November 2008

Rethinking the subluxation ... Part 2

by Dr. John F. Markham

The modern chiropractor's dilemma is that he or she can produce enviable clinical results using methods of adjustment based upon wildly differing models of the subluxation. None of our techniques and methods of detecting subluxations have been shown to achieve high levels of validity or reliability. This highlights a great paradox in chiropractic. It suggests we're doing something right but our models may not be complete.

This frustration has led many to renounce much of chiropractic art and philosophy and accept only those things that can be demonstrated to be valid and reliable through research. While the "Evidence-Based Practice" and "Best Practices" movements are badges of honor and symbols of intellectual honesty for some, for others they represent an abandonment of the vitalistic core of this profession or perhaps a euphemism for chiropractic containment.

I've had difficulty reconciling many of the proposed models of subluxation and adjustment. I believed it was a matter of just doing more research to discover the truth of chiropractic. Yet, trying to prove a vitalistic premise with a mechanistic science has shown itself to be an irreconcilable and inappropriate juxtaposition. A vitalistic healing art and philosophy can't ignore the science, but it must accommodate the fact that vitalism attempts to recognize and deal with things that are true but cannot be measured. Healing arts have historically honored that reality but of late the mechanists are crushing the life out of the healing professions, including chiropractic.

Most chiropractors use a variety of techniques to find the best approach for each patient. It's time we made it a higher priority as a profession to develop a method of determining optimal response indicators and profiles of how to adapt the adjustment styles to the patient, rather than force patients to find the style that works for them.

Our philosophy keeps us patient-focused, not diagnosis-focused. Having the correct diagnosis is crucial to the practice of physical medicine. To some extent this is an area we should all master. However, the adjustment isn't dependant upon the diagnosis. How we manage the case will depend upon a correct diagnosis. In theory, any diagnosed condition will respond better when the patient isn't subluxated. Other appropriate treatments will be more effective if the patient isn't subluxated.

Even the most scientific-minded doctors develop an intuitive feel regarding where and how to apply their specialty. Chiropractors do this better than anyone. Some techniques seem to reflect the intuitive, right brain, sub-threshold perceptions of the doctor, rather than actually measure any objective condition of the patient. This can be seen in muscle testing, leg checks, or other interactive methods of assessment.

If the technique is actually serving as a method of eliciting our innate impression, it seems obvious that we shouldn't expect the inter-examiner reliability to be high because impressions are personal and quite variable. Malcolm Gladwell, in his book "BLINK," expressed the idea that our ability to get reliable impressions at a glance is natural and is especially useful when we have much experience in working in an area. This innate ability has caused us to prosper beyond the limits of our science.

Much of our success may have as much to do with what we don't do as opposed to what we do. We don't focus on the "diagnosis" or treat the "disease." Instead, we focus on the inherent capacity to be well and involve the patient in the process of expressing health, and we treat the patient. We don't use drugs or surgery. We don't ignore the impact of emotional stress, bad nutrition, and unhealthy lifestyle choices. We actively encourage healthy habits. These practices are driven by our philosophy and may be the most impactful aspect of being cared for by a chiropractor.

It's critical that we expand the definition of the subluxation to include the systemic subluxation. The localized functional lesions may be evidence of the systemic distortion that's taken place and reduced the adaptive capacity of the entire body. This expanded definition can be explored using the bio-tensegrity, neuro-mechanical model. No doubt we'd find leadership on this approach from Dr. Ted Carrick who has enlarged everyone's vision and understanding of the importance of the fully integrated nervous system and how to apply local adjustments to normalize the system.

As we established and demonstrated this approach, then every specialty in chiropractic would have a frame of reference and a core principle to revolve around. We'd be better prepared to communicate to the medical community why appropriate medical treatments will all work better if the patient is adjusted. That could mean fewer medications and fewer surgeries in the long run.

Dr. Virgil Strang once said to our philosophy class that "Rational medicine had no argument with rational chiropractic." I believe there are enough rational people on both sides who'd prefer a symbiotic relationship rather than the antagonistic one we have now.

(Dr. John Markham is the director of Level III Clinics at Life University, and director of the Life University Clinic P.E.A.K. Program. He practices in Kennesaw, Georgia.)