Fee: £305.00

SAVE THE (PROVISIONAL) DATE: FICS/RCCSEF ICSSP Upper Extremity Seminar 19-21 October 2018 Oxford

Brexit:


BUSINESS & FINANCE

The rollercoaster ride of Brexit continues to breed uncertainty for employers but, one thing looks clear, we are set to leave the EU on March 29th 2019. Louise Barnes from Croner takes a look at what to expect.

Employment Law Predictions

workers. They give rights where once there were none and put responsibilities onto end users which restrict the many advantages of taking on casual agency staff.

Equality Act 2010: It has been suggested that post-Brexit the UK will introduce a cap on the level of the maximum award for successful claimants, seeing the end of the potential for employers needing to have a blank cheque book at the ready in cases where there has been a breach under the Equality Act.

Working Time Regulations 1998: Our departure from the EU could allow the UK to draw a line under the mass of messy case law surrounding the accrual of annual leave during sickness and inclusion of extra elements (e.g. commission) in holiday pay.

TUPE: Freedom from Europe may provide for employers to be relieved of the restraints preventing the harmonisation of terms and conditions post transfer… or might that be one change too far?

EU legislation: Potential RemainersUnfair dismissal: the UK’s protection against unfair dismissal has been around for over 20 years and it has grown from strength to strength, developing with the times and protecting employees from unjustified dismissals, which require employers to follow fair and reasonable procedures. This is unlikely to be going anywhere as we depart from the European Union.

Gender pay reporting: Given its young age and media attention gender pay reporting is likely to be here to stay.

Pension and auto-enrolment: Following a recent

announcement to reduce the age of auto enrolment from 22 to 18 and, in light of its focus on encouraging people to save for their future, this piece of legislation stands firm and has good rooting in employment law.

National Minimum Wage and National Living Wage: Minimum basic rates of pay are the cornerstone of employment rights and their annual increments are, for many people, the only guarantee of a pay rise.

The truth is that, like many of the wider implications of Brexit, there is no legal crystal ball meaning that these changes are pure speculation. However, the future is bright and no matter which pieces of legislation prove to be movers and shakers there is scope for change. Once the process of leaving has been identified and the departure process is established domestic law-makers should have a little more time on their hands at which point change is sure to come. Croner has been advising businesses on employment law for the past 70 years. If you need any support please contact us on 0844 561 8116 (give your name and quote BCA plus the scheme number 25742).

As the Brexit deadline fast approaches, we wait to see what employment laws may go and which are likely

to remain. In May 2017, Theresa May made the following statement:

“Since becoming Prime Minister I have made it clear that I will use the UK’s departure from the EU to strengthen and enhance workers’ rights.”

Although it’s possible that various laws could be affected by the UK’s departure from Europe that won’t necessarily be so.

Consequently the legislation outlined below identifies areas where there is scope to bring about change once the UK is no longer restrained by the chains that bind them to the many EU requirements:

EU legislation: Potential LeaversAgency Workers Regulations 2010: these burdensome regulations have never been popular amongst employers who engage agency


BUSINESS & FINANCE

All employers have situations where the candidate they employ does not live up to expectations. Finding the right candidate is always a challenge and, every so often, recruitment decisions may not work out as anticipated. Croner has some advice for employers.

ManagingProbationaryPeriods

employees to bring a claim against their employer. A common misconception is that dismissals during or at the end of the probationary period are automatically fair. This is likely to stem from the view that a probationary period equates to the employee having no statutory employment rights. Though an employee cannot bring a claim for unfair dismissal during the first two years of employment they are entitled to all other employment rights, including the right to national minimum wage, rest breaks, statutory sick pay and various family friendly rights within their probationary period. Therefore, an employee who has been dismissed during their probationary period could bring a claim for ‘wrongful dismissal’ for which there is no qualifying period. An evaluation of the risks is therefore vital when considering a probationary dismissal. To rely on a probationary period it should be made clear at the offer of employment stage and within the contractual terms that the employment is subject to the satisfactory completion of a probationary period, with a specification of its duration.

There is no law specifying the length of a probationary period though it should be reasonable against the requirements of the role. Often a period between three and six months is deemed reasonable.

Extending The Probationary PeriodIf the contract allows the probationary period can be extended for a reasonable period, normally between one and three months, provided specific reasons for the extension are given. Ideally an extension of the probationary period should be with good reason so, for instance, where it is felt that the employee may be able to demonstrate an improvement in performance with further training or where the employee’s

performance has not been effectively evaluated due to periods of absence.

An extension can also go some way in evidencing that a reasonable process has been undertaken.

Probationary DismissalsAlthough often overlooked, the usual test of ‘reasonableness’ should be applied to probationary dismissals. Therefore, to dismiss for reason of conduct or performance, the employee should know what is expected of them. In addition to a detailed employee induction, regular interventions, reviews, support and training throughout the probationary period should re-affirm the requirements of the employee.

As such, the probationary period would be fair and safe, giving employees a reasonable opportunity to demonstrate improvements and avoid a dismissal and ensure that only genuinely unsuitable employees are being caught in the ‘safety net’. Any complaints or grievances from the employee that may arise during the course of the probationary period, particularly those involved statutory rights, must be thoroughly investigated and appropriate solutions must be put in place. Ensuring there is documentary evidence of the process throughout is key and it could be the difference between a tribunal win and loss.

Expert SupportIf you’re facing challenges with an employee who is in their probationary period, or any other sickness, disciplinary, grievance or employment law issue, please contact us on 0844 561 8116 (give your name and quote BCA plus the scheme number 25742).

More employers are recognising the importance of having a ‘safety net’ to address recruitment

misjudgements. That safety net, in this context, is referred to as a ‘probationary’ period or ‘trial’ period.

