October 2008

Structure vs function: dueling paradigms

by Dr. Mark Payne

The seventies and eighties brought sweeping changes to chiropractic. Perhaps the most ground shaking was the introduction of the "new paradigm" in chiropractic.

Popularized largely by proponents of motion palpation methods, the new paradigm emphasized the importance of function over form and motion over structure. The new motion paradigm emphasized the restoration of normal spinal motion (function) and began the intellectual demise of chiropractic's traditional raison d'être, restoring normal spinal alignment.

Practitioners in the field, already frustrated by the difficulties of trying to correct spinal alignment, were eager to embrace the concept that it was possible to "fix" the problem without every actually changing the spinal architecture.

At the time, most chiropractic techniques emphasized the correction of small misalignments of adjacent vertebrae. I am sure many of you recall the phrase "loss of normal juxtaposition."

Incredibly, the profession had spent nearly a hundred years focused on tiny misalignments of individual vertebrae, while ignoring the overall alignment (or posture) of the spine as a whole.

Many doctors, myself included, had been taught that chiropractors "correct subluxations, NOT straighten spines." The result, of course, was that we concentrated on the minutiae of small intersegmental problems while ignoring the larger picture of global spinal posture.

The idea behind most techniques was that if "nerve interference" was corrected by reducing the intersegmental misalignment, then the spine would naturally assume a healthy position as innate intelligence was allowed to express itself

Most doctors reading this would probably agree this was a hopelessly simplistic view of how the spine behaves and responds to chiropractic care. The evidence of how naive we were has since been demonstrated by numerous studies indicating our adjustments do very little to change spinal posture.

Figure A --Kyphotic Cervical Spine

Figure B -- Lordotic Cervical Spine

The scientific literature now clearly bears out what every observant field doctor knew after only a year or two in practice. For all of the good that traditional adjustments do for our patients, they actually do very little to correct spinal alignment… the very thing they were supposed to address.

In this frustrated environment, the "motion" paradigm found fertile ground in a profession skeptical at the lack of tangible results over and above symptomatic resolution.

Whereas, chiropractic was founded around a concept of adjusting the spine to restore segmental alignment, soon much of the profession had completely distanced itself from any structural definition of subluxation and chiropractic.

Today, structure is now considered largely irrelevant. Consider this quote from the ACA website, "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 or restricted in their movement."

The problem of course is that since the motion paradigm was popularized, we now know a lot more about the interrelationship between spinal function and spinal structure. We now know this isn't possible because the intricate coupling patterns of spinal motion are inseparably linked to the overall posture from which the movement is initiated. [1]

Likewise, it isn't possible for the spine to maintain normal postural alignment when trying to compensate for functional deficits such as muscular imbalance or movement impairment disorders. It would seem that in our rush to become more scientific, we had thrown out the proverbial baby with the bath water.

It is intuitively obvious that the end goal of all health care methods is improved function for the patient. True health is optimum function. Even an old structure-based chiropractor like me can understand that in mechanical systems such as the spine, motion is one very important measure of function.

Where the new paradigm fell short was in assuming that normal spinal motion could be possible within the framework of sub normal spinal alignment. Figures A and B show two very different necks. I don't think anyone would expect the intersegmental motion of the two to be identical. It simply can't happen.

Expecting vertebrae to move normally within a misaligned column is a bit like expecting a car with a bent and twisted frame to roll smoothly down the road without veering to either side.

Conversely, expecting a weak dysfunctional spine to maintain normal alignment is equally silly. Structure and function, as it turns out, are just two sides of the same coin. The interrelationship of the two is an inescapable fact. Once we realize that, we can start to move past our own incomplete paradigms toward one which is more philosophically sound. It is vital that we know and understand the value of both approaches to patient care. Anything less shortchanges the folks who trust us to care for them.

The subject of this column, postural chiropractic implies by definition that we will be seeking to improve human posture/structure. Regardless of your personal approach to practice, I'll try to share with you an integrative approach to achieving better structural corrections by incorporating concepts from both paradigms.

Next time, I'll start covering some of the simple proven methods which doctors from either paradigm can easily embrace to improve their outcomes. Best of all, the methods I'll share can be implemented without investing a fortune in dollars or time.

Reference

1. Oxland TR, Crisco JJ 3rd, Panjabi MM, Yamamoto I. "The effect of injury on rotational coupling at the lumbosacral joint. A biomechanical investigation." Spine. 1992 Jan;17 (1):74-80.

(Mark Payne, DC, is the president of Matlin Mfg., a manufacturer and distributor of postural rehabilitation products since 1988. For more information regarding postural chiropractic call 334-448-1210 for a free report, "The Best Corrections of Your Career." For more articles and information, visit www.matlinmfg.com.)