Dr Anthony Nicholson B.Sc. (Qld.), M.Chiro. (Macq.), DACNB. FACO.

Dr Anthony Nicholson is the CEO of Chiropractic Development International (CDI), a global continuing education organisation for chiropractors that he co-founded in 2002. CDI’s innovative online learning technology has led to formal accreditation in over 35 states in North America, along with a growing learner base in the UK, Europe and South East Asia. CDI provides 250 hours of advanced online clinical training for the Neuromusculoskeletal Medicine Program offered by the University of Bridgeport in Connecticut and has developed an online board examination for the Academy of Chiropractic Orthopedics.

As a partner of Spine Partners Wahroonga in Sydney, Australia, Dr Nicholson is also a full-time chiropractic physician in private practice, is a board certified chiropractic neurologist (DACNB) and is board certified in Chiropractic Orthopedics (FACO). In addition, he is an adjunct senior lecturer in Neuromusculoskeletal Diagnosis and Evidence-based Practice at Macquarie University in Sydney.

Discussion Topics

As a kid, what did you want to be when you grew up?
Orthopedic "gap year" before chiropractic school at Macquarie University
Early realization of the "Grand Canyon" in clinical practice, between "pain in the frame" approach and pathology
Working and studying in the clinic at 4 a.m. Sunday mornings to improve clinical understanding
The need to improve chiropractic education and the state of online CE
How communication is the best marketing
CDI’s high level of production quality and value
Why we don't need to explain how the adjustment works to medical professionals.
Orthopedic diplomate and partnership with University of Bridgeport

Resources

Chiropractic Development International: CDI.edu.au
Orthopedics & Neuromusculoskeletal Medicine - Postgrad Program (Sign-up for free membership here)
Principles of Neural Science, Kandel & Schwartz

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Read Transcript¹

Episode 52: Chiropractic Development International with Anthony Nicholson

Nathan Cashion: [00:00:00] Well, I'm excited to learn a little bit more about CDI what I've known and what I've read has certainly impressed me, but I do want I do always like to start out just asking you when you were a young kid, what did you want to be when you grew up?

Anthony Nicholson: [00:00:16] Well, I've often thought about that and to be entirely honest. I'm not I can't recall being actually sure. I mean it depends how far I try and go back but I think I recognize quite early that I was gravitating towards you no more the biological sciences health care and things like that.

I developed a bit of a fascination with the brain I recall. Quarterly and just with you know Sports Performance well-being. I was I was I was pretty active. So I think it was going to be something down that path but it wasn't really clear to me. I started school quarterly here. I'm not quite sure how it goes over there.

But I was I was really for when I started grow one, so. And I had a very active mind. So I was pretty easily distracted by all the usual stuff growing up. So so I think the maturity and focus required to a sort of apply. Your mental faculties didn't come until a bit later when I had some clarity.

But so yeah, I think it was going to be something along the lines of Health, but I really didn't have one or you know, even two things that you know, I knew very early that's what I want to

Nathan Cashion: [00:01:24] Yes starting at 4 is quite young for for the first grade. We starts more round 5 6 so

Anthony Nicholson: [00:01:32] it might have been my mother thinking he does have a very active mind.

So let's slip sir. Let's get him engaged. I think it

Nathan Cashion: [00:01:41] Did you have any other Hobbies as you're growing up that you may have at some point considered turning into a career or profession?

Anthony Nicholson: [00:01:51] Well, I mean I had a I certainly had an interest in swimming. I need to take I almost became a professional swimmer.

I was you know, certainly the two or three hours in the morning to 3 hours in the afternoon and was any and I was always at State and National events and things like that. But then when it really came down to taking that next step I just didn't I wasn't really sure that that's what I wanted to devote my life to so so it was certainly something Sports orientated.

I had a great interest in martial arts too. And I was you know, I'm a teenage years in the later years of school. So, you know and that may have been you know, something something again sports like we're may have been a pathway, but but no, not really other than

Nathan Cashion: [00:02:43] What first exposed you to Chiropractic?

Anthony Nicholson: [00:02:46] Well interesting. I mean I grew up with Chiropractic I guess. You know a common story you here with chiropractors is that they had some sort of exposure to I guess the benefits of chiropractic treatment quarterly and for me look it was the same. My mother responded very well to a chiropractor when really nothing else helped her she.

You know, I had severe back pain in her early 20s after trampolining accident and you know along the year trampolining a belly flop going wrong. I she tells me these days Yeah.

Nathan Cashion: [00:03:22] gymnastics type of trampolining.

Anthony Nicholson: [00:03:24] Well, yeah in a way.

Nathan Cashion: [00:03:26] playing or just playing in the

Anthony Nicholson: [00:03:28] Yeah, well, I think I actually not quite sure.

I think it may have been some sort of school event. She was doing but yeah, so it was a an injury that didn't seem all that severe at the time. But you know, she had really constant back pain from that point on which just got more and more severe and I guess she was heading for all sorts of invasive procedures and there are all these sorts of things discussed until.

You know, I know she's ended up seeing a chiropractor for one reason or another and now never went to surgery as now, you know, very healthy and well 70 year old. So so in that respect, I I guess I was exposed to Chiropractic early with all sorts of sports injuries and things naturally. She then took me along to see a chiropractor and I always responded well and I always remember, you know being impressed by just the ability to apply, you know, Place hands on and do so much so.