Probation Period: What It Means for EmployersIrrespective of the terminology used this is a period of time in which the employer can assess suitability of the individual against the role they are recruited to before the employment is confirmed. Although the probationary period allows the employee to also determine whether the role meets their expectations, undoubtedly it provides greater benefit to the employer. This flexibility is supported in that notice periods during the probationary period tend to be much shorter, usually a week on either side, allowing both parties to easily bring the employment relationship to an end as necessary or required. If used appropriately the probationary period is an effective tool to avoid employers struggling with employee relations issues further into the employment relationship.

Overcoming Probationary MisconceptionsThe key to maximising the benefits of the probationary period is that employers overcome some basic misconceptions and understand the simplicity of this process against the possible pitfalls which expose employers to litigation. This should hold more significance for employers given the recent abolishment of tribunal fees making it free for

What matters to you, matters to us01823 250750 • www.lloydwhyte.com

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We’ve been working with chiropractors long enough to know which income protection providers give you the best cover, so we put them all in one place.

What’s more we’re rewarding BCA members with 10% off their renewal membership when they take the policy out. Full terms and conditions are available on our website.

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Lloyd & Whyte (Financial Services) Ltd are Corporate Chartered Financial Planners. Authorised and regulated by the Financial Conduct Authority. Calls may be recorded for use in quality management, training and customer support. You will not receive advice or a recommendation from us. You will be asked a number of questions to narrow down the selection of products that are available. You will then need to make your own choice on the right policy for you.

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BUSINESS & FINANCE

What is the definition of “casual worker?”A casual worker is someone who agrees to work providing personal service on an ‘as and when’ basis. There is no obligation on the Company to provide them with work and, similarly, there is no obligation on a casual worker to accept work when it is offered.

In order to avoid workers becoming employees it is important that you do not use them too regularly and that you do not require them to accept work. Furthermore, casual workers should not be subject to the company’s disciplinary and grievance procedure. If they do something wrong you simply do not offer them work again.

Workers do not enjoy the entire raft of employment rights available to employees such as the right to redundancy pay, remedies for unfair dismissal or the right to a written statement of particulars. However, they are entitled to be paid the national minimum wage, they are entitled to paid holiday and not to be subjected to unlawful discrimination or unlawful deductions from wages.

Claire Moore, Senior Consultant from Croner’s Business Support Helpline, takes a look at recent issues that BCA members have faced and gives guidance on how to deal with them. For free help with tax, VAT, employment, payroll, health & safety and commercial legal issues contact the helpline on 08445 618116 quoting scheme number 25742 (24 hr service for employment queries, normal office hours for other topics). Members can also use the online Business Essentials portal accessed via the Members’ website.

Employed chiropractors at my clinic work an eight hour shift. I know that after six hours they are entitled to 20 minutes unpaid rest but this is not always convenient. Can I meet the rest break entitlement by ‘’adding up’’ shorter breaks?The Working Time Regulations state that, after six hours work, adult workers are entitled to an uninterrupted period of 20 minutes unpaid rest. There are some exempted categories under which certain workers, for example where there is a requirement for continuity of service or production however, they remain entitled to “an equivalent period of compensatory rest” at some other time. Employers should avoid the practice of splitting up break periods and wherever possible adhere to the working time regulations for rest breaks and only depart from this where they can successfully show that they fall into an exempted category and there is no alternative opportunity for meet the full break entitlement e, g, examine working practices, provide relief staff to cover breaks, etc. to avoid falling foul of the working time regulations.

DID YOU KNOW? Changes came into force on 6th April with regards to taxation of payments in lieu of notice – PILONWhere the contract of employment allows that PILON can be made upon termination of employment, where there is no contractual right to make these payments, HMRC provides a tax exemption for the first £30,000 of notice pay made. The rules on this and the tax exemption have changed such that, with effect from 6th April 2018, the Finance (No. 2) Act 2017 provides that all PILONs representing “basic pay” will be subject to tax and National Insurance Contributions (NICs) regardless of whether or not there is a relevant PILON clause in the contract of employment.

FREE businessadvice

How should we deal with an employee who regularly has one or two days off every month?You could deal with persistent poor attendance through your disciplinary procedure. It is important that you carry out a thorough investigation to ascertain if there is an underlying reason for the employee’s poor attendance. You will need to be very careful if the absence is related to a potential physical or mental disability.

In the event that there is no risk of potential disability discrimination, following conclusion of the investigation, the employee should be invited to a formal disciplinary hearing (ensure you follow your procedure) and should be given the opportunity to state their case.

In the first instance it is likely that the employee will be issued with a verbal warning. As part of the disciplinary outcome you should explain that you will continue to monitor the employee’s attendance and an immediate and sustained improvement in attendance is required. Failure to do so could result in further disciplinary action being taken. Call the helpline for more assistance with this process.


BUSINESS & FINANCE

For future reference, when unforeseen circumstances close a business (i.e. due to snow) are we required to pay the employees who work in that business? Even if we give them notice so they don’t travel to work?Where the company takes a decision to close facilities due to the weather or circumstances outside of their control there is likely to be a contractual obligation to pay the employee for the work that they have missed out

on. However, if the facility remains open and the employees fail to attend, payment may not be due. The options are that it is treated as unpaid leave or, if the employee prefers and has remaining entitlement, they can

request paid holiday. The company needs to ensure that they are mindful of their health and safety obligations and do not force employees to take unnecessary risks to get to work where there are hazardous driving conditions.

Members of the BCA have access to the Croner Business Support Helpline and Croner-i Business Essentials as part of their membership package.

Can I be held liable for a third party, someone outside of my clinic (not a patient or other member of staff), harassing one of my employee’s?Harassment is defined as a situation where an individual is subjected to unwanted conduct which has the purpose or effect of violating their dignity or creating an intimidating, hostile, degrading, humiliating or offensive environment. The Equality Act 2010 made employers liable if a third party harassed their employees so long as the employer was aware of the harassment taking place on at least two previous occasions and reasonable steps had not been taken to prevent further harassment occurring. However, this was removed from the Equality Act in October 2013 as the government felt that it was unfair on Employers to make them liable for the acts of parties they have no control over. Employers can no longer be held liable. It is worth noting however that Employers continue to be vicariously liable for harassment by employees against other employees during employment

If a disciplinary matter goes to an appeal, does the person dealing with the appeal always need to be more senior than the person who made the disciplinary decision?Any person dealing with an appeal must have the authority to overturn the original disciplinary decision. This will normally mean that it should be someone of the same level of seniority or someone more senior than the original decision maker to avoid any arguments that the appeal was biased or pre-determined.

