College presidents discuss role of subluxation in education and research

Recent attempts by the World Federation of Chiropractic (WFC) to gain control of the global educational system has put U.S. chiropractic colleges in the spotlight.

More than just campuses filled with eager students, they represent the future of the profession. What students learn today will translate into how they practice tomorrow. If subluxation-based chiropractic is either ignored or denounced in our colleges, the traditional form of chiropractic could be doomed.

To examine how our colleges view subluxation-based chiropractic and how it is taught in schools today, the World Chiropractic Alliance asked the presidents of each of the 16 CCE-recognized chiropractic colleges in the U.S., as well as the University of Bridgeport, to answer five questions regarding subluxation and education.

The unedited responses of the eight presidents who participated are reprinted here. The other presidents refused to answer the questions.

The questions asked were:

1) What role should the vertebral subluxation play in today's chiropractic education, research and practice?

2) Does your college conduct and/or support research, specifically dealing with the vertebral subluxation? Do you feel such studies advance or hinder the acceptance of chiropractic as a science-based health care approach?

3) Does your college consider and/or support research, specifically dealing with chiropractic as a treatment for musculoskeletal/low back and neck pain? Do you feel such studies advance or hinder the perception of chiropractic as a wellness care approach?

4) At this year's 4th Research Agenda Conference, "Chiropractic Research: Implications for Practice Policy and Professional Development," several prominent researchers and academicians suggested that our profession must abandon the concept of vertebral subluxation and, in fact -- as Anthony Rosner, Ph.D., stated in the September 20, 1999 issue of Dynamic Chiropractic -- "be both prepared and willing to modify (and possibly relinquish)" the subluxation as a clinical reality. Do you agree or disagree?

5) In selecting researchers and other staff members for your college, do you seek those who are primarily interested or have experience on the impact of the vertebral subluxation?

The answers provided by the college presidents:

CLEVELAND CHIROPRACTIC COLLEGE
6401 Rockhill Rd
Kansas City, MO 64131
816/333-8230
President Carl S. Cleveland III, D.C.

(Also answering on behalf of CLEVELAND CHIROPRACTIC COLLEGE -- LOS ANGELES)

1) The vertebral subluxation is at the core of chiropractic theory, and its detection and correction and at the heart of chiropractic practice. Application of this term is fundamental to communication between doctors of chiropractic and their patients. The vertebral subluxation complex (VSC) model, as described in the chiropractic literature, is fundamental to the educational program at Cleveland Chiropractic College. It is important that basic and applied research continue in relation to the VSC.

2) The present emphasis of Cleveland's research activity is on clinical outcomes of chiropractic care of the geriatric patient and of the pregnant female patient. Study of chiropractic management of the migraine patient, and a demographic overview of patients at the Kentuckiana Children's Center is also in progress. Additional basic and clinical research is needed to better understand the interface between altered spinal biomechanics, the nervous system, and the relationship of these factors to health and wellness.

3) The present emphasis of the college's research activities is noted above. The various studies demonstrating the outcomes of the spinal adjustment/manipulative procedure in the management of low back and neck pain have helped advance and legitimize chiropractic's role as part of mainstream healthcare. It is anticipated that additional studies clarifying the relationship between maintaining proper spinal mechanics and patient health and well-being, as assessed through generic non-disease specific health surveys (RAND 36 or MOS SF-36), may aid chiropractic practitioners in achieving recognition as wellness providers. Should such studies objectively demonstrate even moderate change related to this testable hypothesis, the profession may finally be able to exchange its public image of "back pain" practitioner for that of doctor of "spinal hygiene and wellness."

4) The representatives from Cleveland Chiropractic College in attendance at the 4th Research Agenda Conference did not come away with the impression as stated above.

Regarding the comments attributed to Dr. Rosner, all health care professionals, both within and outside of the chiropractic profession, should remain open and objective as new evidence emerges related to our understanding of spinal function, its interface with the nervous system and subsequently all body systems, and the role of this relationship in the restoration and maintenance of health. Such openness also means, to paraphrase Dr. Rosner, that those outside the profession must be willing and prepared to accept the subluxation as a clinical reality.

LIFE COLLEGE
1269 Barclay Cir.
Marietta, GA 30060
404/424-0554
President and Founder Sid E. Williams, D.C.

1) The full impact of the vertebral subluxation is yet to be understood and recognized. The vertebral subluxation is the central scientific tenet of chiropractic education and practice, and should be the primary focus of chiropractic research. The chiropractic theory strongly emphasizes that the subluxation interferes with nerve transmissions between the brain and the body. The role of chiropractic research is the development of new methods to investigate the mechanism and correction of vertebral subluxation.