It was for me a normal part of growing up and I saw the benefit to my with my family as well. So I guess then when it came to sort of the later years of school, it was starting to appeal, I guess more and more but I was also leaning heavily really towards medicine as well at that point. The likes of surgery was starting to really appeal and so it wasn't really till I get out of school that are then I guess had to try and decide, you know be a little bit more firm my decision so back at that time.

You could do a Bachelor of Science and really would be the start point for both Journeys. You could either go into medicine straight out of school or you could do a science degree and then go into a postgraduate stream, so. From there after school. It was always fairly sure. It was going to be something in healthcare that point.

So I thought look I'll start a Bachelor of Science and just see what I think see where that takes me. So

Nathan Cashion: [00:05:29] Which school did you end up going to in Australia?

Anthony Nicholson: [00:05:31] And then... Which chiropractic school? Well, there are only - I grew up in Brisbane as you may have known from our previous, you know interactions in. And there was no Chiropractic program in Queensland at that time.

So it was either making the trip to Melbourne or Sydney. So I moved to Sydney and attended Macquarie University their program there, but even before I mean even before getting to that, I I was still really. In much of a quandary at the end of that science degree. I was still thinking alright do I go towards medicine here or you know chiropractic school appeals as well.

And so I took a year off to sort of really think about that a little bit more and some money and I ended up working for an orthopedist. In Brisbane actually and I and I dealt with you know, Prosthetics knee and hip replacements and all those sorts of things and I was involved in going out meeting with the surgeons, you know showing new equipment and I would often even scrub up and be in theater with the mud being a bit many nights.

I'd be out there like well, I finish their lists. and and. And just you know, I guess dealing with end-stage pathology all the time and the setting and that sort of that sort of stuff over. I guess. I realized it didn't that didn't sort of ignite my passions like I thought it might and so I was really sort of again with sports and my you know, my earlier sort of you know school and Teenage life was was thinking more along the lines of performance and those sorts of things.

So I guess. Again, then Chiropractic started to touch started to strongly appeal again. So I ended up making the

Nathan Cashion: [00:07:22] They're interesting. And so so the being in the surgery theater for a lot of people I think kind of as a feeling of Glamour and you know, you're kind of the top of the Heap the cream of the crop,

Anthony Nicholson: [00:07:37] Absolutely.

Yes. Yeah, for sure and and look at I mean, there's still certainly an appeal there. Definitely. I mean the ability to help people at that level. I guess for me what I mean at that point it would again it was really a fork in the road and I guess what one out was that. Appeal at that point of being of being able to place hands on and do so much.

I really had quite a strong desire to learn how to do that at that point rather than sort of take that other very long journey. You know, we towards you know surgery so yeah, you're right. I thought when I got that job. I thought I'd this is you know, this is perfect. It'll give me an exposure to this and sort of, you know, help me think about it a lot more and decide whether I really want to you know, go down that track.

Do you do the entrance exam and sort of, you know, enter sort of that sort of course of study but. Really I then was spending some time with some chiropractors at the time as well, you know speaking with them and just you'd see the patients and the results that get I mean at that point, of course, I really had no Insight.

Well some small Insight but no real insight into the complexity of the journey that that would be either to be honest. I mean, I hadn't really been exposed to a lot of the. Controversy and all of that surrounding, you know, the profession and the politics involved. So at that point it was really what do you what might you enjoy doing more on a daily basis and what has a stronger appeal so I ended up going

Nathan Cashion: [00:09:32] so interesting how that exposure can really clarify.

What what's interesting and what you really want to do, I think. You know, I've known a lot of students who are just pretty confident. That's what they want to do and then they get into it and then like you mentioned the day-to-day just isn't quite what they expect especially today in medicine and also in Chiropractic how much charting and documentation is taken over as the biggest portion of time spent during the day.

Anthony Nicholson: [00:10:08] I also point to I guess when I look back at it now. I guess it in with experience in life comes in sight Looking Backward and I think I've always really, you know, really been a people person. I guess. I've always really enjoyed interacting with people and find it very easy to do and when you really consider what a clinical or interaction involves, it's not just the specific physiological effect, but it's really.

On so many levels. I mean we're not only applying a physical force with healing and 10th in terms of just the mechanical parameters of that but you're really part psychologist. You're really, you know, you're listening intently. There's an emotional leverage with what we do. A social part psychological part so there's really so much to a clip to a successful clinical interaction.

And I think that some people just have a more naturally inclined to go down that route versus something that you know surgery was really I mean obviously highly Technical and as you say has that glamour effect, but at the end of the day, you're not really it's not it's a different type of interaction with the patient as I guess is what I'm saying.

So I guess that's probably why I went down

Nathan Cashion: [00:11:36] It brings in a lot of water trimmed contextual effects and just recently I had Brian Fulton the author of the placebo effect in manual therapy on the podcast and we had a long discussion about all the biopsychosocial and all of those different aspects that play into it including the Hands-On now, how how long have you been in practice now?

Anthony Nicholson: [00:11:57] 20 years.

Nathan Cashion: [00:12:01] And at one point did you get involved in?

Anthony Nicholson: [00:12:04] station. Not long after graduating. Actually. I went back and was a tutor back at the University fairly quickly and that within a few years built into doing some lectures in neurology. Because I have a special interest in neurology. And so I was then back, you know lecturing each year in tutoring and then that naturally led to I guess developing programs for practicing chiropractors as well and very early that was centered around professional communication.

