528- Transforming Osteoarthritis Care in Chiropractic Practice

Welcome to the Evidence Based Chiropractor, where each week we deliver the latest chiropractic research and marketing strategies, all in the time it takes to get to your office. Now here's your host, Dr. Jeff Langman.

Hello and welcome to the Evidence Based Chiropractor. I'm your host, Dr. Jeff Lengmaid. On today's episode, we are talking all about osteoarthritis. This is one of those conditions that almost every patient in your practice is walking through the front door with. But I'm saying it's dramatically overlooked. We think about spinal discs, we think about radiculopathy, we think about sprain strain, and certainly we think about the challenges that happen at a segmental level of the spine. But often osteoarthritis is. I had the opportunity to sit down and chat with Dr. Scott Munsterman all about osteoarthritis. It was fascinating to dive deep into the science and also get to understand the Novopulse device and how it can really make a positive impact on those patients who are struggling with osteoarthritis, not only in your practice, but outside in your community. So here you get to tune in to a conversation I recently had with Dr. Scott Munsterman. Scott, I'm going to ask you to kick it off with, from your perspective, how big is the osteoarthritis problem? You know, why is it one of those big missed opportunities in conservative care today?

Oh, my goodness. So, you know, according to the statistics, there's over 75 million people and, and I think that's understated, but that have oa, at least some form of oa, you know, whether it's a mild, moderate or severe form of oa. And of course, as we've learned as clinicians, we've understood that injuries can to damage to cartilage, which as we know as clinicians is largely avascular. And so it's going to rely on any type of imbibing nutrients to get into that area for those cells to repair. Well, many times they don't repair and they continue to degrade. And the body's ability to be able to clean, you know, those dead cells out and replace it with new cells, it's just a very slow process. And so over time, we have that degenerative type of situation that, that occurs and we've got a cascade of events that lead us, you know, especially when we get into our 40s and 50s and 60s on up, we begin to feel it in our joints and our patients are, are those Folks that have OA to some degree, a large percentage of them, and for us as, as chiropractic physicians, as we look at the biomechanical structure and working with the joints and normalizing that structure and function many times away in a joint, whether it's an extremity joint or a facet joint, really gets in the way because that's that inflammatory reaction that's there. We're trying to get our job done and, and it can result in a very slow recovery or even a point where there's chronic pain that we can just not seem to get rid of for patients or to help them get rid of. And, and that's where the Novopulse is really shined.

I've been really impressed as I've learned and I got a feeling there's a lot of docs that ears just perked up as you started to describe a lot of, a lot of patient type and symptomatology that they see day in and day out and probably haven't thought of in this type of specific way. And let's tie that directly into Novopulse. For somebody who's never heard of Novopulse, how would you explain it in simple terms then? We'll get into the details.

Yeah, well it's actually a pulse electromagnetic field device. However, what the founders and inventors did with this is that they created a unique electric field out of that they went in and they looked at all the research in regards to the electric field that actually changes cartilage cells. Now the interesting thing about that is that within, and this was relatively new and I'll be real brief with this, but what was discovered recently, and I'd say over the last probably five to seven year recently was the adenosine A2A receptor anti inflammatory pathway that there's a pathway that can be interrupted and changed. Well in order for that to happen and it can happen with electric fields, but that electric field has to have the right unique nature to it in order for it to interact with the cell. So for instance cartilage cell or, or any cells to interact with electric field it takes a minimum pulse width of 5 microseconds. And the other thing is that many times with electric fields they only go so far and they get absorbed by bone or, or dense tissue or that type of thing. Well, what they figured out with the noble pulse was how to bring that electric field to have a potentiate at a depth of it was been measured at 7 cm in the body, you know, where they actually have that interaction occur? Well, when you're able to reach and target like that, you're reaching facet joints, you're reaching deep into extremity joints right where the cartilage is allowing the electric field to interact with that cell and then to begin to turn that pathway around to the benefit of the patient and reduce inflammation. Now, in the labs, and this is not the device I'm talking about now, but in the labs and the research, they actually were able to show cartilage regeneration through Mr. Scans and mankin scoring and all of that. And so that has not been tested on this device yet. However, this device is built based on what that research has demonstrated the electric field needs to be and it's actually more potent than what they used in the research environment. So, you know, very exciting with, with what was discovered and then how they took that information and put it into a device that can be used.

