The Truth of the Matter Pt VIII — In Search of the Magic Bullet

Ah the “Holy Grail” in Chiropractic.

It continually shows up in our dialog but takes on different forms. We can trace the roots back to D. D’s insight regarding the first adjustment of T4 to restore Harvey Lillard’s hearing. The application of x-ray plates and the supposition that a vertebral mal-position was the magic subluxation was the next step. All we needed to do then was adjust the magic spot and all would be well.

Our great desire to make the application of Chiropractic simple has lead to hundreds of techniques, all claiming to have the answer as to where to adjust a patient for the best results. We have seen personal battles and challenges that have created splits within the profession based on this “magic bullet” concept of Chiropractic care.

The over simplification of Chiropractic stems from the lack of the ability to explain the great benefits the practitioner sees in his/her practice. Any DC, having been in practice for more than 10 years, has most likely seen good patient responses to a variety of techniques.  By far the most used approach in practice, when it comes to describing a technique, is called “diversified”. Which just means the practitioners use a variety of techniques in their practice? This puts a “twist” in the “magic bullet” quest when addressing the concept of a “one technique is the answer” approach.

My 32 years of practice taught me that I needed to evaluate the needs of each patient and closely monitor their responses to care. There were patients whose nervous systems where so damaged that only very light forms of care were indicated, while others needed to have a “kick start”.  Well, not actually kicked, but a firm manual adjustment was the only care that altered their current poor neurological pattern.

The search for the simplest answer continues to persist in the profession and we now have an additional “Simple Simon” format.  The magic wellness index number, – “if you’re a 3, your bad, and if you’re now a 20 you’ve improved” approach.  My question is based on “What”? This is like evidence based care – based on what evidence? – Symptom relief? – Reduction of drug use? Who compiled these numbers? What was the baseline data? Was it from acceptable research or did someone just make it up? The concept may be good but we need to be very careful about our supporting claims.

Chiropractic has been doing this for years and it is one of the challenges that continue to get us in trouble. Where is the proof that a straight spine makes you healthy? Or that a normal cervical curve improves your health?  Now that I have your attention listen up – How do we explain the patients who improve (at least symptom relief) while their curves don’t change? How do we explain how the light touch techniques get great results? Where is the magic bullet here?

As we continue to demonstrate the power of the adjustment to improve the neurological response through pre and post NeuroInfiniti stress response evaluations we have begun to see that all the techniques have merit. Not only is there no “Magic Bullet” for technique but how can you measure health through a number? It reminds me of the scene in “Dead Poet’s Society” where measuring poetry was reduced to a graph and number rating.

Look at this definition of Health

“The states of health or disease are the expressions of the success or failure experienced by the organism in its efforts to respond adaptively to environmental challenges.”

Success or failure starts at the central nervous system and ends with the body’s systems being able to respond and adapt to its environment. This is a very complex, interrelated, closed loop system that continues to respond to health challenges on an individual basis. The Stress Response Evaluation (SRE) shows how individuals continue to change and adapt. We continually get asked, “Does this SRE tell you where to adjust?” Ah, in search of the “Holy Grail” once again!

The reason we call our career “practice” is because what we get to do every day, with every individual, is to think, apply our training and experience, so that we meet the needs of that individual in front of us.

For me the “Magic Bullet” is the adjustment and the “Holy Grail” is what the nervous system does with that stimulus.

The Truth of the Matter Pt VII — Moving Forward by Going Backward

Dr. Alvah Byers, a pioneer in biofeedback and a research Psychologist, taught me more than he thought I was absorbing. As a Chiropractor, I tend to exercise by jumping to conclusions. After all, that was really my training. As a profession, we do this all the time. Just this morning I had a phone conversation with a DC who was explaining how his technique could access and alter brain function. The explanation was in great detail and while it sounded very logical, without any method of objective measurement and reproducibility, it was really just another exercise of conclusion jumping. Now don’t get me wrong here.  I’m not “dissing” the DC or the idea. One of Dr. Al’s teachings was that there is a difference between possible and probable. What the DC said may be possible; but without proof, the probability must be questioned.