So.

Nathan Cashion: [00:12:45] what point did Chiropractic develop International Development International start and I don't know the full structure if hopefully you can explain just a bit about who's involved and who founded it and all of that.

Anthony Nicholson: [00:13:01] Well, there's a bit of a story there so I might I might go back a little bit on that one in my last year of chiropractic school in the in the in the final year of a master's degree.

One of the lectures there in preclinical studies that knows particularly impressive to me was Matthew Matthew long who's now my business partner in city, I and I remember thinking how professional he was in the way he presented in the way he seemed to practice and so. Should be the year after I graduated I teamed up with him in practice.

So I started working with him and then you know down the line we became Partners in the practice and grew that and so what we what we're focused on initially was I remember my journey through chiropractic school back then it was a very.

There were there were two sides to the program. If you like on one side. It was very pathological by medical. I mean, you have to cover off all of the neurology all of the Radiology all of these Orthopedics pathology all of that and then on the other side you had all the technical. Was manipulative technique and and then of course there was all sorts of different philosophies being presented to you by practicing chiropractors who came in to lecture in those sorts of things, but I remember thinking that there is this Grand Canyon if you like in between these two sides is that when you go and see a chiropractor in practice pathology really wasn't what you were seeing mostly in day-to-day.

So you might see someone who had a specific route lesion where you would do a segmental neurological exam and find it will find a focal deficit and you were treating that specifically in the deficit would go. I mean we do obviously see ridiculous engines and things but I guess if you look at most people's practice, let's call it pain in the frame then for the most part.

There isn't a specific pathology in that way. There is a name disease there is pain and fright and so on the other side, you've got all of these techniques these skills that we're developing but yet the bigger question was what are we aiming that at? What are we really doing? So at the time I went through you were left to sort of fill that framework.

If you like in yourself between the pathological side because after all you weren't going to work in a hospital and work, Like, you know in the in the scope of practice that a medical doctor would in that area, but on the other side philosophy, you know was you know, you're getting all sorts of different philosophies as to as to what adjustments and manipulation could achieve and so you either really pushed to one side.

You're either going to know. Manipulating the just based upon, you know overall health and well-being and all of these different aspects or you're going to really be more towards the pathological side, which is really mechanical low back pain treating this protrusions my Facial Pain syndromes despain all that sort of stuff.

So it was it was really a kind of a bit of a confusing time because you were sold this bigness if you like of. Follow what could be done with adjustments but yet. The other side was pathology and really the evidence was quite limited and the understanding quite limited back at that time. So I remember, you know having so many discussions with Matthew and it was wonderful to have someone who I could really cerebrally interact with and we could throw ideas around and I remember an hour early practice.

I would we would meet at 4 a.m. Every Sunday morning at the practice and spend several hours. Just reading looking through research and and trying to understand look is this is there something more than just? Peripheral tissue source of back pain here. Why are we seeing certain results? Why are we observing all sorts of other changes take place in these patients.

What's really happening? But we don't think it's the simplistic sort of explanations that we've been given in the past. They don't seem plausible. So and nor is it nor can that be presented in a way that just about anyone else would understand it because we were starting to really communicate with local medical doctors at that point because I remember thinking when I got out of chiropractic school. look. I've I've I took this up with vigor.

I mean when I decided to really study chiropractor, I mean I have a racially read every all of the text books and I considered that I was you know had a reasonably strong biomedical knowledge when I left and so I was really quite dismayed when our contributions or the way we would approach a patient wasn't really given much relevance at all.

For many in the medical profession at that point and there's very little communication at all. Very little collaboration cooperation nothing. So at that point, we'd Matthew I'd meet and say right. Okay. Well, you know, we can restrict it to just this all we can try and start explaining a little bit more about what we do here.

So we started a sort of crystallized a framework for doing that. And that's really what gave rise to CDI in the in the first place was running professional communication programs how to communicate with medical professionals with medical doctors and how to generate referrals. So it really hinged on it started with communication.

Excuse me, and I remember. thinking at the time. That all of the types of marketing that would go on with chiropractors. Some of that didn't really do us any favors. I frankly think it you know, degraded are credibility a little bit and so we started doing the math on this and this was quite a while back now, but I think in round figures if I remember correctly, you know, the math of the day was that, you know, we worked out that.

There are around 30 thousand medical practitioners in Australia, and this would have been back in the early 2000s and and they would each come in average see around about twenty twenty seven thirty patients a day. So you really talking about 800 patient visits a day. Let's say and then if you consider the most common reason that a patient sees their medical practitioner, it's going to be some sort of probably common cold virus and some sort of pain in the front.

So low back pain neck pain and then we said well, okay how many chiropractors have we got here now and at that point there is probably in the order of 4,000 or so, maybe a few more as I said, I've got the exact figures but we work to what we crunched it was this that there are 220 225 thereabouts patients per chiropractor per day in Australia seeing their GP.

Right now here was I someone who had trained heavily in pain in the frame and you know felt that I could do something meaningful for these patients and yet here's a group. Here's the medical profession seeing all these people that need this potentially. But no referral no Corporation. So I thought that this was this was and we felt this was a big gap and and this if you think about this for a moment, I mean if one out of those 225 just one per day per chiropractor out of the 225 were referred.

