Tag Archives: drx9000c

Spinal Decompression or Chiropractic?

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Spinal Decompression Therapy with DRX9000

We have been providing chiropractic and spinal decompression services in San Francisco for over 20 years in the Financial District.

Often times patients present to our clinic with back or neck pain related to a herniated disc and say they are interested in nonsurgical spinal decompression with the DRX9000 or DRX9000c.

This is great, but it may not make the most sense. The reason I say this is that pinched nerves due to bulging or herniated discs respond favorably to conventional chiropractic care, which is cheaper and less of a time commitment than disc decompression.

Sure, a certain percentage of herniated disc patients will not respond to chiropractic and will end up on the decompression machine…but we find it works best when we try chiropractic first.

Some patients do not want to try chiropractic for various reasons and we will honor their wishes and initiate decompression. Some patients have already tried chiropractic without favorable results so we go right to decompression. And sometimes we do both chiropractic and decompression together.

All cases are different. When you have as much experience as we do treating lumbar and cervical disc herniations non-surgically, you get good at mixing and matching therapies. We also incorporate acupuncture, physical therapy, and deep tissue laser as needed into the mix and the results are outstanding.

So, if you have been diagnosed with a herniated disc and are wondering if you should try chiropractic or spinal decompression, why not go to a chiropractor that does both and has lots of experience. Chances are you will be glad you did 🙂

To schedule an appointment with one of our back pain doctors in San Francisco please call 415-392-2225.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Neck and Shoulder Pain?

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DRX9000c Cervical Decompression

We have been providing nonsurgical treatment for neck and shoulder pain in San Francisco for over 20 years in the Financial District.

If you are experiencing neck, shoulder or arm pain you may have a “pinched nerve” from a herniated or bulging disc in the neck. There are other causes as well such as misaligned vertebrae, muscle spasms, degenerative disc disease or spinal stenosis.

Chiropractic care is probably your best bet for a pinched nerve in the neck. If chiropractic fails to deliver results there is always nonsurgical cervical decompression with the DRX9000c.

Cervical decompression systems like the DRX9000c are designed and built to treat cervical disc herniations and bulges naturally. They do this be enlarging the disc space, elongating the spine, and strengthening the spinal muscles ligaments and tendons.

A typical course of treatment is 20 sessions over a 6-8 week period. The sessions are an hour long. Treatment cost is approx $3500 depending on what level of service is required.

Success rates are high if your case is accepted.

To find out if you are a candidate for neck and shoulder pain treatment in San Francisco call 415-392-2225. Ask for a complimentary consultation.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Pinched Nerve in the Neck?

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DRX9000c Cervical Decompression

Have you been told you have a Pinched Nerve in the Neck? Or, do you just feel like you have one? What is a pinched nerve anyway?

Well, a pinched nerve in the neck is a term used to describe the pressure or trapping of a cervical nerve root mostly from a bulging or herniated cervical disc. Degenerative disc disease, vertebral subluxatons, and facet syndrome can also cause pinched nerves.

Nerves are very delicate and sensitive to any kind of pressure. Famous research studies from the University of Colorado demonstrated that just the weight of a pencil erasure on a nerve can interfere with the transmission of the nerve impulse by 60%.

When nerves become irritated it can cause severe pain and dysfunction. The nerves that exit from the bones in the neck travel down the arm and into the hand. When these nerves become pinched, stretched or irritated it can cause neck pain, shoulder pain, arm pain, and hand pain. Now this does not mean if you have a pinched nerve you will have all these symptoms, heck you might not have any symptoms at first…these are just some of the symptoms that can present from nerve pressure in the neck.

You may also experience numbness and tingling in the arms or hands, weakness of grip, night pain, and swelling in the hands and fingers. Some patients even get headaches.

The symptoms in the hand can mimic those of carpal tunnel syndrome (CTS).  In fact, you can have a herniated or bulging disc in the neck and be experiencing the signs and symptoms of CTS without any neck pain at all. This can lead to a misdiagnoses and unfortunately, unnecessary carpal tunnel surgery.

A chiropractor or orthopedic doctor that specializes in the neck, arms, and hands is your best bet for pinched nerve treatment. They will most likely order cervical x-rays and a cervical MRI…maybe even a nerve conduction test of the upper extremities.

Once a determination and diagnosis is made of the underlying condition, most likely a herniated disc in the neck, then treatment will commence.

Chiropractic care is probably what we would recommend first as it is very safe, gentle and effective. If chiropractic fails to deliver results we can try nonsurgical cervical decompression with the DRX9000c, a machine designed and built to treat pinched nerves resulting from herniated and bulging discs. We would not recommend rushing into neck  surgery unless it is an emergency (most are not). If chiropractic and spinal decompression fail to deliver a favorable outcome you are still whole and can pursue other treatment options, including surgery.