When we (Drs. Long, Byers, et al) started doing the studies on the effects of the adjustment on brain wave activity, I had already jumped and said that I expected to see changes. Dr. Byers cautioned me on this and suggested that perhaps any changes might be the result of the people selected, or the room, or some other yet unconsidered factor. I thought he was just being a stick in the mud or worse, someone who was going to find that Chiropractic didn’t do anything and it was simply a placebo effect. (my secret greatest fear) His next suggestion made matters even worse – he suggested that we do a Null Hypotheses. I must have given him that dumb stare as he then said, “That is where we prove that the adjustment does nothing!” Oh well, this made me happy!!! (a lot of sarcasm here) I was dumbfounded! I mean, I really liked Dr. Byers (who has since passed away) – he was a dear friend, but I just wasn’t sure if I should hit him or not. He suggested that we prove the adjustment does nothing! All of a sudden I got very nervous.

When he finally got my attention he explained, “If we set out to prove that nothing happens when you adjust someone, and we are wrong, it means that the adjustment ‘does’ do something. Then the challenge becomes one of now knowing that the adjustment changes something, – what does it change?” He continued, “Then we can start looking at: How does it change activity? or, How can we improve the adjustment’s effectiveness? But first, we have to go backward (Null) before we can go forward.”

Here I was, prepared to jump all over the place and he just sat me down into a chair and said, “Sit still for a minute, and let’s look at why Chiropractic continues to have problems as a viable profession”. He got my attention!!!

I know that there are many DCs out there in “Wonderland” who get upset with me using the terms viable or verifiable, and Chiropractic in the same sentence but the truth of the matter is that it is exactly the challenge we face.

We continue to attempt to justify Chiropractic on the basis of narrative reports. These are known as anecdotes or stories. This form of information gathering doesn’t even make it to the lowest rung of the research acceptance ladder, the case study.  I continually hear from DCs using one technique or another that their technique can discover incredible facts about neurological function and because of this, they get better results. When I question them about how they know, I get one of those, “oh you’re one of those disbelievers” looks. Listen folks, I want, I mean I really, really want everyone of them to be right; but I also want to stop simply exercising my conclusion jumping and start exercising my brain through reproducible proof that will move Chiropractic forward.

So here is something I learned from Dr. Al. Real research does not care about the direction of the results except that they are reproducible.  Real research may show that what you did produced nothing and there is value in that knowledge. Or it may prove that what you did produced unexpected results. There is also value in that knowledge. It may show that the patient’s narrative doesn’t agree with objective findings – The results are just results. The key is, can we start a care prediction that is greater than chance, based on our research? Not yet but soon!

So this is what we know about research and Chiropractic. First we have to back up and start with the Null Hypothesis. After 114 years of Chiropractic care, we can safely say that there is more than enough evidence (even though poorly gathered) to prove that Chiropractic adjustments do change something. Further, and critically important, this something is greater than joint motion, otherwise you can’t offer any explanation as to the effectiveness of techniques such as TRT, Network and many others. Now in order to move forward, we need to find out what that “something” is and what it affects. We need to be willing to put our techniques to the test of objective measurement, stop conclusion jumping and through real research move Chiropractic forward. Thank you Dr. Byers you were a great friend to both me and to this profession.

Click HERE to read the next article in this series.

The Truth of the Matter Pt VI — The Nasty Truth about Prescription Drugs

The AARP news bulletin continues to offer interesting facts about the myths and truths in the health care field.

One that received my recent attention is “The 50 Most Prescribed Drugs”1. It starts with this statement by Betsy Towner, “Prescription drugs …. consume more than 10 percent of the nation’s annual health care costs…. Though brand-name drugs make up only 22 percent of the names on the list, they represent 62 percent of the $53.2 billion cost.”  Now we are talking big money here but worst than this, the drugs are not a means to an end! There is no end to drug consumption, outside of death, so it never gets better.

The number one drug most prescribed is (drum roll please) hydrocodone with acetaminophen for PAIN with 121.3 million prescriptions and a retail cost of $1.78 billion. This is just for pain relief, not corrective medicine. (If there is such a thing). The next in line is Lisinopril for hypertension at 69.8 million prescripts at $686 million in cost.