I mean a profession would be busy very busy busy work week probably handle if you add in the referral effect of those patients once they experience benefit all of that, so. The message we wanted to strongly send was this if you can start to communicate effectively what you do then that is the most sustainable way to build a practice over time.

Forget about marketing. The best type of marketing is the type. That doesn't look like Market. It's it's you doing your job at an outstanding level. Just do what you do communicated communicate with the medical doctor just like any other. Specialists in their field would so we built programs to teach chiropractors how to write a professional report a letter how to document what you do and provide a rationale for the treatment you're providing and then build referral relationships.

So that's what that's where CD. I. Yes.

Nathan Cashion: [00:22:24] amazing. That's so interesting and it echoes a lot of what's becoming more and more popular now with the primary spine practitioner model that Don Murphy. And Michael Schneider and others are you know actually have a course now, so and I'm and I'm sure you're familiar with Scott Haldeman and his kind of conceiving of that idea.

And so it's amazing to hear that that's been going on at least, you know on a personal level with you and your business partner for quite a while.

Anthony Nicholson: [00:22:59] Well, exactly. Well then so we were doing it first a lot of you know live seminars. We're traveling a lot and at that time so we so we formed you know CDI together and then and then again, I guess in then in what would it would be now?

Jay I'd have to go back and look at the exact use but eight and nine years ago now maybe even earlier because I remember we were one of the early adopters in terms of online education for chiropractors. I remember sitting on a plane like Matthew we're traveling a lot of those days we were doing we were running seminars in.

Not five cities in Australia Auckland in New Zealand Hong Kong around a series. So it meant a lot of weekends away and at that by that time what we what we realized was that for chiropractors to effectively communicate. In fact, it was way before that we realized that the big need for chiropractors to communicate was actually not just the communication skills.

They now needed a really clear clinical. For understanding what they were doing and to communicate that so we really then developed a real a broader range of modules and seminars on all of the the clinical side. So so then I remember saying to Matthew now if we go, you know, if we if we do this online, how are we going to do it because.

How can we get a really effective learning experience online which at that point was a lot of just pop a PowerPoint series up on the internet, you know and formal education was really quite didactic. It was topic-based. And I remember thinking boy to get an entire. Synopsis and cover off all of that the entire scope of practice put that online that just seems a massive undertaking but then then we sort of realized we'll hang on.

Maybe we're looking at this the wrong way. Let's look at the way continuing education takes place in practice your day isn't topic-based or subject-based. It's not like you do shoulders on a Monday and low backs on a Tuesday. That's you know, when you're the the education model University and what happens in practice different in practice it is what walks through the door next.

So we said to each other we said. Yeah.

Nathan Cashion: [00:25:36] Right, my problem with didactic learning and lecture. Is that the. Is tell you okay here is the condition and now here are the symptoms and then this is the treatment but that's not it. It's completely the opposite people walk in and

Anthony Nicholson: [00:25:49] People walk in with a problem that you have to solve exactly you start with the problem.

It's the reverse exactly. That's the other main Theory or the other main basis. What we did is that if you your real education starts when you're in practice, let's face. I mean because experience is the glue that holds together knowledge mean we understand we understand knowledge now or we hold together knowledge based upon patients.

We've seen with that and we have to solve a problem with it. So so we said yes, I we need to start with the problem because no matter what you learn at University. You can miss silly stuff when you first start out because of that exact reverse process someone to walk in with a sore big toe. And you you have to get to get out versus University say here's Gap.

It'll often present with us or big toe. So but you already know the answer that point so so yeah, it's a complete reversal and not only that it's not topic-based. It's. Integrating multiple areas of knowledge at the same time. You might have to read something on some Imaging you might have to you know, they'll be a lab report.

There will be clinical findings. There will be history. So and there might be multiple problems. And so what we decided to do with so we need to offer knowledge new knowledge education in the. In which is to be used immediately you can you can't give people knowledge and they have to refine it themselves, you know a whole lot of didactic sort of information and then and then they take that away process it use it it it doesn't really work like that.

So we said, okay, what we'll do is we'll turn it on some of them online learning programs and make it a slice of practice as if you were doing an internship. No, not so much an internship. But if as if you're doing rotations and you actually in there yourself, so we did it from a doctor perspective and we just chose what work what walks through the door next.

Okay, let's pull the research on this look at what's the latest evidence say about it? What clinical information do you need and it each decision point where you need to make a decision or test something? What if you had, you know some new knowledge and new evidence available to you at that point in time?

It's very on time information. And so we decided and Matthew has you know, he's other hobby an interest in life is cinematography. And Final Cut Pro and video editing. So yeah

Nathan Cashion: [00:28:29] oh, we I think we would

Anthony Nicholson: [00:28:30] you and

Nathan Cashion: [00:28:32] that stuck out to me so much when I discovered CD I was. Not just this idea of project-based learning which is kind of the the buzzword in education that you're describing but the production quality of it when I after I well while I was still an undergrad and then after I graduated what I spend a lot of my time doing was presentation design and when I watched a few of you know of your presentation.

I noticed that it wasn't, you know this classic Death by PowerPoint reading line by line by line, but you use images and you use you know questions on the slides rather than just using it as a teleprompter not to mention the video interviews you have of you know, some amazing clinicians and Educators is really high quality video.

It's not you know, it's not just a Skype recording for the most part.

Anthony Nicholson: [00:29:30] it it is a little bit more time intensive to produce but we thought look we've got to give people an outstanding learning experience on all levels. It's got to be exciting to engage with you've got to excite motivate and stimulate your learner.