2) The Sid E. Williams Research Center has pursued innovative techniques, instrumentation, and methods in assessing the presence and correction of spinal structural distortions, primarily subluxations. Presently, Life University is funding the research efforts of C.H. Suh, Ph.D.

Dr. Suh is now in the final stages of a three-year project to develop a computerized distortion free x-ray analysis system. In 1985 Dr. Suh and his team of researchers presented a study which, 1) validated the existence of the chiropractically-defined subluxation, and 2) noted that subluxations were corrected by specific chiropractic adjustments performed by skilled chiropractors.

Life University is presently heading several studies under the direction of Sarah Webster, Ph.D., in physiology. These studies focus on the visceral physiological response to the chiropractic adjustment through the reduction of subluxation inpatients suffering from chronic conditions. Our research approach also focuses on the yet unrecognized importance of chiropractic care and its impact on human performance.

I believe it is the responsibility of every chiropractic institution to conduct scientific subluxation based chiropractic research programs. The Sid E. Williams Research Center at Life University is focused on this task and is dedicated to providing advanced documentation on the mechanism and physiology of the vertebral subluxation especially in the upper cervical region.

3) For the past five years the Sid E. Williams Research Center has participated in the World Health Organization's (WHO) "Low Back Pain Initiative". The chiropractic focus of the study was centered on the adjustment of upper cervical subluxations and lower spine misalignments and how each adjustment affected patients suffering from low back pain. During the study, chiropractic care was not rendered as a direct intervention to "treat" low back pain but rather to primarily reduce the effects of the upper cervical subluxation by correcting the neurological and biomechanical components of the subluxation. This 130 page, double blind study will soon be released by the WHO.

The Low Back Pain Initiative is the first WHO research project to include chiropractic healthcare and research. It is crucial for chiropractic, as a scientific subluxation based healthcare profession, to continue to investigate the vivification process - the underlying mechanism at the cellular level demonstrating the effects of vertebral subluxation. We must not forget that subluxations have a more widespread influence on the body than just the musculoskeletal system. Fifty years from now, it won't be surprising to science that the underlying cause of bacterial infections will be vertebral subluxations.

4) Over the years, the integration of biomechanical and neurological research has proven the validity of the vertebral subluxation. Many models of the vertebral subluxation complex have been developed and investigated. These models demonstrate not only the biomechanical and neurological component but also the physiological ramifications and the impact of subluxation on body system function and general health. Furthermore, the Association of Chiropractic Colleges (ACC) agree that the subluxation is the primary focus of our profession. However, there are some chiropractic "educators and researchers" who have tried to discredit and replace the subluxation in an attempt to gain a greater acceptance from the medical community.

As more and more research is conducted and new discoveries are made, continued controversy, revelation and acceptance of chiropractic will occur. The truth is in our favor!

5) In selecting our research faculty and staff we seek professionals who are not only capable of demonstrating and documenting the power of chiropractic care and the mechanism of the subluxation, but who are skilled in anatomy, physiology, biomechanics, research methodology, clinical assessment, and statistical analysis. With continued chiropractic research, both scientist and laymen alike will have an increased awareness and interest in the clinical application of chiropractic science.

The Sid E. Williams Research Center functions with contributions from the following professional personnel: Sid E. Williams, B.S., D.C., Bruce Pfleger, Ph.D., Medhat Alattar, M.D., D.C., Andrei Bourdeinyi, M.D. Ph.D. D.C., Susan Brown, Ph.D., D.C., Omar Elsangak, M.D., J. Roger Hinson, D.C., Kathryn Hoiriis, B.S., D.C., James Provoost, B.E., D.C., Bryan Salminen, B.S., D.C., Clifford Smith, Ph.D., Chung-Ha Suh, Ph.D., Gregoria T. Verzosa, D.C., and Sarah Webster, Ph.D.

LIFE CHIROPRACTIC COLLEGE-WEST
2005 Via Barrett
P.O. Box 367
San Lorenzo, CA 94580
510/276-9013
President Gerald Clum, D.C.

1) The subluxation should hold the same central prominence in today's profession and the practice of chiropractic as it has held over the first century of our existence. The explosion of information and perspectives about the subluxation and its related neurological insult and the impact on health and well being demands that curricular modification be made in terms of theory, presentation, instrumentation, documentation and clinical management of the vertebral subluxation complex.

The opportunities for research in the area of the subluxation and the comprised neurological environment associated with it represent a tremendously rich area for investigation in terms of basic and clinical sciences.

