Dr. Jay Bulloch completed the SMAC program in October 2015, and is now a practicing sports acupuncturist in Los Angeles, California.
“In asking me to write this, Matt had asked if there was ‘an out of the ordinary and successful case study that their SMAC training has helped with.’ I could rack my brain for maybe the most unique case, but the greatest benefit SMAC training has had in my personal practice is the ability to find clarity in diagnosis, efficiency in treatment, and a common language that gives me the ability to work with and support other doctors and practitioners in an integrative, multidisciplinary clinic.
About eight years ago, I became part of an integrative, multidisciplinary clinic. The clinic provides acupuncture, chiropractic, physical therapy, massage, Pilates, Gyrotonic, and Yoga—and, we also have a 4,000 square foot functional training gym.
Working in a setting like this has its pros and cons. On the up side, you have other practitioners who you can collaborate and work together with to carry the load and responsibility of patient care. From an administrative perspective, you also have other people running the business side of operations so you can put all of your focus and attention onto patient care. However, one of the significant challenges is working within the complex schedule of the patient when they are working with multiple practitioners in one visit and also have their own busy personal schedule they have to stick to.
On a day-to-day basis, the single biggest challenge I frequently face is time constraints. Because patients like to come to our clinic to receive multiple modalities of care in the same visit, I am often working not only within the limits of other practitioners’ schedules, but also the time limits of the patient’s personal schedule. The patients themselves are frequently juggling work, meetings, kids’ school and sports, and other family and social obligations, etc.,while also trying to see up to three different practitioners during the same office visit.
The clinic itself is about 10,000 square feet. We have 10 treatment rooms, a dedicated Pilates and Gyrotonic studio, the functional training gym, and space for physical therapy. On any particular day, there can be a chiropractor, three massage therapists, two of three physical therapists, three to four Pilates and/or Gyrotonic instructors, a couple of personal trainers, and an acupuncturist (me).
Many patients are also using health insurance to pay for their medical care, and this adds its own layer of complexity to scheduling covered services within and out of network provider network.
In a clinic of this size and complexity, there are lots of moving parts, and you have to be flexible and able to accommodate the time constraints of the patient and other care providers.
While having 10 treatment rooms means the patient can be in a room for as long as necessary, their scheduling doesn’t always give me an hour or more. It would not be uncommon to have three to four patients scheduled in an hour at peak times of the day and for the patient to only have 30 minutes before they need to be getting to their next appointment. As the goal is to provide high quality care within the time constraints I am given on these occasions, time management and efficiency in treatment are imperative to be able to work in a setting like this.
It is the systematic precision and detail of diagnosis and treatment, combining both Chinese and Western medicine, that is learned in the SMAC training that has served me best and enabled me to operate in a busy, multidisciplinary clinic. The integration of Western sports medicine and postural and structural analysis provides a common language that can be used to collaborate with the other physicians. This has enabled me to work alongside our physical and exercise therapists, chiropractor, and massage therapists and continue to earn the trust and referrals of MDs and surgeons who frequently refer to our clinic, precisely because of the type of service we can offer their patients.
It is the systematic and modular approach of Sports Medicine Acupuncture that allows me to perform quality diagnosis and treatment in a timely fashion. While I’m diagnosing, I’m simultaneously constructing an entire treatment plan that I can communicate to the other practitioners in the clinic. Because I can also understand the approach and terminology of the other practitioners, they can communicate to me what they may have diagnosed and begun treating, and I can support them in helping the patient by adding my set of skills to the overall treatment plan. It is because Sports Medicine Acupuncture integrates Western anatomical and physiological concepts that we can all work together, in an integrated fashion, for the patient’s benefit.
Due to previously mentioned time constraints, I need to be able to diagnose and treated efficiently and expeditiously. As I go through the diagnostic process systematically, I am simultaneously constructing the treatment in my head and making notes for the other care providers in the clinic.
Because I work with a chiropractor, I see a lot of back and neck pain, so in an example of low back pain, the first thing I do is have the patient stand to check posture. With my very first observations I can begin constructing the treatment.
If there is left pelvic tilt/elevated right ilium the working prescription begins with GB 41, SJ 5, and Quadratus Lumborum on the elevated side along with gluteus medius and minimus. If there is anterior pelvic tilt, I’m adding Liver 4 and GB 39.5 and psoas and lumbar extensor motor points (UB 24 for psoas, UB 22 for longissimus thoracis, and UB 52 for iliocostalis lumborum) bilaterally.
Then, I check the feet, as pronation can frequently lead to anterior hip translation and/or pelvic rotation. I can take note of any issues there, and if, for the sake of this example, the feet are fine, then I move on to have the patient perform a squat. If there is right valgus knee with the squat, then adductor longus and brevis on the valgus side get added to the prescription along with Liver 5 (Luo Point) and GB 40 (Source Point). If there is pain at the SI joint, I’ll check Gillet test while they are still standing. If there is positive Gillet test, I hold that thought for the next phase.
At this point, I move to manual muscle tests and other orthopedic tests, such as straight-leg-raise if needed. If the gluteus medius and minimus are only weakened with adductor strain, then this reinforces my decision to treat the adductors and, depending on the findings, I may change from only treating the side with valgus knees to treating adductors bilaterally.
While the patient is in supine position, I can check tongue and pulse, adding any appropriate points. Then, I have the patient lie prone and complete manual muscle tests of Gluteus Maximus, hamstrings if indicated, and orthopedic tests such as Yeoman’s. I also palpate the SI joint due to the positive Gillet test and Hua Tuo Jia Ji points. Corresponding Hua Tuo Jia Ji points to muscle weakness and any painful points get added to the prescription as I’m building my treatment. (If the patient presented with an MRI, I will have checked that in their records before seeing them.) In a case with an elevated ilium, I can palpate the best points on quadratus lumborum (motor point, yaoyan, pi gan). Each step of the way, I am building out the entire treatment plan.