So we you know set up. Studio at a practice. I mean some of them we would do four a.m. In the morning my home because it was quiet and you wouldn't get as much road noise outside, but Matthew was writing to lighting and you know outstanding video editing so we would actually get a patient video the patient.

In often go out to their home or their workplace to make it more realistic and actually when they're describing their history, it's like it's the case becomes real. It's like you're dropped into a real case as its unfolding as the layers of information are offered so, you know, and then we and then we'd move through from symptoms through problem solving diagnostic thinking examining the patient and then at the end provide.

Also an example piece of communication here's how you would take the next step here and that is professionally communicate this to the patient's medical practitioner to their medical doctor to stimulate, you know, I refer a relationship or cooperative relationship so that you would have this mutual respect for each other did and I think I think that's ultimately one of the larger goals here.

Is that there really needs to be mutual respect and I remember this reminds me of a story back at the University at one at one point where I was contributing to a forum for students and in a major frustration there was was when they were first graduating, how do we explain the mechanism of adjustment or manipulation to a medical practitioner?

And I said, well, you know, I remember saying at the time actually. You're going about it the wrong way. That's that's not even that the question we want to ask. Let's ask another question and that is.

first of all, how could you be respected for your diagnostic capacity? Because I was only the end of the day it's when your knowledge is valued what you do is trusted so they need to travel you what you know, then they will simply trust what you. I very we very rarely in a report now go into great detail as to what's going to be done in terms of manipulation or adjustment.

It's when you demonstrate a depth of diagnostic expertise and ability to make subtle diagnostic distinctions that that that outperforms others because it's your dominant scope of practice. Then you are now The Trusted person to manage the car. So it's simply a matter of saying this person is a good candidate for a manual treatment approach.

And your and your and your just trusted to do that like a surgeon is trusted to do things. That would be seen as dangerous in the hands of the unskilled. It's the same so I think it comes down to River trust issue that needs to First be cleared Away by a perceived expertise in diagnostic.

Nathan Cashion: [00:33:01] I love that and I think that comes for me at least it comes directly back to this idea of Flipping The Learning model around because when we learn condition followed by symptoms followed by, you know, kind of a recipe of treatment that doesn't build.

Diagnostic thinking but when you flip that and you start with here is the picture of the patient and they have these certain symptoms. And this is their history you're forced into that diagnostic thinking and that pathway gets carved in in the way your mind works and it you know, it reminds me of this book.

I read about survival and there's a section in there when they. It's the author was kind of on the survival retreat with a Native American instructor who took him on a hike and as they were going they stopped and said do you see this scat here? What animal did that come from? And they continue walking and you see this plant here.

Is it edible and they talk about it and they move on and do see these tracks and they got to a point where he realized. He didn't know where they were. And the instructor said now turn around and tell me where did we last stop? And what did we talk about and he was able to go backwards and say oh, yes, we talked about this tracks we talked about that plan.

We talked about the. In by turning around and seeing the path that they had followed then he knew where he was in to me. It's very similar when we learn about about conditions and all that. We I think that's why it's taught that way is because for the instructor it's easy for them to turn around and see the.

But they start at the wrong place. They don't allow the learner to go through that process, which I think is so so important for them to actually be able to see the whole picture and see the path

Anthony Nicholson: [00:34:59] that's a great analogy and one of the analogies we use with we've professionally communicating to a medical doctor is is.

Revealing your clinical reasoning your diagnostic thinking. I mean, it's a little bit like maths class back at school. It wasn't enough to get the right answer. You got to you got to sunlight for the right answer but you get a lot of the marks most of the marks. In fact for your working. They wanted to see how you arrived at that answer.

And in fact if you're working with solid, but you made a silly mistake right at the end and you've got the wrong answer you'd probably still get a lot of them are. Because it was your reasoning your problem-solving and I think and I think this is the key part about making the invisible visible, but we do see another issue.

I see and one that I'm commonly I guess responding to back here with students and things is that. chiropractic is often seen as synonymous and I hear it mentioned as a treatment. And one of the distinctions on care for the Michael the Tommy's Chiropractic is not a treatment. It's a profession a profession is a body of knowledge skills proven efficacy education.

Its its expertise across a breath. Of of issues or disorders at a depth that outpaces or that out that the outreaches anyone else so you defined really by your scope of practice, which is the breadth of conditions that you would have great depth in dealing with and so. When Carver it's important to say that it's a profession because if someone for example has you know, there's some stunning you see it in the media.

There's a reaction to you know treatment then what they'll say is chiropractic is called into question. Maybe that's like saying someone has a bad reaction to an antibiotic or some other drug and same medicine has been called into question today because of this reaction it it's generalized instead of being localized to the practitioner level and saying well.

Was the diagnosis and was that an appropriate treatment for that person with that condition at that time? And so instead of being localized is generalized and I see this is a big problem because we lead with a treatment modality and therefore the whole profession is reduced down as soon as synonymous with one treatment modality which quite obviously is ridiculous.

And so and so that that I think is another another big issue with.

Nathan Cashion: [00:37:34] love this. This is really, you know again I came across CDI based on one blog article that that your partner Matthew had written and it just struck me as you know it. Clarified a lot of the thoughts I had and then I started going through a lot of the course offerings in and was just so impressed.

