Dr. Tatiana Masanena, a Russian- trained radiologist has joined the staff of the Regional Center for Chiropractic. The first time we met I asked her if she'd mind taking a look at a few cases with me as I had some questions. The questions were about possible pathological findings which might need cooperative care.

It was interesting that part of her analysis after assessing the pathological findings was to assess biomechanics by visualizing and drawing spinographic lines. She made further recommendations on a number of cases regarding the use of stress films as well.

This has happened many times before here in Russia and I've written about it. Still, every time it happens it strikes me as interesting since very rarely did I encounter similar experiences with radiologists in the U.S.

What makes matters worse is the negative attitude of many within the chiropractic profession itself towards subluxation, spinography, the reality of abnormal static and motion biomechanics and the importance of it all.

I got some grief recently from a couple of D.C.s because they felt the evidence I gave in a column to support subluxation was "shaky." I hope by now anyone who has read my column or knows me personally realizes that I feel we are only in the beginning stages of elucidating the vertebral subluxation.

I've been outspoken to the point of being heretical about how the profession as a whole is throwing money down the toilet with its research agenda, since very little "chiropractic" research occurs. The central tenet of chiropractic science, vertebral subluxation, requires extensive new research until it is fully understood -- including the components of structural misalignment.

However, I maintain that there is an abundance of literature which exists and provides evidence to support the subluxation hypothesis right now and it is irresponsible to make blanket statements that the fundamental tenet of chiropractic -- the finding and reducing of vertebral subluxations which assists the body's inherent recuperative powers -- is unproven. No one in the profession should put up with such nonsense anymore.

The problem is that this literary evidence is scattered throughout libraries, textbooks, journal articles, seminars, proprietary documents, lecture notes, the internet, etc. and no systematic project has ever been undertaken to exhaustively review all of it and compile it into a practical tome. Perhaps if this were done it might give a starting point for placing of the next brick in the institution of chiropractic research.

Last month, I discussed abnormal motion segment integrity ("medical-speak" for subluxation) and what the American Medical Association's "Guides to the Evaluation of Permanent Impairment" had to say about it. (1)

In my next few columns, we'll be looking further into the evidence supporting the phenomenon of vertebral subluxation.

Bear in mind that I try to keep the information in this column practical for doctors in the trenches. So, if you feel some of the evidence I refer to may be "shaky," please lighten up. The bricks need cement.

Also, the information I'm sharing is only what I have available to me here in Russia which is an even smaller version of my personal library and I didn't access a chiropractic, medical, university or electronic library. My guess is that most of you have similar evidence sitting on your shelves.

Let's begin with evidence that isn't necessarily pure science, like the Policy Position of the Association of Chiropractic Colleges titled, "The ACC Chiropractic Paradigm." This document was signed by all 16 chiropractic college presidents in North America and was adopted by the ICA's research arm, The Foundation for the Advancement of Chiropractic Tenets and Science (FACTS). (2)

I know you've at least heard of it and, by now, I hope every chiropractor has a copy and has it memorized so I won't go into its details here. Basically, it defines the purpose, principles and practice of chiropractic as the finding and reduction of vertebral subluxations which will prevent and restore health by removing interference to the body' inherent recuperative powers.

Next, let's look at the federal and state legal aspects of subluxation since the reality of chiropractic practice flow from them.

The federal government defines what we do as the correction of subluxation through Medicare and federal worker's comp laws. Necessity to demonstrate subluxation on X-ray has been taken out as of the year 2000. (3)

Perhaps, however, this will necessarily open the way to allow other evidence as indicative of subluxation within the federal legislative language. I suggest we be diligent, as some among us with hidden agendas will certainly try to stop this.

Common to all state statutes is the adjustive process being utilized to reduce subluxations and the resultant interference to nerve transmission.

The word "adjustment" is used in 38 state statutes, with 18 including the concept of manipulation. Specific references to responsibility for neurological complications of biomechanical origin are contained in 34 state statutes and, in addition, 11 specifically discuss the concept of subluxation.

Moving on to the national associations, the International Chiropractors Association states: "Of primary concern to chiropractic are abnormalities of structure or function of the vertebral column known clinically as the vertebral subluxation complex." (4)

The World Chiropractic Alliance definition of chiropractic reads: "A limited primary health care profession in which professional responsibility and authority are limited to the anatomy of the spine and immediate articulations, the condition of vertebral subluxation and a scope of practice which encompasses educating, advising about, and addressing vertebral subluxations." (5)

In a monograph published by the American Chiropractic Association it is stated: "The most characteristic aspect of chiropractic practice is the correction (reduction) of a subluxated vertebral or pelvic segment(s) by making a specific, predetermined adjustment." (6)

I know what a few doubters are saying at this point: "It's all hearsay so far." Be patient. In upcoming columns we'll get into the evidence which these organizations, the states, and the federal government used to come to these conclusions.

Until next time, Da svidanya!

References

1. McCoy M: "Kinesiopathology." The Chiropractic Journal. September 1997.

2. "Chiropractic Colleges Publish Position paper on Chiropractic and Chiropractic Paradigm." ICA Review. November/December 1996.

3. "Medicare Language is Amended," in The Latest Stuff From Gerry. Life Chiropractic College West. August 15, 1997.

4. "Chiropractic Science and Practice in the United States." International Chiropractors Association. 1991.

5. "What is Chiropractic?" The World Chiropractic Alliance.

6. "Chiropractic: State of the Art 1991-1992." The American Chiropractic Association.