June 2008

The subluxation's missing component

by Dr. Terry A. Rondberg

Too often we see chiropractic viewed as a "treatment" for musculoskeletal disorders, without any regard for the neurological aspect. So, when I first read this month's Chiropractic Journal Commentary, "Do you want to re-define medical necessity?" by John Davila, DC, I found myself nodding vigorously in agreement, especially when he states: "The neurological component of the subluxation is our greatest weapon to expanding the definition of medical necessity."

In a past Journal article, noted chiropractic researcher Christopher Kent, DC, put it this way: "Although medical authorities acknowledge that neurological complications may occur as a result of subluxation, classical chiropractic definitions mandate the presence of a neurological component."

Another researcher, Charles Lantz, PhD, DC, has stated that "common to all concepts of subluxation are some form of kinesiological dysfunction and some form of neurological involvement."

Nevertheless, more and more often we're ignoring that neurological involvement. As a result, we're known as back-pain doctors and used in much the same way as aspirin or exercise equipment: to relieve musculoskeletal stiffness and pain.

One reason for this is that we were sold a bill of goods about needing to find a "niche" market. Back pain, we were told, was a big market -- with nearly eight of every ten people suffering from it at one time or another. We figured the medical profession would "allow" us to treat back pain as long as we didn't mess around on their turf (which included everything else).

It was also a lot simpler to describe how chiropractic could ease back pain than it was to explain the entire vitalistic philosophy. It was also easier to advertise. All we had to do was show a person with red lightning bolts radiating from his or her back or neck and we were in business!

The final -- and probably most important -- reason we ignored the neurological component was that we didn't have the scientific research to prove what we knew from clinical experience. As Dr. Davila says, "We need show a neurological connection to the subluxation so we have the proof we have talked about over the years and then tie that connection to functional improvement."

Why then is so much of our current research still directed to back pain and similar musculoskeletal conditions? Here, for instance, is the complete list of all the projects funded by FCER last year:

***  "Chiropractic Dosage for Lumbar Stenosis"

***  "Chiropractic and Acute Neck Pain: A Practice-Based Study"

***  "Preventive Care of Chronic Cervical Pain and Disabilities: Comparison of Spinal Manipulative Therapy and Individualized Home Exercise Programs"

***  "Does Chiropractic Care Decrease Fall Risk in Older Adults?" (The grant description notes that: "It is proposed that balance, the risk factor for falls, is adversely affected by both musculoskeletal function and low back and lower extremity pain -- which have been found to be responsive in previous studies to chiropractic intervention.)

Do you see the pattern here?

Instead of continuing to lock our profession in the tiny (and shrinking) musculoskeletal box, we need to reclaim the missing component of subluxation: neurological involvement. We need to talk about it with our patients and members of the community, making it part of all our patient education programs. We need to redesign our advertising so we aren't reinforcing the old, erroneous idea of "back pain doctors." And, we need to demand that our colleges and research institutions stop plucking the low-hanging fruit by examining, ad nauseam, the connection between chiropractic and back pain!

Every chiropractic college and researcher should be following the lead of Quixote Software's research and clinical science program, which is probing the real questions concerning how subluxation affects all aspects of human health and wellness. Field doctors need to start using instrumentation that will accurately measure a patient's neurological response before and after subluxation correction, and learn to document vital information for use not only in research but for insurance companies.

In the hundred-plus years since DD Palmer discovered chiropractic, we've lost much of the spirit and substance of chiropractic. If we lose the neurological component of the subluxation also, we will lose our original identity and, quite possibly, our entire future as well.