At the Washington, D.C. Chiropractic Centennial July 6-8, 1996, various authors spoke on a plethora of topics, among them was the concept of nerve compression and what it really means. Also put in historical perspective were these concepts:
"Nerve compression held sway through much of the first half of the century and bone-out-of-place, which could presumably be the cause of the nerve compression or irritation. However in the second half of the century there has been increasing recognition that this does not provide a satisfactory explanation for the clinical phenomena in the majority of patients,... etc. Therefore, in attempting to explain these clinical phenomena there has been a growing emphasis on the role of afferent and efferent neural activity, and the interaction of this activity within the central nervous system."1
It is a well-known fact that at least 30 percent of all individuals have myelographic or MRI evidence of disc herniation; these are asymptomatic populations, not patients. So the question arises: "Can nerve root compression occur without pain production?" Physiologically, it is known that compression of a normal nerve or nerve root does not cause pain,
2-3 rather numbness, paresthesia, motor weakness, and related symptoms and signs. However, if a nerve root is irritated, for example as a result of disc herniation, even minimal mechanical deformation can result in production of sciatic pain. The deformation that most are familiar with is the SLR. The reason for this preamble is the following situation that faces many of our young, impressionable, and naive students.
Last week a student from one of the numerous chiropractic colleges throughout the U.S. stopped by my office to tell me that he and one of his friends were serious about dropping out of chiropractic. After inquiring about how long they had been in college, where they were attending, what their background was and experience with chiropractic, and why they came to me, I asked why they were thinking of dropping out of chiropractic. The answer to my question was placed before me in the form of a brochure, a mail reminder card, and a pocket-sized picture of a bone out of place showing the pinching and withering up of a dying nerve. The items in question displayed the often used and entirely anatomically inaccurate picture of a bone out of place, as well as a statement defining the word subluxation. The spinous process of the three vertebra are all the same size and shape however, the so-called "subluxed" one displayed a vertebral body approximately two-thirds of its normal size. (I guess this means that subluxations actually reduce the size of a vertebral body to put pressure on the nerve, obviously new research not as yet in print ... how absurd). The text of the brochure indicates that a subluxation is a vertebrae that is out of alignment with the ones above and below (so I guess the adjustment actually causes the vertebral body to grow and look just like the adjacent two, an equally absurd definition of the picture). In looking at this picture, I am confronted by a very perplexing thought. Why is it that the creators of such illusions and inaccuracies never put on the dorsal ramus? Do subluxations only affect the ventral roots, or do the shrinking vertebral bodies become so small that these rami are spared? Perhaps they are not aware that the chiropractic adjustment affects primarily the dorsal components.
Clearly, the chiropractic profession has a huge problem. Information such as this is one of the reasons that our great profession lacks respect. We crave acceptance and respect and then offer partial or half truths like this in response. There is no easy way to get acceptance other than by earning it. When misinformation and fabricated statements such as these items portray are allowed into the public domain, we lose a lot of respect.
I took the above mentioned brochure and put it on a notice panel for my patients to read, and waited for a response. The student was still with me in the office and he was very shocked when the first person asked if he should find a new chiropractor, because he left his last one over just this point (the patient in question is a dentist). I explained that we were just conducting an experiment to see if our patients were paying attention to our own patient information handouts, needless to say he was relieved. After about four hours and many patients laughing about the ridiculous pictures and remarks such as, "How could anyone believe such nonsense?" I took them down. The student was relieved as he was under the impression that he might have to compromise his standards of excellence (and lie to his patients) in order to practice chiropractic. I assured him this was not necessary and that chiropractic is based upon sound and very rational concepts without the bells, whistles, and the blue smoke that lurks on the very fringes of credible quality chiropractic care.
I still have the three items and display them in my office with the following statements clearly visible: "If any of your friends are attending a chiropractor who displays or uses these models then do your friends a favor and explain to them the reality of rational chiropractic and then give them my card." You might think that this was somewhat brutal in approach, however, when we consider the future of chiropractic, and keeping in mind our heritage and the concept of our founder who stated that subluxations are caused by trauma, toxins, and autosuggestion, it is so easy to slip into a mindless model of minute historical perspectives based on only one of the causes. This denies and defies the work of our chiropractic researchers and colleges, not to mention the scientific works of today.
Chiropractic is going ahead into the future, with or without us. I am aware that there will always be those who, for whatever reason, take the turtle adjustment and stick their heads and innate un-intelligence in a shell. Chiropractic can ill-afford to lose bright young students over such inadequately illustrated, highly emotional loquacious verbiage and used car lot sales techniques. Perhaps the chiropractic profession should create an agency to approve or turn down the material that is presented to our patients to prevent half truths and showmanship from holding back the inevitable journey to the forefront of health care of the future. Chiropractic is a rationale and alternative care for people's health based upon a sound historical foundation, and has a scientific basis grounded in the research performed in the current decade. This is a reality in spite of those who cling to the past and try, with all their emotional games ("Watch me -- I can cry on demand" antics) and tricks, to invite our students into their "den of antiquity" and ignorance.
The student and his friend are now getting ready to continue at their chosen profession and college. The student also read D.D. Palmer's text The Chiropractor's Adjustor, as well as some of B.J. Palmer's works and current literature that supports chiropractic and the adjustment. They are also armed with a new attitude and a positive lateral view of chiropractic history (not philosophy), science, and most importantly, they have developed a much better nonsense detector, so that in the future, items such as described at the beginning of this article will be scoffed at and trashed.
In ending this dialogue I would like to clarify a point: there is no doubt that pressure from whatever source on a dorsal root or DRG will cause pain, however, the pain is not from the pressure alone. Quoting from Basic and Clinical Anatomy of the Spine, Spinal Cord, and ANS by Drs. Cramer and Darby, we find on page 369 the following: "pressure on dorsal root or dorsal root ganglion>>edema within the nerves>>further edema and hemorrhage with the DRG>>decreased blood flow to sensory nerve cell bodies>>ischemia of neural elements>>ischemia perceived as PAIN." This is an accurate account of radicular (dermatogenous pain) and not referred (sclerogenous pain). The subject of the adjustment and these two types of pain will be the substance of my next column.
References
- Conference Proceedings of the Chiropractic Centennial Foundation, pg. 135-136.
- Ibid pg. 96-97.
- The Aging Spine, Boden, Wiesel, Laws, Rothman.
Keith Innes, DC
Ontario, Canada