DID YOU KNOW? Since the Shared Parental Leave scheme was launched in 2015 as few as 2% of eligible working couples are using the scheme Shared Parental Leave (ShPL) allows eligible working couples the opportunity to share and organise leave from work in a way which works best for their family, following the birth of their child or adoption. Whilst the BEIS believes an estimated 285,000 couples are eligible to take ShPL each year, they have judged half of the general public are unaware of this right and how it works.

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2nd May 2018GDPR Workshop – What will the new regulations mean for clinics?The Mount Somerset Hotel and Spa, Tauntonw rcc-uk.org/rcc-events

9th May 2018Using communication skills to enhance therapeutic outcomesHoliday Inn Maidstone-Sevenoaks, Kentw rcc-uk.org/rcc-events

12th May 2018HePAG Acupuncture Foundation CoursePaul Battersby • TBC – over three weekends • Peterborought 01733 646888 e [email protected] w http://bit.ly/2ET0og6

16th May 2018Soft tissue shoulder pathologyHoliday Inn, Newportw rcc-uk.org/rcc-events

19th – 20th May 2018 Introduction to Functional MedicineRebecca Furlano • 11 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

25th – 27th May 2018ECU Convention Budapestw ecu2018.com/registration

2nd June 2018Royal College of Chiropractors Summer Conference The Studio, 7 Cannon Street, Birminghame [email protected] w rcc-uk.org/rcc-events

2nd – 3rd June 2018OMT – Medical AcupunctureGiles Gyer and Jimmy Michael • CPD TBC • WIOCw www.uswcommercial.co.uk/cpd/chiropractic-cpd/

2nd – 3rd June 2018NOI – Explain PainTim Beames • 14 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

6th June 2018Interpretation of spine MRI and x rays: Consigning the ‘radiology report’ to room 101! Venue: Holiday Inn Taunton Jct 25, M5, Deane Gate Avenue, Taunton TA1 2UAw rcc-uk.org/rcc-events

9th June 2018Taping for Nero from Rocktape Melissa Benyon • 6.5 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

13th June 2018Empowering your patients: helping your patients achieve their desired healthcare outcomesQueen Alexandra Hospital, Portsmouthw rcc-uk.org/rcc-events

16th June 2018Successful Integration of the Health Professional in Sports Medicine Dr Alan Sokoloff • 8 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

23rd June 2018HePAG Acupuncture Foundation CourseMike Chapman • TBC – over three weekends • Manchestert 01733 646888 e [email protected] w http://bit.ly/2DsWOJW

23rd June 2018Pregnancy and Paediatrics Symposium 2018Holiday Inn London Gatwick Airportw rcc-uk.org/rcc-events

23rd – 24th June 2018Cervicogenic Dizziness & Vestibular RehabilitationRichard O’Hara • 14 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

BCA Council MembersPresidentCatherine Quinn e [email protected]

Vice-PresidentStephen Williams

Immediate Past PresidentMatthew Bennett

TreasurerTim Button

SecretaryUlrik SandstrØm

Jatinder Benepal Prab Chandhok Matthew Clifton-Hadley Nick Rowe (Lay Member)Arif Soomro Victoria Wheeldon

Updated contact details for council members can be found at www.chiropractic-uk.co.uk/whos-who

Editorial BoardRishi Loatey (Editor) e [email protected]

Anne Barlow (Sub-editor) t 01865 522861 e [email protected]

Mark Rawden t 0118 950 5950 e [email protected]

30th June – 1st July 2018Postural Restoration ConceptsRobert George • 16 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

5th July 2018The Spine and the Golf Swing: Biomechanics, Assessment and Rehabilitation.Chiropractic ‘Masters’ Golf TournamentJack Wells • 1 hour CPD • Solihullt 0121 7331642 e [email protected] w http://golfbiomechanics.eventbrite.co.uk

5th July 2018HePAG Acupuncture Foundation CourseMike Chapman • TBC – over three weekends • Norwicht 01733 646888 e [email protected] w http://bit.ly/2FdD5LZ

7th – 8th July 2018An Introduction to the Essentials of Receptor Based Rehabilitation with Manual TherapiesMatthew Antonucci • 12 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

14th – 15th July 2018NLP Foundation CourseJo Blakeley • 13 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

21st – 22nd July 2018Extremity AdjustingMark Charrette • 12 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

28th July 2018NMES an Adjunct to Expedite the Rehabilitation ProcessCliff Eaton • 6 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

28th – 29th July 2018Motion Palpation Institute – The DiscCorey Campbell • 12 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

11th August 2018The McKenzie Method of Mechanical DiagnosisJohn Thomson • 7 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

11th – 13th October 2018Evidence Based Clinical PracticeJ Bolton, A Jones-Harris • 16 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

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Who & WhereAECC University CollegeParkwood Campus, Parkwood Road, Boscombe, Bournemouth, Dorset BH5 2DF t 01202 436200 f 01202 436312 w www.aecc.ac.uk

British Chiropractic Association (BCA)59 Castle Street, Reading, Berkshire, RG1 7SNt 0118 950 5950 f 0118 958 8946 e [email protected] w www.chiropractic-uk.co.uk

Chiropractic Patients Association (CPA)Twingley Centre, The Portway, Salisbury, Wiltshire SP4 6JL t 01980 610218 w www.chiropatients.org.uk

European Chiropractors’ Union (ECU)The Glasshouse, 5A Hampton Hill, Middlesex, TW12 1JNt 020 8977 2206 w www.ecunion.eu

General Chiropractic Council (GCC)44 Wicklow Street, London, WC1X 9HLt 020 7713 5155 f Fax: 020 7713 5844 e [email protected] w www.gcc-uk.org

The Royal College of Chiropractors (RCC) Chiltern Chambers, St. Peters Avenue, Reading RG4 7DH t 0118 946 9727 e [email protected] w www.rcc-uk.org

Welsh Institute of Chiropractic (WIOC)University of South Wales, Treforest, Pontypridd, CF37 1DLt 01443 480480 f 01443 482285 w www.southwales.ac.uk/chiro/

• These diary dates can also be found on the members’ area of the BCA website: www.chiropractic-uk.co.uk

• Contact endeavours to make sure diary date entries are accurate, but we strongly advise you always check the details with the training provider before booking.