What really got my attention was that out of the top 50: ten were for depression and anxiety; 9 for hypertension; 6 for bacterial infection; 4 for high cholesterol; and 4 for pain. That counts for 82% of the top 50 most prescribed drugs!!!  This means that the major problems we are facing are depression and anxiety, hypertension, bacterial infection, cholesterol and pain.

Has anyone even asked “WHY” we are challenged with these problems? All of this drug use is directed toward symptom control, not cause reduction. How about asking the question, “How did we all get so focused on symptom based care?” Look at the mess with bacterial infection drugs. The use of antibiotics has only lead to increased resistance to the drug by the bacteria. How many people are either addicted to pain reduction drugs or have used them to cover a more serious problem until it is too late for more effective care?  Once people start on drugs to control hypertension, cholesterol, anxiety or depression, will they ever be able to get off the drug? Not likely!

This is the nasty truth! Now please answer this, “Why has the chiropractic profession bought into the concept of symptom based care?” Is it because we have been very carefully taught that this is the only approach in health care? – or is it motivated by MONEY? (Insurance will pay for x number of visits, so just go with the flow and take the money.

Health research today continues to direct our attention toward “cause” rather than symptoms.  This attention goes all the way up to and including cancer2 (the ugly of the ugly), as well as other nasties such as A.L.S., fibromyalgia and other autoimmune system killers. When we look down to the other end of the scale, we find pain and depression/anxiety. The message is becoming clear that in the search to rid the world of pain and suffering, somewhere we missed the boat. Many years ago Hans Selye3 talked about the effects of stress on health and while we knew that stress was a factor, we had no idea that it was the door to understanding the human condition.

Each of the conditions listed in the 50 most prescribed drugs are the result of a breakdown in one or more systems of the body due to abnormal neurological responses to stresses in our lives. The nervous system becomes less able to adapt to a stressor and/or to reset to normal once the stressor is removed. It seldom happens suddenly; but usually, over time, the controls in the body shift and an imbalance within the body occurs. As time goes on the imbalance will create symptoms and at this point drugs are prescribed. The real heartbreak is that these drugs will create further imbalances (known as side effects) and further failure is inevitable.

It is beyond time that change take place in the health care field. $53.2 billion cost in the top 50 prescribed drugs alone to deal with “after the fact care” and not one of them addresses the cause of the problem! This is either criminal or a case of mass stupidity!

Today the role of the Stress/Recovery response has become the new direction for optimizing our ability to be healthy. Today the medical research has provided the link between stress and the neurological response. Today the role of chiropractic care to improve neurological function is fact4,5. Today is the time for the real chiropractic message to be told!

Click HERE for the next article in the series.

 

  1.  Betsy Towner – AARP Bulletin October 2009 Volume 50, No 8, page 39 bulletin.aarp.org
  2. Meisel et al., Nature Rev. Neurosci. 6:775-786, 2005
  3. “A Syndrome Produced by Diverse Nocuous Agents” – 1936 article by Hans Selye from The Journal of Neuropsychiatry and Clinical Neurosciences
    • The Stress of life. New York: McGraw-Hill, 1956.
    • Selye, H. “Stress and disease”. Science, Oct.7, 1955; 122: 625-631.
    • From Dream to Discovery: On Being a Scientist. New York: McGraw-Hill 1964
    • Hormones and Resistance. Berlin; New York: Springer-Verlag, 1971.
    • Stress without Distress. Philadelphia: J. B. Lippincott Co., c1974.
  4. Cervical spine manipulation alters sensorimotor integration: A somatosensory evoked potential study Heidi Haavik Taylor – Bernadette Murphy – Clinical Neurophysiology 118 (2007) 391-402
  5. A Four Case Study: The effect of the Chiropractic adjustment on the brain wave pattern as measured by EEG. Richard Barwell, DC; Annette Long, Ph.D.; Alvah Byers, Pd.D; Craig Schisler, B.A., M.A., DC. Sherman Chiropractic College, International Paper and Research Symposium, 2005

What’s Stopping You From Growing Your Network? Technique?