And now that we're having this discussion. I'm beginning to put together all the pieces of why and I'd love it. If you could just give an overview of what's offered on on CDI for those who may be looking for some see what are the different modules or types of learning that's there for them.

Anthony Nicholson: [00:38:16] do with the online especially is a gift cover off different.

Skill sets and also different levels of thinking so I mean some people listening this might think well hang on, you know diagnosing spawned pathology is one thing that but what about all of the other levels we work at and I would say with that that we built these online programs really to cover off a range of conceptual levels.

So. First there are the diagnostic drills which are drills in diagnostic thinking so it's literally a case of what walks through the door next. Well figuratively the case really what will shut the door Nest isn't it the use of the word literal bit but what works for the door next here's a problem to be solved and so it might be hip pain in an adolescent and so we'll go through a series of drills as to how you would.

Diagnosed or differentially diagnose that to reach the most likely diagnosis. So those focus on diagnostic Acumen diagnostic skills. Rather than really anything comprehensive in management. Then there's the communication drills which challenge you in terms of here's a here's a situation where you might need to communicate with another professional.

They can be tricky. You know, we're all faced with tricky situations. Maybe the patient has a disc lesion. There are about to see go off and see a neurosurgeon. You think it's a contain lesion that it can be managed effectively conservatively. However, you've never communicate with this person before they don't know whether or not you know, you know, you know, they don't know how much you know, and so and you've got.

You know right to this person quickly and put a case forward for managing them. And so maybe it's another situation where you need to disagree slightly with a diagnosis or something like that. So we challenged you with complex situations and then get you to. Do a drill in how you would communicate that and then we run you through an example and show you the strategy and the you know, the thinking behind why we said mention this don't mention this.

This is important information. This isn't so their communication drills and there's obviously a lot of clinical information embedded in those as well and then we've got. Yeah, eLearning episode which are more complete video master classes. If you like where we video an actual patient action patient actual patient case and integrate both of those how its diet.

Hey, you're diagnosing the condition and communicating it. And then so they're the three main programs that we have on there the diagnostic drills communication drills and what we call e-learning episodes. And then we've got a range of then master classes that are our Live Events recorded but edited and what I mean by edited is that we break them down into case-based problem-solving sections and you know put learning objectives against each one.

So it's not just record what we do but rather break it up into an actual learning. Program as well. So we've got a range of those on there as well. So that the moment there are more than 250 online hours that can be done and the main thrust in the US would that program is on board certification so higher credentialing and that's where that's

Nathan Cashion: [00:42:13] that's for the Orthopedic

Anthony Nicholson: [00:42:15] Yeah, it is for the for board certification in Orthopedics, which is more sort of along the lines of neuromusculoskeletal medicine rather than just Orthopedics.

You can also get some credit towards the forensic board certification as well. Yeah, so so yeah, it was very much and I'll go back and I'll just mention a little bit more about the level. Conceptually, so I guess let me just get rid of that. My apologies for that. We'd start with so some of them will focus on you.

No red flags because if you look at a framework that that might describe the day-to-day practice of a chiropractor. Is that obviously first and foremost there is recognizing serious conditions. That shouldn't be there. And this level and the next one which is spinal diagnosis Dives, you're attempting makers the clearest possible diagnosis as to the tissue and lesion on the cause of the patients path where judged mostly on those two levels because no matter what you think you can do functionally.

And also has all sorts of other meaningful contributions this patients quality of life. If we miss a serious pathology or something, you know, something goes wrong in terms of a spine diagnosis, then you know, your credibility is affected. So really our our value and our credibility is very much judged based upon.

Recognizing Sinister problems ensuring that they are appropriately referred and also diagnosing at the pathological end knowing that you've got an uncontained disc protrusion that is likely to cause a progressive neural deficit if we don't handle that deftly and professionally then instantly our credibility is shot no matter what sort of result you might get with some other things down the line so we look at.

First of all that that step of recognizing serious pathology then making a diagnosis as to the tissue in the lesion then we look at well now we can access higher levels if you really earn your stripes there so to speak and you demonstrate your diagnostic expertise, then I think your audience just about any other health care professional is much more open to what you might have to say now about why did the patient end up?

With this tissue failure to begin with and that's where we could go. I guess now even with a whole lot of other discussion as to you know, what is the nature of what we're treating here. Is it a peripheral tissue and lesion or is it a faulty internal construct in the Brian? I mean as a obviously I world of Neuroscience has opened up for us there but we really start to look at the proprioceptive impairment side of a persistent spinal problem.

Now the fact that that annular failure or that. Facet Joint impaction that recurrent microtrauma of those Facet Joint issues might really be now perpetuated by a proprioceptive impairment that the central nervous system is no longer responsive or accurately reporting the position of that joint, man.

And so you're failing to reflexively stabilize it and that has more of course more Global ramifications that once someone starts to activate their pain system over and over again. So, we now start to sensitize the pain Pathways right up into the brain that takes on a psychological Dimension. We know that patients now who are in pain lose functional capacity make poor emotional decisions.

It affects their work. It affects their diet. It affects their activity and it doesn't take too long to get from pain in the frame in some sort of mechanical application to the well-being of this individual if if you really using a communication Bridge. Overtime with your audience and I think that's one of the biggest issues that we see with the compressor professional communication is the people try and make a paradigm shift.

That's too large from some sort of perceived mechanical problems. Someone's back. I mean think about the audience, you know, someone not in this Arena would think okay. So you're dealing with some sort of tight joint or painful joint and you're now talking about health and well-being. I mean, well, well, how did you even get there?