To find out if you are a candidate for care at our San Francisco Spinal Decompression Center please call 415-392-2225 and ask for a complimentary consultation. 

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Cervical Disk Herniations: Common Questions

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DRX9000c Cervical Decompression

We have been providing natural solutions for cervical disk herniations in San Francisco for over 20 years now in the SF Financial District. We are located in the landmark Embarcadero Center One.

Last month, we discussed the topic of neck pain arising from cervical disk herniations. The focus of this month’s Health Update is common questions that arise from patients suffering from cervical disk derangement.

1. “What can I do to help myself for my herniated disk in my neck?” The mnemonic device “PRICE” stands for Protect, Rest, Ice Compress, and Elevate is a good tool to use in the acute stage of many musculoskeletal conditions.

  • Protect your health by NOT placing yourself in an environment that is likely to harm you, such as playing sports or doing heavy yard work. That is, think about what you do BEFORE you do it and if sharp, radiating pain occurs, STOP and assess the importance of what you are doing. Use the concept, “…don’t pick at your cut.” This means if you want the injury to heal, don’t keep irritating it!
  • Rest is similar. Limit your activities to those that can be done without increasing symptoms, especially radiating pain.
  • Ice – The use of ice reduces swelling/inflammation, which reduces pain and promotes healing. Alternate it every 15-20 minutes (on/off/on/off/on) several times a day. You can also use contrast therapy (Ice/heat/ice/heat/ice) at 10/5/10/5/10 minute intervals to “pump” out the swelling.
  • Compress – The use of a collar worn backwards, if it’s more comfortable that way, can literally “take the load off.” the neck and disks. There are even inflatable collars which are pumped up with air to traction the neck. Other forms of traction will be discussed further.
  • Elevate – The concept of raising the ankle to the height of the heart so swelling can drain out of the ankle is the classic example of “elevation.” In the neck, the traction concept may apply once again.

 

2. “I don’t want to have surgery if I can help it. What can you do as a chiropractor to help me?” This is one of our primary goals, and in fact, the goal of ALL health care providers, even surgeons! Chiropractic offers anti-inflammatory measures: ice, herbal anti-inflammatory agents (ginger, turmeric, bioflavonoid, curcumin, bromelain, Rosemary extract, Boswellia Extract, and more), digestive enzymes taken between meals, muscle relaxant nutrients (valerian root, vitamin D, a B complex, chamomile, magnesium, and others) as well as other non-pharmaceutical options. Treatments consist of manual manipulation, mobilization, traction (for home and office), modalities such as deep tissue laser therapy and low-level laser, electrical stimulation, magnetic field, ultrasound, and others. We also offer nonsurgical cervical decompression with the DRX9000c. Most important is having a “coach” guide you through the stages of healing by first addressing the acute inflammatory stage (first 72 hrs), the proliferative or reparative phase (up to 6-8 weeks), followed by the remodeling phase (8 weeks to 1 or 2 years) and finally, the contraction phase (lifetime – includes the natural shortening of scar tissue). If manual traction reduces neck and arm pain, the use of home traction is very effective. Options include sitting over-the-door traction, laying down versions, and mobile traction collars (discussed previously). Exercises to stretch and strengthen the neck are also very important in reducing neck pain as well as preventing recurrences. If in spite of all the best efforts of this non-surgical care approach should ongoing neurological loss and relentless symptoms continue, we will coordinate care with physiatrists for possible injection therapy and pharmaceuticals, with neurology for further testing (such as EMG/NCV – a nerve test), and/or neuro- or orthopedic surgery – THE LAST RESORT!

            We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

To schedule a consultation for cervical disk herniation treatment in San Francisco please call 415-392-2225. Mention this blog post for a complimentary consultation.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Cervical Decompression or Neck Surgery?

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DRX9000c Cervical Decompression

We have been providing treatment for cervical disc herniations in San Francisco for over 20 years now. About 8 years ago or so we began to incorporate cervical decompression with the DRX9000c into the mix. Since then we believe we have helped prevent many neck surgeries.

How many times have you heard, “I have a pinched nerve in my neck and have to have surgery.” Though there certainly are cases where surgical intervention is required, surgery should ONLY be considered after ALL non-surgical treatment approaches have been tried first (and failed). It is alarming how many cases of cervical radiculopathy (i.e., “pinched nerve”) end up being surgically treated with NO trial of non-surgical care. Hence, the focus of this month’s article will look at research (“MEDICAL EVIDENCE”) that clearly states neck surgery DOES NOT improve the long term outcomes of patients with chronic neck pain.

