Chiropractors are always looking for newer and more innovative ways to expand their practice with explosive growth. Learn how to use X-ray and posture analyzing software to help you help your patients.
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Tabor Smith: Well, hello and welcome, ladies and gentlemen. On behalf of Genesis Chiropractic Software, I’m Dr. Tabor Smith, and I’m proud to have our guest today. He’s an instructor with Chiropractic Biophysics and president and CEO of Posture Co, Dr. Joe Ferrantelli.
Joe, welcome to the show. How are you doing today?
Ferrantelli: I’m doing, well, as Sid would say, nearly perfect.
Tabor: Awesome. I love your attitude and I love what you’re doing for the profession. For those of the people, the chiropractors out there that maybe haven’t heard your name yet, tell us a little bit about you, how you got into, not only corrective care chiropractic but also getting into the softwares that you provide chiropractors today.
Joe: Yeah. Well, great. Well, since I grew up in athletics and power lifting and a family that was in bodybuilding, it was pretty much ingrained in me that I had to see a chiropractor, our chiropractor, the team chiropractor.
As a kid, I saw my dad going and I thought it was all pain-based. I didn’t think anything of it. I told my dad, “Why do I have to go? I don’t hurt.” He was like, “Because you want to be a better athlete, don’t you?” And I said, “Yeah.” “Well then you have to have to go see Doc.” And I’m like, “Okay, I’ll go.”
I was still very skeptical even as 14-year old kid. I thought I knew everything back then, too. So I started going to him and he was working a bit on my posture, and all of a sudden, my strength went up, in my squat. And I remember going to him because he didn’t . . . Unfortunately, he didn’t do a good job educating us on . . . maybe it was because I was a kid and he didn’t think that he had to educate the kid, but obviously educating my dad enough to bring me in.
So I asked him. I go, “Is what you’re doing related to my performance because, nothing else has changed but my strength has went up tremendously?” Then he related posture and how it affects the nerves and spinal position and things like that.
Ever since then I knew it was a toss up between being a meteorologist and a chiropractor, and obviously a chiropractor won out. I stayed on with him for many years until I went to chiropractic college. That’s what inspired me to go.
But once I got there, how I found corrective care was I was starting to get a little bit uneasy and almost wanted to drop out of school, like first, second quarter because I always understood the philosophy and the chiropractic improved everything.
What I was exposed to, it was obviously the good and bad. Going to Life East, I was exposed to everything, which is great because sometimes you’re not exposed to anything if you go to certain other schools. The problem was that I was really frustrated. I’d go to different clubs with the same person from . . . you know how they would have clubs every night somewhere?
Joe: I would go to different technique clubs and they would find a different problem with the guy that I was just with. My friend that I was going to the clubs with, last night he had one problem, one technique said, and then the next night, he had another problem, another type of subluxation and it didn’t make any sense.
So I went to CBP because I heard that it was scientific and that it was subluxation-based and it fulfilled the philosophy of chiropractic. At least that they didn’t have all the answers, but they had a lot of answers that seemed to go unlooked [sounds like 00:03:32].
I went in there, and everybody found the same problem on everybody all the time. It was reliable, and I said, “Huh, this makes sense.” Then I started hearing about this crazy guy named Don Harrison. He’s really, really smart, has a lot of answers, and is so passionate about chiropractic. Just don’t sit in the front row and ask a dumb question because he would always joke with you and say, “Hello, hello.” If you didn’t understand the question, stuff that you should have known.
He was a fantastic teacher. It was like I was blessed to be a part of that, and if it wasn’t for Don Harrison, I would have dropped out of school, and I have countless friends that have said the same thing. He affected so many lives, including what he did, it changed the whole course of my life.
Just little things like, here I was going through so many years of chiropractic care, going through the clinics at Life, and I don’t know, I met Don, it would probably be maybe my third quarter at Life.
First thing he says to me, when he sees me walk he goes, “Joe, you need to get an x-ray. You have a short leg.” And I go, “Well, I have lots of x-rays.” He’s like, “No, somebody screwed up. You have a short leg.” I’m like, “Don,” I go, we’ve . . . back then it wasn’t Don. It was, “Dr. Harrison, I’ve had lots of x-rays.” I brought him the x-rays the next day at a seminar, and he goes, “Well, I’m not good at reading obliques.”