Yeah, that, that, that is powerful and I think that's really a differentiator and we're going to dig a little bit deeper on it. There's a lot of docs out there that are familiar or have looked at or maybe implemented laser, maybe they've implemented Shockwave in their practice. Maybe they even have or have heard of another PEMF device. You referenced it briefly, but I want to dive a little bit deeper. Novopulse has patents on this and I just would like you to spend a moment or two diving into. Okay, how does that actually differentiate? And you just highlighted some of it. But this is a patented device that really addresses things in a distinctly different way than the modalities that I just discussed. What does that make you think of when I say that?

Yeah, well, to your point, it's backed up by six patents, unique patents, you know, for spine, for extremity, it's backed up based on the type of electric field that I briefly described there. The other component that they brought in, which I didn't mention, but I will now, and that's the thermal activity that goes along with that, which has been shown to be a very high synergistic component to electric field stimulation. And so, yeah, that's, it's just the uniqueness of it taking something that has been out there, but then being able to design it in a way that will allow it to the body to interact with it in a very targeted, specific way.

That is one of the unique aspects that really caught my attention as we started discussing and I started learning about Novopulse late last year, was really getting a true understanding of the Depth of differentiation, what I'll say. And even if a doc has some of these other modalities in their practice, Novopulse is really separate and distinct because of much of much because of the patented technology and approach that it takes for docs listening and thinking. Okay, I'm starting to put this together. I, I do chiropractic adjustments, maybe I do some rehab, maybe I do some other modalities. How do you see and where do you see Novopulse fit in alongside or with the, a typical chiropractic practice?

Oh well, like I mentioned earlier and I'll, I'll kind of dive into that a little bit more. It does not replace the chiropractic adjustment. It does not replace any soft tissue work that you're doing to normalize, you know, neurological function, neuromuscular function. What it does do is that it, it reduces the inflammation within that joint and it helps those tissues to interact with that electric field to repair themselves. I mean it stimulates that because it interrupts that anti inflammatory path or that inflammatory pathway that we mentioned earlier. And so it, whether the patient is acute or chronic and maybe even has oa, that's evidenced by X ray. It becomes a mainstay treatment and even maintenance therapy moving forward so that you can manage and control that while you get the body structure, the biomechanics normalized for the patient the best that you can. And so from an adjunctive perspective, very specifically that's, that's where it comes into play. My early experience, just as a sidebar if I may, please. When I, when I became familiar with the Nova pulse and the founders who are, are honestly rocket scientists, I mean they're nuclear physicists. They've been in the field for like 40 years. They have over 120 patents. I mean these guys are amazing. Anyway, I was, I had had difficulty with my lower cervicals facet arthrosis to the point where I was getting radiculopathy. And I mean like I felt like my shoulders can blow off, honestly tried everything did, you know, traction, adjustments, all of that. I practiced in a surgery center and so I ended up seeing one of the pain management anesthesiologists. They ended up injecting my facet joints which brought it like from 8 or 9 down to like a 3 or 4. And then it just stayed there, you know, on the pain scale. And as I started learning about this I, and it started, then my neck started to kick up, you know, and I thought, okay, well let's try this thing. Let's See if it works. Within three weeks my pain was completely gone. Completely gone. And, and, and then I left it alone. And it was about a year later I felt it start to come back. Like, oh, you know, I can feel this. Put it on again and it was gone. And what was interesting about that, my experience matches what they found in the research with this type of electric field stimulation that when they put people through treatment for. And then they did it like in a six week trial. Okay. And then what they did is they did a one year follow up and they did a two year follow up. Their pain scores and their function scores remain relatively stable. I mean how many therapies do have we used over the years that, and, and even like our adjustments that, that we can say that, you know, a year or two down the road, you know, that they're good now. We can say that I think overall for our adjustments. But there are cases where, you know, that they have ongoing problems if they don't get treatment, they're going to regress, you know, within a certain time frame. Well, this gives you a pretty good clue as to the effectiveness of this type of device and what it actually does to help break up that inflammatory pathway and cause, you know, some reparation to occur, you know, within, within that cartilage tissue. So yeah, in terms of what we can do in practice and how we utilize it in practice, honestly, it becomes a very necessary adjunct if you've got joint inflammation, patient's in an acute or subacute situation, it's relevant. If the patient has chronic pain, maybe due to OA or whatever, it becomes relevant. It even becomes relevant that for patients who have, let's say moderate OA or have, you know, continued problems, that they can utilize this at home. You know, and that's one of the unique things about this device is very simple and patients can purchase it from their providers and use it at home. So yeah, just a wide range of things.