Chronic neck pain (CNP) is, by definition, neck pain that has been present for a minimum of three months. This category of neck pain is very well represented, as many neck pain sufferers have had neck pain, “…for years” or, at least longer than three months. Depending on the intensity of pain and it’s effect on daily function, many patients with CNP often ask their primary care provider, “…is there anything surgically that can be done?” The desire for a “quick fix” is often the focus of those suffering with neck pain. Unfortunately, according to recent studies, there may not be a “quick fix” or, at least surgery is NOT the answer. The December 2012 issue of The European Spine Journal reports that spine surgery did NOT improve outcomes for patients with CNP. Moreover, they pointed to other studies that showed some VERY STRONG REASONS NOT to have spine surgery unless everything else has failed. One of the reasons was a higher hospital readmission rate after spine surgery. Another reported that most studies on surgical vs. conservative [non-surgical] care showed a high risk of bias, suggesting the research on surgical intervention was biased in the research approach used. They further reported, “The benefit of surgery over conservative care is not clearly demonstrated.” It is important to point out that the research analyzed studies that included patients with and without radiculopathy (radiating arm pain from a pinched nerve), and myelopathy (those with pinching of the spinal cord creating pain, numbness, weakness in the legs, and/or bowel / bladder dysfunction).

In February of 2008, the Neck Pain Task Force published overwhelming evidence that research supports the use of cervical spinal manipulation in the treatment of both acute and chronic neck pain with or without radiculopathy. Bronfort published similar findings in 2010 in a large UK based study that looked at the published evidence supporting different types of treatment for various conditions. They found cervical spine manipulation was effective for neck pain of ANY duration (acute or chronic). Chiropractic utilizes manipulation, manual traction, mobilization, muscle release techniques, home cervical traction, exercise, as well as a multitude of physiotherapy modalities when managing patients with CNP. Given the overwhelming research evidence that surgical intervention for CNP is NOT any better than non-surgical care, the greater amount of negative side-effects, and the obviously long recovery time post-surgically, chiropractic treatment of anyone suffering from CNP should be tried FIRST.

We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

If you are considering neck surgery than you owe it to yourself to find out more about cervical disc decompression with the DRX9000c.

 To schedule an appointment with one of our Cervical Decompression Doctors in San Francisco please call 415-392-2225

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Spinal Decompression for Bulging and Herniated Discs

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Pinched Lumbar Nerve Causing Sciatica

We have been treating bulging and herniated discs in San Francisco for over 20 years now. About 8 years ago we began to incorporate nonsurgical spinal decompression into the mix. The machines we use are the DRX9000 Lumbar Decompression system and the DRX9000c Cervical Decompression machine. The results have been outstanding.

Some common symptoms of herniated and bulging cervical and lumbar discs are as follows:

  • Low Back and Neck Pain
  • Arm and Leg Pain (sciatica)
  • Arm and Leg Weakness
  • Numbness and Tingling in the Arms and Legs
  • Weakness of Grip
  • Abnormal Gait
  • Night Pain

Nonsurgical spinal decompression therapy is able to repair the bulging disc and often times prevent disc herniation. And once a disc has herniated spinal decompression can help the disc heal and return to more normal function. Disc decompression elongates the spine, enlarges the disc space, re-positions the injured disc to a more normal position, re-hydrates the disc, and strengthens the spinal ligaments and tendons.

Success rates are very high and spinal decompression therapy has now become the gold standard for nonsurgical treatment of neurovascular compression syndromes such as herniated and cervical disc syndromes.

To find out if you are a candidate for the DRX9000 or DRX9000c, contact our San Francisco Spinal Decompression Clinic and ask for a complimentary consultation. 

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Cervical Traction Protocols and Indications

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DRX9000c Cervical Decompression

Often times, cervical traction is indicated for neck, shoulder or arm pain. If the problem is a bulging or herniated disc than cervical traction done at home or in a doctors office  may not be such a good idea. This is when you want to consider nonsurgical spinal decompression with the DRX9000c.

Last month, we looked at the published evidence that overwhelmingly supports the use of cervical traction. As promised, this month’s focus is the proper methods of applying it. The type of traction that this discussion will address will be limited to the kind that can be purchased and then used in the home, usually multiple times a day, giving it a clear advantage over in-office traction treatments which can only be applied a few times a week during office visits. In some cases however, it may be appropriate to use the in-office type for a few sessions to determine dosage and/or tolerance prior to administering a home unit, but this varies from case to case, and each type of traction unit is different. In the neck or cervical spine, there are many varieties including: sitting over-the-door types, cervical collar types, as well as supine (lying on the back) types. Each variety has its pros and cons and prices vary considerably from $10 to $600.