That was always his joke I found out later, was when you have a misaligned x-ray that hey, you need to retake this x-ray because what you’re seeing on the x-ray is not true biomechanics.
Sure enough I went to a CBP doctor that’s very specialized in taking x-rays. It’s kind of we grew out of upper cervical. So think of upper cervical positioning really meticulous, and for every area in the spine, so when they took it they found that I had a huge short leg, that had been missed by my family chiropractor, the clinic doctors at Life, my interns.
As soon as I put a lift in, it started changing my life, and I’m like, “Wow.” This was the opportunity to learn more, and I got inspired. That’s how I found CPB.
Tabor: Well, just for the listeners that aren’t familiar with CPB, that Don Harrison is Deed Harrison’s father, and Deed Harrison is the main guy in CPB right now, correct?
Joe: Yes, correct. What Don’s claim to fame was, that he was a passionate chiropractor that originally when he got out of school, he was working with Earl Pettibon, structural-based, Dr. Pettibon technique. When he was working with Dr. Dan Murphy, and everybody’s heard of Dan Murphy. A lot of people don’t know that he was practice partners with Dr. Dan Murphy.
Tabor: Oh, wow, I didn’t know that.
Joe: Yeah. And, yeah, Dan Murphy is a CBP doc. He stumbled upon CPB, in effect . . . I’ll just make the long story short. He stumbled upon working on a tough case that when he was calculating vectors for trying to tap atlas [sounds like 00:06:53] so to speak, that he would have had to correct this person’s spine, he would had to draw a hole through the skull to contact the atlas.
Then at that point in time, it hit him. He said, “You know what? What we’re seeing on the x-ray is a three-dimensional image smashed on to a two-dimensional film, so we’re seeing the shadow, and some of these shadows can counteract each other to make the person look better or worse on an x-ray, and we need to look at their posture. If we fix our posture, most times, except for cases where there’s severe instability or things like scoliosis, it will improve.”
That’s when he, long story short, stumbled upon CBP technique, and he was working on it early on with Dr. Dan Murphy. That’s how CBP was born.
Tabor: That’s awesome. I personally, I love CPB, and I don’t know, I never knew Don, but Deed is awesome. I’ve got to be around him a few times. Been to some CPB seminars and I just, I really enjoy Deed. He’s a good guy.
Joe: Yeah, he’s doing wonders for the profession as far as he’s carried the torch for CBP very, very well. Even though Deed and I are the same age, I consider him one of my mentors.
He’s a lot like his father to where he never forgets anything, anywhere, any time. The guy has a memory that’s unbelievable. He has a knack for spinal biomechanics, you know?
Joe: And he’s very, very gifted at it and really has advanced CPB even beyond what Don saw the vision of CBP early on. Don would be very, very proud of his son.
Tabor: Yeah, oh, absolutely. They’re great, and I encourage all chiropractors out there, if you’re listening to this right now, I highly encourage you to go to a CBP seminar. It’s life-changing. It’s definitely practice-changing. You’ll love it.
So moving on into . . . Joe, you’re getting into CBP. You found that this is your calling, that you’re moving towards posture correction. Where does the software come in? How did that work?
Joe: Funny story. Well, when I was working with Don early on, I’ve always been into technology. As a kid, as a hobby. I grew up in technology, it was one of my hobbies besides athletics, it was computers.
So I realized that CBP did not have a website when I was going to school. And I made a website for the club, for CBP club, idealspine.com. At the time, Life was very, very strict. They said, “Well, you can’t have a website for a club.” I said, “Okay, that’s unconstitutional. You can’t tell me what we can or can’t do.”
Rather than be controversial or cause any problems at the club for Life, I was discussing this with Dr. Don, and he goes, “You know what, Joe? You have a knack for this, but we don’t have a website. How about you become . . . what do they call it? A web master.” I’m like, “Okay.” I never thought about that.
So we turned the club website into idealspine.com. That’s how Ideal Spine came to be. I managed the website for quite a long time until I realized, “Hey, you know what? There are specialists that . . . ” Deed and I decided several years ago, we need to find people that are really gifted at . . . do what they do. We wouldn’t expect a graphic designer to do chiropractic care, so why are we trying to meddle in doing something that’s not our specialty.
