How Activator And Biomarkers Are Shaping Chiropractic Care - Dr. Ricardo Fujikawa

What if pain relief could be tracked as clearly as a lab result? We sit down with Dr. Ricardo Fujikawa—a physician who became a chiropractor—to explore how precision tools, rigorous research, and biomarkers are reshaping conservative spine care. From Brazil to Madrid, he’s built programs, founded a research foundation, and pushed chiropractic into high-impact journals where the broader medical community pays attention.

WATCH THE FULL PODCAST AT: https://www.youtube.com/watch?v=eaWZCdk_NB4

We dig into mechanism research that moves beyond small, expensive clinical trials to answer how an adjustment creates change. In osteoporotic rat and osteoarthritic rabbit models, controlled force from an activator instrument produced measurable tissue effects, including changes tied to mechanogrowth factor and bone density. That same reproducibility has opened doors at major universities and fueled NIH-funded collaborations, proving that standardized inputs let researchers isolate variables and ask smarter questions about dose, timing, and outcomes.

The conversation shifts to objective measurement with TNF alpha and related inflammatory biomarkers. Patient-reported pain scales still matter, but they’re subjective; urine-based testing and algorithmic prediction promise a practical, noninvasive way to track real physiological improvement. Imagine a clinic where a quick strip test guides care plans, validates progress, and reduces reliance on drugs—while giving medical doctors, physical therapists, and chiropractors a shared language for results.

We also touch on the future of chiropractic technology, from instrumented assessments to precisely targeted adjustments, and the rise of global education standards that prepare the next generation to practice with data-driven confidence. With an international network of proficiency-rated practitioners, patients can expect consistent, high-quality care whether they’re in Phoenix or Madrid. If you care about evidence, safety, and real-world outcomes, this conversation lays out a compelling blueprint for where spine care is heading.

Enjoyed the episode? Follow the show, share it with a colleague, and leave a quick review to help more listeners discover evidence-driven chiropractic.

SPONSORED BY Softec - Use promo code: ACTIVATE25 at https://www.softectables.com/ayp

Support the show

Episode Transcript

SPEAKER_00 (00:00):
Softtech manufactures specialized
treatment tables designed tohelp chiropractors who utilize
the activator method, maximizetheir time, and the success of
their procedures.
Upgrade to the only adjustingtables endorsed by Activator
Methods at SoftechTables.com.

SPEAKER_01 (00:15):
Today's podcast is brought to you by SoftTech
Chiropractic Tables.
We finally found a table that ismaintenance free, as maintenance
free as you can get, and thatwill withstand the hard use of
chiropractic gear.
You can find more information onthis table at softechtables.com.
Okay, now let's get into thepodcast.

(00:37):
Hi, I'm Dr.
Arlen Foor, the chairman andfounder of Activator Methods
International.
And I'm welcome to the activateyour practice podcast.
Today I'm really honored to havethe guest be here because he's
from Madrid, Spain, Dr.
Ricardo Fujukawa.
And welcome, Dr.
Ricardo.
Thank you for having me here.

(00:57):
Well, Dr.
Ricardo has an interestingbackground.
Tell us about your degrees.

SPEAKER_02 (01:03):
Well, I went through medical school.
So I studied from 1988 until1993.
I graduated from medical schooland then went through residency,
medical residency in internalmedicine and hematology and
oncology.

SPEAKER_01 (01:19):
So then how did you get interested in chiropractic?

SPEAKER_02 (01:22):
Well, while I was doing um part of my residency at
the University of Kentucky inthe US, here in the US, uh, I
got to know a chiropractor, andI was really impressed.
I had never heard aboutchiropractic in my life.
He took care of me, and then Igot interested.
So I returned to Brazil tocheck.
And in a country of 200 millionpeople, there were only 10

(01:46):
chiropractors in the wholecountry.
So I decided that I would liketo become one.

SPEAKER_01 (01:51):
And give me a little history.
Your parents are Japanese, anduh how did they go to Brazil?

SPEAKER_02 (01:58):
Yeah, my family uh immigrated from Japan to Brazil
at that time.
They Japan they were looking fora new place to get started.
So it was like discovering theWest.
So they they came, part of thefamily returned to Japan, but my
grandfather decided to stay, andthen like my family.

(02:21):
Well, we we just like it was thenucleus that started my family
there.

SPEAKER_01 (02:26):
Your dad, if I remember correctly, was a
lawyer.

SPEAKER_02 (02:30):
Yes, he retired, he's retired now, but he's a
lawyer, and my mother was anurse.

SPEAKER_01 (02:35):
I knew that they were really professional people.
You live in Madrid, Spain.
I mean, you went from Brazil toSpain.
Tell me a little bit about thatjourney.

SPEAKER_02 (02:49):
Yes, I was uh working in Brazil teaching at
the chiropractic college andbeing the coordinator for the
clinic train clinical training.
Then I also had a privatepractice, and then I saw the
opportunity to start the firstchiropractic program in Spain.
So I moved to Spain in 2007, andI stayed with that program until

(03:13):
two years ago.
And that was the college inMadrid, is that correct?
Yeah, that was a school inMadrid.
It's not working anymore.
They they closed the program.
And two years ago, when I left,before they closed the program,
I opened a foundation.