I met Dr. Chris Reid a few years back, and I have been more aware of my profession ever since.  His dedication to chiropractic philosophy and continuing education can not be mirrored or mocked.

Imagine if you were running an extremely successful diversified/heavy-force manual adjusting practice, and you turned the whole thing upside down for new research and new concepts.  (1)

Can you make a change? Of course.

Will you?

Up to you.

Dr. Reid learned Koren Specific Technique so he could “ask the body” by using a binary biofeedback challenge called the Occipital Drop to check and correct subluxation and shut off the stress response.  He also started using the NeuroInfiniti/Stress Response Evaluation as a part of his Neurologically Based Chiropractic examination.

No matter your level of success or technique, do you think you could benefit from technology that proves the need for your care?  Allows you to read the nervous system and correct subluxation in order while never over adjusting?

What’s stopping you from growing your network?

 

The Whole Poop On Chiropractic

A seven year-old boy was brought by his mom to our clinic this week, several months after she started considering chiropractic care for him to address behavior issues. Her ultimate motivation this week was to solve his longstanding chronic constipation issue. The patient frequently hadn’t moved his bowels for several days at a time, and when he did it was usually accidental. This had dramatic psychosocial implications for him. His pediatrician recommended laxatives to “solve the problem”, but mom knew it was masking symptoms at best, and not doing that very well.

My associate doctor conducted a Stress Response Evaluation (evaluating stress effects on the brain and body) which showed his brain and nerve system are under-aroused. Some hallmark signs of under-aroused brains are poor attention, impulsive, poor concentration, easily distracted and constipation. After the evaluation and first adjustment, the mom begrudgingly made a follow-up appointment for the next week. The next morning she called to schedule an appointment immediately, emotionally telling the front desk “he pooped 3 times since his adjustment yesterday!!!”.

A few adjustments later, this smart and funny kid’s mom has noticed dramatic increases in the length of his ability to focus (we’ll address that in a future blog!) on schoolwork. She also noted a positive shift in the energy of their household, and great relief that she doesn’t need to discuss bowel movements constantly with a boy his age any more. His mood and confidence are greater. Please share this case with friends who may be having this experience with their kids – you could spark a shift in the better for their family.

Dr. St. Denis: Bioenergy Teleconference Replay

“Neurologically Based Chiropractic Changed My Life: A Recent Grad’s Perspective” 

Welcome Cory St. Denis DC, Co-Founder and Creative Director at the DCTree—with a mission to update the definition of modern Chiropractic, and expand its impact.  His vision is to ensure all Chiropractors and Chiropractic students receive cutting edge technique, neuroscience, along with valuable mentorship. A native of Harrison, MI, Cory is a recent graduate. As Doctorate of Chiropractic, he is in private practice in Jay, Maine, at Paradigm Wellness.

Dr. Porter: Bioenergy Teleconference Replay


Dr. Terry Rondberg’s Bioenergy Teleconference series of interviews are being replayed for those of you who missed it! Join Dr. Rondberg and four other expert doctors for conversations on groundbreaking neuroscience and innovative practice concerning the evolution of chiropractic and brain based wellness care. You will enjoy hearing from these doctors—about something you may not know!!

“How to Reboot Your Brain and Live Your Best Life Now”

Welcome Patrick K. Porter, Ph.D. who has been on the cutting edge of brain wave entrainment technology for 25 years; author of seven books; 450 audio-recorded motivational programs and creative visualization processes. His newest brain-training device, the MindFit Neuro-Trainer™ is distinctively designed to activate the brain’s neuroplasticity. His latest book, Your Flourishing Brain teaches chiropractors why they must focus on neurological health and brain balance.

Dr. Dennis Perman’s Message of the Week: A Birthday Gift For Chiropractic

September 22, 2014

A Birthday Gift For Chiropractic

Dear Doctor:

January of 2015 will mark forty years since I first set foot on the campus of the Columbia Institute of Chiropractic, which morphed into my alma mater, the New York Chiropractic College. It seems like only yesterday that my face was flushed with positive expectancy, my heart was open, and my desire to serve and succeed was surpassed only by my curiosity about what I was getting myself into.

