A Talk with
Dr. Marshall Dickholtz, Sr.
By Michael Thomas, D.C.
(Interview originally published in The NUCCA News in 2000.)
Dr. Marshall Dickholtz, Sr. is seventy six years young. He has the energy of at least two thirty eight year olds and he shows no sign of slowing down. A founding board member of NUCCA, Dr. Dickholtz, Sr. has been of invaluable service to several generations of upper cervical chiropractors. His mechanical inclinations and innovative mind have resulted in many if not most of our current x-ray protocols. These include invention of, and use of the chin centering device, filter system, x-ray alignment (booklet and video), numerous articles on improving film accuracy, investigation of improved grids, invention of and use of the horizontal lines wall chart, investigation into improvement in the teaching of the roll-in and other phases of the adjustment.
He has been incredibly selfless in terms of time and money in teaching many, many students in all phases of the work. He is presently finishing up an amazing study which will probably be published in the medical, peer-review literature and promises to open some eyes. Dr. Dickholtz has also quietly and consistently kept us all supplied with the various x-ray analysis templates and maintained the high degree of quality that is mandatory for this work and for which NUCCA has become known.
Dr. Dickholtz has been married to his wife, Mary Ann for forty six years and has been known to cut a mean rug with her. He has two children, well known to the NUCCA community. Dr. Sherry Gaber who lives in Santa Fe, New Mexico and Dr. Marshall Dickholtz, Jr. who practices in Morton Grove, Illinois. They are also both certified NUCCA doctors.
MDT How did you become involved with chiropractic?
MDS I had been a pre-med student at one point and then been out of school for about ten years. I went down to Arkansas for a year to work in sales and Dr. Tina Murphy was my landlady. She got a lot of students involved with chiropractic. She told me what school to go to and what technique to take up. She was using the Grostic technique at the time. Being the wonderful person that she was, she gave me free chiropractic care.
I took up the Grostic technique as soon as I graduated in 1956. I began to go to the Grostic seminars immediately, and in fact I have never used any technique other than the Grostic technique, as it was called at the time. I was with Dr. Grostic for seven years. There were fifty people at the seminars. He had, and this is important, a beginnerâ€™s class that lasted for five days. All of the beginnerâ€™s, and if I remember right, all of the people who took the classes were adjusted by Dr. Grostic. The advanced classes were also five days. There was one beginnerâ€™s class, and two advanced classes a year. It was a private enterprise. NUCCA is a non profit organization.
Dr. Grostic was quite a person. He was soft spoken and very determined, very exacting. You couldnâ€™t go to his class unless you had two references from other Grostic doctors. You had to be referred. Of course he didnâ€™t give us all the detail that Dr. Gregory gave us in later years.
Registration for his classes was cut off at 50 applicants. So when you got your application in the mail, you sent it out the next day so you could be sure you had a spot in that class. At one time, to be in the advanced class, everybody had to send in a set of pre and post x-rays. If your x-rays were not up to par, you couldnâ€™t get into the May class. In other words, it was very important that you didnâ€™t have a low arch, Iâ€˜ll tell you that! If you did, your x-rays were turned down immediately. A straight arch would not do. The arch has got to be slightly elevated so you can pinpoint the exact spots of the attachments. Youâ€™re dealing with some very small measurements. In my office we might have to occasionally send a patient back to get re-filmed two or three times to get a perfect x-ray.
MDT What was Dr. Gregoryâ€™s role in the Grostic days?
MDS Dr. Gregory developed the work along with Dr. Grostic. Unbeknownst to Dr. Gregory, Dr. Grostic went out and patented the work. I think you might say it was a shock to Dr. Gregory. Gregory always stayed in the background. Grostic had wanted him to help teach the classes, but he never came to the forefront. Just before Dr. Grostic passed away, he asked Dr. Gregory to begin teaching some one day classes in Monroe. I attended these classes once a month for a year or so. We would drive up there early Saturday morning and Gregory would charge us a whole ten dollars to teach us the class, look at our patientâ€™s x-rays, and even adjust us. He took that money and bought a tape recorder for our classes. He never made a dime from any of the chiropractic seminars. He left 400,000 dollars for NUCCRA in perpetuity. This allows NUCCRA to spend the interest. I was the treasurer for NUCCA for twenty five years and the treasurer for NUCCRA for fifteen years.
