Increasing chiropractic utilization has been equated with establishing a central identity for the profession. Theoretically, once recognized as filling a specific role in the health care system, all of our offices would be overflowing with patients. While this does fit into the current model of health care, this is not the only option to essentialize chiropractic and bring our utilization numbers over 9.2%.
Schneider and Murphy contend that the public’s perception of chiropractic as neck and back pain specialists will drive our future. In the medical model and interdisciplinary settings, everyone has a single role; therefore, for chiropractic to survive in those environments our role needs to be simply defined. For example, in a sports medicine team the DC often has a specific role such as CMT only, a specific soft-tissue technique or even the provider of a specific modality, with the team trainer overseeing the athlete’s care.
“Chiropractors are perceived as specialists who provide nonsurgical, nonpharmacologic spine care ... chiropractors possess the specialized knowledge, skills, and training to provide care for patients with spine-related disorders ... the general public, legislative/regulatory bodies, and chiropractic organizations appear to have already established a default identity for the chiropractic profession; namely, as back and neck pain doctors.” – Schneider, et al., 2016
Legislative bodies also need a clear definition of chiropractic to ensure we are placed at the correct seat at the table, or even given a seat at all for that matter. One seat we can easily embrace is we are recognized as providing natural, drugless care by both the public and professional sectors. Unfortunately, this keeps us out of the medically driven healthcare system - medicine needs a paradigm shift of its own to embrace natural, non -surgical and drugless care to fully embrace Chiropractic in this model.
In a previous article (February issue), I discussed the value of creating a personal identity within our local communities through superior clinical outcomes and establishing our presence as an erudite professional who exhibits the core values of prudence, justice and temperance. Schneider agrees that exceptional clinical standards need to me upheld, and Good adds the emphasis on the values of truth, respect and tolerance. This is a grassroots approach which overtime will reach critical mass leading to national and even global recognition with the net effect being increased utilization of chiropractic.
A central challenge in creating our identity is that chiropractic is a method of care, not a technique or procedure. This is an important concept for us to promote. Our patients are treated with lifestyle modification, exercise, nutritional supplements, diet and a whole-body approach to accelerate the natural healing process. We are not simply CMT providers.
“Our findings suggest that many chiropractors do provide multimodal care, includes SMT, formal patient education, soft-tissue therapy, mechanically-assisted manipulative therapy, nutritional supplements, exercise instruction, ice, heat, mobilization/manual traction, orthopedic supports, electrical stimulation, therapeutic ultrasound, and acupuncture. Therefore, chiropractic care should not be considered consisting exclusively of spinal manipulation.” – Beliveau, et al., 2017
O’Neil identifies our emphasis on the chiropractic adjustment as an integral component of treatment as a weakness in defining our identity and in increasing utilization. Although a highly effective modality in the treatment of back and neck pain, current research indicates these conditions are managed, and not “cured,” even with CMT. In addition, there is minimal evidence that CMT is beneficial for non-musculoskeletal complaints; therefore, the tenet that chiropractic adjustments alone enhance healing, regardless of the condition, remains a hypothesis.
“Providing spinal manipulative manipulation (SMT) for non- musculoskeletal disorders probably does nothing beneficial for patients, but harms the profession’s image and standing in society and negatively affects its legitimacy in the wider healthcare landscape.” – O’Neil, et al., 2024
We know CMT works and is highly effective, but so do osteopaths, physical therapists and athletic trainers who also perform manipulation. In reality, as far the public is concerned, CMT is the same as OMT (osteopathic manipulative therapy) and SMT (spinal manipulative therapy).
In the literature the terminology of SMT is utilized, regardless of the provider and although individual professions contend their brand of manipulation as superior, this is only an attempt to bring credibility to a philosophical belief.
“Although a veritable smorgasbord of treatments is available for patients with musculoskeletal (MSK) disorders like LBP, and while some are more expensive or associated with higher risks, none has proven decisively superior to others. However, exercise and SMT stand out as being both safe and inexpensive.” – O’Neil, et al., 2024
But it still comes back to increasing chiropractic utilization. Perhaps the ticket is to accept a specific role such as the spine specialist to get “spines in the door” and then treat them with a chiropractic methodology. While accepting a mainstream role as the manual therapist in an interdisciplinary setting with care coordinated by another provider can increase utilization, it is not the only choice of integration into the health care system.