Now I see my son Daniel entering the clinic at Life West, not so much following in my footsteps as blazing his own trail, pointing consistently and passionately in the direction of his dreams. It’s inspiring to see the baton passed and the destiny of chiropractic unfolding – like Moses, I may not get to set foot in the promised land, though I can see it from here, but I am certain that this next generation will motivate the public to take the actions necessary to break through to higher health consciousness.

Between the talent of these young doctors and the burgeoning disdain that is ever-developing around the greed and malfeasance of organized health, there’s no question that a massive paradigm shift is coming, and nowhere is this better illustrated than under The DCTree.

What is The DCTree? It’s a group of committed young chiropractors and students who are dedicated to the interconnection and synergy of chiropractors and chiropractic students worldwide. The brainchild of Cory St. Denis, Lance Rynearson and Shaughnessy Reid from Logan College of Chiropractic, it aims to be a compendium of neurologically-based chiropractic thought, for chiropractic students to pool resources and learn from field practitioners and mentors and facilitate their integration into the reality of chiropractic practice.

I had the privilege of addressing this fledgling group this past weekend, and I was struck with the serious nature of their approach — with the guidance of dear friend and longtime Masters Circle member Patrick Keiran of Jay, Maine, they brought in top brain-based talent, like Richard Barwell, Tedd Koren, and Patrick Porter, and orchestrated a focused, meaningful seminar, which was extremely well-received by a roomful of engaged chiropractors.

But what set this event apart was the exuberance of the recent and soon-to-be graduates, wide-eyed with discovery and building upon their perceptions of things natural. I remember when the light first went on for me, realizing that health and wellness came from above down, inside out — for The DCTree, it’s more than lip service or dogma, it’s real, and it makes me more confident in our profession’s ultimate success. With health and wellness in the capable hands of such fine young leaders, our future is assured.

Please nurture and support this significant effort — we’re not that far away ourselves from those early feelings of wonder and awe at the magnitude of our potential contribution to society, and the intense compelling desire to do something that makes a difference. Go to TheDCTree.org and read their posts, add your two cents, and be a part of this blossoming movement. You have so much to share, and who knows, you could learn something, too.

Dennis Perman DC,
for The Masters Circle

The Truth of the Matter pt V — The Lifetime Wellness Patient!

The Lifetime Wellness Patient!

While not as allusive as a unicorn the amount of effort, sales energy and just plain misconception that is attached to the “Lifetime Wellness Patient” tends to put them into the same category. There has been practice management programs built around the perfect practice based on patients who become “regular” patients since the beginning of the Chiropractic profession.   So much so that this pressure to convert every patient entering into Chiropractic care in this idyllic patient that the profession has become tainted in the public opinion. If you have not heard the comment, “once to start going to a chiropractor they want to keep coming” you haven’t been listening.

Now don’t get me wrong with this – I’m not opposed to a regular life time patient but the way we have gone about developing this type of client has created some serious criticisms. Over my years in practice I seen and heard about every method of practice management around and most are just a rehash of the same approach just tied with a new ribbon. The main challenge to the method was that most practice management is based on selling and much of it involves high pressure fear selling.  I know of one system that taught the DC to confront the new patient with the challenge that if they didn’t bring in their entire family and have them all sign up for life time wellness care they would not be accepted as a patient. Take about pressure selling – no thanks and no thanks for my profession as well.

Jim Parker realized that the profession needed help in how to build a stable income practice. He developed a care plan with a goal to build regular visits programs. He called it the maintenance based practice. The method was simple and easy to recommend. New patients were booked three times a week for two weeks, twice a week for 2 weeks and then once a week for two weeks. Within that 6 week period the majority of patients responded with reduction of their presenting problems. The final step was then to convert them into once a month regular care for maintenance. While this method was very successful, the challenge was that not one of the steps was based on any objective information as to why the visit schedule changed. So it came down to the intent of the care wasn’t about the patient’s needs but rather the Doctors need for a stable income. My exposure to many of the practice management program over the years has left me with the opinion that the maintenance plan was the basis for most with a twist added to make them seem different.