• The GCC mandatory CPD cycle for 2017/18 runs from 1st September 2017 to 31st August 2018.

• Don’t forget the BCA has a CPD guide for members and this can be found on the Members’ Area of the website or by calling the BCA office

12th October 2018BCA Autumn Conference pre-seminarHilton Birmingham Metropole@bcaconference

13th – 14th October 2018BCA Autumn Conference Chiropractic: it’s all about the patientHilton Birmingham Metropole@bcaconference

13th – 14th October 2018Evidence based understanding of clinical anatomy, diagnostics & treatment of the pelvisAndry Vleeming • 13 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

17th October 2018Clinical AuditJennifer Bolton • 6 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

18th – 20th October 2018Research MethodsJ Bolton, A Jones-Harris & P Miller • 20 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

20th – 21st October 2018Introduction to Dry NeedlingJohn Reynolds • 11 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

27th October 2018The Art of CommunicationJo Blakeley • 6 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

2nd – 4th November 2018Dynamic Neuromuscular Stabilisation Course BZuzana Suzan • 19 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

10th – 11th November 2018The Shoulder and Thorax in Sports and PerformanceEvan Osar • 16 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

17th – 18th November 2018Motion Palpation Institute – SpineCorey Campbell • 14 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

1st – 2nd December 2018Assessing & Building Load Tolerance for Sustainable Activity & AthleticismCraig Liebenson • 14 hours CPD • AECCt 01202 436237 e [email protected] w www.aecc.ac.uk/cpd

Support• Comprehensive insurance

package

• Subsidised fee structures

• Free tax, employment and health & safety advice

• Skilled office staff, there to support and advise you

• Free access to the latest worldwide research

• Discounted X-Ray reporting service plus a wide variety of discounts and exclusive offers

• Members’ website, packed with a wide range of information and downloadable tools

For Patients• Patient support information

• Expanding suite of online videos

• Promotional leaflets

• Clinic stationery

• ‘Find a Chiropractor’ feature on website attracts thousands of hits per month

For Business• Largest UK Association

classifieds: online and in print

• Variety of marketing packs and bespoke advice

• X-Ray compliance advice and guidance

Promotion• New patient referrals via

phone and website queries

• Lobbying the media / ongoing PR activity

• Range of marketing tools

• High-profile brand partnerships

For the Future• Empowering members to

engage with the NHS

• Assist in the defence of members at the GCC / in civil actions

• Ongoing support of UK colleges and students

Benefits of being a BCA Member


CLASSIFIEDS

ASSOCIATE REQUIREDASSOCIATE POSITION AVAILABLE – SOUTH COAST

We are looking for a confident chiropractor to take over existing patient base in a mature practice close to Southampton. Ideal for independent clinician willing to self manage either part or full-time. Diversified approach in a friendly comfortable clinic. Generous percentage for successful candidate. If interested please send CV with cover letter to [email protected]

Location: Southampton area Phone: 07884 286773

ASSOCIATE REQUIRED FOR A BUSY MULTIDISCIPLINARY CLINIC

A friendly, professional and award winning but relaxed clinic in Plymouth, Devon is looking for an enthusiastic chiropractor to join our existing team. The clinic is focused on providing excellent care to its patients and offer a range of services including traditional chiropractic techniques, MSK diagnostic scanning, Shockwave pain relief therapy and Acupuncture/Dry needling. The clinic also offers massage therapy and Podiatry.

We are looking for a new chiropractor to take on a combination of existing patients along with a high volume of new patients.

You will be confident and compassionate and not afraid to get out into the community and grow your practice. Only you can do this.

You will work in a well established clinic with multi disciplined chiropractors with some 30 years experience who will mentor, support and coach you as required.

This is a self employed position with flexibility on working days and hours.

The clinic is based in Plymouth and close to the famous Hoe where it is said Sir Francis Drake played bowls. It is steeped in history and close to moorlands and coastal paths. Not too far from stunning beaches.

Maybe you could be our perfect match. For more information please forward your CV to

[email protected] Telephone Linda Desborough: 01752 606 600

CHIROPRACTOR NEEDED IN ST MARGARETS, TWICKENHAM

Exciting opportunity for a patient-focused, self-motivated Chiropractor to join our established and expanding clinic. Strong diversified adjusting skills required with an interest in patient education through rehab/lifestyle.

The clinic is located in the centre of St Margarets, a great location near Richmond Upon Thames and a short train ride to central London. We have a thriving patient base and will ensure that you have the opportunity to build yours with our investments into marketing, up-to-date clinic facilities and computerised notes and exercise programmes. Full support and mentoring provided if required.

We look forward to showing you around!

Contact name: Ruth Elphick Location: South West London Phone: 07718 482976 Webpage: www.elphickclinic.com Contact email: [email protected]

CHIROPRACTOR WANTED FOR IMMEDIATE START IN A WELL ESTABLISHED FRIENDLY CLINIC IN NORTH WEST LONDON, ZONE 2

You will be joining a team and taking over an existing client base. The position would be more suited to someone with experience however new graduates will also be considered. Start date Dec/Jan 2018, latest Feb 18. For more information and to send CV please email [email protected].