SPEAKER_01 (03:29):
Now tell us a little bit about your research
foundation.
We know about it in Activatorbecause the last three papers
that you had published werepublished in Nature.
And uh for those of you thatdon't know, uh in the world of
chiropractic GMPT serves about3% of the medical population.
That's how many people look atJMPT.
Well, Nature has scientificreports, that's the medical

(03:52):
side, and they service 83% ofthe medical community.
So if you get published inNature, you're really published
in a top-notch journal.
Tell us a little bit about howyou worked up to that level.

SPEAKER_02 (04:04):
Well, um in Spain, chiropractic is not regulated.
So there's still we still needto build credibility.
Um nobody knows exactly what theprofession it's all about.
They don't know that we study inthe university level, so we can
get a degree in chiropractic.
So I think that uh at that timewhen I left the academia,

(04:27):
together with my partner inbusiness, Dr.
Arancho Ortega, we decided thatit was time for us to build up
evidence and chiropracticresearch within Spain so the
authorities would recognize theprofession as a legitimate
profession.

SPEAKER_01 (04:46):
Well, you know, um we got doing things with you
when uh I had a I had arandomized control trial and it
was about a hundred people, andthey were people were
complaining in the researchworld that didn't give it enough
uh numbers to really validateit.
And uh John Triano is aresearcher in chiropractic, is a
friend of mine for years, andhis wife, uh Marianne McGregor,

(05:09):
was a PhD in statistics, and shesaid to me when I was
complaining about how much itcosts to do a randomized control
trial, she said, Why don't youresearch the mechanism?
And I didn't know what she meantby the mechanism.
She said, Well, I'm sure youhave some things you'd like to
know that can you usechiropractic on?
And that's the mechanism.
So research that.
That's how we got together, andI think our first go at it was

(05:32):
the osteoporosis of the hip.
I wanted to find out is it safeto adjust a hip with an
activator?

SPEAKER_02 (05:40):
Exactly.
That was a study that wedeveloped with rats, and uh we
did that at the uh uh we callthe research foundation.
It's a hospital, it's calledJimenez Diaz uh hospital, and I
remember that you also visitedour lab there at that time.
So we did research to understandthe mechanism of how using the

(06:04):
instrument we could recover thebone in osteoporotic animals.
Of course, it's a preclinicalkind of study, but that gave us
some uh some ideas about themechanism, like the MGF, the
mechanogrowth factor, increasingbone density.
And then we moved on to rabbitsto study uh osteoarthritis, also

(06:24):
in the same hospital.
Um, and we were using the modelsthat they used to test drugs and
medications.
And they said, Here are therabbits, you can use
chiropractic.
And it was osteoarthritis, uh anosteoarthritic model, and we
used chiropractic using theactivator, and the results were
outstanding.

SPEAKER_01 (06:44):
We're gonna stop the podcast briefly just to remind
you that this podcast is broughtto you by SoftTech, the table
company in chiropractic that weuse.
You can find more information onthis table at
softtechtables.com.
Well, that's the ones that gotpublished in Nature, and that
got a lot of traction.
And I don't know if you knewthis, but uh about six months

(07:07):
ago I got a call from Ohio StateUniversity, and they call it the
Ohio State University.
She was very clear about that.
And they said, We understandyou're an expert in force.
And I said, Well, I'm not, but Igot biomechanical PhDs that are.
Well, she said, we are going todo a rat study.
And she said, Have you ever donea rat study?
I said, Oh, yes, we've done arat study because you guys did

(07:29):
the rat study.
And long story short, they said,Would you be willing to go on
the study with us?
We just got a$4 million grantfrom NIH, and we'd like to have
you, you know, give us anactivator to get started with
it.
And they have been veryimpressed because of the
reproducibility.
And uh, we made a tip for FredKerrick to do the animal

(07:53):
adjusting, and so we uh modifiedthat for them.
And uh the tests just got done.
They just finally completed thetest.
But what I'm saying is wewouldn't have had an opportunity
to be in Ohio State had it notbeen for you and being published
in Nature.
Um why do you use Activator?

SPEAKER_02 (08:15):
Because, first of all, I like technology and I
like precision.
I think it has to do with myJapanese uh mindset that to have
precision and to have a protocoland to use something that you
can trust that every single timewill produce the same results.

(08:36):
So I think that what got myattention when I was a
chiropractic student.

SPEAKER_01 (08:41):
Well, the other thing is I want to bring up a
little bit because you uh and uhRancha Ortega de Meuse, she by
the way, she is a PhD inmolecular biology and uh
discovered a TNF alpha, is thatright, a TNF uh molecule?

SPEAKER_02 (08:59):
Yes, we are working now with our research foundation
in biomarkers because we want tosee how how can we show that the
patient is improving?
How can we have like anobjective measure?
Because so far we havesubjective measures, uh we have
patient reported outcomemeasures.
No, the patient will report onpain and other things.

