In this interview, Dr. Cameron Kammerer explains the "airway cascade" that begins with common airway challenges such as enlarged tonsils, adenoids, or chronic congestion, leading to mouth breathing, altered tongue posture, forward head posture, and ultimately craniofacial development issues. He illustrates how early intervention—especially in children—can prevent permanent structural changes, using his own daughter's experience with a palate expander as an example. While chiropractors can address some postural and breathing mechanics, Dr. Kammerer emphasizes that they should not market themselves as "airway chiropractors" due to scope‑of‑practice concerns. Instead, the most effective growth strategy is to build relationships with ENT physicians, airway‑focused dentists, myofunctional therapists, and sleep medicine doctors, speaking their language and earning referrals. He discusses how these professionals fit into the cascade, noting that ENTs are primary for obstructive issues, while myofunctional therapists and airway dentists are most likely to send patients back after dental or functional interventions. The conversation also touches on the importance of community education, patient communication, and the nuanced ranking of referral partners based on where a patient is in the airway progression.
Chapters
I think it's a growing space in all professions, right? And definitely sleep medicine's evolving all the time. Airway dentistry is evolving all the time. And the chiropractor just hasn't really been a thought about that. But I think we gotta look at it as the signs and the symptoms that are showing up and what we can do at each stage so that maybe potentially it doesn't turn into the following consequence. Using my daughter's palate expander, you know, if we'd have got, if we'd have addressed the nasal, the poor nasal breathing and the open mouth breathing and some of her sleep issues and maybe dental issues sooner, maybe it wouldn't have evolved into this. And then that's kind of, that kind of leads me to the whole airway cascade aspect of all this. So I can kind of tell you about that if you'd like.
Yeah, please go for it.
Yeah. So let's say we got a kid that comes in and we notice that they, or their parents tell us that they're mouth breathing. Usually that's gonna start with an airway challenge. Like I said, enlarged tonsils, enlarged adenoids, maybe chronic congestion. I imagine if you've ever had a cold or something and your nose is all plugged up, what do you do? You breathe outta your mouth, right? We have to get, we have to get air in. And so our body's gonna prioritize breathing over posture, right? So you're gonna start noticing that they're gonna open their mouth to breathe and eventually long-term that could turn into habitual mouth breathing. Okay? So that's, that's a problem. It, one reason it's a problem is cuz their tongue posture's gonna change. So this is kind of important because you're typically, your tongue is supposed to rest at the top of your palate when you breathe. And you imagine if you're mouth breathing, you can't breathe while your tongue is up in the top of your mouth, right? So long-term you're gonna adapt and start continuously breathing through your mouth and then you're gonna adapt your posture. Likely it's gonna be forward head posture and cervical extension, right? So to get more air in, you're gonna lean forward, tilt your head back to make that easier. So that's kind of the cascade that leads people to seek chiropractors, right? We're treating people more predominantly for those types of issues. But while that's happening, if they don't have proper tongue posture, they can have craniofacial development issues. And so that's what my daughter had. So that's kind of that step, right? We're there, we're dealing with that. That's where we're referring to an airway dentist to help address those issues. 'Cause the, the palate eventually it fuses, right? And it's gonna be much harder to address that. with an adult as it is a kid. So you want to get to these problems before that. And then, like I said, then it turns into chronic postural compensations, and that's what we're treating. So we can treat that all day, every day, but if we never address the root cause of the problem, likely these, these adaptations are going to keep coming back because the, the body prioritizes survival over posture every day of the week. So that's, that's kind of the cascade of how these things happen.
Let me ask a follow-up to that. When you think about how a chiropractor could approach this in their practice, I'll throw out a variety of things. Is this something where chiropractors have an opportunity to attract new patients by getting information out in their community? Is this something that maybe they are just looking at with their existing patients to potentially take care of or refer? What are the dynamics of this and what do you see as the opportunities within those dynamics?
Well, I think opportunity would be just talking to patients about this issue and letting them know there is things we can do with the breathing mechanics as well as cervical stabilization. Some of these things that we do help these issues to some degree, but the biggest one would probably be getting your name out there with the other professionals, right? If you're speaking the language of an ENT, of an airway-focused dentist, or a sleep medicine doctor, and they know that you understand how this works, Well, when they have a patient that maybe is complaining about their neck hurting or something like that, they're more likely to say you should go to Dr. Cameron, you know, or you should go this place because they know you actually know that condition. And so I think that's probably the biggest way to build your practice with it is not marketing that you're an airway chiropractor because, you know, there's scope of practice things with that too. But just knowing that you understand this, this connection and a lot of these other professions somewhat do, but they're not adjusting patients. So I think that's probably the best way to build your practice within the mindset.
And you mentioned a few different types of doctors there. I'd love to drill down into some of those. So, and I'll use a correlative example. This is, this is my personal opinion, my personal opinion only. Yeah, I, you know, I am probably less likely to refer to a pain management doctor. Why? Because I view that most of them, most of the time, are immediately going to go to injections, which for most cases, most of the time, are completely counterintuitive to what's going on. So I might rather refer an orthopedic case if it's beyond, you know, what I feel comfortable with, or the patient's not progressing, or there's a red flag, I might go to an orthopedic doctor rather than a pain management doctor. You mentioned a few different types of docs there, a dentist that might have airway expertise, a sleep doctor, et cetera. I know it's not apples to apples because there are some differences just inherently in how those doctors, you know, who they take care of and how they approach care. But if you had to rank for docs listening and saying, I get it. I see what Dr. Kammerer is talking about. I think I got a few patients right now that might be good, uh, to have a second set of eyes on. Are there any of those professions where you would, so to speak, rank them higher than others in terms of whether it be compl— being complementary to what we do, uh, aligned with how we might approach care, or maybe some that you have found are, oh, maybe just inherently by their training, a little more aggressive than we would like? Or is it totally doctor dependent?
I think it's dependent on where you catch the airway progression at, right? So I think first and foremost, ENTs, whether they agree with chiropractic or not, if you have an airway obstruction from enlarged tonsils, adenoids, things like that, well, they're gonna be the people that can address those issues. So that's, and since that's the first kind of step in the cascade, that would probably be one of the first people that I would refer to. Probably the best aligning with this, I think, I guess in my opinion it'd be either a myofunctional therapist actually, or airway dentist because they kind of understand the changes that are happening within the airway through their dental work. But they also realize, and when they're looking at these films, they even talk about the cervical spine with those. And a lot of the studies that have, I guess, proven this, this theory are done by airway dentists. And so I think that'd probably be, The most likely to actually send referrals back.
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