There is a very simple fundamental reason why the public doesn't understand the value and necessity of quality chiropractic spinal care. No matter how much chiropractors advertise, how well we run our practices, and how well we do all the marketing, chiropractic will continue to struggle to see little more than a small percentage of the population. Most patients that do turn up will expect quick fixes and terminate treatment after they feel better. Chiropractors will continue to bash their heads up against brick walls trying to change things.
The problem is not that the medics don't like us. It's much simpler than that. This article discusses that problem, and provides a solution with the potential to enable chiropractic to flourish beyond most chiropractors' dreams.
Question: Drugs and dentistry are seen as necessities, but the spine does not receive such recognition. Why?
Answer: The public understands the formation of tooth cavities, so the need for regular dental care is obvious. People understand that germs cause disease, so it is easy to sell the need for drugs to kill the germs. On the other hand, there is no such understanding by the public for the principles of spinal injury and care. Let's consider four principles of spinal care that are no more difficult for the public to understand than cavities or germs.
Principle One: The abnormal mechanical stress resulting from faulty spinal mechanics causes muscle tightness and inflammation.
The public believes anti-inflammatory drugs and massage to be logical treatments for spinal inflammation and muscle tightness, while "cracking" a spine is not. If they did understand, chiropractic adjustments would be seen as a logical form of care, whereas drugs and massage would be seen as not treating the cause.
Principle Two: Prolonged abnormal stress from faulty spinal mechanics causes "arthritis" and other forms of spinal deterioration.
"Arthritis" is seen by the public as a natural consequence of old age that can only be treated palliatively. If people understand principle two, regular chiropractic adjustments as a preventative measure would be seen as sensible and logical.
Principle Three: Once the spine works abnormally, structural changes rapidly occur. For example, a part that is stiff or seized will weaken like an immobilised limb in a cast.
When patients do not understand this, they perceive that things can be "put back in place" and the spine becomes normal again. If principle three were understood by patients, long-term restoration/rehabilitation would be seen as necessary.
Principle Four: The spine has a chain of joints. When one is not working properly, others will compensate.
The public believes that exercise will strengthen a weak back. It they understood principle four, corrective adjustments would be seen to be necessary before exercise becomes effective.
With the public's broad public understanding of these and some other simple, indisputable principles, chiropractic marketing and patient management would be easy.
Working Within the Public's Understanding
Everyone understands pain, so some chiropractors gear their practices toward pain relief. This form of care provides little long-term benefit for patients, and is a poor use of chiropractic.1
Presenting a Simplified Model
The most obvious example of a simplified model is the "bone out of place." This has provided great service over the years. Unfortunately, it has several disadvantages:
Complicated concepts, such as the popular "five-component model," especially when combined with some big words, can be very impressive for patients. However, such phrases do not motivate potential patients to have their spines cared for by chiropractors as the germ and cavity models motivate people to have dental and medical care. Why?
1. Germ and cavity models are simple and easy to understand, while the "five-component model" and similar are not. 2. The end result of proper dental care and its relationship to cavities and oral disease is more readily accepted than the dependence of corresponding components of the body on the spine.
Partial Models
Spinal problems are complex (hence the term "vertebral subluxation complex"). It is easy to tell patients part of the problem. For example, doctors may tell patients they have nerve irritation. While true, this approach has weaknesses. Other practitioners may tell the patients about another part of the problem. A medical practitioner may mention inflammation, muscle spasm or degeneration, and also be correct. Patients are left confused.
The Opportunity
Despite the lack of a strong foundation of public understanding on which to base marketing and patient management, chiropractors have succeeded in building practices, through dedication and ingenuity. What could this same effort yield when working with a solid foundation?
Chiropractors only see about 10 percent of the population, and a fair portion of this only gets symptomatic care. This means there is room for phenomenal growth in the preventative or restorative chiropractic health care that everyone needs. On the other hand, many alternative ways of caring for one's spine and health defy logic.
How Can Chiropractors Form a Solid Foundation?
More attention needs to be paid to creating a vast public understanding of the principles of spinal injury and care; it has been done for germs and cavities. This author contributes the following thoughts to the profession for discussion.
Production of Information/Education Material
Material should be produced that explains the factors comprising spinal injury. This should be written in a simple and easy-to-understand manner. Rather than make statements like "There will be abnormal movement, tissue damage and inflammation," the material should paint a picture of how it occurs. This will greatly add to credibility and understanding. The following example demonstrates this:1
Initial Injury
The joints of a spine should be balanced and move freely. If a spinal joint is injured the surrounding small muscles will pull tight to form a natural immobilising splint while the damage heals. Other joints close to the injured joint may help by doing extra work.
Altered Spinal Movement
With one joint splinted (and usually a bit crooked), while others move too much, the movement of the spine becomes abnormal. If the injured joint stiffens while it is healing, or the joint is repeatedly injured (for example: through repeated bending and twisting)this abnormal movement will remain. If uncorrected, the processes described in the rest of this chapter cause damage and deterioration that adds up over years.
Ongoing damage
Out of balance or forced to move too far, sliding surfaces that normally rub gently may grind forcefully. There will be ongoing damage and the joints will be slightly red and swollen. Just as mild sunburn is not sore unless slapped, the damaged joints will not be painful unless ground together hard. The body will try to avoid movements that do this. Educational material should explain the following and more:
Back problems are of universal interest, so the market for quality information on spinal injury and care is huge, and should include prospective patients, educators, unions, occupational health and safety personnel, insurers, and the media. The tremendous resources of the profession should be used to push the benefits of chiropractic via the principles of spinal care.
Graeme Blennerhassett
Barnsdale, Australia
drgraeme@net-tech.com.au
Reference
When I graduated from chiropractic college in 1981 and started practice, I heard it all, and very little was positive. “You are a quack; you do not know what a subluxation is; you couldn’t get into a real health care program, so you chose the one that is slightly above a mail-order degree; you have no proof that chiropractic works; Are you really licensed?”, and so much more.
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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.
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