Yeah, you're describing just an overwhelming majority of the patients that go into so many chiropractic practices each and every day and really being able to have an additional opportunity to help them not only in the short term, but as you described, also in the long term in a way that I'm going to say complements a lot of what you're already doing is I think is really just fantastic. And for docs listening and watching, we're going to make sure to drop a link down in the show notes. So if you'd like to connect with the Novopulse team and understand how this would fit into your practice. Please connect with them at the link down below. And on that note, I want to take a moment to discuss really what I call the system you highlighted to me a little bit behind the scenes of, you know, NovoPulse. There's a device component to this, but there's much more. And you've spent a good amount of time, effort, and energy building just what I call a fantastic resource library that enables a doctor and their team, docs and your team to be able to step in and understand how to utilize this, how to speak about it, and additional continuing education. Maybe I'll just pause for a moment and let you sort of highlight some of the novopulse education and resource center that I have seen and really some of the tools that are available to Novopulse doctors.

Yeah, thank you for that. Well, the team at Novopulse, you know, said, hey, this isn't just about a device. This is about treating patients, meeting them where they're at, and helping everybody understand, you know, there's a multifaceted approach to pain management. And so what we did was we brought in pain management modules, training courses, how to utilize the device, different patient handout, you know, all of those things that you can wrap around. And we call it the novoplus OA Pain Recovery Center. And we even took the step to say that, look, if. If our clients and we. We call docs who purchase devices from us, our clients because they're our clients, you know, we. We have that kind of a relationship with them that if our clients would like to open a new service line within their practice that is a.08 Pain Recovery center, here it is. You know, they get access to the dashboard. They have all of our training modules. Their staff can learn about pain management and how to utilize the device. What's the best way to incorporate it into the practice, you know, who are the target patients, if you will, that you can help identify, utilizing pain assessment tools, all of that. And so we do have a pain management certification course for the Doctors. It's approximately 15 credit hours that we do provide CE4, you know, so that is an added component, if you will, for the docs. But it's really getting everybody on the same page when it comes to pain management. And there's a lot to know and understand about that because pain can be derived from a number of different ways. Well, understanding that and then being able to use appropriate resources in the practice to help that patient, you know, becomes important. And so we step back and realize that, look, this is going to take a comprehensive approach. Yes, our device is central to this approach, but then we wrapped it around, you know, the knowledge base that'll be. That is. Has been very helpful for our clients as they move forward in using it.

Yeah, I think, I think it's really fantastic because there's so many docs out there that purchase a new modality, maybe at a seminar or wherever it might be, and then they're never just able to get it implemented because they bought a device, not a system. So I'll tip my hat to Novopulse and yourself for really developing that OA pain recovery center because it gives the doc the opportunity to have a holistic understanding of how to approach implementing this in their practice, which is just so critical because that's what takes a really good idea into something that can actually help people in the community. And with that, I just want to touch on for docs, listening, watching and maybe unfamiliar. This is something that the patient can wear on their belt, so to speak. So as you visit the website link, you will see all the pictures, you'll be able to see it. But this is really something that, you know, it doesn't take up a lot of real estate in the practice. You don't need to, you know, devote an entire room to the. The unit fits on a belt pack, so to speak, or on the belt and then goes from there. Now with that, one of the things I just want to touch on briefly are just, you know, just talk loose business sense and revenue case this opens up, you mentioned it, a new line of potential business into their practice. You also mentioned, you know, being able to sell it to a patient. I just would like for you to highlight some of the opportunities and options whether a doc wants to deliver the care in their practice. Resell, rent a unit. How does that work and what does a doc need to know?