Current studies demonstrate back pain (as well as many MSK conditions) progresses along a chronic course, as there is no definitive “cure” according to the literature. Haldeman contends, “The current health care environment for spine care is chaotic, costly, and, in many parts of the world, of little benefit to patients.” Furthermore, there is a distinct lack of a recognized provider to oversee care for MSK complaints to ensure the most cost effective, beneficial and safest care is provided.
“Chiropractic could re-invent itself with less focus on the role of SMT and shift away from a chiropractic identity as providers of SMT within a distinct theoretical framework, towards a broader role as coordinators of long-term management of MSK disorders well-integrated in the wider health-care landscape. A role as an MSK manager.” – O’Neil 2024
Chiropractic is uniquely suited to fill this role. We have MSK training, awareness of conservative interventions, strong interpersonal skill and high satisfaction among patients. In fact, patients with back pain are looking for a chiropractic experience, even if they do not know it! They seek reassurance the pain is real, an understandable diagnosis, a plan to address the issue, suggestions for home care and pain relief. This is a standard chiropractic intake procedure, Report of Findings and the first treatment.
So, perhaps chiropractic’s role in the modern system is that of the doctor who oversees the care of patients, ensuring the most appropriate and cost-effective treatment is provided. Our background would fit well into that space. Ruling out red flags, limiting excessive diagnostics incorporating natural and conservative methods, and coordination of care with medical specialists for advanced treatment or diagnostics. Frankly, O’Neil and his team have made a strong case for this paradigm shift.
However, this author does find benefit in a wellness paradigm for chiropractic, regardless of the literature. I get adjusted every 2-3 weeks for health and wellness and have patients that have developed the “once-a-month chiropractic check-up habit,” too. I have seen it over the past 39 years: long-term, multimodal chiropractic care can make a difference in how we age.
Spine specialist, general wellness provider or MSK manager, we own the natural and wellness health care space. The multimodal approach of chiropractic adjustments, supplements, diet, exercise, sleep, stress management all fall under our umbrella and a majority of health conditions will improve, if not resolve, with a multimodal chiropractic approach.
Embrace our commonalities, demonstrate high clinical and ethical standards and manage your patients with short-term pain relief or long-term MSK management depending on your spot on the team.
Resources
- Beliveau PJH, Wong JJ, Sutton DA, et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap, 2017 Nov 22;25:35.
- Gliedt JA, Perle SM, Puhl AA, et al. Evaluation of United States chiropractic professional subgroups: a survey of randomly sampled chiropractors. BMC Health Serv Res, 2021 Oct 5;21(1):1049.
- Good CJ. Chiropractic identity in the United States: wisdom, courage, and strength. J Chiropr Humanit,2016 Sep 15;23(1):29-34.
- Glucina TT, Krägeloh CU, Spencer K, Holt K. Defining chiropractic professional identity: a concept analysis. J Bodyw Mov Ther, 2023 Jul;35:75-83.
- Haldeman S, Dagenais S. A supermarket approach to the evidence-informed management of chronic low back pain. Spine J, 2008;8(1):1-7.
- O’Neill SFD, Nim C, Newell D, Leboeuf-Yde C. A new role for spinal manual therapy and for chiropractic? Part I: weaknesses and threats. Chiropr Man Therap, 2024 Mar 26;32(1):11.
- O’Neill SFD, Nim C, Newell D, Leboeuf-Yde C. A new role for spinal manual therapy and for chiropractic? Part II: strengths and opportunities. Chiropr Man Therap, 2024 Mar 27;32(1):12.
- Rosner AL. Chiropractic identity: a neurological, professional, and political assessment. J Chiropr Humanit, 2016 Jul 20;23(1):35-45.
- Schneider M, Murphy D, Hartvigsen J. Spine care as a framework for the chiropractic identity. J Chiropr Humanit, 2016 Nov 4;23(1):14-21.
- Verbeek J, Sengers MJ, Riemens L, Haafkens J. Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine, 2004;29(20): 2309-2318.