            CONDITIONS: Probably the most common condition treated with cervical traction is “cervical radiculopathy,” or a pinched nerve. When a nerve root in the neck is pinched, pain, numbness, tingling, and/or muscle weakness occurs in the area the particular nerve innervates. For example, if a patient presents with pain and numbness radiating down the arm to the thumb and index finger and/or have weakness in bending their elbow and extending their wrist, then we know that the C6 nerve is pinched. When pulling or stretching the neck relieves the arm pain, traction is usually helpful. If pain worsens, the person is probably not ready for traction yet.

            PROTOCOL (DOSAGE): The key to a successful outcome using cervical traction is finding the right dosage. If you start with too much weight, it may leave you feeling sore, or worse, making you reluctant to try it a second time. Therefore, rather than relying on using a certain percentage of body weight, it’s safest to start with less weight and then gradually increase it, such as 5# (# = pounds or .45 kg) for 15-20 minutes. If that dose feels fine, try 7#/15-20 min., then 9#, 11#, 13#, etc., until you find it just isn’t quite as comfortable at the last weight. You have now found your current threshold and should drop down to the last most comfortable weight and use that for a few days and then MAYBE try increasing it again. Studies show a maximum stretch is usually achieved within 15-20 minutes, so extending the time longer may be less productive. Facing the over-the-door unit may be better tolerated than facing away. Try it both ways and you decide which feels best. The next most important issue is frequency.

            How often to repeat the traction sessions depends on: 1. The condition’s severity and your response; 2. Your time availability. If there is a severe nerve pinch with muscle twitching, weakness and dense numbness/tingling, then the traction be repeated MANY times a day, gradually increasing the weight to find the optimum amount. We’ve had people repeat the traction 10x/day! With the option of wearing a cervical collar traction unit, you can actually travel and/or do certain activities during traction. We’ve had people travel to and from work while performing traction! Since each case is unique, we’ll discuss that individually. The bottom line, IT WORKS GREAT with proper chiropractic management and in many cases, surgery CAN be avoided!

            We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

To schedule a complimentary consultation for cervical spinal decompression in San Francisco call 415-392-2225 and mention this blog post.

 

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Is Spinal Decompression Affordable?

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DRX9000 Lumbar Decompression

We heave been providing spinal decompression therapy in San Francisco for 9 years now. We were the first to introduce the DRX9000 and DRX9000c to the SF Bay Area.

Slowly, over the years, more decompression machines began to appear in other back pain clinics. Now that disc decompression is mainstream and there are more machines, the price has come down. Supply and Demand 101.

In reality, the difference in price does not mean much when you consider what you are getting in return…your life back!

For instance, when I purchased my first lumbar decompression machine it costs me $150,000. I ordered the combination unit with the DRX900c so we could treat cervical and lumbar disc herniations. Then I ordered a few more machines because the demand was so great. Our price, depending on the package was between $6000-$12,000. That was 7-8 years ago.

Now, because there are more spinal decompression system’s in San Francisco, and there are quite a few used machines for sale on the secondary market, the price is anywhere from $2500-$5000, depending on how many sessions and the adjunctive therapies. Big difference.

There is something you should know though. It’s possible to have a machine like the DRX9000 and not know how to operate it properly and successfully manage cervical and lumbar disc patients. We were already experts at this so the decompression just made things better. Lots of new doctors purchase the machines and do not get good results. It takes time to master the harnessing process and the control system of the decompression machine.

The more chronic neck and back pain cases you manage the better you become. I am confident that we have performed more spinal decompression sessions than any clinic in the SF Bay Area, so we have lots of experience. It is rare when we do not achieve a favorable outcome. But it can happen.

So…there you go. Disc decompression therapy is a lot cheaper these days than it used to be. It’s still not covered by insurance, but if you have insurance we can use it for re-exams, exercises, ice, and some parts of the treatment to lower your costs.

If you would like to make an appointment with one of our San Francisco Spinal Decompression Doctors please call 415-392-2225.

 

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Traction: Does It Help Neck Pain and Headaches?

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DRX9000c Cervical Decompression

We have been providing neck pain treatment in San Francisco for over 20 years now. We have incorporated cervical traction and now nonsurgical spinal decompression  with the DRX9000c.

Traction is defined as, “…the act of pulling a body part.” Therefore, it is commonly used in many regions including legs, arms, low back, mid-back, and the neck. We will be limiting this discussion to cervical or neck traction, and the question of the month is, “…does it help patients with neck pain and headaches?” Though I’m assuming you already know, the answer is YES! You may want a little “proof,” so here it goes!

