November 2008

Great vision, fuzzy picture

by DeDe Van Riper

I was really excited about the movie and even arrived early to get that "middle of the theater" seat. As the show started, everyone noticed the film wasn't focused properly, but we thought that somebody would either inform the management or the projectionist would re-focus the lens. Time went by and the problem persisted. Some in the audience started complaining.

Finally, a man got up, apparently to find a person to fix the problem. Naturally, this created an inconvenience for those sitting in his row but it seemed to be a small price to pay. We didn't realize that instead of going to seek help, he was leaving the theater out of frustration. So, there we sat trying to understand what was going on in the movie without a clear picture of the action.

Finally, we used up so much energy trying to interpret the information, we all had headaches and eye strain. Not only that, but I felt like I'd just put in a hard day's work by the time the movie ended. What a difference a little effort to focus the lens would have made. I know I missed a lot of the film's beauty and perfection. The picture was an Oscar winner and my vision was 20/20, so the problem was elsewhere.

Over the weekend, in a discussion with fellow chiropractors and some extraordinary chiropractic advocates, we talked about the "big picture" of chiropractic and I recognized a direct link between the movie story above and the current state of the profession. The foundations of chiropractic are sound and the intent (principles) in play. What isn't working is the focus.

What's so surprising is that most in the professional audience (the DCs), have accepted the fuzzy view of chiropractic as normal and continue to sit though the film (their practices) with no concern as to the cost. This lack of awareness is sure to have dramatic results -- eye damage (short term planning only), headaches (poor comprehension), reduction in clients (narrowed scope of practice), personal frustration (practice dissatisfaction), degrading of future productions (quality of care diminished), and a move of consumers to other venues (clients will seek other forms of care), etc.

As I travel and speak to chiropractors around the world, they repeatedly tell me that the nervous system is our major focus. Students are taught this at most chiropractic colleges, even though the direct mechanism isn't understood. The simple version of vertebral misalignment and nerve root interference remains the sole explanation of the cause of neurological interference, although there's still no proof that this is what happens.

Here's where the picture becomes fuzzy and while we're content to sit though the show, many have already left the theater. The truth is staggering. About 20% of chiropractic graduates are not in practice within two years of graduating. There are so many DCs who know that this is a great show but they just can't find the fulfillment they'd expected.

With all of the practice management programs and educational materials available, one would think practice success should be automatic. Yet, this isn't the case. New practice management groups start up all the time with more marketing ideas, but don't address the real problem. The actual problem lies in the profession's focus.

If the focus is to use chiropractic strictly as a get rich quick scheme, there's a problem. If it's simply to accept the fuzzy view as normal and do nothing to improve quality, still a problem. If we continue to accept what our heart tells us, but tell our patients something different, that's an inconsistency and, surely, we have a problem.

With this in mind, let's take a seat in the theater and view the show called "chiropractic." Let's look at the existing model of chiropractic subluxation and the chiropractic adjustment.

These are the current definitions of chiropractic and subluxation:

***  "Chiropractic is a health care profession that focuses on disorders of the musculoskeletal system and the nervous system, and the effects of these disorders on general health. Chiropractic care is used most often to treat neuromusculoskeletal complaints, including but not limited to back pain, neck pain, pain in the joints of the arms or legs, and headaches." [1]

***  "When the vertebrae of the spine become misaligned through trauma or repetitive injury, two major consequences will result: 1) the range of motion becomes limited and 2) spinal nerves emerging from the spinal cord are compromised. DCs use the term 'subluxation' to describe such disruptions. Interruption of nerve flow can eventually lead to pain, disability, and an overall decrease in the quality of life. Conversely, the removal of that interference has been shown to have significant, lasting health benefits." [2]

Examining the first wrong way twists of the focusing device in point one, note the order of importance: musculoskeletal first, nervous system, second. In the second point, there's no proof of this at all.

