Justifying Care and the Short-Leg Diagnosis
[Editor's note: The following letter to the editor is a response to "Things I Have Learned: The Short-Leg Dilemma," by Douglas R. Briggs, DC, published in the Feb. 26, 2005 issue of Dynamic Chiropractic.]
Dear Editor:
I have just read this article with, well, pity I suppose. Pity for my American colleagues who have to practice not for the good of the patient, but with the fear that they will have to justify every professional breath somewhere down the line.
It is mind-boggling to read, let alone justify, the two pages of tests outlined in the article to determine what kind of "short leg" we are dealing with. It reminds me of the new headache classifications that run to the tens of pages in the medical literature. I would personally rather spend my time contemplating how many angels can dance on the head of a pin than make myself crazy with this kind of exercise.
But then, I practice in Holland, where there is no such thing as "medical physicians, insurance companies, and attorneys ... looking over our records at some point in time." No one does that here; the patient is allowed a certain amount of money each year for chiropractic care and pays cash, which is returned to the patient by the insurance company.
No one looks at our records, so we do not have to invent spurious tests to justify our therapy. If the patient is satisfied, he/she stays; if not, he/she seeks another form of treatment. It doesn't make any sense for the insurance companies to interfere, and they don't. And, by the way, my malpractice insurance costs $100 per year.
(As an aside, the tests mentioned in Dr. Briggs' article seem to attribute a short leg to a cervical dysfunction. In my thinking, a cervical dysfunction is a finding, not a diagnosis. What is the cause of the cervical dysfunction? Hint: look to the L/S area.)
Running the risk of being classified as "overly simplistic and degenerat(ing) the art of chiropractic to a brainless therapy," I have always adjusted the patient and have thereby corrected the condition causing the short leg. (For this discussion, I omit the two cases I have seen where surgery had caused the short leg, easily identified from the intake discussion.) Simple? I guess it is, because it always works. Always? Yes, always! (And being once an attorney, I do not use words lightly.)
Using drop, side-posture or Leander flexion/distraction techniques, I have never seen a patient whose leg-length difference was not resolved after a series of adjustments. And this by definition refutes the observation and justification of poor results due to the leg-length difference being "anatomical" - another excuse for not learning to be proficient in the trade.
Do I use "corrective lifts"? I would sooner use leeches. These things make the "short" leg even shorter over time; at best, they hold the body in the wrong biomechanical position and do not let it respond to the adjustment, which seeks to change the posture, to correct it so that the leg-length discrepancy disappears. They prevent the body from seeking its own natural state. That's what chiropractic is all about, isn't it - permitting the body to heal itself?
But then again, I still prefer to commit my thoughts to paper by means of a fountain pen. Sorry, Computer Generation, if I tend to step on toes. But someone should tell the emperor he isn't wearing any clothes.
Clifford H. Morris, JD, DC
Wilp, The Netherlands
"It's Worked for Over 200 Years"
Dear Editor:
"Heaven forbid we should all think alike. Difference of opinion is what makes for horse races."
- Mark Twain
If we consider the professional associations to be political parties and every licensed chiropractor considered a registered voter, how far are we from creating a Representative Republic of Chiropractic? Licensed chiropractors elect representatives nominated/funded/supported by professional associations (parties). Representatives represent their constituents to a chiropractic congress, where consensus is built and a unified face is presented.
We have a model. It's worked for over 200 years.
Nuff said?
James N. Scott, BS, DC
Frankfort, Indiana
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Dr. Louis Sportelli received the Lee-Homewood Chiropractic Heritage Award during the annual conference of the Association for the History of Chiropractic (AHC). During his nearly 60-year career, Dr. Sportelli has embodied the spirit of the award, given to “living individuals who have made outstanding contributions to the chiropractic profession.”
Presently there is no consensus on the best treatment for Achilles tendon rupture; and its management is still controversial. The treatment options are conservative treatment and surgical repair. With either treatment, be it conservative or surgical, Achilles tendon tears necessitate prolonged recovery and rehabilitative management.
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