The two point pivot system was invented by Dr. Gregory. Grostic introduced the two point pivot system after Gregory showed it to him. But Grostic had said you should only use it on baby skulls. We even had a baby cephalometer. I am one of the few still alive who attended both classes. Itâ€™s a shame that Dr. Gregory never got the recognition in his lifetime that he should have gotten. Gregory figured out the four basic types. He also mentioned a fifth basic type, as far as Iâ€™m concerned, which is the abnormal type one where the head and neck is leaning away from laterality. Get rid of laterality, and donâ€™t worry about the lower neckâ€¦ Gregory mentioned that in class. I give full credit to Dr. Gregory for everything that I know.
Due to the small handicap I have of one bad wrist, I had to use everything to the nth degree that he taught me otherwise I couldnâ€™t do what I do today. I had fractured my wrist and the medical doctor didnâ€™t read the film correctly. By the timeI realised I had a broken wrist, there was non-union of the fracture. I donâ€™t have any real radial deviation or dorsal flexion of my wrist so I only take right hand contacts. The point is that if you get your parallel forces lined up then regardless of which contact hand you use, there shouldnâ€™t be any problems.
Dr.Gregory should be well remembered for all that he did. When he formed NUCCA he didnâ€™t want his name connected with the technique name. His reasoning was that other people will add to it and it shouldnâ€™t carry one manâ€™s name. He was so unselfish in every way.
MDT You were there at the beginning of NUCCA.
MDS I am a founding director of NUCCA. We had Saturday classes for a while before it was decided we should have an organization. He felt we needed an organization to perpetuate the work. In fact, I still worry about the perpetuation of this work. Unless we can get the students to understand the critical need for sharp x-ray films and a good roll-in they arenâ€™t going to be able to reduce the subluxation to the degree necessary to make a statistical difference.
MDT Gregory wasnâ€™t the first President of NUCCA was he?
MDS No, it was Irwin Matthias. He was President for a year or two and then we voted Dr. Gregory into the presidentâ€™s position. Itâ€™s always been a democratic organization.
MDT Your contributions are immense. Every time I take a film I think of you because so much of the procedure has come from you, from the chin centering device, the use of the leaded fishing line or beaded chain, and mirror on the wall, the filters, closing down the port, and so much more. You have also been responsible for the templates and quality control in manufacture of the x-ray analysis instruments.
â€œUnless you teach
a good roll-in
and good, sharp x-rays,
the work will be lost.â€
MDS I have a machine shop background, as did Dr. Gregory. When you have a machine shop background youâ€™ve got to be more mechanically minded and precise. Iâ€™ve probably got that advantage over my fellow chiropractors.
MDT What were the initial goals of NUCCA?
MDS The initial goals of NUCCA were to help sick people. Gregory once said that if it takes adjusting the big toe, weâ€™ll adjust the big toe. The point is that we arenâ€™t interested in perpetuating what weâ€™ve done if something else is better.
MDT But so far nothing else has come upâ€¦.
MDS Nothingâ€™s come up. Basically and essentially, the way we measure post x-rays should be the criteria of everything we do. Nothing else counts. If it takes adjusting them on the other side to get good post x-rays then I would say, adjust them on the other side. But on the other hand, people mis-mark their x-rays to make them look better. Iâ€™ve never found in the few cases I did accidentally adjust on the opposite side that it worked out. They never would hold their adjustment. Temporarily, they may feel better, but the case falls apart later on. It just doesnâ€™t work to adjust on the wrong side. There have been chiropractors that use different techniques who would profess itâ€™s okay to adjust that way.
MDT Have the goals of NUCCA changed?
MDS I donâ€™t think the goals of NUCCA have changed. NUCCA stands for reducing the subluxation. The way it is taught has to change to produce better chiropractors faster..
In my office we sell no vitamins or minerals. There is nothing but my office equipment, x-ray, the neurocalometer, side posture tables, and my two hands. No massage therapists, nothing. When you want to do research, youâ€™ve got a clear understanding of your results when you do one thing. If you start to mix in more things, you donâ€™t know if it was the vitamins or the massage or the colonic or the ultrsound. You just canâ€™t do all those things and come up with a clean research project. When you start to do these other things you may get away from the demand, from the accuracy that is necessary to help sick people. Very soon we will have research from my office which will show the results of what a certified NUCCA doctor is capable of doing.
MDT What are your thoughts on certification?
MDS The certification process helps to perpetuate the accuracy which is critical to reduction of the subluxation.
MDT Would you mind talking about the triceps pull?
MDS According to Dr. Gregory, the object of the triceps pull is to get the shoulders to move first. Gregory said that from an engineering standpoint, the largest body, or weight, moves first. Our body has to move first because that is the largest weight. If your elbows move first when you put your hands on the patient, youâ€™re actually going to push. The weight behind your arms isnâ€™t so great and you wonâ€™t produce the desired result. You want the largest lever to move first. Consequently, we place our body and itâ€™s parallel forces in balance. Then you have to move your body off balance to get the force vectors moving toward the patient. The whole body is involved in adjusting the patient. The triceps pull involves many more muscles than just the triceps. Youâ€™re talking about your supraspinatus muscle, the deltoids and others.