But if we look at the fact that I've just provided a framework through which you could get there, but I think we have to be able to be a debt skilled at at communicating at all of those levels and I think then what we can really do is start to encapsulate Chiropractic practice in the something.

That's much clearer.

Nathan Cashion: [00:47:06] That's great. It's such a full spectrum and I've noticed Anthony and some of your material that there's. A lot about neurology and I'm curious whether you are Matthew incorporate any of the so-called functional or Chiropractic neurology or is this more of a focus on spinal?

Anthony Nicholson: [00:47:26] of the American Chiropractic neurology board.

I completed that back in 2006. So again on I. I mentioned earlier that I had a real interest in neurology and that naturally extended into studying that particular specialty. I was intrigued by the higher neurology and Neuroscience of what we did so I took candle and Schwartz and I read. Cover to cover looked a lot of clinical neurology and that's where you know, I came across obviously Scott Haldeman and he was you know, certainly been a mentor of mine.

I considered it one stage going back and sort of traveling a similar course to him. But yes, I ended up I studied the neurology, but I guess I would then bring that. mortu. A very I guess core evidence-based. No, but what I mean by that is I guess functional neurology has sort of come with a little bit of I guess controversy around that term.

I think if you look at where the evidence is going in sensory motor control, for example, there is there are multiple there are multidisciplinary efforts now. To really investigate since your motor control say for example after Whiplash where people develop balance disorders a whole range of things when they're Century motor control is impaired.

And so the Neurology in our program is very much along those lines functional balance disorders impaired sensory motor control, you know as a basis for ongoing and chronic sign pain, But also also there's an obvious extension there to other issues bppv, and and and all of the common things that we would see in day-to-day practice.

Now, you can choose to be more and more specialized obviously in urology and between be dealing with rehabilitating people from you know more chronic. Disease has Parkinson's stroke rehab all of that, but I think really the that's not the core scope of Chiropractic practice. We aim our programs at you know, Core Chiropractic practice everyday stuff who walks through the door rather than sort of going off into sort of more.

I guess narrow sort of specialty fields.

Nathan Cashion: [00:50:22] So I like that you incorporate that but it kind of sounds like you're not trying to replace the Chiropractic neurology program, but taking a lot of that and making sure it's. It's not just again using a treatment template but understanding it and how it applies to the most common Chiropractic

Anthony Nicholson: [00:50:46] mean, I think I think techniques in my view.

Tools for execution. They're not they don't they are the there the how of treatment not the Y so, you know, you're not I don't use them as a sort of a recipe like model for assessment. I think techniques systems I think are accumulated observations. You know of our predecessors and often what what has happened there is that I've made you know, I've clearly made observations and links between certain clinical features and decisions.

They make in terms of where and what that do, but, you know, we obviously are thrust as much more towards understanding mechanisms. And and applying reasoning and not and not being restricted by any particular system of treatment and that that's sometimes why people say well look you didn't really go heavily into exactly what how you how you manage that patient case.

And and the reason for that is that what we do is quite diverse. There are so many different ways you can get out of. And this is why we go through sort of the neurological underpinnings of you know, chronic spine pain is that we know for example that the specificity model of segmental dysfunction of the evidence just isn't there.

There are so many contradictions. Why is it that you know, I could send a patient to five different Chiropractic doctors and they would all choose somewhere different in the spine to treat that patient yet. They might all get results. So what that suggests is that we are not dealing with a specific segmental dysfunction, which requires a vector reversal of that so-called, you know mechanical destruction in order to achieve a result.

In fact, you know we look at where the Neuroscience is going now. It's more a case of. Some sort of faulty internal construct some sort of impaired or disorganized Central representation of that body part and therefore, you know, he's our manipulation is our adjustment and Amplified proprioceptive input, you know, are we really exploiting an inherent signaling property of the muscle spindle apparatus in which we can amplify.

The reporting of joint position back to the brain and change the brains responsiveness to that region of the spine such that now reflect stabilization improves. There's a clearer Central representation. I mean is that they're the sorts of Concepts we see coming through the Neuroscience now. So I think that's exciting.

So I think there's so many ways in which you can now treat a patient but. What defines us I think ultimately will be your rationale for treating them. How are you explaining? What's wrong and what you're doing that has to be in line with the latest Concepts in terms of what the evidence is saying if we want to be seen as dominating this field and to be seen as Leaders of this field or at the frontier, we can't be using implausible constructs and explanations.

And this is what I guess it's always fascinated me. I mean, you know people will often say well hang on how I care about is unique if we're if we're doing this and I once again, I think we'll hang on. Are we asking let's go back a step and zoom out. It's sort of like if you're down at the detail level, I mean, you know manipulation if you like Hands-On treatment with healing intent your predates all Health Professions, I mean, They're their depictions in cave paintings and we see the first comprehensive account by Hippocrates two and a half thousand years ago.

I mean if you look at that, he had tables much like the ones you'd see in our practices today many of his documented procedures were similar to the manipulation and the adjustments would use today and that was synonymous with medicine for the next 15 or 1600 years was manipulation. I mean you you see a cancers Galen one of the most famous Roman surgeons.

Describing a patient coming in with tingling in the hand and using manipulation to the cervical spine to treat that and that was even before an understanding of nerves of any of that. It was it's quite remarkable. So manipulation adjustment therapeutic physical forces with healing and temp have are not really called into question itself.

