For Referring Providers

Thank you for considering Back In Balance Chiropractic as a referral partner. This page is written for medical doctors, physical therapists, dentists, physiatrists, neurologists, ENT specialists, regenerative medicine physicians, and other clinicians evaluating whether NUCCA upper cervical chiropractic care might benefit specific patients in your practice. Our goal is to give you enough clinical detail to make appropriate referrals and to make clear where NUCCA is a genuinely helpful adjunct — and equally, where it isn't the right care.

About Dr. Justin Schallmann

Credentials: Doctor of Chiropractic, Palmer College of Chiropractic (Cum Laude). NUCCA Part 2 Certified — one of approximately 300 doctors worldwide who have completed advanced NUCCA training and actively practice the technique.

Experience: 18+ years serving the Seattle Eastside since 2008. Approximately 70 patient visits per week across a broad case mix of cervicogenic, post-traumatic, and complex craniocervical presentations.

Areas of clinical focus: post-concussion syndrome, craniocervical instability (CCI), whiplash-associated disorders, migraine and cervicogenic headache, vertigo of cervical origin, TMJ/TMD with cervical contribution, and chronic pain patterns where upper cervical dysfunction is a plausible contributor.

About the NUCCA Approach

NUCCA (National Upper Cervical Chiropractic Association) is a specialized technique within chiropractic focused exclusively on the atlas (C1) and axis (C2). Three features distinguish it from general chiropractic manipulation:

Ideal Referral Profile

NUCCA is most likely to contribute to your patient's care when one or more of the following apply:

• Cervicogenic headache not responding to standard PT and pharmacologic management
• Post-concussion syndrome with persistent cervicogenic symptoms after the acute phase
• Whiplash-associated disorders (WAD) — acute or chronic, especially where cervical range of motion and postural presentation suggest upper cervical involvement
• Migraine with cervicogenic contribution or postural triggers
• Vertigo where BPPV, vestibular neuritis, and Meniere's have been evaluated or ruled out and a cervical origin remains plausible
• TMJ/TMD with cervical contribution, particularly post-traumatic cases and patients already in dental co-care
• Trigeminal neuralgia where the neurology team has confirmed diagnosis and the patient is seeking a complementary conservative approach alongside medical management
• Craniocervical instability (CCI) — see co-management section below
• Chronic pain patterns with a plausible upper cervical or postural cascade contribution
• Patients who have been advised to avoid high-velocity manipulation due to prior injury, hypermobility, connective tissue disorders, or personal preference

When NUCCA Is NOT the Right Care

Building trust with referring providers requires clarity about scope. We do not accept referrals or continue care in situations where NUCCA has no reasonable mechanism of benefit — and we routinely refer patients back to the appropriate specialist when the presentation warrants it. NUCCA is not the right care for:

• Structural spine pathology requiring surgical evaluation (severe stenosis with progressive myelopathy, unstable fractures, tumors, infections)
• Vascular emergencies including venous or arterial thoracic outlet syndrome, subclavian vein thrombosis, or acute carotid/vertebral pathology
• Progressive neurological disease requiring disease-modifying therapy (MS, Parkinson's, ALS) — though we may provide adjunctive musculoskeletal care alongside neurology-led management
• Metabolic, autoimmune, or infectious causes of peripheral neuropathy
• Primary psychiatric presentations without a clear musculoskeletal component
• Allergic, immune, endocrine, or infectious disease
• Children with routine developmental concerns — we do not market chiropractic care for colic, ear infections, or general pediatric wellness
• Cases where a course of physical therapy has not been trialed for conditions where PT is the evidence-supported first-line intervention (thoracic outlet syndrome, most cases of neck and back pain, radiculopathy without red flags)

In each of these categories, we will decline care or refer back to the appropriate provider rather than continue with an intervention unlikely to help.

