Perhaps one of the bigger challenges our profession faces centers on syntax. Clarity in how one uses words is an essential component of good communication. We chiropractors have several words that are unique and perhaps (forgive the pun) "out of alignment" with another's usage. The term "chiropractic" itself is a source of some conundrum. The suffix -ic makes the word appear to be an adjective, along the lines of "osteopathic" medicine" or the like. People unfamiliar with chiropractic often refer to it as "chiropractics," "chiropraxis," "chiropathy," or "chiropractic medicine." Don't get offended or think others ignorant. Just understand that our term looks like something it isn't. I wonder if D.D. ever thought about this when it was originally coined. B.J. had a lot of fun with it over the years, that's for sure.
Another word used in chiropractic that means other things to some is "subluxation." Oh, I know we add all kinds of clarifying elements like "vertebral" and "complex" to try and communicate our perspective that it has something to do with function of the nervous system, but to everyone else it usually just implies a teeny alignment problem. When you consider the difficulty the chiropractic profession itself has had with it over the years, its no wonder that everyone else doesn't get it right the first time either. I like the term, particularly the concept of it as a model of "spinal lesion" of sorts we can adjust. But I'm not sure I like it as a diagnosis per se, because everyone seems to have it (or someone's definition of it) regardless of their observable health status.
When I have to go back in the insurance record of the state of Washington's workers' compensation system (where I work), it's about the only thing coded as a diagnosis for chiropractic patients. Yes, we are restricted by state law to only care for individuals with it, but what happens from an actuarial standpoint is that chiropractors are perceived as "overtreaters." Why? Because for the same condition, there is a huge amount of variation in how it is treated. Some doctors can care for subluxation in a visit or two; others take much, much longer. Red flags abound. With no standard way to account for severity, complexity, and other confounders the patient might have, our care becomes suspect.
Think of dental carries. Most everyone gets them, but dentists vary in the ways they treat them. The range of care, cost, and duration, however, is fairly well-defined, but not so with subluxation. It's all over the map. It's not that subluxation is a bad concept, it's just that it is not very useful as a diagnosis.
Our term "adjustment" also means different things to different people (including chiropractors). An adjustment to one person might be a high velocity manipulation with cavitation of a certain joint; to someone else it might mean being left on pelvic blocks for 15 minutes. What's the problem, you ask? Aren't the terms "surgery" or "medication" guilty of the same variation transgression? Actually no, because surgery and medication always have qualifiers (like "anterior interbody fusion" surgery or "nonsteroidal anti-inflammatory" medication) which help narrow down what they are and how they are being used, even for billing purposes. We're still not there yet with the term adjustment.
And that is the paradox of the term. To us, an adjustment implies precision and specificity (in each chiropractor's own individual view of the world), but everyone else just sees excessive variation. Somehow, we seem to feel a sense of security and identity by being unique, and certainly a distinct syntax contributes to this. But we do have a challenge: syntax alone (and any related belief system) does not insure uniqueness or "nonduplication."
I don't believe for a minute that if large numbers of osteopaths and family physicians get more proficient at providing manipulation for people with nonspecific low-back pain, and can provide it cheaply in a well-defined, predictable fashion, that we will be considered "nonduplication" just because we "adjust subluxations" rather than manipulate articular dysfunction. Unless, of course, we demonstrate through research that our adjustments do something different, better, cheaper or faster than the competition.
So, am I proposing to abandon our syntax in favor of similar nonchiropractic terminology? Not at all, in fact, just the opposite. But I do think we need to understand why everyone else doesn't quite get it. And I do think we need to consider the context in which we use our terminology.
A chiropractor should become "bilingual" and be able to talk intelligently and specifically about similarities and distinctions between his approaches to manipulation/adjusting and those of other chiropractors.
I've listed a few recent publications of this topic that I think every chiropractor should read and be familiar with.
Our profession has a lot of syntax work ahead of us. The community at large needs clear, definable, and unambiguous terminology to characterize what we do. There is still too little precision and too much variation and emotion in how we use words.
For us to be payable resources in the health care system of the future, I believe we need to be firmly entrenched in the thinking and management side of patient care, not just the procedural and technical side of it. It is easy for others to confine us into a technical or procedural box when we identify ourselves in an absolute fashion with terms that imply a diagnostic condition or procedure.
I suggest that we emphasize our identity as direct access caregivers and boldly embrace our beliefs, models, and approaches to care as tools we use to provide the best care we can. I think we should be careful not to let our emotions make us vulnerable to others turning it the other way around simply because our syntax is "nonstandard." Scott Haldeman has often stated that power in society lies in the hands of the "knowers" rather than the "doers." In chiropractic, we should strive to make sure that we can be both, and are perceived as both.
Some Recent Essential Readings on "Chiropractic Syntax"
When sports chiropractors first appeared at the Olympic Games in the 1980s, it was alongside individual athletes who had experienced the benefits of chiropractic care in their training and recovery processes at home. Fast forward to Paris 2024, where chiropractic care was available in the polyclinic for all athletes, and the attitude has now evolved to recognize that “every athlete deserves access to sports chiropractic."
It is estimated that 61% of patients with CTS avoid taking surgical options due to postoperative complications and costly surgical procedures. Chiropractic care offers a comprehensive and effective treatment for carpal tunnel syndrome, addressing the condition from multiple angles. Recent studies also have unveiled a game-changing adjunct to chiropractic treatments for CTS: nerve flossing.
Some doctors thrive in a personality-based clinic and have a loyal following no matter what services or equipment they offer, but for most chiropractic offices who are trying to grow and expand, new equipment purchases help us stay relevant and continue to service our client base in the best, most up-to-date manner possible. So, regarding equipment purchasing: should you lease, get a bank loan, or pay cash?