Contact name: Nina Location: NW3 6LU Phone: 07786 515643 Webpage: www.hampsteadchiropractic.co.uk

2 FULL TIME ASSOCIATES WANTED FOR BUSY CARDIFF AND NEWPORT CLINICS

We are looking for an enthusiastic, confident, self motivated associate to join our happy team of 4 Chiropractors. This is a fantastic opportunity to join an award winning, busy, friendly and thriving practice in Newport or Cardiff South Wales.

We are not a high volume, wellness or vitalistic clinic. We are family run with a patient centered approach to care. We are offering 35 hours a week taking over an existing patient base at our Newport Clinic and 25 Hours a week taking over a patient base at our Cardiff clinic.

You will get a guaranteed number of new patients a week to build a strong and busy patient base. We are offering a 2k retainer for the first 6 months to ensure a guaranteed income. These are self employed positions based on % take home.

We are looking for someone with a minimum of 2 years experience as they will be taking over a patient base from an experienced and seasoned Chiropractor. The position will suit someone looking to make South Wales their permanent home as we are looking for a long term practice member.

We have a fantastic team of Chiro’s and Reception staff ready to welcome a new member!

If you have the experience and are a confident, outgoing, motivated Chiropractor then get applying! A fantastic opportunity awaits you.

Contact name: Michelle Location: Cardiff/Newport Phone: 07730 573640

Webpage: www.axischiropractic.co.uk Contact email: [email protected]

LINCOLN – ENTHUSIASTIC ASSOCIATE CHIROPRACTOR REQUIRED TO JOIN OUR TEAM

A fabulous opportunity for an enthusiastic, motivated chiropractor to join our purpose built, caring, friendly practice (Est 1992) in the beautiful university city of Lincoln.

We have an superb reputation with the local community and GP practices.

Excellent remuneration on a self employed % basis.

Retainer + GCC/BCA fees paid for new graduate.

Experienced or new graduates are welcome to apply.

Contact name: Anita Compton Location: Lincoln – East Midlands Phone: 01522 530645 Webpage: www.lincolnchiropracticclinic.co.uk Contact email: [email protected]

FULL OR PART TIME ASSOCIATE REQUIRED IN SALISBURY

An associate required to join busy clinic in Salisbury, Wiltshire. Seen over 38,000 patients since established over 35 years ago. Averaging 10 NP’s a week. Predominantly MSK and all techniques and patient management used with exercise rehabilitation and physiotherapy. Regular meetings with colleagues to discuss patients and learn from each other.

Location: SALISBURY Contact: Nigel Hunt +441722 328606 [email protected]

AN EXCEPTIONAL ASSOCIATE POSITION WITH BUSINESS INVOLVEMENT POTENTIAL

Come to Edinburgh and really live a chiro lifestyle! Scotland offers great arts, culture, cuisine, and easy outdoor activities. It is exceptional for cost of living and has easy travel access to Europe and America.

Our practice has a very high new patient quota, averaging 15 per week. This is due to our high standards of care and credibility within the communities we serve. Our practice is multidisciplinary and wellness focused, with chiropractic at the centre. We offer complimentary services in our clinic, including: digital X-ray facilities, sports therapy, podiatry, orthopaedics, counselling, dietary consultation, PT and Yoga.

A well established patient base is yours to inherit. That, along with visa sponsorship, in-house locuming and great support staff, makes this job exceptional and rewarding. You’ll receive unique principle support from a chiropractor that has completed a postgraduate in Pregnancy and Paediatrics as well as an MBA, majoring in clinical management and health innovation. You’ll receive training that no coach "on the circuit" can provide.

Please send your CV to: [email protected]

ASSOCIATE JOB IN PENZANCE AND THE ISLES OF SCILLY IN SEPTEMBER 2018

Come and join our well established, supportive and friendly practice which has a new associate position starting in September 2018.

We are looking for an enthusiastic, well motivated chiropractor prepared to build on the existing patient base alongside our two experienced chiropractors. You would be working mainly in the Penzance clinic but also flying to the Isles of Scilly once a month to treat patients from the islands. We predominantly use diversified, SOT and dry needling as well as soft tissue techniques and home exercise. Our patient base covers all ages and occupations. The RCC PT scheme is available so it could suit a new graduate.

West Cornwall is one of the most beautiful parts of the UK with a strong tradition of arts in the area for those who are creative. There are countless opportunities for all water based sports as well as excellent beaches, walking and cycling.

Contact name: Louise Gough Location: Penzance and the Isles of Scilly Phone: 01736 364912 Webpage: http://chiropractic-pz.co.uk Contact email: [email protected]


CLASSIFIEDS

ASSOCIATE CHIROPRACTOR – BIRMINGHAM

Hands on Health Clinic requires an professional & motivated Chiropractor to join our expanding clinic.

If you are passionate about chiropractic care with excellent clinical & communication skills we want to hear from you. The successful candidate must enthusiastically maintain the existing patient base, whilst growing their own.

We are a multidisciplinary clinic including Massage Therapists, Sports Therapist, Counselors & Hypnotherapist who liaise to ensure patients receive the best care.

Our Chiropractors use primarily diversified technique, along with needling, blocking & soft tissue techniques.

The current position is available from July 2018 covering 3-4 days a week, including 2 evenings & Saturdays. For further details send your CV & cover letter to:

Contact: Gem Phipps Location: Birmingham Phone: 0121 325 1927 Email: [email protected]

CALLING ALL ASSOCIATES – BRISTOL – BASED ON % £40-90K+

Existing patient base. Do you know how to build the practice you want, whilst remaining true to your personal values? We believe that success is the inevitable result of doing what is best for your patients in every case. If this resonates with you, whatever your level, we want to hear from you.

Join us in the beautiful city of Bristol, the Sunday Times best place to live 2017. Based in the South West, this is a city that does not disappoint. With a vibrant cultural and social scene, excellent schools, a superb international airport, surrounded by beautiful countryside and only 1.5 hours from London or beautiful beaches.