That’s how I got into the technology with chiropractic, so to speak. Early on in my career, when we’re marking x-rays, Deed and I would take photographs of our x-rays on a view box and want to basically make reports, report of findings reports for our patient. So we would take photos, put them in a Word template, and it would take like 20 minutes to get just one report. What we found that if we gave customized reports to our patients, the retention went way up.
So early on, I tried doing, dabbling, and doing a future version of what became Posture Ray, our x-ray analysis software. And eventually as we started doing some of the spinal modeling studies, it was inevitable, in 2006, we had a sister company that I was the liaison to the programmers on how to develop the software.
Where we could mark x-rays like we did, and using the backend of our research software, and just put a graphical user interface on it. So clinicians, when they digitized x-rays, could have a report of findings that went home with the patient.
Clinical documentation that could be uploaded into an EHR, even though back then I didn’t know what an EHR was. We were just basically getting basic note systems. Be able to have a view box that even if we had . . . because we didn’t have a digital x-ray back then, but we had photographs, that I could educate a patient and draw on the x-ray in real time, and I didn’t have to go looking for the x-rays.
So that was the genesis of really getting going with our x-ray software, and at the same time we’re also working with another company on development of Posture software.
Tabor: Nice, and that eventually became Posture Ray, I’m assuming.
Joe: Yeah. So Posture Ray had its birth really in 2006, and the company was formed Posture Co in 2006. We’re all a part of it. Then early in 2006, we realized, too, our Posture software, even though it was reliable and valid and published in several journals, it took way too long for clinicians to use. Clinicians were not even using that because it just simply took too long.
And in 2007, when the iPhone came out, I approached Don. I said, “You know what? There might be a better way.” When I started doing apps, I said, “How cool would it be if we could take a photograph on an iPhone and mark the picture and anywhere, any time, be able to do a photograph of a person and educate them, and at the same time market CBP.” He thought it was a good idea, so I started thinking about it.
And in 2009, I really started to get the ball rolling. I heard there was an iPad coming out, and I basically took all the money that I possibly had and invested it in this idea. In 2010, I took over Posture Co when unfortunately Don got sick. Deed took over CBP seminars, and I took over PostureCo. Really haven’t looked back at it.
It’s crazy how things happened, and this – my purpose was to be able to get to more chiropractic patients worldwide, getting them aware about their posture and helping doctors succeed in practice.
I get a lot of enjoyment. I miss patient care. I stopped seeing patients except for friends and family in 2012 to focus on this full time, and of course teach with CBP.
Tabor: Well, let’s focus on that. What you just said, you’re helping chiropractors reach more people worldwide, and so in this portion of the interview, I’d like to get into the benefits that your software provides chiropractors. Bottom line, it’s going to help make their lives better. It’s going to help make their practice easier. It’s going to help them to communicate the power of chiropractic to their patients.
You have three software components, the PostureRay, the PostureScreen, and the LeanScreen. So take us through how a chiropractor that’s not familiar with those, how would it benefit their practice and . . . well, each one of those does for the practitioner.
Joe: Okay, well, for anybody that takes x-rays, I’ve already kind of spoke about PostureRay, and the reason why it’s called PostureRay was because Don Harrison thought it was . . . posture affects x-rays so we’re going to combine those two terms and make PostureRay. People still . . .
Tabor: Digital, a lot of people are taking digital x-rays now.
Joe: Yes. And effectively now, we don’t replace what’s called the PAC system. We work in tandem. Think about it as a radiographic EMR system.
Tabor: Got you.
Joe: So we’re like a note system specific to x-ray that help document and build the practice. So I could spend a whole hour discussing what PostureRay is, but you can have your staff help you and the doctor verifies all the markings are correct. Literally you’ll get a report that shows a patient versus normal their percentage differences at every spinal level showing subluxation, educational reports.
Then of course you can document everything from instability to subluxation correction, pre-, post-, correction potential x-rays. It goes on and on what you can do with PostureRay.
PostureScreen is an iPad or Android or an iPhone app. It runs on iOS and Android, and works in tandem with PostureRay. You can upload the images that you annotate to your EHR system, but what it allows you to do, quite simply, is do a reliable postural analysis as detailed as you want.
If you’re at a spinal screening, you can do just lateral views that take 10 seconds to be able to do, and because if you’re at a spinal screening, which of all people you know, because that’s your specialty. You may have 15 people walk up at once, so you got to be able to process some.