So is there such a thing as a lifetime wellness patient. Listen up if the people of the world knew what I know based on my years of experience with Chiropractic care they would all volunteer to be under regular chiropractic care in their lifetime. That said, what is it that I know that they don’t. This is the secret to building a patient committed based practice. If my commitment is based on knowledge which allows me to make an informed decision wouldn’t it be the way to build the commitment in others? Presenting the facts and options so that the patient makes the ideal choice will bring about and higher level of commitment on the part of the patient.

Now I need to clarify a couple of issues here – 1.  What does Regular visits mean and 2. What is wellness?  Both of the words have little meaning in the real world. Regular visits can mean any number from every day to every year, so we need to start using a different term as it applies to each patient. Regular for some may be three time a week or once every two week. The term wellness is also a slippery slope with little to no meaning. Wellness for someone diagnosed with a term illness versus someone eighteen years old and in good condition will have completely different meaning.

Life time wellness patients are the strength of any successful practice but the truth of the matter is that the intent of the care, based on mutual agreement of Patient and doctor is the keep to these long term relationships. The first stage of care intent may be to help the patient get the current challenge under control. This involves more than simply symptom reduction and address the cause of the neurological challenge at the center of the issue.  The next step would be to start monitoring the changes in neurological function and helping the system back to stabilization. The last step is greater than maintenance and is focused on peak performance. This involves monitoring the patient neurological responses throughout life and responding with appropriate care which the intent of keeping the system in balance.

How does the patient gather the knowledge about their choices in health care? Well not from medical ads seen on television, in magazines, on the radio or now the Internet! If you want to build a practice  based on patient  making the right choices about Chiropractic in their lives you best  be ready to offer the information in your office. B.J. Palmer bought a radio station so that the public would get to know what he knew.

Click HERE to read the next article in this series.

An Open Letter to the Profession

In the words of Bob Dylan,

Come gather ’round people
Wherever you roam
And admit that the waters
Around you have grown
And accept it that soon
You’ll be drenched to the bone.
If your time to you
Is worth savin’
Then you better start swimmin’
Or you’ll sink like a stone
For the times they are a-changin’.”

 

While change is a constant, there are times when those changes are critical. The dinosaurs are a good example. Adapt or die is the law of survival.

The chiropractic profession has been in a fight for survival from its beginning and this is the time for the choice that will determine whether the profession lives on as viable alternative to drug based medicine or vanishes into the world of physical medicine. While there are many who view the latter as a good step, there are just as many who are strongly opposed.

There have always been divisions within the profession but never on such a critical scale. The creation of these divisions has two separate foundations: the first being the dedication to the theory of vertebral subluxation as cause and the second being reimbursement for service rendered.

On the Theory of Vertebral Subluxation as Cause.

The original concepts of a misaligned vertebra and the theory of nerve root pressure creating nerve interference and therefore dysfunction, to this day has not been supported. It is still a theory1. This fact has left the basic concepts of the entire profession as questionable. Meanwhile, we still have a great number of chiropractors staunchly defending this theory and using the positive results of Chiropractic care as their proof. As the basic concept of vertebral subluxation is not supported there is no explanation offered as to how these results are achieved. Instead of focusing on “why” the adjustment gets results, the hardcore of the profession continues to defend vertebral subluxation as the heart and soul of Chiropractic. This has only served to alienate the side of the profession not accepting the old theory.

What has exacerbated the problem is that the Chiropractic colleges, in attempting to bring their curriculum up to university standards, have found it necessary to drop much of the old chiropractic theories and education. This shift has pushed the profession toward physical medicine and away from any connection with the adjustment and neurological responses. In so doing, they have ignored the century old history of fantastic responses to Chiropractic care in areas beyond pain relief or improved joint function.