Because all of the SMAC modules integrate seamlessly, I can go through this process pretty quick and efficiently. After doing this several thousand times, the process has become quite fluid. Once again, as I’m working through the diagnostic process, I’m building not only the acupuncture prescription, but also manual therapy and exercises. By the time I have completed a systematic diagnosis, I don’t have to spend more time deliberating before I can start treatment, and I have notes for all the other therapists if needed. I can also communicate with the Chiropractor what adjustment could be helpful. In this case where the SI joint was stuck on one side, I can ask him to adjust the SI joint after acupuncture.
While this is just a single, simple example, I can follow this approach with any case. Each time I have an efficient and systematic process. As I decide which motor points are going to be treated, I already know where the massage therapist needs to work, and I can communicate that in a way that they don’t need to know anything about Chinese medicine or acupuncture channels, because we have a common language. The same goes for communicating with the Physical therapists, Pilates instructors, or Chiropractor.
If, for example, I determined there was a vertebral fixation during diagnosis, I can treat that with acupuncture, have the massage therapist further loosen the muscles and fascia around the fixation, and communicate to the Chiropractor the level that I would like adjusted. I can also put notes for an exercise therapist to work on spine mobilization exercises. Regardless of what type of postural imbalance I determine there is, the same process applies to communicating with massage, movement, and/or physical therapists.
This process can also work in reverse, if for example a physical therapist examines a patient first. In a case where the gluteus muscles are not firing due to a bulging disc impinging the motor nerve, the physical therapist can refer them to me and I can address this with acupuncture. I can then instruct the patient to schedule acupuncture prior to their physical therapy session so that I can activate those muscles with acupuncture and e-stim first, and then they can strengthen them during physical therapy without creating dysfunctional compensations.
While the time constraints of having to work within the complex scheduling means I have to stay on my toes and be maximally efficient in my diagnostic and treatment process, this team work can actually be better all around, providing we schedule the patient in the correct order. In a case where there is something like pelvic rotation due to a pronated foot with collapsing arches, I can needle the motor points and sinew channels and then ask the physical therapist or other exercise therapists to address the corrective exercises in the patient’s session with them after me. In this way, rather than trying to rush the exercise component at the end of acupuncture treatment, the patient can go from the treatment table and do a full 30-60 minute session with another practitioner to make sure they understand their exercises and can perform them properly. The patient doesn’t have to be rushed through their exercises while I’m juggling other patients. I can apply the best of my skill set, and the other practitioners can do what they do best in plenty of time.
If I were working on my own, I wouldn’t necessarily be able to perform 30 minutes of manual therapy and 30-60 minutes of exercise therapy after a front and back treatment (not if I want to make a living). However, in a case of something like upper cross syndrome, I can focus on the motor points and acupuncture channels, have the massage therapists perform manual therapy for 15-30 minutes (that’s what insurance pays for), and then by the time they get to the physical therapist, they are all set to get maximum benefit from that session, which can focus on movement rather than a rushed combination of manual therapy and movement.
Once I have performed initial assessment, I have an entire treatment plan that can be clearly communicated to a team of other practitioners (in familiar terminology) who all have their own specialties and skill sets. The whole plan can be executed very efficiently for maximum benefit on follow up visits. In this way, I can work within a team in a synergistic way and, together, we can provide a quality, integrated approach in a single patient visit.
Based on how I was taught in the Masters and Doctorate program, I would never be able to work in such a comprehensive way, and I would not be able to fit in as well within a big, multidisciplinary practice. With Sports Medicine Acupuncture, diagnosis and treatment strategy is a singular process, and I can communicate findings and treatment strategy clearly to massage therapists, physical therapists, movement therapists, and the chiropractor in terminology that they are familiar with. If they are first to see the patient, then they can also communicate their findings and treatment to me, which I can consider as I go through my own assessment and treatment.
If a patient has an injury or pain due to specific muscles not firing, they can do all the physical therapy they want, and it won’t help. I have seen countless cases in patients who tell me they have spent months in physical therapy at another clinic with no benefit. With SMAC training, I can quickly and efficiently figure out why their prior physical therapy didn’t help, treat the postural imbalance and motor points so that they are now balanced and functional. Using this approach, the physical therapists and I can work with each other to actually facilitate the process of rehabilitation effectively.
Sometimes, I would definitely like more time with my patients, and that is always on offer to them. The reality is, however, that I practice in a big city where people live very busy lives. Sometimes a patient needs to be able to cut out of work, get treatment (acupuncture, massage, physical therapy) and be on the road in a timely fashion to pick their kids up from school, get them off to soccer practice, then homework, dinner, etc. Or, they need to be on a conference call and can’t adjust their schedule to give me (and the other doctors) more time. I don’t always have hours, or even an hour, to spend with a patient, but I still need to be able to perform a quality diagnosis and treatment and then come up with a comprehensive plan that I can communicate with other practitioners to best serve the patient within the constraints of their own schedule.
I really think the great strength of my SMAC training is that it has enabled me to perform comprehensive diagnosis and treatment efficiently so that I can practice in a busy, multidisciplinary, modern practice, where time is often of the essence. We must always adapt to the time and the culture, and SMAC training has definitely given me the ability to do that in a way that no other system of acupuncture I’ve come across does.”
To connect with Dr. Jay Bulloch, visit him C.SMA Directory Listing.