Last fall I attended a three-day, multidisciplinary conference, "A Sports Medicine Approach to Back Injuries." The conference, coordinated by leading authorities in the treatment of back pain, was to review recent theories in evaluation, prevention, and treatment of occupational injury. The audience of more than 400 health professionals (orthopedic surgeons, neurosurgeons, physical therapists, and others from the medical professions) included just a few chiropractors.
Scheduled for the first day was the session, "Spinal Manipulation: When, How and by Whom." I could hardly wait to hear what the medical profession had to say about manipulation. The session was to take place in a room set up for about 50 people. To my surprise, all the seats were quickly taken, and people kept crowding in, standing wherever they could. I felt as if I were sitting in on a secret meeting.
The moderator for the sessions was the dean of a prominent college of medicine, an orthopedic surgeon by training. He began by reviewing current studies on manipulation, including the British study and the RAND study. I was amazed to hear medical doctors, most of whom had never seen a spinal manipulation, discuss it with such interest.
The audience was deeply involved with the questions of how and when manipulation is done. Then we got to the question of who should perform manipulation. A neurologist told of the positive results she had in referring patients for manipulation. She recommended that everyone in the group find a physical therapist trained in manipulation, but she also said she would never refer to a chiropractor. Up to this point the word chiropractor had not been mentioned, but it was about to get a whole lot of attention.
A doctor in front said, "These chiropractors think they can treat everything; I will never refer to one." From the back of the room someone shouted, "Chiropractors never release any of their patients." Sarcastic comments were made about the way chiropractors advertise, and the complaints flew about chiropractors sending coupons in the mail and placing cheap looking newspaper ads.
After several long minutes of chiropractor bashing a strange thing happened. The moderator of the session stood up and said, "It's too bad you feel this way, because right now there are more studies showing the effectiveness of manipulation than for surgery." He also told the group that chiropractors perform the majority of manipulations done in health care today and that they are getting good results. An orthopedic surgeon in the audience chimed in and described what a positive experience it had been to work with a chiropractor in his town. He said everyone in the room should get to know and work with a good DC.
The audience was a little taken aback. Then someone asked what chiropractors actually do. The moderator, instead of answering the question himself, asked if there were any chiropractors in the audience. Two hands went up, and we were asked to come to the front and demonstrate some manipulation. I would like to say I wasn't nervous, but that wouldn't be true. The other DC and I talked for a few moments, deciding that he would be "the patient," while I would demonstrate some manipulative procedures.
As I began, the room fell strangely silent; everyone was straining to see. As I got to the cervical spine, my "patient" said, "Why don't you go ahead and give my neck a real adjustment. It's been hurting all day." You could have heard a pin drop as I palpated and set up to adjust his cervical spine.
It was at this point that I hesitated. With all the negative press about cervical manipulation and strokes, I thought it only right to add a little commentary. I looked straight out at the group and told them, "You know, one out of a million of these may cause a stroke." Then I thrusted.
For a moment there was a complete silence. Then someone giggled, and the group began to laugh in surprise and relief. Several orthopedic surgeons, who admitted they had never seen manipulation performed before, told me that they were very impressed by the demonstration. Some of the same doctors who were bashing chiropractors only a few minutes before now asked where I practiced. From that point on and for the rest of the weekend, I was treated as a peer.
This experience made me realize that although many people in the medical professions already understand the importance of manipulation, they know very little about what we do. Unfortunately, they are "educated" by the coupons they get in the mail and the ads they see in the newspaper.
If we can break through the old biases (and the practices that encourage those biases) we can have a powerful ally in the medical profession. More importantly, we can free ourselves and our patients from intraprofessional bickering and concentrate on providing the very best care possible.
Anthony Battaglia, DC
Akron, Ohio
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