 On the Influence of Reimbursement for Service Rendered

The other mitigating factor in the shift of the profession lies in access to health insurance for services rendered. The inclusion is not so much about being recognized as a health profession as it is about security of income. In the beginning the profession saw its inclusion as vindication and acceptance. The long road, now in place, has shown this to be a misconception. The misconception lies in more than one area, one being the terms used such as, “Health” insurance. It has little to do with health and is really medical care insurance which in turn exposes number two misconception inclusion. Unless chiropractic becomes a medically modeled profession, it will be totally excluded. Once again the Colleges are well aware of this and will continue to move their education toward a model that will garner income for their graduates. (Remember that Colleges are profit run organizations even though they may claim not to be.)

 On the Effects of Politics on Scope of Practice.

All of these challenges, opinions, and political maneuverings have had a dramatic effect on the “Scope of Practice” of Chiropractic and then you have to add in the local effects of States, Provinces, and/or Countries. There have been two documents produced which address the Chiropractic Scope of Practice. One is the Mercy Documents2 and the other the Council of Chiropractic Practice (CCP) guidelines3.

While both are registered documents, the Mercy guidelines are very medically modeled and dated 1993. The CCP guidelines are much more Chiropractic modeled and have gone through a series of updates with the latest being 2013. The CCP organization is composed of elected members from a worldwide base. Elections are held each year and the updates are from member reviews of new research. The update includes current research that pertains to Chiropractic. One of the most important changes in the last Guidelines update is as a result of the information regarding the research on the effect of the chiropractic adjustment on central nervous system function. Three papers now show that the adjustment directly alters CNS function4,5,6. This information dramatically shifts the focus position of vertebral subluxation nerve root interference as cause, to the effect of the adjustment to improve brain function.

The new information takes the old concepts of vertebral subluxation as representing the best and only interest of Chiropractic and places it in the history books. This does not suggest that vertebral subluxation does not exist, but rather places it in the perspective of a third level response. Compromised Neural Integrity (CNI) due to neurological stress overloads and inappropriate neural responses are the primary damage. This in turn creates abnormal muscle activity throughout the body’s various systems and in the case of the structural system, the vertebral subluxation.

This research has changed the playing field for the Chiropractic profession. As the profession has been affected by the shift in the education toward physical medicine and structurally based care, not only has the scope of practice been reduced, but the very future of the profession is in jeopardy.

It is interesting to note that at the time when the colleges have turned away from the core principles of Chiropractic, along comes this groundbreaking research to support the greater picture of Chiropractic. The challenge now lies in “how” and “if” the profession is willing to entertain the new direction.  This has to start at the grass roots level.  Change does not come from the higher levels of education as they are the standard of yesterday. The changes start with the research being made available to the profession and with it must come evidence based application in the practice environment.

The profession has a history of outrageous claims based on non-supported concepts so the responsibility lies on those presenting the new direction to provide solid, reproducible, objective evidence to the effectiveness of the adjustment to alter CNS function. This includes certified accurate instrumentation.

That said, there are other aspects that needs consideration, which include understanding and defining the subluxation as applied to both the profession’s historical standing and current research. The chiropractic adjustment also needs defining in this context.

On the New Direction for the Profession

The CCP guideline committee took on this task during the 2013 update. In light of the new research on the adjustment and the CNS responses the committee, after 2 years of work, listed this definition.

Subluxation is a neurological imbalance or distortion in the body associated with adverse physiological responses and/or structural changes, which may become persistent and progressive. The most frequent site for the chiropractic correction of subluxation is via the vertebral column.”                CCP Guidelines 2013.

This not only represents a radical shift of the definition but also a radical shift for the entire profession. It shifts the direction away from the structural model and restriction to spinal or joint care to a total neurological foundation. It opens the scope of practice from a pain reduction model to a model based on functional neurology.  This model supports all technique approaches and calls for Chiropractors to look to the appropriateness of their care plans. This also calls for neurological assessments pre and post care.

Defining the adjustment from a neurological assessment calls for new approach as well. As the research now shows that the adjustment alters CNS function, we can no longer use terms such as realignment or joint play to describe an adjustment. The new definition calls for a two-step clarification.

Step one – The definition of feedback is important.

Feedback: A procedure whereby the consequence of an action serves to continually modify further action.

As that is exactly what the adjustment does within the CNS an appropriate definition of the adjustment is:

A Chiropractic procedure whereby the consequence of an action serves to continually modify further action within the nervous system with the intent of creating harmony within the body’s systems.

