January 2009

Looking at the 'why' question

Chiropractic researchers have labored for many years to prove chiropractic works, and compiled a relatively small but growing body of evidence answering what impact chiropractic has on the body.

Yet, until recently, they hadn't addressed the question of why it works. How do subluxations alter the system and why does correcting those subluxations have a beneficial affect?

It's been a major challenge to chiropractic researchers because they haven't had the appropriate tools to obtain objective measurements on the neurological changes caused by subluxations and adjustments.

Chiropractic science and philosophy agree that subluxations primarily impact the nervous system, which in turn can result in musculoskeletal problems, organ malfunction, and a eroding of the body's normal state of homeostasis.

Because in the early days it was easier, thanks to x-rays, to document musculoskeletal abnormalities, chiropractors focused on that manifestation of subluxations. Many DCs concentrated so hard on that one aspect that they ignored everything else, defining chiropractic for themselves and their patients as a musculoskeletal treatment. They became back pain doctors or, at best, "spinal care" doctors. The role of the nervous system, as well as the neurological component of the subluxation, was lost.

According to researcher Richard Barwell, DC, a major hurdle was the lack of instrumentation that would produce the same kind of objective evidence as an x-ray, but do it for the nerve system.

"Our stumbling block was instrumentation," he says. "What tools did I have to prove that I altered neurological function? X-rays did not provide any proof. I could use static para-spinal sEMGs to show change in muscle activity or para-spinal static thermal scans to show changes in temperature due to blood flow, but I had nothing to show any direct dynamic changes in neurological function. Without proof our rhetoric becomes dogma and the profession suffers from a lack of credibility."

Experiments conducted by Dr. Barwell and two psychologists who were experts in biofeedback revealed that the adjustment had an effect on brain wave patterns. Their paper -- "A Four Case Study: The effect of the chiropractic adjustment on the brain wave pattern as measured by EEG," was presented at the 2005 Sherman College International Research Symposium and was awarded top honors.

"We came to realize that the chiropractic adjustment fit the definition of a neurofeedback application, but with much more dramatic effects than simple bio/neurofeedback techniques," Barwell explained. "What we saw was that one single adjustment had the power to alter neurological function to an extent that would take between 50 to 200 sessions of bio/neurofeedback. Finally we had a direct link between the chiropractic adjustment and the nervous system without any dialog of spinal or nerve root irritation."

Up until that time, most doctors were using static views (x-ray film, static sEMG and thermal para spinal) and were limited to a "moment in time" assessment. "As the critical factors in health are the dynamic response and recovery, our old assessments were far too limiting to be of any value," Barwell realized.

He set about developing an instrumentation package that could demonstrate the power of the adjustment to alter neurological function. The package included baseline data, stress responses and recovery ability over three different stress events.

"What this provides is an objective view of the functioning level of the nervous system," Barwell explains. "Once we have this in place, we now have a method to measure the efficiency of care in improving neurological function. The program looks at brain wave activity (cortical function) and limbic system responses (sympathetic /para-sympathetic balance)."

The autonomic responses include hand temperature, skin conductance, heart rate, respiration rate heart rate variability, and muscle tension. The test is non invasive and takes about 12 minutes to run.

The instrumentation -- dubbed "NeuroInfiniti" -- is capability of doing static sEMG and thermal (both para-spinal and spot) examinations. And it has the capability of doing scripted dynamic cervical and lumbar sEMGs as well. These tests are extremely valuable in assessing abnormal muscle activity patterns, in determining changes in neuromuscular balance and for appropriate retraining exercises.

While Barwell focuses on the ways the NeuroInfiniti can help improve patient care standards, he also recognizes that its objective findings and outcome assessment tools can help doctors provide insurance companies and Medicare with acceptable proof of "medical necessity." They can also be used to successfully defend against accusations of malpractice in court.

"We now have the means of not only showing exactly what chiropractic does, but why it does it," he says. "After 114 years these concepts lack the proof we so desperately need and we remain the only health profession not to alter its concepts based on current information and research. This is the moment of which BJ Palmer spoke when he said: 'He who seeks truth and factual progress for the development of mankind is a breaking-plow. He denies and ignores stagnant customs and traditions. His task is to liberate man's mind and body from LIMITATIONS OF OLD PRINCIPLES by introducing NEW PRINCIPLES with greater possibilities.'"