Yeah, so yeah, you, you covered a number of it. So we'll drill down so it can be utilized as an in office, you know, procedure. It's unattended and, and it's 30 minutes because that's what the research has found is that that 30 minutes allows for everything to, you know, cartilage interaction with the electric field and all of that to get the best benefit. The research from an in office perspective has been based on three times a week for six weeks protocol and then reassessing at that time. Generally speaking, patients, some patients, if they don't have a huge amount of inflammation and you know, big problems going on within the joint, they'll they'll see a return in terms of their pain reduction and function returning, you know, relatively quickly within a week or two or three. Everybody else, you'll begin to see function improved by week 3, 4, 5, 6. And then the clinicians can decide, okay, should we continue with this, you know, at a reduced rate or, you know, are we clear? If you will and don't need it at that point anymore. So in office, what we recommend is utilizing the unlisted procedure code 97039 because it is a unique electric field. And so that's how it can be done. And that could be billed either through, you know, payers or, you know, just on a cash basis. And they can price it accordingly based on, you know, maybe other modalities they have. And that's, we don't get into telling people what, you know, they should charge, obviously. But you're in office procedures. There's number one. Number two would be you could also have multiple devices which a number of our clients do, and they rent out the device to the patient because especially those patients that are a tougher case, you know, that, that you're, you know, that. And maybe they can't, you know, make it in three times a week or whatever. So then they rent it out on a weekly basis or a monthly basis or for like a six week program for a certain amount. And then the patient, you know, pays for that and then obviously then they can renew it at the end of that. And so that's another way. And it's, and I mentioned earlier, pretty straightforward on how the patient can use it. There's one button, it's hard to mess that up too bad. But yeah, and then the patients utilize it. And then the third part that you alluded to has to do with patients saying, how much does that cost? Because I think I want to buy one of these and I would say that occurs probably 5 to 10% of the time, you know, so it's not like it's a, you know, a lot, but it's, but there is some revenue generation for the, for the doc when it comes to any of those three fields. And then we work directly with clients to let them know what that means, you know, for them, we help them figure out their roi. But the return on their investment, you know, or excuse me, their return of their investment, which means when do I get my money back? Usually occurs anywhere from that three or four month range, which is fairly quickly with, with a close to a $6,000 device. And then past that point, it's a return of their investment for that amount, you know, what they generated each month. And, and so our, our clients do do pretty well with the device. They know when to use it, you know, they've been able to talk to patients about it and then, you know, use different types of, like we have a poster and we've got, you know, different things that will help them describe the patient. Here's what we're going to do with you because of this, this and this. You know, we're going to utilize this therapy and this is what it does and all that. So yeah, but those would be the three primary areas from a business model perspective that that helps you keep it in your practice and make it viable for your practice.

Yeah, yeah. It's fractional compared to so many other modalities out there and the need is so high. This is not a niche of one in a thousand. This is probably an overwhelming majority of many patients that are coming into many chiropractors practices each and every day. Also want to give a thank you to you and the Novopulse team and also just let everybody know. As a partner of the evidence based chiropractor, docs that connect with the Novopulse team can have continued access to that resource center. So you're going to have the opportunity also for the cost of the unit to also have access to the entire pain recovery center. All of the resources, tools, marketing, clinical ce, as you mentioned, all wrapped up in a really wonderful opportunity that enables you to help more people in your community in a very distinct way. So, Scott, I really appreciate you taking some time and coming on and chatting today with everybody and I'm gonna encourage everybody listening and watching to click on down below. Connect with the team, ask questions, discover how this can fit into your practice. Because it's a change that you can make that really opens the door to a tremendous amount of opportunity in your practice from a business sense, but I'm saying most importantly from a clinical sense, being able to help people with a lot of specificity. So, Scott, I really appreciate you coming on and chatting today.

No, thank you very much. Dr. Jaap, thank you for joining us on this episode of the Evidence Based Chiropractor. If you want to grow your practice, come back for next week's episode. If you want to grow faster, visit theevidencebasedchiropractor.com and join our MD Marketing membership today.