2) The Research Department of Life Chiropractic College West has a lengthy history of supporting subluxation-oriented research. Dr. Skip Lantz has authored one of the seminal papers in the profession on the definition and modeling of the subluxation complex. In recent years the College has had a specific emphasis on spinal movement and range of motion related issues as they related to altered biomechanics associated with subluxation and its correction.

At the most recent Congress of the World Federation of Chiropractic Life West, researcher Dr. Alan Solinger presented a paper on the dynamics of spinal segment coupling and the implications on normal motion and motion during spinal adjusting. More recently Dr. Skip Lantz has had a series of papers published addressing new normative data associated with cervical spine range of motion. These publications have placed Dr. Lantz among the world's authorities on cervical range of motion.

3) Life West has conducted a number of projects assessing the impact of chiropractic care on various clinical scenarios. These situations have included asthma, scoliosis, and range of motion aberrations. These studies have not been conducted or completed with the intent of defining chiropractic as a treatment for any condition, nor have they been conducted in a dose/response format for any condition.

As to the contribution to any given perspective, the purpose of each study is to explore a given question. How that answer is "perceived" or what those answers "advances" or "hinders" is up to the person applying the results of the study.

4) I was not present at the conference you have cited. Subsequent to the conference I heard comments of concern indicating a rejection of subluxation theory as an outcome of the meeting as well as comments of concern about context and misrepresentation of such remarks.

The final word on the nature, causes, corrections and management of a subluxation has not been written. Therefore, it seems prudent to be prepared to modify perspectives as more information is gained and as more is learned.

The concept that something will be learned or discovered that causes this institution to deny that the subluxation is a clinical entity of importance to the health and well being of people everywhere is a moot point as its nature and effects have been demonstrated to date beyond my ability to fathom the proposition.

5) Life West seeks faculty and staff who are bright, curious, dedicated and open to learning and teaching. The track record of our faculty speaks to this fact. Persons such as Skip Lantz or Alan Solinger have already been referenced. In addition we are proud to include among our undergraduate and/or postgraduate faculty people such as Dan Murphy, D.C., Malik Slosberg, D.C., Bill Ruch, D.C. (author of "An Atlas of Common Subluxations of the Spine and Pelvis"), Drs. Plaugher and Anrig (authors of "Chiropractic Pediatrics"), Michael Gazdar, D.C. (author of "Taking Your Back to the Future"), Larry Nordhoff, D.C. (author of "Motor Vehicle Accidents"). The list could fill the allotted space several times over!

The "primary" interests of our faculty and staff are to assist our students in becoming the best chiropractors they can be and then after graduation to assist them in maintaining and refining their knowledge and skills.

LOGAN COLLEGE OF CHIROPRACTIC
1851 Schoettler Rd.
Chesterfield, MO 63006
314/227-2100
President George A. Goodman, D.C., F.I.C.C.

1) Vertebral subluxation is unique and distinct within the chiropractic profession. It plays a significant role in chiropractic education, especially at Logan College.

2) Our institution has not specifically conducted research dealing with vertebral subluxation. We have conducted and supported chiropractic research on the utilization of chiropractic adjustive procedures, which, of course, focuses on the vertebral subluxation. Research and the support of research advances both the acceptance and the utilization of chiropractic.

3) Logan College of Chiropractic has applied for research grants through the Health Resources and Services Administration (HRSA) Bureau of Health Professions, a division of Health and Human Services. Many of the studies relate to chiropractic treatment of the low back, yet are specific to chiropractic. The results of research on musculoskeletal/low back and neck pain support the need for chiropractic to continue its wellness/preventative care approach.

Logan College has both a philosophical and a historical background for the wellness/preventative care approach. This does not preclude Logan from advancing studies, which strongly support chiropractic utilization for musculoskeletal/low back and neck pain.

4) We have already indicated that Logan College of Chiropractic clearly acknowledges the vertebral subluxation in chiropractic education, practice and research.

5) Logan College seeks to hire men and women of the highest qualifications both in the areas in which an individual is seeking employment and specific to the needs of the college.

LOS ANGELES COLLEGE OF CHIROPRACTIC
P.O. Box 1166
Whittier, CA 90609
310/947-8755
President Reed Phillips, D.C.
   Failed to respond

NATIONAL COLLEGE OF CHIROPRACTIC
200 East Roosevelt Rd.
Lombard, IL 60148
708/629-2000
President James F. Winterstein, D.C.
   Failed to respond

NEW YORK CHIROPRACTIC COLLEGE
P.O. Box 800
Route 89
Seneca Falls, NY 13148
315/568-3000
President Kenneth Padgett, D.C.
   Failed to respond

NORTHWESTERN COLLEGE OF CHIROPRACTIC
2501 West 84th St.
Bloomington, MN 55431
612/888-4777
President John F. Allenburg, D.C.