Evaluation Methodology

Your patient's first visit is a full 45–60 minute evaluation with no correction delivered:

• Comprehensive history including prior imaging, specialist notes, medications, and prior interventions
• Neurological screening, cervical range of motion assessment, palpation, and postural evaluation
• Objective postural measurements (head tilt, shoulder height, hip alignment, functional leg length) documented for tracking
• Three-view digital cervical imaging with mathematical analysis quantifying atlas position
• Honest clinical determination of whether NUCCA is appropriate; if not, direct referral guidance

The second visit is a formal report of findings with imaging review, discussion of the specific correction plan, first correction, and post-correction imaging to confirm alignment change.

Co-Management Model

We routinely co-manage patients with other providers and consider this the norm rather than the exception for our case mix.

Craniocervical Instability (CCI)

We collaborate with a local regenerative medicine physician on co-management of CCI patients. Our positioning follows the framework established by Dr. Christopher Centeno, MD, in the peer-reviewed and clinical literature — NUCCA sits as second-line conservative care on the ladder of invasiveness, above baseline PT and below prolotherapy, PICL (percutaneous implantation of craniocervical ligaments), and surgical fusion. For CCI patients who respond to NUCCA temporarily but do not achieve sustained improvement, we make appropriate onward referrals for interventional or surgical evaluation.

Post-Concussion Syndrome

We work alongside neurology, vestibular therapy, and cognitive rehabilitation providers. NUCCA addresses the cervicogenic contribution to PCS symptoms; it is not a substitute for concussion-specific care from the primary team.

TMJ/TMD

Dental co-care is standard for our TMJ patient population. We coordinate with your patient's dentist, TMJ specialist, or LVI-trained provider on split management of the cervical and dental components.

Physical Therapy

Many of our patients are also under active PT care. NUCCA and PT address different components of the same clinical picture — atlas alignment on our side, motor control and tissue mobility on the PT side. We prefer this model to sequential care in most cases.

Chronic Headache and Migraine

We routinely coordinate with neurology on migraine cases where preventive pharmacology, CGRP inhibitors, or Botox is already in place. NUCCA is positioned as complementary, not competing.

Reporting Back to Referring Providers

Communication back to the referring provider is central to how we practice. With patient consent, we provide:

• Initial evaluation summary — sent to the referring provider after the second visit, includes exam findings, imaging measurements, correction plan, and expected timeline
• Progress updates — at meaningful clinical milestones or at the referring provider's request
• Non-response notification — if measurable improvement is not occurring in the expected window, we notify the referring provider and discuss whether to continue, modify, or discontinue care
• Discharge summary — at completion of active care or transition to maintenance

Requests for records, imaging, or clinical letters can be handled by phone, email, or fax with an appropriate release on file.

How to Refer

Three options depending on urgency and complexity:

1. Direct Patient Booking

Give your patient our website and phone number. They can book their initial consultation online 24/7 or by phone, and can mention your name so we know to send you the initial evaluation summary. This is the simplest option for most referrals.

backinbalanceredmond.com · (425) 437-9974

2. Provider-to-Provider Discussion

For complex or unusual cases where you'd like to discuss the referral before sending the patient, call the office and ask to speak with Dr. Schallmann directly. Callback is typically same-day for referring provider calls.

3. Written Referral

Fax or email a brief note with the patient's name, contact information, presenting concern, and any prior imaging or specialist notes you'd like us to review. We will contact the patient to schedule and follow up with you after the evaluation.

Direct Provider Contact

Continuing Education and Peer Discussion

We're happy to speak at grand rounds, PT clinic in-services, dental study clubs, or informal peer meetings on topics including the evidence base for upper cervical chiropractic, differentiating cervicogenic headache and vertigo presentations, CCI recognition and referral pathways, and the honest positioning framework we use with patients. Contact the office to discuss.

Send a Patient Our Way

Whether you're considering a first referral or have been sending patients our way for years, thank you. Clear communication with referring providers is central to how we practice — please don't hesitate to call directly if you have questions about a specific patient or want to discuss the fit before a referral.