(09:22):
So we wanted to verify abiomarker that could tell us
what's going on.
So we are working with TNF alphaand showing that we can get
inflammation down using we areusing the activator, treating
patients and seeing the patternof the TNF alpha in those

(09:43):
patients.
And we correlate the pain, thedecrease of low back pain,
together with the decrease oflevels of TNF alpha.

SPEAKER_01 (09:51):
Well, and the good thing it used to be called a
visual analog scale or theossewestri, and you ask the
patient, where are you where'syour pain level between one and
ten?
Everybody said ten.
And it was a not it was just asubjective way of talking to a
patient, didn't prove anything.
And today now this is a uh thenew way of doing it is a lab

(10:13):
test, and uh it's a urine test,and there's a strip that goes in
the urine.
Is that correct?

SPEAKER_02 (10:18):
Yes, and that's what we were trying to do because you
can measure that in the blood,but some of these biomarkers can
be found in the urine.
So that's non-invasive, thatwould be really practical if we
could develop a kit doctorscould use in their practice, you
know, medical doctors, physicaltherapists, chiropractors, to

(10:38):
measure that inflammation and topredict, because now we are
working with algorithms thatwill tell you and predict the
improvement of the patient.

SPEAKER_01 (10:48):
Now you're getting the into real diagnosis.

SPEAKER_02 (10:51):
Exactly, exactly.
That that's the whole point ofthe usage of technology.

SPEAKER_01 (10:57):
Now, you know, medicine has advanced like
crazy.
Uh if you look at surgery today,they're using robotic surgery
and the surgeon isn't even inthe operating room.
And uh what do you see inchiropractic as the future for
research and for things that weneed to do?

SPEAKER_02 (11:16):
I think that because medicine works a lot with um
several procedures, pharmacologyand other things, that it's
important to develop thattechnology.
And so far we have been usingour hands and now we have
instruments, even electronicinstruments.
And I think that the next stepis to go deep into diagnosing

(11:38):
and understanding better how wecan find that dysfunction, the
articular uh neurologicaldysfunction, and address that in
a very precise way.
I think that that's the nextstep for our technology.

SPEAKER_01 (11:52):
Well, how would you rate chiropractic in the
educational world?

SPEAKER_02 (11:58):
I think we are doing a pretty good job.
I mean, it has improved a lotfrom the days of small private
colleges all the way touniversity integrated programs.
I think that more and more theeducation is reaching uh higher
standards.
And we see now that pretty muchum all continents, they have a

(12:19):
CCE, a council on chiropracticeducation.
Now Latin America is buildingtheir own to standardize the
programs, to verify the levels.
So I think we are doing a prettygood job around the world.
It's like the next generation ofdoctors are going to have all
this knowledge and education.

SPEAKER_01 (12:38):
Uh one thing I found interesting in casual
conversation, you talked aboutgetting patients from the
activator website.
Tell me a little bit about howthat happened.

SPEAKER_02 (12:46):
Oh, yes, I'm uh probably the only two advanced
proficiency doctors in in Spain.
And uh once in a while I getpatients that come through the
website, especially I now I havea couple of missionaries from
the U.S.
working in Spain, and I alsohave flight attendants from
American uh airlines that whenthey are in Madrid, they want to

(13:10):
be seen by an activator doctor.
So yeah, I get once in a while afew patients through the
website.

SPEAKER_01 (13:17):
Well, last month we sent 17,000 new patients to our
doctors of chiropractic.
We got about 2,000proficiency-rated doctors now.
And so we're getting pretty goodinfiltration around the the
well, the U.S.
for sure, but then there you aresitting out in Madrid, Spain,
and somebody can go to you andget the same adjustment as they

(13:38):
do in Phoenix, Arizona.
So uh I think our project iscoming along.
It only took 15 years to getthere, but we're we're making
progress.
Well, I want to thank you forbeing on the podcast.
You know, we've been friends fora long time, and uh we've been
through many trials andtribulations, but I think we're
starting to see, for example,the uh the urine test to find

(14:00):
out if you're making progress inpain is a big deal because you
know, with the drug problemstoday and the different uh
oxycontins and so forth, I'msure a medical doctor would like
to have that test too.

SPEAKER_02 (14:12):
Exactly.
I think that that's going toopen the open the door for more
collaboration and also betterunderstanding of what we do.

SPEAKER_01 (14:20):
Aaron Ross Powell Well, thank you again, Dr.
Ricardo Fujukawa from Madrid,Spain.
Uh we're very happy to have youon the program, and uh we'll
look forward to spending sometime.
Thank you.
Thanks for listening to ActivateYour Practice Podcast.
Remember, this is brought to youby Softtech Table Company.

(14:43):
You can find more information onthis table at
softtechtables.com.

SPEAKER_00 (14:48):
Softtech manufactures specialized
treatment tables designed tohelp chiropractors who utilize
the activator method, maximizetheir time, and the success of
their procedures.
Upgrade to the only adjustingtables endorsed by Activator
Methods at SoftechTables.com.