1) According to the Chiropractic Paradigm of the Association of Chiropractic Colleges, developed and adopted by the Presidents of all North American chiropractic Colleges, the practice of chiropractic includes establishing a diagnosis, facilitating neurological and biomechanical integrity through appropriate chiropractic case management, and promoting health. In addressing neurobiomechanical disintegrity, "chiropractic... focuses particular attention on the subluxation." Chiropractic students, therefore, in biomechanical aspects of the chiropractic and clinical science curricula, should learn examinations and treatment procedures to identify and adjust vertebral subluxations as primary sources of aberrant neural activity which may cause pain, dysfunction and physiologic system manifestations.

There is need for much basic and clinical research in relation to vertebral subluxation, not the least of which is for reliable and valid subluxation and neural function indicators which may be identified through examination, and monitored in the course of care to assess the effectiveness of adjusting or other case management procedures.

2) One research faculty member focuses his research on validity and reliability studies related to chiropractic assessment procedures. He will soon publish an investigation of relationships between level of pain, static subluxations identified in radiographs, thermographic findings and severity of subject complaints.

Additionally, several randomized clinical trials have been completed or are in process which compare the efficacy of spinal adjusting or manipulation in the management of migraine and tension headache, bronchial asthma, carpal tunnel syndrome, chronic pelvic pain, sciatica and others.

Such studies advance chiropractic science, enhance our profession's credibility and improve the quality of chiropractic health care.

3) Northwestern conducts clinical trial research to assess the outcomes of chiropractic care in the management of both musculoskeletal and physiological (organ) system problems, and we believe that the outcomes of studies such as these have high potential to advance the perception that chiropractic care is applicable to a spectrum of health problems and, coupled with healthful living, is a credible approach to wellness.

4) Several Northwestern faculty members attended the Research Agenda Conference, and did not return with the impression that there was any serious sentiment in favor of abandonment of the subluxation concept toward which we give respect and importance.

5) Important criteria for faculty members to teach in the department of chiropractic principles and methods, or to carry out related research, are chiropractic science dedication and scholarship, experience in chiropractic practice and the adjustment of subluxations, open-mindedness toward specific methods pending the outcomes of research, and seeking the values among chiropractic adjustive procedures.

PALMER COLLEGE OF CHIROPRACTIC
1000 Brady St.
Davenport, IA 52803
319/326-9600
President Guy Riekeman, D.C.

1) Every study that I have ever seen conducted on the practice of chiropractic indicates that the vast majority of chiropractors feel that the primary focus of their practice is the correction of subluxation. Therefore, for philosophical, historical, education, research and practice reasons, the subluxation complex should be the central focus of these efforts.

2) The Palmer Center for Chiropractic Research has become a major center of the chiropractic research world. Significant funding from the Government, and specifically from the National Center for Complementary and Alternative Medicine (NCCAM) at NIH, is targeted for research that NIH wants done. In short, every dollar that comes into chiropractic research cannot be used solely at the discretion of the profession. However, our Board of Trustees has recently directed us to conduct the most comprehensive research program on the vertebral subluxation and spinal biomechanics ever within the profession. Therefore, we currently conduct an extensive amount of subluxation research, including animal models, practice-based issues and issues of initial intensive as well as wellness care parameters. This program is growing rapidly, but details on this program will be forthcoming. We believe it will be very important research for the future survival and success of our profession.

3) Yes, we do conduct this type of research. We are sensitive to the perception that this be used as a full scope of practice versus only a part of the benefit of seeing a chiropractor. We believe that such studies throughout our profession have affected the perception of chiropractic in the past. We are working, as are most chiropractors, to change the perception of our profession. As all chiropractors know, this is a difficult battle in a society and health care system that is currently treatment oriented.

4) We believe there were many misconceptions about what occurred at this year's RAC Conference. Unfortunately, these misconceptions were perpetuated by those who had a specific political agenda or were not in attendance at the conference. I believe it's important for our profession to carry on critical dialogues including the willingness to look at and defend subluxation models. I do not agree, however, that abandoning the subluxation as a clinical model should be considered a viable direction for the profession, especially when so little research has been conducted on the subluxation at this point.

5) At Palmer College, we determine what our research agenda is going to be and then we look for those researchers who can help us complete that agenda. These researchers come from inside and outside the profession.