Join a clinic which is at the centre of its community and be part of a group of chiropractors who are all passionate about helping people to live their lives to the full through chiropractic care. Our clinics are fantastic contemporary spaces, our focus is to provide an environment where patients can trust that they will feel cared for. Enjoy significant freedom and autonomy, making your own decisions about how you practice whilst enjoying the support of being part of a larger team.

Our marketing team ensure you don’t have to worry about where your new patients are coming from. With an in-house coaching team; you can learn and progress to become the best version of yourself. Our unique working environment has enabled many chiropractors to develop their passion and, in every case, our team members enjoy greater clinical, personal and financial success.

About the role:• A complete patient centred approach to practice

– we always put patients first• A typical 30 hours per week in practice leads to

earnings significantly above an average Chiropractor• Full-time in-house Coach to support your growth

and development• Get personal support with the challenges you face

in your career• Access to the Willow training centre including

CPD events• In-house marketing team to ensure you are never

stressed about where new patients are coming from• We have a lot of fun and care for each other, we

have regular social events

• Choose your own treatment times and method of working

• Learn directly from highly successful chiropractors, with your own mentor

• Partnership development program for the most successful, leading to clinic ownership

• Become a mentor to less experienced chiropractors and learn how to be a coach

Don’t take our word for it – come and meet the team, shadow us, ask us questions.

If you have any questions or would like an informal chat please get in touch today.

Contact name: Pippa Cliff Location: Bristol Webpage: www.willowlife.co.uk Contact email: [email protected]

EXCELLENT CHIROPRACTOR FOR SAYER BACK PAIN CLINICS: LONDON (CITY BRANCH) TO START APRIL 2018

Join us part-time at London's leading Clinics to take over a patient base.

Confident, experienced, self-motivated, great adjuster and enthusiastic chiropractor to practice at Sayer Clinics London from March 2018. GCC registered with valid professional indemnity insurance.

You should have outgoing personality, positive energy, fitness, excellent diversified and digital radiology skills.

Please see: www.sayerclinics.com Email CV to: [email protected] Call: 020 7937 8978

PRACTICE IN SUNNY SCOTLAND!

A motivated Chiropractor is needed to take over a part-time position in Bridge of Allan. Presently offering 3 or 4 days a week with potential to expand hours. We are situated just beside Stirling in an affluent community close to the university. Road , rail, bus links all very close. Established in 2001 we are a friendly, busy clinic that includes a massage therapist and podiatrist. A long term commitment is important.

Please visit AllanwaterChiropractic.co.uk for info regarding our clinic

Contact name: James McGee Location: Stirling, Scotland Webpage: AllanwaterChiropractic.co.uk Contact email: [email protected]

ASSOCIATE REQUIRED FOR HAMPSHIRE CLINIC

Come and join us!!

Self employed, enthusiastic, motivated chiropractor, preferably with SOT experience, required to join multidisciplinary clinic in Hampshire.

At The Botley Chiropractic Clinic we strive to achieve optimum health for patients with our team of practitioners providing Chiropractic Care, Sports Massage Therapy, Hypnotherapy and Podiatry.

We are flexible on hours and days and successful associate would be able to tap in to our present patient base as well as building their own.

Please send your letter and CV to [email protected]

Contact name: Dr Pam Elkins Location: Hampshire Phone: 01489 787170 Webpage: www.botleyclinic.com

ARE YOU MOTIVATED AND INDEPENDENT?

Do you wish to start with an established base of patients, earning from day one but willing to grow within the practice?

We are looking for a new graduate or experienced Chiropractor to join our friendly, established team in Rugby, Warwickshire.

This is a full-time position, taking over an existing patient base offering earnings of £75,000 per annum.

We are looking for a confident, hardworking chiropractor with exceptional communication and adjusting skills.

A high level of ongoing support will be provided by our other DC’s and receptionists.

You will need to be hard working and enthusiastic, know what a positive change Chiropractic can be to patients’ lives and be able to convey your conviction.

Please send CV and covering letter to [email protected]

Contact name: Connor Salter Location: Rugby, Warwickshire, Midlands Phone: 01788 565100 Webpage: www.cliftonroadchiro.co.uk

ASSOCIATE POSITION AT ADVANCED CHIROPRACTIC CLINICS, ESSEX.

Associate position available in busy and expanding group of clinics in east Essex. Advanced Chiropractic are looking for a motivated, enthusiastic, confident and energetic associate to join our award winning multidisciplinary team.

Due to patient demand we are expanding our reach and we need more fantastic Chiropractors to join our team. The successful applicant would be taking over a current patient base and joining our Maldon clinic as a full-time, self-employed associate. Our vibrant, fun and successful team are proud to have been awarded “Best Customer Service in Essex” and all our clinics have been awarded both PPQM and CMQM quality marks. Both Chiropractic and business mentoring, self-improvement and PRT training is available with our clinic directors and external speakers. Our Chiropractors use mainly diversified techniques, activator technique, dry needling, exercise, FMS and rehabilitative care.

Massage therapists work alongside the Chiropractors to provide all round care to our patients.

The right candidate must have great communication skills, be a confident adjustor and a team player. Join a professional, fun, lively community and get the most out of your job.

Send your CV and covering letter to [email protected]

Contact name: David Elliott Location: Essex Phone: 07793 768825 Webpage: www.advancedchiropractic.co.uk

ASSOCIATE CHIROPRACTOR WANTED – SOUTHAMPTON REGION – P/T OR F/T

You must be confident with good adjusting and excellent communication skills.

New graduates considered.

CV to: [email protected] Contact name: Practice Manager Location: Southampton Contact email: [email protected]


CLASSIFIEDS

CHIROPRACTOR REQUIRED IN THE NETHERLANDS

We are looking for an enthusiastic, confident, motivated associate to join our team. This is a fantastic opportunity to join 2 busy, friendly and thriving practices in the North West of The Netherlands. This is a full time, self employed position working between Heerhugowaard and Volendam. 2 years experience preferred. We are offering a competitive rate of commission and the full support from 2 well established clinics with excellent potential for future growth.