 The impact of the new information is in a shift from the physical concepts of Chiropractic – this being:  vertebral misalignment or vertebral subluxation and its correction as the main focus of chiropractic, to a total neurological foundation based on the effectiveness of the chiropractic adjustment’s ability to improve neurological function. The neurological recovery ability is a key factor of the effect of the adjustment which is the connection to the cataloging of the adjustment as a neurofeedback response.

The researchers dealing with bio/neurofeedback over the last 50 to 60 years have established the science of this field7 and once we were able to show the adjustment’s responses and subsequent ongoing changes in neurological function, it became self-evident that the chiropractic adjustment is a feedback event.

The next step was to use the adjustment as a neurological pattern interrupt and then apply bio and neurofeedback as a method to train the patient’s neurological pattern to a more ideal response.

This brings us back to scope of practice. To date there are no license requirements in place governing bio/neuro feedback. Australia has just taken the first steps to regulation but not so in North America. These are both valuable tools in the field of Neurologically Based Chiropractic and need to be included in our practice guidelines. They are included in the CCP guidelines for Chiropractic practice. That said, correct application is a necessity and those using the system should require training.

On the Intent of this Letter

 This letter is intended to provide information, evidence, and be thought provoking, not just to Chiropractors in practice but across the scope of bodies governing the practice of chiropractic worldwide.  Throughout North America, we have State and Provincial boards comprised of Chiropractors and the public controlling the profession based on concepts that are over100 years old or thinking that Chiropractic is just another branch of medicine.   Neither of these is acceptable. The boards are responsible for the protection of both the public and the profession; however, when they make rulings based on outdated information they serve neither.

I am calling for the profession to get activated, to get involved because you can’t change something from outside or through inactivity. So you don’t like your State or Provincial association position – get active and change them.  The scope of practice for Chiropractic is in your hands. You can let medical insurance coverage or the product of the chiropractic education system define Chiropractic and reap the consequences. Talk to your Boards and Associations! It is time for Chiropractors to define Chiropractic and its scope of practice.

Chiropractic is not medicine.   Chiropractic deals directly with neurological function.  Medicine deals with pathology.  Change will only happen through action!

Come writers and critics
Who prophesize with your pen
And keep your eyes wide
The chance won’t come again
And don’t speak too soon
For the wheel’s still in spin
And there’s no tellin’ who
That it’s namin’.
For the loser now
Will be later to win
For the times they are a-changin’.

 

 

References

1. Bolton P (2000). “Reflex effects of vertebral subluxations: the peripheral nervous system. An update.”. J Manipulative Physiol Ther 23 (2): 1013

2. www.chiro.org/LINKS/GUIDELINES/…/Mercy_

3. ccp-guidelines.org

4. Richard Barwell, DC; Annette Long, Ph.D.; Alvah Byers, Ph.D; Craig Schisler, B.A., M.A., DC. The Effect of the Chiropractic Adjustment on the Brain Wave Pattern as Measured by EEG. – A Four Case Study
International Research and Paper symposium 2005 Awarded the best research paper in review Sherman Chiropractic College

5. HeidiHaavikTaylor*,BernadetteMurphy  Cervical spine manipulation alters sensorimotor integration:  A somatosensory evoked potential study. Human Neurophysiology and Rehabilitation Laboratory, Department of Sport and Exercise Science, Tamaki Campus, University of Auckland, Private Bag 92019, 261Morrin Road, Glen Innes, Auckland, New Zealand Accepted 11 September 2006

6. Takeshi Ogura, oc, PhD; Manabu Tashiro, MD, phD; Mehedi Masud, MD, phD; Shoichi Watanuki; Katsuhiko Shibuya, us;Keiichiro Yamaguchi, MD, phD; Masatoshi Itoh, MD, phD: Hiroshi Fukuda, MD, phD; Kazuhiko yanai, nro, prroCerebral Metabolic Changes in Men After Chiropractic Spinal Manipulation for Neck pain.

7. Alvah P Byers (1998) The Byers neurotherapy reference library: Version 1.02