So we came out with quick-screen module with that, so we can just do very quick, annotated images for patient education. So when they come in, you can do a two-view or even a high-end four-view postural analysis.
We got some other things in the works as well, too, and that allows you to clinically find out what’s going on with the patient because as we know where the posture is, is where the spine is within. So we want to be able to educate the patients because here’s the biggest thing that I see with people that are struggling in practice.
Well, A), if they’re not structural-based, that makes the world that much harder for you to practice because how are you unique and different compared to the chiropractor that’s dealing with pain, down the road? We know that chiropractic’s much more than pain.
Well, if you don’t get them, just like what I would say, from that pain idea to posture and organ and systemic health, how are they going to express a better life through what it is that you’re doing?
Posture is really that key. So what it allows, is that the staff can help with the posture exams is very, very fast, but it gives you the clinical data that you need to know how to fix the person, but realistically it shows the patient. They understand their posture, a lot of times, much better than their x-rays.
So you can show them their neck, and they’re going to think it’s their lower back. Even sometimes, unfortunately, nurses can’t tell the difference. But they all can see their posture, so if you make a change in their posture, you’re making a change obviously in their health, in their spine, and used it in tandem with the x-ray findings. You don’t have to be a CBP doctor.
It’s just amazing the retention that you’ll get from this, not to mention that it’s easier to get patients in the door. But it’s easier to retain them when you can show them predictable changes, especially with even just simple postural based types of regimens.
Tabor: Right. Well, and for me personally, and all your software is awesome. I use PostureScreen mobile the most just because we do our screenings, and I’ll tell you, I think every chiropractor on the planet should have this software, should have an iPad. I think that’s what we found it works best on.
Joe: Yes, absolutely.
Tabor: And should get that and use that in the practice. Another thing I think we should mention here, especially our Genesis Chiropractic Software users out there, it’s beautifully implements with your EHR software. You take the key in and plug it in, and just hit a button, and it can upload and it can create a patient file in your EHR file.
Joe: Oh, yeah. For Genesis, it works fantastic. Genesis was the first EHR that we integrated with, and they were a pleasure to work with. What’s great about it is if you’re at a screening and you have Genesis software.
As soon as you’re done with the screening, if you push it to Genesis, it will create an account in Genesis already. So that when that patient comes in, Genesis already has an account waiting for them. It’ll have the postural photographs and PDFs already in there.
Then if they already have an account, it’s going to obviously upload those PDF documents and images directly to Genesis as well.
So when you have Genesis, you don’t even have to manually upload anything. There’s no using Box or Dropbox or any other syncing type of third-party software. It’s directly pushed right into their software. It’s fantastic.
Tabor: Talk about making your life easier, right there.
Joe: Yeah, absolutely.
Tabor: Then the newest software that you came out with is LeanScreen. Is that correct?
Joe: Yeah. LeanScreen is pretty cool in the fact that since – I was a trainer long before I was a chiropractor – and I got really frustrated when we’re doing body composition analysis on people. Like if I started somebody and I did, I was good with calipers and they followed up with somebody else, we know that calipers for body fat are like 5% to 8% unreliable.
You have validity issues. Which means they could pinch too much skin, pinch not enough skin, pinch in the wrong areas with the calipers, and then my client that I started on maybe not . . . we didn’t get a good follow-up exam unless I was the one, the trainer that did it.
Then even the electro-impedance methods out there, they still have some variance, too, so there’s no body comp method that is fool proof. Even high end like water displacement or what they called DEXA scans, which is a DEXA dual x-ray absorptiometry, dual exposure [sic] x-ray absorptiometry measurement.
So you can calculate bone density to soft tissue and calculate body fat. Those are pretty much the gold standards, those two. But they still have 1% or 2% variance, depending on what study you’re looking at.
So I thought about this. I said, “We actually have a full utility patent on PostureScreen mobile”. Since I did research with none other than Dr. Don got me thinking about different things, if I could calibrate the size and the pixel of the image, and I knew the person’s exact type or I know distance on say the wall behind them, I could calculate – I hired very smart PhDs that helped us with spine modeling to help me with these equations – we could estimate circumferences around the person from two photographs.