According to the Association of Chiropractic Colleges, in a definition taught around the world, a subluxation is: "A complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system and general health." [3]

Where are the "fuzzies" here? Again, note the order. First, it's "a functional, structural or pathological articular change" so, the further wrong twist of the lens is that it is the "joint" as the primary focus, not the nervous system.

The distortion becomes great at "neural compromise." Not only is the "form" of the compromise not explained, but this entire statement is theory and hasn't been proven.

The worst comes next in the use of the word "may." It "may influence." This allows that it may or it may not (not said, however) and if it may, what's the form of the "influence"?

Where does this leave us? In a dark theater watching a show that's so fuzzy it has us all guessing at what's really going on.

What do the experts have to say about this? Professor Philip S. Bolton states: "The traditional chiropractic vertebral subluxation hypothesis proposes that vertebral misalignment cause illness, disease, or both. This hypothesis remains controversial." [4]

Not only is the picture blurry but it appears the light just went out!

At this stage, there's an interesting reaction. Many DCs dismiss all of this as a betrayal because it makes them feel so uncomfortable. Rather than find out the rest of the story, it's easier for them to quit and keep on watching the fuzzy show.

Another response I hear is, "I understand that the nervous system is our primary focus and that's why I adjust the spine." Interesting point.

Look first at the definition of adjustment: "Any chiropractic therapeutic procedure that utilizes controlled force, leverage, direction, amplitude and velocity which is directed at specific joints or anatomical region." [5]

The American Chiropractic Association says: "The most common therapeutic procedure performed by doctors of chiropractic is known as "spinal manipulation," also called "chiropractic adjustment." The purpose of manipulation is to restore joint mobility by manually applying a controlled force into joints that have become hypomobile -- Through the adjustment of the subluxation, the doctor of chiropractic endeavors to restore normal nerve expression." [6]

We're now watching "Apollo 13" and the message is, "Houston, we have a problem!" If the basic foundation is that chiropractic works by removing interference to the spinal nerves by moving the vertebra, the problem is that this is nothing more then theory. While we've been telling everyone for 112 years that this is what we do, we still can't prove it.

The point is, we need to stop for a moment to consider that in continuing to look at the joint mechanics, we've lost focus on the direct relationship between the chiropractic adjustment and the nervous system.

If chiropractic is only about correcting vertebral subluxations by force, then how do we explain the fantastic effectiveness of all those light touch techniques? How can we focus on the effects of the adjustment from a strictly neurological response and demonstrate the power it has to change neurophysiological function with just light touch? How can we, for the first time, sit in the theater and see the effect of subluxation and the power of chiropractic in High Definition?

The good news is, we can. But only if we're willing to re-focus the lens. The film is real and so is chiropractic. We have to do some work at setting things right. And, the first step is to stop and look at neural-based chiropractic. What a focus, what a show.

References

1. American chiropractic Association -- "What is chiropractic?" http://www.amerchiro.org/level2_css.cfm?T1ID=13&T2ID=61

2. International Chiropractors Association -- "The practice of chiropractic is based on sound scientific principles." http://www.chiropractic.org/index.php?p=chiroinfo/main

3. "Foundations of Chiropractic" -- Gatterman www.chirocolleges.org/

Association of Chiropractic Colleges (ACC) -- Chiropractic Scope and Practice

http://www.chirocolleges.org/collegest.html

4. Bolton P (2000). "Reflex effects of vertebral subluxations: the peripheral nervous system. An update." J Manipulative Physiol Ther 23 (2): 101-3. PMID 10714535

5. "Foundations of Chiropractic" -- Gatterman www.chirocolleges.org/

Association of Chiropractic Colleges (ACC) -- Chiropractic Scope and Practice

http://www.chirocolleges.org/collegest.html

6. American Chiropractic Association -- "What is chiropractic?" http://www.amerchiro.org/level2_css.cfm?T1ID=13&T2ID=61

(DeDe Van Riper has extensive knowledge and experience in the chiropractic field, having worked with Insight Technology, CLA [Chiropractic Leadership Alliance], Now You Know, and other major chiropractic companies. For questions about chiropractic instrumentation, call her at 877-233-0022.)