PALMER COLLEGE OF CHIROPRACTIC-WEST
90 East Tasman
San Jose, CA 95134
408/944-6000
President Peter Martin, D.C.
    Failed to respond

PARKER COLLEGE OF CHIROPRACTIC
2500 Walnut Hill Ln.
Dallas, TX 75229
214/438-6932
President Fabrizio Mancini, D.C.

(Note: Dr. John Moltz, Director of Research, responded for President Mancini)

1) The vertebral subluxation should continue to be an integral part of chiropractic education, research and practice.

2) Parker College is currently conducting basic research into the neurophysiological mechanisms that mediate the pathophysiological effects of the subluxation. It is precisely these types of studies that will advance chiropractic as a "science-based health care approach."

3) Parker College is currently engaged in clinical trials to assess the effectiveness of chiropractic treatment on neck pain. These types of clinical trials in no way undermine the chiropractic philosophy of a "wellness care approach" to health care.

4) Parker College strongly disagrees with the suggestion that chiropractic "must abandon the concept of the vertebral subluxation."

5) Parker College recruits faculty and research staff based on overall qualifications, experience and a desire to advance the art and science of chiropractic.

SHERMAN COLLEGE OF STRAIGHT CHIROPRACTIC
P.O. Box 1452
Spartanburg, SC 29304
803/578-8770
President David Koch, D.C.

1) Sherman College is committed to the vertebral subluxation as the center of its education and research efforts. In fact, the college includes the centrality of the vertebral subluxation in its mission statement, and is proud to be the one chiropractic college to do so. Patient care at Sherman College's Chiropractic Health Center is directed toward one clinical outcome - the safe and effective identification and correction of vertebral subluxation. In support of this, Sherman College's curriculum provides students with the understanding and skills necessary to identify and correct vertebral subluxations effectively and safely, along with all the other skills on which successful practice as a chiropractor is incumbent. We believe this will best enable graduates to contribute to the health of their future patients to the greatest degree possible.

2) Sherman College has an intensely active research program focused on study of the vertebral subluxation - its location, analysis, correction and effects, and on the improvement of chiropractic education. Sherman College researchers have designed a vertebral subluxation hypothesis tree to guide our research into the vertebral subluxation for the next several decades. Sherman College has numerous vertebral subluxation research projects underway, including one investigating the relationship between vertebral subluxation and quality of life, several evaluating innovative vertebral subluxation location and correction techniques, and some involving human performance outcomes related to the correction of vertebral subluxations. Sherman College consistently and vocally supports the study of vertebral subluxation as essential to furthering the science of chiropractic.

3) Sherman College recognizes that the vertebral subluxation, by interfering with the transmission of nerve impulses in the body, has negative effects that are far-reaching. On the other hand, by defining and conducting chiropractic research activities in terms of specific treatments for any conditions, including musculoskeletal/low back and neck pain, the profession will send an ambiguous message to the public. By pursuing research within an allopathic paradigm, the profession risks being perceived as exclusively a "back pain treating profession" rather than one that can contribute profoundly to the overall quality of life. The college is dedicated to exploring the phenomenon of vertebral subluxations, so that we may eliminate them from the lives of all people, and so that people will understand that this is the true potential for benefit from chiropractic care.

4) Sherman College strongly disagrees that chiropractic research should "abandon the concept of vertebral subluxation." In fact, the spirited and most useful discussion at RAC IV demonstrated that the vertebral subluxation is central to chiropractic. As Ed Owens, M.S., D.C., Sherman College's Director of Research, noted in his presentation at RAC IV, it is an empirical fact that the majority of practicing chiropractors view the correction of vertebral subluxations as the center of chiropractic practice; this alone is enough to position the vertebral subluxation as the center (if not the sole) focus of study in chiropractic research.

5) Sherman College specifically seeks researchers and other staff members who are primarily interested in vertebral subluxation. In recruiting members of the research department, teaching faculty in clinical sciences, or teaching faculty in the Chiropractic Health Center, Sherman College thoroughly investigates a candidate's experience and interest in the vertebral subluxation as the center of chiropractic care. Sherman College's central focus is to train its students in the location, analysis and correction of vertebral subluxation; thus it is essential that all faculty members be committed to this outcome. Likewise, with a research program focused on the vertebral subluxation, it is imperative that each and every researcher advance the college's, and the profession's, understanding of the nature and effects of the vertebral subluxation.

TEXAS CHIROPRACTIC COLLEGE
5912 Spencer Hwy.
Pasadena, TX 77505
713/487-1170
President Shelby M. Elliott, D.C.
   Failed to respond

UNIVERSITY OF BRIDGEPORT COLLEGE OF CHIROPRACTIC
Bridgeport, CT 06601
203/576-4279
Dean Frank Zolli, D.C.
   Failed to respond