What's what's the issue is the claims made around what it can do. And that is what creates the controversy and so I think it's what's vital for us now is to really provide the clearest most robust framework for what it is that we think is wrong and what we are aiming our adjustment at that I think is key and that that's where our communication has to be first class.

Nathan Cashion: [00:56:15] I feel like I'm getting a master class right now is that this is amazing. I appreciate you sharing all of this with lister's one thing. I. Did I want to make sure you know doctors who might be interested in taking some courses understand is whether this is accredited for continuing education in the states.

Anthony Nicholson: [00:56:36] the these programs are. Really being used for board certification of credentialing High credential and studying towards board certification. So you will get and that that's really the only way to access them now is through the University of Bridgeport to study towards becoming board certified you do they also do attract seeds in.

Again, the u.s. Is obviously a bit more complex than Australia in Australia. We have one National registration. We went away from any sort of State based registration quite a number of years ago. So in the u.s. obviously every you really got like a little mini profession in every state in some ways, I guess Avenue.

So it's a credited in many states for those that allow online. Education to be to be recognized for see but that's through the University of Bridgeport. So through their site you you can see whether you know the state you're in we'll accept that. But but ultimately it is more now for training towards the the higher credentialing.

Nathan Cashion: [00:57:51] Now due to register for sure for some of these course some of these modules that you have is that I know I can, you know log in create an account on CDI and there's a way to purchase credits and all of that. But if I'm in the states do I need to go through University of

Anthony Nicholson: [00:58:09] an agreement with University of Bridgeport who we provide the learning programs to the university and the university then offers those as.

The neuromusculoskeletal medicine program so that program involves 250 online hours and 50 live seminar hours and that gets you to 300 to be eligible eligible to be to set the board exam. So all of that is then done through the University of Bridgeport. So accessor program now in Australia, you know, that's different and Australia New Zealand for chiropractors over here.

You know, you do your continuing education directly through us, but in the US all of our programs are through the University of Bridgeport. So anyone interested would need to go to the University of Bridgeport site and register with them.

Nathan Cashion: [00:59:10] All right. I will ask you to send that link to me just so I know I can point people directly to it, but I would encourage the listeners to go to CDI and create a free account.

I believe that still an

Anthony Nicholson: [00:59:23] Yes, you can and we have you know, as you've seen a range of interviews with experts Now by that. I mean, we've interviewed spine surgeons and we sit down with them. We say look, what are the criteria you would use to decide when to operate and when not with a dissolution with a disc protrusion.

And when would you fuse and when widget not what goes through your head talk us through it? You know, we might go and see another neurologist about migraine and so look, you know, what what's your thinking in terms of what medications you've described and how you manage migraine sufferers, you know what, you know, are they different categories?

You take different approaches based upon different clinical features. Just what goes through your head share that with us so, you know that so we we go to a whole range of different experts and get them to share their clinical thinking with us. So

Nathan Cashion: [01:00:17] As a younger practitioner. As someone who's you know more recently out of school and getting ready to start possibly my own practice in a new area.

These are great interviews to sit down and and to learn what questions to ask because I do want to go around and meet the the GPS the neurologists the. And and these are the questions that I think clinician should be asking to be able to learn about the medical colleagues in the area to build that relationship.

And so I think that's a really great resource. There's lots and lots of blog articles that again, that's how I first found it and I've read through a few of those in there so well-written and really informative and there are some previews of a lot of. The courses especially the clinical masterclasses which again show just how high of a production quality that you guys provide as well as an insight into what's covered in those symposiums and.

Master classes so I really encourage your listeners to go take a look browse it. I think it's again a great resource. I'm thinking you know for the new grads. I recommend Don Murphy's clinical reasoning in spine pain texts as a way to kind of bring everything together, but I think that paired with the articles on your site as well as some of the online see would be.

One of the most powerful resources. I think that new graduates could use to really hone their clinical and diagnostic skills. Thank you so much for what you and your business partner Matthew long and put together. I honestly feel that this is the best quality online see that is available that I've been able to find whereas most online see is.

Logging in and reading, you know a few thousand words of text which could easily be put into a book or you know into audio. I think the format that you use and the effort that you go into making it making it quality do make it more engaging and really increase the value that clinicians can get out of it.

So, thank you so much.

Anthony Nicholson: [01:02:38] for noticing as I think that's that's humbling. And you know, I just hope it you know, it makes a difference. I think as you say especially with interviews with experts the reason we did that was to. Just because you know, we're all sort of really responsible for educating ourselves on going and you know without.

Getting these insights and perspectives from you know, from the view of other health professionals. It can be, you know, it can be a bit Solo in practice. So I think that we tried to make that sort of accessible as if you went and sort of did it yourself so so not look thank you. I really I really appreciate that.

It was it was very nice for you to ask me to come on and speak to

Nathan Cashion: [01:03:24] It's been my pleasure. So for those listening you can go to CDI dot EDU. A you it is, of course in Australia and browse the website take a look at some of the free material and dr. Anthony Nicholson. Thank you so much for being on exploring Chiropractic.

Well, thank you. I think we've gone we filled the time and I imagine you need to get back to pseudo to seeing patients. ↩︎

Dr Anthony Nicholson B.Sc. (Qld.), M.Chiro. (Macq.), DACNB. FACO.

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