The triceps is the focus for the adjustor. If you pull your distal triceps first, then your elbows will come in first. If you pull a little higher up, say in the belly, the elbow and the head of the humerus will go deeper in the socket. If you pull your triceps high enough, the head of the humerus goes into the glenoid fossa first before the rest of the arm or the shoulder moves. So youâ€™ve got to pull your triceps in high to get your scapula to begin to move. Then the clavicles, episternal notch, and chest come forward. Thatâ€™s what gets your body in the proper motion. This is all done with virtually no depth. Itâ€™s not just a matter of putting your hands on the patient and thinking about it, youâ€™ve got to get your parallel forces to come forward which is your whole torso coming toward the patient. The depth should be about a sixteenth and never more than one eighth of an inch. The patient should barely feel the adjustment if at all. You may not believe this but 100% of my patients do not feel me adjust them.
MDT What are the most common problems people have in getting clear x-rays?
MDS The most common problem is getting rid of scatter radiation. The best way to address this is to close down the port. That will improve the quality of your x-rays by 40-50 %. The port opening should be about one quarter inch by three eighths of an inch. You need very low radiation to check your port opening. Maybe 50 kvp at 1/30th of a second. That will show you your port opening. First though, you must have your equipment aligned vertically and horizontally. Put a marker just off center of your grid carrier so you know which side of the port you are looking at. Drill only an eighth inch hole in a 1/16th inch lead plug. Scribe a vertical line on the front of the plug so it is always replaced in the same position. Use some needle nose files to fine tune the size. Spot it in with some super glue after it is in place. I use a 24 by 30 centimeter film, not a 10 by 12, however, you want the width of the port to expose 80% of the width of a 10 by 12. You want 100% of the heighth. Then you want to put 1/16th lead strips on the side of the front of your collimator. This makes a very sharp white line on each side of your film. Then you never have to move your collimators again.
â€œBasically and essentially,
the way we measure
post x-rays should be
the criteria of
everything we do.
Nothing else counts.â€
MDT You love to teach.
MDS I donâ€™t want any knowledge that Dr.Gregory gave me and I gained over forty three years to be lost. Thereâ€™s just so muchâ€¦..Right now, raise your arm in front of you with your elbow pointing at the floor. The long head of your triceps now has a straight shot from the olecranon process to the glenoid fossa. Can you feel that?
MDT Yes I can.
MDS Isnâ€™t that easy? It took me many years to work out this simple stuff. You know the horizontal lines chart we put on the wall? It took me thirty seven years to think of it. Gregory would have loved that. Anytime a patient comes in with a type two, three or four, look at their earlobes before you adjust them. See if their head is in the same position as when they were before their first adjustment. If the head starts to get away from that position on these types, two, three and four, maybe you have to raise the height vector a little bit, maybe support their head a little different. Isnâ€™t that simple? It just isnâ€™t that complicated and we should be able to teach it so chiropractors help sick people. If you help sick people, youâ€™ll make money.
We had a chiropractor come in yesterday. She just graduated from school, a chronic fatigue case. I looked at her x-rays and her head is way forward. I told her sheâ€™d never been really adjusted in her whole life. I hate to tell people that, but it is the truth. I used to take care of two percent of the Palmer students and five percent of the National students.
MDT You are the new president of NUCCRA.
MDS Yes, I am. The board is now composed of myself, Dr.Dunn, Dr. Denton, Dr. Dickholtz, Jr., Dr. Brooks, and Dr. Palmer. NUCCRA was founded as a research organization and we have to produce. We have several projects under way at this point. Weâ€™ve got to strive to get things published in peer review journals as fast as possible. Dr.â€™s Dunn and Seemann are working on a grant proposal right now in the area of sports performance. Dr. C. Woodfield is working on writing up several projects that we have worked on. Our present project is on chronic fatigue syndrome.
MDT You have lived and breathed this work for a long time.
MDS The last forty three years of my life. Well, hopefully if we can get these projects published and the NUCCA organization is brought to the forefront, we will be able to attract more chiropractors who will stay with the work. It takes doctors who will keep doing it even if it is harder, because itâ€™s right. We can get the statistical results. Thatâ€™s what will perpetuate the science.
MDT Thanks for your time and your amazing efforts over all these years, Doctor Dickholtz.
MDS Any questions?
MDT Only a million, but thatâ€™ll have to do for now!