Contact name: Wim Kes Location: The Netherlands Phone: 0031299650740 Webpage: www.chiropractiekes.nl Contact email: [email protected]

OPPORTUNITY OF A LIFETIME TO LIVE AND PRACTICE IN SUNNY DUBAI!

Pure Health Dubai is seeking chiropractors to work for our rapidly expanding practices. We pride ourselves on being ethical, highly effective and providing an international level of chiropractic care in the country.

We provide:• Base salary and excellent incentives• Relocation assistance• Full support team of assistants and translators

Qualifications you MUST have:• Minimum 2 years experience• Desire to grow personally and professionally• Proficient adjusting and analysis skills

Pure Health Dubai is supported by a team of Physiotherapists and also offers Child Development Care including Occupational, Speech and Behavioural Therapy.

We are looking for doctors who are interested in developing new skills, and working as part of our high tech and multidisciplinary team.

Please email [email protected]

OPPORTUNITY TO JOIN A SUCCESSFUL AWARD WINNING CLINIC IN GLOUCESTERSHIRE

If you want to be the best you can possibly be and are looking for your next challenge then we would like to hear from you. Both grads & experienced chiros are welcome to apply.

Here's what we offer:• Excellent financial reward• Fantastic well established multidisciplinary team• PRTS mentor training• Fully equipped, well furnished rooms• On-site digital x-ray• Diagnostic ultrasound• Sports & massage therapy• Gait analysis and orthotics• PPQM and CMQM• Strong links with GPs and local community• Busy with a solid marketing strategy

We are a sports injury clinic but we look for chiros with a variety of interests, not just sport, so we are keen to hear about your own area of interest / specialisms.

Contact name: Leah Rose Location: Gloucester Phone: 07786 010078 Webpage: www.longlevenschiro.com Contact email: [email protected]

FULL TIME ASSOCIATE WANTED IN BUSY CLINIC IN KENT

Come and join our amazing wellness clinic.We have an amazing opportunity for an associate to join our happy and inspired team. We are based in Chislehurst, Kent. Our fantastic location means we have the best of both worlds being 25 minutes from London, yet surrounded by beautiful countryside.

Having had several associate positions ourselves we understand the importance of working in a supportive environment. We love mentoring our passionate team to achieve their goals.

We have a thriving patient base and will ensure that you have the opportunity to build yours as well.

We are right for each other if you:• Want mentoring from experienced, inspired

chiropractors.• Are a team player who loves to get involved.• Want a full time position with excellent work life

balance.• Want great salary potential.• Want GCC and UCA/BCA fees paid.• Want great support and keen to grow in an

empowering environment and also interested in personal development and wellbeing.

• Want to work in a newly extended and refurbished centre, with computerised notes, x-ray facilities and purpose built class space.

• Want fantastic career progression opportunities.

Our passion is to give you the best start.

Send your application and covering letter on why you would like to work with us via email to [email protected] and check out our link chislehurstchiro.com/kickstart for some great information to get you started.

Contact name: Emma Byrne Location: Chislehurst Phone: 0208 2951 733 Webpage: https://chislehurstchiro.com Contact email: [email protected]

PART TIME POSITION IN CHIROPRACTIC CLINIC IN ALTON, HAMPSHIRE SEEING PRIVATE AND NHS PATIENTS

Position available immediately to replace Chiropractor who has left.

Contact name: Mark Christensen Location: Hampshire Phone: 01730 267423 Webpage: www.b2h.co.uk Contact email: [email protected]

ASSOCIATE CHIROPRACTOR REQUIRED TO TAKE OVER EXISTING PATIENT BASE IN CORNWALL

We are looking for an enthusiastic, self-motivated chiropractor to join our well established, semi-rural clinic. Primary techniques are diversified with STW & rehab exercises; experience of SOT & dry needling advantageous but not essential.

Self employed position based on % take home, starting in August.

Post suitable for new grad or experienced.

Send CV & covering letter to: [email protected]

Contact name: Emma Staton Location: Redruth Phone: 01209 204600

EXPERIENCED ASSOCIATE CHIROPRACTOR WANTED FOR ESTABLISHED LONDON MULTIDISCIPLINARY CLINIC

We are an established multidisciplinary clinic located in the Fulham, west central London. The clinic is ideally located in an affluent area close to many transport links offering easy access to all areas in and out of London. Fulham is an area that has developed significantly over the past 20 – 30 years and is becoming a hub for private health clinics and health and lifestyle businesses with an active and health conscious local population.

Since opening in 2010 we have worked hard to build our reputation in the area and have also strived to build a team of like-minded and motivated health professionals. We are now looking for an experienced chiropractor who has a desire to focus on delivering excellent patient care and developing a long term position within our company. The chiropractor should be confident to take the role of a lead practitioner, guiding trainers and massage therapists to deliver effective co-management where necessary. As a team we are focussed on working hard to continue to grow and develop the clinic whilst still maintaining a healthy work life balance. We have a healthy supply of new patients normally ranging between 30-50 per month with huge opportunity for growth with the right candidate.

We are only asking for applications from chiropractors with a minimum of 3 years experience who would like to join a company that will help them continue to build a solid career as a respected health professional in London with many routes of opportunity.

Please send a cover letter and CV to [email protected]

Contact name: Luther Location: London Webpage: www.ml-chiropractic.com

PRACTICE FOR SALE

PROFITABLE, ESTABLISHED CLINIC FOR SALE IN BEAUTIFUL CORNWALL

Fantastic opportunity to purchase a thriving clinic in a fast developing area.

484 square foot, operates as two adjusting rooms at present, however easy to adapt to open plan if desired.

• Well established and busy clinic, averaging 20 NP per month.

• Sought after Exclusive access to local Shows/events booking up to 40 New Patients per show.