For those not familiar on this, the Navy in particular and the military has been doing body composition analysis using a tape measure, where you measure the circumference of the neck, mid-torso, stomach on men, and hips. They would do these large-scale studies where they have thousands of people, these measurements correlated to body fat percentage, and it was very, very good. As a matter of fact, most body-comp methods are based on what they did.
So what I did that was unique and different, to steal a phrase from my friend Dr. Fred, what was unique and different from this, was I was bypassing the tape measure, and doing a virtual tape measure from using the mathematical formulas from my friend, that helped us with our spine modeling. He has a PhD in mathematics.
We were blown away on how accurate this is. It is very, very accurate when done correctly. As a matter of fact, it got the attention of a major university. We’re in a major study right now, with well over a hundred subjects, comparing inter and intra examiner reliability between examiners, as well as validity against DEXA scan.
It’s going to be a really great study, but anybody that’s used it after a few patients and you watch our videos, you can get very good and accurate with using body comp.
How it helps a chiropractor is this, how many people out there want to talk about health and wellness? If a person is not getting better, you might be doing great adjustments for them, but if their diet stinks and they have poor health outside of what you’re doing, you’re never going to achieve those goals.
So a lot of doctors are moving into having diet, weight loss, and working with personal trainers within their community. What’s great about the PostureScreen, LeanScreen module is someone comes in for weight loss, it was usually hard for them to convert them into chiropractic patients.
Well, the same photographs that we can use with LeanScreen – they come in for LeanScreen, we can then do an analysis of their posture and get them started thinking about structural alignment. Maybe have a consultation with the chiropractor when they only came in for weight loss.
Or conversely they start coming in for pain, get them going with their spine, the same photographs can be re-used for body composition analysis. So it does everything from waist to hip ratio, to lean body mass, percent body fat, you name it.
So I’m really, really proud of LeanScreen. You’ll only have a couple of good thoughts in life, and this was my one good idea.
Tabor: Oh man, I think it’s awesome. I think all three of those softwares are awesome, and as we move into our close, Joe, let me ask you, is there anything we should be looking for in the future? I’m sure you’re working on a lot of things. Is there anything that you want to announce or anything that you’re doing right now?
Joe: Yeah. Good question. I feel like this whole thing has been a little bit of me just talking about PostureScreen, but we got . . . one of the big problems that there is right now is that if you have more than one device is getting your exams on multiple devices so that way if you start on one iPad, well, you got to do a follow up on that person.
Maybe they screened them with an iPhone and they come in to your office and that iPhone’s no longer with you, you want to have to access that data. So we’re going to be launching a cloud synchronization and back-up service that we do that you could have all your devices basically sharing one common database.
One of the main advantages is it saves tremendous space. If you’re doing video capture on our app or any app, it takes up a lot of space on the device. Now you’ll be able to offload that on to the cloud. So that way it saves tremendous amount of space on your device. That’s one thing that we have coming out.
Another thing that I can announce because Dr. Deed Harrison already announced it, is will have very shortly three-dimensional posture analysis. You heard me correctly, real 3D analysis. As for those doctors that want even more, you’ll actually be able to attach a scanner to your iPad and literally scan an image that you can pan zoom and actually have a three-dimensional replica of your patient.
It’s going to be the most accurate form of postural assessment there is. That from clinicians that obviously structural-based care is their thing, but talk about bringing it to another level. So we’re going to have a version of that, hopefully, to show off in about two weeks at the CBP Annual.
Tabor: Man, that is awesome. I got to tell you, Joe, that’s one of the things I love about you and I love about CPB is your dedication to excellence. It’s not just good enough to be good.
You guys, you go above and beyond. There’s precision. There’s reliability. When you’re using your software, you can be 100% certain that you’re using the best that’s out there, so.
Joe: Thank you.
Tabor: Yeah, you bet. Thank you for being on the call with us today. I really appreciate your time. If you can leave us with maybe some information about how would a doctor find more about these softwares. Where can we find them? How can we reach you? Any information you want to give us.
Joe: Yeah, the website that you can reach to us at postureanalysis.com. You can go to Facebook.com/postureanalysis. If you want to email me directly, it’s firstname.lastname@example.org.
Tabor: Awesome. Thank you, Dr. Joe. We’ll have all of those websites and email on the show notes. Thank you again for your time, and thank you all for listening today. You have a great day.
Joe: Thanks, Doc. Okay, have a good day.
Tabor: You, too. Bye.