  1. REDUCES DISK PROTRUSIONS: In 2002, a medically based study found traction to be very effective in the treatment of cervical radiculopathies (pinched nerves in the neck that radiate pain into the arms). A 2008 study using MRI (images) described the effect traction had on the disk protrusions in the neck reporting 25 of 35 (or 71%) were reduced while in traction with a 19% increase in the spacing (disk height) and improved neck range of motion after the traction was applied. They postulated that by pulling the vertebrae in the neck apart, there was a suction-like effect pulling the disk material back in place.
  1. RECOMMENDED BY GUIDELINES: Around the world, guidelines have been published giving doctors information that allows us to know how well certain forms of treatment work for different conditions. In a 2008 publication, it was reported that, “Clinicians should consider the use of mechanical intermittent cervical traction, combined with other interventions such as manual therapy and strengthening exercises, for reducing pain and disability in patients with neck and neck-related arm pain.”
  1. CLINICAL PREDICTION RULES: These help us determine who is most likely to benefit from a certain type of treatment (in this case cervical traction and exercise). If 3 of 5 variables are found, the likelihood of success with traction & exercise was reported to be 79%, and if 4 of the 5 are found, 90%. The 5 variables are: 1. Radiating neck to arm pain in certain positions; 2. Positive shoulder abduction sign; 3. Age >55years old; 4. Positive limb tension test; 5. Relief of symptoms using manual distraction test (if pain is relieved while the neck is being pulled).
  1. INTERMITTENT AND CONTINUOUS TRACTION: Either way, significant improvement in neck and arm pain, neck mobility, and nerve function occurred with both approaches.
  1. TRACTION VS. SURGERY: In this study, patients with radiating arm pain and positive neurological findings on exam were offered a course of traction before surgical options. They reported 63 of 81, or 78%, of the patients experienced significant or total relief, 3 could not tolerate traction and 15 simply didn’t respond. They concluded that when neck and arm symptoms with neurological deficits were present for 6 weeks, that 75% will respond to neck traction over the next 6 weeks.

            There are MANY additional studies available that show well beyond doubt that cervical traction is a GREAT option in the management of neck and arm pain and sometimes headaches. Next month, we will discuss “HOW TO” apply cervical traction.

            We realize that you have a choice in where you choose your healthcare services.  If you, a friend or family member requires care for neck pain, we sincerely appreciate the trust and confidence shown by choosing our services and look forward in serving you and your family presently and, in the future.

To schedule an appointment with one of our San Francisco Spinal Decompression Doctors call 415-392-2225.

 

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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Cervical Decompression for C7 Disc Bulge

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DRX9000c Cervical Decompression

We have been providing spinal decompression therapy in San Francisco for over 8 years now. The machine we use is the DRX9000c.

Cervical decompression systems are designed and built to treat bulging and herniated cervical discs without drugs or surgery.

The C7 disc bulge is one of the most common conditions we treat with the DRX9000c. The C7 disc is the disc at the very bottom of the cervical spine in between the C7 and T1 vertebra. The C7 disc will often bulge as an adaption to things like abnormal stresses from poor posture over time, injury (sports, auto accident, repetitive strain) or degenerative disc disease…to name a few.

Typically, a bulging disc in the neck will eventually herniate if left untreated. This is why it’s so important to get the right kind of treatment as soon as the disc bulge is diagnosed.

Cervical disc decompression treats bulging and herniated disc by elongating the spine, re-positioning the disc, enlarging the disc space, and creating a negative pressure, which actually pulls the bulging disc material back to the center of the disc.

The treatment protocol is 20 sessions done as follows:

5 times for 2 weeks, 3 times for 2 weeks, 2 times for 2 weeks.

The sessions are about 50 minutes. You receive cervical decompression for 30 minutes, then 10 minutes of muscle stimulation, then 10 minutes of ice.

Bulging cervical discs at C7 can cause symptoms like arm pain and weakness, loss of grip strength, numbness and tingling in the arm and hand, night pain, and headaches.

Success rates are high with the DRX9000c.

If you have been diagnosed with a bulging or herniated disc in the neck and would like to fined out if you are a candidate for cervical decompression with the DRX9000c we would like to hear from you.

To schedule a complimentary consultation at our San Francisco Spinal Decompression Center please call 415-392-2225.

Scott Calzaretta

Chiro-Medical Group is an innovative collaboration of health care professionals who work together as a team to promote optimal health. Our group includes experts in the fields of medicine, chiropractic, physical therapy, massage, nutrition, and personal athletic training.

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