• Written manuals, including front desk and DC systems – enable fulfillment of a thorough and smooth patient journey and experience.

• Supported maintenance programme for our long-standing patients.

Includes all equipment:• Ergosystems drop bench.• Thiule portable bench with hi/lo stand.• Large touch screens in treatment rooms.

Owners willing to offer supported transition of ownership.

Sale due to owner relocating nearer to family.

Location: Mid Cornwall Webpage: On request Email: [email protected]


CLASSIFIEDS

Terms£60 minimum for up to 400 characters. £75 for 401-800 characters. £15 for every additional 400 characters after 800.

Charges for non-BCA members will attract an uplift of 25%.

• Payment must be received by copy date

• Payment by card, BACS, or cheque (made payable to BCA)

• There is no VAT

• To advertise or reply to a box no. contact: Ann Goble, British Chiropractic Association, 59 Castle Street, Reading, Berkshire RG1 7SN. T: 0118 950 5950 F: 0118 958 8946 E: [email protected]

• Confirmation of booking: all advertising must be confirmed in writing and paid for before copy date, otherwise entry cannot be guaranteed

• Tell us if you also want to place your advert in the In Touch Newsletter or online

• If you would like a box no. please enquire

• Contact’s acceptance of classified advertisements does not imply that advertisers are members of the BCA

• The BCA reminds all advertisers that they must comply with Advertising Standards Authority rules and that recruitment classifieds must also comply with laws on discrimination. The BCA will make best efforts to point out where adverts may fall short of legislation, but ultimately, the responsibility must rest with the person placing the ad.

CLINIC FOR SALE IN VIBRANT, UPMARKET TOWN OF ASHBOURNE, DERBYSHIRE

Established in 2014 the clinic comprises: private ground floor access, 2 treatment rooms, reception, kitchen & WC. Currently run part time with no advertising costs, huge potential for expansion. Selling due to owner relocation. Priced to sell.

Contact name: Victoria Cartwright Location: Derbyshire Webpage: www.ashbournechiropracticcentre.co.uk Email: [email protected]

WEST LONDON PRACTICE FOR SALE

Situated at the north end of the Portobello Road in London's Notting Hill. Private street level access and ground floor level throughout (approx 900sq feet). Current lay out is set as generous reception area, changing area and very large treatment room. Could be divided easily to create second treatment space. (Current owner opted for x-ray facilities, but has since outsourced this to a local private diagnostic centre).

The practice was established 8 years ago and sees on average 6-8 new patients weekly along side reactivations and maintenance patients in the region of 50 per week (over 3 days). This is not a high volume practice, and as such will see a patient on average between 4 and 5 visits before discharge. This approach has the benefit of creating steady referrals to the practice. Organic (non paid) internet searches provide around 40% of new patients. There is no advertising costs other than maintaining the website. It has a very good working relationship with local independent gyms. A remote reception service covers phones from 8:30am to 6pm Monday

to Friday (total annual cost of this is 5% of full time staff). Turnover is around 75K/year.

Would suit a young Chiropractor/s looking for independence.

Currently there is 2 years left on a ten year lease (£1500/month), with a very good, proactive landlord.

Reason for sale: practitioner is relocating to the South West of England.

Offers in region of 40K

Contact name: Nick Location: London Webpage: www.portobellochiropractic.co.uk Email: [email protected]

CLINIC FOR SALE – LEAFY SOUTH SURREY

South Surrey Chiropractic Multitherapy Clinic for Sale

£85K for Busy clinic in beautiful village 8 miles south of Guildford, £120-130K turnover, 9-year lease, 3 treatment rooms, bright well maintained building, own car park with 7 spaces, high reputation, staff on both percentage and room rental; 2 p/t front desk staff, chiropractor, osteopath, masseur, reflexologist with room time and potential to accommodate a lot more treatments for a much bigger turnover with the right manager and marketing. Info, Data & Valuation pack available upon request. Negotiation with landlord may give potential for a joint human / animal practice in the middle of horse & hound country. 2-Bedroom House 200m from Clinic also currently for sale.

Contact Manager/Owner on [email protected]

FANCY A CORNISH COUNTRY LIFE?

Established Chiropractic clinic over 21years in Truro. NEW PRICE OF £65,000.

Email: [email protected] for more information or call 01872 264040.

YOUR BCAThe various committees of the BCA; Conferences, Student/New Graduate, PR & Marketing and Contact Editorial Board are all looking for new members.

Interested? Get in touch [email protected]

PRODUCT FEATURESThe Chiro 8 – 8 Section Chiropractic Table (Electric) with 4 sections of adjustable tension – drops at the head thorax and abdomen sections.The Chiro 8 has the following features:• 4 Sections are equipped with adjustable tension-drops• 2 Fixed arm rests for absolute patient comfort • 1 Electric motor for height adjustment• 8 Upholstered sections • Twin oversized pillars for added stability• 2 Individual levelling feet at head end• 2 Hauling wheels at the rear – designed to be lifted and moved around by lifting just the arm rest• Maximum load capacity 225kgs / 496lbs

Order Now on 0161 429 7330 Delivery charge applicable

Unit 8, Martel Court, S. Park Business Park, Hamilton Road, Stockport, SK1 [email protected] 429 7330

www.thetenscompany.co.uk

CONTACT US

Chiropractic 8 Section Electric TableBuy direct from the Manufacturer

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£2,795 £1,995Save £800

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£2,995 £2,195Save £800

PRODUCT FEATURESThe Chiro 8+ – 8 Section Chiropractic Table (Electric), has 4 sections of adjustable tension – drops at the head, thorax and abdomen sections.The Chiro 8+ has the same features as the Chiro 8 plus the ability to control the head via an electric motor, controlled by an easy to use joystick for precise adjustment.

Chiro 8 Chiro 8+

The adjustable tension drop can be initiated on all sections of the bodyCervical Drop | Lumbar Drop | Thoracic Drop | Pelvic Drop

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